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December 17, 2014
American Journal of Alzheimer's Disease and Other Dementias November 2014
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
Association of Apolipoprotein E Genetic Variation
in Alzheimer’s Disease in Indian Population A Meta-Analysis
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.
Diagnosis and Prognosis in Idiopathic Normal
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
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
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.
Exploring the Service and Support Needs of
Families With Early-Onset Alzheimer’s Disease
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.
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 =
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.
The Added Value of 18-Fluorodeoxyglucose-Positron
Emission Tomography in the Diagnosis of the Behavioral Variant of
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.
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
Conclusions: The data suggest a role of the APOE genotype as a
Psychometric Properties of the Dependence Scale in
Large Randomized Clinical Trials of Patients With Mild and Moderate Alzheimer’s
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
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.
Dementia and Cognitive Impairment in Patients With
Parkinson’s Disease From India
A 7-Year Prospective Study
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.
Multisensory Stimulation on Mood, Behavior, and
Biomedical Parameters in People With Dementia
Is it More Effective Than Conventional One-to-One Stimulation?
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 (Spo2) 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.