Review of Issue: Non-Alzheimer’s Dementia: Clinical Features, Management, and Genetics
Review of Issue: Non-Alzheimer’s Dementia: Clinical Features, Management, and Genetics
Role of Insulin Metabolism Disturbances in the Development of Alzheimer Disease: Mini Review
Alzheimer disease (AD) is the most common form of dementia. Different pathogenic processes have been studied that underlie characteristic changes of AD, including Aβ protein aggregation, tau phosphorylation, neurovascular dysfunction, and inflammatory processes. Insulin exerts pleiotropic effects in neurons, such as the regulation of neural proliferation, apoptosis, and synaptic transmission. In this setting, any disturbance in the metabolism of insulin in the central nervous system (CNS) may put unfavorable effects on CNS function. It seems that disturbances in insulin metabolism, especially insulin resistance, play a role in most pathogenic processes that promote the development of AD. In this article, the relationships of disturbances in the metabolism of insulin in CNS with Aβ peptides aggregation, tau protein phosphorylation, inflammatory markers, neuron apoptosis, neurovascular dysfunction, and neurotransmitter modulation are discussed, and future research directions are provided.
Background: The availability of increasingly sophisticated technology has meant that ambulation can be measured with precision over an extended period. Methods: An integrated circuit tag-monitoring system was set up to measure the distance moved in a dementia care unit in Korea in 2006. Various indicators were developed to measure temporal patterns of ambulation over time, such as the median distance moved per hour and the percentage of hours moved. Results: 12 consecutive days of movement data were available for 8 subjects. The mean age of the subjects was 76 ± 5.3 years. The median distance walked per day ranged from 206 to 976 m, and the percentage of hours with movement ranged from 28% to 81%. The changes in the activity level during daytime, evening, and nighttime also differed among the 8 subjects. Discussion: The indicators developed appeared to differentiate temporal patterns of movement in demented persons.
Effects of a Goal-Oriented Rehabilitation Program in Mild Cognitive Impairment: A Pilot Study
Background: Memory disturbance, deficient concentration, and fatigue are symptoms seen in amnestic mild cognitive impairment (MCI) as well as in mild traumatic brain injury (TBI). The aim of this study was to assess if an established rehabilitation program commonly used in TBI can aid MCI patients to develop compensatory memory strategies that can improve their cognition, occupational performance, and quality of life (QoL). Methods: Fifteen patients with MCI participated in the program 2 days per week for 8 weeks. Cognitive function, occupational performance, and self-perceived QoL were assessed at baseline, at the end of the intervention, and at follow-up after 6 months. Results: Significant improvements were seen in cognitive processing speed, occupational performance, and in some of the QoL domains. Conclusion: As this goal-oriented rehabilitation program in MCI resulted in some improvements in cognition, occupational performance, and QoL, further randomized controlled studies are warranted.
Review of Issue: Management Strategies, Medical Issues, and Pathobiology
There is little information regarding the usefulness of the Mini-Mental State Examination (MMSE) for tracking progression of non-Alzheimer’s disease dementias. This study examined the utility of the MMSE in capturing disease severity in the behavioral variant frontotemporal dementia (bvFTD) and primary progressive aphasia (PPA), 2 nonamnestic clinical dementia syndromes. Retrospective data from 41 bvFTD and 30 PPA patients were analyzed. bvFTD patients’ change in MMSE scores over time was significantly correlated with change over time on a measure of activities of daily living. In contrast, PPA patients’ MMSE scores showed greater decline over time than scores on the activities of daily living scale. Results suggest that the MMSE score, heavily dependent on language skill, overestimates dementia severity in PPA patients. However, the score may be a more accurate measure of functional impairment in bvFTD due to the influence of their executive function and attentional deficits on MMSE performance.
Young Adult Attitudes About Alzheimer’s Disease
The current generation of young adults will be greatly affected by Alzheimer’s disease(AD), but little is known about their attitudes toward persons with Alzheimer’s disease. The current study assessed attitudes about Alzheimer’s disease in young adults with varying levels of contact with the disease. It was hypothesized that participants who had a high level of contact with someone with Alzheimer’s disease previously, in the form of a close relationship, would report more positive attitudes than participants with a low level of contact or no contact. Results revealed that participants who had a high level of contact with persons with AD were more willing to make personal sacrifices for Alzheimer’s disease than those who had no contact. Younger persons may realize a greater need to support persons with Alzheimer’s disease if they have been personally affected by the disease through a close relationship.
Review of Issue: Treatment Strategies, Early Disease Detection, and Insulin Metabolism
Diffuse Neurofibrillary Tangles With Calcification (DNTC): Kosaka-Shibayama Disease in America
Alzheimer’s disease and Pick’s disease are representative dementias. Cases which do not fit prototypes are termed unclassifiable dementias. New dementia subtypes are identified when a conglomerate of clinical, radiologic and pathologic findings are consistently identified. One such variant is diffuse neurofibrillary tangles with calcification (DNTC), which has been reported almost exclusively from Japan. Significant pathological advances in this decade have established DNTC as a distinct entity. Although initially the diagnosis was neuropathologic, increasing knowledge about DNTC has made it possible for a clinical diagnosis to be made. We report a clinical case of DNTC in a Caucasian American. The diagnosis of DNTC was based on his atypical senile dementia, anomia, apathy and parkinsonian features, normal serum biochemistry, and evidence of basal ganglia and cerebellar calcification with predominant temporal lobe atrophy on neuroimaging. To the best of our knowledge, this is the first clinical description of DNTC from the United States.
Evidence for Grief as the Major Barrier Faced by Alzheimer Caregivers: A Qualitative Analysis
Feelings of loss and grief are frequent companions for current Alzheimer’s family caregivers. Increased acknowledgment and understanding of caregiver grief among researchers has led to more comprehensive explorations of the multifaceted nature of caregiver grief and loss. Absent from the literature, however, is an exploration of anticipatory grief as an actual barrier to the task of caregiving. Through an analysis of 353 open-ended survey responses, the present article explores links between anticipatory grief, ambiguous loss, and principal barriers that family members face as dementia caregivers across the state of Indiana. By drawing parallels between caregiver responses and the Marwit-Meuser Caregiver Grief Inventory subscales, this article illustrates that the fundamental barrier experienced by current Alzheimer’s caregivers appears to be a combination of anticipatory grief and ambiguous loss rather than hands-on care issues. The implications of this finding for future caregiver research and interventions are discussed.
An Educational Intervention to Support Caregivers of Elders With Dementia
The majority of home-dwelling elders with dementia are cared for by family members or friends. Interventions to support community-based caregivers are needed. A community-based seminar series was provided to 300 self-referred family caregivers with dementia. Participants were surveyed for caregiver burden and overload and perceived competence before and 6 months after the seminars. In all, 88 (29%) of participants completed a 6-month survey. Self-perceived caregiver competence improved (3.9 ± 1.6 to 5.0 ± 0.32, P < .006); a trend toward improvement in caregiver overload, and there was no change in caregiver burden. Caregivers with baseline parameters indicative of higher burden, overload, or lower competence showed improved scores at 6 months. The educational program was effective in improving competence and may have slowed the expected increase in burden associated with caring for those with a progressive dementia. Caregivers with higher burden may be targeted for this type of intervention, as they seemed to benefit the most.
Serum Albumin Levels Predict Cognitive Impairment in Elderly Hip Fracture Patients
The aim of this study was to investigate the possible interrelation of serum albumin levels and cognitive function of elderly hip fracture patients. The study involved 331 elderly patients with hip fractures, admitted for rehabilitation. Cognition was assessed by Mini-Mental State Examination (MMSE). MMSE scores less than 24 points were considered suggestive of cognitive impairment. Age, serum albumin levels, and previous stroke emerged as the only statistically significant parameters differing between those with MMSE score less than 24 or higher. After adjusting for confounding variables, the middle and lowest tertiles of serum albumin levels were associated with an increased risk of cognitive impairment (odds ratio 1.97, 95% confidence interval 1.15-3.38, P < .01 vs 3.06 and 1.79-5.23, P < .001, respectively). This study shows that lower serum albumin levels are independently associated with lower MMSE scores in hip fractured elderly patients, supporting the possible role of chronic low-grade inflammation in age-related cognitive decline.
The Japanese MCI Screen for Early Detection of Alzheimer’s Disease and Related Disorders
Early detection of Alzheimer’s disease and related disorders in Japan is increasingly important. The Mild Cognitive Impairment Screen (MCIS)—derived from the National Institute of Aging CERAD neuropsychologic battery—differentiates normal aging from MCI and mild dementia with 97.3% and 99% accuracy, respectively. The Japanese MCIS (JMCIS), Mini-Mental State Examination (MMSE), quantitative SPECT (qSP), and quantitative MRI (qMRI) were used to classify 63 outpatients at Fukuoka University Hospital who were either normal or had MCI based on Clinical Dementia Rating scores of 0 and 0.5, respectively. Performance statistics for the JMCIS, MMSE, qSP, and qMRI were, respectively: (1) accuracy = 0.964, 0.768, 0.722, 0.733; (2) sensitivity = 0.958, 0.792, 0.688, 0.700; (3) specificity = 1.000, 0.625, 1.000, 1.000; and (4) validity = 0.813, 0.420, 0.296, 0.308. This initial study shows negligible differences between the English and Japanese MCIS, supporting its potential use for early detection in Japan.
Patient Care and Management of Frontotemporal Lobar Degeneration
Frontotemporal lobar degeneration (FTLD) is a neurodegenerative disease that affects frontal and temporal regions of the brain. Two proteins indicated in the pathology are tau and the recently discovered TDP-43. Major manifestations include progressive aphasia and a disorder of social comportment. The diagnosis of a patient includes a detailed cognitive exam, clinical testing, and neuroimaging techniques. The current goal of therapy for FTLD is symptomatic management with medications borrowed from other conditions. Nonpharmacologic management such as behavioral interventions and environmental engineering are also efficacious in optimizing quality of life.
Integrating Patient and Informant Reports on the Cornell-Brown Quality-of-Life Scale
Patients with mild cognitive impairment and mild to moderate Alzheimer’s disease can provide information about their quality of life. This study determined whether aggregating patient and informant quality-of-life reports on the Cornell-Brown Scale for Quality of Life in Dementia can provide a broader perspective on the quality of life relative to patient or informant reports separately. Aggregated Cornell-Brown Scale for Quality of Life in Dementia scores were hypothesized to correlate more strongly with both patient and informant perspectives of patient’s memory, function, and neuropsychiatric symptoms than the unaggregated measures. Results indicated that aggregated Cornell-Brown Scale for Quality of Life in Dementia scores reflected a blend of patient and informant perspectives on patient function. This study contributes to a growing line of research that recommends integrating patient and informant perspectives to achieve the most complete assessment of quality of life.