Comparison of dementia with Lewy bodies to Alzheimer's disease and Parkinson's disease with dementia.

We compared the clinical and neuropsychological pattern of dementia with Lewy bodies (DLB) to Alzheimer's disease (AD) and Parkinson's disease with dementia (PD-d). Sixteen patients clinically diagnosed with DLB were compared with two groups of patients with PD-d (n = 15) and AD (n = 16) matched for level of dementia. Isolated cognitive impairment was the most common form of presentation in AD (93.8%) and DLB (31.3%) groups, while parkinsonism was in 100% of PD-d subjects. Psychoses associated with cognitive impairment at the beginning of the disease were more frequent in DLB patients (31.3%) than in AD (6.3%) and PD-d (0%) groups. There were no significant differences in Unified Parkinson Disease Rating Scale motor-subscale scores between DLB and PD-d patients. DLB and PD-d patients performed significantly worse on attentional functions and better on memory tests than AD. DLB patients also showed lower scores than AD subjects on visual memory, visuoperceptive, and visuoconstructive tests. No significant differences were found between PD-d group and DLB subjects on any neuropsychological test. We were unable to find any differences in cognitive tasks between PD-d and DLB subjects. Clinical features and neuropsychological deficiencies of DLB (attentional, visuoperceptive, and visuoconstructive deficits) and PD (attentional deficits) compared to AD (amnesic syndrome) can contribute to accurate identification of these entities and to the understanding of the neuropathological and neurochemical substrate underlying these diseases.     

Apolipoprotein E allelic variants predict dementia in elderly patients with memory impairment

Apolipoprotein E-?4 (ApoE_?4 allele is a major risk factor of late-onset Alzheimer's disease (AD). We now report that: (1) this allelic variant is more frequent among patients with age-associated memory impairment (AAMI) than among healthy control subjects; (2) after a 3 year follow-up, those AAMI patients who developed dementia had ApoE_?4 more frequently than those who did not; (3) ApoE allele distribution did not differ significantly between demented AAMI and late-onset AD patients. These results suggest that ApoE_?4 predicts the development of dementia in AAMI patients, and that AAMI, an idiopathic amnesic syndrome of high prevalence among the elderly, and late-onset AD are different stages of the same disorder.     

Measure of quality of life for Taiwanese persons with early to moderate dementia and related factors

BACKGROUND: This study validates the Chinese Dementia-Quality of Life instrument (DQoL) in patients with early to moderate stages of Alzheimer's disease (AD) (Clinical Dementia Rating Scale, CDR=0.5, 1, and 2; MMSE >or= 12). METHODS: A cross-sectional design was used involving 98 participants (27 controls, 35 patients with questionable dementia (QD), and 36 patients with mild to moderate AD) and 51 paired family caregivers (FCs) (20 FCs of QD patients, 31 FCs of AD patients). FCs were recruited to evaluate patients' DQoL using the parallel form. Internal consistency, construct validity and concurrent validity of the DQoL were examined. RESULTS: The findings indicated that the Chinese DQoL instrument has stable internal consistency but only moderate validity when used in early to moderate AD participants with MMSE greater than, or equal to 12. The DQoL and Self-esteem subscales were significantly different across the three dementia severity groups. The values of internal consistency of the DQoL and its five subscales were high for the ratings of both the patients and the FCs. The interscale correlations for the DQoL were almost all significant for patients' and FCs' ratings. Agreement of the DQoL and its subscales for patients and FCs was significant. However, two inconsistencies were found in the results of the factor analysis and the prior conceptualization of patients' DQoL, the subscales of Self-esteem and Negative Affect. Global cognitive impairment and self-care problems significantly correlated with the patients' DQoL, while the patients' depressive symptoms and self-care problems significantly correlated with the FCs' DQoL. CONCLUSIONS: The Chinese DQoL reported by early to moderate AD patients has good reliability, but moderate validity because the patients' depressive symptoms did not correlate with their DQoL and the major subscales. Both patients' and FCs' ratings on DQoL are important in research and treatment decision making.     

Usefulness of a blood flow analyzing program 3DSRT to detect occipital hypoperfusion in dementia with Lewy bodies

In the latest criteria for the clinical diagnosis of dementia with Lewy bodies (DLB), supportive features include generalized low uptake on SPECT/PET perfusion scan with reduced occipital activity. In this study, we investigated the usefulness of a cerebral blood flow (CBF) quantification program '3DSRT' in detecting occipital hypoperfusion in DLB. Twenty two patients with probable DLB, 38 patients with probable Alzheimer's disease (AD) and 16 normal controls underwent brain perfusion SPECT. Compared with AD, DLB patients had a bilateral lower CBF in the posterior cerebral segments. The correlation of clinical symptoms and brain blood perfusion was examined by dividing the subjects into subgroups. DLB patients with Parkinsonism, when compared to non-Parkinsonism subgroup, had a lower CBF throughout the cerebrum with statistical significance in the posterior cerebral segments. The quantitative analysis of brain perfusion SPECT by 3DSRT could be a useful supportive measurement in the diagnosis of DLB.     

A comparison of clinical,psychometric and behavioural memory tests: Findings from a community study of the early detection of dementia

Diagnostic criteria for dementia require assessment of the ability to learn new information. Ideally, this assessment should be brief and sensitive to early impairment. We present comparative data on a variety of memory tests administered to a population sample of elderly community residents who are being studied longitudinally. Of the three classes of memory tests, clinical, psychometric and everyday tests, discriminant function analysis indicated that, overall, the best discrimination between demented and non-demented individuals was achieved by some everyday tests: recalling a news item, retracing a route, and recalling a name after learning a name-photograph association. However, of the 11 tests examined in total, two were identified which together discriminated almost as efficiently as all 11 measures combined. These were recalling a name and recalling six objects. By comparison, the principal memory item in the Mini Mental State Examination, the recall of three words, produced poor discrimination. The two simple measures which provided good discrimination in this population sample may therefore be recommended to assess the ability to learn new information, where the aim of the assessment is the diagnosis of dementia.     

Sundown syndrome in persons with dementia: an update

"Sundowning" in demented individuals, as distinct clinical phenomena, is still open to debate in terms of clear definition, etiology, operationalized parameters, validity of clinical construct, and interventions. In general, sundown syndrome is characterized by the emergence or increment of neuropsychiatric symptoms such as agitation, confusion, anxiety, and aggressiveness in late afternoon, in the evening, or at night. Sundowning is highly prevalent among individuals with dementia. It is thought to be associated with impaired circadian rhythmicity, environmental and social factors, and impaired cognition. Neurophysiologically, it appears to be mediated by degeneration of the suprachiasmatic nucleus of the hypothalamus and decreased production of melatonin. A variety of treatment options have been found to be helpful to ameliorate the neuropsychiatric symptoms associated with this phenomenon: bright light therapy, melatonin, acetylcholinesterase inhibitors, N-methyl-d-aspartate receptor antagonists, antipsychotics, and behavioral modifications. To decrease the morbidity from this specific condition, improve patient's well being, lessen caregiver burden, and delay institutionalization, further attention needs to be given to development of clinically operational definition of sundown syndrome and investigations on etiology, risk factors, and effective treatment options.     

Inflammatory markers and the risk of dementia and Alzheimer's disease: A meta-analysis

Introduction

Inflammatory markers are often elevated in patients with dementia, including Alzheimer's disease (AD). However, it remains unclear whether inflammatory markers are associated with the risk of developing dementia.

Neuropathology of dementia in a large cohort of patients with Parkinson's disease

The aim of our study was to establish the contribution of distinct pathological aggregates (cortical Lewy bodies (LB), neuronal tau-inclusions and β-amyloid plaque (Aβ) deposition) in dementia related to Parkinson's disease (PD) in a large autopsy cohort.We studied the brains of 155 PD patients, 109 of whom were clinically demented. The total LB score, the Braak stages for neurofibrillary tangles (NFT) and the Thal phases for Aβ deposition were assessed in each case, according to previously published guidelines.All the three lesion types were more abundant in the demented PD group, compared to the non-demented PD group, but neocortical LB pathology was the most important substrate of dementia. A significant correlation was found between the severity of Aβ phases, NFT stages and cortical LB scores. In a subgroup of severely demented PD patients, cortical tau burden was much higher than in the rest of the group. Extensive cortical NFTs associate unavoidably with dementia. Some patients remain cognitively intact despite high cortical LB score. In conclusion, our data strongly support a combining, yet distinct role of neocortical LBs and tau deposits.     

Assessment of agitation in elderly patients with dementia: correlations between informant rating and direct observation

BACKGROUND: Assessment of behavior problems in elderly persons with dementia is important for understanding and managing those behaviors. The most common method for assessing agitation is the use of informant ratings; however, these ratings may be affected by staff bias, inaccurate or insufficient memory, or stress. An alternative method is direct observation, which is more objective, but very costly and necessitates time sampling, thereby limiting the period covered by the assessment. To date, little research attention has been given to the degree to which these two methods converge. METHODS: In the present study, 175 elderly persons with dementia who manifested problem behaviors were recruited from 11 nursing home facilities in Maryland. The average age for the participants was 87 years; 78% were female. Two methods were employed for assessing agitation: the Agitated Behaviors Mapping Instrument (ABMI), which is based upon direct observations, and the Cohen-Mansfield Agitation Inventory (CMAI), which is a frequency rating scale completed by a formal caregiver. The ABMI and CMAI contain some identical items for tapping behavior problems. RESULTS: Data analysis revealed significant Pearson correlations between identical items on the two assessment instruments, as well as significant correlations of summary measures based on these different instruments, demonstrating a strong convergence between informant ratings and direct observations. CONCLUSIONS: Informant ratings can achieve moderate agreement with direct observation when valid instruments and informants are used.     

Quantitative electroencephalography as a marker of cognitive fluctuations in dementia with Lewy bodies and an aid to differential diagnosis

Objective

We investigated for quantitative EEG (QEEG) differences between Alzheimer’s disease (AD), dementia with Lewy bodies (DLB) and Parkinson’s disease dementia (PDD) patients and healthy controls, and for QEEG signatures of cognitive fluctuations (CFs) in DLB.

Helicobacter pylori and the risk of dementia: A population-based study

Introduction

Helicobacter pylori infection might increase risk of dementia, but available evidence is inconsistent, and longitudinal studies are sparse. We investigated the association between H. pylori serology and dementia risk in a population-based cohort.

The worldwide costs of dementia 2015 and comparisons with 2010

Introduction

In 2010, Alzheimer's Disease International presented estimates of the global cost of illness (COI) of dementia. Since then, new studies have been conducted, and the number of people with dementia has increased. Here, we present an update of the global cost estimates.

Individualized clinical management of patients at risk for Alzheimer's dementia

IntroductionMultidomain intervention for Alzheimer's disease (AD) risk reduction is an emerging therapeutic paradigm.MethodsPatients were prescribed individually tailored interventions (education/pharmacologic/nonpharmacologic) and rated on compliance. Normal cognition/subjective cognitive decline/preclinical AD was classified as Prevention. Mild cognitive impairment due to AD/mild-AD was classified as Early Treatment. Change from baseline to 18 months on the modified Alzheimer's Prevention Cognitive Composite (primary outcome) was compared against matched historical control cohorts. Cognitive aging composite (CogAging), AD/cardiovascular risk scales, and serum biomarkers were secondary outcomes.ResultsOne hundred seventy-four were assigned interventions (age 25–86). Higher-compliance Prevention improved more than both historical cohorts (P = .0012, P < .0001). Lower-compliance Prevention also improved more than both historical cohorts (P = .0088, P < .0055). Higher-compliance Early Treatment improved more than lower compliance (P = .0007). Higher-compliance Early Treatment improved more than historical cohorts (P < .0001, P = .0428). Lower-compliance Early Treatment did not differ (P = .9820, P = .1115). Similar effects occurred for CogAging. AD/cardiovascular risk scales and serum biomarkers improved.DiscussionIndividualized multidomain interventions may improve cognition and reduce AD/cardiovascular risk scores in patients at-risk for AD dementia.     

Rapid eye movement sleep behavior disorder and subtypes in autopsy-confirmed dementia with Lewy bodies

The purpose of this study was to determine whether dementia with Lewy bodies with and without probable rapid eye movement sleep behavior disorder differ clinically or pathologically. Patients with dementia with Lewy bodies (DLB) with probable rapid eye movement sleep behavior sleep disorder (n = 71) were compared with those without it (n = 19) on demographics, clinical variables (core features of dementia with Lewy bodies, dementia duration, rate of cognitive/motor changes), and pathologic indices (Lewy body distribution, neuritic plaque score, Braak neurofibrillary tangle stage). Individuals with probable rapid eye movement sleep behavior disorder were predominantly male (82% vs 47%) and had a shorter duration of dementia (mean, 8 vs 10 years), earlier onset of parkinsonism (mean, 2 vs 5 years), and earlier onset of visual hallucinations (mean, 3 vs 6 years). These patients also had a lower Braak neurofibrillary tangle stage (stage IV vs stage VI) and lower neuritic plaque scores (18% vs 85% frequency), but no difference in Lewy body distribution. When probable rapid eye movement sleep behavior disorder developed early (at or before dementia onset), the onset of parkinsonism and hallucinations was earlier and Braak neurofibrillary tangle stage was lower compared with those who developed the sleep disorder after dementia onset. Women with autopsy-confirmed DLB without a history of dream enactment behavior during sleep had a later onset of hallucinations and parkinsonism and a higher Braak NFT stage. Probable rapid eye movement sleep behavior disorder is associated with distinct clinical and pathologic characteristics of dementia with Lewy bodies.