Unspecified Dementia Research Articles

치매환자 특성의 추이 분석

우리나라는 고령화 사회로 빠르게 진입함에 따라 치매환자가 급속히 증가하고 있다. 본 연구는 대도시에 위치한 5개 V병원의 자료를 활용하여 12년간 치매 신환자의 특성 추이를 분석하고 향후 치매환자 증가 수요에 대처하고 치매환자 관리에 기초자료를 제공하고자하는 것이 목적이다. 5개 V병원의 전체 치매 신환자수는 2003년 410명이었으나 2014년에는 5,048명으로 11.3배 증가하였으며, 5개 병원중에서는 P병원이 2003년에 비해 2014년은 30.3배로 가장 많이 증가하였고, D병원은 6.0배 증가하여 병원간에 차이가 많았으나 전반적으로 5개 V병원 치매환자 수가 크게 증가한 것으로 나타났다. 연령별에서는 75세~84세군에서 40.4%로 가장 높았고, 85세 이상 20.2%로 65세 이상이 93.5%로 대부분을 차지하여 고령층에서도 치매환자의 비율이 높게 나타났다. 치매환자 유형별에서는 알츠하이머병이 44.4%로 가장 높게 차지하였으며, 상세불명의 치매는 33.3%, 혈관성치매가 20.4% 순이었다. 연구결과는 12년 동안 큰 폭으로 증가하였으며, 치매환자는 연령이 높을수록 발생률이 높기 때문에 앞으로 5개 V병원의 치매환자 수는 더욱 증가할 것이다. 치매환자 증가 수요에 따른 효과적인 치매관리를 위한 체계적이고 지속적인 추진방안이 요구된다. South Korea is becoming an aging society, increasing the population with dementia. This study analyzed the characteristics of the trend of dementia patients by utilizing 12 years' worth of data from five V hospitals within metropolitan cities. The results show that there has been an 11.3 times increase in the total number of new dementia patients in these five hospitals from 410 in 2003 to 5,048 in 2014; and among them, the rate of increase was highest in P hospital with a 30.3 times increase. Conversely, there has been a 6-times increase in D hospital, illustrating a noticeable gap between these hospitals. Overall, these hospitals have shown an enormous increasing ratio. In an analysis according to age, it's been shown that those aged between 75 and 84 showed the highest prevalence, and most patients, approximately 93.5%, were 65 years or older, while 20.2% were 85 years or older, showing a high ratio of elderly among dementia patients. In an analysis by type of dementia, it's been shown that Alzheimer's was the most prevalent with 44.4%, followed by unspecified dementia with 33.3%, and vascular dementia with 20.4%. As evident by the outcome of the study, there's been a drastic increase in the number of dementia patients in the past 12 years; since the prevalence of dementia was shown to be higher with older age, it is expected that the number of dementia patients will rise further in these five hospitals, where there's a high ratio of elderly patients. More elaborate and continuous plans are necessary for the management of dementia patients following the growing number of dementia patients.

The legal appearances of dementia in court rulings: mapping the terrain.

Individuals with dementia may appear before the court in different roles: as victims, as witnesses, and as those standing up for their rights. While there is growing interest in the rights of older persons with dementia, relatively little empirical data exists regarding their actual interactions in courts. Therefore, the goal of this study was to empirically map this legal terrain. This study used a descriptive quantitative method. A computerized search of a national legal database limited to the period 2004-2014 and a screening process for the results were used to establish a sample of 280 court rulings that directly addressed dementia. All cases were analyzed and categorized into the following four criteria groups: characteristics of the person with dementia; characteristics of the legal procedure; the legal substance of the case; and the legal outcome. The majority of cases involved a single, very-elderly (i.e. over 80 years) woman, living in the community, with unspecified dementia. The majority of cases were heard and decided in lower level courts, addressing a broad range of primarily non-criminal legal issues. Finally, in the majority of non-criminal cases, the person with dementia was found to be legally capable, whereas in the majority of criminal cases, the person with dementia was found incapable. The legal needs and rights of persons with dementia are much broader than issues of legal capacity or social protection. Deeper knowledge and more research is needed in order to fully understand the contexts in which dementia is constructed under the law.

Neurocognitive and Affective Baseline Profile of the Elderly Individuals Living in Long-Term Care Nursing Home Facility: a New Brunswick Study

Context: The average nursing home residents in Canada face many health challenges and cognitive and emotional problems overlap with the natural aging process, thus making them difficult to detect. Therefore, better assessment approach in long-term care setting is needed. Objective: To verify if early identification of Mild Cognitive Impairment (MCI) in an elderly care facility allows better management of dementia. Design: A longitudinal study. Setting: Nursing home. Participants: 35 nursing home residents (NB) were neuropsychologically tested and follow-up assessments were set for every 6 months for 3 years. Main outcome measures: The paper and pencil neuropsychological testing included the Mini Mental State Examination (MMSE), the Montreal Cognitive Assessment (MoCA), the Wechsler’s Digit Symbol subscale (WAIS-R, Digit symbol), the Bell's Test, the Trail Making Test A and B, and the Geriatric Depression Scale-30 items (GDS-30). Results: Cognitive statuses of the individuals were Alzheimer’s disease, MCI or unspecified dementia, and reported chronic comorbid conditions. Conclusion: The base line data profile indicates that the following aspects need to be taken into consideration: mortality, medications effect on cognitive performance and affect and their implication on dementia. These factors would help in better understanding and instigate better treatment and care in nursing home.

DEMENTIA MORTALITY IN THE UNITED STATES: 2000–2014

Objectives-This report presents data on mortality attributable to dementia. Data for dementia as an underlying cause of death from 2000 through 2017 are shown by selected characteristics such as age, sex, race and Hispanic origin, and state of residence. Trends in dementia deaths overall and by specific cause are presented. The reporting of dementia as a contributing cause of death is also described. Methods-Data in this report are based on information from all death certificates filed in the 50 states and the District of Columbia. Using multiple cause-of-death data files, dementia is considered to include deaths attributed to unspecified dementia; Alzheimer disease; vascular dementia; and other degenerative diseases of nervous system, not elsewhere classified. Results-In 2017, a total of 261,914 deaths attributable to dementia as an underlying cause of death were reported in the United States. Forty-six percent of these deaths were due to Alzheimer disease. In 2017, the age-adjusted death rate for dementia as an underlying cause of death was 66.7 deaths per 100,000 U.S. standard population. Age-adjusted death rates were higher for females (72.7) than for males (56.4). Death rates increased with age from 56.9 deaths per 100,000 among people aged 65-74 to 2,707.3 deaths per 100,000 among people aged 85 and over. Age-adjusted death rates were higher among the non-Hispanic white population (70.8) compared with the non-Hispanic black population (65.0) and the Hispanic population (46.0). Age-adjusted death rates for dementia varied by state and urbanization category. Overall, age-adjusted death rates for dementia increased from 2000 to 2017. Rates were steady from 2013 through 2016, and increased from 2016 to 2017. Patterns of reporting the individual dementia causes varied across states and across time.

Does Schizophrenia in Offspring Increase the Risk of Developing Alzheimer's Dementia

Background/Aims: Prior studies have consistently found a higher risk of dementia in individuals with schizophrenia, but whether this is due to a common etiology between the disorders remains obscure. We wanted to elucidate this association by investigating whether schizophrenia in offspring increases the risk of Alzheimer's dementia. Methods: All individuals born between 1930 and 1953 were identified through national registers and followed from their 50th birthday until the date of Alzheimer's dementia, death or end of the study. Regressions were performed to evaluate the association between offspring with schizophrenia and Alzheimer's dementia. Results: Individuals with offspring with schizophrenia did not have an increased risk of Alzheimer's dementia [incidence rate ratio (IRR), 0.97; 95% CI, 0.88-1.07] compared to individuals with offspring without psychiatric contact. This finding remained stable when evaluating early-onset (IRR, 1.10; 95% CI, 0.91-1.31) and late-onset Alzheimer's dementia (IRR, 0.92; 95% CI, 0.88-1.07). Similar findings were made for vascular and unspecified dementia. Conclusion: The finding of no familial coaggregation between schizophrenia and Alzheimer's dementia may suggest that no common etiology between the disorders exists. This may indicate that the excess risk of dementia in individuals with schizophrenia is a by-product of the higher rates of somatic comorbidity and adverse health risk factors among these individuals.

Geographical Variation in Dementia Mortality in Italy, New Zealand, and Chile: The Impact of Latitude, Vitamin D, and Air Pollution

Background: Dementia risk is reported as being higher in the north compared to the south, which may be related to vitamin D deficiency. If this were the case, an opposite gradient of risk would be observed in the southern hemisphere, but this has not been investigated previously. Methods: We calculated standardised mortality ratios (SMRs) for deaths in 2012 where dementia (Alzheimer's disease, vascular or unspecified dementia) was recorded as the underlying cause for 20 regions in Italy, 20 District Health Board areas in New Zealand and 29 Health Service areas in Chile. Results: Dementia SMRs were higher in northern than central or southern Italy. The inverse pattern was seen in women in New Zealand, with rates higher on South Island than North Island. However, dementia risk was raised in eight regions in the north and centre of Chile in both men and women. Conclusions: Geographical variation plays a key role in dementia risk, but patterns vary in men and women. In the northern hemisphere, dementia mortality is higher in the north, but the pattern in the southern hemisphere is more complex.

Trend of centenarian deaths in Hong Kong between 2001 and 2010.

To examine the trends in the leading causes of deaths in centenarians in Hong Kong. Descriptive analyses of vital statistics data on mortality in Hong Kong from 2001 to 2010 were carried out. The number of centenarians' deaths increased by 136% in 10 years, from less than 28 men and 166 women in 2001 to 80 men and 378 women in 2010. During the study period, the top leading cause of death was pneumonia, accounting for 33.8% of all deaths. In contrast, the other leading causes accounted for much smaller percentages; for example, the second and third leading causes were chronic ischemic heart disease and unspecified dementia, and account for 4.3% and 4.2% of the total, respectively. This cause-of-death pattern has remained fairly stable between 2001 and 2010. A total of 985 (30.8%) deaths occurred in January to March. The correlation between the average monthly temperature and the number of deaths was -0.720 (P < 0.01). The number of deaths continues to increase in Hong Kong. These trends have major implications for healthcare in an aging population. Geriatr Gerontol Int 2017; 17: 931-936.

Mini-Mental State Examination (MMSE) for the detection of dementia in clinically unevaluated people aged 65 and over in community and primary care populations.

The Mini Mental State Examination (MMSE) is a cognitive test that is commonly used as part of the evaluation for possible dementia. To determine the diagnostic accuracy of the Mini-Mental State Examination (MMSE) at various cut points for dementia in people aged 65 years and over in community and primary care settings who had not undergone prior testing for dementia. We searched the specialised register of the Cochrane Dementia and Cognitive Improvement Group, MEDLINE (OvidSP), EMBASE (OvidSP), PsycINFO (OvidSP), LILACS (BIREME), ALOIS, BIOSIS previews (Thomson Reuters Web of Science), and Web of Science Core Collection, including the Science Citation Index and the Conference Proceedings Citation Index (Thomson Reuters Web of Science). We also searched specialised sources of diagnostic test accuracy studies and reviews: MEDION (Universities of Maastricht and Leuven, www.mediondatabase.nl), DARE (Database of Abstracts of Reviews of Effects, via the Cochrane Library), HTA Database (Health Technology Assessment Database, via the Cochrane Library), and ARIF (University of Birmingham, UK, www.arif.bham.ac.uk). We attempted to locate possibly relevant but unpublished data by contacting researchers in this field. We first performed the searches in November 2012 and then fully updated them in May 2014. We did not apply any language or date restrictions to the electronic searches, and we did not use any methodological filters as a method to restrict the search overall. We included studies that compared the 11-item (maximum score 30) MMSE test (at any cut point) in people who had not undergone prior testing versus a commonly accepted clinical reference standard for all-cause dementia and subtypes (Alzheimer disease dementia, Lewy body dementia, vascular dementia, frontotemporal dementia). Clinical diagnosis included all-cause (unspecified) dementia, as defined by any version of the Diagnostic and Statistical Manual of Mental Disorders (DSM); International Classification of Diseases (ICD) and the Clinical Dementia Rating. At least three authors screened all citations.Two authors handled data extraction and quality assessment. We performed meta-analysis using the hierarchical summary receiver-operator curves (HSROC) method and the bivariate method. We retrieved 24,310 citations after removal of duplicates. We reviewed the full text of 317 full-text articles and finally included 70 records, referring to 48 studies, in our synthesis. We were able to perform meta-analysis on 28 studies in the community setting (44 articles) and on 6 studies in primary care (8 articles), but we could not extract usable 2 x 2 data for the remaining 14 community studies, which we did not include in the meta-analysis. All of the studies in the community were in asymptomatic people, whereas two of the six studies in primary care were conducted in people who had symptoms of possible dementia. We judged two studies to be at high risk of bias in the patient selection domain, three studies to be at high risk of bias in the index test domain and nine studies to be at high risk of bias regarding flow and timing. We assessed most studies as being applicable to the review question though we had concerns about selection of participants in six studies and target condition in one study.The accuracy of the MMSE for diagnosing dementia was reported at 18 cut points in the community (MMSE score 10, 14-30 inclusive) and 10 cut points in primary care (MMSE score 17-26 inclusive). The total number of participants in studies included in the meta-analyses ranged from 37 to 2727, median 314 (interquartile range (IQR) 160 to 647). In the community, the pooled accuracy at a cut point of 24 (15 studies) was sensitivity 0.85 (95% confidence interval (CI) 0.74 to 0.92), specificity 0.90 (95% CI 0.82 to 0.95); at a cut point of 25 (10 studies), sensitivity 0.87 (95% CI 0.78 to 0.93), specificity 0.82 (95% CI 0.65 to 0.92); and in seven studies that adjusted accuracy estimates for level of education, sensitivity 0.97 (95% CI 0.83 to 1.00), specificity 0.70 (95% CI 0.50 to 0.85). There was insufficient data to evaluate the accuracy of the MMSE for diagnosing dementia subtypes.We could not estimate summary diagnostic accuracy in primary care due to insufficient data. The MMSE contributes to a diagnosis of dementia in low prevalence settings, but should not be used in isolation to confirm or exclude disease. We recommend that future work evaluates the diagnostic accuracy of tests in the context of the diagnostic pathway experienced by the patient and that investigators report how undergoing the MMSE changes patient-relevant outcomes.

Living Unnoticed: Cognitive Impairment in Older People with Multimorbidity.

To investigate the correlation between MMSE ≤ 23 and the presence of a diagnosis of dementia in the medical record in a population with multimorbidity. This cross-sectional study was part of the Ambulatory Geriatric Assessment - a Frailty Intervention Trial (AGe-FIT; N = 382). Participants were community dwelling, aged ≥ 75 years, had received inpatient hospital care at least three times during the past 12 months, and had three or more concomitant diagnoses according to the International Classification of Diseases, 10th revision. The Mini Mental State Examination (MMSE) was administered at baseline. Medical records of participants with MMSE scores < 24 were examined for the presence of dementia diagnoses and two years ahead. Fifty-three (16%) of 337 participants with a measure of MMSE had a MMSE scores < 24. Six of these 53 (11%) participants had diagnoses of dementia (vascular dementia, n = 4; unspecified dementia, n = 1; Alzheimers disease, n = 1) according to medical records; 89% did not. A MMSE-score < 24 is not well correlated to a diagnosis of dementia in the medical record in a population of elderly with multimorbidity. This could imply that cognitive decline and the diagnosis of dementia remain undetected in older people with multimorbidity. Proactive care of older people with multimorbidity should focus on cognitive decline to detect cognitive impairment and to provide necessary help and support to this very vulnerable group.

Association between inflammatory potential of diet and mortality in the Iowa Women's Health study.

Chronic diseases such as cancer and cardiovascular disease (CVD) are well-established causes of disability and premature deaths. Dietary components that are known to affect chronic inflammation have been implicated in the etiology and prognosis of these chronic diseases. We examined the ability of the dietary inflammatory index (DII) to predict overall, cancer and CVD mortality in the Iowa Women's Health study. The DII was computed from baseline dietary intake assessed in this cohort of 37,525 women, who were aged 55-69years when enrolled starting in 1986. During the follow-up period, through December 31, 2010, in a total of 17,793 deaths, 5044 cancer- and 6528 CVD-related deaths were identified through mortality record linkage. Cox proportional hazards regression was used to estimate hazard ratios (HR) with DII expressed both as a continuous variable and as quartiles. Comparing subjects in DII Quartile 4 versus Quartile 1, modest positive associations were noted for all-cause mortality (HRQ4vsQ1 1.07; 95% CI 1.01-1.13; p-trend=0.006), digestive cancer mortality (HRQ4vsQ1 1.19; 95% CI 1.00-1.43; p-trend=0.05), CVD mortality (HRQ4vsQ1 1.09; 95% CI 1.01-1.18; p-trend=0.08), non-cancer/non-CVD/non-acute mortality (HRQ4vsQ1 1.09; 95% CI 1.00-1.19; p-trend=0.19), coronary heart disease (CHD) mortality (HRQ4vsQ1 1.17; 95% CI 1.05-1.30; p-trend=0.001) and chronic obstructive pulmonary disease (COPD) mortality (HRQ4vsQ1 1.43; 95% CI 1.18-1.75; p-trend=0.0006). No substantial associations were observed for mortality from stroke, Alzheimer's disease or unspecified dementia. These results indicate that a pro-inflammatory diet, as evidenced by higher DII scores, may be associated with total mortality as well as mortality from digestive cancer, CVD, CHD and COPD.

ABO Blood Group and Dementia Risk--A Scandinavian Record-Linkage Study.

BackgroundDementia includes a group of neuro-degenerative disorders characterized by varying degrees of cognitive impairment. Recent data indicates that blood group AB is associated with impaired cognition in elderly patients. To date there are no large-scale studies that have examined the relationship between ABO blood group and dementia-related disorders in detail.MethodsWe used data from the SCANDAT2 database that contains information on over 1.6 million blood donors from 1968 in Sweden and 1981 from Denmark. The database was linked with health outcomes data from nationwide patient and cause of death registers to investigate the relationship between blood groups and risk of different types of dementia. The incident rate ratios were estimated using log-linear Poisson regression models.ResultsAmong 1,598,294 donors followed over 24 million person-years of observation we ascertained 3,615 cases of Alzheimer’s disease, 1,842 cases of vascular dementia, and 9,091 cases of unspecified dementia. Overall, our study showed no association between ABO blood group and risk of Alzheimer’s disease, vascular dementia or unspecified dementia. This was also true when analyses were restricted to donors aged 70 years or older except for a slight, but significantly decreased risk of all dementia combined in subjects with blood group A (IRR, 0.93; 95% confidence interval [CI], 0.88-0.98), compared to those with blood group O.ConclusionsOur results provide no evidence that ABO blood group influences the risk of dementia.

A novel mutation P112H in the TARDBP gene associated with frontotemporal lobar degeneration without motor neuron disease and abundant neuritic amyloid plaques

IntroductionAlthough TDP-43 is the main constituent of the ubiquitinated cytoplasmic inclusions in the most common forms of frontotemporal lobar degeneration, TARDBP mutations are not a common cause of familial frontotemporal dementia, especially in the absence of motor neuron disease.ResultsWe describe a pedigree presenting with a complex autosomal dominant disease, with a heterogeneous clinical phenotype, comprising unspecified dementia, parkinsonism, frontotemporal dementia and motor neuron disease. Genetic analyses identified a novel P112H TARDBP double variation located in exon 3 coding for the first RNA recognition motif of the protein (RRM1). This double mutation is probably pathogenic based on neuropathological findings, in silico prediction analysis and exome sequencing. The two autopsied siblings described here presented with frontotemporal dementia involving multiple cognitive domains and behavior but lacking symptoms of motor neuron disease throughout the disease course. The siblings presented with strikingly similar, although atypical, neuropathological features, including an unclassifiable TDP-43 inclusion pattern, a high burden of tau-negative β-amyloid neuritic plaques with an AD-like biochemical profile, and an unclassifiable 4-repeat tauopathy. The co-occurrence of multiple protein inclusions points to a pathogenic mechanism that facilitates misfolded protein interaction and aggregation or a loss of TDP-43 function that somehow impairs protein clearance.ConclusionsTARDBP mutation screening should be considered in familial frontotemporal dementia cases, even without signs or symptoms of motor neuron disease, especially when other more frequent causes of genetic frontotemporal dementia (i.e. GRN, C9ORF72, MAPT) have been excluded and when family history is complex and includes parkinsonism, motor neuron disease and frontotemporal dementia. Further investigations in this family may provide insight into the physiological functions of TARDBP.Electronic supplementary materialThe online version of this article (doi:10.1186/s40478-015-0190-6) contains supplementary material, which is available to authorized users.

Rates of formal diagnosis of dementia in primary care: The effect of screening

BackgroundScreening could improve recognition of dementia in primary care. We sought to determine the effect of screening for dementia in primary care practices on the formal diagnosis rate; the distribution of differential diagnoses; and the factors associated with receiving a formal diagnosis. MethodsThe “Dementia: life- and person-centered help in Mecklenburg-Western Pomerania” is an ongoing general practitioner (GP)-based, randomized, controlled intervention trial. A total of 4064 community dwelling patients (aged ≥70 years) were screened for dementia in 108 GP practices. Of these patients, 692 (17%) had positive screening results (DemTect score <9). Of these 692 patients, 406 (59%) provided informed consent. The analyses included the data from 243 patients with a complete baseline assessment (preliminary data; January 2014). ResultsOf 146 patients without a formal diagnosis of dementia, 72 (49%) received a formal diagnosis after a positive screening outcome (69% with “unspecified dementia”). Female sex was significantly associated with receiving a formal diagnosis (multivariate analyses). ConclusionScreening improved the identification of dementia considerably. Because of the risk of receiving a false-positive diagnosis, additional diagnostic assessment should be mandatory.

Clinical characteristics of loss-of function mutations in TBK1 in Belgian FTD and ALS patients

Clinical characteristics of loss-of function mutations in TBK1 in Belgian FTD and ALS patients

Cardiovascular Diseases in ~30,000 Patients in the Swedish Dementia Registry.

Cardiovascular diseases are leading causes of death and patients with dementia are often affected by them. Investigate associations of cardiovascular diseases with different dementia disorders and determine their impact on mortality. This study included 29,630 patients from the Swedish Dementia Registry (mean age 79 years, 59% women) diagnosed with Alzheimer's disease (AD), mixed dementia, vascular dementia, dementia with Lewy bodies (DLB), Parkinson's disease dementia (PDD), frontotemporal dementia (FTD), or unspecified dementia. Records of cardiovascular diseases come from the Swedish National Patient Register. Multinomial logistic regression and cox proportional hazard models were applied. Compared to AD, we found a higher burden of all cardiovascular diseases in mixed and vascular dementia. Cerebrovascular diseases were more associated with DLB than with AD. Diabetes mellitus was less associated with PDD and DLB than with AD. Ischemic heart disease was less associated with PDD and FTD than AD. All cardiovascular diseases predicted death in patients with AD, mixed, and vascular dementia. Only ischemic heart disease significantly predicted death in DLB patients (HR = 1.72; 95% CI = 1.16-2.55). In PDD patients, heart failure and diabetes mellitus were associated with a higher risk of death (HR = 3.06; 95% CI = 1.74-5.41 and HR = 3.44; 95% CI = 1.31-9.03). In FTD patients, ischemic heart disease and atrial fibrillation or flutter significantly predicted death (HR = 2.11; 95% CI = 1.08-4.14 and HR = 3.15; 95% CI = 1.60-6.22, respectively). Our study highlights differences in the occurrence and prognostic significance of cardiovascular diseases in several dementia disorders. This has implications for the care and treatment of the different dementia disorders.

Capgras' syndrome in an elderly patient with dementia.

To the Editor: Capgras’ syndrome is an eponym named after the French psychiatrist Joseph Capgras, who first described the disorder in 1923 in a French woman complaining of seeing doubles or imposters of her husband.1 It is a disorder in which a person holds a delusion that a close relative like a spouse or parent, a friend, or even an object has been replaced by an identical looking imposter or replica.2 The disorder is classified as a delusional misidentification syndrome that involves persistent alterations in entities of personal significance.3 These alterations are classified in the DSM-IV and ICD-10 under unspecified persistent delusional disorders.4 There is a prevalence of 0.12% in the general population, and the disorder is seen more frequently in women, blacks, and schizophrenics.5 Capgras’ syndrome has a high (15%) incidence in patients diagnosed with schizophrenia5 and has an incidence between 2% and 30% in those with Alzheimer’s disease.6,7 It can present in acute, transient, or chronic form. Described here is a case report of Capgras’ syndrome in an elderly patient with dementia. Case report. Mr A, an 80-year-old white man, was brought to the hospital with the complaint of increasing confusion. His confusion had started 1 month ago when he woke up after a nap and walked up to his wife and asked, “Who are you?” He asked their children why this woman made him dinner. This delusion, consistent with Capgras’ syndrome, fluctuated on and off for the next month. Mr A also had visual hallucinations of seeing his wife in the house when she was in fact in a different room or in the same room but at a different spot. This symptom was consistent with doppelganger hallucinations. While in the hospital, Mr A had visual hallucinations of helicopters and thought he had a conversation with a man who did not exist. At one point, he became aggressive and tried to strangle a nurse. Mr A had no previous psychiatric history. His past neurologic history was a traumatic brain injury at age 13 years when he was hit in the head with an ax. His score on the Montreal Cognitive Assessment was 19/30. An electroencephalogram was nonsignificant. Urine analysis, chest x-ray, and vitamin B12, folic acid, and thyroid-stimulating hormone levels were all within normal limits. Treponema palladium antibody, antiperoxidase antibody, and paraneoplastic antibodies were negative. A lumbar puncture was negative for fungal, viral, and bacterial infection but did show elevated protein levels. Computed tomography scan of the head showed chronic small vessel ischemic changes and moderate parenchymal loss but no acute changes. The neurology consultant diagnosed Mr A with unspecified dementia. Mr A was started on quetiapine 12.5 mg twice a day in the hospital and showed improvement in his psychotic symptoms within the next few days. He was discharged home on quetiapine 12.5 mg twice per day and 25 mg at night. Capgras’ syndrome presents at younger ages in conditions other than neurodegenerative diseases (52 vs 72 years), which include schizophrenia, major depressive disorder with psychosis, paranoid schizophrenia, schizoaffective disorder, and cerebrovascular disease.8 Evidence shows that Capgras’ syndrome is also associated with traumatic brain injuries, cerebrovascular accidents, multiple sclerosis, dementia including Alzheimer’s disease, and Lewy body dementia.8 Diagnostic workup usually includes electroencephalogram findings, head computed tomography, magnetic resonance imaging, and neuropsychological testing.9 Treatment has ranged from typical antipsychotics and atypical antipsychotics to even antidepressants. In the past, pimozide was used successfully.10,11 But, more recently, atypical antipsychotics such as quetiapine have been prescribed to decrease Capgras’ delusions.12 Two case reports showed positive response to mirtazapine.13,14 Prognosis relates to the etiology of the cause. If the cause is treatable, such as an infection or a depressive episode, the prognosis is more favorable.15 Patients with schizophrenia have a poorer prognosis.15 In patients with dementia, such as Mr A, the prognosis is less understood. Medications can alleviate the symptoms, but relapses may occur with the progression of the neurodegeneration.

RETROBULBARINIS PSEUDOTUMORAS DĖL SKRUOSTE UŽSILIKUSIO SMULKAUS METALINIO SVETIMKŪNIO: KLINIKINIO ATVEJO APRAŠYMAS IR LITERATŪROS APŽVALGA

Aim: to present a patient’s clinical case; to demonstrate how important is to suspect rertrobulbar pseudotumor timely, why it is necessary to remove even the smallest metal foreign bodies from the jaw area; to show the importance of an integrated simultaneous clinical delivery on the spot during the investigation of a complex illness. Case report: presenting the clinical case – patient MA (66 years of age) right eye vision started to deteriorate 6 years ago, a small defect of a pupil (abnormal pupil shape) was found; after the remove a cataract operation, the vision improved (during the week after the operation the patient has not used prescribed corticosteroid drops in the eye, this incompliance with prescription caused the uveitis anterior, which went away in 2 months after relevant treatment started). One year after surgery a pain appeared in the area of the right cheek, teeth and beneath the right eye, manifested hearing weakness dextra side. Several dentists treated this patient. Also rhinologist, mouth, face, jaw surgeons and oncologists were involved. Diagnosis: alveolitis, sinusitis, osteomielitis sinus maxilaris dextra, a foreign body in a right maxillary sinus projection. Patient was examined for TBC, sarcoidosis, fungal illness, syphilis, all with negate results. Gradually right eye became blind. After the vision of the left eye began to deteriorate, further cataract surgery was undertaken. The further sudden deterioration in the general condition of the patient was treated in the neurological and supportive therapy departments for several months. Diagnosis: cerebellar degeneration and chronic polyneuropathy ataxia, unspecified dementia, extraocular palsies, metabolic hepatitis, chronic pancreatitis, bladder disturbance. During that time a protrusion of the right eye gradually enlarged and became more exposed. The left eye became blind several months later. KT and MRT: right eye’s retrobulbar tumor spread through eyehole slots intracranial and to left orbit; a small metal foreign body was found subcutaneously in the right cheek. A biopsy was taken from the para- and retrobulbar tissues: fibromatosis was diagnosed. Half a year later a sphenoorbital meningioma was suspected and the surgery aimed to partially remove a tumor from the right orbit was performed. During this stay under the neurosurgeons care it becomes clear that episodes of psychomotor agitation were also present. The eyelids of the right eye were sutured to protect the cornea against perforation. Histologic diagnosis: retrobulbar pseudotumor of both eyes. Metal foreign body remained untouched. The ophthalmologist removed the foreign metal body, which was situated in the cheek subcutaneously, close to N. infraorbitalis with capsule in a local polyclinic soon afterwards. The composition of the foreign metal object was investigated: it was found that 95% of it was iron with small amounts of rare metals usually found in steel alloy, calcium. Histology detected hemosiderosis in connective tissue of capsule. Patient was examined by a rheumatologist on the basis of the suspicion of Wegener granuliomatosis. Data to confirm Wegener’s granulomatosis was not enough; internal organs without lesions, it was diagnosed cholelithiasis and fibrotic lesions in the lungs. It was confirmed systemic transgression of connective tissue with retrobulbar pseudotumor diagnosis. Corticosteroid treatment was given for 1 month. Patient was examined 8, 15 and 27 month after foreign body removal later: the skin of the face was free of scars, eyelids of the right eye has been sutured; the left eye had no inflammation, refracto- and keratometry findings were the same, like 4 years before; levels of immunoglobulins G and E in blood decreased - normal; the systemic transgression of connective tissue remained. Patient walks with a wide-based gait, he becames totally dependent on care (he is blind and desorientated at place and time, his personality has changed; Mini Mental State Examination 13/30). This story showed, how it is important to have a complete understanding of the patients health from various medical specialists at the same physical place and at the same time. The case shows surprising differences of results of radiologic examination of the same case.

Pseudoexfoliation and Alzheimer’s disease: a population‐based 30‐year follow‐up study

To determine the effect of pseudoexfoliation (PEX) on the development of Alzheimer's disease (AD) in a population in which PEX is a common finding. The relationship between open-angle glaucoma (OAG) and AD was also studied. Predictors of incident AD, including mixed and unspecified dementia, were analysed in a cohort of 679 residents 65-74 years of age, examined in a population survey in the municipality of Tierp, Sweden, 1984-1986. To expand the cohort, participants in other studies in Tierp were enrolled. In this way, the cohort embraced 1123 people, representing more than 15,700 person-years at risk. Medical records were reviewed to identify subjects diagnosed with dementia. Those with a follow-up time shorter than 2 years were excluded from the study. By the conclusion of the study, in December 2011, 174 new cases of AD, including mixed and unspecified dementia, had been detected, 41 of whom were affected by PEX at baseline. Higher age and female gender were the only predictors identified. No association between PEX and AD was found (hazard ratio 0.98; 95% confidence interval 0.69-1.40). Newly diagnosed OAG at baseline did not increase the risk (hazard ratio 1.09; 95% confidence interval 0.69-1.74). Pseudoexfoliation is not a predictor of AD. No association was found between OAG and AD.

Is There Evidence for Cognitive Intervention in Alzheimer Disease? A Systematic Review of Efficacy, Feasibility, and Cost-Effectiveness

Several studies have shown that cognitive intervention may be beneficial for people with Alzheimer disease (AD), but literature reviews conducted so far, have yielded mixed and inconclusive results. In this work, through an extensive bibliographic search, we aim: (1) to analyze the efficacy of cognitive intervention in patients diagnosed with AD; (2) to provide an estimate of the feasibility of cognitive intervention; and (3) to review available cost-effectiveness data of this approach. Four randomized controlled trials of cognitive intervention, for patients diagnosed with AD that incorporated cognitive intervention and mock intervention control conditions, were included in the analysis. Only the domain of global cognitive functioning, as measured by Mini-Mental State Examination, showed significant intervention effects. No effects were observed in the remaining domains. Concerning feasibility, high rates of completion and adherence were found. A single randomized controlled trial, with unspecified dementia, suggested cognitive intervention to be cost-effective. Given the currently available dearth of well-controlled and focused trials in AD, these results should be carefully interpreted and remain to be confirmed in the future. There is a clear need for more high-quality research.

523 – Datscan in differential diagnosis of lewy body disease - case report

Introduction Differentiating Lewy Body Disease from dementia of Alzheimer's type might be difficult in clinical practice. Althought the clinical signs in both cathegories are well known, difficulties may occur in patients with incomplete clinical picture. Objectives and aims Description of the case with incomplete clinical picture (women with unspecified dementia) and benefit of the DatCAN in differential diagnosis of clinically unclear dementia. Methods Case report. Results DatCAN helped in differential diagnosis of unspecified dementia. As the clinical picture of the case was incomplete and clinical diagnosis could not been done according diagnostic criteria, DatSCAN proved benefit in diagnostics of Lewy Body Disease.