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January 24, 2015
American Journal of Alzheimer's Disease and Other Dementias - December 2014
The Value and Underutilization of Simple Reading
Glasses in Geropsychiatry Inpatient Settings
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
Antibodies Against Gangliosides in Patients With
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
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
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
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
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
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
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
Differential Diagnosis of Degenerative Dementias
Using Basic Neuropsychological Tests - Multivariable Logistic Regression Analysis of 301
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
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
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
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
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
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
Synergistic Epistasis of Paraoxonase 1 (rs662 and
rs85460) and Apolipoprotein E4 Genes in Pathogenesis of Alzheimer’s Disease and
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.