Dementia In People Research Articles

TREATMENT OF HYPERSEXUALITY IN ALZHEIMER'S DISEASE

Hypersexuality in Alzheimer's disease (AD) has been rarely investigated. No randomized clinical trials regarding the treatment of hypersexuality in demented people have been conducted, but available data from isolated case reports suggest the efficacy of selective serotonin reuptake inhibitors (SSRIs), antipsychotics, antiandrogens, and H2-receptor antagonists. Although theere are no evidence-based treatment guidelines for hypersexuality in AD. The patient was a 72-year-old man, who presented for a neuropsychological evaluation performed at the Elbistan State Hospital with a Mini-Mental State Examination (MMSE) value of 18/30. The presenting symptom was persistent sexual desire. Rivastigmine was started at a dose of 5 mg once daily and the sexual desires terminated on the second week of the treatment. Unfortunately, hypersexuality occurred 1 month later. Rivastigmine patch (10mg) was prescribed again to reduce the hypersexuality, and this proved to be effective. We present a case of a 72-year-old male patient with Alzheimer's disease with hypersexual behaviour as reported by his wife. Our patient exhibited significant improvement with rivastigmine. Hypersexuality, also referred to in the literature as sexually inappropriate behavior and sexual disinhibition, involves persistent, uninhibited sexual behaviors directed at oneself or at others. Hypersexuality is a significant symptom because of logistical and ethical problems for caregivers. In this case we would like to emphasize that cholinesterase inhibitors can be effective in treatment of hypersexuality in Alzheimer's disease.

Primary caregivers' awareness and perception of early-onset dementia conditions in adolescents and young and middle-aged adults with Down syndrome.

The present study aims to investigate the onset of dementia conditions using the Dementia Screening Questionnaire for Individuals with Intellectual Disabilities (DSQIID) scale and to identify the possible factors associated with DSQIID scores in people with Down syndrome (DS). The study population was recruited from the voluntary registry members of the Republic of China Foundation for Persons with Down syndrome; primary caregivers provided DSQIID information on 196 adolescents and adults with DS (aged 15-48 years) who were entered into the database and analyzed using SPSS 20.0 software. The results described the distribution of early-onset dementia conditions in 53 adolescents and adults with DS, and 2.6% of the subjects with DS had possible dementia (DSQIID score ≧ 20). Univariate analyses found that older age (p=0.001) and comorbid conditions (p=0.003) were significantly associated with DSQIID scores. Older subjects were more likely to have higher DSQIID scores than were younger age groups after ANOVA and Scheffe's tests. Lastly, a multiple linear regression analysis revealed that age (p<0.01), severe disability level (p<0.05) and comorbid condition (p<0.01) significantly explained 13% of the variation in DSQIID scores after adjusting for the factors of gender, education level and multiple disabilities in adolescents and adults with DS. The study highlights that future research should focus on the occurrence of dementia in people with DS and on identifying its influencing factors based on sound measurements, to initiate appropriate healthy aging policies for this group of people.

Neuroinflammation in the pathogenesis of Alzheimer's disease. A rational framework for the search of novel therapeutic approaches.

Alzheimer disease (AD) is the most common cause of dementia in people over 60 years old. The molecular and cellular alterations that trigger this disease are still diffuse, one of the reasons for the delay in finding an effective treatment. In the search for new targets to search for novel therapeutic avenues, clinical studies in patients who used anti-inflammatory drugs indicating a lower incidence of AD have been of value to support the neuroinflammatory hypothesis of the neurodegenerative processes and the role of innate immunity in this disease. Neuroinflammation appears to occur as a consequence of a series of damage signals, including trauma, infection, oxidative agents, redox iron, oligomers of τ and β-amyloid, etc. In this context, our theory of Neuroimmunomodulation focus on the link between neuronal damage and brain inflammatory process, mediated by the progressive activation of astrocytes and microglial cells with the consequent overproduction of proinflammatory agents. Here, we discuss about the role of microglial and astrocytic cells, the principal agents in neuroinflammation process, in the development of neurodegenerative diseases such as AD. In this context, we also evaluated the potential relevance of natural anti-inflammatory components, which include curcumin and the novel Andean Compound, as agents for AD prevention and as a coadjuvant for AD treatments.

Diabetes Mellitus and Dementia

Growing epidemiologic evidence has suggested that people with diabetes mellitus are at an increased risk for the development of dementia. However, the results for the subtypes of dementia are inconsistent. This review examines the risk of dementia in people with diabetes mellitus, and discusses the possible mechanism underpinning this association. Diabetes mellitus is associated with a 1.5- to 2.5-fold greater risk of dementia among community-dwelling elderly people. Notably, diabetes mellitus is a significant risk factor for not only vascular dementia, but also Alzheimer's disease. The mechanisms underpinning the association are unclear, but it may be multifactorial in nature, involving factors such as cardiovascular risk factors, glucose toxicity, changes in insulin metabolism and inflammation. The optimal management of these risk factors in early life may be important to prevent late-life dementia. Furthermore, novel therapeutic strategies will be needed to prevent or reduce the development of dementia in people with diabetes mellitus.

Dementia in intellectual disability

Dementia is emerging as a significant condition in the population with intellectual disability. This review is aimed at clinicians working in the field. We revisit what is known on the subject and expand on this with results from recent research. The emphasis of this review is on the clinical research rather than laboratory or molecular research. Research has encompassed all aspects of dementia in intellectual disability, from epidemiology, assessment and diagnosis, through to management. There remains a lack of evidence concerning both pharmacological and nonpharmacological treatment of dementia in people with intellectual disability. Recent research has tended to focus on dementia in Down syndrome. More research is necessary in order to translate improvements in the understanding of the neuropathology of intellectual disability and dementia into effective treatments. There is also a need to investigate the optimum environment in which to provide holistic care for individuals affected.

RESPECT TOWARDS ELDERLY DEMENTED PATIENTS

One question of applied ethics is the status and proper treatment of marginal cases, i.e., of people who are not yet or not anymore in full possession of their rational capacities, such as elderly demented people. Does one belittle them if one does not treat them like normal human adults, or would it be disrespectful and demanding too much if one did? Are elderly demented even the proper object of respect? In this paper I explore what Kant would say about these questions if he had addressed them. I look at what Kantian respect is, how he justifies the requirement to respect others, and what it demands more specifically. My claim is that Kant conceives of respect as a maxim of not exalting oneself above others. One should adopt this attitude independently of what the other is like. Differences between normal human adults and marginal cases are important for how one should treat them, but ultimately not for the question of why one should treat them with respect. Accordingly, elderly demented people should be respected, and it depends on the individual case what kind of actions this implies.

Hippocampal atrophy in people with memory deficits: results from the population-based IPREA study

Clinical studies have shown that hippocampal atrophy is present before dementia in people with memory deficits and can predict dementia development. The question remains whether this association holds in the general population. This is of interest for the possible use of hippocampal atrophy to screen population for preventive interventions. The aim of this study was to assess hippocampal volume and shape abnormalities in elderly adults with memory deficits in a cross-sectional population-based study. We included individuals participating in the Italian Project on the Epidemiology of Alzheimer Disease (IPREA) study: 75 cognitively normal individuals (HC), 31 individuals with memory deficits (MEM), and 31 individuals with memory deficits not otherwise specified (MEMnos). Hippocampal volumes and shape were extracted through manual tracing and the growing and adaptive meshes (GAMEs) shape-modeling algorithm. We investigated between-group differences in hippocampal volume and shape, and correlations with memory deficits. In MEM participants, hippocampal volumes were significantly smaller than in HC and were mildly associated with worse memory scores. Memory-associated shape changes mapped to the anterior hippocampus. Shape-based analysis detected no significant difference between MEM and HC, while MEMnos showed shape changes in the posterior hippocampus compared with HC and MEM groups. These findings support the discriminant validity of hippocampal volumetry as a biomarker of memory impairment in the general population. The detection of shape changes in MEMnos but not in MEM participants suggests that shape-based biomarkers might lack sensitivity to detect Alzheimer's-like pathology in the general population.

Use and Safety of Antipsychotics in Behavioral Disorders in Elderly People With Dementia

In recent years, the use of antipsychotics has been widely debated for reasons concerning their safety in elderly patients affected with dementia. To update the use of antipsychotics in elderly demented people, a MEDLINE search was conducted using the following terms: elderly, conventional and atypical antipsychotics, adverse events, dementia, and behavioral and psychotic symptoms in dementia (BPSD). Owing to the large amounts of studies on antipsychotics, we mostly restricted the field of research to the last 10 years. Conventional antipsychotics have been widely used for BPSD; some studies showed they have an efficacy superior to placebo only at high doses, but they are associated with several and severe adverse effects. Atypical antipsychotics showed an efficacy superior to placebo in randomized studies in BPSD treatment, with a better tolerability profile versus conventional drugs. However, in 2002, trials with risperidone and olanzapine in elderly patients affected with dementia-related psychoses suggested the possible increase in cerebrovascular adverse events. Drug regulatory agencies issued specific recommendations for underlining that treatment of BPSD with atypical antipsychotics is "off-label." Conventional antipsychotics showed the same likelihood to increase the risk of death in the elderly as atypical agents, and they should not replace the atypical agents discontinued by Food and Drug Administration warnings. Before prescribing an antipsychotic drug, the following are factors to be seriously considered: the presence of cardiovascular diseases, QTc interval on electrocardiogram, electrolytic imbalances, familiar history for torsades des pointes, concomitant treatments, and use of drugs able to lengthen QTc. Use of antipsychotics in dementia needs a careful case-by-case assessment, together with the possible drug-drug, drug-disease, and drug-food interactions.

APOE -ε4 allele for the diagnosis of Alzheimer's and other dementia disorders in people with mild cognitive impairment in a community setting

This is the protocol for a review and there is no abstract. The objectives are as follows: Our primary objective is to determine the diagnostic accuracy of the APOE-e4 allele in detecting AD dementia and other types of dementia in people with MCI in a primary care setting. Our secondary objective is to investigate the following potential sources of heterogeneity of test accuracy, where reported: characteristics of participants, namely, baseline MMSE score, age, and gender; APOE-e4 background prevalence; MCI definition; length of follow-up; and reference standards.

APOE -ε4 allele for the diagnosis of Alzheimer's and other dementia disorders in people with mild cognitive impairment in a primary care setting

This is the protocol for a review and there is no abstract. The objectives are as follows: Our primary objective is to determine the diagnostic accuracy of the APOE-e4 allele in detecting AD dementia and other types of dementia in people with MCI in a primary care setting. Our secondary objective is to investigate the following potential sources of heterogeneity of test accuracy, where reported: characteristics of participants, namely, baseline MMSE score, age, and gender; APOE-e4 background prevalence; MCI definition; length of follow-up; and reference standards.

Black, Asian and Minority Ethnic Communities and Dementia – Where Are We Now?

Produced for the Race Equality Foundation’s Better Health briefing paper series. The Race Equality Foundation (www.raceequalityfoundation.org.uk) is a UK not-for-profit organization that seeks to influence national policy on support and services for black and minority ethnic communities by developing evidenced-based better practice to promote equality. This briefing looks at developments in the UK since the launch of the National Dementia Strategy in 2009. It uses census data to estimate the number of black and minority ethnic people living with dementia in the UK, and proposes innovative solutions for care, including the use of community dementia navigators. The briefing argues that: • Existing policy recommendations have not been taken into account when developing information and services to meet needs of black and minority ethnic communities. • The prevalence of dementia in some black and minority communities in the UK has been significantly underestimated. • Dementia is misunderstood and highly stigmatized in many UK black and minority ethnic communities. • There is an economic case for financing improvements in ‘living well’ with dementia for people in black and minority ethnic communities, • There should be a vision of a culturally appropriate approach to the dementia pathway that starts from raising awareness, leads to facilitating early diagnosis and lasts into appropriate end-of-life care.

Microglial pathology

This paper summarizes pathological changes that affect microglial cells in the human brain during aging and in aging-related neurodegenerative diseases, primarily Alzheimer’s disease (AD). It also provides examples of microglial changes that have been observed in laboratory animals during aging and in some experimentally induced lesions and disease models. Dissimilarities and similarities between humans and rodents are discussed in an attempt to generate a current understanding of microglial pathology and its significance during aging and in the pathogenesis of Alzheimer dementia (AD). The identification of dystrophic (senescent) microglia has created an ostensible conflict with prior work claiming a role for activated microglia and neuroinflammation during normal aging and in AD, and this has raised a basic question: does the brain's immune system become hyperactive (inflamed) or does it become weakened (senescent) in elderly and demented people, and what is the impact on neuronal function and cognition? Here we strive to reconcile these seemingly contradictory notions by arguing that both low-grade neuroinflammation and microglial senescence are the result of aging-associated free radical injury. Both processes are damaging for microglia as they synergistically exhaust this essential cell population to the point where the brain’s immune system is effete and unable to support neuronal function.

Dementia in people with intellectual disability: Insights and challenges in epidemiological research with an at-risk population

The population with intellectual disability (ID) is ageing, but age-related health concerns such as dementia have received little research attention thus far. We review evidence regarding the prevalence and incidence of dementia in people with ID, and discuss some possible explanations for an increased risk, such as shared genetic risk factors, co-morbid physical and mental disorders, lifestyle factors, trauma, and lowered brain reserve. We discuss practical and theoretical challenges facing researchers in this field, before highlighting the implications of findings to date for future research and clinical care. Research on dementia in this at-risk population has the potential to help us understand dementia in general and to improve services for this group of vulnerable individuals.

Prevention of Decline in Cognition after Stroke Trial (PODCAST): a study protocol for a factorial randomised controlled trial of intensive versus guideline lowering of blood pressure and lipids.

BackgroundStroke is a common cause of cognitive impairment and dementia. However, effective strategies for reducing the risk of post-stroke dementia remain undefined. Potential strategies include intensive lowering of blood pressure and/or lipids.Methods/DesignDesign: multi-centre prospective randomised open-label blinded-endpoint controlled partial-factorial phase IV trial in secondary and primary care.Participants: 100 participants from 30 UK Stroke Research Network sites who are post- ischemic stroke or intracerebral haemorrhage by three to seven months.Interventions - all patients (1:1): intensive versus guideline blood pressure lowering (target systolic < 125 mmHg versus < 140 mmHg).Interventions - ischemic stroke (1:1): intensive versus guideline lipid lowering (target low density lipoprotein-cholesterol (LDL-c) < 1.4 mmol/l versus < 3 mmol/l).Hypotheses: does ‘intensive’ blood pressure lowering therapy and/or ‘intensive’ lipid control reduce cognitive decline and dementia in people with ischemic stroke; and does ‘intensive’ blood pressure lowering therapy reduce cognitive decline and dementia in patients with hemorrhagic stroke.Primary outcome: Addenbrooke’s Cognitive Examination-Revised.Secondary outcomes: feasibility of recruitment and retention of participants, tolerability and safety of the interventions, achieving and maintaining the blood pressure and lipid targets, maintaining differences in systolic blood pressure (> 10 mmHg) and low density lipoprotein-cholesterol (> 1 mmol/l) between the treatment groups, and performing clinic and telephone follow-up of cognition measures.Randomisation: using stratification, minimization and simple randomization.Blinding: participants receive open-label management. Cognition is assessed both unblinded (in clinic) and blinded (by telephone) to treatment. Adjudication of events (dementia, vascular, serious adverse events) is blinded to management.DiscussionThe PODCAST trial is ongoing with 78 patients recruited to date from 22 sites. Outcomes of cognitive impairment and dementia are accruing.Trial registrationISRCTN85562386

Glucose Levels and Risk of Dementia

BackgroundDiabetes is a risk factor for dementia. It is unknown whether higher glucose levels increase the risk of dementia in people without diabetes.MethodsWe used 35,264 clinical measurements of glucose levels and 10,208 measurements of glycated hemoglobin levels from 2067 participants without dementia to examine the relationship between glucose levels and the risk of dementia. Participants were from the Adult Changes in Thought study and included 839 men and 1228 women whose mean age at baseline was 76 years; 232 participants had diabetes, and 1835 did not. We fit Cox regression models, stratified according to diabetes status and adjusted for age, sex, study cohort, educational level, level of exercise, blood pressure, and status with respect to coronary and cerebrovascular diseases, atrial fibrillation, smoking, and treatment for hypertension.ResultsDuring a median follow-up of 6.8 years, dementia developed in 524 participants (74 with diabetes and 450 without). Among participants without diabetes, higher average glucose levels within the preceding 5 years were related to an increased risk of dementia (P=0.01); with a glucose level of 115 mg per deciliter (6.4 mmol per liter) as compared with 100 mg per deciliter (5.5 mmol per liter), the adjusted hazard ratio for dementia was 1.18 (95% confidence interval [CI], 1.04 to 1.33). Among participants with diabetes, higher average glucose levels were also related to an increased risk of dementia (P=0.002); with a glucose level of 190 mg per deciliter (10.5 mmol per liter) as compared with 160 mg per deciliter (8.9 mmol per liter), the adjusted hazard ratio was 1.40 (95% CI, 1.12 to 1.76).ConclusionsOur results suggest that higher glucose levels may be a risk factor for dementia, even among persons without diabetes. (Funded by the National Institutes of Health.)

Increased risk of dementia in people with previous exposure to general anesthesia: A nationwide population-based case–control study

BackgroundDementia, which leads to disability, is one of the important diseases occurring among older populations. However, the exact mechanism of the disease remains unknown. The potential risk factor of general anesthesia (GA) in the development of dementia is a controversial topic. Therefore, this study aimed to evaluate the association between previous exposure to different GA types and the incidence of dementia. MethodsUsing the claims data of 1 million insured residents covered by Taiwan's universal health insurance from 2005 to 2009, 5345 newly diagnosed dementia patients older than 50 years were eligible for the study group. The control group, which consisted of 21,380 individuals without dementia, was matched for age, gender, and index date. GA was categorized into three subtypes: endotracheal tube intubation general anesthesia (ETGA), intravenous injection general anesthesia (IVGA) or intramuscular injection general anesthesia (IMGA), and heavy sedation. The multiple logistic regression model was used for analyses. ResultsIndividuals exposed to surgery under ETGA (odds ratio [OR], 1.34; 95% confidence interval [CI], 1.25–1.44) and those exposed to surgery under IVGA or IMGA (OR, 1.28; 95% CI, 1.14–1.43) were at significantly higher risk of dementia in a dose–response relationship (P < .0001), whereas surgery under heavy sedation was not associated with increased risk of dementia (OR, 1.04; 95% CI, 0.68–1.59). The dementia risk for subjects with diabetes mellitus who received surgery under ETGA (OR, 1.59; 95% CI, 1.42–1.78), hypertension (OR, 1.98; 95% CI, 1.78–2.21), atherosclerosis (OR, 1.35; 95% CI, 1.22–1.50), or after having experienced a stroke (OR, 3.52; 95% CI, 3.13–3.97), but no interaction was found between surgery under ETGA and depression for the risk of dementia. ConclusionsA history of previous exposure to surgery under GA might be associated with an increased risk of dementia, particularly in subjects who have undergone repeated exposure to GA. In addition, subjects who had received surgery under ETGA with comorbidities such as stroke, hypertension, diabetes mellitus, and atherosclerosis could have a potential relationship with dementia risk.

Subjective memory concerns, objective memory impairment and risk of Alzheimer's dementia in people with MCI

Subjective memory concerns, objective memory impairment and risk of Alzheimer's dementia in people with MCI

The trajectory of cognitive decline in preclinical dementia in people attending a memory clinic: The 4C-MCI study

P2-242 THE TRAJECTORY OF COGNITIVE DECLINE IN PRECLINICAL DEMENTIA IN PEOPLE ATTENDING A MEMORY CLINIC: THE 4C-MCI STUDY Renske Hamel, Sebastian Koehler, Nicole Sistermans, Wiesje Van der Flier, Pieter Jelle Visser, Pauline Aalten, Philip Scheltens, Frans R. J. Verhey, Inez Ramakers, Maastricht University Medical Centre/Alzheimer Centre Limburg/School for Mental Health and Neuroscience, Maastricht, Netherlands; VUMC Alzheimer Centre/VUMC Medical Centre, Amsterdam, Netherlands; Maastricht University Medical Centre/Alzheimer Centre Limburg/School for Mental Healthy and Neuroscience/VUMC Alzheimer Centre/VUMC Medical Centre, Maastricht, Netherlands. Contact e-mail: r.hamel@maastrichtuniversity.nl

Risk and protective factors for dementia in people 85 and older

Risk and protective factors for dementia in people 85 and older

Rivastigmine in the Treatment of Hypersexuality in Alzheimer Disease

Inappropriate sexual behaviors (ISB) represent uncommon and often misdiagnosed clinical disorders among patients with Alzheimer disease. So far, no randomized clinical trials regarding the treatment of ISB in demented people have been conducted, but available data from case series and isolated case reports suggest the efficacy of selective serotonin reuptake inhibitors (SSRIs), antipsychotics, antiandrogens, and H2-receptor antagonists. Controversial data exist on the therapeutic influence of cholinesterase inhibitors on sexual disorders. In the present article, we describe the case of an Alzheimer disease patient presenting hypersexuality, successfully treated with rivastigmine. Thus, we perform a revision of the existing literature regarding the therapeutical effect of cholinesterase inhibitors in the treatment of ISB.