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June 19, 2015
American Journal of Alzheimer's Disease and Other Dementias June 2015 30 (4)
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Firearms in Frail Hands: An ADL or A Public Health
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
Background: Delusions can complicate practically all brain
disorders. They may be dramatic and bizarre. An example is the so-called
delusion of pregnancy.
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.
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.
Clinical Compliance of Donepezil in Treating
Alzheimer’s Disease in Taiwan
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.
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
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.
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
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
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.
of Corpus Callosum and Frontotemporal Dementia: A Casual Finding?
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.
Experiences of an Art Museum Engagement Activity for Persons With Early-Stage
Alzheimer’s Disease and Their Family Caregivers
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
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.
and Apathy as Relevant Symptoms of Subcortical Vascular Dementia
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.
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
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.
Peripheral Sympathetic Neuron is Intact in Alzheimer’s Disease and Behavioral
Variant of Frontotemporal Dementia
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).
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.
and Cognitive Impairment Among Older Persons in Malaysia
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.
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.
Chinese Verbal Learning Test Specifically Assesses Hippocampal State
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
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.
Malignant Syndrome in an Elderly Patient With Normal Pressure Hydrocephalus
Overlapping Corticobasal Degeneration
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.
Treatment of Men With Mild Cognitive Impairment and Low Testosterone Levels
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.
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.