July 15, 2015

Journals -

American Journal of Alzheimer's Disease and Other Dementias

American Journal of Alzheimer's Disease & Other Dementias® (AJADD) is for professionals on the frontlines of Alzheimer's care, dementia, and clinical depression--especially physicians, nurses, psychiatrists, administrators, and other healthcare specialists who manage patients with dementias and their families. Published six times per year, each issue offers practical information about medical, psychiatric, and nursing issues; diagnostic tools; psychosocial issues; clinical research; and administrative and legal issues.

Table of Contents

May 2015; 30 (3)

op of FOpinions and Controversies

 
*        Is Alzheimer’s Disease Autoimmune Inflammation of the Brain That Can be Treated With Nasal Nonsteroidal Anti-Inflammatory Drugs?

AM J ALZHEIMERS DIS OTHER DEMEN May 2015 30: 225-227,

The Alzheimer’s Association recently reported that a woman’s estimated lifetime risk of developing Alzheimer’s at age 65 is 1 in 6, compared to nearly 1 in 11 for a man (ie, female to male ratio 1.8). Based on female to male ratio, Alzheimer’s disease could well be an autoimmune disorder. Like Alzheimer’s, multiple sclerosis, an autoimmune inflammation of the central nervous system, has a female to male ratio of 2.3. Also based on female to male ratio, Alzheimer’s resembles the autoimmune inflammatory disease rheumatoid arthritis, which has a female to male ratio of 2.7. The reasons for the female preponderance in autoimmune disease are unclear, but nonsteroidal anti-inflammatory drugs (NSAIDs) are widely and successfully employed to treat autoimmune anti-inflammatory disease and dramatically relieve symptoms. Moreover, oral NSAIDs consistently reduce the risk of Alzheimer’s disease, although they have been totally ineffective as a treatment in multiple failed clinical trials. A basis for this failure might well be that the brain dose after oral administration is too small and not sufficiently early in the pathogenesis of the disorder. But NSAID brain dose could be significantly increased by delivering the NSAIDs intranasally.

Current Topics in Care

  
*       Experiences of Nursing Staff Using Dementia-Specific Case Conferences in Nursing Homes

AM J ALZHEIMERS DIS OTHER DEMEN May 2015 30: 228-237,

Background: Dementia specific-case conferences with the Innovative dementia oriented assessment tool (CC-IdA) could be an important tool with which to analyze and manage challenging behavior. The study gives an insight into nursing staff' experiences using CC-IdA in dementia care.

Conclusions: CC-IdA represents an important tool in the management of challenging behavior of people with dementia. For the successful implementation of these case conferences, both structural and personal resources are needed.

 

Burden Among Male Alzheimer’s Caregivers: Effects of Distinct Coping Strategies

AM J ALZHEIMERS DIS OTHER DEMEN May 2015 30: 238-246,

Focusing on the understudied, increasing population of male Alzheimer’s disease (AD) caregivers, the purpose of this study was to identify their likelihood of utilizing 3 coping strategies (task focused, emotion focused, and avoidance focused) and to examine the effects of each coping strategy on caregiving burden.

The sample reported high burden. Task focused was the highest reported coping strategy. Yet, regression models indicated no significant effect of task-focused coping on burden outcomes. Emotion-focused and avoidance-focused coping each showed significant proportional effects on burden. Implications suggest that emotion- and avoidance-focused coping among male AD caregivers may be maladaptive, that is, reinforcing burden. Male AD caregivers may benefit from more task-focused coping, such as planning and active problem solving.

 
Examining Trends in the Administration of “As Needed” Medications to Inpatients With Behavioral and Psychological Symptoms of Dementia

AM J ALZHEIMERS DIS OTHER DEMEN May 2015 30: 247-256,

Rationale: The use of “pro re nata” (PRN) medication in patients with behavioral and psychological symptoms of dementia (BPSD) is common but may be a source of inappropriate medication administration.

Objective: To identify trends in the administration of PRN medications to inpatients with BPSD.

Results: A total of 170 inpatients with dementia were included. Over 50 346 bed days, 4000 PRNs were administered. Individuals were more likely to receive a PRN if they were younger, shortly after shift change, in the evening, or during the weekend. If a ranged dose is provided they are more likely to receive the higher dose. If they are receiving regularly scheduled medication from the same class, there is risk of double dosing.



Current Topics in Research

 
Benefits of Mindfulness Training for Patients With Progressive Cognitive Decline and Their Caregivers

AM J ALZHEIMERS DIS OTHER DEMEN May 2015 30: 257-267,

New strategies are needed to help people cope with the repercussions of neurodegenerative disorders such as Alzheimer’s disease. Patients and caregivers face different challenges, but here we investigated an intervention tailored for this combined population. The program focused on training skills such as attending to the present moment nonjudgmentally, which may help reduce maladaptive emotional responses. Patients participated together with caregivers in weekly group sessions over 8 weeks. An assessment battery was individually administered before and after the program. Pre–post analyses revealed several benefits, including increased quality-of-life ratings, fewer depressive symptoms, and better subjective sleep quality. In addition, participants indicated that they were grateful for the opportunity to learn to apply mindfulness skills and that they would recommend the program to others. In conclusion, mindfulness training can be beneficial for patients and their caregivers, it can be delivered at low cost to combined groups, and it is worthy of further investigation.

  
Strengthening the Dementia Care Triad: Identifying Knowledge Gaps and Linking to Resources

AM J ALZHEIMERS DIS OTHER DEMEN May 2015 30: 268-275,

This article describes a project to identify the needs of family caregivers and health care providers caring for persons with dementia. Participants included 128 caregivers, who completed a survey, and 27 health care providers, who participated in a focus group and completed a survey. Caregivers reported their primary source of information about the disease was the doctor; however, the majority also reported they were primarily informed of medications and not about needed resources. Health care providers identified limited time with patients and families, and lack of awareness of community services, as their main challenges. Recommendations include strengthening the partnership between physicians, patients, and caregivers (the dementia care triad) through additional support and training for physicians and caregivers, increasing awareness of the Alzheimer’s Association, and utilization of technology for families and professionals to track the needs of persons with dementia.

Keywords

Evaluation of a Pet-Assisted Living Intervention for Improving Functional Status in Assisted Living Residents With Mild to Moderate Cognitive Impairment: A Pilot Study

AM J ALZHEIMERS DIS OTHER DEMEN May 2015 30: 276-289,

Background: In older adults with cognitive impairment (CI), decreased functional status and increased behavioral symptoms require relocation from assisted living (AL) to nursing homes. Studies support positive effects of pets on health/function.

Results: In linear mixed models, physical activity depressive symptoms improved more with PAL.

Conclusion: Evidence supports that the PAL program helps preserve/enhance function of AL residents with CI. Additional study is required to evaluate the duration and predictors of effectiveness of the PAL intervention.


Exercise, Sedentary Pastimes, and Cognitive Performance in Healthy Older Adults

AM J ALZHEIMERS DIS OTHER DEMEN May 2015 30: 290-298,

Background: Moderately vigorous physical activity (MVPA) provides a protective affect against cognitive decline and cardiovascular risk factors. Less is known about sedentary pastimes or non exercise physical activity (NEPA) and cognitive performance.

Conclusions: Study highlights: negative impact of sedentary pastimes on executive function, need for additional investigation of sedentary behavior, NEPA, the impact of addictions upon activity in late life.

Keywords
The Patterns of Inheritance in Early-Onset Dementia: Alzheimer’s Disease and Frontotemporal Dementia

AM J ALZHEIMERS DIS OTHER DEMEN May 2015 30: 299-306,

Aim: To investigate the patterns of inheritance and gene mutation status in early-onset dementia (EOD).

Methods: Data were collected on 202 consecutive patients presenting to an EOD clinic. Early-onset Alzheimer’s disease (EOAD, n = 120) and early-onset frontotemporal dementia (EOFTD, n = 82) were studied.

Results: The majority of participants, 72.5% with EOAD and 74.4% with EOFTD, did not have a positive family history of dementia. An autosomal dominant pattern of inheritance was observed in 14.2% of patients with EOAD and 13.4% of patients with FTD. Of those with an autosomal dominant pattern of inheritance, 11.8% of EOAD and 45.5% of FTD probands had known pathogenic mutations. Only 1.6% of the total population of EOAD and 7.3% of EOFTD possessed known gene mutations.

Conclusion: Early-onset dementia does not appear to be a strongly inherited autosomal dominant condition. The majority of patients were sporadic. Known mutations were uncommon and do not explain the total autosomal dominant burden.

A Descriptive Study of Elderly Patients With Dementia Who Died Wandering Outdoors in Kochi Prefecture, Japan

AM J ALZHEIMERS DIS OTHER DEMEN May 2015 30: 307-312,

This was a descriptive study of elderly persons with dementia who were found dead after becoming lost in the community. Nineteen forensic autopsy cases were performed at Kochi Medical School, Japan. The mean age of the patients (9 males and 10 females) was 82.1 ± 6.6 years. Causes of death were drowning (n = 8), trauma (n = 5), hypothermia (n = 2), and debilitation possibly due to fatigue (n = 1) or were unknown (n = 3). Thirteen (68%) individuals had been reported missing, most at least 6 hours after they had left. They moved on foot (n = 14), by car (n = 3), or by bicycle (n = 2). Distances from residences to spots of death ranged from 20 to 5800 m for 11 patients on foot. In 8 cases, it was less than 500 m. The study has potential implications for enabling their early discovery and protection.

 
Induction of GADD34 Regulates the Neurotoxicity of Amyloid β

AM J ALZHEIMERS DIS OTHER DEMEN May 2015 30: 313-319,

The possible roles played by growth arrest and DNA damage-inducible gene 34 (GADD34) in Alzheimer’s disease (AD) are so far less understood. In this study, we found that GADD34 was increased in the brains of AD transgenic J20 mice. The deposition of β-amyloid (Aβ) peptide is the main component of neurotic plaques in AD brain. Thus, we examined the effect of Aβ in the expression of GADD34 in human SH-SY5Y cells in vitro. Amyloid β (Aβ1-42) treatment led to increased expression of GADD34. Pretreatment with 50 nmol/L of c-Jun N-terminal kinases (JNK) inhibitor SP600125 abolished the upregulation of GADD34. c-Jun silencing by transfection with c-Jun small-interfering RNA abolished the effects of Aβ1-42 on the expression of GADD34. Importantly, chromatin immunoprecipitation studies verified the ability of c-Jun to bind to the GADD34 promoter, and this ability was increased more than 3-fold by Aβ1-42. These data suggest that the induction of GADD34 by Aβ is mediated by JNK/c-Jun pathway. Finally, depletion of GADD34 significantly rescued Aβ-induced cell apoptosis as evidenced by a marked decrease in the number of terminal deoxynucleotidyl transferase deoxyuridine triphosphate nick-end labeling (TUNEL)-positive cells. Consistently, knockdown of GADD34 attenuated caspase 3 activation induced by Aβ1-42.

Keywords Correlates of Pain Intensity in Community-Dwelling Individuals With Mild to Moderate Dementia

AM J ALZHEIMERS DIS OTHER DEMEN May 2015 30: 320-325,

Objectives: To identify correlates of participant-reported pain in community-dwelling individuals with mild to moderate dementia.

Methodology: Associations among participant-reported pain intensity and depressive symptoms, mental health diagnoses, pain diagnoses, pain medications, level of functional ability, and cognitive impairment were assessed in 136 community-dwelling veterans with mild to moderate dementia and pain. Univariate and multiple regressions were used to assess relationships among the independent variables and participant-reported pain.

Results: Pain diagnoses (β = .23, t 132 = 2.65, P < .01) and pain medications (β = .21, t 132 = 2.48, P < .05) were correlated with participant-reported pain intensity in univariate regression models. Only pain diagnoses (β = .20, t 132 = 2.17, P < .05) remained a significant predictor in adjusted models.

Conclusion: Participant-reported pain in individuals with dementia appears to be a unique construct for which other psychosocial indicators cannot be substituted. Therefore, directly asking community-dwelling individuals with mild to moderate dementia about their pain is a critical component of assessment.

Using Party Horns to Test Respiratory Function in Patients With Dementia

AM J ALZHEIMERS DIS OTHER DEMEN May 2015 30: 326-329,
 
This study assessed the utility of party horns for quick, simple respiratory function testing in 66 inpatients with dementia to maintain safe eating activity. Relationships of forced vital capacity (FVC) to Mini-Mental State Examination (MMSE) score and complete extension when blowing 40- and 80-cm party horns were examined. The FVC differed significantly by both MMSE score (P = .000) and party horn score (P = .000). Significant differences in FVC were found between groups categorized by MMSE score and in groups categorized by the ability to extend both party horns. Multiple regression analyses performed on possible FVC indicators identified a significant correlation for the party horn examination (regression coefficient: .562). Breathing is always coordinated with swallowing. Party horns seem highly effective as a simple tool for testing respiratory function in patients with early-stage dementia, and the ability to offer breathing rehabilitation for patients in need is likely to result in safer eating activity.Bottom of Form
 
to get the full text of articles members of AANSW - please email the Library on nsw.library@alzheimers.org.au

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