Kind Of Dementia Research Articles

Checklist Highlights Factors That Raise Dementia Risk

Back to table of contents Previous article Next article Clinical & Research NewsFull AccessChecklist Highlights Factors That Raise Dementia RiskJoan Arehart-TreichelJoan Arehart-TreichelSearch for more papers by this authorPublished Online:17 Jul 2009https://doi.org/10.1176/pn.44.14.0021aWith the specter of Alzheimer's disease or other types of dementia threatening an aging American society, researchers are urgently looking for ways to determine who is going to develop such illnesses.For example, Deborah Barnes, Ph.D., an assistant professor of psychiatry at the University of California, San Francisco, and the San Francisco Veterans Affairs Medical Center, and colleagues set out to develop a late-life dementia checklist. They wanted an instrument that could reasonably stratify adults aged 65 or older into those with a low, moderate, or high risk of developing dementia within six years. And that is what their new tool does, they reported online May 13 in Neurology.Barnes and her coworkers focused on more than 3,000 individuals aged 65 or older who had no sign of dementia and who had been evaluated for many factors known to influence or suspected of influencing dementia susceptibility risk—for example, demographic variables, medical conditions, physical-performance measures, lifestyle factors, genetic predisposition, or the number of prescription medications used. The researchers followed these individuals for six years to see which ones developed Alzheimer's or another form of dementia—480 (14 percent) did—and then looked to see which of the known or possible dementia risk factors would have predicted these individuals getting Alzheimer's or another kind of dementia. Finally they assigned points to the most predictive factors and developed a late-life dementia risk checklist based on the assigned points.The checklist included poor cognitive test performance (2-4 points), low body mass index (2 points), older age (1-2 points), one or more copies of the APOE e4 gene variant (1 point), white matter disease as revealed through a MRI brain scan (1 point), ventricular enlargement as revealed through a MRI brain scan (1 point), internal carotid artery thickening as revealed through an ultrasound scan (1 point), a history of bypass surgery (1 point), slow physical performance based on time to put on and button a shirt (1 point), and lack of alcohol consumption (1 point). The checklist had a maximum possible score of 15 points.This checklist, the researchers reported, stratified subjects into those with low, moderate, or high risk of developing dementia. Whereas only 4 percent of subjects with low scores developed dementia over a six-year period, 23 percent of subjects with moderate scores and 56 percent of subjects with high scores did. Predictive accuracy did not differ by gender, race, or education.“It is important to caution that the factors we identified are predictive, but not necessarily causal,” Barnes explained to Psychiatric News. “[For example,] lack of alcohol consumption is likely to be a marker for other things, such as worse health status [or] use of medications for which alcohol consumption is contra-indicated....” A low body mass index could be an indication that the disease is already under way (Psychiatric News, May 15).Such a checklist, Barnes and her colleagues wrote in their report, could have several uses. It could reassure concerned older individuals whose dementia risk is low or moderate. It could encourage concerned older individuals whose dementia risk is high to seek treatment at the earliest possible stage of disease or to participate in a clinical trial exploring new intervention or prevention strategies for dementia.The next step will be to develop a briefer dementia risk checklist, Barnes told Psychiatric News. “We'd like to develop a tool that could be administered in a physician's office in 10 minutes at low cost.”The study was funded by the National Institutes of Health and the University of California, San Francisco's Clinical and Translational Sciences Institute.An abstract of “Predicting Risk of Dementia in Older Adults” is posted at<www.neurology.org/cgi/content/abstract/WNL.0b013e3181a81636v1>.▪ ISSUES NewArchived

Diabetes: A Risk or Protective Factor in ALS?

Patrice Wendling is with the Chicago Bureau of Elsevier Global Medical News. CHICAGO — Diabetes mellitus appears to delay the onset of motor symptoms in patients with amyotrophic lateral sclerosis, but it also may be associated with diminished cognitive functioning in patients with the neurodegenerative disease, according to the findings of a retrospective study. Although a cause and effect relationship could not be determined because of the design of the study, it is hoped the findings will stimulate research into whether increasing blood glucose level might benefit patients who have ALS, said the study's lead investigator, Paul E. Schulz, MD, of Baylor College of Medicine, Houston. Among 2,359 consecutive patients with ALS, mean patient age at the onset of motor symptoms was significantly greater in 174 patients with diabetes than in 2,185 patients without diabetes (60.3 years vs. 56.3 years). Patients in the study were diagnosed with ALS from 1977 to 2006, and were tested for diabetes at the time of their ALS diagnosis. Overall, the mean age at first ALS symptom was 56.6 years; 62% of the patients were male and 89% were white. Later age of onset for ALS is typically associated with a faster rate of progression of motor symptoms. However, the mean rate of progression on the Appel scale (3.1) and the mean duration of ALS (3.2 years) were similar between diabetics and nondiabetics at baseline, Dr. Schulz and his associates reported in a poster at the annual meeting of the American Academy of Neurology. “To my knowledge, diabetes mellitus is the first factor that has been associated with a later age of onset for ALS, and hence one that might be protective against ALS,” Dr. Schulz, director of the cognitive disorders clinics at Baylor, said in an interview. On neuropsychological testing that controlled for age, ALS patients with diabetes performed significantly worse than did nondiabetics on tasks measuring memory, confrontation naming, semantics, and processing speed. Some of these domains tend to be relatively preserved in ALS patients, Dr. Schulz said. ALS patients with diabetes also did significantly worse on tests measuring executive function including the Verbal Series Attention Test, both time to completion (VSAT-T) and errors (VSAT-E), and phonemic fluency (FAS test), Dr. Schulz said. Cognitive status by FAS scores was rated “intact” in 228 patients, of which 3% were diabetic; “mild” in 163 patients, of which 5.5% were diabetic; and “moderate” in 50 patients, of which 16% were diabetic. The difference between diabetics and nondiabetics was significant, indicating that the severity of cognitive function correlated with the presence of diabetes, he said. ALS patients with diabetes were also significantly more likely than those without diabetes to score positive for depression on the Beck Depression Inventory. There are several possible explanations for the poor cognitive findings, Dr. Schulz said. It could be that diabetes advances the loss of neurons in the cognitive areas of the brain or that diabetes protects against motor neuron loss, but not cognitive neuronal loss. Finally, “it could be that diabetes produces a different kind of dementia than we normally see in ALS patients, which is frontotemporal dementia.” Previous work by the same study group and others has shown some degree of cognitive impairment in about 50% of patients with ALS. Dr. Schulz disclosed that he has given talks on Alzheimer's disease that were sponsored by Pfizer Inc. and Forest Pharmaceuticals Inc., which market Aricept (donepezil) and Namenda (memantine), respectively.

Effects of cholinesterase inhibitor metrifonate on naive rats and rats with a model of hypoxia-induced impaired memory

Abstract Cholinesterase inhibitors are currently used in the therapy of different kind of dementia to improve brain memory functions. The acetylcholinesterase inhibitor metrifonate was studied in naive rats and in rats with a model of sodium nitrite-induced hypoxia. One active avoidance test and in two passive avoidance tests were used. In the active avoidance test metrifonate increased the number of avoidances during the learning session only. In both passive avoidance tests, metrifonate prolonged latency differently during the learning session and in short-term or in long-term memory retention. Hypoxic rats showed lower numbers of avoidances in learning and memory retention sessions. Metrifonate increased the number of avoidances during the learning session for hypoxic rats. In the step-through passive avoidance test, metrifonate increased the latency of reactions in the learning session and in long-term memory retention tests. In the step-down passive avoidance test, the groups with hypoxia and metrifonate did not change the latency of reaction in the learning and long-term memory retention sessions, but increased the latency of reactions in the short-term memory retention test. Morphological data showed a significant impaired neuronal structure in a CA1 zone of the hippocampus in hypoxic rats and a tendency to preserving in rats treated with metrifonate. Our results suggest that metrifonate improves cognitive functions in naive and in hypoxic rats.

Lifestyle factors and risk of dementia: Dubbo Study of the elderly

To identify risk factors for dementia in an elderly Australian cohort. A longitudinal cohort study conducted in Dubbo, NSW. 2805 men and women aged 60 years and older living in the community and initially free of cognitive impairment, first assessed in 1988 and followed for 16 years. Admission to hospital or nursing home with any kind of dementia. There were 115 cases of dementia in 1233 men (9.3/100) and 170 cases in 1572 women (10.8/100). In a proportional hazards model for dementia, any intake of alcohol predicted a 34% lower risk, and daily gardening a 36% lower risk. Daily walking predicted a 38% lower risk of dementia in men, but there was no significant prediction in women. The lowest tertile of peak expiratory flow predicted an 84% higher risk of dementia, the upper tertile of depression score predicted a 50% higher risk. While excess alcohol intake is to be avoided, it appears safe and reasonable to recommend the continuation of moderate alcohol intake in those already imbibing, as well as the maintenance of physical activity, especially daily gardening, in the hope of reducing the incidence of dementia in future years.

On the Importance of Never Making it to Mars

WHEN I was a child, my brother and I spent several weeks each summer visiting our cousin Mickey in Eastern Kentucky. He lived in Baptist Bottom, one of the narrow ribbons of flat land that separate the tightly clustered mountains in that area. One of our favorite adventures was blazing mountain trails. On our trailblazing days, we rolled out of bed early to pack our provisions of bologna, bread, and Kool-Aid. With the brown paper bags in tow, we began our climb. Winding around the steep mountainside, carefully avoiding sticker bushes and copperheads, we made our arduous way to the Elephant Rocks. Once there, we crawled inside an opening in the rocks to the spot where we started a small fire, placed our cast-iron skillet on the flames, and fried our bologna. On these expeditions, we often made plans to defend Baptist Bottom should the Nazis spring a surprise attack across the narrow wooden bridge that connected the Bottom to the rest of the world. Now should understand that the war had been over for many years, and, had it still been raging, it is hard to imagine what military advantage the Nazis might have sought in taking Baptist Bottom. Still, we were prepared. Houses in the Bottom were built on stilts to protect them from the annual floods. On hot summer days, the coolness created by the buffer of the house above us made the floor, as we called it, the perfect place to while away the hours. On one sweltering July day, it was under the floor that Aunt Leona taught me an important lesson. On this particular day, the boys were planning a trip to A year earlier, I might have been the main architect of such a plan. Being three years older, though, I had outgrown such foolishness. I had found a new role, one that built on certain of my natural talents. It was somewhat akin to playing Lucy to their Charlie Brown and Linus. Their Mars plans were quite clearly ridiculous, and I saw it as my responsibility to inform them of this fact. guys are crazy. You can't go to Mars in that thing. It's a bunch of crates. Crates can't hold up for a trip to Mars. I thought the science in that statement would help them see just how silly their plan was. They ignored me and continued planning. I returned to my diary, writing great thoughts about boys and Elvis and the injustice of my genetic link to two such simpletons. As they plotted, a big washtub became a central feature in their rocket design. The washtub, they decided, would hold the canisters of booster fuel (empty milk cartons and lard cans, as I recall) that would propel them through the galaxy. The only problem was that Aunt Leona kept the washtub filled with potted plants. Since they planned to blast off on that very day, the plants would have to go. Okay, I thought. This ought to be good. I knew Aunt Leona was not going to move all those geraniums on that hot day because these two fools wanted to explore space in a bunch of crates and a washtub. I watched with smug amusement as they tugged her into their workshop and enthusiastically explained their plan and her role in it. Aunt Leona and I had always been especially close. I knew I could count on her to straighten them out. Well, boys, she said in her lyrical mountain dialect, you let me know when you're ready, and I'll get those plants out of there right away. What? a voice inside my head screamed. Was I the only person not suffering from some kind of dementia? Assured the washtub would be ready when they needed it, the boys went back to work. A few hours later, Mickey and Tom decided to delay their Mars trip. They thought their time would be better spent planning to take over the world using two helicopters. Although I had been discouraged by Aunt Leona's defection, I couldn't let it pass. Two helicopters! I exclaimed. How can even two think could take over the world with only two helicopters? …

Alzheimer’s Sleep Problems Linked To Circadian-Rhythm Disruption

Back to table of contents Previous article Next article Clinical & Research NewsFull AccessAlzheimer’s Sleep Problems Linked To Circadian-Rhythm DisruptionJoan AreharT-TreichelJoan AreharT-TreichelSearch for more papers by this authorPublished Online:15 Jun 2001https://doi.org/10.1176/pn.36.12.0021The cognitive and memory devastation of Alzheimer’s disease gets a lot of publicity. But there is another symptom of the disease that can take even more out of the families of Alzheimer’s patients. And that is sleep disturbance.Caretakers often find that looking after patients who wake up at night and roam about is so exhausting that they have to put the patients in a nursing home to save their own health and sanity.A possible explanation for Alzheimer-provoked sleep disturbances may now have been identified by David Harper, Ph.D., of McLean Hospital in Belmont, Mass., and his coworkers. It is out-of-whack circadian rhythms.Indeed, both the peak in daily body temperature and the peak in daily spontaneous motor activity—two yardsticks of daily circadian rhythms—were found to be delayed in Alzheimer’s patients compared with healthy older subjects.Harper and his team report these findings and the details of their study in the April Archives of General Psychiatry.Harper and his colleagues first measured the daily body temperature patterns and the daily spontaneous motor activity patterns of 38 men with advanced dementia over a three-day period. They also measured the daily body temperature patterns and the daily motor activity patterns of eight healthy control subjects under comparable conditions. After all the patients with dementia died, which was on average about two years later, autopsies were performed to determine exactly what kind of dementia they had had. Twenty-three were found to have had Alzheimer’s disease, nine to have frontotemporal degenerative dementia, and six to have diffuse Lewy body disease with mixed Alzheimer’s or frontotemporal degenerative pathologies.Harper and his colleagues then compared the daily body temperature patterns and daily spontaneous motor activity patterns that they had recorded in the 23 Alzheimer’s patients with those that they had recorded in the nine patients with frontotemporal degenerative dementia and also with those that they had recorded in the healthy control subjects. They wanted to know whether they could find any differences.They could, it turned out.The Alzheimer’s patients had experienced a delayed daily peak in body temperature and delayed daily peak in spontaneous motor activity compared with control subjects. But the frontotemporal patients had experienced another temperature-activity pattern. They showed a daily temperature peak similar to that of controls, but an activity peak earlier than that of controls. What’s more, Alzheimer’s patients had engaged in more nocturnal spontaneous motor activity than had either controls or frontotemporal patients.Taken together, the findings suggest that disturbances in circadian rhythms underlie the sleep disturbances that Alzheimer’s patients experience.The findings also have some practical implications. For one, the daily temperature and activity profiles noted by the researchers might prove of help in differential diagnosis—that is, in determining whether a demented patient has Alzheimer’s or frontotemporal degenerative dementia. For another, the findings might lead to some way of mitigating sleep disturbances in Alzheimer’s patients. In fact, Harper told Psychiatric News, “we have a proposal already in for funding to attempt to use light to shift the rhythms of Alzheimer’s patients back to a normal phase relationship with the environment.”The study, “Differential Circadian Rhythm Disturbances in Men With Alzheimer Disease and Frontotemporal Degeneration,” is posted on the Web at http://archpsyc.ama-assn.org. ▪ ISSUES NewArchived

Alzheimer's Disease: Unskilled Vulgarity Decays Into Stunning Artistic Genius

To the Editor. —In the recent article by Drs Cummings and Zarit, 1 the reproductions that are supposed to illustrate the progressive intellectual decay of the artist show in fact a progression toward better pictorial quality, if not toward genius. Figure 1 in the article, painted near the time of onset of Alzheimer's disease, is a vulgar, unskilled amateur painting with gross errors in perspective and nauseating colors. Figure 2, painted seven years after the onset of disease, is the work of a genius, recalling the best of Van Gogh. Figure 4, completed at the nadir of his Alzheimer's dementia, could compete with the best attainments of modern art. This leads to one question: Are our contemporary artists collectively suffering from advanced Alzheimer's or from another kind of dementia?