Dementia Of Alzheimer's Type Group Research Articles

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.

Oral environment and cerebral blood flow in patients with neurodegenerative dementia: comparison of Alzheimer type dementia and dementia with Lewy bodies.

The number of patients with dementia is increasing worldwide. Modifying risk factors may significantly reduce the prevalence and cost of dementia. The number of remaining teeth, occlusal force, denture use, and periodontal disease status are associated with the risk of developing dementia. The oral environment may be a risk factor for dementia. This study aimed to investigate the association between the oral environment and cerebral blood flow in patients with mild cognitive impairment and dementia (either Alzheimer type dementia (ATD) or dementia with Lewy bodies (DLB)). We aimed to identify differences in the oral environment according to the underlying neurodegenerative disease. The participants were 25 patients with ATD and 25 patients with DLB who visited the Department of Dementia and Geriatric Medicine, Kanagawa Dental University Hospital. Patients were diagnosed with ATD and DLB by well-trained specialists certified by the Japanese Dementia Society and categorised as Level 3 or 4 by the Functional Assessment Staging of Alzheimer Disease scale. The correlation between oral environment (number of teeth, periodontal tissue, and oral function) and cerebral blood flow in each brain area calculated by single photon emission computed tomography was examined. The DLB group showed a significant correlation between masticatory performance and cerebral blood flow in some areas, while no such correlation was observed in the ATD group. Significant correlations were found between periodontal pocket depth and bleeding on probing and cerebral blood flow in some areas in both groups, although the correlation was considerable in the ATD group. The results of this study suggest that the association between changes in the oral environment and cerebral blood flow may differ among patients with ATD and DLB, depending on the underlying causative disease.

Evaluation of retinal and choroidal changes in patients with Alzheimer's type dementia using optical coherence tomography angiography.

To evaluate the changes in fundus parameters in patients with Alzheimer's type dementia (ATD) using optical coherence tomography angiography (OCTA), to record flash electroretinograms (ERG) using the RETeval system and to explore changes in retinal function. Twenty-nine patients with ATD and 26 age-matched normal subjects were enrolled. All subjects underwent OCTA scans to analyse the superficial retinal vessel parameters in the macular area, including the vessel length density, the vessel perfusion density and the area of foveal avascular zone (FAZ), as well as the choroidal thickness. The differences between the patients with ATD and the normal control group were compared and explored the relevant factors affecting vessel parameters. We also recorded the flash ERGs using the RETeval system and intended to explore changes in retinal function by analysing the ERG image amplitude in patients with ATD. The vessel parameters [P vessel length density=0.005 and P vessel perfusion density=0.006) and average choroid thickness (P<0.001) in the macular area of the ATD group was less than the control group. The FAZ area was statistically significantly enlarged in the ATD group (P<0.001). These parameters were correlated with the Mini-Mental State Examination (MMSE) score and the Montreal Cognitive Assessment (MoCA). Patients with ATD exhibit decreases in the parameters associated with fundus. In addition, these indicators significantly correlate with the MMSE score and the MoCA score. OCTA may be an adjunct tool with strong potential to track changes in the diagnosis and monitoring the progression of the disease.

Quantification of Oscillatory Shear Stress from Reciprocating CSF Motion on 4D Flow Imaging.

Oscillatory shear stress could not be directly measured in consideration of direction, although cerebrospinal fluid has repetitive movements synchronized with heartbeat. Our aim was to evaluate the important of oscillatory shear stress in the cerebral aqueduct and foramen magnum in idiopathic normal pressure hydrocephalus by comparing it with wall shear stress and the oscillatory shear index in patients with idiopathic normal pressure hydrocephalus. By means of the 4D flow application, oscillatory shear stress, wall shear stress, and the oscillatory shear index were measured in 41 patients with idiopathic normal pressure hydrocephalus, 23 with co-occurrence of idiopathic normal pressure hydrocephalus and Alzheimer-type dementia, and 9 age-matched controls. These shear stress parameters at the cerebral aqueduct were compared with apertures and stroke volumes at the foramen of Magendie and cerebral aqueduct. Two wall shear stress magnitude peaks during a heartbeat were changed to periodic oscillation by converting oscillatory shear stress. The mean oscillatory shear stress amplitude and time-averaged wall shear stress values at the dorsal and ventral regions of the cerebral aqueduct in the idiopathic normal pressure hydrocephalus groups were significantly higher than those in controls. Furthermore, those at the ventral region of the cerebral aqueduct in the idiopathic normal pressure hydrocephalus group were also significantly higher than those in the co-occurrence of idiopathic normal pressure hydrocephalus with Alzheimer-type dementia group. The oscillatory shear stress amplitude at the dorsal region of the cerebral aqueduct was significantly associated with foramen of Magendie diameters, whereas it was strongly associated with the stroke volume at the upper end of the cerebral aqueduct rather than that at the foramen of Magendie. Oscillatory shear stress, which reflects wall shear stress vector changes better than the conventional wall shear stress magnitude and the oscillatory shear index, can be directly measured on 4D flow MR imaging. Oscillatory shear stress at the cerebral aqueduct was considerably higher in patients with idiopathic normal pressure hydrocephalus.

Machine‐learning‐based Alzheimer's disease dementia score using structural MRI neurodegeneration patterns: Independent validation on ADNI, AIBL, OASIS and MIRIAD

AbstractBackgroundBiomarkers for dementia of Alzheimer's type (DAT) are sought to facilitate accurate prediction of the disease onset, ideally predating the onset of cognitive deterioration. T1‐weighted magnetic resonance imaging (MRI) is a commonly used neuroimaging modality for measuring brain structure in‐vivo, potentially providing information enabling the design of biomarkers for DAT.MethodWe propose a novel biomarker using structural MRI volume‐based features to compute a similarity score for the individual's structural patterns relative to those observed in the DAT group. We employed ensemble learning framework that combines structural features in most discriminative ROIs to create an aggregate measure of neurodegeneration in the brain. This classifier is trained on 423 stable normal control (NC) and 330 DAT subjects, where clinical diagnosis is likely to have the highest certainty, and then validated on several independent datasets for subjects at various stages along the longitudinal trajectory from NC to DAT.ResultIndependent validation on 8834 un‐seen images from ADNI, AIBL, OASIS, MIRIAD Alzheimer's disease (AD) databases showed promising potential to predict the development of DAT depending on the time‐to‐conversion (TTC). Classification performance on stable versus progressive mild cognitive impairment (MCI) groups achieved an AUC of 0.81 for TTC of 6 months, and 0.73 for TTC of up to 7 years, achieving the state‐of‐the‐art results.ConclusionWe propose and validate a novel ensemble‐learning based biomarker score based on 3D topographic patterns of MRI‐observed structural volumetric features. The output score, indicating similarity to patterns seen in DAT, provides an intuitive measure of how closely the individual's brain features resemble the DAT group. This score can be used for assessing the presence of AD structural atrophy patterns in normal aging and MCI stages, as well as monitoring the progression of the individual's brain along the disease course.

Using machine learning to quantify structural MRI neurodegeneration patterns of Alzheimer's disease into dementia score: Independent validation on 8,834 images from ADNI, AIBL, OASIS, and MIRIAD databases.

Biomarkers for dementia of Alzheimer's type (DAT) are sought to facilitate accurate prediction of the disease onset, ideally predating the onset of cognitive deterioration. T1‐weighted magnetic resonance imaging (MRI) is a commonly used neuroimaging modality for measuring brain structure in vivo, potentially providing information enabling the design of biomarkers for DAT. We propose a novel biomarker using structural MRI volume‐based features to compute a similarity score for the individual's structural patterns relative to those observed in the DAT group. We employed ensemble‐learning framework that combines structural features in most discriminative ROIs to create an aggregate measure of neurodegeneration in the brain. This classifier is trained on 423 stable normal control (NC) and 330 DAT subjects, where clinical diagnosis is likely to have the highest certainty. Independent validation on 8,834 unseen images from ADNI, AIBL, OASIS, and MIRIAD Alzheimer's disease (AD) databases showed promising potential to predict the development of DAT depending on the time‐to‐conversion (TTC). Classification performance on stable versus progressive mild cognitive impairment (MCI) groups achieved an AUC of 0.81 for TTC of 6 months and 0.73 for TTC of up to 7 years, achieving state‐of‐the‐art results. The output score, indicating similarity to patterns seen in DAT, provides an intuitive measure of how closely the individual's brain features resemble the DAT group. This score can be used for assessing the presence of AD structural atrophy patterns in normal aging and MCI stages, as well as monitoring the progression of the individual's brain along with the disease course.

P2‐459: EXECUTIVE CONTROL DEFICITS AS AN EARLY DIAGNOSTIC TO DEMENTIA OF ALZHEIMER'S TYPE

Dementia of Alzheimer's type (DAT) is marked by executive control deficit which allows monitoring and resolution of conflict between different stimuli and responses. The possible underlying cause of executive control deficit may be the dysfunction of inhibitory mechanisms due to the reduced availability of attentional resources early in the course of the disease. Literature have evidenced of deficit in executive control as an early diagnosis to DAT before memory impairment which indicate that as the disease progresses early onset of executive deficit may lead to conversion of patient with amnestic mild cognitive impairment (aMCI) to DAT. The early diagnosis of DAT may reduce its devastating effects. The current research converging on executive control function as an earlier indicator of DAT in patients with mild cognitive impairment (MCI) at preclinical stage. The present study examined the executive control in attentional function among people with aMCI, mild and moderate levels of DAT compared with age-matched healthy controls (HC) by using the attentional network paradigm. The flanker paradigm of Attentional Network Task (ANT) was used to assess executive control effect. The reaction time and performance accuracy of the participants were recorded. The result showed that the inhibitory control function was less efficient in DAT as compared to HC. The aMCI group differed to mild and moderate DAT in response time measure. Further, the post-hoc analysis showed significantly slower performance of aMCI and mild DAT with HC group, the performance of patients with mild DAT was also significantly faster than moderate DAT, however, it was seen that aMCI group showed a non-significant difference with mild DAT group on executive control performance. This non-significant result suggests that the few patients with aMCI who performed significantly different at congruent and incongruent condition may progresses to DAT in comparison to those who don't face difficulty in resolving conflict among responses. The impairment in executive control network in aMCI revealed by difference in performance of response inhibition task could be proven as an early diagnostic to DAT which could further delay the onset of symptoms.

A validity study of the Working Group's Autobiographical Memory Test for individuals with moderate to severe intellectual disability

The purpose of the present study was to investigate the validity of the Working Group's Autobiographical Memory Test as a dementia screening tool for individuals with moderate to severe intellectual disabilities (ID). Twenty-one participants with Dementia of Alzheimer's Type (DAT) and moderate to severe ID and 42 controls with similar levels of ID were tested. The majority were re-tested one year after the initial evaluation. The DAT group scored considerably lower than the control group on the initial evaluation. The controls with DS exhibited a considerable decline on the follow-up evaluation whereas other participants exhibited little changes. This demonstrates an insignificant overall difference between the DAT group and the control group on the follow-up evaluation. Virtually all participants exhibited the same scores on 3 out of 6 test items and the percentage of participants who correctly answered the remaining three test items were not significantly different from the DAT or control groups. In conclusion, the Working Group's Autobiographical Memory Test may be useful as a dementia screening tool for individuals with moderate to severe ID from DS when validated with a large sample size study. However, it is questionable whether this test is a reliable dementia screening tool for individuals with moderate to severe ID from non-DS etiologies. This test has a significant psychometric weakness because of the restricted score variability among the participants.

A validity study of the Working Group's Orientation Test for individuals with moderate to severe intellectual disability

Decline in orientation skill has been reported as an early indicator of Dementia of Alzheimer's Type (DAT). Orientation subtest of the Working Group's Test Battery was examined whether this test is useful to identify DAT patients among adults with moderate to severe ID. Sixteen DAT patients and 35 non-demented normal controls with moderate to severe ID were followed for a year using Orientation Test. The scores on the baseline evaluation and the longitudinal changes over a 1-year period among the DAT patients and the normal controls were compared. The effects of age and etiologies of ID on the performance of Orientation were also examined. The DAT group's score was significantly poorer than that of the normal control group on the baseline evaluation. The score changes over the 1-year period were not significantly different between the groups. However, there was a considerable overlap between the score distributions of the two groups. The effects of age and etiologies of ID on the performance of Orientation were not significant. Screening DAT patients based only on the score of the Orientation Test of the Working Group's Test Battery may produce a large number of diagnostic errors.

Apathy Symptom Profile and Behavioral Associations in Frontotemporal Dementia vs Dementia of Alzheimer Type

Apathy is a common and significant problem in patients with dementia, regardless of its cause. Observations about frontosubcortical circuit syndromes indicate that apathy may have affective, behavioral, or cognitive manifestations. To explore whether the apathy manifested in frontotemporal dementia (FTD), with its predominantly anterior brain neuropathologic features, differs from the apathy in dementia of Alzheimer type (DAT), with its predominantly hippocampal- and temporoparietal-based neuropathologic features, and to determine whether other behavioral disturbances reported in frontosubcortical circuit syndromes correlate with apathy. Analyses included individual items within Neuropsychiatric Inventory subscale items. Items of the apathy/indifference subscale were designated by consensus as affective (lacking in emotions), behavioral (inactive, chores abandoned), or cognitive (no interest in the activities of others). Proportions of correlated nonapathy Neuropsychiatric Inventory items were calculated. Several neurology specialty clinics contributed to our data set. A total of 92 participants with FTD and 457 with DAT. The Neuropsychiatric Inventory was analyzed. Apathy was more prevalent in patients with FTD than in those with DAT, but when present, the specific apathy symptoms associated with both types of dementia were rarely restricted to 1 of the 3 domains of apathy. Dysphoria concurrent with apathy was unique to the DAT group and negatively correlated in the FTD group. Participants with affective apathy more frequently copresented with an orbital frontosubcortical syndrome in FTD (impulsivity and compulsions). Affective apathy also copresented with uncooperative agitation, anger, and physical agitation in both types of dementia. Apathy is common in patients with FTD and DAT, although it is more common in those with FTD. When present, it usually involves changes in affect, behavior, and cognition. It is associated with behaviors that have previously been shown to affect patient safety, independence, and quality of life.

CSF cholinesterase in early-onset and late-onset Alzheimer's disease and multi-infarct dementia of Chinese patients.

Using Ellman spectrophotometric method we measured the total cholinesterase (ChE) activity in lumbar cerebrospinal fluid (CSF) of 13 persons without neurological disorder, 10 non-demented patients with cerebral infarcts, 17 patients with dementia of Alzheimer's type (DAT) (11 presenile, 6 senile cases), 10 patients with multi-infarct dementia (MID), 1 patient with Parkinson's disease associated with dementia. The ChE activity in CSF was significantly lower in the DAT group compared with age-matched control subjects (p < 0.001). This paper also analyses the possibility of using CSF ChE activity as a marker of DAT, and the relationships between its level of activity and the age of the patient at onset, stage of illness and severity of dementia as well as discrepancies in the data published so far. Previous work has shown that ChE activity in the brain tissue and CSF of MID is normal: therefore, if low ChE activity is found in the CSF of MID patients, as was obtained in 8 out of 10 cases in our series, the diagnosis of mixed dementia should be considered.

Executive dysfunction and its association with personality and behaviour changes in the development of Alzheimer's disease in adults with Down syndrome and mild to moderate learning disabilities

Recent research suggests that preclinical Alzheimer's disease (AD) in people with Down syndrome (DS) is characterized by changes in personality/behaviour and executive dysfunction that are more prominent than deterioration in episodic memory. This study examines the relationship between executive dysfunction and the clinical and preclinical features of AD in DS. To determine the specificity of this relationship, performance on executive function (EF) measures is contrasted with performance on memory measures. One hundred and three people with DS (mean age 49 years, range 36-72) with mild to moderate learning disabilities (LD) took part. Dementia diagnosis was based on the CAMDEX informant interview conducted with each participant's main carer. Reported changes in personality/behaviour and memory were recorded. Participants completed six EF and six memory measures (two of which also had a strong executive component) and the BPVS (as a measure of general intellectual ability). First, performance was compared between those with and without established dementia of Alzheimer's type (DAT), controlling for age and LD severity using ANCOVA. Next, the degree to which informant-reported changes predicted cognitive test performance was examined within the non-DAT group using multiple regression analyses. The DAT group (N=25) showed a consistent pattern of impaired performance relative to the non-DAT group (N=78), across all measures. Within the non-DAT group, number of informant-reported personality/behaviour changes was a significant predictor of performance on two EF and two 'executive memory' tests (but not on episodic memory tests). Informant-reported memory changes, however, were associated with impaired performance on a delayed recall task only. These findings provide further evidence for a specific impairment in frontal-lobe functioning in the preclinical stages of AD in DS. Implications for the assessment, diagnosis, and management of dementia in DS are discussed.

Decision-making with explicit and stable rules in mild Alzheimer's disease

Decision-making in mild dementia of Alzheimer's type (DAT) was assessed in a gambling task with stable and explicit rules [Game of Dice Task; Brand, M., Labudda, K., Kalbe, E., Hilker, R., Emmans, D., Fuchs, G., et al. (2004). Decision-making impairments in patients with Parkinson's disease. Behavioural Neurology, 15, 77–85]. DAT patients in an early stage of the disease chose safe alternatives as frequently as healthy elderly persons and did not show risky behaviour as has been reported for other neurological patient groups. However, a more detailed analysis disclosed important differences between DAT and healthy elderly. Compared to healthy controls, DAT patients shifted more frequently between safe and risky alternatives and showed less consistent response patterns. Frequent changes between strategies indicate that decisions were taken randomly, that no advantageous strategy was established and that no consistent response pattern was developed over time. As regards performance changes over the task, healthy participants had a stronger tendency towards safe and advantageous responses than DAT patients. While healthy controls showed learning as the task proceeded, DAT patients did not adapt their strategies. The proportion of “consistently safe responders” was significantly higher in the control group than in the DAT group. Analysis of reaction times indicated that differences in response behaviour were not due to fast and impulsive decision taking in the DAT group. DAT patients’ response pattern may be attributed to deficits in learning and in executive functions. The frequency of changes between safe and risky choices proved to be a fair predictor for the distinction between mild DAT and healthy aging.

Olfactory dysfunction in dementia of Alzheimer's type and vascular dementia

AbstractBackground: Olfactory function in vascular dementia has not been extensively investigated to date. We studied olfactory function in vascular dementia (VD) and dementia of Alzheimer's type (DAT).Methods: We studied olfactory functioning in 12 patients suffering from dementia of Alzheimer's type, 11 patients with vascular dementia and 30 normal subjects. For these subjects we examined a 12‐item version of the Pennsylvania smell identification test and mini‐mental state examinations. These three groups were matched for age, sex and educational level.Results: Although the dementia scores were comparable in the DAT and VD groups, the smell identifications were low in DAT patients compared with VD patients and normal control subjects.Conclusions: These results suggest that the smell identification test may be useful in differential diagnosis between DAT and VD patients

Usefulness of P300 in Subjective Memory Complaints

The existing studies about the utility of P300 latency for diagnostically classifying patients in preclinical stages of dementia are cross-sectional rather than longitudinal in design, and their results are inconclusive. The authors investigated the P300 value in a series of patients with subjective memory complaints using a prospective design. The study was performed in a consecutive series of 116 outpatients with subjective memory complaints as the predominant symptom. P300 (auditory oddball task) was performed immediately after the first clinical evaluation, and at 12 and 24 months. Final cognitive syndrome diagnosis (mean follow-up period, 27.7 months) was then made by a neurologist who was blinded to the neurophysiologic results. Diagnosis at the end of follow-up was 30 cases of normal cognition, 30 cases of mild cognitive impairment, 28 cases of dementia of Alzheimer's type (DAT), five cases of vascular dementia, and one case of frontotemporal dementia; 22 patients were lost to follow-up. P300 latency was significantly higher for the DAT group (analysis of variance: P=0.023) throughout the study. The diagnostic value of P300 latency at baseline examination for DAT had a sensitivity of 52.9% and a specificity of 76.9%; the odds ratio was 3.75 (95% confidence interval, 1.23-11.41). Findings from the present study suggest that assessment of evoked related potentials may contribute to the early detection of DAT.

Lack of coherence in the narrative discourse of patients with dementia of the Alzheimer's type

The lack of coherence in the narrative discourse of patients with dementia of Alzheimer's type (DAT) is attributed to the presence of irrelevant information. The definition of irrelevant information, however, varies across studies. For some authors, any utterance is considered as irrelevant, whether or not it is linked to the topic. In this study, we distinguished Relevant (expected), Related (unexpected but linked to the topic) and Irrelevant (unexpected not linked to the topic) utterances. We hypothesized that DAT patients produce more Irrelevant utterances than controls. We administered a narrative discourse test to 29 DAT and 29 controls. Results revealed that controls produced more Relevant than Irrelevant utterances whereas the proportions for these two utterance types did not differ in the DAT group. We conclude that the lack of coherence in the narrative discourse of DAT patients is due to the lower proportion of relevant information it contains.

Number-stroop performance in normal aging and Alzheimer's-type dementia

The number-Stroop paradigm was used to investigate changes in the inhibitory system and in numerical processing in healthy elderly and individuals with dementia of Alzheimer's type (DAT). The size-congruity effect (i.e., relative to neutral trials, incongruent pairs interfere and/or congruent pairs facilitate either numerical or physical comparison) was found in all groups, though the pattern of interference and facilitation varied across them. Overall, the selective attention breakdown was reflected by the increase in interference shown by the older group and the DAT group. On the other hand, the observation of a standard laterality effect andof automatic numerical processing in all groups suggests that access and retrieval of numerical information is relatively resistant to cognitive deterioration.

Semantic memory is impaired in both dementia with Lewy bodies and dementia of Alzheimer's type: a comparative neuropsychological study and literature review

OBJECTIVETo test the hypothesis that semantic impairment is present in both patients with dementia with Lewy bodies (DLB) and those with dementia of Alzheimer's type (DAT).METHODSA comprehensive battery of neuropsychological...

Assessment by means of a Minimum Data Set of the changes of mental and physical status of elderly patients with dementia during two years of institutionalization

Using a Minimum Data Set, we studied how the mental and physical conditions of elderly people with dementia changed during two years of institutionalization. Fifty-five patients with dementia of Alzheimer's type (DAT) and 25 with vascular dementia (VD) admitted to the dementia ward in Kyoto Higashiyama Geriatric Hospital were investigated. We assessed them at the time of their institutionalization, and every three months for two years. On institutionalization, a difference between DAT and VD was noted in the group in which more than 10 areas of Resident Assessment Protocols (RAPs) were triggered. The areas of delirium, communication, behavioral problem, activities, activities of daily living, dehydration/fluid maintenance, and psychotropic drugs were evenly triggered in both dementia groups. In the DAT group, however, mood state and dental care were also highly triggered while urinary incontinence, falls and nutritional status were highly triggered in the VD group. Three months later, marked improvements were observed in all of the above areas. However, RAPs areas gradually increased subsequently, and there was marked difference in the areas and their course of progression between the dementia groups. In the DAT group, the trigger rate of the areas of communication, activities of daily living, urinary incontinence, dental care, nutritional status and falls gradually increased after 6 months of evaluation. However, the trigger rate in only three areas, such as communication, visual function and urinary incontinence, become higher, but their patterns of increase were irregular. Mental and physical conditions of the patients with dementia were different in each dementia subtype on institutionalization, but these conditions improved soon after. However, the conditions were gradually became worse, and the pattern was different in each dementia group: DAT showed a slow and steady decline, but VD showed irregular progression and differed among individuals.

Dementia of Alzheimer type with and without multiple lacunar infarctions: evaluation of white matter lesions.

The white matter lesions in dementia of Alzheimer type (DAT) with and without multiple lacunar infarctions were studied relative to a normal control group. The frequency and distribution of white matter (WM) lesions in DAT (22 cases; mean age +/- standard deviation (SD), 88.1 +/- 5.8), DAT with multiple lacunar infarctions (DAT + CVD, 18 cases; mean age +/- SD, 87.8 +/- 6.0), and in a normal control group (17 cases; mean age +/- SD, 85.2 +/- 4.8) were evaluated. The frequency of myelin pallor (frontal, parietal and occipital lobes) was significantly higher in the DAT + CVD group than in the other groups (DAT and controls). There was no significant difference in the frequency of myelin pallor between the DAT and control groups. Therefore, it was concluded that the WM lesions in DAT are the result of ischemia rather than wallerian degeneration.