July 10, 2009

Alzheimer's & Dementia: The Journal of the Alzheimer's Association

May 2009 No. 3, p199

  • The pattern of cognitive symptoms predicts time to dementia onset,
    Few studies have examined whether cognitive symptom patterns differ by age and length of time before dementia onset. Our objective was to investigate whether different patterns of cognitive symptoms at ages 70, 75, and 79 years predict short-term (≤5 years) and long-term (>5 years) dementia onset.
    Conclusion: A global pattern of low cognitive performance predicts short-term but not long-term onset of dementia, whereas isolated low memory performance predicts dementia only in the long-term. Our findings also suggest that preclinical symptoms of dementia might differ by age
    pages 199-206

  • Fourteen-year longitudinal study of vascular risk factors, APOE genotype, and cognition: The ARIC MRI Study, Atherosclerosis Risk in Communities Study Brain MRI Study

    Strokes, vascular risk factors, and apolipoprotein E (APOE) genotype are associated with cognitive decline in the elderly, but definitive evidence that these affect cognition as early as middle age is limited.
    We describe the relationships of APOE genotype, stroke, and vascular risk factors with cognitive change over a 14-year follow-up in the Atherosclerosis Risk in Communities (ARIC) Study cohort recruited while in middle age.
    The vascular risk factors diabetes and hypertension, a history of stroke itself, and APOE ɛ4 genotype independently contribute to cognitive decline in late middle age and early elderly years....pages 207-214

  • Early identification and treatment of Alzheimer's disease: Social and fiscal outcomes
    Background: Alzheimer's disease (AD) is a progressive neurodegenerative disease that places substantial burdens on those who provide support for family members with declining cognitive and functional abilities. Many AD patients eventually require formal long-term care services because of the absence, exhaustion, or inability of family members to provide care. The costs of long-term care, and especially nursing home care, often deplete private financial resources, placing a substantial burden on state Medicaid programs. Current evidence suggests that pharmacological treatments and caregiver interventions can delay entry into nursing homes and potentially reduce Medicaid costs. However, these cost savings are not being realized because many patients with AD are either not diagnosed or diagnosed at late stages of the disease, and have no access to Medicare-funded caregiver support programs.
    A Monte Carlo cost-benefit analysis, based on estimates of parameters available in the medical literature, suggests that the early identification and treatment of AD have the potential to result in large, positive net social benefits as well as positive net savings for states and the federal government.
    Conclusions: These findings indicate that the early diagnosis and treatment of AD are not only socially desirable in terms of increasing economic efficiency, but also fiscally attractive from both state and federal perspectives. These findings also suggest that failure to fund effective caregiver interventions may be fiscally unsound.
    pages 215-226

  • Prevalence rates for dementia and Alzheimer's disease in African Americans: 1992 versus 2001
    This study compares age-specific and overall prevalence rates for dementia and Alzheimer's disease (AD) in two nonoverlapping, population-based cohorts of elderly African Americans in Indianapolis in 2001 and 1992.
    We found no differences in the prevalence rates of dementia and AD between 1992 and 2001, despite significant differences in medical history and medical treatment within these population-based cohorts of African American elderly.
    pages 227-233

  • 2009 Alzheimer's disease facts and figures Alzheimer's Association
    Alzheimer's disease (AD) is the sixth leading cause of all deaths in the United States, and the fifth leading cause of death in Americans aged 65 and older. Whereas other major causes of death have been on the decrease, deaths attributable to AD have been rising dramatically. Between 2000 and 2006, heart-disease deaths decreased nearly 12%, stroke deaths decreased 18%, and prostate cancer-related deaths decreased 14%, whereas deaths attributable to AD increased 47%. An estimated 5.3 million Americans have AD; the approximately 200,000 persons under age 65 years with AD comprise the younger-onset AD population. Every 70 seconds, someone in America develops AD; by 2050, this time is expected to decrease to every 33 seconds. Over the coming decades, the “baby-boom” population is projected to add 10 million people to these numbers…This report provides information meant to increase an understanding of the public-health impact of AD, including incidence and prevalence, mortality, lifetime risks, costs, and impact on family caregivers. This report also sets the stage for a better understanding of the relationship between MCI and AD. pages 234-270

  • Concordance rates for cognitive impairment among older African American twins

    There is significant attention to the growing elderly African American population and estimating who and how many within this population will be affected by cognitive impairment.
    The study findings indicate that cognitive impairment is highly heritable, suggesting that genetics may play a relatively large role in the development of cognitive impairment in African American twins. pages 276-279

  • Commentary on Low and Anstey: Cross-cultural findings and insights
    Current work focuses investigating dementia literacy in population samples of Australian residents from Italian, greek and Mainland Chinese backgrounds…. pages 280-281

  • Early detection
    The Alzheimer’s Association has kicked off its Know the 10 Signs: Early Detection Matters campaign, a multi-faceted national education effort to increase awareness of the 10 warning signs of Alzheimer's and the benefits of early detection and early diagnosis. Early detection, diagnosis and intervention are vital because they provide individuals the best opportunities for treatment, support and planning for their future. page 285

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