Demented Population Research Articles

The prevalence and co-existence of geriatric syndromes in older patients with dementia compared to those without dementia

BackgroundThis study aims to compare frequency and coexistence of geriatric syndromes in older patients with dementia to those without dementia.Methods1392 patients admitted to geriatric outpatient clinics were evaluated. Evaluations for eleven geriatric syndromes including polypharmacy, malnutrition, fraility, sarcopenia, dysphagia, urinary incontinence, fear of falling, falls, insomnia, excessive daytime sleepiness, and orthostatic hypotension (OH) were carried out in consultation with the patient and the caregiver. Two groups with and without dementia were matched according to age and gender using the propensity score matching method.ResultsA total of 738 patients, 369 with dementia and 369 without dementia were included, of whom 70.1% were female and the mean age was 80.5 ± 6.8. Polypharmacy, malnutrition, frailty, sarcopenia, dysphagia, fear of falling, and excessive daytime sleepiness were significantly higher in patients with dementia (p < 0.05). There was no difference between OH, urinary incontinence and insomnia between groups (p > 0.05). The co-existence of 0, 1, 2, 3, 4 and ≥ 5 geriatric syndromes in the same patient was 4.3%, 10.2%, 11.8%, 16.8%, 13.4% and 43.7% in non-dementia patients, respectively; 2.4%, 7.2%, 9.6%, 8.3%, 10.4% and 62.1% in those with dementia, respectively (p < 0.05).ConclusionThe presence and co-existence of geriatric syndromes is common in patients with dementia. These geriatric syndromes should be examined by clinicians and healthcare professionals who work with the demented population, so that more successful management of dementia patients may be achieved.

Survival and anti‐psychotic treatment in young onset Alzheimer’s disease

AbstractIntroductionPsychosis and agitation represent a major therapeutic problem in young onset Alzheimer’s disease (YOAD), given that these symptoms pose a great risk to the patient, but treatment options are limited. Anti‐psychotic use is connected to different side effects, but increased mortality noted in older demented population is particularly worrying. Since YOAD patients are younger we wanted to examine if anti‐psychotic use is connected to decreased survival in these patients as well.AimTo examine the association between the use of anti‐psychotics and the length of survival in YOAD.Material and methodsThis is a retrospective study on 135 patients from Memory Center of Neurology Clinic, Clinical Center of Serbia, with clinical diagnosis of YOAD. We included outpatients that had first visit to our clinic from 01.04.2012. do 01.04.2017. The need to introduce anti‐psychotics was noted during the follow‐up period and the difference in the survival of patients who at some point during the observation (from inclusion in the register until 2019) received anti‐psychotic therapy and those who did not. In this analysis we used Kaplan Meier survival analysis with log rank test with the time from the onset of symptoms to the outcome as an independent variable. Outcome was survived/died (at 2019.) and dependent variable was whether or not the patient received anti‐psychotics.ResultsDuring the period covered by this analysis, ending in 2019, among patients who received anti‐psychotics, 42 patients died while 20 remained alive. In patients who did not receive anti‐psychotics, 47 patients died while 26 remained alive. There was no statistically significant difference between the number of deaths in the group of patients who were and were not treated with anti‐psychotics (p = 0.682). Kaplan Meier analysis showed that the use of anti‐psychotics (at any point during observation) did not significantly affected survival measured as the time elapsed from the onset of symptoms to the outcome (death or 2019).ConclusionThe use of anti‐psychotics in patients with YOAD is not associated with reduced lifespan.

Application of virtual reality for dementia management

Age is recognized as the major factors of dementia, especially in for Alzheimer’s disease (AD). Given to the aged population, the increased number of demented population has been receiving a great impact in our society. Unfortunately, so far, no cured medicines have been demonstrated to provide effective treatment in AD. The combination of pharmacological and non-pharmacological interventions has been proposed to manage dementia with potential benefits especially in decreasing caregiver’s burden and behavior, as well as psychological problems of demented patients. Recently, giving to the glorious development in digital technologies, the virtual reality, one of the non-pharmacological interventions has been used extensively in dementia managements for its strengths which can be adapted in accordance with the heterogeneous needs from demented patients and their caregivers. However, various study designs and other reasons made these results difficult to be interpreted. In this review our goal is to provide a better understanding for these points.

Magnetic resonance elastography of the ageing brain in normal and demented populations: A systematic review.

The aim of this systematic review was to evaluate the ability of magnetic resonance elastography (MRE) to identify significant changes in brain mechanical properties during normal and pathological aging. PubMed, Web of Science and Scopus were searched for human studies using MRE to assess brain mechanical properties in cognitively healthy individuals, individuals at risk of dementia or patients diagnosed with dementia. Study characteristics, sample demographics, clinical characterization and main MRE outcomes were summarized in a table. A total of 19 studies (nine aging, 10 dementia), comprising 700 participants, were included. The main findings were decreased cerebral stiffness along aging, with rates of annual change ranging from −0.008 to −0.025 kPa per year. Also, there were regional differences in the age effect on brain stiffness. Concerning demented patients, differential patterns of stiffness were found for distinct dementia subtypes. Alzheimer's disease and frontotemporal dementia exhibited decreased brain stiffness in comparison to cognitively healthy controls and significant declines were found in regions known to be affected by the disease. In normal pressure hydrocephalus, the results were not consistent across studies, and in dementia with Lewy bodies no significant differences in brain stiffness were found. In conclusion, aging is characterized by the softening of brain tissue and this event is even more pronounced in pathological aging, such as dementia. MRE technique could be applied as a sensible diagnostic tool to identify deviations from normal aging and develop new brain biomarkers of cognitive decline/dementia that would help promote healthier cognitive aging.

An Exploration of Subgroups of Neuropsychiatric Symptoms in Mild Cognitive Impairment and Their Risks of Conversion to Dementia or Death

To explore the heterogeneity of neuropsychiatric symptom (NPS) complexes in individuals with mild cognitive impairment (MCI) and assess the relative risks of converting to dementia or dying. Latent class analysis using 7,971 participants with MCI. Participants in the Uniform Data Set (UDS) from 39 NIH Alzheimer's Disease Centers. Persons with a diagnosis of MCI at initial visit from each center and with either a Mini-Mental State Examination (MMSE) score of 22 or greater or an equivalent education-adjusted Montreal Cognitive Assessment (MoCA) score of 16 or greater. Neuropsychiatric Inventory Questionnaire (NPI-Q) administered at initial visit. In addition to a subgroup with mild or no NPS (relative frequency, 50%), three empirically-based subgroups of NPS were identified: 1) an "affect" or "negative mood" subgroup (27%) with depression, anxiety, apathy, nighttime disturbance, and change in appetite; 2) a "hyperactive" subgroup (14%) with agitation, irritability, and disinhibition; and 3) a "psychotic with additional severe NPS" subgroup (9%) with the highest risk of delusions and hallucinations, as well as highest risk of all other NPS. Each of these three subgroups had significantly higher risk of converting to dementia than the "mild NPS" class, with the "psychotic with additional severe NPS" subgroup possessing a 64% greater risk. The subgroups did not differ in their risks of death without dementia. Our findings of three NPS subgroups in MCI characterized by affect, hyperactive, or psychotic features are largely consistent with a previous 3-factor model of NPS found in a demented population. The consistency of these findings across studies and samples, coupled with our results on the associated risks of converting to dementia, suggests that the NPS structure is robust, and warrants further consideration in classification models of MCI.

Deprescribing process in demented patients: What is the rationale?

Polypharmacy is rather a rule than an exemption in the elderly. This applies also to the demented population, whether they live in private homes or in nursing homes. The application of multiple drugs increases the risk to develop delirium, to promote falling and to hasten cognitive decline, What can be done to reduce these risks? First of all, drugs should be given on the basis of an appropriate assessment. Pain e.g. may be misunderstood as challenging bevhaviour. Side affects might be misunderstood as newly occuring symptoms. Drugs should be prescribed with a written protocol, what the drug is expected to do. If this does not occur, the drug should be deprescribed. In addition, antidepressants should be deprescribed. Many demented patients receive more than two of them, mostly for years. Depresciption follows the evidence, that antidepressants are not much helpful in dementia. They may induce hyponatriamia, too. The deprescription of benzodiazepines requires patience and a long tapering-out. And overall, what about the antipsychotics? They shall be given at a minimum dosage and duration. That means, that drug pauses should be established regularly. And finally, what about the antibiotics, antihypertensive drugs and more? Having in mind, that severe dementia is mostly a state, where the priniciples of palliative medicine should be applied, also many of these drugs can be deprescribed.DisclosureNo significant relationships.

Vortioxetine use in demented patients

AbstractBackgroundVortioxetine is a new antidepressant with a distinctive pharmacological profile. It combines inhibition of serotinine transporter with modulation of various serotonine receptors. Its cognitive benefit in adults depressed patients has been previously demonstrated. There is evidence of its antidepressant effect in the elderly but not specifically of its utiliity in demented population. Effects in a group of different types of dementia patients are showed and hypothesis of its efficacy based on its properties are proposed.MethodA retrospective study was conducted. Eligible patients were those observed in our memory outpatient clinics during 2019. All patients had behavioural symptoms (BPSD), Main symptoms were anxiety, apathy, irritability and restlessness. Thirty‐two patients were reviewed.Result32 patients were included, of which 60,6% were women. Median age was 74 years (SD 12,070). Alzheimer´s disease was the most common type of dementia (51.5%), as expected. Median dose of vortioxetine used was 10 mg/day. Symptoms that led to vortioxetine initiation were anxiety (57,6%), apathy (48,5%) and irritability (42,4%). Depreesion was present in 33,3% of cases, but anxiety and apathy were the symptoms that improved the most after vortioxetine introduction. 60,6% of patients were concomitantly treated with antidementia drugs, mostly Rivastigmine (30,3%). Coexistent benzodiazepines or antipsychotics use in patients treated with vortioxetine was not significant (24,2% and 21,2% each one). No side effects were reported.ConclusionVortioxetine may be an useful option for BPSD in dementia population. Available evidence indicates that target receptors for vortioxetine play an important role in brain networks, and this could explain its efficacy regardless the antidepressive effect. No safety concerns were found in this group of patients with doses from 10 to 20 mg/day according with tolerability profile already described. Further studies with a more extensive number of eligible patients and prospective design are needed.

Neuropharmacology of the Neuropsychiatric Symptoms of Dementia and Role of Pain: Essential Oil of Bergamot as a Novel Therapeutic Approach.

Aging of the population makes of dementia a challenge for health systems worldwide. The cognitive disturbance is a serious but not the only issue in dementia; behavioral and psychological syndromes known as neuropsychiatric symptoms of dementia remarkably reduce the quality of life. The cluster of symptoms includes anxiety, depression, wandering, delusions, hallucinations, misidentifications, agitation and aggression. The pathophysiology of these symptoms implicates all the neurotransmitter systems, with a pivotal role for the glutamatergic neurotransmission. Imbalanced glutamatergic and GABAergic neurotransmissions, over-activation of the extrasynaptic N-methyl-D-aspartate (NMDA) receptors and alterations of the latter have been linked to the development of neuropsychiatric symptoms experienced by almost the entire demented population. Drugs with efficacy and safety for prevention or long term treatment of these disorders are not available yet. Aromatherapy provides the best evidence for positive outcomes in the control of agitation, the most resistant symptom. Demented patients often cannot verbalize pain, resulting in unrelieved symptoms and contributing to agitation. Bergamot essential oil provides extensive preclinical evidence of analgesic properties. Incidentally, the essential oil of bergamot induces anxyolitic-like effects devoid of sedation, typical of benzodiazepines, with a noteworthy advantage for demented patients. These data, together with the reported safety profile, form the rational basis for bergamot as a neurotherapeutic to be trialed for the control of behavioral and psychological symptoms of dementia.

A pilot study and brief overview of rehabilitation via virtual environment in patients suffering from dementia.

Dementia is one of the increasing problems of modern societies. The immediate cure is not a possible solution, at least at the moment, but science has found a number of new ways to retard and under specific conditions to halt its development. A potential, and constantly evolving scientific field is the use of Computerized Cognitive Rehabilitation (CCR) and Virtual Environments (Vr.E). According to the existing literature, subjecting patients to various neuro-rehabilitative conditions within 3D virtual environments, allows them to obtain significant therapeutic benefits in which both transferability and durations over time are observed, in relation to the training period of the intervention. In the present study we examine whether "Serious Games (SGs)" - (learning and rehabilitating games in virtual and augmented reality) - have utilitarian value in the field of cognitive neurorehabilitation, concerned with demented population. For research purposes, we have conducted a number of case studies, based on 10 elderly patients, suffering from moderate or mild severity impairment of higher cortical functions, attributed to various types of dementias (Vascular, Alzheimer's disease, DLB dementia and mixed dementia). Each participant underwent rehabilitative intervention through our SG for a total of 10 hours within 4-5 weeks period. At the end of the cognitive rehabilitation program, patients' performance was assessed based in standard neuropsychological tests (measuring: working memory, memory retention, attention, problem solving, rigid thinking and executive function) and the results were compared with measurements taken before, during, and at the end of the intervention. Our experimental hypothesis states that there will be a significant difference between the results of cognitive performance of the patients between the pre- and post- rehabilitative period, consequential of the Interactive Computer-based Training (ICT). In conclusion, a review and brief analysis of the relevant literature was carried out in order to investigate the specification of potentially beneficial variables and to appreciate as much as possible the multifactorial causes related to this particular rehabilitation method of the corresponding suffering population. The ultimate purpose of our research is the design and creation of a prospective interactive cognitive rehabilitation training SG, able to combine both the neuro-rehabilitative character of the controlled virtual environment, as well as the potential realism that is also attributed to it (factual validity under high experimental realism). The results showed a relative improvement in the total of the cognitive variables under consideration after the completion of the neuro-rehabilitative program, while a parallel review of the literature on the subject revealed methodological considerations similar to those of the present study.

Femoral Fractures in Demented Population

Femoral Fractures in Demented Population

CONSTRUCTIONAL PRAXIS PERFORMANCE ON PAPER VERSUS ELECTRONIC TABLET COLLECTION

Importance of computer-based tests has becoming increasingly relevant in clinical trials due to the greater availability of computers. However, the debate over equivalency continues and many trials have been reluctant to adopt technology. In many cases the move from paper to the computer testing, the equivalency of the two methodologies has been assumed. Research indicates that this may not be the case. While results of many comparison studies have shown no difference, however some results have been mixed. A randomized trial to assess the impact of the change in administration method on specific elements of two standard measurement scales was conducted. In this study, 53 healthy normal men and women aged 23-59 were asked to complete the constructional praxis items of the ADAS-Cog and the copying item on the Mini Mental State Exam (MMSE). Subjects were randomized into one of four groups defined by which modality (paper and pencil vs tablet computer) and which task (MMSE or ADAS-cog) they would be asked to perform first. Instructions for all tasks were read verbatim. All drawings were scored by two independent raters. Both the paper and pencil and the tablet techniques produced similar levels of rater agreement. The rater reliability was 63%; Kappa = 21%; r = .69. Both raters scored the drawings consistently within +/-.05 = 95%). Paper and pencil scores were significantly higher for both the MMSE interlocking pentagon drawing: t (53) = 2.016, p < .05; for the four ADAS-Cog drawings: t (53) = 2.89, p < .01. Subjects were able to copy designs with more accuracy on paper as compared to the tablet. Completing praxis tasks on a tablet computer resulted in significantly lower scores as compared to paper and pencil techniques. These methodologies do not seem to be equivalent. The subjects in this study were young, healthy normals and results with an older, demented population with less experience using tablet technology would presume to be increasingly detrimental. More research is needed to fully understand the impact of tablet technology on traditional assessment of cognition in Alzheimer’s disease.

High Risk of Dementia in Ventricular Enlargement with Normal Pressure Hydrocephalus Related Symptoms1.

Differential diagnosis of ventricular enlargement with normal pressure hydrocephalus (NPH) related symptoms is challenging. Patients with enlarged ventricles often manifest cognitive deterioration but their long-term outcome is not well known. We aim to evaluate long-term cognitive outcome in patients with enlarged ventricles and clinically suspected NPH. A neurologist and a neurosurgeon clinically evaluated 468 patients with enlarged ventricles and suspected NPH using radiological methods, intraventricular pressure monitoring, and frontal cortical brain biopsy. The neurologist confirmed final diagnoses after a median follow-up interval of 4.8 years. Altogether, 232 patients (50%) with enlarged ventricles did not fulfill the criteria for shunt surgery. The incidence of dementia among patients with enlarged ventricles, and at least one NPH-related symptom with adequate follow-up data (n = 446) was high, varying from 77 (iNPH, shunt responders) to 141/1000 person-years (non-shunted patients with enlarged ventricles). At the end of the follow-up, 59% of all these patients were demented. The demented population comprised 73% of non-shunted patients with enlarged ventricles, 63% of shunted iNPH patients that did not respond to treatment, and 46% of iNPH patients that were initially responsive to shunting. The most common cause of dementia was Alzheimer's disease (n = 94, 36%), followed by vascular dementia (n = 68, 26%). One-half of patients with enlarged ventricles and clinically suspected NPH were not shunted after intraventricular pressure monitoring. Dementia caused by various neurodegenerative diseases was frequently seen in patients with ventricular enlargement. Thus, careful diagnostic evaluation in collaboration with neurologists and neurosurgeons is emphasized.

Caloric supplements for the elderly.

Malnutrition and weight loss have serious consequences in older adults. The use of caloric supplementation may provide nutritional and functional benefits in this population. This article reviews the recent literature on oral nutritional supplementation (ONS) in the elderly. Inadequate caloric intake is a factor consistently associated with weight loss, and use of ONS can increase weight in community-dwelling as well as acute and chronically ill elders. ONS does not improve function or mortality in the general elderly population but has shown benefits in those who are frail or malnourished. Improvement in functional status and mortality was not seen in postacute, hip fracture, or demented populations. At this time, research does not clearly show that providing ONS to unselected groups of older adults results in functional or mortality benefits; however, a small increase in body weight is a likely outcome.

Cyclooxygenase-1-Dependent Prostaglandins Mediate Susceptibility to Systemic Inflammation-Induced Acute Cognitive Dysfunction

Systemic inflammatory events often precipitate acute cognitive dysfunction in elderly and demented populations. Delirium is a highly prevalent neuropsychiatric syndrome that is characterized by acute inattention and cognitive dysfunction, for which prior dementia is the major predisposing factor and systemic inflammation is a frequent trigger. Inflammatory mechanisms of delirium remain unclear. We have modeled aspects of delirium during dementia by exploiting progressive neurodegeneration in the ME7 mouse model of prion disease and by superimposing systemic inflammation induced by the bacterial endotoxin lipopolysaccharide (LPS). Here, we have used this model to demonstrate that the progression of underlying disease increases the incidence, severity, and duration of acute cognitive dysfunction. This increasing susceptibility is associated with increased CNS expression of cyclooxygenase (COX)-1 in microglia and perivascular macrophages. The COX-1-specific inhibitor SC-560 provided significant protection against LPS-induced cognitive deficits, and attenuated the disease-induced increase in hippocampal and thalamic prostaglandin E2, while the COX-2-specific inhibitor NS-398 was ineffective. SC-560 treatment did not alter levels of the proinflammatory cytokines interleukin (IL)-1β, tumor necrosis factor-α, IL-6, or C-X-C chemokine ligand 1 in blood or brain, but systemic IL-1RA blocked LPS-induced cognitive deficits, and systemic IL-1β was sufficient to induce similar deficits in the absence of LPS. Furthermore, the well tolerated COX inhibitor ibuprofen was protective against IL-1β-induced deficits. These data demonstrate that progressive microglial COX-1 expression and prostaglandin synthesis can underpin susceptibility to cognitive deficits, which can be triggered by systemic LPS-induced IL-1β. These data contribute to our understanding of how systemic inflammation and ongoing neurodegeneration interact to induce cognitive dysfunction and episodes of delirium.

Malnutrition in demented care home residents

Introduction.– People with dementia have been identified to be at high riskofmalnutrition, especially if they reside in carehomes. The aim of this studywas to investigate the prevalence and characteristics ofmalnutrition in demented care homepatients longitudinally. Methods.– This study is part of the annual Dutch National Prevalence Measurement of Care Problems conducted by Maastricht University (LPZ).Onpatient level amongstother, demographicdata, (co)morbidity, care dependency and the prevalence aswell as other relevant indicators of nutritional care are measured. The diagnosis of malnutrition is determined by low BMI, undesired weight loss and low nutritional intake. Results.– Seventy-five thousand three hundred and ninety-nine residents (mean age 84) from 670 care home organizations participated over a period of 4 years. Sixty percent of the residents was care dependent and 32,6% suffered from dementia. When discriminating between demented (D) and non-demented (ND) residents, demented residents were overall significantly more care dependent (D 43,2, ND 85,2) P<0.001) and more often malnourished than non-demented residents (D26,7, ND18.0) P<0.001). Looking to the overall care home population and taking into account several care improvement programmes the prevalence of malnutrition shows a gradual but progressive decline over the years, while the malnutrition prevalence in the demented care home population remains rather stable. Conclusions.– That malnutrition prevalence in the demented care home population, despite increasing nutritional attention in daily practice, remains the same over the years, raises the question whether the phenomenon of Alzheimer cachexia should receive renewed scientific attention.

Systematic reviews on behavioural and psychological symptoms in the older or demented population

IntroductionBehavioural and psychological symptoms of dementia (BPS) include depressive symptoms, anxiety, apathy, sleep problems, irritability, psychosis, wandering, elation and agitation, and are common in the non-demented and demented population.MethodsWe have undertaken a systematic review of reviews to give a broad overview of the prevalence, course, biological and psychosocial associations, care and outcomes of BPS in the older or demented population, and highlight limitations and gaps in existing research. Embase and Medline were searched for systematic reviews using search terms for BPS, dementia and ageing.ResultsThirty-six reviews were identified. Most investigated the prevalence or course of symptoms, while few reviewed the effects of BPS on outcomes and care. BPS were found to occur in non-demented, cognitively impaired and demented people, but reported estimates vary widely. Biological factors associated with BPS in dementia include genetic factors, homocysteine levels and vascular changes. Psychosocial factors increase risk of BPS; however, across studies and between symptoms findings are inconsistent. BPS have been associated with burden of care, caregiver's general health and caregiver depression scores, but findings are limited regarding institutionalisation, quality of life and disease outcome.ConclusionsLimitations of reviews include a lack of high quality reviews, particularly of BPS other than depression. Limitations of original studies include heterogeneity in study design particularly related to measurement of BPS, level of cognitive impairment, population characteristics and participant recruitment. It is our recommendation that more high quality reviews, including all BPS, and longitudinal studies with larger sample sizes that use frequently cited instruments to measure BPS are undertaken. A better understanding of the risk factors and course of BPS will inform prevention, treatment and management and possibly improve quality of life for the patients and their carers.

Non-Steroidal Anti-Inflammatory Drugs and Cognitive Function: Are Prostaglandins at the Heart of Cognitive Impairment in Dementia and Delirium ?

Studies of non-steroidal anti-inflammatory drugs (NSAIDs) in rheumatoid arthritis imply that inflammation is important in the development of Alzheimer’s disease (AD). However, these drugs have not alleviated the symptoms of AD in those who have already developed dementia. This suggests that the primary mediator targeted by these drugs, PGE2, is not actively suppressing memory function in AD. Amyloid-β oligomers appear to be important for the mild cognitive changes seen in AD transgenic mice, yet amyloid immunotherapy has also proven unsuccessful in clinical trials. Collectively, these findings indicate that NSAIDs may target a prodromal process in mice that has already passed in those diagnosed with AD, and that synaptic and neuronal loss are key determinants of cognitive dysfunction in AD. While the role of inflammation has not yet become clear, inflammatory processes definitely have a negative impact on cognitive function during episodes of delirium during dementia. Delirium is an acute and profound impairment of cognitive function frequently occurring in aged and demented patients exposed to systemic inflammatory insults, which is now recognised to contribute to long-term cognitive decline. Recent work in animal models is beginning to shed light on the interactions between systemic inflammation and CNS pathology in these acute exacerbations of dementia. This review will assess the role of prostaglandin synthesis in the memory impairments observed in dementia and delirium and will examine the relative contribution of amyloid, synaptic and neuronal loss. We will also discuss how understanding the role of inflammatory mediators in delirious episodes will have major implications for ameliorating the rate of decline in the demented population.

Malnutrition in an elderly demented population living at home

Malnutrition is a frequent complication for elderly demented patients even if they live at their own home with the assistance of a caregiver. The present study evaluates nutritional characteristics of a population of 130 non-institutionalized demented patients. The results show that the mini nutritional assessment (MNA) total score is inversely related with the neuro-psychiatric inventory (NPI) score and that the level of cognitive impairment is related with the nutritional status: patients with mild cognitive impairment (MCI) showed a mean MNA score higher than patients affected by Alzheimer's disease (AD) or vascular dementia (VaD). Moreover, patients depressed, with hallucinations or with behavioral disturbs are more exposed to underfeeding than only cognitively impaired subjects. In conclusion, an appropriated evaluation of nutritional status could prevent and treat nutrition-related problems even in the elderly demented patients living at home.

Severely stressful events and dementia: A study of an elderly Greek demented population

There is evidence that proneness to experience psychological distress is a risk factor for Alzheimer's disease (AD). In the present study, an attempt is made to examine the possible association between stressful events and cognitive impairment of the elderly, based on a sample of 1271 patients (500 male, 771 female) diagnosed with dementia according to the DSM-IV criteria and 140 age- and gender-matched cognitive healthy subjects. All patients were recruited from the Memory and Dementia Outpatient Clinic of the 3rd University Department of Neurology in “G. Papanikolaou” General Hospital, Thessaloniki, and examined over a period of 7 years. The majority of patients reported a history of a stressful event before the onset of dementia ( n = 990, 77.9%), while fewer patients reported insidious onset ( n = 281, 22.1%). The most frequently reported event was the announcement of a life threatening disease ( n = 472, 37.1%), followed by problems within the family ( n = 157, 12.4%), spouse death ( n = 100, 7.9%), death of a sibling or other beloved person ( n = 77, 6.1%). Only 55% of the control subjects encountered stressful events, which is significantly different from the percentage of the study group. Our results demonstrate that a stressful event in the elderly could potentially trigger a cognitive decline.

HAI Seattle: Does Brain Amyloid Correlate With Sagging Metabolism?

7 May 2009. Slowly but surely, Alzheimer’s disease (AD) researchers are coming to grips with the possibility that some experimental therapies could be failing because they have been tested in people whose disease is too advanced. The field’s focus is therefore shifting toward earlier diagnosis, even prevention. Reflecting the new emphasis, this year’s Human Amyloid Imaging (HAI) meeting drew some 150 researchers to Seattle on 24 April to share and discuss the latest in brain imaging, which will be crucial for identifying at-risk individuals and helping them resist impending AD. A growing literature documents elevated brain amyloid in a substantial proportion of seniors who appear cognitively normal. This finding has stirred up new questions – not the least of which is whether this amyloid foretells future AD. That issue remains to be clearly resolved. However, ask any number of researchers at the HAI meeting, and chances are they’ll reckon that having a head full of amyloid is worrisome. “There was consensus that among normal people, amyloid is associated with changes in the brain,” said Reisa Sperling of Brigham and Women’s Hospital in Boston, Massachusetts, in a conversation with this reporter during the poster session. “That might be very valuable in identifying individuals who will get preventive treatment. If we can identify people who are going to get AD a decade later, we have a window to treat people before they get symptoms,” Sperling noted. To address that “if,” HAI’s opening session explored the relationship between amyloid deposition and functional changes in the brain. Each can be measured by positron emission tomography (PET) – the former with radiolabeled amyloid tracers, the latter using fluorodeoxyglucose (FDG) metabolism. Previous live brain imaging with the PET tracer Pittsburgh Compound-B (PIB) has revealed elevated Aβ in 10 to 30 percent of cognitively normal elderly, and has shown that amyloid load tracks longitudinally with whole brain atrophy. Elizabeth Mormino, a Ph.D. student in Bill Jagust’s lab at the University of California, Berkeley, addressed whether high amyloid deposition also coincides with reduced glucose metabolism, i.e., portends a loss of brain function. In her study, normal seniors and AD patients received magnetic resonance imaging (MRI) to track brain atrophy, FDG-PET to measure glucose metabolism, and PIB-PET to detect amyloid load. Based on a published method for defining cut-offs, all AD patients in Mormino’s group were classified as “high PIB,” as were 11 of 40 normal participants. Among the remaining healthy seniors, 21 came up as having “low PIB,” and the rest fell into an intermediate zone. The subjects were also grouped according to FDG metabolism. Within the cognitively normal group, high PIB was associated with reduced glucose metabolism, albeit with FDG-PET patterns less pronounced than in demented populations. Among those with high PIB, lower glucose metabolism also correlated with worse episodic memory. This trend did not hold for the people with low PIB. All told, the data suggest that elevated PIB uptake in normal seniors may suggest preclinical AD, Mormino said. Ann Cohen, a postdoctoral fellow in Bill Klunk’s group at the University of Pittsburgh, Pennsylvania, also reported a link between amyloid load (PIB-PET) and cerebral metabolism (FDG-PET). In her study of 51 healthy seniors, 38 had high PIB uptake and 13 fell into the low-PIB group. Cohen used software