Inflammatory signaling in Alzheimer disease and depression

To help define the relationships among inflammation, Alzheimer disease, and depression, the Texas Alzheimer's Research Consortium analyzed an array of inflammatory biomarkers in a cohort of patients with Alzheimer disease and in controls. Inflammation severity was highly correlated with earlier age at onset of Alzheimer disease and was also associated with cognitive decline. The relationship between inflammation and depression was not as clear, and it varied with aspects of depression, gender, and the presence of Alzheimer disease.     

Relationships of cognitions associated with coping reactions to depression in spousal caregivers of Alzheimer's disease patients

Attributions (globality and stability) related to the reformulated learned helplessness (RLH) model of depression, and attributes, self-evaluations, and expectancies concerning coping reactions (degree of upset, success, satisfaction, control in future, future coping success) postulated by Wortman and Dintzer (1978) were examined for their respective relations to severity and prevalence of diagnosable depression in a highly stressed sample (N =68) of spouse caregivers of Alzheimer's disease patients. Subjects' attribution-related cognitions concerning two situational contexts were obtained: (1) an unpredictable upsetting behavior by the Alzheimer patient, and (2) significant life change experienced by the caregiver as a result of his/her spouse's Alzheimer's disease. The results indicated that only globality was related to depression for the Alzheimer patient's unpredictable behavior; however, both globality and stability were related to depression for the subject's life change situation. The pattern of the other depressogenic coping cognitions was also different for the two contexts: While ratings of upset and lack of current and future control were related to depression for the Alzheimer patient's behavior, ratings of poor current and future coping, lack of coping success, and coping dissatisfaction were related to depression for the subject's life change context. The discussion of the contextual specificity of coping cognitive patterns focused on the possible significance of the intrapersonal versus the interpersonal nature of the situational context. This study was funded by National Institute of Mental Health Grant MH33779 to the third author.     

护理干预对出院后帕金森病后抑郁障碍的疗效观察

目的 探讨护理干预对出院后帕金森病患者抑郁障碍的作用及影响.方法 帕金森病后抑郁障碍出院患者92例,随机分为观察组和对照组各46例.对照组出院后按常规定期复查,观察组在此基础上,由责任护士对家属及照顾者进行护理培训,并以定期和电话访问的形式进行心理干预和康复指导.干预前后,所有患者分别评定疗效和生存质量.结果 出院后采用相应护理干预措施,帕金森病患者抑郁障碍病情减轻,生存质量得到显著提高(P＜0.05).结论 采取出院后护理干预措施,能有效改善帕金森病后抑郁障碍症状,提高患者的生存质量.     

护理干预对出院后帕金森病后抑郁障碍的疗效观察

目的 探讨护理干预对出院后帕金森病患者抑郁障碍的作用及影响.方法 帕金森病后抑郁障碍出院患者92例,随机分为观察组和对照组各46例.对照组出院后按常规定期复查,观察组在此基础上,由责任护士对家属及照顾者进行护理培训,并以定期和电话访问的形式进行心理干预和康复指导.干预前后,所有患者分别评定疗效和生存质量.结果 出院后采用相应护理干预措施,帕金森病患者抑郁障碍病情减轻,生存质量得到显著提高(P＜0.05).结论 采取出院后护理干预措施,能有效改善帕金森病后抑郁障碍症状,提高患者的生存质量.     

护理干预对出院后帕金森病后抑郁障碍的疗效观察

目的 探讨护理干预对出院后帕金森病患者抑郁障碍的作用及影响.方法 帕金森病后抑郁障碍出院患者92例,随机分为观察组和对照组各46例.对照组出院后按常规定期复查,观察组在此基础上,由责任护士对家属及照顾者进行护理培训,并以定期和电话访问的形式进行心理干预和康复指导.干预前后,所有患者分别评定疗效和生存质量.结果 出院后采用相应护理干预措施,帕金森病患者抑郁障碍病情减轻,生存质量得到显著提高(P＜0.05).结论 采取出院后护理干预措施,能有效改善帕金森病后抑郁障碍症状,提高患者的生存质量.     

Treatment of Alzheimer disease

Alzheimer disease is the most common form of dementia, affecting more than one-third of Americans older than 85 years. It is characterized by progressive memory loss and cognitive decline. Amyloid plaque accumulation, neurofibrillary tau tangles, and depletion of acetylcholine are among the pathologic manifestations of Alzheimer disease. Although there are no proven modalities for preventing Alzheimer disease, hypertension treatment, omega-3 fatty acid supplementation, physical activity, and cognitive engagement demonstrate modest potential. Acetylcholinesterase inhibitors are first-line medications for the treatment of Alzheimer disease, and are associated with mild improvements in cognitive function, behavior, and activities of daily living; however, the clinical relevance of these effects is unclear. The most common adverse effects of acetylcholinesterase inhibitors are nausea, vomiting, diarrhea, dizziness, confusion, and cardiac arrhythmias. Short-term use of the N-methyl-D-aspartate receptor antagonist memantine can modestly improve measures of cognition, behavior, and activities of daily living in patients with moderate to severe Alzheimer disease. Memantine can also be used in combination with acetylcholinesterase inhibitors. Memantine is generally well tolerated, but whether its benefits produce clinically meaningful improvement is controversial. Although N-methyl-D-aspartate receptor antagonists and acetylcholinesterase inhibitors can slow the progression of Alzheimer disease, no pharmacologic agents can reverse the progression. Atypical antipsychotics can improve some behavioral symptoms, but have been associated with increased mortality rates in older patients with dementia. There is conflicting evidence about the benefit of selegiline, testosterone, and ginkgo for the treatment of Alzheimer disease. There is no evidence supporting the beneficial effects of vitamin E, estrogen, or nonsteroidal anti-inflammatory drug therapy.     

Verbal Cueing and Environmental Modifications: Strategies to Improve Engagement in Occupations in Persons with Alzheimer Disease

This study examined the effects of individual intervention programs using environmental modifications and caregiver training in verbal cueing and verbal reinforcement in persons with Alzheimer disease residing in an assisted living facility. Five residents were observed performing two daily living tasks of their choice and evaluated using the Assessment of Motor and Process Skills (AMPS). Using results of AMPS evaluations, individual intervention programs were developed for each resident by the researcher. Following caregiver training the individual programs were implemented with residents who were re-evaluated after two weeks. All residents showed statistically significant improvements in process ability measures and two residents showed improvement in motor ability measures. The results from this study demonstrated that caregiver training and environmental modifications can improve performance in activities of daily living in those with Alzheimer disease.     

Estrogen replacement therapy for Alzheimer disease in postmenopausal women

OBJECTIVE: To evaluate the clinical utility of oral conjugated equine estrogen in postmenopausal women with Alzheimer disease. DATA SOURCES: Literature was identified through MEDLINE (1997-January 2002). Key search terms included Alzheimer disease, estrogen replacement therapy, and treatment. DATA SYNTHESIS: Estrogen has been identified as a neuroprotective agent with possible application in degenerative disorders. Observational studies have demonstrated an association between estrogen replacement therapy and decreased incidence of Alzheimer disease. Two recent, controlled clinical trials have evaluated the role of oral conjugated estrogen in the treatment of Alzheimer disease. CONCLUSIONS: Clinical trials indicate that oral conjugated equine estrogen is not an effective treatment for Alzheimer disease in postmenopausal women.     

A community-based exercise programme to improve functional ability in people with Alzheimer's disease: a randomized controlled trial

Scand J Caring Sci; 2012; 26; 12–19
A community‐based exercise programme to improve functional ability in people with Alzheimer’s disease: a randomized controlled trial Rationale: Dementia is a common neurodegenerative condition in older age associated with functional decline across multiple domains. This decline impacts not only on the person with dementia, but also on their informal carers and health and aged care systems. With the number of people with dementia rapidly increasing and few effective treatments, there is now a critical need for interventions to improve functional ability in those with the condition. Aims and objective: This study assesses the effectiveness of a community‐based home exercise programme in improving cognitive and physical function and independence in activities of daily living (ADL) in people with Alzheimer’s disease, the most common form of dementia. Methods: In a 4‐month randomized controlled trial, 40 community‐dwelling patients diagnosed with Alzheimer’s disease and their informal carers were randomly allocated to either the treatment (exercise plus usual treatment) or control (usual treatment) group. The exercise programme consisted of daily exercises and walking under the supervision of their carer. Patients were assessed at baseline and 4‐months follow‐up by a blinded assessor on primary outcome measures of cognitive and physical function and ADL using standardized assessment scales. Results: Sixteen men and 24 women diagnosed with Alzheimer’s disease participated in the study. They had a mean age of 74.1 years (range 51–89) and a mean Mini Mental State Examination score of 22.0 (range 10–28), indicating mild to moderate dementia. At 4‐months follow‐up, patients who exercised, compared with controls, had improved cognition (increased Mini Mental State Examination scores by 2.6 points, p < 0.001), better mobility (2.9 seconds faster on Timed Up and Go, p = 0.004) and increased Instrumental Activities of Daily Living scores by 1.6 (p = 0.007). Conclusion: This study suggests that participation in a community‐based exercise programme can improve cognitive and physical function and independence in ADL in people with Alzheimer’s disease.     

Depression: a shared risk factor for cardiovascular and Alzheimer disease

Depression has been linked to cardiovascular disease and cognitive impairment, including Alzheimer disease, but the exact nature of the relationship is poorly understood. Although depression seems to progress little after the onset of Alzheimer disease, depression in earlier life increases the risk of dementia and cognitive impairment many years in the future. Depression is also associated with reduced vascular function and is a poorly recognized but significant risk factor for stroke.     

Policy issues in mental health among the elderly

Americans are living longer than ever before in history. With age comes an increased risk for chronic mental health disorders. About 1 in 8 baby boomers is expected to be diagnosed with Alzheimer disease, which will amount to some ten million members of this age cohort. The prevalence of mental health disorders among the elderly is often unrecognized. One in four older adults lives with depression, anxiety disorders, or other significant psychiatric disorders. Mental health disorders are frequently comorbid in older adults, occurring with a number of common chronic illnesses such as in diabetes, cardiac disease, and arthritis. The public is becoming more aware of the aging of the population and the difficulties that are exacerbated by unmet services and limited access to mental health services. This article describes policy issues related to chronic mental health disorders and the older population. Mental health parity, a recent policy issue occurring at the national level, is discussed first followed by workforce issues specific to the discipline of nursing.     

Alzheimer's disease and vascular factors: facts and theories

Although Alzheimer s disease is classified as a neurodegenerative dementia, in Alzheimer s dementia there is increasing evidence of an association with vascular risk factors and vascular pathology. These observations are supported by epidemiological and pathological studies. Vascular factors may play a significant role in the pathogenesis of Alzheimer s dementia. Further research is needed to explore this relationship. Modification of vascular risk factors could make a significant impact towards prevention and treatment of Alzheimer s disease, which is a distressing and prevalent condition in the community. This article considers the relationship of these vascular risk factors and potential mechanisms associated with the aetiopathogenesis of Alzheimer s dementia.     

心房颤动患者焦虑抑郁程度及人口学影响因素分析

目的：研究心房颤动患者焦虑和抑郁发生程度以及人口学影响因素。方法：纳入心房颤动患者240例,应用患者一般资料调查表,焦虑自评表(SAS)、抑郁自评表(SDS)进行焦虑和抑郁程度评估,将病程、性别、年龄、文化程度、经济状况、婚姻状况等11个人口经济学因素进行分析。结果：房颤患者焦虑、抑郁发生率分别为29.2%、61.6%。单因素分析显示：年龄、居住地、主要经济来源、职业、居住状况为房颤患者焦虑、抑郁的主要影响因素(P<0.05)。Logisitic多因素回归分析发现高龄、农村居民、无稳定收入为焦虑发生独立影响因素；无固定收入职业、独居为抑郁发生的独立影响因素。结论：提示需重视房颤患者心理影响因素,及时给予干预,对疾病诊断、治疗效果和护理有重要临床意义。     

Update on Treatments for Cognitive Decline in Alzheimer’s Disease

Alzheimer’s disease (AD) is a progressive neurodegenerative disorder and a leading cause of dementia in the elderly. AD initially presents as mild cognitive impairment (MCI); later, as AD progresses, memory and cognition are destroyed, preventing the ability to carry out activities of daily living. The primary care provider may be the first to suspect MCI, and screening tests can help with diagnosis. Development of drugs for cognitive decline in AD has been slow; however new therapies are in the pipeline and discovery of biomarkers make early diagnosis and future treatment of AD hopeful.     

小檗碱在神经系统疾病中的应用进展

小檗碱作为一种抗炎药在中国的传统医学中得到广泛的应用,近几年小檗碱在神经系统疾病方面的应用受到众多研究者的关注,该文就小檗碱在神经系统自身免疫性疾病、脑血管病、癫痫、阿尔茨海默病、抑郁症等疾病中的研究进展作一介绍,希望能为小檗碱的进一步研究提供参考。     

米氮平治疗阿尔茨海默病所致抑郁的随机对照研究

目的：比较米氮平与阿米替林治疗阿尔茨海默病（AD）所致抑郁患者的临床疗效和安全性。方法：诊断为AD抑郁患者60例，随机分为A、B2组各30例，分别采用米氮平与阿米替林治疗8周。采用汉密尔顿抑郁量表（HAMD）和副反应量表（TESS）于治疗前和治疗后2、4、6、8周末时分别评定疗效和副反应。结果：A组和B组显效率分别为83．0％和70．0％，疗效相仿；HAMD评分，A组在治疗2周末即显著下降（P〈0．01），B组在第4周才明显下降（P〈0．05）；8周末2组差异无显著性意义。副反应A组明显少于和轻于B组（P〈0．01）。结论：米氮平治疗AD抑郁安全性高、副反应轻微，且见效快。     

综合社会支持对早期阿尔茨海默病患者生活质量及日常生活能力影响的研究

目的探讨综合社会支持干预对改善早期阿尔茨海默病(AD)患者生活质量及日常生活能力的影响。方法将90例早期AD患者随机分为干预组和对照组,干预组接受综合社会支持干预,对照组采用常规护理干预。采用日常生活能力量表、阿尔茨海默病生活质量测评量表评估并比较患者干预前后的生活质量及日常生活能力。结果干预后,2组躯体生活自理量表及工具性日常生活能力量表评分均呈不同程度的降低,但干预组患者量表评分降低幅度更大;干预组患者的生活质量评分改善更佳。结论积极为AD患者寻求社会支持,为患者提供良好的社会、就医环境,有助于改善患者的日常生活能力和生活质量。     

多学科协作模式结合循证护理对阿尔茨海默病患者ADL能力、认知功能及抑郁状态的影响

目的探讨多学科协作模式结合循证护理对阿尔茨海默病患者ADL能力、认知功能及抑郁状态的影响。方法选取2016年10月至2017年6月我院收治的60例阿尔茨海默病患者为研究对象,将其随机等分为对照组和观察组。对照组行常规阿尔茨海默病护理,观察组行多学科协作模式结合循证护理干预。比较两组护理前后的ADL能力(Barthel指数)、认知功能(ADAScog量表)及抑郁状态(GDS-15量表)。结果护理后12周观察组的Barthel指数、ADAScog量表及GDS-15量表评估结果持续改善,均好于对照组,差异有统计学意义(P<0.05)。结论多学科协作模式与循证护理对阿尔茨海默病患者ADL能力、认知功能及抑郁状态的影响相对更好,因此在阿尔茨海默病患者中的应用价值较高。     

丧偶独居老年人抑郁状况及相关因素的调查

目的调查丧偶独居老年人的抑郁状况及影响因素以便采取有效的干预措施。方法采用老年抑郁量表（cos）及自行设计问卷对某社区内的160例丧偶后独居老年人进行问卷调查。结果62．5％的老人存在不同程度的抑郁情绪,其主要原因号隋感障碍、疾病的影响、经济状况、社会支持缺失及缺乏必要的社会活动有关（P〈0.01）。结论丧偶独居老人抑郁发生率高,影响因素复杂,应引起社会和家庭的关注,以改善老人的健康状况,提高生活质量。     

Galantamine: a new alzheimer drug with a past life.

OBJECTIVE: To review the historic, pharmacologic, pharmacokinetic, therapeutic, and toxicologic features of galantamine, a new acetylcholinesterase inhibitor, and to assess its role in the treatment of Alzheimer disease symptoms. DATA SOURCES: A search of articles was conducted using MEDLINE, TOXLINE, and the literature database Psychinfo, from 1966 to June 1999. The manufacturers, Janssen and SoPharm (Bulgaria), were contacted to obtain relevant preclinical data. Published textbooks of meeting symposia were also reviewed. STUDY SELECTION: Studies with animals and humans addressing preclinical pharmacology, human studies on pharmacokinetics, open clinical trials, and controlled studies were evaluated. DATA EXTRACTION: Relevant data were extracted from published studies and meeting abstracts only. DATA SYNTHESIS: Galantamine has an extensive record of activity as a reversal agent for neuromuscular blockade. Galantamine is also effective in the treatment of mild to moderate Alzheimer disease symptoms. Its efficacy versus similar Alzheimer treatment agents has yet to be determined. Adverse effects are gastrointestinal in nature and usually appear during the first weeks of therapy. CONCLUSIONS: Galantamine is a useful agent for the treatment of Alzheimer disease and for the reversal of neuromuscular blockade. It acts as both an acetylcholinesterase inhibitor and a nicotinic receptor agonist.