Senile Dementia Of Alzheimer Type Group Research Articles

A swallowing study, based on clinico-pathological evaluation, performed by video-fluoroscopy

A clinico-pathological evaluation was performed on patients requiring nasogastric nutritional support. As a result, it was found that nasogastric tube feeding was common in patients with cerebrovascular diseases (CVD) and senile dementia of Alzheimer's type (SDAT). Pneumonia was anamnestic in many CVD patients, which was frequently the direct indication for nasogastric tube feeding and the major cause of death in these patients. On the other hand, pneumonia was not common in SDAT in which the major indication of nasogastric tube feeding was abnormal appetite. However, pneumonia was an infrequent cause of death in SDAT compared to CVD patients. The mean age in which nasogastric tube feeding was started was 8 years older in SDAT than CVD patients, however, there was no significant difference in the duration of nasogastric tube feeding ranging from initiation to death. A swallowing study, based on a clinico-pathological evaluation, was performed by video-fluoroscopy on healthy seniors and senior patients neurological diseases. There was no abnormal finding in the healthy seniors. Findings in CVD patients with single-sided neurological diseases indicated that 27.3% had moderate abnormalities and 18.2% had severe abnormalities. In CVD with bilateral defects, 35.7% had moderate abnormalities and 42.9% had severe abnormalities. Though even single-sided CVD defects can frequently cause swallowing disorder, oral food intake was maintained in nearly half of the patients with bilateral CVD, despite high incidence of severe swallowing disorder. In the mild SDAT group, rated on a scale from 0.5 to 1.0 according to the Clinical Dementia Rating (CDR), 11.1% had moderate swallowing disorder. In the CDR 2-3 group, 23.1% had moderate disability and 15.4% had severe disability. It appears that SDAT patients do not suffer from rapid deterioration in swallowing ability, which was relatively retained in this disease group. In Parkinson's disease patients with a Yahr grade of I-II, 55.6% had normal findings and 44.4% had mild abnormalities. In Yahr grade III-IV patients, 28.6% had mild and 28.6% had severe disability. Patients with severe dysfunction had a high incidence of silent aspiration. The swallowing function was maintained in the early course of mild Parkinson's disease patients, however the ability rapidly deteriorated with the course of the disease. The radiological findings of the swallowing study supported the clinico-pathological characteristics of each disease.

Orthostatic hypotension in Alzheimer’s disease: Result or cause of brain dysfunction?

In Alzheimer's disease (AD), an association was found between autonomic dysfunction and frontal hypoperfusion in brain during orthostatic testing. To ascertain whether frontal hypoperfusion is dependent on longitudinal effects of hemodynamic disturbances, or contributes to them, we studied the relationship between the presence of orthostatic hypotension (OH) and resting cerebral blood flow (CBF) in late stages of AD. Twelve women with senile dementia of Alzheimer type (SDAT), and 15 non-demented women (mean age 82.6 years, SD 3.8 vs 81.8 years, SD 3.5) were examined with the orthostatic test. Four of 12 patients with SDAT, and 9 controls had OH (defined as systolic blood pressure fall > or = 20 mmHg). CBF was determined under resting conditions using 600 Mbq 99mTc HMPAO single photon emission computerized tomography (SPECT), and quantified in cortical areas in relation to cerebellum. In patients with SDAT and OH, CBF was lower in frontal and parieto-frontal cortical areas than in SDAT patients without OH. The former group was younger and had a shorter dementia duration. No significant differences in CBF were observed between controls with vs without OH. No differences in SDAT patients with or without OH were observed in the Berger dementia scale or Katz' ADL index. No difference in incidence of symptoms related to autonomic disturbances (diarrhea, obstipation, dysphagia, vertigo) was observed in either the SDAT or control group with regard to OH presence. We conclude that during the course of AD, OH can contribute to frontal brain changes and may exacerbate the disease. The further involvement of frontal dysfunction in aggravating blood pressure dysregulation in the elderly is discussed.

A follow-up study on the outcome and relevant factors in senile dementia of Alzheimer type and vascular dementia

We followed 126 patients with senile dementia of Alzheimer type (SDAT), and 129 over age 65 with vascular dementia (VD) who were diagnosed at the Center for Elderly Dementia in our institution between February 1990 and February 1993. At 5-year follow-up, 62 patients with SDAT and 71 patients with VD had died. These patients were assessed prospectively to investigate the neuropsychiatric and somatic factors related to the prognosis of SDAT and VD. There were no significant differences in the average age at onset and time of diagnosis of dementia between the SDAT and VD groups. Mean age at death, mean duration of dementia and 75% survival duration from dementia onset were shorter in patients with VD than in those with SDAT. Pneumonia was the most common cause of death in patients with either SDAT or VD, followed by geromarasmus in the SDAT group, and cerebrovascular and cardiovascular diseases in the VD group. In patients with SDAT, a poor prognosis was correlated with severe dementia, impaired intellectual function and degree of cortical atrophy. In patients with VD, physical complications, impaired motor function and hypoproteinemia enhanced the probability of death. This study confirmed that a progressive neurodegenerative course and physical conditions such as motor dysfunction or malnutrition are closely associated with the prognosis of patients with SDAT and VD, respectively.

CT study in senile dementia of Alzheimer type

AbstractWe evaluated 14 patients with senile dementia of Alzheimer type (SDAT) and 15 age‐matched normal elderly controls using psychological test and computed tomography scans. The low‐density rate (LDR) was used as an index of brain atrophy. SDAT patients had significantly higher scores on the Hasegawa Dementia Scale (p< 0.01) and significantly lower scores on the Bender Gestalt Test (p<0.01) than control subjects. The LDRs of the left and right hemispheres were significantly higher in the SDAT group than in the control group in all three slices investigated (p<0.05/6 = 0.0083). In SDAT patients, significant diagnosis by hemisphere interaction was observed in one slice (p<0.05), with higher LDR on the left than on the right (p<0.05/6 = 0.0083). Our findings suggest that cortical atrophy is predominant on the left side in patients with SDAT.

Basic visual processing in Alzheimer's disease: A note on Stevens

Many of us will have speculated on whether the form in which stimulus materials are presented affects a neurological patient's ability to carry out a common clinical task such as picture naming. It is a practical issue that clearly has important consequences for how materials should be presented for assessment and therapy. Stevens addresses the question by comparing the performances of adult dysphasics and patients with senile dementia of Alzheimer's type (SDAT) in naming familiar objects presented either as colour photographs or as line drawings. It has been reported that Alzheimer patients can have problems with a variety of visual tasks (e.g. Cogan, 1979, Cases 12 & 13; Corkin, 1982), as well as displaying amnesic and aphasic difficulties which commonly accompany the disease. Stevens hypothesises that the SDAT group will make visual perceptual errors in naming both kinds of picture stimuli. Line drawings, she suggests, will be particularly prone to error because of ‘an increased likelihood of mispercep...

Differences in olfactory test performance between normal aged, Alzheimer and vascular type dementia individuals

AbstractA comparison was made between 3 groups of elderly subjects — normal controls aged 69–79 years, patients with vascular dementia aged 64–84 years and patients with probable senile dementia of Alzheimer type (SDAT) aged 70–90 years — by means of several tests of olfactory functions. Significant group differences were found at all levels assessed — olfactory thresholds, smell recognition, smell identification, naming of smells — with the normal aged performing best and the SDAT group scoring lowest throughout. The differences were most pronounced with regard to smell recognition and smell identification where minimal or no overlap at all between controls and SDAT patients was found. Differences in age and severity of dementia did not fully account for the findings, suggesting that differential diagnosis of Alzheimer ‐ type dementia could be facilitated and improved by the use of olfactory tasks. Neurophysiological and ‐ pathological findings support a close association or even identity of brain structures involved in olfaction and affected in Alzheimer's disease.

Somatostatin immunoreactivity in cortical and some subcortical regions in Alzheimer's disease

Reverse phase HPLC analysis of somatostatin immunoreactivity in the cerebral cortex in elderly normal individuals revealed that the majority of the immunoreactivity co-eluted with synthetic somatostatin-14. While an immunoreactive peak corresponding to somatostatin-28 was not detected there was a peak of immunoreactivity which eluted after somatostatin-14. In cases of senile dementia of Alzheimer type (SDAT), where abundant neurofibrillary tangles and senile plaques (density > 30 per 1.3-mm 2 field) were present in the cerebral cortex, somatostatin immunoreactivity was found to be significantly decreased in either the frontal or temporal cortex. Chromatographic analysis, however, revealed that both the major immunoreactive peaks detected in the normal group were reduced in SDAT in the temporal and frontal cortex. Using a punch microdissection technique somatostatin immunoreactivity has been assessed in the nucleus of Meynert and amygdala of SDAT and elderly normal cases. While there was no change in somatostatin immunoreactivity in the nucleus of Meynert in the SDAT group, tissue punches taken from the amygdala revealed a selective decrease in somatostatin immunoreactivity in the basal nucleus, in the SDAT cases.

A longitudinal EEG study of mild senile dementia of Alzheimer type: changes at 1 year and at 2.5 years

This longitudinal study of resting EEGs compared patients with senile dementia of Alzheimer type (SDAT) and healthy controls at 3 times of testing over a 2.5 year period. Measures included the mean EEG frequency as well as the percentage of power in alpha, beta, theta, and delta frequency bands obtained from power spectral analysis. The values from occipital to vertex derivations were averaged for the left and right hemispheres. In healthy older adults delta increased, and both beta and mean frequency decreased over the study period; there was no significant change in theta or alpha. In the SDAT group, all 5 EEG measures changed significantly; there were increases in delta and theta, and decreases in beta, alpha and mean frequency. Theta percentage power distinguished between all 4 stages of dementia (control, mild, moderate and severe). Other EEG measures discriminated only at certain stages. In the mild stage of SDAT theta, beta and mean frequency were already different from control values. In the moderate stage, these differences persisted, and alpha became different. Delta was the last to change, and in the present small sample of those with severe SDAT the difference had not yet reached significance.

Somatostatin immunoreactivity in cortical and some subcortical regions in Alzheimer's disease

Reverse phase HPLC analysis of somatostatin immunoreactivity in the cerebral cortex in elderly normal individuals revealed that the majority of the immunoreactivity co-eluted with synthetic somatostatin-14. While an immunoreactive peak corresponding to somatostatin-28 was not detected there was a peak of immunoreactivity which eluted after somatostatin-14. In cases of senile dementia of Alzheimer type (SDAT), where abundant neurofibrillary tangles and senile plaques (density greater than 30 per 1.3-mm2 field) were present in the cerebral cortex, somatostatin immunoreactivity was found to be significantly decreased in either the frontal or temporal cortex. Chromatographic analysis, however, revealed that both the major immunoreactive peaks detected in the normal group were reduced in SDAT in the temporal and frontal cortex. Using a punch microdissection technique somatostatin immunoreactivity has been assessed in the nucleus of Meynert and amygdala of SDAT and elderly normal cases. While there was no change in somatostatin immunoreactivity in the nucleus of Meynert in the SDAT group, tissue punches taken from the amygdala revealed a selective decrease in somatostatin immunoreactivity in the basal nucleus, in the SDAT cases.

Muscarinic receptor compensation in hippocampus of Alzheimer patients.

The activity of the acetylcholine synthesizing enzyme choline acetyltransferase (ChAT) (presynaptic marker) and number of muscarine-like receptor binding sites have been measured in the hippocampus from eight individuals with senile dementia of Alzheimer type (SDAT) and ten controls. A negative correlation (r = 0.80; p less than 0.05) was found between the ChAT activity and the number of muscarine-like receptors in the SDAT group but not in the controls. The findings might indicate an ongoing compensatory receptor mechanism as a response to changes in presynaptic cholinergic activity.

Changes in blood glucose and insulin secretion in patients with senile dementia of Alzheimer type.

A retrospective study of 839 hospital records with various dementia diagnoses showed that 63 cases had a diagnosis of diabetes mellitus as well. None of these were found in the group of patients with senile dementia of Alzheimer type (SDAT). Oral glucose tolerance tests (OGTT) were performed in patients with SDAT, multiinfarct dementia (MID), cerebrovascular disease (CVD), hospitalized control patients (Chosp) and healthy elderly persons (Celd). Fasting blood sugar was significantly lower and the areas under the OGTT curves were significantly smaller in the SDAT group than in the CVD and the Chosp group. SDAT patients had higher insulin levels than Celd during the OGTT and on a statistically significant level 90 min after ingestion of sugar. Our findings suggest that SDAT and diabetes mellitus may not co-exist and that patients with SDAT have decreased blood sugar concentrations and elevated serum insulin levels. It is discussed whether this is an effect of the transmitter deficiencies in SDAT or may serve to explain these deficiencies.