The influence of white matter lesions on neuropsychological functioning in demented and non-demented 85-year-olds

White matter lesions on computed tomography of the head were studied in relation to neuropsychological functioning in subjects from a representative sample of non-demented ( n = 134) and demented ( n = 98) 85-year-olds. Non-demented subjects with white matter lesions ( n = 46) scored significantly lower in tests of verbal ability (Synonyms), spatial ability (Block Design, Clock Test), perceptual speed (Identical forms), secondary memory (Thurstone Picture Memory), basic arithmetic (Coin Test) and the global cognitive screening test Mini-Mental State Examination than non-demented subjects without white matter lesions ( n = 88). Demented subjects with white matter lesions ( n = 67) scored significantly lower in tests of spatial ability (Block Design and Clock Test) and secondary memory (free recall in the MIR memory test, Ten-word memory test I and II) and in the Mini-Mental State Examination than demented subjects without white matter lesions ( n = 31). It is concluded that white matter lesions contribute to cognitive decline in both non-demented and demented elderly subjects.     

APOE-epsilon4 predicts incident AD in Japanese-American men: the honolulu-asia aging study

ARTICLE ABSTRACT: The authors assessed the 3-year incidence of dementia, including subtypes, in 2,603 Japanese-American men 71 to 93 years of age who were dementia free at baseline. There were 137 new cases of dementia according to the Diagnostic and Statistical Manual of Mental Disorders, 3rd edition, revised, including 51 with a primary diagnosis of AD. The rates for all subtypes increased with age. Men with an APOE4 allele had a significantly increased risk of AD of 2.39 (95% CI, 1.07, 5.31), after adjusting for age and education. There was no significant relationship of APOE4 with other subtypes of dementia.     

Electroencephalography of demented and non-demented Parkinson's disease patients

We investigated the correlation between electroencephalography (EEG) abnormalities and dementia in Parkinson's disease. Three groups of subjects were examined: Parkinson's disease patients without dementia, Parkinson's disease patients with dementia, and healthy age-matched controls. Dementia was assessed with the use of Mini-Mental State Examination. All subjects underwent a routine EEG examination with determination of arousal reaction to eye opening, hyperventilation and photic stimulation. Demented patients with Parkinson's disease more often showed no response to eye opening and presented more slow wave activity in comparison to non-demented patients and healthy controls.     

Underlying cause of death in demented and non-demented elderly Canadians

This paper examines the associations between clinical dementia and underlying cause of death (UCD) in a population-based sample of seniors who took part in the Canadian Study of Health and Aging (CSHA). Cause-of-death data were obtained via death certificates for 2,924 of 2,982 deceased subjects. Among the decedents were 823 clinically demented and 670 clinically non-demented participants. Using logistic regression we examined factors associated with a particular UCD in the overall group and also in the subgroup of demented seniors. Dementia was found to be associated with an increased risk of death from pneumonia. Both Alzheimer's disease and vascular dementia appear to decrease the risk of mortality from neoplasm. To our knowledge, this study is the first of its kind that combines a large, representative sample with thorough clinical assessment of cognitive status.     

Immediate causes of death of demented and non-demented elderly

Objective – To investigate the immediate causes of death, in autopsied demented and non-demented elderly. Design – Retrospective clinicopathologic correlations. Setting – Acute and intermediate care geriatric hospital. Participants – 342 hospitalized demented and non-demented elderly (mean age 84.94±6.9 years) who underwent consecutive post-mortem examinations: 120 demented patients with either vascular dementia (VaD, n =34), mixed dementia (MD, n =65) or Alzheimer's disease (AD, n =21) neuropathologically confirmed and 222 non-demented elderly. Results – Primary causes of death were similar in both demented and non-demented patients; the commonest were cardiovascular disease and bronchopneumonia. Cardiac causes of death and especially cardiac failure were more frequent in VaD than in AD or MD (respectively P =0.027 and 0.005). Dementia was an underlying but never a primary cause of death. Conclusions – Immediate causes of death are similar in elderly demented and non-demented patients.     

Usefulness of primitive reflexes in demented and non-demented cerebrovascular patients in daily clinical practice

The aim of this study was to investigate the usefulness of primitive reflexes (PRs) as additional alert signs in a routine clinical setting of cognitive decline in an elderly population of chronic ischemic cerebrovascular patients. We considered the occurrence of grasp, palmomental, glabellar and snout reflexes in 75 demented (VaD) and 75 non-demented (VaND) patients, and in 75 healthy elderly controls. We never elicited more than two PRs in controls. The occurrence of three or four PRs provided the strongest correlation with dementia (p < 0.0001), with 93% specificity irrespective of low sensitivity. In conclusion, the occurrence of more than two PRs might serve as an additional warning sign of possible mild cognitive impairment in chronic ischemic cerebrovascular patients.     

Alzheimer's changes in non-demented and demented patients: a statistical approach to their relationships

The anterior hippocampus and the entorhinal cortex of 167 non-demented individuals (controls) and 22 patients with Alzheimer's dementia were investigated. Senile plaques and neurofibrillary tangles were counted on paraffin sections stained with methenamin silver and Gallyas silver iodide, respectively. The results showed that both senile plaques and neurofibrillary tangles areal densities (lesions per mm²) correlated significantly with age in the control collective. No significant correlation between Alzheimer's disease lesions and age was found in patients with Alzheimer's dementia. Positive and significant correlation between senile plaques and neurofibrillary tangles was found in the control group but not in the Alzheimer group. Control individuals (n = 43, matched for age with the Alzheimer group) displayed both plaques and tangles. In this subgroup neither plaques nor tangles correlated with age; however, there was a significant correlation betwen senile plaques and neurofibrillary tangles. We hypothesize that the continuous activity of underlying processes associated with senile plaques and neurofibrillary tangles formation or resolution might lead to the unbalanced production of these lesions in Alzheimer's disease.Supported by the Ciba-Geigy Jubiläum Stiftung, and a grant from the Swiss National Foundation (grant no. 31-32314.91) (to J.U.)     

The prevalence of psychotic,depressive and anxiety syndromes in demented and non-demented 85-year-olds

One-month prevalence of mental syndromes in demented and non-demented subjects was studied in a representative sample of 85-year-olds living in Gothenburg, Sweden (N = 494). All subjects were examined by a psychiatrist. Schizophreniform syndrome was significantly more common in subjects with Alzheimer's disease than in nondemented subjects (13% vs 1%, p < 0.001), and more common in severe dementia (p > 0.01). Depressive syndromes were significantly more common in subjects with mild dementia than in non-demented subjects (34% vs 20%, p > 0.05). Phobic syndrome was less common in demented than in non-demented subjects. It is hypothesized that the occurrence of mental syndromes in demented subjects may be related to structural and neurochemical brain changes.     

Cause of death in demented and non-demented elderly inpatients; an autopsy study of 308 cases

Few studies evaluated cause of death (COD) in elderly demented and non-demented people, the majority based on death certificates alone. The present study is based on autopsy reports with neuropathological examination of 308 inpatients (58.1% female) over age 60 years (mean: 83.5, SD: +/-8.6). CODs were classified into seven groups. The most common were bronchopneumonia (n=117; 38%) and cardiovascular disease (n=116, 37.7%). In 176 patients (57.1%) neuropathology was indicative for dementia: 76.7% Alzheimer disease (AD), 4.5% vascular dementia, 4.0% mixed type dementia (AD + vascular dementia), and 14.8% other dementias. Main COD significantly differed in demented and non-demented patients: bronchopneumonia (45.5% in demented versus 28.0% in non-demented), cardiovascular disease (46.2% in non-demented versus 31.3% in demented). Whereas there were significant differences in COD between AD patients and non-demented ones (bronchopneumonia versus cardiovascular disease), no differences were seen between the latter and patients with other types of dementia than AD. Our data emphasize the high incidence of bronchopneumonia as a COD in patients suffering from AD.     

Acetylcholinesterase and butyrylcholinesterase in frontal cortex and cerebrospinal fluid of demented and non-demented patients with Parkinson's disease

The molecular forms of acetylcholinesterase (AChE) and butyrylcholinesterasse (BChE) were studied in frontal cortex (grey and white matter), postmortem, and in cerebrospinal fluid (CSF) of demented patients with Parkinson's diesease compared to controls and non-demented parkinsonians. In the frontal cortex, AChE activity decreased significantly in both demented and non-demented parkinsonian subjects compared to controls; the 10S form of the enzyme was significantly lower in demented parkinsonians than in the non-demented subjects. The decrease in AChE activity was correlated with a decrease in choline acetyltransferase activity thought to reflect lesion of cholinergic neurones in the substantia innominata which innervate the cerebral cortex. BChE activity decreased only in the non-demented parkinsonians; in the demented subjects, BChE activity was at control levels. Similar results were obtained with grey and white matter, although absolute levels of the two enzymes were different in the two types of tissue, suggesting that the enzymes were affected in the cholinergic neurones before transport to cortical nerve terminals. No decreases in AChE or BChE activity were observed in the CSF of the patients studied. On the contrary, AChE and BChE levels were significantly higher in demented parkinsonian patients compared to the non-demented subjects.     

Motor dysfunction in mildly demented AD individuals without extrapyramidal signs.

BACKGROUND: Although not as prominent as cognitive decline, motor dysfunction occurs in AD, particularly in the later stages of the disease. OBJECTIVE: To determine whether early-stage AD is also characterized by motor impairment. METHODS: We examined very mildly (Clinical Dementia Rating [CDR] 0.5) and mildly (CDR 1) demented AD individuals in comparison with healthy elderly control individuals (CDR 0) on a variety of nonmotor cognitive and psychomotor measures and on four motor measures (gait velocity, finger tapping, reaction time, movement time). To minimize the possibility of extrapyramidal dysfunction contaminating the groups, only individuals who were clinically free of extrapyramidal signs were included in the study. RESULTS: Mildly demented AD individuals were slowed on all motor measures except for finger tapping. No evidence of motor dysfunction was found in the very mildly demented AD group. As expected, both AD groups were impaired on the nonmotor cognitive and psychomotor tests. CONCLUSIONS: These results indicate that AD alone, in the absence of clinically confirmed extrapyramidal dysfunction, is associated with motor slowing in a stage-dependent manner. It remains to be determined whether this motor slowing represents a general characteristic of mild AD or indicates other neuropathology such as PD or the Lewy body variant of AD.     

White-matter lesions without lacunar infarcts in CADASIL

To better characterize the clinical spectrum related to white-matter hyperintensities (WMH) in small vessel disease, 66 patients with WMH but without any lacunar infarct were selected out of a cohort of 248 CADASIL individuals. Characteristics of these patients were compared to those of patients with lacunar infarcts. Relationships between the normalized volume of WMH (nWMH), presence of microhemorrhages, brain parenchymal fraction (BPF). and cognitive performances were assessed. The Trail Making Test (TMT) A and B times, Mattis Dementia Rating Scale (MDRS) total score, attention subscore, verbal fluency score and delayed memory recall were significantly correlated with nWMH but not with BPF. Presence of microhemorrhages was associated with worse TMT B time and attention MDRS subscore after adjustment for WMH. All subjects had Mini-Mental Status Examination scores ≥24 and presented with no or only mild disability. These results suggest that CADASIL patients with isolated WMH can present with executive and attention deficit but not with severe disability and that additional lesions are needed to cause significant disability and/or dementia.     

Outcome of depression in demented and non-demented elderly: Observations from a three-year follow-up in a community-based study

In the Kungsholmen project, a longitudinal study of a total population, samples of non-demented and demented elderly persons with a depressive disorder were followed over 3 years. Of 668 persons who received a full medical examination, 62 were found to have a depressive disorder. Of these, 28 were demented and 34 non-demented. Two-thirds of the 62 had not been previously recognized as having a depressive disorder. There was no difference in this regard between the demented and non-demented samples. After 3 years, only two out of 20 non-demented cases had recovered from their depressive disorder. This is in contrast to the demented cases, where only one of 11 were still depressed. These results indicate the need for greater attention to the recognition and management of depressive disorders in the elderly.