December 17, 2014

American Journal of Alzheimer's Disease and Other Dementias November 2014

Full text articles are available to fee paying members of Alzheimer’s Australia NSW by emailing

Efficacy and Tolerability of Benzodiazepines for the Treatment of Behavioral and Psychological Symptoms of Dementia
A Systematic Review of Randomized Controlled Trials
The objective of this review is to summarize the available data on the use of benzodiazepines for the treatment of behavioral and psychological symptoms of dementia (BPSD) from randomized controlled trials (RCTs). A systematic search of 5 major databases, PubMed, MEDLINE, PsychINFO, EMBASE, and Cochrane Collaboration, yielded a total of 5 RCTs.
p. 565-574 

Association of Apolipoprotein E Genetic Variation in Alzheimer’s Disease in Indian Population A Meta-Analysis
Apolipoprotein E (ApoE) 4 allele is a known genetic risk factor for Alzheimer’s Disease, which not only predisposes and influences the severity of pathological changes in the brain, thereby modifying the age at onset, but also promotes cognitive decline early in nondemented older people.
Objectives: To review the published evidence on ApoE polymorphism with the susceptibility to AD and frequency of ApoE 4 genotype (4/-) and homozygotes (4/4) among patients diagnosed with AD as compared to controls in Indian Population.
p. 575-582 

Diagnosis and Prognosis in Idiopathic Normal Pressure Hydrocephalus
Idiopathic normal pressure hydrocephalus (iNPH) is a communicating hydrocephalus, of unknown pathophysiology, characterized by the classical triad of dementia, urinary incontinence, and ataxia. The most popular treatment option is shunt surgery, although it is not a cure. The diagnosis of the disorder is challenging as it may mimic a lot of other neurological conditions and has no distinct biomarker. It becomes even more challenging as majority of the cases are diagnosed by invasive cerebrospinal fluid (CSF) removal tests. However, a careful history taking, a keen and detailed physical examination, and pertinent imaging studies can lead to an early diagnosis. The gait symptoms respond the most to surgery. The predictors deciding the postsurgical prognosis has been discussed. Improved shunting modalities and novel shunt materials with valve adjustments have improved the precision of the shunting procedures. Still we have lot more to achieve in terms of early diagnosis and definitive management of iNPH.
p. 583-589

A Case of Inappropriate Apolipoprotein E Testing in Alzheimer’s Disease Due to Lack of an Informed Consent Discussion
Background/Objective: Apolipoprotein E (APOE) genetic testing is used to assist in the diagnosis of Alzheimer’s Disease (AD). Whenever genetic testing is performed, an informed consent process should occur.
Methods: In this case, a patient with memory loss presented to the neurologist. The neurologist ordered a lumbar puncture (LP). The LP was performed by a neuroradiologist who also ordered APOE genetic testing. The patient received no genetic counseling, nor was an informed consent document offered.
Results: After the testing was completed, the neurologist faced an ethical dilemma. His solution was to offer the genetic testing to the patient in order to have an informed consent process. It was clear that the patient and her adult children did not want the genetic testing and that they would have been burdened with the results. The neurologist opted not to disclose the results.
Conclusion: Genetic counseling and a signed informed consent document are required prior to any genetic testing. In this case, neither occurred and it led to an ethical dilemma that was ultimately resolved by the neurologist. As the population ages and AD becomes more prevalent, there is a need to expand the workforce of genetic counselors and educate physicians who commonly treat AD about genetic testing.
p. 590-595 

Exploring the Service and Support Needs of Families With Early-Onset Alzheimer’s Disease
Although often cast as a disease of later life, a growing number of people are being diagnosed with Alzheimer’s disease in their 50s and 60s. Early-onset Alzheimer’s disease (EOAD) poses special challenges and needs for individuals and their caregivers, such as employment and access to services. In this cross-sectional study, the researchers surveyed 81 (N = 81) family caregivers to individuals with EOAD to identify service and support usage and need. Descriptive analyses revealed that families utilized a range of formal services (eg, adult day) and informal support from family and friends. In terms of challenges and needs, participants indicated that they struggled most with employment, benefits, and financial issues. Although most caregivers felt that they were coping well, they also indicated that their needs were not well understood by service providers and the public. These findings highlight the need to better understand and respond to the specific issues surrounding EOAD.
p. 596-600 

Construct Validity and Extended Normative Data for Older Adults for the Brief Visuospatial Memory Test, Revised
Purpose: This study examined the construct validity of a visual memory test (Brief Visuospatial Memory Test, Revised [BVMT-R]) in a sample of older adults and provided normative data for adults aged 80+ years.
Method: The sample included 109 community-dwelling individuals (mean [M] age = 74.9 years, M education = 15.0 years, 62.4% female, and 97.2% European American).
Procedures: Measures administered included the BVMT-R, California Verbal Learning Test, 2nd edition, and subtests of the Delis-Kaplan Executive Function System and Neuropsychological Assessment Battery.
Results: The BVMT-R correlated highly with another measure of memory and less so with unrelated measures (e.g., verbal fluency). Age and education were significantly correlated with BVMT-R Total and Delayed Recall scores, with education as the strongest predictor. No significant differences were found for sex. Normative data were provided for adults aged 80 to 88 years (n = 29).
Conclusions: Adequate evidence was found for convergent validity and only partial support for discriminant validity. Normative data should continue to be stratified by age and also by formal education level.
p. 601-606 

The Added Value of 18-Fluorodeoxyglucose-Positron Emission Tomography in the Diagnosis of the Behavioral Variant of Frontotemporal Dementia
Characteristic frontotemporal abnormalities on structural or functional neuroimaging are mandatory for a diagnosis of probable behavioral variant of frontotemporal dementia (bvFTD) according to the new criteria. 18-Fluorodeoxyglucose-positron emission tomography (18F-FDG-PET) imaging is commonly reserved for patients with suspected bvFTD without characteristic structural neuroimaging results. We studied the diagnostic value of 18F-FDG-PET in these patients.
p. 607-613 

Cognitive, Neuropsychiatric, and Motor Features Associated With Apolipoprotein E 4 Allele in a Sample of Bulgarian Patients With Late-Onset Parkinson’s Disease
Objective: To evaluate the role of apolipoprotein E (APOE) 4 allele on cognitive, neuropsychiatric, and motor features in a sample of Bulgarian patients with late-onset Parkinson’s disease (LOPD, age at onset > 55 years).
Methods: A total of 16 patients with LOPD having APOE 3/4 genotype were compared to 30 patients with LOPD having APOE 3/3 genotype and 20 healthy control individuals. Detailed cognitive assessment and evaluation of neuropsychiatric and motor symptoms were performed.
Results: The patients with LOPD had significantly lower scores in all cognitive domains compared to controls. The patients with LOPD carrying an 4 allele showed some significant differences in their cognitive, motor, and neuropsychiatric features.
Conclusions: The data suggest a role of the APOE genotype as a disease-modifying factor.
p. 614-619 

Psychometric Properties of the Dependence Scale in Large Randomized Clinical Trials of Patients With Mild and Moderate Alzheimer’s Disease
Objective: The need for assistance from others is a hallmark concern in Alzheimer’s disease (AD). The psychometric properties of the Dependence Scale (DS) for measuring treatment benefit were investigated in large randomized clinical trials of patients with mild to moderate AD.
Methods: Reliability, validity, and responsiveness of the DS were examined. Path models appraised relationships and distinctiveness of key AD measures. The responder definition was empirically derived.
Results: Generally acceptable reliability (α ≥ .65), significant (P < .001) known-groups tests, and moderate to strong correlations (r ≥ .31) confirmed the DS psychometric properties. Path models supported relationships and distinctiveness of key AD measures. A DS change of ≤1 point for patients with limited home care and ≤2 points for patients with assisted living care best described stability of the level of dependence on caregivers.
Conclusion: The DS is a psychometrically robust measure in mild to moderate AD. The empirically derived responder definition aids in the interpretation of DS change.
p. 620-629 

Dementia and Cognitive Impairment in Patients With Parkinson’s Disease From India
A 7-Year Prospective Study
Depression and cognitive impairment are frequent manifestations in Parkinson’s disease (PD). Although a few longitudinal studies have reported on depression and dementia in PD, there is a yet a lack of such studies in India. This 7-year longitudinal study is a hospital-based prospective case (n = 250)–control (n = 280) study. In all, 36.8% had PD with no cognitive impairment (PD-Normal), 27.2% of the patients with PD were affected by dementia (PDD), and 36% of the remaining patients with PD had mild cognitive impairment (PD-MCI) at baseline.
p. 630-636

Multisensory Stimulation on Mood, Behavior, and Biomedical Parameters in People With Dementia
Is it More Effective Than Conventional One-to-One Stimulation?
The purpose of this study was to assess the effects of multisensory stimulation in a multisensory stimulation environment (MSSE) such as a Snoezelen room versus one-to-one activity sessions with regard to mood, behavior, and biomedical parameters (heart rate and blood oxygen saturation). The MSSE group and activity group (one-to-one activities) of patients with dementia participated in 2 weekly individualized intervention sessions over 16 weeks, where mood and behavior before, during, and after the sessions, and biomedical parameters immediately before and after, were recorded. Immediately after the sessions, patients spoke more spontaneously, related better to others, were more attentive to their environments, more active/alert, less bored/inactive, and more relaxed/content. Both groups exhibited decreases in heart rate and increases in oxygen saturation (Spo 2) values from before to after the sessions. The MSSE sessions in a Snoezelen room were found to be as effective as activity sessions, highlighting the importance of the one-to-one interaction with the therapist.
p. 637-647

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