March 15, 2016

American Journal of Alzheimer’s Disease & Other Dementias. -

American Journal of Alzheimer’s Disease & Other Dementias.

Volume 31, Number 1, February 2016


Dementia With Lew Body

Impacts of Surgery

Pervin, et al. (pp. 5-17).

Patients who have dementia with Lewy bodies (DLB) and undergo surgery may develop aggravated postoperative cognitive dysfunction or postoperative delirium. Many patients with DLB respond poorly to surgery and anesthesia, and their conditions may worsen if they have other medical complications along with dementia. They may also face high risk of prolonged hospital stay, increased medical problems and/or mortality, causing significant physical, psychosocial, and financial burdens on individuals, family members, and society. Anesthesia, pain medications, old age, and surgery-related stresses are usually held responsible for the complications; however, the exact causes are still not fully understood. Literature on surgery-related complications for patients with DLB appears to be inadequate, and hence the topic merits detailed and systematic research.

American Journal of Alzheimer’s Disease & Other Dementias.

Volume 30, Number 8, December 2015

Effects of Person-Centered Care Approaches to Dementia Care on Staff

A Systematic Review

Barbosa, et al. (pp. 713-722).


Person-centered care (PCC) has been the subject of several intervention studies reporting positive effects on people with dementia. However, its impact on staff remains unclear. The purpose of this systematic review was to assess the impact of PCC approaches on stress, burnout, and job satisfaction of staff caring for people with dementia in residential aged care facilities. Research articles published up to 2013 were searched on PubMed, Web of Knowledge, Scopus, and EBSCO and reference lists from relevant publications. The review was limited to experimental and quasi-experimental studies, published in English and involving direct care workers (DCWs). In all, 7 studies were included, addressing different PCC approaches: dementia care mapping (n = 1), stimulation-oriented approaches (n = 2), emotion-oriented approaches (n = 2), and behavioral-oriented approaches (n = 2). Methodological weaknesses and heterogeneity among studies make it difficult to draw firm conclusions. However, 5 studies reported benefits on DCWs, suggesting a tendency toward the effectiveness of PCC on staff.


Potential Similarities in Temporal Lobe Epilepsy and Alzheimer’s Disease

From Clinic to Pathology

Li, et al. (pp. 723-728).


Alzheimer’s disease (AD) is clinically characterized by insidious onset of memory and cognitive impairments, which are also presented in patients with temporal lobe epilepsy (TLE). Many studies have shown that seizures occur in some patients with AD, and AD is a risk factor for epilepsy, mainly complex partial and secondary generalized seizure. Here, we focus on the relationship between TLE and AD in clinical and pathological aspects, as they are having similar comorbidities and mechanisms. In this study, we first reviewed the clinical observations that showed concomitant AD and TLE. Then, we picked up common genetic and pathological changes in both the diseases from neurobiological researches. Although both the diseases have delicate differences in many aspects, their common characteristics intrigue more detailed research to be done by newer technology.


Elevated Galectin-3 Levels in the Serum of Patients With Alzheimer's Disease

Wang, et al. (pp. 729-732).


Alzheimer’s disease (AD) is a neurodegenerative disorder of the central nervous system. Galectin-3 (Gal-3) is characterized by a conserved sequence within the carbohydrate recognition domain. The effect of Gal-3 in AD is presently unknown. In this study, we found significantly increased Gal-3 serum levels in patients with AD compared to control participants (P = .017). There was no significant difference between patients with mild cognitive impairment (MCI) and healthy controls (P = .143) or between patients with AD and MCI (P = .688). The degree of cognitive impairment, as measured by the Mini-Mental Status Examination score, was found to have a significant correlation with the Gal-3 serum levels in all patients and healthy controls. These data suggest that Gal-3 potentially plays a role in the neuropathogenesis of AD. The Gal-3 found in serum could be a potential candidate for a biomarker panel for AD diagnosis.


The Impact of Enhanced Programming on Aging in Place for People With Dementia in Assisted Living

Hyde, et al. (pp. 733-737).


Background: Assisted living (AL) is a growing and operationally diverse option in our nation's long-term care system. Many consumers view AL communities as a viable option to receive needed services and age in place. However, little is known about the factors that influence residents’ ability to age in place when experiencing cognitive decline.

Objective: To estimate the association of resident and site characteristics to length of stay, reason for leaving and destination for residents with dementia in assisted living. In particular, this study sought to assess the impact of an ‘Enhanced’ Program intended to facilitate aging in place.

Method: Data were gathered from a retrospective evaluation of residents’ clinical records (N = 312) in five dementia-specific ALs (3 with robust enhanced programs) in the Northeastern United States.

Results: The time to 50% survival for the full cohort (N = 312) was 20.2 months. Both age at move-in and gender were statistically significant predictors of length of stay. Sites with robust support for aging in place exhibited a statistically significant longer length of stay compared to sites with limited support. Of the residents who left or died (N = 165) nearly one quarter (24%) were able to stay until the end of their lives, while 52% moved to a nursing home, primarily because of family, financial, or medical concerns. Few residents left these settings because of behavioral problems. Conclusion: AL sites with a more robust commitment to an aging in place model and a willingness to provide palliative care demonstrated a significantly longer length of stay.


Detection of Amyloid β Signature in the Lens and Its Correlation in the Brain to Aid in the Diagnosis of Alzheimer’s Disease

Kerbage, et al. (pp. 738-745).


We report the findings from a clinical trial in which a group of patients clinically diagnosed with probable Alzheimer’s disease (AD) were discriminated from an age-matched group of healthy volunteers (HVs) with statistical significance (P < .001). The results from 20 patients with AD and 20 HVs were obtained by a Fluorescent Ligand Eye Scanning (FLES) technique that measures a fluorescent signature specific to an exogenous ligand bound to amyloid-β in the lens of the eye. Sensitivity and specificity of 85% and 95%, respectively, have been achieved in predicting clinical diagnosis. Additionally, amyloid brain imaging using florbetapir F18 positron emission tomography shows significant correlation with the results obtained in the eye. Results of the study demonstrate the safety of the FLES system.


Analysis of Differentially Expressed Genes Associated With Alzheimer’s Disease Based on Bioinformatics Methods

Feng, et al. (pp. 746-751).


Objective: To screen differentially expressed genes (DEGs) of Alzheimer’s disease (AD).

Methods: The gene expression profile (GSE26972) of AD was downloaded from Gene Expression Omnibus database. The DEGs were mapped to protein–protein interaction (PPI) data for acquiring the potential PPI relationship. The coexpressed significance of a gene pair in AD was determined. Then significantly enriched Gene Ontology (GO) terms and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways of DEGs were analyzed based on database for annotation visualization and integrated discovery tool.

Results: The PPI network showed 7 upregulated genes and 4 downregulated genes that might play meaningful functional roles in AD. Meanwhile, 3 significantly enriched KEGG pathways as well as several significant GO terms (included α-actinin binding, interleukin 33 receptor activity, and telethonin binding) were identified.

Conclusions: The screened DEGs have the potential to become candidate target molecules to monitor, diagnose, and treat AD.


Clinically Unsuspected Prion Disease Among Patients With Dementia Diagnoses in an Alzheimer’s Disease Database

Maddox, et al. (pp. 752-755).


Background: Brain tissue analysis is necessary to confirm prion diseases. Clinically unsuspected cases may be identified through neuropathologic testing.

Methods: National Alzheimer’s Coordinating Center (NACC) Minimum and Neuropathologic Data Set for 1984 to 2005 were reviewed. Eligible patients had dementia, underwent autopsy, had available neuropathologic data, belonged to a currently funded Alzheimer’s Disease Center (ADC), and were coded as having an Alzheimer’s disease clinical diagnosis or a nonprion disease etiology. For the eligible patients with neuropathology indicating prion disease, further clinical information, collected from the reporting ADC, determined whether prion disease was considered before autopsy.

Results: Of 6000 eligible patients in the NACC database, 7 (0.12%) were clinically unsuspected but autopsy-confirmed prion disease cases.

Conclusion: The proportion of patients with dementia with clinically unrecognized but autopsy-confirmed prion disease was small. Besides confirming clinically suspected cases, neuropathology is useful to identify unsuspected clinically atypical cases of prion disease.


Association of Alzheimer's Disease With APOE and IL-1α Gene Polymorphisms

Yildiz, et al. (pp. 756-761).


Apolipoprotein E (ApoE) gene polymorphisms are thought to be the most important genetic risk factor in the pathogenesis of late onset and sporadic Alzheimer’s disease (AD). Moreover, interleukin-1α (IL-1α) is found to be associated with the pathogenesis of AD. In this research, ∊2, ∊3, and ∊4 polymorphisms of ApoE gene and C889T polymorphism of IL-1α gene were genotyped in patients with AD and controls. Genotyping was performed by real-time polymerase chain reaction. ∊3/∊3 and ∊3/∊4 genotype frequencies were significantly higher in control and case groups, respectively. While ∊3 allele frequencies were significantly higher in the control group, ∊2 and ∊4 allele frequencies were significantly higher among the cases with AD. No difference was found between the groups according to C889T polymorphism of IL-1α. In conclusion, we demonstrated that there was a strong association between ApoE ∊4 allele and AD, while there was no relation with IL-1α C889T polymorphisms for this study.


French Validation of the Revised Algase Wandering Scale for Long-Term Care

Martin, et al. (pp. 762-767).


Objectives: The aim of this study was to create a French equivalent of the revised Algase wandering scale for long-term care (RAWS-LTC).

Methods: The RAWS-LTC French version (F-RAWS-LTC), Mini-Mental State Examination, and Neuropsychiatric Inventory were administered to a sample of 100 institutionalized patients from 12 specialized homes.

Results The mean of the overall F-RAWS-LTC was 2.32 (standard deviation [SD] = 0.74, range 1-4), and the mean of each subscale was 2.48 for persistent walking, 1.62 for eloping behavior, and 2.30 for spatial disorientation. The correlation between the overall F-RAWS-LTC and each subscale was between 0.73 (for Spatial Disorientation) and 0.87 (for Persistent Walking). The correlation between the degree of behavioral disturbances and the overall F-RAWS-LTC is 0.42, and the correlation with the cognitive impairment is 0.50. Differences between the wanderers and nonwanderers are significant for the overall F-RAWS-LTC and for all the subscales.

Discussion Data demonstrate the statistical validity of the F-RAWS-LTC.



American Journal of Alzheimer’s Disease & Other Dementias.

Volume 30, Number 7, November 2015


Clinical Subtypes of Frontotemporal Dementia
Ghosh, S. & Lippa, C.F. (pp. 653-661).



Frontotemporal dementia (FTD) was one of the lesser known dementias until the recent advancements revealing its genetic and pathological foundation. This common neurodegenerative disorder has three clinical subtypes- behavioral, semantic and progressive non fluent aphasia. The behavioral variant mostly exhibits personality changes, while the other two encompass various language deficits. This review discusses the basic pathology, genetics, clinical and histological presentation and the diagnosis of the 3 subtypes. It also deliberates the different therapeutic modalities currently available for frontotemporal dementia and the challenges faced by the caregivers. Lastly it explores the scope of further research into the diagnosis and management of FTD.


Honoring Identity Through Mealtimes in Chinese Canadian Immigrants

Lam, I. T., & Keller, H. H. (pp. 662-671).


Mealtimes are opportunities for social interactions and expressions of individual and family identity, and serve as a microcosm of the broader lives of families living with dementia. The Eating Together study and its resulting Life Nourishment Theory (LNT) explicated the importance of mealtimes for honouring individual and family identities in the context of dementia. This sub-study examined a specific ethnocultural group with cultural food-ways and caring expectations, to determine if the concept of honouring identity needed to be modified or extended. Using active interview techniques, two Cantonese speaking researchers completed dyad/triad family and individual interviews with six Chinese Canadian immigrant families, recruited from two service providers in a large, urban, multicultural city. This sub-study provided insight into the challenges and rewards of mealtimes for Chinese immigrant families with dementia in the community and specifically provided further insights into the honouring identity concept. Although LNT and specifically the honouring identity concept was generally confirmed in this group, some culturally-specific themes were also identified. This work serves as a basis for future studies examining the meaning and experience of mealtimes in specific cultural groups living with dementia. Such work would confirm if the LNT can be applied to specific ethnocultural groups as well as the general population living with dementia.



Characteristics of Depressed Caregivers of Veterans With Dementia

Bejjani et al. (pp. 672-678).


This study examined the characteristics of caregivers and persons with dementia (PWD) to determine their association with caregiver depression. Participants included 508 PWD (veterans) and 486 caregivers from Boston, Houston, Providence, Beaumont (Texas), and Oklahoma City, identified from diagnoses from medical records and recruited from February 2007 to July 2009, for a larger study evaluating Partners in Dementia Care, a care-coordination intervention. Characteristics evaluated for PWD included activities of daily living, instrumental activities of daily living, cognitive impairment, and disruptive behavior. Caregiver characteristics evaluated included caregiver unmet needs, support-service use, and number of informal helpers. Caregiver depression was measured using the Iowa form 11-item Center for Epidemiologic Studies Depression Scale. Depressed caregivers reported significantly more unmet needs than the nondepressed caregivers. Depressed caregivers also reported a high frequency of disruptive behavior in their PWD. Caregiver perceptions of unmet needs may be an important target for intervention.



The Influence of Cognitive Status on Elder Food Choice and Meal Service Satisfaction

Crogan et al. (pp. 679-685).


Background: This article describes the testing of a new nursing home food delivery system that empowers elders to choose the foods they want to eat and gives them an active voice in menu development.

Methods: Using a 2-group, repeated measures design, 61 elderly residents from 2 eastern Washington nursing homes were recruited to participate in a 6-month study. Outcome measures included food and meal service satisfaction, body weight, serum prealbumin, and food intake.

Results: Serum prealbumin levels and body weight increased post intervention for treatment group residents. Mini-Mental Status Examination (MMSE) scores were not associated with the changes in serum prealbumin, body weight, or food intake.

Discussion: The MMSE scores did not influence the resident’s ability to actively participate in the rate the food process or choose the foods they liked and preferred to eat. Cognitive impaired older adults experienced weight gain similarly to higher functioning elderly individuals.

A Control-Based Multidimensional Approach to the Role of Optimism in the Use of Dementia Day Care Services

Contador et al. (pp. 686-693).


We examined whether grounded optimism and external locus of control are associated with admission to dementia day care centers (DCCs). A total of 130 informal caregivers were recruited from the Alzheimer’s Association in Salamanca (northwest Spain). All caregivers completed an assessment protocol that included the Battery of Generalized Expectancies of Control Scales (BEEGC-20, acronym in Spanish) as well as depression and burden measures. The decision of the care setting at baseline assessment (own home vs DCC) was considered the main outcome measure in the logistic regression analyses. Grounded optimism was a preventive factor for admission (odds ratio [OR]: 0.34 and confidence interval [CI]: 0.15-0.75), whereas external locus of control (OR: 2.75, CI: 1.25-6.03) increased the probabilities of using DCCs. Depression mediated the relationship between optimism and DCCs, but this effect was not consistent for burden. Grounded optimism promotes the extension of care at home for patients with dementia.



Coping Strategy and Caregiver Burden Among Caregivers of Patients With Dementia

Huang et al. (pp. 694-698).


Background: This study aims to examine whether coping strategies employed by caregivers are related to distinct symptoms of patients with dementia and to investigate the associations between burden and coping among caregivers of patients with dementia.

Methods: A cross-sectional study design was used. A total of 57 caregivers of patients with dementia were enrolled. Coping strategies were assessed using the Ways of Coping Checklist, and burden was assessed using the Chinese version of Caregiver Burden Inventory. Correlations between coping and patients’ behavior or memory problems were examined. Severities of behavior and memory problems were adjusted to examine the correlations between caregiver burden and coping strategies.

Results: The patients’ disruptive behavior problems were associated with avoidance, and depression problems were associated with avoidance and wishful thinking. After adjusting for severity of behavior problems, coping strategies using avoidance were positively correlated with caregiver burden.

Conclusions: Emotion-focused coping strategies are a marker of caregiver burden.



Brain Metabolic Dysfunction in Capgras Delusion During Alzheimer’s Disease

A Positron Emission Tomography Study

Jedidi et al. (pp. 699-706).



Capgras delusion is characterized by the misidentification of people and by the delusional belief that the misidentified persons have been replaced by impostors, generally perceived as persecutors. Since little is known regarding the neural correlates of Capgras syndrome, the cerebral metabolic pattern of a patient with probable Alzheimer’s disease (AD) and Capgras syndrome was compared with those of 24-healthy elderly participants and 26 patients with AD without delusional syndrome. Comparing the healthy group with the AD group, the patient with AD had significant hypometabolism in frontal and posterior midline structures. In the light of current neural models of face perception, our patients with Capgras syndrome may be related to impaired recognition of a familiar face, subserved by the posterior cingulate/precuneus cortex, and impaired reflection about personally relevant knowledge related to a face, subserved by the dorsomedial prefrontal cortex.

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