June 19, 2015

American Journal of Alzheimer's Disease and Other Dementias June 2015 30 (4)



Top of Form
Opinions and Controversies


Firearms in Frail Hands: An ADL or A Public Health Crisis!

P, 337-340,


The incidence of neurocognitive disorders, which may impair the ability of older adults to perform activities of daily living (ADLs), rises with age. Depressive symptoms are also common in older adults and may affect ADLs. Safe storage and utilization of firearms are complex ADLs, which require intact judgment, executive function, and visuospatial ability, and may be affected by cognitive impairment. Depression or cognitive impairment may cause paranoia, delusions, disinhibition, apathy, or aggression and thereby limit the ability to safely utilize firearms. These problems may be superimposed upon impaired mobility, arthritis, visual impairment, or poor balance. Inadequate attention to personal protection may also cause hearing impairment and accidents. In this article, we review the data on prevalence of firearms access among older adults; safety concerns due to age-related conditions; barriers to addressing this problem; indications prompting screening for firearms access; and resources available to patients, caregivers, and health care providers


Delusion of Pregnancy: An Unusual Symptom in the Context of Dementia

p.  341-345,


Background: Delusions can complicate practically all brain disorders. They may be dramatic and bizarre. An example is the so-called delusion of pregnancy.

Method: MEDLINE and Google Scholar searches were conducted for relevant articles, chapters, and books published before 2014. Search terms used included delusion of pregnancy, uncommon presentation, behavioral and psychological symptoms, dementia, Alzheimer’s disease, and frontotemporal dementia (FTD). Publications found through this indexed search were reviewed for further relevant references. We included case reports that highlight the relationship and overlap between dementia presenting as schizophrenia-like psychosis and schizophrenia.

Results: Literature on delusion of pregnancy in the course of dementia consists mostly of case reports and small samples of patients.

Conclusion: Psychotic phenomena such as delusion of pregnancy may be a feature in some cases of dementia. If this bizarre features of dementia appears as early presentation of FTD whose usual onset is in the presenium, it may be mistaken for schizophrenia.


Current Topics in Care


Clinical Compliance of Donepezil in Treating Alzheimer’s Disease in Taiwan

p. 346-351,


Background/Rationale: Adherence to cholinesterase inhibitor (ChEI) is associated with treatment effectiveness in the treatment of Alzheimer’s disease (AD). We investigated the clinical adherence to donepezil in Taiwan.

Results: A total of 273 patients were included in our analysis. Sixty-seven patients withdrew from donepezil treatment with mean treatment duration of 28.0 ± 25.9 months. Better initial scores on the Mini-Mental Status Examination (P = .007), Cognitive Abilities Screening Instrument (P = .003), and the Clinical Dementia Rating Scale (CDR) Sum of Boxes (P = .011) were positively associated with clinical adherence. The clinical adherent rate was higher in the CDR-0.5 group than in the CDR-2.0 group with significant difference.

Conclusion: Although there are some limitations in our study, these findings indicate that early intervention with ChEI in patients with AD should be emphasized and may lead to a better clinical adherence.

The Impact of Living Arrangements on Dementia Caregiver’s Sleep Quality

p. : 352-359,


In the United States half of the 15 million informal caregivers of persons with Alzheimer's disease or a related dementia (PWDs) do not live with the PWD. This paper compares the sleep quality and health of 59 community-dwelling caregivers living with the PWD and 21 living apart from the PWD. Variables of interest were caregiving experience (hours caregiving, problematic behaviors of the PWD, caregivers' perception of dementia severity), sleep quality, and health (perceived health, stress, and depressive symptoms). Parametric unpaired t tests were used to calculate the differences between key variables. Multiple regression models were constructed, controlling for age, gender, behavior index, and dementia severity to examine the variance explained by living arrangements on sleep quality and health. Caregivers living apart from the PWD experienced the same level of poor sleep quality as did caregivers living with the PWD. The living arrangements of the caregiver did not make a unique contribution to sleep quality or health variables except for reports of unhealthy days. Given the importance of good quality sleep for health, the findings highlight the importance of evaluating caregivers living apart from the PWD for sleep problems with the same level of concern as one would have for those living with the PWD.

Current Topics in Management


Cognitive Fluctuations as a Challenge for the Assessment of Decision-Making Capacity in Patients With Dementia

p.  360-363,


Decision-making capacity (DMC) is an indispensable prerequisite for medical treatment choices, including consent to treatment, treatment discontinuation, and refusal of treatment. In patients with dementia, DMC is often affected. A particular challenge in assessing DMC are cognitive fluctuations that may lead to a fluctuation in DMC as well. Cognitive fluctuations are a diagnostic core feature of dementia with Lewy bodies and occur in Parkinson’s and Alzheimer’s diseases. In this article, these challenges are discussed and suggestions for assessing the DMC of patients with dementia with cognitive fluctuations are presented.

Current Topics in Research


Effects of Alcohol Consumption on Cognition and Regional Brain Volumes Among Older Adults

p: 364-374,


This study utilized data from the Framingham Heart Study Offspring Cohort to examine the relationship between midlife and late-life alcohol consumption, cognitive functioning, and regional brain volumes among older adults without dementia or a history of abusing alcohol. The results from multiple linear regression models indicate that late life, but not midlife, alcohol consumption status is associated with episodic memory and hippocampal volume. Compared to late life abstainers, moderate consumers had larger hippocampal volume, and light consumers had higher episodic memory. The differences in episodic memory according to late life alcohol consumption status were no longer significant when hippocampal volume was included in the regression model. The findings from this study provide new evidence that hippocampal volume may contribute to the observed differences in episodic memory among older adults and late life alcohol consumption status.


Agenesis of Corpus Callosum and Frontotemporal Dementia: A Casual Finding?

p: 375-379


Agenesis of corpus callosum (AgCC) is a congenital malformation characterized by total or partial absence of corpus callosum with a good neuropsychological profile. Frontotemporal dementia (FTD) is the third most common cause of cortical dementia, and it is characterized by alterations in personality and social relationship, often associated with deficits in attention, abstraction, planning, and problem solving. Herein, we report a case of a 73-year-old woman presenting with FTD associated with primary AgCC. The possible “causal or casual” relationship between these 2 different conditions should be investigated in large prospective studies.


Subjective Experiences of an Art Museum Engagement Activity for Persons With Early-Stage Alzheimer’s Disease and Their Family Caregivers

p: 380-389,


Objective: To describe the subjective experiences of older adults with early-stage Alzheimer’s disease or related cognitive disorders (ADRDs) and their family caregivers who participated in an art museum engagement activity.

Results: Three key themes were identified: cognitive stimulation, social connections, and self-esteem. In addition, we identified programmatic issues such as activity-specific concerns and program logistics that could help improve future art program offerings. Past experience with art and perceived social cohesion were correlated with participants’ overall satisfaction with the program.

Discussion: Efforts aimed at improving the quality of life of those with Alzheimer’s disease and their family caregivers should consider the potential role of art museums.


Gait and Apathy as Relevant Symptoms of Subcortical Vascular Dementia

p 390-399,


Background: Subcortical vascular dementia relates to small-vessel disease and hypoperfusion, resulting in focal and diffuse ischemic white matter lesions. The main target of the disease are the frontal subcortical neural networks. There is no clinical standard definition of the pathology, on the contrary, everyday clinical practice suggests dominant behavioral alterations and dysexecutive syndrome.

Results: Our data suggest that there is a significant increment in apathy levels and a dramatic decrease in gait and equilibrium control in the patients examined during follow-up.

Conclusion: Subcortical vascular dementia may be associated with gait and balance alteration and apathy per se; we suggest to implement clinical data with these major aspects.


The Peripheral Sympathetic Neuron is Intact in Alzheimer’s Disease and Behavioral Variant of Frontotemporal Dementia

p: 400-404,


Introduction: The study was undertaken to evaluate the postganglionic sympathetic sudomotor function employing the quantitative sudomotor axon reflex test (QSART) in tauopathies Alzheimer’s disease (AD) and behavioral variant of frontotemporal dementia (bvFTD).

Results: In all, 15 patients with AD (7 female) and 14 patients with bvFTD (9 female) were included. Mean age (±standard deviation) of patients with AD and bvFTD was 74 ± 9 and 71 ± 10 years, respectively. Severe sudomotor dysfunction (Composite Autonomic Severity sudomotor score 3) was present in 3 (20%) patients with AD and 0 (0%) patients with bvFTD (P = .037). The upper extremity was only involved in 1 patient with AD and 1 patient with bvFTD. Sweat results of the 4 recording sites did not differ between both groups. Patients’ history correlated with severe autonomic symptoms as assessed with QSART.

Conclusion: Postganglionic sudomotor involvement in AD and bvFTD is most likely not part of the disease.


Smoking and Cognitive Impairment Among Older Persons in Malaysia

p: 405-411,


Introduction: Previous studies have shown conflicting results on the association between smoking and cognitive function. This study aims to examine the relationship of smoking with cognitive function.

Methodology: Data for the study, consisting of 2553 older adults aged 60 years and older, were drawn from a nationwide household survey entitled “Determinants of Wellness among Older Malaysians: A Health Promotion Perspective” conducted in 2010.

Results: Current smokers had lower rates of cognitive impairment compared to never smokers (17.4% vs 25.9%), while cognitive function in former or ex-smokers was almost similar to that of the never smokers. Findings from multiple logistic regression analysis showed that current smokers were 37% less likely to be cognitively impaired, compared to the never smokers (odds ratio [OR] = .63; 95% confidence interval [CI]: .46-.86) while controlling for potential confounders. No difference in cognitive function was observed between former smokers and never smokers (OR = .94; 95% CI: .71-1.25).

Conclusion: Although the findings indicated a negative association between cigarette smoking and cognitive impairment, we are unable to conclude whether this relationship is causal or affected by other unmeasured confounding factors, especially survival bias.


The Chinese Verbal Learning Test Specifically Assesses Hippocampal State

p: 412-416,


Background: Recently, the Chinese Verbal Learning Test (ChVLT) was developed to assess episodic memory in Chinese speakers. The goal of this analysis was to determine whether memory consolidation as measured by the ChVLT was specifically associated with hippocampal volume in patients with cognitive impairment.

Results: Linear regression revealed that hippocampal volume explained 9.9% of the variance in delayed memory (P = .018) after controlling for the effects of age, education, immediate recall after the last learning trial, overall level of cognitive impairment, and volumes of other cortical regions.

conclusion: These results indicate that the ChVLT is specifically correlated with hippocampal volume, supporting its utility for detecting hippocampal disease and monitoring hippocampal state over time.


Neuroleptic Malignant Syndrome in an Elderly Patient With Normal Pressure Hydrocephalus Overlapping Corticobasal Degeneration

p: 417-420,


In this case report, neuroleptic malignant syndrome (NMS) in an elderly patient with normal pressure hydrocephalus overlapping corticobasal degeneration was reported. The case highlights the need for clinicians to be cautious when using dopaminergic medication in the elderly patients, since these agents have risks for NMS which is a life-threatening complication. Additionally, co-occurrence of primary and secondary parkinsonian dementia syndromes should be kept in mind to avoid additional complications in the elderly patients.

Testosterone Treatment of Men With Mild Cognitive Impairment and Low Testosterone Levels

p: 421-430,


Introduction: This study investigated the effects of testosterone (T) treatment on cognition, mood, and quality of life in men with mild cognitive impairment (MCI) and low serum T levels.

Results: Total T levels significantly increased in the T treatment group. No significant changes were observed in measures of cognition, mood, or quality of life other than improvement in 1 objective measure of verbal memory (P < .05) and decreased depression symptoms (P < .02) in the treatment group.

Conclusions: Testosterone treatment may modestly improve verbal memory and depression symptoms in men with both MCI and low T.


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