June 2016; 31 (4)
Acetylcholinesterase
Inhibitors for Delirium in Older Adults
Abstract
Objectives: The aim of this systematic
review is to identify published randomized controlled trials (RCTs) that
evaluated the use of acetylcholinesterase inhibitors for delirium in older
adults (≥60 years).
Methods: A literature search was
conducted of PubMed, MEDLINE, EMBASE, PsycINFO, and Cochrane collaboration
databases for RCTs in any language that evaluated the use of
acetylcholinesterase inhibitors for delirium in older adults (≥60 years). Also,
bibliographic databases of the published articles were searched for additional
studies.
Conclusion: Current evidence does not suggest efficacy of
acetylcholinesterase inhibitors for the prevention or management of delirium in
older adults.
Challenges With Manual-Based
Multimodal Psychotherapy for People With Alzheimer’s Disease
A Case Study
Abstract
Earlier
detection of dementia requires increased knowledge of how to help people in the
early stages of dementia. However, few
studies have focused on how psychotherapy should be adapted to improve the
outcome of therapy for people with Alzheimer’s disease. The aims of the present
study were to identify and to explore possible obstacles encountered during the
use of manual-based
psychotherapy for people with early-stage Alzheimer’s disease. The study
found that individual adaptations to the treatment manual were necessary,
particularly the modification of memory aids in order to adapt them to
patients’ functional level
and previous experience with modern technology. In addition, caregivers
were essential for both treatment and homework completion, while reduced
awareness constituted an obstacle for adherence to the manual.
Rapidly Versus Slowly
Progressing Patients With Alzheimer’s Disease
Differences in
Baseline Cognition
Abstract
Rate of progression of cognitive deficits is
variable among patients with Alzheimer’s disease (AD). The purpose of the
current study was to compare demographic characteristics and performance on
neuropsychological measures at baseline evaluation between rapidly and slowly
progressing patients. Participants were divided into 2 groups based on change
in Alzheimer’s Disease Assessment Scale-Cognitive subscale score from baseline
to 2-year follow-up, and baseline performance was compared between the groups.
Participants were 55 rapidly progressing and 55 slowly progressing patients
with probable AD who had a follow-up evaluation 21 to 27 months after the
baseline evaluation. The groups differed in age and initial Clinical Dementia
Rating. Performance differed significantly between the groups on Verbal Series
Attention Test time, Logical Memory I, Visual Reproduction I, Block Design, and
Controlled Oral Word Association Test. Differences were found between rapidly
and slowly progressing patients on baseline neuropsychological testing
Neuropsychological and
Neuroanatomical Correlates of the Social Norms Questionnaire in Frontotemporal
Dementia Versus Alzheimer’s Disease
Abstract
Traditional neuropsychological batteries may not
distinguish early behavioral variant frontotemporal dementia (bvFTD) from
Alzheimer’s disease (AD) without the inclusion of a social behavioral measure.
We compared 33 participants, 15 bvFTD, and 18 matched patients with early-onset
AD (eAD), on the Social
Norms Questionnaire (SNQ), neuropsychological tests and 3-dimensional
T1-weighted magnetic resonance imaging (MRI). The analyses included
correlations of SNQ results (total score, overendorsement or “overadhere”
errors, and violations or “break” errors) with neuropsychological results and
tensor-based morphometry regions of interest. Patients with BvFTD had
significantly lower SNQ total scores and higher overadhere errors than patients
with eAD. On neuropsychological measures, the SNQ total scores correlated
significantly with semantic knowledge and the overadhere subscores with
executive dysfunction. On MRI analysis, the break subscores significantly
correlated with lower volume of lateral anterior temporal lobes (aTL). The results also suggest that
endorsement of social norm violations corresponds to the role of the right aTL
in social semantic knowledge.
Cerebral Glucose Metabolism
Assessment in Rat Models of Alzheimer’s Disease
An 18F-FDG-PET Study
Abstract
Objective: This study was designed to detect the brain
glucose metabolism in rat models of Alzheimer’s disease (AD) by the application
of 18F-2-fluoro-deoxy-d-glucose
positron emission tomography (18F-FDG-PET) and to provide new
insights for the early detection of AD.
Methods: Forty Wistar rats were randomly divided into 2
groups. Fifteen sham-operated rats were used as a control group. The remaining
rats as a premodel group were intracerebroventricularly injected with ibotenic
acid and were intraperitoneally injected with d-galactose,
of which 15 rats were included as the experimental group. The above-mentioned 2
groups were assigned to Y-maze test and underwent 18F-FDG-PET
scanning. Positron emission tomography images were processed with SPM 2.0.
Conclusion: Our data indicate that the changed glucose metabolism in cerebral regions
in 18F-FDG-PET imaging could be an important predictor for early
AD.
Multisensory Stimulation as an Intervention Strategy for Elderly
Patients With Severe Dementia
A Pilot Randomized
Controlled Trial
Abstract
The objective of this study was to compare the
effect of multisensory stimulation environment (MSSE) and one-to-one activity
sessions in the symptomatology of elderly individuals with severe dementia.
Thirty-two participants were randomly assigned to the following 3 groups: MSSE,
activity, and control group. The MSSE and activity groups participated in two
30-minute weekly sessions over 16 weeks. Pre-, mid-, and posttrial; 8-week
follow-up behavior; mood; cognitive status; and dementia severity were
registered. Patients in the MSSE group demonstrated a significant improvement
in the Neuropsychiatric Inventory and Bedford Alzheimer Nursing Severity Scale
scores compared with the activity group. Both MSSE and activity groups showed
an improvement during the intervention in the Cohen-Mansfield Agitation
Inventory aggressive behavior factor and total score, with no significant
differences between groups. The MSSE may have better effects on
neuropsychiatric symptoms and dementia severity in comparison with one-to-one
activity sessions in patients with severe dementia.
Deficits in Attention and Visual Processing but not Global Cognition
Predict Simulated Driving Errors in Drivers Diagnosed With Mild Alzheimer’s
Disease
Abstract
This study sought to predict driving performance
of drivers with Alzheimer’s disease (AD) using measures of attention, visual
processing, and global cognition. Simulated driving performance of individuals
with mild AD (n = 20) was contrasted with performance of a group of healthy
controls (n = 21). Performance on measures of global cognitive function and
specific tests of attention and visual processing were examined in relation to
simulated driving performance. Strong associations were observed between measures
of attention, notably the Test of Everyday Attention (sustained attention; r
= −.651, P = .002) and the Useful Field of View (r = .563, P
= .010), and driving performance among drivers with mild AD. The Visual Object
and Space Perception Test–object was significantly correlated with the
occurrence of crashes (r = .652, P = .002). Tests of global
cognition did not correlate with simulated driving outcomes. The results
suggest that professionals exercise caution when extrapolating driving
performance based on global cognitive indicators.
Knowledge and Attitudes in
Alzheimer’s Disease in a Cohort of Older African Americans and Caucasians
Abstract
African American participation in Alzheimer’s
disease (AD) research studies has been historically low. To determine whether
older African Americans and Caucasians had different knowledge or attitudes
related to AD, we administered the Alzheimer’s Disease Knowledge Scale (ADKS)
to 67 older African Americans and 140 older caucasians in the greater Atlanta
area as well as questions targeting locus of control over general health and AD
risks. Older African Americans scored slightly lower on ADKS than older
caucasians, with race only accounting for 1.57 (95% confidence interval [CI]
0.57-2.61, P < .001) points of difference in a multivariate model.
Attitudes toward AD were also similar between the 2 groups but 1 (35.7%) in 3
adults reported control over general health but not AD risks. In addition to
enhancing education content in outreach efforts, there is an urgent need to
address the perception that future AD risks are beyond one’s own internal
control.
Validation of Neuropsychological Tests to
Screen for Dementia in Chinese Patients With Parkinson’s Disease
Abstract
To compare the accuracy of different
neuropsychological tests and their combinations for deriving reliable cognitive
indices for dementia diagnosis in Parkinson’s disease (PD). One hundred forty
consecutive patients with PD were recruited and administrated an extensive
battery of neuropsychological tests. Discriminant analysis and
receiver–operator characteristic curve were used to evaluate their correct
classifications and validity. Patients with PD having dementia (PDD; 23.5%)
performed significantly worse in all tests than patients without dementia. Age
of onset, disease duration, Hoehn-Yahr grade, Unified Parkinson’s Disease
Rating Scale part III scores, and education were associated with dementia in
patients with PD. Mini-Mental State Examination (MMSE), Montreal Cognitive
Assessment, and Block Design (BD) showed better specificity and sensitivity
when used alone, and combined use of MMSE and BD further increased the
validity. Our results indicated that the accuracy of MMSE was better in
dementia diagnosis of Chinese patients with PD, and combined use of MMSE and BD
could further increase the validity of dementia diagnosis.
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