October 21, 2014

American Journal of Alzheimer's Disease and Other Dementias - September 2014

Full text articles are available to fee paying members of Alzheimer’s Australia NSW by emailing NSW.Library@alzheimers.org.au

Thoughts, opinions and Controversies

New York Can be Our Nation's Center for Alzheimer's Research

By 2025, it is estimated that there will be 350,000 residents living with Alzheimer's in New York. Congressman Steve Israel and New York Assemblyman Charles Lavine issued a joint proposal in June, 2013 suggesting that New York become this country's center for Alzheimer's research.

p. 489-491


Clinical Significance in Dementia Research: A Review of the Literature

Clinical research traditionally relies on measures of statistical significance to assess the strength of evidence while less attention is paid to the practical import of the results. The objective of this study was to provide a critical overview of the current approaches to measuring clinical significance in dementia research and to provide suggestions for future research. A systematic search was conducted of Medline and Embase for original, English-language, peer-reviewed articles published before July 2012. A total of 18 articles met the inclusion criteria, of which 13 used multiple approaches to measure clinical significance. In all, 5 articles used expert opinion as anchors; 4 also used distribution-based approaches. In all, 8 articles used Goal Attainment Scaling; 7 of these also relied on clinician-based impressions of change. Another 3 articles used only clinical global impressions of change, 1 article used changes in symptomatology, and another used the value from literature.

p. 492-497


Periodontal Health Condition in Patients With Alzheimer's Disease

Objective: To compare periodontal health status in individuals with and without Alzheimer’s disease (AD). Results: All the evaluated periodontal parameters were higher in individuals with AD than that in ND individuals, and the periodontal status deteriorated with the progression of AD. There were significant differences in mean Gingival Index, Plaque Index, Probing Depth, Clinical Attachment Level, and % of bleeding sites between all the groups. Conclusion: The periodontal health status of individuals with AD deteriorates with disease progression and was closely related to their cognitive function.

p. 499-502


Cognitive Stimulation for Portuguese Older Adults With Cognitive Impairment

A Randomized Controlled Trial of Efficacy, Comparative Duration, Feasibility, and Experiential Relevance

Although some studies point to cognitive stimulation as a beneficial therapy for older adults with cognitive impairments, this area of research and practice is still lacking dissemination and is underrepresented in many countries. Moreover, the comparative effects of different intervention durations remain to be established and, besides cognitive effects, pragmatic parameters, such as cost-effectiveness and experiential relevance to participants, are seldom explored.

p. 503-512


Ms L

A Case of a Reversible Phenotypic and Brain Function Equivalent of Frontotemporal Dementia

Frontotemporal dementia (FTD) is second only to Alzheimer’s disease in individuals younger than 65 years of age. Behavioral variant FTD (bvFTD) presents with nonspecific symptoms such as disinhibition, apathy, or emotional blunting. Although neuropsychological testing and structural neuroimaging are not very helpful in diagnosing bvFTD in its initial stages, newer quantitative structural methods and functional neuroimaging have better sensitivity and specificity. Ms L presented with blunted affect, disinhibition, impairments in insight, planning ability and social comportment, changed dietary habits, and episodes of mutism. We suggest that Ms L had a reversible phenotypic and brain function equivalent of bvFTD. The case highlights the limitations of our diagnostic tools and the complex relationship between clinical symptoms, neuroimaging, and etiology.

p. 513-520


Vascular Risk Factors Aggravate the Progression of Alzheimer's Disease

A 3-Year Follow-Up Study of Chinese Population

Purpose: To explore the correlation of vascular risk factors for Alzheimer’s disease (AD) in Chinese population.

Conclusions: Vascular risk factors are common comorbidities in patients with AD in China, with younger, better educated ones showing faster cognitive decline. Hypertension and hyperhomocysteinemia may also aggravate the progression, and it is important to prevent and treat patients with AD.

p. 521-525


Gene Expression Profiles of Entorhinal Cortex in Alzheimer’s Disease

This study aimed to analyze the differentially expressed genes (DEGs) in entorhinal cortex with AD and identify featured genes related to AD. Gene expression profile GSE5281 was downloaded from Gene Expression Omnibus, including 10 AD and 13 control samples. Differentially expressed genes were identified by Student t test including 119 upregulated and 591 downregulated DEGs. Then, we obtained 14 enrichment Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways among which 11 pathways were significantly enriched (adjusted P value < .05). The KEGG pathway network which was constructed by 14 KEGG pathways showed that 6-phosphofructokinase, muscle type, phosphoglucomutase 1, aldolase A, and adolase C had high degree. Glycometabolism pathways network which was constructed by 4 glycometabolism pathways showed that adenosine triphosphate (ATP) synthase, H+transporting, mitochondrial F1 complex ATP5B, ATP5C1, ATP5D, and ATP5G1 had high degree related to ATP metabolism. These findings suggested that these genes with high degree may be the underlying potential therapeutic targets for AD.

p. 526-532


Clinical Correlates of Unawareness of Deficits Among Patients With Dementia Due to Alzheimer’s Disease

Background: To investigate the associations between unawareness of deficits and clinical correlates, including apathy and depression, among patients with dementia due to Alzheimer’s disease (AD).

Conclusion: Unawareness of deficits among patients with AD was common. The 2 domains of unawareness showed different characteristics and may possibly present different etiologies.

p. 533-539


Quantitative Evaluation of Changes in the Clock-Watching Behavior of a Patient With Semantic Dementia

Background: Clock-watching activity in patients with dementia has not been documented in detail.

Methods: A male patient having semantic dementia was monitored at a dementia care unit in a general hospital in Japan. We used an integrated circuit monitoring system to record the distance and location of ambulation and the total number of movements that occurred outside the patient’s room.

Results: The patient was reported to clock watch a couple of years prior to monitoring. In 2011, when monitoring started, he regularly came out of his room saying, “8 o’clock” about 40 minutes into every hour. It seemed as if he could only recognize the minute hand. The median number of sensor detections increased by 4-fold at this clock-watching phase. Behavior consistent with his clock-watching patterns was also detected during the night. In 2012, clock-watching activity disappeared.

Conclusions: This study documented the progression of clock-watching and subsequent disappearance with worsening cognitive function.

p. 540-547


Evaluation of a Group Cognitive–Behavioral Dementia Caregiver Intervention in Latin America

Research has identified unique cultural factors contributing to dementia caregiving in Latin America but very few caregiver interventions have been systematically piloted and evaluated in this region. The purpose of this study was to examine the effectiveness of a group cognitive–behavioral intervention in improving the mental health of dementia caregivers from Cali, Colombia. Sixty-nine caregivers of individuals with dementia were randomly assigned to the cognitive–behavioral intervention or an educational control condition, both spanning 8 weeks. Compared to controls, the treatment group showed higher satisfaction with life and lower depression and burden over the posttest and 3-month follow-ups although there was no effect of the condition on participants’ stress levels.

p. 548-555

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