Differential attrition in a caregiver skill training trial

Participant attrition in randomized trials can reduce statistical power and bias outcomes. However, elective withdrawals are seldom discussed in trial reports. We examined factors associated with elective withdrawals for the first 131 Alzheimer's disease (AD) and Parkinson's disease (PD) caregiver participants that entered Project ASSIST (Assistance, Support and Self-health Initiated through Skill Training), an on-going trial of caregiver skill training interventions. After 20 months of recruitment, 14 (11%) of the 131 ASSIST participants had electively withdrawn before completing the final assessment. Survival analysis demonstrated AD caregivers and non-spousal caregivers dropped out earlier than PD and spousal caregivers, even after controlling for selected baseline covariates. Findings suggest caregiver trial contact strategies may need to be tailored to retain different caregiver groups.     

Recruitment and enrollment of caregivers for a lifestyle physical activity clinical trial

This article presents the efficacy of the recruitment framework used for a clinical trial with sedentary family caregivers of persons with Alzheimer's disease. An integrated social marketing approach with principles of community‐based participatory research provided the theoretical framework for organizing recruitment activities. This multi‐pronged approach meant that caregivers were identified from a range of geographic locations and numerous sources including a federally funded Alzheimer's disease center, health care providers, community based and senior organizations, and broad‐based media. Study enrollment projections were exceeded by 11% and resulted in enrolling n = 211 caregivers into this clinical trial. We conclude that social marketing and community‐based approaches provide a solid foundation for organizing recruitment activities for clinical trials with older adults. © 2011 Wiley Periodicals, Inc. Res Nurs Health 35:70–81, 2012     

Ultrastructural Study of Senile Plaques and Microvessels in the Brain with Alzheimer's Disease and Down's Syndrome

This study examined the relation between amyloid fibrils and senile plaques in brains of patients with Alzheimer's disease. All the senile plaques contained some amyloid fibrils, which seemed to be produced in the basement membranes of capillary endothelial cells and projecting into surrounding parenchyma. Even when amyloid fibrils could not be seen in senile plaques using light microscopy, at least one degenerate capillary containing amyloid fibrils was found when serial sections were examined by electron microscopy. Amyloid fibrils consisted of hollow rods and were composed of filaments arranged as a tightly coiled helix, each turn comprising five globular subunits. Many capillaries and microvessels showed degenerative changes. Many terminal arterioles had smooth muscle cells with an irregular shape and arrangement, often showing a series of focal constrictions.

The findings suggest that the capillary degeneration with the formation of amyloid fibrils may be a primary change in the genesis of senile plaques. Furthermore, degenerative changes in the microvessels may also be an important factor in the loss of neurons in the brain of subjects with Alzheimer's disease.     

A Stress‐Busting Program for Family Caregivers

Aging baby boomers, longer life spans, and rising levels of Alzheimer's disease and related dementias (ADRD) will result in a caregiver crisis in the near future. The ways in which caregivers deal with stresses related to caregiving will be critical to both their own well‐being and their ability to care for others. The purpose of this article is to describe the Stress‐Busting Program (SBP) for family caregivers and its effectiveness. The essential components of the SBP are education, stress management, problem solving, and support delivered in a group setting for 9 weeks. Results of the SBP indicate that throughout the program, caregivers experienced significant improvements in general health, vitality, social function, and mental health scores and decreases in anxiety, anger/hostility, depression, perceived stress, and caregiver burden. The SBP is a cost‐effective health‐promotion strategy for caregivers who have substantial ongoing stress.     

运动对阿尔兹海默症患者认知功能影响的系统回顾和荟萃分析

目的:评估运动的干预对AD患者的认知功能的影响。方法:通过对中英文数据库的检索,收集运动对AD患者干预效果的临床随机对照试验,使用RevMan 5.3软件进行统计学分析。结果:总共纳入12篇随机对照试验(7篇国外研究,5篇国内研究),结果提示运动可以提高AD患者的认知分数(SMD=1.54,95%CI[0.99,2.09],P0.01,I2=84%),差异有统计学意义(P0.05)。结论:运动的干预对AD患者的认知功能有积极的影响。     

Ability to manage everyday technology: a comparison of persons with dementia or mild cognitive impairment and older adults without cognitive impairment

Purpose.?The ability to manage technology is important for performance and participation in everyday activities. This study compares the management of technology in everyday activities among people with mild-stage dementia or mild cognitive impairment (MCI) with older adults without known cognitive impairment (OA).

Method.?Persons with mild-stage dementia (n?=?38), MCI (n?=?33) and OA (n?=?45) were observed and interviewed when managing their everyday technology at home by using the Management of Everyday Technology Assessment (META). A computer application of a Rasch measurement model was used to generate measures of participants' ability to manage technology. These measures were compared groupwise with ANCOVA.

Results.?The management of everyday technology was significantly more challenging for the samples with mild-stage Alzheimer's disease (AD) or MCI compared to the OA sample (AD – OA, p?<0.001; d?=?1.87, MCI – OA, p?<0.001; d?=?0.66). The sample with MCI demonstrated a significantly higher ability to manage technology than the sample with mild-stage AD (AD – MCI, p?<0.001; d?=?1.23). However, there were overlaps between the groups and decreased ability appeared in all groups.

Conclusions.?Persons with cognitive impairment are likely to have decreased ability to manage everyday technology. Since their decreased ability can have disabling consequences, ability to manage technology is important to consider when assessing ability to perform everyday activities.     

Alzheimer's Disease and the Disablement Process: Directions for Future Research

The purpose of this theoretical paper is fourfold. First, the evolution of disability models is reviewed. Second, critique of current models and the need for an age-specific model is discussed. Third, the clinical symptoms of Alzheimer's disease (AD) including the physical disabilities that accompany the disease are addressed. Fourth, future directions in disability research in regards to AD are proposed. Disability models that are specific to persons with progressive cognitive disorders will aid in increasing researchers and clinicians understanding of the multifaceted and complex relationship between cognitive and physical impairments that characterize the disease trajectory of AD.     

Younger-onset Alzheimer's disease: learning from the experience of one spouse carer

• ? There are estimated to be 17 000 younger sufferers of dementia currently living in the UK. At present, individualized service and practice initiatives for younger sufferers and their carers remain fragmented and poorly developed. This is despite potential additional caregiving stressors caused by the age of onset, such as financial difficulties due to disruption in the work pattern, children still living at home, and the sufferer's decreased life expectancy.
• ? Drawing on an individual carer's personal case history, this article details a spouse carer's individual experience of her husband's decline through the stages of younger-onset Alzheimer's disease. Pointers for policy and practice for younger sufferers and their carers are drawn from this case history and a role for the community psychiatric nurse is outlined.

     

Clinical pharmacology of anti-Alzheimer drugs

Alzheimer's disease (AD) is a chronic neurodegenerative disorder characterized by a progressive loss of cognitive and functional abilities, associated with various degrees of behavioural disturbances, with a devastating impact on public health and on the whole society. Slowing of cognitive impairment, duration of disease, self-sufficiency and behavioural disturbances represent the best outcomes of the pharmacologic therapy. Cholinesterase inhibitors (ChE-I) have been shown to be effective in the treatment of the cognitive, behavioural, and functional deficits of AD. In addition to ChE-I, a number of studies have been carried out to investigate the possible use of other compounds and pharmacologic strategies; more compounds, postsynaptic muscarinic and nicotinic receptor agonists, are under investigation. The standard suggested care for pharmacologic management of the cognitive and functional disabilities of AD at present consists of treatment with ChE-I. Practice recommendations and treatment guidelines are derived from clinical trials.     

Caregiver competence to prevent home injury to the care recipient with dementia.

Home safety is a major concern for persons with a progressive dementia, such as Alzheimer's disease, because much direct care is provided in the home setting. This study used the Home Safety/Injury Model as a frame work to describe the domain of caregiver competence, one of the model's key constructs. Interview data from the perspectives of 17 informants yielded a total of 68 clinical situations that allowed exploration of the scope and dimensions of caregiver competence to prevent accidents in the home. The factors most influential for effective caregiver prevention of home injury were family support, an acceptance and ability to make role changes, teaching and role modeling from professionals, and long-standing values and family traditions. No single factor was sufficient to achieve effective caregiving for making the home safer, but the strength of one or two factors could compensate for the absence of others.     

Automated microparticle enzyme immunoassay for neural thread protein in cerebrospinal fluid from Alzheimer's disease patients.

An automated microparticle enzyme immunoassay (MEIA) with the IMx analyzer for the detection of neural thread protein (NTP) in cerebrospinal fluid (CSF) from Alzheimer's disease (AD) patients was developed. This assay uses monoclonal antibodies produced against the purified pancreatic form of the protein. The assay employs one monoclonal antibody covalently coupled to the microparticle to capture immunoreactive material in CSF or brain tissue. The second monoclonal antibody was conjugated to alkaline phosphatase and serves as detection antibody. The assay provides results in approximately 45 minutes with a sensitivity of 60 pg/ml (3 fmoles/ml). The titration curve of both normal and AD CSF resulted in a linear relationship with respect to the volume of CSF used. A similar relationship was observed when normal and AD brain tissue extracts were serially diluted. The molecular weight of NTP in CSF was approximately 20 kD as determined by gel filtration method under non-denaturing conditions. The recovery for pancreatic thread protein (PTP) spiked in either normal or AD CSF was 104% and 108%, respectively. Intra-, inter-, and total assay CVs (coefficient of variation) for controls were less than 2.9%, 3.3% and 3.0%, respectively. This assay will provide a useful tool in the study of the Alzheimer's disease and may help research in diagnosis and prognosis of Alzheimer's disease and related disorders.     

Getting it wrong: the clinical misdiagnosis of Alzheimer's disease

Two patients whose diagnosis of Alzheimer's disease proved to be incorrect on follow-up are presented. Factors which contributed to the misdiagnosis included failure to obtain collateral history, failure to apply widely accepted diagnostic criteria, over-reliance on structural brain imaging and lack of longitudinal follow-up. Analysis of diagnostic errors may permit avoidance of similar pitfalls in future.     

睡眠节律紊乱与阿尔兹海默病研究进展

认知功能损害患者睡眠障碍患病率高,表现形式多样,主要包括：失眠、日间过度思睡、睡眠呼吸障碍、异态睡、不宁腿综合征、睡眠节律紊乱等。阿尔茨海默病(Alzheimer"s disease,AD)是最常见的认知损害类型,73%的中国汉族AD患者伴有睡眠障碍,其中53%伴有不同程度的睡眠节律紊乱。AD患者睡眠障碍在病程中后期较为突出,所以一直以来睡眠节律紊乱都被认为是AD相关神经退行性变的结果,例如“日落现象”,患者一到傍晚就焦虑不安、难以入睡,而白天则睡眠过多。但近期研究表明,睡眠节律紊乱很可能参与AD发生的始动环节。国外前瞻性的随访研究发现,睡眠节律紊乱的认知正常老年人群,在5-10年后更容易发生AD。目前,关于睡眠节律紊乱究竟通过何种途径促使神经系统退行性变发生的研究尚不深入,本文将回顾睡眠节律紊乱引发AD相关病理、生物标记物变化的研究报道。     

Antibodies to viral antigens, xenoantigens, and autoantigens in Alzheimer's disease

Sera from 19 patients with Alzheimer's disease (AD) and 21 control subjects were studied by immunofluorescence and enzyme immunoassay for antibody activity against various viruses and 12 self- and non-self-antigens. Total IgG mean level was significantly higher in the AD group; the IgG level was above 15 g/L in 52.8% of AD patients versus 14.3% of control subjects. Antiviral antibody titers showed no significant differences except for antibodies to herpes simplex virus-1, which were increased in control group. In contrast, autoantibodies were more frequently found in AD patients, and the prevalence of antibodies to spectrin, peroxidase, and thyroglobulin was significantly increased. Thus, in our series, autoimmune but not antiviral responses were heightened in at least 42% of AD patients (versus 9% of the control group) suggesting the existence of two subpopulations in the AD group.     

A possible significant role of zinc and GPR39 zinc sensing receptor in Alzheimer disease and epilepsy

Zinc the essential trace element, plays a significant role in the brain development and in the proper brain functions at every stage of life. Misbalance of zinc (Zn²⁺) ions in the central nervous system is involved in the pathogenesis of numerous neurodegenerative disorders such as Alzheimer's disease, Depression, and Epilepsy. In brain, Zn²⁺ has been identified as a ligand, capable of activating and inhibiting the receptors including the NMDA-type glutamate receptors (NMDARs), GABA_A receptors, nicotinic acetylcholine receptors (nAChRs), glycine receptors (glyR) and serotonin receptors (5-HT3). Recently GPR39 has been identified as a zinc-specific receptor, widely expressed in brain tissues including the frontal cortex, amygdala, and hippocampus. GPR39, when binding with Zn²⁺ has shown promising therapeutic potentials. This review presents current knowledge regarding the role of GPR39 zinc sensing receptor in brain, with a focus on Alzheimer’s disease and Epilepsy. Although the results are encouraging, further research is needed to clarify zinc and GPR39 role in the treatment of Alzheimer's disease and Epilepsy.     

Chronic Respiratory Diseases and Neurodegenerative Disorders: A Primer for the Practicing Clinician

Chronic respiratory disorders represent a world epidemic. Their incidence and prevalence in the world population is increasing, and especially among elderly subjects, they are commonly associated with other pathologies, often generating a status of high clinical complexity. Neurology, internal medicine, and pneumology specialists should be aware of the common background of these disorders in order to treat correctly the patient''s comorbid state and optimize the treatment considering potential overlaps. In this review, we aimed to focus on the relationships between chronic respiratory disorders and chronic neurodegenerative diseases at different levels; we review the shared risk factors and the interactions between disorders, the indications to explore respiratory function in neurodegenerative diseases, pathology-pathology and drug-pathology interactions in patients affected by both chronic neurologic and respiratory diseases.     

Analysis of adverse events following the treatment of autologous cytokine-induced killer cells for adoptive immunotherapy in malignant tumour sufferers

Background: Passive immunization strategies are under investigation as potential disease-modifying therapies for Alzheimer's disease (AD). Current approaches, based on data demonstrating behavioral improvement and reduced pathology in transgenic animal models, have focused exclusively on immune targeting of β-amyloid. Objective: To examine immunization strategies for AD. Methods: A review of relevant publications. Results/conclusions: Preliminary results from three Phase II trials suggest both the promise and the need to exercise caution with this method of immunotherapy. The strategies used were distinct, using monoclonal N-terminal, central epitope, and polyclonal antibodies to maximize the efficacy and safety of each approach. The tested compounds are moving into Phase III trials for mild to moderate AD. We await the discoveries that from these studies that may yield the first disease-modifying therapy for AD.     

A sandwich enzyme immunoassay for measuring AD7C-NTP as an Alzheimer's disease marker: AD7C test

A simple, fast, reliable, and specific immunoassay has been developed to detect and measure AD7C-NTP, a biochemical marker for Alzheimer's disease, in cerebrospinal fluid (CSF). This assay, called the AD7C Test, is an enzyme-linked sandwich immunoassay (ELSIA) using 96 well microtiter plates. The plate surface is coated with a monoclonal antibody (N₃I₄) which has a high affinity and specificity for AD7C-NTP, capturing it effectively from CSF samples. The detection was achieved using a polyclonal antibody (ADRI). Both N₃I₄ and ADRI were generated using recombinantly produced AD7C-NTP. The assay is highly sensitive (30–50 pg), linear to 2.0 ng (r² > 0.99), and reproducible (C.V. < 10%). The utility of the assay has been demonstrated using CSF specimens from early Alzheimer's disease patients and age matched controls (sensitivity of 89% and specificity of 89%). J. Clin. Lab. Anal. 12:223–226, 1998. © 1998 Wiley-Liss, Inc.     

Optimizing the Function of Geriatric Amputees

No abstract available for this article.