January 24, 2015

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

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

The Value and Underutilization of Simple Reading Glasses in Geropsychiatry Inpatient Settings
For almost everyone, the need for reading glasses is an inevitable part of the second half of life. Forgetting one’s reading glasses at a restaurant can be a disturbing reminder of one’s dependence on them. For geriatric inpatients, however, the value of reading glasses in improving quality of life and preventing delirium may be overlooked. Subsequently, the authors present a brief review of visual impairment, the relationship of visual impairment and cognition and the cost of reading glass, and the results of a survey that was conducted to determine the proportion of inpatient geriatric psychiatry inpatient units in the United States, which provide reading glasses to inpatients as well as to assess the knowledge of medical directors of these units regarding the cost and perceived value of providing reading glasses to hospitalized patients. 

Antibodies Against Gangliosides in Patients With Dementia
Background: Increasing evidence suggests that gangliosides act as important mediators in both de- and remyelination. The scope of the present research was to investigate the presence of immunoglobulin (Ig) M antibodies against GM1, GD1b, and GQ1b gangliosides in the sera of patients with dementia and the possible connection with clinical parameters of the disease.
Conclusion: This study indicates that elevated IgM anti-GM1 may be connected with the neurodegeneration in older patients with severe dementia and that AD may also be associated with increased IgM anti-GD1b levels. 

Needs Assessments of Memory Disorder Patients
Background: Previous research shows that informal caregivers of individuals with a memory disorder experience financial strain, declining physical health, and psychological distress. Various resources and services have been developed to address and/or prevent these potential outcomes, yet caregivers continue to be negatively affected by the demands of caregiving. We hypothesize that better identification and clarification of concrete patient and caregiver needs will aid in the modification and improvement of the available resources. The purpose of this study is to determine the psychosocial needs of the cognitively impaired population and their caregivers.
Conclusions: This study satisfied the initial identification of caregiver and patient needs; now each must be explored further to determine how to successfully meet such needs. If the primary needs of the patient can be met by a focused service, the caregiver will no longer be the sole provider of meeting the specific need. This will decrease the involved role of the caregiver, maximize patient homecare, minimize caregiver stress, and increase the quality of life for both the patient and caregiver.  

Prognosis of Short Survival in Patients With Advanced Dementia as Diagnosed by Aminoff Suffering Syndrome
On the first few days after admission to the Geriatric-Internal Medicine department, the suffering level of patients with advanced dementia (Mini-Mental State Examination 0 of 30) was evaluated according to the Mini-Suffering State Examination (MSSE). During hospitalization, 14.8% (27 of 183) of patients with advanced dementia were died with a mean survival rate of 19.86 ± 26.9 days. The MSSE scale score of died patients was 7.56 ± 1.71 during the first few days of admission which indicates high suffering levels. The MSSE scale score of survived patients with advanced dementia was 3.99 ± 2.10 which confirms their low level of suffering. There was a significant difference (P < .001) between the groups. Patients with dementia who died and were diagnosed as having Aminoff suffering syndrome during the first few days of admission had a high suffering level and short-survival time.
“I’m a Storyteller!”
Exploring the Benefits of TimeSlips Creative Expression Program at a Nursing Home
Background: TimeSlips creative storytelling program is beneficial for persons with dementia and caregivers, but no studies have qualitatively explored participant experience.
Conclusion: Involvement in TimeSlips can engender benefits for residents, staff, and nursing home communities. Future research is needed to quantitatively assess whether the benefits noted in this study can longitudinally improve quality and lower cost of long-term care.  

Impact of Amyloid β25-35 on Membrane Stability, Energy Metabolism, and Antioxidant Enzymes in Erythrocytes
Amyloid β25-35 (Aβ25-35) represents a neurotoxic fragment of Aβ1 - 40 or Aβ1 - 42, and is implicated in the progressive neurodegeneration in cases of the Alzheimer disease (AD). Amyloid β25-35 was shown to lyse rat erythrocytes (RBCs) of all ages, and the extent of the RBC toxicity is directly correlated with Aβ25-35 concentration and cell age. Activities of glycolytic, antioxidant, and Na+/K+-adenosine triphosphatase (ATPase) enzymes, in vivo, are significantly decreased in older RBCs as compared to the young RBCs. In vitro, Aβ25-35 reduced activities of hexokinase, phosphofructokinase, pyruvate kinase, glutathione peroxidase, and glutathione transferase and increased Na+/K+-ATPase activity; these effects are significantly greater in aged RBCs as compared to those of the younger cells. The diminution in activity of certain enzymes may determine the life span of the RBCs in vivo and may be relevant to the human AD; higher sensitivity of older RBCs to Aβ25-35 toxicity may contribute to the ultimate death of the RBCs in patients with AD. 

Sonas - A Pilot Study Investigating the Effectiveness of an Intervention for People With Moderate to Severe Dementia
Objective: To investigate the feasibility and effectiveness of Sonas, a group intervention involving multisensory stimulation, reminiscence, and light physical activity.
Conclusions: Sonas sessions did not lead to improvements in QoL and behavioral and psychological symptoms of dementia. 
Meta-Analysis of the Association Between Polymorphisms of Estrogen Receptor α Genes rs9340799 and rs2234693 and Alzheimer’s Disease  - Evidence From 23 Articles
Objective: A meta-analysis was performed to better clarify the association between polymorphisms of estrogen receptor α genes rs9340799 and rs2234693 and risk of Alzheimer’s disease (AD).
Conclusions: This meta-analysis suggested that x allele of rs9340799 might have a protective effect on the risk of AD in Asia and in patients with SAD. In addition, the p allele of rs2234693 might decrease the risk of patients with SAD. 
Cognitive Impairment Among Elderly Individuals in Shanghai Suburb, China
Association of C-Reactive Protein and its Interactions With Other Relevant Factors
Objectives: To investigate the association between serum C-reactive protein (CRP) concentration and cognitive impairment as well as interactions between CRP and other relevant factors.
Conclusions: Increased CRP was associated with cognitive impairment, and additive effects of increased CRP with hypertriglyceridemia and hyperglycemia on cognitive impairment were observed among elderly individuals. 
Correlational Analysis of 5 Commonly Used Measures of Cognitive Functioning and Mental Status - An Update
There are numerous measures for detecting the presence of dementia and quantifying its severity and progression. We analyzed the relations between scores on 5 commonly used measures (Mini-Mental State Examination, Montreal Cognitive Assessment, Alzheimer’s Disease Assessment Scale-Cognitive Subscale, Activities of Daily Living Scale, and Global Deterioration Scale) of 101 successive admissions to a memory clinic. Patients were included in the analysis only if they received a diagnosis of mild cognitive impairment (MCI) due to Alzheimer’s disease (AD) pathophysiological process or probable AD and if they received all measures. Regression analysis yielded 20 linear equations that allow for conversion between test scores on any 2 measures. Further, participants were grouped by MMSE scores with regard to level of disease severity, allowing for the creation of a quick reference table for estimating an approximate score range between measures. Results from this study provide a useful tool for clinicians when comparing between multiple different instruments that measure the mental status and functional ability of individuals with AD and MCI due to AD pathology.
Differential Diagnosis of Degenerative Dementias Using Basic Neuropsychological Tests - Multivariable Logistic Regression Analysis of 301 Patients
Background: The validity of neuropsychological tests for the differential diagnosis of degenerative dementias may depend on the clinical context. We constructed a series of logistic models taking into account this factor.
Conclusion: The models constructed from basic neuropsychological variables allowed an accurate differential diagnosis of AD versus DLB but not of FTLD versus AD or DLB.  

Clinical Presentation of Early-Onset Alzheimer’s Disease as a Result of Mutation in Exon 12 of the PSEN-1 Gene
Introduction: Mutations in the gene for presenilin 1 (PSEN-1) cause familial, early-onset Alzheimer’s disease (EOAD). Diagnosis of EOAD is often a challenge because of the high frequency of atypical presentations. Clinical manifestation of EOAD may vary depending on underlying mutation; specific genetic mutations influence development of specific clinical phenotypes; however, intrafamilial phenotypic heterogeneity has also been noted in some pedigrees.
Case presentation: We report a case of a 36-year-old woman presenting with progressive behavioral disturbances, dementia, involuntary movements, pyramidal signs, epilepsy, and a family history of early-onset dementia accompanied by involuntary movements. On genetic testing, the mutation at codon 424 (Leu→Arg) in PSEN-1 gene was identified.
Conclusion: Our case describes a new phenotype of a known mutation of PSEN-1 at codon 424. 
Which Rivastigmine Formula is Better for Heart in Elderly Patients With Alzheimer’s Disease  - Oral or Patch?
Objective: Rivastigmine is commonly used for the treatment of Alzheimer’s disease (AD). All cholinesterase inhibitors, including rivastigmine, may cause cardiac side effects. The aim of this study is to compare the electrocardiographic (ECG) and hypotensive effects of formulations of rivastigmine.
Conclusion: It was demonstrated that rivastigmine formulations were not associated with increased arrhythmogenic or hypotensive effects in elderly patients with AD and was not superior to each other.  

Acupuncture Stimulation of Taichong (Liv3) and Hegu (LI4) Modulates the Default Mode Network Activity in Alzheimer’s Disease
Objectives: The acupuncture has been used in the therapy of Alzheimer disease (AD), however, its neural underpins are still unclear. The aim of this study is to examine the acupuncture effect on the default mode network (DMN) in AD by using resting state functional magnetic resonance imaging (RS-fMRI).
Conclusion: It was found that the acupuncture stimulation could modulate the DMN activity in AD. The current findings suggest that the acupuncture treatment on the relative earlier AD patients might have a better therapy effect. 
A Selective Egocentric Topographical Working Memory Deficit in the Early Stages of Alzheimer’s Disease - A Preliminary Study
The aim of this study was to determine whether an egocentric topographical working memory (WM) deficit is present in the early stages of Alzheimer's disease (AD) with respect to other forms of visuospatial WM. Further, we would investigate whether this deficit could be present in patients having AD without topographical disorientation (TD) signs in everyday life assessed through an informal interview to caregivers. Seven patients with AD and 20 healthy participants performed the Walking Corsi Test and the Corsi Block-Tapping Test. The former test requires memorizing a sequence of places by following a path and the latter is a well-known visuospatial memory task. Patients with AD also performed a verbal WM test to exclude the presence of general WM impairments. Preliminary results suggest that egocentric topographical WM is selectively impaired, with respect to visuospatial and verbal WM, even without TD suggesting an important role of this memory in the early stages of AD.

Utility of the Cognitive Difficulties Scale and Association With Objective Test Performance
Subjective memory complaints (SMCs) are commonly noted in memory disorder clinic patients. The present study sought to examine the presence of SMCs on the Cognitive Difficulties Scale (CDS) in older adults and to examine the relationship between CDS scores and current cognitive ability. Participants were 50 adults diagnosed with possible/probable Alzheimer’s disease (AD), 100 with amnestic mild cognitive impairment (MCI) and 84 cognitively healthy controls (HCs). Participants completed a neuropsychological evaluation and the self- and informant-reported CDS. Results indicated that greater self-reported SMCs were noted in the group with MCI ; however, self-reported CDS scores were associated with cognition in HCs only. Informant-reported CDS scores were predictive of cognitive ability in the diagnosis of MCI but not AD, indicating the importance of obtaining caregiver report in the evaluation of memory disorders. As AD is a neurodegenerative disorder, SMCs lose value in determining degree of cognitive impairment as disease stage increases. 

Odor Identification in Frontotemporal Lobar Degeneration Subtypes
Odor identification impairment is a feature of several neurodegenerative disorders. Although neurodegenerative changes in the frontotemporal lobar degeneration (FTLD) subtypes involve areas important for olfactory processing, data on olfactory function in these patients are limited. An 18-item, multiple-choice odor identification test developed at our memory clinic, the Motol Hospital smell test, was administered to 9 patients with behavioral variant frontotemporal dementia, 13 patients with the language variants, primary nonfluent aphasia (n = 7) and semantic dementia (n = 6), and 8 patients with progressive supranuclear palsy. Compared to the control group (n = 15), all FTLD subgroups showed significant impairment of odor identification (P < .05). The differences between the FTLD subgroups were not significant. No correlation between odor identification and neuropsychological tests results was found. Our data suggest that odor identification impairment is a symptom common to FTLD syndromes, and it seems to be based on olfactory structure damage rather than cognitive decline. 

Synergistic Epistasis of Paraoxonase 1 (rs662 and rs85460) and Apolipoprotein E4 Genes in Pathogenesis of Alzheimer’s Disease and Vascular Dementia
Genetic polymorphism and epistasis play a role in etiopathogenesis of Alzheimer's disease (AD) and vascular dementia (VaD). In this case-control study, a total of 241 patients were included in the study to see the effect of paraoxonase 1 (PON1; rs662 and rs85460) and apolipoprotein E (ApoE) genes in altering the odds of having AD and VaD along with serum PON and lipid profile. The presence of at least 1 variant allele of rs662, but not rs85460, increased the risk of having AD by 1.8-fold (95% confidence interval [CI]: 0.97-3.40) and VaD by 3.09-fold (95% CI: 1.4-6.9). The interaction between PON1 genes (rs662 and rs85460) and ApoE genes showed synergistic epistasis in altering the odds of significantly having both AD and VaD. On the other hand, low serum level of high-density lipoprotein and low level of serum PON activity were found associated significantly (P ≤ .001 in both cases) only in patients with VaD as compared to healthy control.

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