Alzheimer-type Dementia Patients Research Articles

Evaluation of Early Diagnosis via Some Blood Parameters in Alzheimer Type Dementia and Type 2 Diabetes Mellitus Patients

Aim: Alzheimer's disease is a neurodegenerative disease with cognitive loss, which does not have a curative treatment and a bloodbased
 biomarker to make a definitive diagnosis. There is a strong relationship between Alzheimer's disease and type 2 diabetes mellitus.
 Neutrophil-lymphocyte, platelet-lymphocyte and monocyte-lymphocyte ratios are recommended parameters as inflammation markers.
 It was aimed to compare blood parameters and their ratios to each other in terms of their potential to provide early diagnosis in patients
 with Alzheimer's disease and type 2 diabetes mellitus.
 Material and Methods: 80 healthy controls, 47 type 2 diabetes mellitus and 45 Alzheimer's type dementia patients were included in this
 study. Various blood parameters and their ratios to each other were scanned. One way ANOVA and post hoc Scheffe tests were used for
 statistical analysis.
 Results: Serum iron levels were lower in type 2 diabetes mellitus (53.21±29.28 μg/dL) and Alzheimer’s disease (61.26±21.69 μg/dL)
 groups compared to the control (76.96±30.99 μg/dL) (p=0.001). Lymphocyte numbers were lower in type 2 diabetes mellitus (1.94±0.79
 count.10³) and Alzheimer’s disease (1.84±0.68 count.10³) groups compared to the control (2.25±1.03 count.10³) (p=0.032). Monocytelymphocyte
 ratio were significantly higher in type 2 diabetes mellitus (0.3±0.18) and Alzheimer’s disease (0.28±0.11) groups compared
 to the control (0.24±0.1) (p=0.039).
 Conclusion: The high monocyte-lymphocyte ratio can be considered as an indicator of systemic inflammation in Alzheimer's disease
 and type 2 diabetes mellitus. In conclusion, serum iron levels, lymphocyte numbers and monocyte-lymphocyte ratio as inflammation
 markers can be useful for the early diagnosis of type 2 diabetes mellitus and Alzheimer’s disease

Cognitive impairments predict the behavioral and psychological symptoms of dementia.

The purpose of this study was to (1) validate the Thai version of the Neuropsychiatric Inventory Questionnaire (NPI-Q) as a screening tool for behavioral and psychological symptoms of dementia (BPSD), and (2) examine the relationship between cognitive performance and BPSD in an elderly population with amnestic mild cognitive impairment (aMCI) and dementia of Alzheimer's type (DAT). One hundred and twenty participants, comprising 80 aMCI and 40 DAT patients, and their respective caregivers were included in the study. Participants completed the NPI-Q and the Neuropsychiatric Inventory (NPI) within 2 weeks of each other and cognitive performance was primarily assessed using the Montreal Cognitive Assessment (MoCA). The Thai NPI-Q had good validity and reliability. Pure exploratory bifactor analysis revealed that a general factor and a single-group factor (with high loadings on delusions, hallucinations, apathy, and appetite) underpinned the NPI-Q domains. Significant negative correlations between the MoCA total score and the general and single-group NPI-Q scores were found in all subjects (aMCI + DAT combined) and DAT alone, but not in aMCI. Cluster analysis allocated subjects with BPSD (10% of aMCI and 50% of DAT participants) into a distinct "DAT + BPSD" class. The NPI-Q is an appropriate instrument for assessing BPSD and the total score is largely predicted by cognitive deficits. It is plausible that aMCI subjects with severe NPI-Q symptoms (10% of our sample) may have a poorer prognosis and constitute a subgroup of aMCI patients who will likely convert into probable dementia.

Changes in Ocular Biomarkers from Normal Cognitive Aging to Alzheimer's Disease: A Pilot Study.

To identify ophthalmic findings in Alzheimer's type dementia (ATD) compared to normal subjects. This comparative descriptive study included participants from the institution's cognitive fitness center. Complete ophthalmic examinations were performed. Optical coherence tomography (OCT) and OCT angiography (OCTA) were used to analyze retinal thickness and vascular density. The Ocular Surface Disease Index (OSDI) score and tear breakup time (TBUT) were used to assess dry eye. The blink rate was counted by a well-trained observer. Cognitive function was evaluated using the Thai Mental State Examination (TMSE) score. Correlation analysis was performed to compare OCT, OCTA parameters, and TMSE. We included 24 ATD patients and 39 normal participants as a control group by age and sex-matched. The prevalence of dry eye using the Asia Dry Eye Society criteria was 15% and 13% in normal and ATD patients, respectively. The differences in OSDI scores, TBUT, and blink rate between the two groups were not statistically significant. The parafoveal and perifoveal macular thickness of the ATD group were significantly lower than that of the control group (p<0.01). All parameters of the vessel density of the ATD group were significantly lower than in the control group, including the whole macular vessel density (p<0.01), optic disc vessel density at the nerve head level (p<0.01), and optic disc vessel density at the radial peripapillary capillary level (p<0.05). After age adjustment, there were no statistically significant differences in all the OCT and OCTA parameters. There was a positive correlation between retinal thickness and vessel density in the macular and optic disc region and TMSE scores. Perifoveal and parafoveal retinal thickness might be more sensitive than peripapillary RNFL thickness to detect neurodegenerative changes in patients with ATD. Macular thickness and vessel density reduction were also positively correlated with cognitive decline.

Impact of Current Alcohol Consumption on Cognitive Function in Patients with Self-Perceived Memory Decline: A Comparative Study of Subjective Cognitive Decline, Mild Cognitive Impairment and Alzheimer-Type Dementia Groups

Background: Alcohol consumption has been considered as a modifiable risk factor for dementia development and alcohol-related brain damage may further impair cognitive abilities in dementia patients. This study aimed to find out the differences in cognitive function according to current alcohol drinking in patients with self-perceived memory decline, including subjective cognitive decline (SCD), mild cognitive impairment (MCI) and early Alzheimer-type dementia (ATD).Methods: From May 2018 to December 2019, retrospective chart review was performed in patients who visited CHA Bundang Medical Center for cognitive decline. A two-way analysis of variance with interaction test were used to analyze the impact of alcohol consumption on cognitive function between groups.Results: A total of 147 patients was classified into three groups of SCD (n=30), MCI (n=53), and ATD (n=64), and each group was divided into two subgroups of alcohol users and alcohol non-users, according to the current status of alcohol consumption. Between SCD, MCI and ATD groups, scores of clock drawing test and Go/No-go test were significantly lower in current alcohol users of ATD groups compared to the SCD and MCI groups (p&lt;0.05).Conclusions: These results suggest that current alcohol consumption has detrimental effects especially on the frontal/executive function in early ATD patients. Considering the association between frontal/executive function and ADL, our finding suggests that cessation of alcohol intake may be a therapeutic strategy to prevent ADL deterioration in patients with ATD.

Pathological verbal repetition by Chinese elders with Dementia of Alzheimer’s Type

Verbal repetition has been acknowledged as one of the most common symptoms in early Dementia of Alzheimer's Type (DAT). Despite previous attempts, the applicability of verbal repetition as an essential linguistic marker indicating this disease remains unexplored for Chinese DAT patients. This study collects Chinese DAT patients' daily conversation data to investigate both structural and functional aspects of pathological verbal repetition. Three major types are set regarding the cases of pathological repetition, respectively ‘unconscious concept repetition', ‘perseveration', and ‘involuntary word repetition'. The analysis focuses on what features these repetitions have from the perspective of ‘ideational function', ‘interpersonal function', and ‘textual function' within the framework of Systemic Functional Linguistics. A better understanding of pathological verbal repetition by DAT elders as the linguistic markers of cognitive impairment promotes effective communication between patients, nursing staff, and family members.

Examination of the influence of cedar fragrance on cognitive function and behavioral and psychological symptoms of dementia in Alzheimer type dementia.

We examined whether symptoms of dementia are improved by olfactory nerve stimulation in Alzheimer type dementia patients. First, a stick‐type olfactory identification ability test was performed in patients with Alzheimer type dementia, to select patients without olfactory dysfunctions. Then, these patients were randomly assigned into the intervention (n = 19) and the control groups (n = 17). To evaluate the effects of olfactory nerve stimulation, we exposed the intervention group to a disinfecting ethanol with added aroma extracts from ceder and the control group to the ethanol without the added aroma extracts. Each group underwent the intervention for 8 weeks, cognitive and behavioral functions were evaluated before and after treatments using the Neuropsychiatric Inventory (NPI), the Japanese version of Zarit Caregiver Burden interview (J‐ZBI), and the Alzheimer's Disease Assessment Scale‐cognitive subscale (ADAS‐cog). A significant improvement was observed in the NPI score and J‐ZBI in the intervention group compared to the control group at 4 and 8 weeks. On the other hand, there was no significant difference in the score of ADAS‐cog. Exposure to cedar fragrance improved behavioral and psychological symptoms of dementia (BPSD) in Alzheimer type dementia and may reduce the burden of nursing care. In addition to its effectiveness, the procedure is simple and minimally invasive and would be a valuable non‐pharmaceutical treatment.

Uncinate fasciculus disruption relates to poor recognition of negative facial emotions in Alzheimer's disease: a cross-sectional diffusion tensor imaging study.

Recognising facial emotions involves visual and emotional information processing. Patients with dementia, including dementia of Alzheimer's type (DAT), are known to poorly recognise facial emotions, especially negative facial emotions. In this study, we aimed to assess if DAT patients exhibit poor facial emotional recognition, and to identify a neural basis for how poor facial emotional recognition might occur. Magnetic resonance imaging and diffusion tensor imaging (DTI) analysis were conducted in 20 DAT patients and 15 cognitive normal (CN) subjects. The uncinate fasciculus (UF), inferior longitudinal fasciculus, and inferior fronto-occipital fasciculus were delineated by deterministic tractography. DTI parameters were calculated for each fibre. Facial emotion recognition was evaluated with the Facial Emotion Selection Test (FEST). The relationships between FEST scores and DTI parameters in each fibre were measured by partial correlation analyses with age, gender, and the Mini-Mental State Examination as covariates. Group-wise comparisons between DAT and CN subjects were performed for each DTI parameter in each fibre. DAT patients showed lower FEST negative emotion scores than CN subjects (P < 0.05). The score of negative emotion subscale was negatively correlated (r = -0.770, P < 0.001) to mean diffusivity of the left UF in DAT patients. There were no relationships between negative emotion subscale and the other fibre tracts. DAT patients showed no differences in the DTI parameters for each fibre compared to CN subjects. DAT-related prefrontal-limbic network dysfunction is associated with poor recognition of unpleasant emotions; consequently, worse facial recognition of negative emotion is observed in DAT patients.

The prevalence of sarcopenia and dynapenia according to stage among Alzheimer-type dementia patients.

In this study, the aim was to identify the prevalence of sarcopenia and dynapenia according to disease stage among Alzheimer-type dementia (AD) patients and collect data to suggest precautions related to reducing the disease load. The study was completed with 127 patients separated into stages according to Clinical Dementia Rating Scale (CDR) criteria and 279 healthy volunteers aged 18-39 years and 70-80 years abiding by the exclusion criteria who agreed to participate in the research. Our prospective and cross-sectional study applied the CDR and mini mental test (MMSE) to patients with disorder in more than one cognitive area and possible AD diagnosis according to NINCDS-ADRDA (National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association) diagnostic criteria. The patient and control groups had skeletal muscle mass index (SMMI), muscle strength and physical performance assessed with sarcopenia diagnosis according to European Working Group on Sarcopenia in Older People (EWGSOP) diagnostic criteria. In our study, in parallel with the increase in disease stage of AD patients, the prevalence of sarcopenia (led by severe sarcopenia) and dynapenia was higher compared to a control group of similar age. In chronic, progressive diseases, like AD, identification of changes in parameters, like muscle mass and strength and reductions in physical performance in the early period, is important for identification and to take precautions in the initial stages considering the limitations of the preventive effects of treatment applied after diagnosis of AD.

Cognitive Mechanisms in Decision-Making in Patients With Mild Alzheimer Disease.

Alzheimer's dementia is characterized by significant cortical and subcortical atrophy, causing diverse neuropsychological deficits. According to the somatic marker hypothesis, the areas responsible for generating the somatic markers that anticipate the consequences of a decision and thereby optimize the process would be affected in these patients. The aim of this experiment is to study the decision-making processes in Alzheimer type dementia patients to determine potential deficits in these processes as a result of the disease, aside from the cognitive impairment that is typical of aging. In addition, we wish to determine the defining characteristics of decision-making in these patients, on the basis of the prospect valence-learning parameters. We evaluated 30 patients with Alzheimer's disease and a control group of 30 healthy subjects. A short version of the Iowa Gambling Task was used. The results showed that patients made less advantageous choices than did controls. Group differences were quantitative and qualitative, as significant differences in cognitive mechanisms identified in the prospect valence-learning decisions were observed. These results are consistent with evidence from neuroimaging studies as well as with work carried out with amnesic patients. That problems in our patients' decision-making could be due to the characteristic memory deficits of this disease, which prevents them from establishing new stimulus-reward relationships and eliminating previously learned responses as a result of the parietal and temporal atrophy they present.

New cerebrospinal fluid biomarkers in Alzheimer’s disease

New cerebrospinal fluid biomarkers in Alzheimer’s disease

The relationship between the premorbid personality traits and the behavioral and psychological symptoms of Alzheimer disease

AimIn this study, we have aimed to investigate the relationship between the premorbid personality traits and the behavioral and psychological symptoms of Alzheimer disease. Method147 dementia patients who have attended to Geriatric Psychiatry Department of Istanbul University Cerrahpaşa Medical Faculty have been selected randomly. Out of these patients, 45 Alzheimer type dementia patients whose family members or a relative could be reached are included in the study. Relatives of each patient have been asked to fill in the Munich Personality Test (MPT) – relatives form for the purpose of assessment of premorbid personality traits of the subjects. ResultsIt could be stated that high level of premorbid isolation tendency and schizoidia scores are the predictors of hallucinations and aggression. Low level of premorbid frustration tolerance is found to be associated with the present anxiety and the higher Behave–AD general assessment scores. ConclusionWe conclude that certain premorbid personality traits could be a risk factor for the later development of behavioral and psychological symptoms in Alzheimer’s disease or that psychopathologic symptoms could actually be exaggerations or morbid distortions of lifelong behavioral tendencies, and it may also be explained by reflection of neuropathological processes occurring in brain in dementia onto clinic practice, in reliance upon detection of similar findings in studies conducted on different types of dementia and in different cultures. Advanced studies conducted on a sufficient number of subjects in prospective design within a biopsychosociocultural model are needed.

Taste detection and recognition thresholds in Japanese patients with Alzheimer-type dementia.

Alzheimer-type dementia (AD) is pathologically characterized by massive neuronal loss in the brain, and the taste cortex is thought to be affected. However, there are only a few reports regarding the gustatory function of AD patients, and the conclusions of this research are inconsistent. This prospective study enrolled 22 consecutive patients with mild to moderately severe Alzheimer-type dementia (AD) with mean age of 84.0 years, and 49 elderly volunteers without dementia with mean age of 71.0 years as control subjects. The control subjects were divided into two groups according to age: a younger group (N=28, mean age: 68.5) and an older group (N=21, mean age: 83.0). The gustatory function was investigated using the filter paper disc method (FPD) and electrogustometry (EGM). The gustatory function as measured by the FPD was significantly impaired in patients with AD as compared with age-matched control subjects; no such difference was found between the younger and the older control groups. On the other hand, as for the EGM thresholds, there were no differences between the AD patient group and the age-matched controls. The FPD method demonstrated decreased gustatory function in AD patients beyond that of aging. On the other hand, EGM thresholds did not differ between the AD patient group and the age-matched controls. These results suggest that failure of taste processing in the brain, but not taste transmission in the peripheral taste system, occurs in patients with AD.

Amyloid-β-Secondary Structure Distribution in Cerebrospinal Fluid and Blood Measured by an Immuno-Infrared-Sensor: A Biomarker Candidate for Alzheimer's Disease.

The misfolding of the Amyloid-beta (Aβ) peptide into β-sheet enriched conformations was proposed as an early event in Alzheimer's Disease (AD). Here, the Aβ peptide secondary structure distribution in cerebrospinal fluid (CSF) and blood plasma of 141 patients was measured with an immuno-infrared-sensor. The sensor detected the amide I band, which reflects the overall secondary structure distribution of all Aβ peptides extracted from the body fluid. We observed a significant downshift of the amide I band frequency of Aβ peptides in Dementia Alzheimer type (DAT) patients, which indicated an overall shift to β-sheet. The secondary structure distribution of all Aβ peptides provides a better marker for DAT detection than a single Aβ misfold or the concentration of a specific oligomer. The discrimination between DAT and disease control patients according to the amide I frequency was in excellent agreement with the clinical diagnosis (accuracy 90% for CSF and 84% for blood). The amide I band maximum above or below the decisive marker frequency appears as a novel spectral biomarker candidate of AD. Additionally, a preliminary proof-of-concept study indicated an amide I band shift below the marker band already in patients with mild cognitive impairment due to AD. The presented immuno-IR-sensor method represents a promising, simple, robust, and label-free diagnostic tool for CSF and blood analysis.

Response to: Comment on "Choroidal Thickness in Patients with Mild Cognitive Impairment and Alzheimer's Type Dementia".

We would like to thank Ilhan et al. [1] for their comments regarding our article. In our study, we found out that choroidal thickness (CT) decreased in the eyes of patients with both Alzheimer's type dementia (ATD) and mild cognitive impairment (MCI) compared to the healthy control group. Therefore, we suggested that CT value could be used as a new biomarker in early diagnosis of ATD and MCI patients and follow-up of their progression [2].

Demencia tipo Alzheimer, deterioro cognitivo y toma de decisiones

El objetivo de este trabajo es el de conocer cómo es la toma de decisiones en la Demencia Tipo Alzheimer (DTA) en situaciones de incertidumbre, si se manifiesta la tendencia al riesgo o no, y la relación que guarda la ejecución con el status cognitivo en cada una de las áreas evaluadas por los test de cribado del deterioro cognitivo propios de las demencias. Participaron 10 pacientes con DTA, y comparados con 10 sujetos controles. Se utilizó la Prueba Cartas (basada en la Iowa Gambling Task), donde los sujetos deben elegir entre varias opciones que entrañan más o menos riesgo, y una batería de cribado del deterioro cognitivo. Los resultados reflejaron que los sujetos con DTA en etapas iniciales presentan cierta tendencia al riesgo en las decisiones que toman y no desarrollan patrones estratégicos de elección. Parece que el deterioro cognitivo y el grado de afectación en las distintas áreas se relaciona con la forma en que toman decisiones.

Viscoelastic and ultrastructural characteristics of whole blood and plasma in Alzheimer-type dementia, and the possible role of bacterial lipopolysaccharides (LPS).

Alzheimer-type dementia (AD) is a neurodegenerative disorder and the most common form of dementia. Patients typically present with neuro- and systemic inflammation and iron dysregulation, associated with oxidative damage that reflects in hypercoagulability. Hypercoagulability is closely associated with increased fibrinogen and in AD patients fibrinogen has been implicated in the development of neuroinflammation and memory deficits. There is still no clear reason precisely why (a) this hypercoagulable state, (b) iron dysregulation and (c) increased fibrinogen could together lead to the loss of neuronal structure and cognitive function. Here we suggest an alternative hypothesis based on previous ultrastructural evidence of the presence of a (dormant) blood microbiome in AD. Furthermore, we argue that bacterial cell wall components, such as the endotoxin lipopolysaccharide (LPS) of Gram-negative strains, might be the cause of the continuing and low-grade inflammation, characteristic of AD. Here, we follow an integrated approach, by studying the viscoelastic and ultrastructural properties of AD plasma and whole blood by using scanning electron microscopy, Thromboelastography (TEG®) and the Global Thrombosis Test (GTT®). Ultrastructural analysis confirmed the presence and close proximity of microbes to erythrocytes. TEG® analysis showed a hypercoagulable state in AD. TEG® results where LPS was added to naive blood showed the same trends as were found with the AD patients, while the GTT® results (where only platelet activity is measured), were not affected by the added LPS, suggesting that LPS does not directly impact platelet function. Our findings reinforce the importance of further investigating the role of LPS in AD.

MicroRNA-193b is a regulator of amyloid precursor protein in the blood and cerebrospinal fluid derived exosomal microRNA-193b is a biomarker of Alzheimer's disease.

Amyloid precursor protein (APP) has an important function in the generation of Alzheimer's disease (AD). In our previous study, miR‑193b was found to be downregulated in the hippocampi of 9‑month‑old APP/PS1 double‑transgenic mice using microRNA (miR) array. In the present study, bioinformatic analyses showed that miR‑193b was a miR that was predicted to potentially target the 3'‑untranslated region (UTR) of APP. Subsequently, the function of miR‑193b on APP was studied. The levels of miR‑193b, exosomal miR‑193b, Aβ, tau, p‑tau, HCY and APOE in samples from APP/PS1 double‑transgenic mice, mild cognitive impairment (MCI) and dementia of Alzheimer‑type (DAT) patients, were measured. The results indicated that overexpression of miR‑193b could repress the mRNA and protein expression of APP. The miR‑193b inhibitor oligonucleotide induced upregulation of APP. Binding sites of miR‑193b in the 3'‑UTR of APP were identified by luciferase assay. MCI and DAT patients had lower exosomal miR‑193b, but not total miR‑193b, in the blood as compared with the controls. DAT patients had lower exosomal miR‑193b levels in blood as compared with the MCI group. A decreased exosomal miR‑193b expression level was additionally observed in the cerebral spinal fluid (CSF) of DAT patients. Negative correlations were found between exosomal miR‑193b and Aβ42 in the CSF of DAT patients. In conclusion, these findings showed that miR‑193b may function in the development of AD and exosomal miR‑193b has potential as a novel, non-invasive, blood‑based biomarker of MCI and DAT patients.

Evaluation of a Japanese version of the Mini‐Mental State Examination in elderly persons

This study aimed to examine the validity and item-response characteristics of the Mini-Mental State Examination (MMSE), which is used for assessing cognitive function, in Japanese older adults. Factor analysis and item response analysis were carried out for MMSE responses (n = 1971) from older adults living in the community (n = 1339) or in a nursing home (n = 632), including Alzheimer-type dementia (n = 330), vascular dementia (n = 36), frontotemporal dementia (n = 7), mixed Alzheimer-type and frontotemporal type dementia (n = 27), and age-related cognitive decline (n = 29). When choosing the cut-off score of 23 points for the MMSE, sensitivity and specificity for each item were calculated. A three-factor solution was found to be most appropriate by factor analysis: complex processing, simple processing and working memory. The item characteristics curves showed unidimensionality with high reproducibility. We identified a simplified scale comprising 10 items in all participants: "naming", "three-step command", "registration", "repeat a sentence", "write a complete sentence", "copies drawing of two polygons", "orientation to place", "delayed recall", "orientation to time" and "serial sevens" tasks. Sensitivity and specificity for both "year" task and "day" task were more than 90% ("year": sensitivity 92.5%, specificity 96.3%; "day": sensitivity 92.4%, specificity 91.7%). For the Alzheimer-type dementia patients, the five-factor solution was suggested by factor analysis and the MMSE also had unidimensionality in terms of level of difficulty. We found that the MMSE had multiple cognitive areas. We showed that the MMSE could be used as an essentially unidimensional measure of cognitive ability and the question about orientation to time might be useful in the simplest assessment to identify cognitive dysfunction.

Alzheimer's dementia, cognitive impairment and decision making

This study aims to know about how is the decision making in Alzheimer Type Dementia (ATD) the target is to see if the tendency at risk appears or not, and the relationship between performance and the cognitive status in each of the areas evaluated by the screening test for dementia cognitive. Ten ATD patients participated in this experiment, compared with ten control subjects. A Card Test (based on the Iowa Gambling Task) was used. Subjects had to choose among different options that implied more or less risk. Furthermore, a screening test was used. The results reflected the fact that subjects with ATD in an initial stage showed a tendency to risk in decision making and they did not develop any election strategy pattern. It seems that the way in which patients make their decisions is related to the cognitive damage and the degree in which Alzheimer affects the different brain areas.

Alzheimer's dementia, cognitive impairment and decision making

This study aims to know about how is the decision making in Alzheimer Type Dementia (ATD) the target is to see if the tendency at risk appears or not, and the relationship between performance and the cognitive status in each of the areas evaluated by the screening test for dementia cognitive. Ten ATD patients participated in this experiment, compared with ten control subjects. A Card Test (based on the Iowa Gambling Task) was used. Subjects had to choose among different options that implied more or less risk. Furthermore, a screening test was used. The results reflected the fact that subjects with ATD in an initial stage showed a tendency to risk in decision making and they did not develop any election strategy pattern. It seems that the way in which patients make their decisions is related to the cognitive damage and the degree in which Alzheimer affects the different brain areas.