Mixed Dementia Research Articles

Phenomenological Understanding of Behavioural and Psychological Symptoms of Dementia: A Clinical Case Presenting Howls and Shouting. The Melancholic Type and Phenomenology of Separation

Background: Behavioural and psychological symptoms of dementia cause great suffering in patients and their families. Phenomenology can help us to clarify the diagnosis and propose some new therapeutic responses, using Daseinanalyse. Phenomenology, that may be complementary to a complete clinical examination, is a Science and a Philosophy. Separation issue and the melancholic type (MT), described by Tellenbach, could explain a melancholy in dementia, using clinical assessment and phenomenology. Subject and methods: A 90-year-old woman who presents a mixed dementia Cluster Dementia Rating, shouting and howls, is the clinical case. The BPSD crisis factors are highlighted. Our first hypothesis is a separation anxiety. We evaluated depression and BPSD using the NPI*, Cornell scale and Montgomery Asberg Depression Rating Scale in order to confirm our second diagnosis hypothesis that is a melancholy. The Big Five inventory validated-scale (heteroevaluation) was also used to investigate her personality. Thirdly, of his relation to the Time, the Space, the Self and the other (the usual standardized evaluation in Phenomenology), we propose to explain VDB* and melancholy in dementia. Results: Melancholy was confirmed. We found an inhibited temperament and a low openness to new experience was measured significantly. Phenomenology of the Separation explains here MT and melancholy that is hidden by the howls’ patient. This particular clinical case, the patient who is shouting, must be considered as a psychotic depression in mixed dementia. Conclusion: MT, melancholy, and a symbiotic relationship led to a situation known as “unbearable” for the patient and the Other (a close relative), unable to separate each other and delegate care to a specialized team. Finally, an effective individualized treatment and perspectives are mentioned.

The Role of Aspirin in Alzheimer’s Disease

Dementia is a common disease in the elderly characterized by memory loss, cognitive dysfunction, disturbance of consciousness, selfcare ability and social activities decline or even loss. According to its cause is divided into the following three class: Alzheimer's disease dementia, vascular dementia, mixed dementia [1]. The incidence of dementia increases with age. International estimated that there will be 11500000 people suffering from Alzheimer's disease/dementia in 2050 and a large part from developing regions or countries, such as Africa, India, Latin America, China, south Asia and the western Pacific region, Ferri et al. [2,3]. Dementia, a devastating as well costly disorder, is the leading causes of disability and mortality in old people. Dementia has a serious threat to the health of the elderly, which makes a serious burden on the state, society and family. Thus, it is an urgent need for effective interventions of treating dementia. Aspirin is a commonly drug which is used to treat headache and fever in daily life. In current, there is a few trials about the role of aspirin in Alzheimer’s disease. The role of aspirin in Alzheimer’s disease is still unclear. Therefore, I had searched some evidence about the role of aspirin in Alzheimer’s disease in order to provide doctors or patients with some useful information.

Behavioral and psychological characteristics of patients with different types of dementia in Mansoura, Egypt

Objective This study aimed to describe the behavioral and psychological symptoms of patients with different types of dementia and to correlate these symptoms to demographic and clinical variables of dementia such as age, sex, and score of cognitive assessment scales. Patients and methods This study was carried out on 73 patients with dementia. Patients were classified into three groups: patients with Alzheimer dementia, patients with vascular dementia, and patients with mixed dementia. Cognitive evaluation of the three groups was performed by the Mini Mental State Examination and Clock Drawing Test. The neuropsychiatric inventory was used to assess behavioral and psychological symptoms. Daily activities were assessed using Activities of Daily Living and The Lawton Instrumental Activities of Daily Living. Results Apathy depression, and sleep disturbances were most prevalent in Alzheimer dementia, whereas depression, anxiety, and apathy were most prevalent in vascular dementia and in the miscellaneous group. There was a highly statistical difference between the three groups as regards depression and anxiety (P≤0.0001). Duration of illness correlated negatively with the scores of Mini Mental State Examination (P Conclusion Apathy, depression, anxiety, and sleep disturbances were the most prevalent psychiatric symptoms. The severity of the symptoms was lower in the Alzheimer group and worse in the miscellaneous group. There was a positive correlation between the cognitive function and the functionality of those patients.

Hippocampus and Basal Forebrain Volumetry for Dementia and Mild Cognitive Impairment Diagnosis: Could It Be Useful in Primary Care?

Once apatient or aknowledgeable informant has noticed decline in memory or other cognitive functions, initiation of early dementia assessment is recommended. Hippocampus and cholinergic basal forebrain (BF) volumetry supports the detection of prodromal and early stages of Alzheimer's disease (AD) dementia in highly selected patient populations. To compare effect size and diagnostic accuracy of hippocampus and BF volumetry between patients recruited in highly specialized versus primary care and to assess the effect of white matter lesions as aproxy for cerebrovascular comorbidity on diagnostic accuracy. We determined hippocampus and BF volumes and white matter lesion load from MRI scans of 71 participants included in a primary care intervention trial (clinicaltrials.gov identifier: NCT01401582) and matched 71 participants stemming from amemory clinic. Samples included healthy controls and people with mild cognitive impairment (MCI), AD dementia, mixed dementia, and non-AD related dementias. Volumetric measures reached similar effect sizes and cross-validated levels of accuracy in the primary care and the memory clinic samples for the discrimination of AD and mixed dementia cases from healthy controls. In the primary care MCI cases, volumetric measures reached only random guessing levels of accuracy. White matter lesions had only amodest effect on effect size and diagnostic accuracy. Hippocampus and BF volumetry may usefully be employed for the identification of AD and mixed dementia, but the detection of MCI does not benefit from the use of these volumetric markers in aprimary care setting.

Impact of coronary heart disease on cognitive decline in Alzheimer's disease: a prospective longitudinal cohort study in primary care.

Arteriosclerotic disorders increase the risk of dementia. As they have common causes and risk factors, coronary heart disease (CHD) could influence the course of dementia. To determine whether CHD increases the speed of cognitive decline in Alzheimer's disease, and to discuss the potential for secondary cardiovascular prevention to modify this decline. Prospective multicentre cohort study in general practices in six cities in Germany. Participants were patients with probable mild-to-moderate Alzheimer's dementia or mixed dementia (n = 118; mean age 85.6 [±3.4] years, range 80-96 years). The authors assessed the presence of CHD according to the family physicians' diagnosis. Cognitive performance was measured during home visits for up to 3 years in intervals of 6 months, using Mini Mental State Examination (MMSE) and Clinical Dementia Rating Sum of Boxes (CDR-SoB). The authors also recorded whether patients died in the observation period. At baseline, 65 patients (55%) had CHD and/or a heart condition following a myocardial infarction. The presence of CHD accelerated cognitive decline (MMSE, P<0.05) by about 66%, and reduced cognitive-functional ability (CDR-SoB, P<0.05) by about 83%, but had no impact on survival. The study shows that CHD has a significant influence on cognitive decline in older patients with late-onset dementia. The dementia process might therefore be positively influenced by cardiovascular prevention, and this possible effect should be further investigated.

Predictors of Vascular Cognitive Impairment Poststroke in a Middle Eastern (Bahrain) Cohort: A Proposed Case-Control Comparison.

BackgroundPoststroke dementia and cognitive impairment are associated with poor long-term outcomes after stroke. The contribution of genetic factors such as the presence of apolipoprotein (ApoE) ɛ4 allele and its association with cognitive impairment poststroke remains inconclusive, particularly in Middle Eastern regions.ObjectiveThe aim of this study is to examine all correlates and potential predictors of cognitive impairment including self-awareness and regulation deficits in stroke patients and compare these functions with healthy older adults from a Middle Eastern population.MethodsA prospective stroke sample of 200 patients (case group) and 100 healthy aging individuals (control group) will be recruited from the largest medical complex in Bahrain. A neuropsychological battery of cognitive assessments (global, executive, and metacognition) will be conducted on all participants. Participants will be categorized into 4 subgroups (nonvascular cognitive impairment, vascular cognitive impairment with no dementia, vascular dementia, and mixed dementia) using standardized cognitive assessment scores and the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, dementia criteria. Biomarkers will include ApoE genotype, soluble form of receptor for advanced glycation end products, neprilysin, beta-secretase 1, biochemistry, and hematology measurements.ResultsThe primary study outcome is to determine early risk factors for cognitive impairment after stroke in a Bahraini cohort. The study has received full ethical approval from the Bahrain Ministry of Health and from the affiliated university.ConclusionsWith increasing stroke incidence rates in the Middle East, this research study will provide useful biological and epidemiological data for future development and planning of health policies and guidelines for stroke care within the Gulf region.

Effect of concomitant use of memantine on mortality and efficacy outcomes of galantamine-treated patients with Alzheimer's disease: post-hoc analysis of a randomized placebo-controlled study.

BackgroundA large, prospective, 2-year, randomized study in patients with mild-to-moderate Alzheimer’s disease or mixed dementia demonstrated reductions in mortality and cognitive/functional decline in galantamine-treated patients. A post-hoc analysis was conducted to study the effect of (the presence or absence of) concomitant memantine use on treatment outcome.MethodsRandomized patients (N = 2045) were divided into subgroups based on memantine use. Analyses included demographic and clinical characteristics (age, nursing home placement, Mini-Mental State Examination (MMSE) and Disability Assessment for Dementia (DAD) scores) and mortality endpoints.ResultsOverall, 496 (24.3 %) patients were memantine users and were older (mean (SD), 74.0 (8.76) vs 72.8 (8.76), p = 0.008), with lower MMSE scores (18.2 (4.16) vs 19.2 (4.02), p < 0.0001) and DAD scores (58.0 (23.49) vs 62.5 (20.52), p < 0.0001) than nonusers. Mortality rates (per 100 patient-years) in memantine nonusers (n = 1549) were lower for galantamine (1.39) vs placebo-treated patients (4.15). In memantine users, mortality rates were similar for placebo-treated (4.49) and galantamine-treated patients (5.57). In memantine nonusers at 24 months, the decline in MMSE scores (effect size (95 % CI) 0.25 (0.14; 0.36)) and DAD scores (0.17 (0.06; 0.28)) from baseline was lower in galantamine patients vs placebo patients. The absence of these benefits in memantine users could not be explained by baseline age, MMSE, or DAD scores.ConclusionThis post-hoc analysis shows that the beneficial effects of galantamine at 2 years post treatment were not observed in patients who had been placed on background memantine. The reasons for memantine treatment and the possibility of interaction between memantine and galantamine merit further investigation.Trial registrationClinicalTrials.gov NCT00679627. Registered 15 May 2008.Electronic supplementary materialThe online version of this article (doi:10.1186/s13195-016-0214-x) contains supplementary material, which is available to authorized users.

Neuroimaging in vascular cognitive impairment: a state-of-the-art review.

Imaging is critical in the diagnosis and treatment of dementia, particularly in vascular cognitive impairment, due to the visualization of ischemic and hemorrhagic injury of gray and white matter. Magnetic resonance imaging (MRI) and positron emission tomography (PET) provide structural and functional information. Clinical MRI is both generally available and versatile – T2-weighted images show infarcts, FLAIR shows white matter changes and lacunar infarcts, and susceptibility-weighted images reveal microbleeds. Diffusion MRI adds another dimension by showing graded damage to white matter, making it more sensitive to white matter injury than FLAIR. Regions of neuroinflammatory disruption of the blood–brain barrier with increased permeability can be quantified and visualized with dynamic contrast-enhanced MRI. PET shows metabolism of glucose and accumulation of amyloid and tau, which is useful in showing abnormal metabolism in Alzheimer’s disease. Combining MRI and PET allows identification of patients with mixed dementia, with MRI showing white matter injury and PET demonstrating regional impairment of glucose metabolism and deposition of amyloid. Excellent anatomical detail can be observed with 7.0-Tesla MRI. Imaging is the optimal method to follow the effect of treatments since changes in MRI scans are seen prior to those in cognition. This review describes the role of various imaging modalities in the diagnosis and treatment of vascular cognitive impairment.

395 - Decrease Paraoxonase-1 (PON-1) Activities in Neurodegenerative Diseases

Background High-density lipoprotein (HDL)-bound paraoxonase-1 (PON-1) is mechanistically related to oxidative stress, inflammation and atherosclerosis and this multirole nature positions the enzyme as potential pathogenic player and candidate biomarker for many diseases. Our previous results suggest a significant derangement in redox balance already present in the prodromal stage of dementia and an association between decline serum PON-1 activities and conversion of mild cognitive impairment (MCI) to late onset Alzheimer’s disease (LOAD) or vascular dementia (VAD). Download : Download high-res image (185KB) Download : Download full-size image Aims 1) evaluate the role of PON-1 in a larger population, including patients with LOAD-VAD mixed dementia (MD); 2) explore a possible association between PON-1 and multiple sclerosis (MS); 3) evaluate if cerebrospinal fluid (CSF) levels of PON-1 activities might be useful biomarkers for MS. Results We found that serum arylesterase, but not paraoxonase, levels of PON-1 were significantly lower in patients affected by MCI (n=232), VAD (n=65), LOAD (n=175), MD (n=88) as well as those with MS (n=104) as compared to healthy controls. Notably, the most pronounced decline in this activity was shown by MD (-18%, p Conclusion Overall our data suggest that a depressed arylesterase activity could be a common denominator of different neurological diseases which, independently of their ethiopathogenesis and pathophysiology, appear to be all characterized by an altered systemic redox balance.

Montefiore-Einstein Center for the Aging Brain: Preliminary Data.

Given the multifaceted nature of dementia care management, an interdisciplinary comprehensive clinical approach is necessary. We describe our one-year experience with outpatient based dementia care at the Montefiore-Einstein Center for the Aging Brain (CAB) involving an multispecialty team of geriatricians, neurologists, and neuropsychologists, supported by geriatric psychiatrists, physiatrists, and social services. The goals of the CAB is to maximize dementia outcomes, including regular monitoring of patient's health and cognition, education and support to patients, their families and caregivers; initiation of pharmacological and non-pharmacological treatments as appropriate, and the facilitation of access to clinical trials. The CAB follows a consultative model where patients referred to the center receive a comprehensive three step evaluation and management plan from Geriatric, Neuropsychology and Neurology specialists that is shared with patient, caregivers and primary care physicians. Of the 366 patients seen for cognitive complaints in our first year, 71% were women with a mean age of 74 years. Self-identified ethnicity of patients included Caucasian (26%), African-American (25%), Hispanic (18%) and multiracial (5%). Common final diagnoses assigned at the CAB included mild cognitive impairment syndromes (31%), Alzheimer's disease (20%), mixed dementia (11%), vascular dementia (9%), Frontotemporal dementia (4%) and dementia with Lewy bodies (4%). Our one-year progress report indicates that an interdisciplinary clinical dementia care model is feasible in the outpatient setting as well as highly accepted by patients, caregivers and referring physicians.

Muscarinic M1 Receptor Coupling to G-protein is Intact in Parkinson's Disease Dementia.

Postsynaptic cholinergic deficits, including reduced cortical muscarinic M1 receptor coupling to G-proteins, are neurochemical findings postulated to underlie the limited efficacy of presynaptically-targeted cholinergic replacement therapies in Alzheimer's disease (AD). While the loss of M1-G-protein coupling has been associated with β-amyloid (Aβ) burden in AD, the status of M1 coupling to G-proteins in Parkinson's disease-related or mixed dementias is unclear. To test the hypothesis that M1 receptor uncoupling is correlated with Aβ burden, we aimed to study muscarinic M1 neurochemical parameters in neurodegenerative dementias characterized by low and high Aβ loads. M1 receptors, M1 coupling to G-proteins as well as Aβ were measured in postmortem frontal cortex of a cohort of longitudinally assessed patients with Parkinson's Disease Dementia (PDD, low Aβ load) and AD with significant subcortical cerebrovascular disease (AD + CVD, high Aβ load). We found unchanged levels of M1 receptors in both dementia groups, while M1 coupling was reduced only in AD + CVD (p < 0.01). Furthermore, Aβ concentration was significantly increased only in AD + CVD, and correlated negatively with M1-G-protein coupling in the dementia groups. Our study suggests that loss of M1 coupling to G-proteins may be a neurochemical feature of neurodegenerative dementias with high cortical Aβ burden, and that cholinergic replacement therapies may be more efficacious for PDD due to low Aβ burden.

The CITIRIVAD Study: CITIcoline plus RIVAstigmine in Elderly Patients Affected with Dementia Study.

Acetylcholinesterase inhibitors (AchEIs), such as rivastigmine, coadministered with cholinergic precursors, such as citicoline, could be effective in Alzheimer's disease (AD) and in mixed dementia (MD), because they are able to increase the intrasynaptic levels of acetylcholine more than the single drugs given alone. The aim of the present study was to show the effectiveness of oral citicoline plus rivastigmine in patients with AD and MD. The CITIRIVAD study was a retrospective case-control study on 174 consecutive outpatients aged ≥65years, affected with AD or MD, mean age 81.3±4.5years. Of the 174 patients, 92 had been treated with rivastigmine+citicoline 1000mg/day given orally (group A); 82 patients had been treated with rivastigmine (group B). In both groups rivastigmine patch had been used for at least six months at the highest tolerated dosage. Group A comprised 62 patients affected with AD and 30 patients with MD. Group B comprised 53 patients affected with AD and 29 with MD. Cognitive functions had been assessed by Mini Mental State Examination (MMSE), daily life functions by activities of daily living (ADL) and instrumental activities (IADL), behavioral symptoms by neuropsychiatric inventory (NPI), comorbidities by the Cumulative Illness Rating Scale and mood by geriatric depression scale (GDS)-short form tests, which had been administered at baseline, 3 and 9months. Data show the effectiveness of combined administration versus the AchEI alone, mainly in slowing disease progression and consequently in disease management, both in AD and in MD. No differences regarding the combined treatment were found between the two groups. Treatment with citicoline plus rivastigmine was safe and well tolerated.

A methodological study of locus coeruleus degeneration in dementing disorders.

Degeneration of the locus coeruleus (LC) of the brain stem is a recognized phenomenon in Alzheimer's disease (AD), in dementia with Lewy bodies (DLB), and in Parkinson's disease with dementia (PDD). Prior studies have suggested that LC degeneration can be used to differentiate various dementing disorders histologically, but the paucity of methodological data may hamper systematic research on this nucleus. The purpose of this study was to evaluate various approaches to quantifying LC degeneration in dementing disorders, and to inform future decisions regarding the most appropriate method for diagnostics and research. 105 LCs from brains of demented individuals with AD, DLB/PDD, vascular dementia (VaD), mixed dementia (AD+VaD), or frontotemporal lobar degeneration (FTLD) were examined, and the extent of LC degeneration was assessed using macroscopic evaluation, cell counting, and two degeneration scales. Scores were compared across diagnostic categories; diagnostic utility and intra- and interobserver reliability were assessed. AD and DLB/PDD were associated with greater LC damage using either assessment method, significantly different from VaD and FTLD. Macroscopic appearance was informative, but cell counting was more sensitive and specific. The degeneration scales did not add significant diagnostic value over cell counting and were associated with greater observer variability. The LC degenerates in certain dementia subtypes, especially in AD and DLB/PDD. Macroscopic assessment of the LC postmortem can be used to differentiate between disorders associated with degeneration (AD, DLB/PDD) or sparing (VaD) of the LC, but counting LC cells in a representative pontine section is the most appropriate method by which to assess LC degeneration.

Calcium supplementation and risk of dementia in women with cerebrovascular disease.

To determine whether calcium supplementation is associated with the development of dementia in women after a 5-year follow-up. This was a longitudinal population-based study. The sample was derived from the Prospective Population Study of Women and H70 Birth Cohort Study in Gothenburg, Sweden, and included 700 dementia-free women aged 70-92 years. At baseline in 2000-2001, and at follow-up in 2005-2006, the women underwent comprehensive neuropsychiatric and somatic examinations. A CT scan was performed in 447 participants at baseline. Information on the use and dosage of calcium supplements was collected. Dementia was diagnosed according to DSM-III-R criteria. Women treated with calcium supplements (n = 98) were at a higher risk of developing dementia (odds ratio [OR] 2.10, 95% confidence interval [CI] 1.01-4.37, p = 0.046) and the subtype stroke-related dementia (vascular dementia and mixed dementia) (OR 4.40, 95% CI 1.54-12.61, p = 0.006) than women not given supplementation (n = 602). In stratified analyses, calcium supplementation was associated with the development of dementia in groups with a history of stroke (OR 6.77, 95% CI 1.36-33.75, p = 0.020) or presence of white matter lesions (OR 2.99, 95% CI 1.28-6.96, p = 0.011), but not in groups without these conditions. Calcium supplementation may increase the risk of developing dementia in elderly women with cerebrovascular disease. Because our sample was relatively small and the study was observational, these findings need to be confirmed.

Comparison of neuropsychological profiles in patients with Alzheimer's disease and mixed dementia

ObjectsWe designed this study to extensively compare the neuropsychological profiles of Alzheimer's disease (AD) and mixed dementia (MD) in a large multicenter cohort of patients. Specifically, we performed subgroup analyses to examine group differences associated with dementia severity. MethodsA total of 1021 AD patients and 577 MD patients were included from the Clinical Research Center for Dementia of South Korea (CREDOS) Study. All patients underwent comprehensive neuropsychological and functional ratings, as well as complete physical and neurological examinations. To avoid floor confounds, only patients with Clinical Dementia Rating (CDR) scores of 0.5–2.0 were included. ResultsOverall, MD patients showed worse performance in frontal/executive function than those with AD. Stratification by dementia severity revealed a significant difference in global cognitive function scores between AD and MD patients only in the low severity groups (CDR 0.5). Also, MD patients showed worse performance in frontal/executive function domains in the CDR 0.5 groups whereas they had better performance in the memory domain in the CDR 1 groups than did AD patients. Additionally, AD patients showed better performance than MD patients with respect to activities of daily living at CDR levels 0.5 and 1. All differences had disappeared at the CDR 2 level of global dementia severity. ConclusionThis study suggests that there are significant differences in neuropsychological profiles between AD and MD patients, with the pattern of this difference varying distinctively according to dementia severity.

Evolution of the Antidepressant Prescribing in Alzheimer's Disease and Related Disorders Between 2010 and 2014: Results from the French National Database on Alzheimer's Disease (BNA).

Safety warnings from health authorities are currently intended to limit the use of psychotropic agents in dementia-related conditions. Evidence concerning the use of antidepressants in dementia is, however, scarce and contradictory. To evaluate antidepressant use among individuals with Alzheimer's disease (AD) and related disorders in the French population between 2010 and 2014. Antidepressant prescriptions in individuals with AD, mixed dementia (MD), and vascular dementia (VaD) in the French National Alzheimer Database between 2010 and 2014 were analyzed (N = 199,544). Multivariate analysis showed an annual significant increase (p < 0.001) in the prescription rate of antidepressants from 26% (2010) to 31% (2014), and identified female gender, younger age, higher education, living in long-term facilities, more severe cognitive decline, and presence of vascular signs (VaD and MD) as associated factors for antidepressant prescribing. The annual increase of antidepressant prescribing among individuals with AD, MD, and VaD in French specialized settings may be partially related to the lack of current valuable medications for dementia-related behavioral symptoms.

Association of interleukin-10 polymorphisms with risk factors of Alzheimer’s disease and other dementias (SADEM study)

Some studies have reported a genetic association between single nucleotide polymorphisms (SNPs) in the promoter region of Interleukin (IL) 10 and Alzheimer's disease (AD), with conflicting results. To further investigate the proposed association and to clarify the role of cytokines as a potential cause for AD susceptibility, we analyzed genotypes, allele distributions and haplotypes of IL-10 promoter polymorphisms −1082 (rs1800896) and −819 (rs1800871) in a Mexican population: 986 normal controls and 221 cases divided as follows: 122 with Alzheimer disease (AD), 67 with (VaD) and 32 with mixed dementia (AD/VaD). Patients with dementia showed increased frequency of “ATA, CTG, and CTA” haplotypes when compared to controls. We identified two risk haplotypes: ATA (OR=3.56, 95%CI=2.84–4.45, p<0.0001), and CTA (OR=1.90, 95%CI=1.38–2.62, p<0.0001), and four protection haplotypes: ATG (OR=0.60, 95%CI=0.45–0.82, p=0.0012), CTG (OR=0.38, 95%CI=0.23–0.62, p<0.0001), ACG (OR=0.01, 95%CI=0.002–1.13, p<0.0001), and CCG (OR=0.02, 95%CI=0.004–0.203, p<0.0001). In summary, this is the first study in Mexican population that considers the analysis of IL-10 in patients with AD, VaD and AD/VaD. Our results showed the relevance of the role that IL-10 plays in the pathological mechanisms that result in the development of dementia. In addition, in our study, it was possible to distinguish two protective and two risk haplotypes for the development of dementia.

Taking a positive spin: preserved initiative and performance of everyday activities across mild Alzheimer's, vascular and mixed dementia.

The literature commonly evaluates those daily activities which are impaired in dementia. However, in the mild stages, people with dementia (PwD) are still able to initiate and perform many of those tasks. With a lack of research exploring variations between different dementia diagnoses, this study sought to investigate those daily activities with modest impairments in the mild stages and how these compare between Alzheimer's disease (AD), vascular dementia (VaD) and mixed dementia. Staff from memory assessment services from nine National Health Service trusts across England identified and approached informal carers of people with mild dementia. Carers completed the newly revised Interview for Deteriorations in Daily Living Activities in Dementia 2 assessing the PwD's initiative and performance of instrumental activities of daily living (IADLs). Data were analysed using analysis of variance and Chi-square tests to compare the maintenance of IADL functioning across AD, VaD, and mixed dementia. A total of 160 carers returned the Interview for Deteriorations in Daily Living Activities in Dementia 2, of which 109, 21, and 30 cared for someone with AD, VaD, and mixed dementia, respectively. There were significant variations across subtypes, with AD showing better preserved initiative and performance than VaD for several IADLs. Overall, PwD showed greater preservation of performance than initiative, with tasks such as preparing a hot drink and dressing being best maintained. Findings can help classify dementia better into subtypes in order to receive bespoke support. It suggests that interventions should primarily address initiative to improve overall functioning. Copyright © 2016 John Wiley & Sons, Ltd.

MAINTAINING COGNITIVE IMPAIRMENT PATIENTS IN A MILDER DISEASE STAGE RESULTS IN LESS HEALTHCARE RESOURCE UTILIZATION

Patients suffering from advanced stages of Alzheimer’s disease (AD) could incur high costs because of gradual loss of the basic life functions and the supervision required. This analysis aimed to compare the healthcare resource utilization (HCRU) of patients in different stages of cognitive impairment (CI). Data were taken from the 2013 Adelphi Real World Dementia Disease Specific Programme, a cross-sectional survey of physicians, and patients over 50 years old with CI in France, Germany, Italy, Spain, the UK and the US. Physicians completed patient record forms containing patient demographics, clinical characteristics and HCRU. Patients were classified into four CI subgroups based on their current mini–mental state examination score and diagnostic labels; prodromal (24-30), mild (18-23), moderate (10-17) and severe (<10). The latter three groups had a diagnostic label of AD, early onset AD or mixed dementia, while the first group could not have one of these labels but had a mild CI (MCI), amnestic MCI, pre-dementia AD or prodromal AD label. Propensity score matching, controlling for patient demographics and clinical characteristics, was used to assess differences in HCRU between prodromal/mild patients and moderate/severe patients. Statistical significance was assessed via the calculation of the Abadie-Imbens standard error. A total of 3592 patients (median age 78.0, 55.5% female) were collected, of which 1959 were prodromal/mild patients and 1633 moderate/severe. Each moderate/severe patient was matched 1:1 to a prodromal/mild patient with replacement. After matching, all covariates had an absolute standardised mean difference <10%. The mean differences in specialist consultations (4.5 moderate/severe versus 3.8 prodromal/mild), number of hospitalizations (0.4 vs 0.3) and number of inpatient days (3.7 vs 1.5) in the last 12 months were all statistically significant (p<0.05). Moderate/severe patients also required significantly more professional caregiver hours per week (36.7 vs 20.8, p<0.001) and a significantly higher proportion of these patients were institutionalized (21.4 vs 8.8, p<0.001). Later stage CI patients incur more HCRU than prodromal/mild patients, consequently imposing a heavier burden on healthcare system. Therefore, therapies that could delay cognitive decline can have the potential for important clinical benefits and substantial cost savings for healthcare systems in countries with rapidly aging populations.

RECENT ANIMAL MODELS FOR DISCOVERING MECHANISMS AND SYNERGIES OF VCID IN MIXED DEMENTIAS

RECENT ANIMAL MODELS FOR DISCOVERING MECHANISMS AND SYNERGIES OF VCID IN MIXED DEMENTIAS