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October 14, 2015
AMERICAN JOURNAL OF ALZHEIMER’S DISEASE & OTHER DEMENTIAS
Assessment of Paraoxonase 1 Activity in Patients With
Alzheimer’s Disease and Vascular Dementia
reported that a significant difference in the serum paraoxonase 1 (PON-1)
activity was observed in patients with vascular dementia when compared to
healthy controls, whereas there were no significant difference between
Alzheimer’s disease and healthy controls.
Melatonin for Sleep Disorders and Cognition in Dementia:
A meta-analysis of Randomized controlled Trials
The current review aims to examine melatonin therapy for
both sleep disturbances and cognitive function in dementia. We searched all
randomized controlled trials published in Medline, Embase, the Cochrane
Library, China National Knowledge Infrastructure, the Cochrane Dementia and
Cognitive Improvement Group’s Specialized Register, and Clinical Trials.gov.
The grading of recommendations assessment, development and evaluation framework
was used to assess the quality of evidence. Seven studies were included (n =
520). Treated participants showed prolonged total sleep time (TST) by 24.36
minutes (P = .02). Sleep efficacy (SE) was marginally improved (P=.07). This
effect was stronger under a longer intervention period lasting more than 4
weeks (P = .02). Conversely, cognitive function did not change significantly.
Additionally, there was no report of severe adverse events. Given the current
studies, we conclude that melatonin therapy may be effective in improving SE
and prolonging TST in patients with dementia; however, there is no evidence
that this improvement impacts cognitive function.
Alzheimer’s Disease and the Elderly in Israel: Are We
Paying Enough Attention to the Topic in the Arab Population?
the continuing rise in the elderly population, Alzheimer’s disease (AD) and
dementia represent an increasing public health concern worldwide. In recent
years, research has focused on the relationship between AD and ethnicity.
Israel, a multiethnic society, provides a natural laboratory for research on
ethnicity and health. The largest ethnic group is that of Israeli Jews,
followed by Arab citizens, mostly Arab Muslims, with smaller numbers of Arab
Christians in addition to Druze, Circassians, and others. The aim of this
review is to clarify ethnic differences in prevalence and risk factors for
Alzheimer’s disease. We review available literature on ethnic differences in
epidemiologic and risk factors for Alzheimer’s disease, including genetic
differences as well as disparities in health access and quality of health
services. We will conclude with research and policy implications.
Using an Emic Lens to Understand How Latino Families Cope
With Dementia Behavioral Problems
group data collected for a larger project to develop a fotonovela for Latino
caregivers was used to conduct a meaning-centered thematic analysis in order to
elicit Latino family caregiver perspectives on how behavior problems occurring
in the context of dementia are perceived and managed. A sample of 42
Spanish-speaking Latino caregivers were recruited from organizations affiliated
with the Alzheimer's Association near San Diego, California. Caregivers were
queried on challenging behaviors, coping strategies, as well as other daily
challenges. Focus group sessions were conducted in Spanish, translated and
transcribed into English, and analyzed using qualitative, grounded
anthropological methods. In addition to a range of behavior problems, five
indigenous approaches to managing challenging behaviors were identified:
acceptance, love, patience, adaptability, and establishing routines of care.
Additionally, participants identified persistent challenges which deter
effective coping. These include: issues with providers, problems with family
members, limited knowledge of resources, emotional distress, and financial
strain. To our knowledge, this is one of the few qualitative studies to report
indigenous coping strategies for dementia behavioral problems. These findings
have the potential to inform culturally-tailored intervention.
Living With Mild to Moderate Alzheimer Patients Increases
the Caregiver’s Burden at 6 Months
objective of our study was to demonstrate that living with a person affected by
mild to moderate Alzheimer’s disease can lead to an increased perception of the
caregiver’s burden using the Caregiver Burden Inventory (CBI). The sample
consisted of 153 dyads, caregiver–patient. At baseline, a greater perception of
the caregiver’s burden was observed in the live-in caregivers. A further
increase in the total burden of the live-in caregivers was noticed at the
6-month follow-up. More specifically, with the inclusion of correction factors
such as the caregiver’s age and the CBI subscales at baseline, the social and
emotional burden becomes statistically significant (P < .001). The present paper confirms
our hypothesis that live-in caregivers perceive a greater burden than
nonlive-in, and this difference increases further after 6 months. The
difference in involvement between live-in and nonlive-in caregivers could be
the foundation to tailor more specific interventions.
Intervention of Multi-Modal Activities for Older Adults
With Dementia Translation to Rural Communities
Language-Enriched Exercise Plus Socialization (LEEPS) Program for older adults
with Alzheimer’s disease and related disorders (ADRD) was implemented in rural
Wisconsin communities. Patterned after a university-based research
intervention,1the LEEPS protocol entailed ongoing weekly to
biweekly sessions with a trained volunteer and an individual with dementia,
with exercise and language stimulation sessions interspersed with social or
volunteer outings. Of 64 persons with ADRD who enrolled, 29 completed an
initial follow-up assessment at an average of 10.65 months, and 8 completed a
second follow-up at an average of 20.55 months. Results generally show
stability in cognition, mood, and physical performance. Improvement was noted
at the initial retest on 1 of the 3 physical fitness measures (arm curls; t = 2.61, P = .015), but
self-rated quality of life declined slightly from baseline to the first retest
(t = −2.09, P = .048). Change in the
Mini-Mental State Examination at the first and second follow-ups (mean = +0.18
and −1.0, respectively) was negligible. The maintenance of function observed
with LEEPS is an encouraging outcome, given the progressive nature of ADRD, but
controlled investigations are needed to establish the efficacy of LEEPS.
Barriers to implementation of an intensive activities-focused intervention in
rural communities are discussed.
The Hypothalamus in Alzheimer’s Disease: A Golgi and
Electron Microscope Study
disease (AD) is a progressive neurodegenerative disorder, characterized by
irreversible decline of mental faculties, emotional and behavioral changes,
loss of motor skills, and dysfunction of autonomic nervous system and
disruption of circadian rhythms (CRs). We attempted to describe the
morphological findings of the hypothalamus in early cases of AD, focusing our
study mostly on the suprachiasmatic nucleus (SCN), the supraoptic nucleus
(SON), and the paraventricular nucleus (PVN). Samples were processed for
electron microscopy and silver impregnation techniques. The hypothalamic nuclei
demonstrated a substantial decrease in the neuronal population, which was
particularly prominent in the SCN. Marked abbreviation of dendritic
arborization, in association with spinal pathology, was also seen. The SON and
PVN demonstrated a substantial number of dystrophic axons and abnormal spines.
Alzheimer’s pathology, such as deposits of amyloid-β peptide and
neurofibrillary degeneration, was minimal. Electron microscopy revealed
mitochondrial alterations in the cell body and the dendritic branches. The
morphological alterations of the hypothalamic nuclei in early cases of AD may
be related to the gradual alteration of CRs and the instability of autonomic regulation.