Dementia and Geriatric Cognitive Disorders Extra最新文献

Introduction: Caregiver burden significantly impacts patient and caregiver outcomes and is an important treatment consideration in dementia. Previous research has demonstrated that like behavioral variant frontotemporal dementia, prion disease has higher levels of caregiver burden than other forms of dementia; however, limited prospective research has investigated this specifically. Here, we aimed to describe caregiver well-being and caregiver burden in prion disease and determine whether demographic features, support group attendance, or features of the disease process predicted higher caregiver burden.

Methods: Thirty patients with prion disease and their caregivers were assessed longitudinally through the Teleneurology Assessment Program for Creutzfeldt-Jakob Disease. Caregivers were administered the Neuropsychiatric Inventory Questionnaire (NPI-Q), MRC Prion Disease Rating Scale, Outcome Evaluation of the National Family Caregiver Support Program, and other assessment instruments. We performed descriptive and inferential statistics to examine the progression of caregiver burden and to identify features that impacted caregiver burden severity.

Results: Thirty caregiver-patient dyads were followed longitudinally. Prion disease duration averaged 7.88 months. Mean initial NPI-Q distress score was 15. Qualitatively, distress increased from the time of study enrollment until peaking on average half-way through study participation and then declined. Higher burden (4-item Zarit Burden Interview) was associated with younger age at disease onset. Burden was not predicted by disease type, duration, caregiver demographics, relationship to the patient, MRC Prion Rating Scale scores, NPI-Q, or support group attendance.

Conclusion: These findings confirm significant caregiver distress in prion disease and help better describe the course of caregiver burden throughout the disease. Statistical analyses were limited by small sample size and phenotypic heterogeneity, and future research would benefit from larger sample sizes.

Introduction: The aim of the study was to provide a comprehensive overview of the current application of tools used for assessing neuropsychiatric symptoms (NPSs) in patients with Huntington's disease (HD), amyotrophic lateral sclerosis (ALS), and multiple system atrophy (MSA) through bibliometric analysis.

Methods: Publications published between 2014 and 2023 were searched using the Web of Science Core Collection database (WoSCC). Only articles and reviews published in the English language were included. CiteSpace was used to analyze the countries, keyword patterns, and reference co-citations. A detailed full-text analysis was further conducted across all studies to assess the usage of NPS assessment tools.

Results: Our analysis included 530 publications demonstrating consistent annual growth, reflecting rising global interest in NPSs within neurodegenerative and neuroinflammatory diseases. However, these studies reveal research deficiency in current assessment methodologies that demands more attention. Research output remains predominantly concentrated in developed nations with aging populations, particularly the USA, which leads in both publication volume and quality. The primary focus of current research involves evaluating the validity of existing assessment tools, while emerging investigations explore next-generation assessment tools designed to enhance diagnostic precision and enable personalized treatment strategies. Despite these advances, widespread clinical adoption remains limited, and further validation studies are required to establish their reliability across diverse populations and disease stages.

Conclusion: This study highlights the growing importance of NPSs in neurodegenerative diseases, particularly in HD, ALS, and MSA. We identify hotspots and deficiencies in the research field of validating NPS assessment tools, integrating NPSs into the diagnostic framework and elucidating neurobiological mechanisms. These findings will contribute to enhanced diagnostic and therapeutic approaches for neurodegenerative diseases.

Introduction: Cutoff values for cerebrospinal fluid biomarkers vary by analytic technique and population, which complicates the differentiation of Alzheimer's disease (AD) from non-AD dementias. We aimed to establish local cerebrospinal fluid biomarker cutoffs within a Thai cohort.

Materials and methods: We recruited 68 patients with various forms of dementia from the Memory Clinic at Siriraj Hospital, Thailand. Each patient underwent clinical subtyping for dementia, and their cerebrospinal fluid levels of Aβ42, p-tau181, and t-tau were quantified using the Fujirebio INNOTEST ELISA. We then employed a data-driven approach, specifically a Z-score-based Gaussian Mixture Model, to define intersection cutoffs for Aβ42, p-tau181, t-tau, and the p-tau181/Aβ42 ratio. These established biomarker cutoffs were subsequently incorporated with clinical manifestations to refine the clinicobiological diagnoses.

Results: Our study included 67 patients (mean age 65.5 ± 7.4 years, 61.2% female). Using a data-driven approach, we established the following CSF biomarker cutoffs for identifying AD in this Thai cohort: Aβ42 at 492.67 pg/mL, p-tau181 at 44.00 pg/mL, t-tau at 545.97 pg/mL, and the p-tau181/Aβ42 ratio at 0.057. After incorporating these CSF biomarker results with clinical profiles, the diagnoses changed in 17.9% of the patients.

Conclusions: In this study, CSF cutoffs for differentiating AD from non-AD dementia were established through a data-driven approach, which has been demonstrated as a valid alternative methodology. The integration of clinical and biological profiles is paramount in achieving accurate dementia diagnoses.

Introduction: Frontotemporal symptoms are usually associated with frontotemporal dementia (FTD), but people with all forms of dementia may develop these symptoms as the dementia disease progresses. Knowledge about psychosocial interventions that meet the needs of people with FTD symptoms, and literature on the subject, is hard to find. The aim of the study was to describe current practice as it is experienced by healthcare experts in the clinical field in Norway.

Method: Three focus groups were conducted. Healthcare personnel with clinical experience in care and treatment to people with FTD and other dementia diseases with frontotemporal symptoms were eligible for inclusion. Qualitative directed content analysis with open coding focusing on both manifest and latent content was applied.

Results: Four categories were described: (1) Dilemmas of anosognosia, (2) establishment of a diagnosis, (3) establishment of post-diagnostic support at home, and (4) establishment of care in the nursing home.

Conclusion: People with FTD and other dementias with frontotemporal symptoms need rigid, easy-to-understand, predictable surroundings and healthcare personnel that are clear, friendly, and respectful in their communication. Post-diagnostic support provided in flexible systems ensuring smooth transitions between services and levels of care is required. To ensure quality of care, frontline healthcare staff should be able to recognize FTD symptoms. To achieve this, supervision and training are needed. More research about clinical care interventions and how to derive good nursing practice should be prioritized.

Introduction: The ε4 allele of the apolipoprotein E (APOE4) gene is a well-known risk factor for the onset and development of late-onset Alzheimer's disease (AD). Lipid metabolism also plays a key role in AD. However, data on the association between APOE4, cognitive function, and blood lipid metabolism, particularly fatty acid metabolism, in the healthy elderly Japanese population are lacking.

Methods: We analyzed the baseline data of 506 healthy elderly Japanese individuals (mean age: 73 ± 0.4 years) from Shimane Prefecture, Japan, who participated in six intervention trials conducted between 2008 and 2020. Among them, participants with mild cognitive impairment (MCI) were divided into the following two groups: APOE4 carriers (n = 104) and noncarriers (n = 321).

Results: Compared with the noncarriers, the APOE4 carriers had significantly lower scores in the "recalling five objects" sub-item of Hasegawa's Dementia Scale-Revised and longer total times in the Cognitive Assessment for Dementia, iPad version. The ratio of docosahexaenoic acid (DHA)-to-arachidonic acid was significantly decreased, and the erythrocyte eicosapentaenoic acid (EPA) and DHA levels tended to be reduced in APOE4 carriers.

Conclusion: These findings suggest a possible association between the APOE4 allele and reduced erythrocyte EPA and DHA levels, even in healthy elderly Japanese individuals with high ω-3 fatty acid intake. Such alterations in lipid metabolism may be linked to cognitive vulnerability in older adults and individuals with MCI.

Background: Comorbid cancer and dementia, which share common risk factors and significantly burden the healthcare system, affect a growing number of individuals, especially the ageing population. As both conditions place a substantial burden on healthcare systems and may be underdiagnosed, there is an urgent need to explore effective management strategies, including the potential benefits of physical activity, which has shown promise in mitigating cognitive decline and improving physical function in both cancer and dementia populations. This scoping review aimed to explore the current knowledge of physical activity for individuals with comorbid cancer and dementia, identifying gaps in understanding and highlighting the need for future research in this area.

Summary: This scoping review followed the 5-stage framework outlined by Arksey and O'Malley, with a focus on identifying the effects of physical activity on individuals with comorbid cancer and dementia. The review involved a comprehensive search across multiple databases, selecting relevant studies based on predefined criteria, and summarizing key findings to highlight research gaps and inform future studies. Out of 263 records identified from multiple databases, none were retained for full-text screening due to exclusions based on review articles, non-human participants, lack of comorbid cancer-dementia, and absence of a physical activity/exercise component.

Key messages: There is a significant gap in research on physical activity in individuals with comorbid cancer and dementia. Future studies are essential to explore the impact of exercise on the development and outcomes of these conditions, which could improve preventative strategies and care pathways for this growing population.

Introduction: Much research has focused on the deposition of amyloid and tau proteins in the Alzheimer's disease (AD) brain, but many amyloid and tau models assumed a single spatial progression of amyloid and tau accumulation. We estimated the changing patterns of an indirect biomarker, i.e., the cerebral blood flow (CBF), in AD, and we discuss the pathological process of AD.

Methods: The participants were 341 patients who visited our hospital's outpatient department for memory loss (146 males, 195 females): 115 diagnosed with AD, 176 diagnosed with mild cognitive impairment, and 50 diagnosed with subjective cognitive decline. For the evaluation of disease-related changes in their CBF, the patients underwent 99mTc-ethyl cysteinate dimer single-photon emission computed tomography scans. We differentiated the subtypes of CBF in AD by using a machine-learning algorithm called the "Subtype and Stage Inference (SuStaIn)"algorithm.

Results: When we divided the data into two groups, the SuStaIn algorithm identified two different CBF subtypes: the typical AD pattern and a cortical pattern with hippocampal sparing.

Conclusion: We observed two subtypes of the pattern of change in the CBF of individuals with AD, and these subtypes were highly similar to previous findings derived from SuStaIn algorithm applied differing neuroimaging modalities. Such subtyping derived from CBF imaging might have clinical utility in the treatment of AD.

Introduction: Dementia patients are at increased risk of polypharmacy and inappropriate medication, exacerbating cognitive decline. The SARS-CoV-2 pandemic constrained access to medical care and monitoring services for dementia patients, potentially worsening medication-related issues. We analyzed the medical treatment of dementia patients during the SARS-CoV-2 pandemic in Bavaria, particularly regarding polypharmacy, anticholinergic medication, and antidementia medication.

Methods: The Bavarian Ambulatory COVID-19 Monitor (BaCoM) is a longitudinal registry study conducted in Bavaria, Germany. Participants in need of nursing care with baseline data during the SARS-CoV-2 pandemic were included in our detailed analysis (N = 345, dementia sample n = 96 with a dementia diagnosis and/or antidementia medication treatment). Descriptive statistics and group comparisons (dementia vs. non-dementia sample; within the dementia sample: participants with vs. without antidementia medication; participants with vs. without anticholinergic medication in both the non-dementia sample and the dementia sample) are provided.

Results: In the dementia sample, 91.7% of the patients received ≥4 medications (polypharmacy), 21.9% even ≥10 medications. Prescription of ≥1 anticholinergic medications was found in 65.6% and prescription of ≥1 antidementia medications in 31.2% of the dementia sample. Persons with versus without anticholinergic medication did not differ from each other in group comparisons.

Conclusion: Despite known risks and adverse effects, polypharmacy as well as the use of anticholinergic and antidementia medication were common among individuals with dementia. Compared to pre-pandemic studies, levels of polypharmacy and anticholinergic medication but not of antidementia medication appeared slightly elevated in people with dementia. Because of the associated risks, polypharmacy and potentially inappropriate medication require regular review (and when possible reduction) in people with dementia. In crisis situations like a pandemic, an outreach approach might be necessary for this patient group.

Introduction: Mild cognitive impairment (MCI) represents a loss of memory or other cognitive function while maintaining the ability to independently perform most activities of daily living. This study assessed how Korean specialists in dementia care diagnosed and treated patients with MCI symptoms.

Methods: A questionnaire on the current management of MCI was developed by 6 experts in MCI care. Specialists in MCI care (n = 24: 14 neurologists/10 psychiatrists) verbally answered questions relating to their experience/views in caring for MCI patients.

Results: Respondents diagnosed MCI using the Seoul Neuropsychological Screening Battery (79%) and the Consortium to Establish a Registry for Alzheimer's Disease - Korea (21%) neuropsychological battery tests. All or nearly all respondents also assessed patients with Mini-Mental State Examination, Geriatric Depression Scale, Clinical Dementia Rating, Activities of Daily Living (ADL), and Instrumental ADL tests. All respondents used MRI or CT for differential diagnosis of diseases causing MCI, about one-third used amyloid PET. Most respondents (96%) treated patients with MCI due to Alzheimer's disease (AD) with medication, commonly choline alfoscerate (71%) and donepezil (53%), mainly as combination therapy. Unmet needs included patient/caregiver education (63%) and time constraints for consulting patients (54%). Most respondents considered that increased amyloid-β testing for patients with MCI due to AD or subjective cognitive decline is likely to increase.

Conclusions: This survey described the current management of MCI due to AD, identified unmet needs and considered possible future developments in the changing landscape of early AD treatment. Early detection and diagnosis and continued development of emerging preventative or therapeutic interventions are critical for MCI outcomes.