Alzheimer Disease & Associated Disorders最新文献

Purpose: Determine whether regional measures of cortical thickness are associated with functional task performance.

Patients: One hundred six older adults who were classified as either cognitively unimpaired (CU), mild cognitive impairment (MCI), or Alzheimer disease (AD) completed a performance-based functional task.

Methods: The SD of completion times of 6 consecutive trials within a session of the functional task was used as the primary measure for each participant, reflecting intraindividual variability. Regression tree analysis identified cortical gray matter thickness measures that best predicted intraindividual variability on the functional task.

Results: Cortical thickness measures from temporal, parietal, frontal, and occipital regions best predicted intraindividual variability on the task, which are cortical regions associated with learning, executive function, and visuospatial function. Specifically, the fusiform gyrus was featured prominently in these and prior regression tree results, suggesting its possible involvement in this behavioral task.

Conclusion: These analyses suggest a mechanistic focus of variability on this functional task, which could serve as an outcome in clinical trials.

Background: Genetic testing for dementia has drawn public attention in recent years, albeit with concerns on its appropriate use. This study leveraged Twitter data to analyze public perceptions related to genetic testing for dementia.

Methods: English tweets from January 1, 2010 to April 1, 2023, containing relevant terms, were extracted from Twitter API. A Bidirectional Encoder Representations from Transformers (BERT) model was used with Named Entity Recognition (NER) to identify individual and organizational users. BERT-based topic modeling was applied to identify the themes for relevant source tweets. Topic coherence was assessed through manual inspection, complemented by the Silhouette Coefficient. Manual thematic analysis, following Braun and Clarke's approach, refined the topics and themes.

Results: The analysis of 3045 original/source tweets identified 9 topics (Silhouette Coefficient=0.19), categorized into 3 main themes: (1) opinions on the appropriateness of genetic testing in dementia diagnosis; (2) discussion on the psychosocial impact; (3) discussion on genetic testing's role in Alzheimer disease treatment and prevention. Theme 1 comprised 90.6% of source tweets, demonstrating prevailing contentions. Tweets in theme 2 were increasingly contributed by organization users over time and included tweets containing misinformation about genetic testing in children. Tweets in theme 3 were increasingly contributed by individual users, possibly suggesting rising public interest in the treatment and prevention of dementia.

Conclusion: The study highlighted limited public understanding of the nondeterministic nature of genetic testing for dementia, with concerns about unsupervised direct-to-consumer genetic test marketing, emphasizing the need to counter misinformation and raise public awareness.

Purpose: This systematic review and meta-analysis aimed to explore differences in optical coherence tomography (OCT) findings between cognitively healthy individuals with Alzheimer disease (AD) biomarkers and healthy controls.

Methods: A thorough literature review was conducted on February 6, 2023, in PubMed, Embase, Cochrane Library, LILACS, and DANS EASY Archive. Studies that involved cognitively healthy individuals with AD biomarkers undergoing OCT or OCT angiography were included. The risk of bias was assessed using validated tools. A narrative synthesis and meta-analysis were performed with standardized mean differences and I2 heterogeneity assessments.

Results: Seventeen studies comprising 601 participants with positive AD biomarkers and 881 controls were included. The reviewed studies varied in design, with notable findings indicating a reduction in retinal nerve fiber layer (RNFL) and ganglion cell layer (GCL) thickness, alongside an increase in inner plexiform layer (IPL) thickness. In addition, OCT angiography revealed reduced vascular density and an enlarged foveal avascular zone-however, variations and inconsistencies in results led to inconclusive outcomes for RNFL and GCL-IPL meta-analyses.

Conclusion: In summary, cognitively healthy individuals with positive AD biomarkers demonstrated RNFL, GCL thinning, and IPL thickening trends. Future longitudinal studies using standardized methods are critical to validate these OCT changes as potential early indicators for AD.

To address disparities in dementia diagnosis and care in American Indian and Alaska Native communities, it is crucial to understand how sociocultural factors, such as language dominance and education, impact performances on standardized neuropsychological assessments. We discuss sociocultural considerations that are important to consider when evaluating cognition in American Indians. We conducted t tests/Kruskal-Wallis tests and correlation analyses to evaluate the impact of language and education factors on performances on the National Alzheimer Coordinating Center's Uniform Data Set Version 3 Neuropsychological assessments in a community of Southwestern American Indians. There were no significant differences in cognitive performances between the Zuni (Shiwi)-dominant and English-dominant individuals. Number of years of education had a greater effect on cognitive performances relative to language dominance, particularly for the common cognitive screening measure, the Montreal Cognitive Assessment. Our results highlight that education factors have a greater effect on cognitive performances relative to language dominance in this unique cohort. The associations with the Montreal Cognitive Assessment raise concerns for the use of this tool in this population, highlighting a need to develop culturally appropriate cognitive testing tools as well as ensuring comprehensive, culturally competent neuropsychological assessments are accessible.

Objective: Cognitive screens to diagnose mild cognitive impairment (MCI) or dementia require supervision and cannot be easily administered in primary care. Here, we validated the Self-Administered Gerontocognitive Examination (SAGE), investigating the alternate version equivalence, the convergent validity using neuropsychological tests, and its diagnostic accuracy.

Patients: Thirty-two MCI patients and 34 with dementia were recruited from a memory clinic in the Netherlands, and 69 healthy controls over the age of 50.

Methods: The 4 alternate versions of the SAGE were compared. Receiver operating characteristic (ROC) analyses were performed, comparing the controls to the MCI and dementia groups. Associations between SAGE scores and standard neuropsychological tests were examined.

Results: No performance differences were found between the alternate versions. Performance differences were found on the SAGE between the 3 groups, with fair to good areas under the curve. A cutoff score of <18 had the best diagnostic accuracy for controls versus dementia, <20 for controls versus MCI and <19 for controls versus cognitively impaired. SAGE scores correlated with standard neuropsychological tests.

Discussion: The SAGE is a valid tool for distinguishing cognitively unimpaired individuals from people with dementia or MCI.

Objective: Safety net enclosures are used in addition to (non-) pharmacological interventions in patients suffering from neuropsychiatric symptoms in dementia. However, no data on effectiveness are available.

Methods: In a prospective observational cohort study of 81 patients diagnosed with dementia, and admitted to a geriatric ward of a psychiatric hospital, available behavioral assessment scores were used to compare 45 patients who used safety net enclosures with 36 patients who never used safety net enclosures. Behavior was evaluated weekly using the Cohen-Mansfield Agitation Inventory (CMAI) and the Neuropsychiatric Inventory Questionnaire (NPI-Q) at admission, start of the enclosure, and before discharge.

Results: At baseline, the intervention group had a significantly higher CMAI and NPI-Q-score. At follow-up, the intervention group showed a greater improvement in CMAI [median -13.0 (interquartile range: -27.3 to 0.05) vs 0.0 (interquartile range: -6.0 to 2.5); Mann-Whitney U = 338.5 ( P = 0.005)] compared with the comparison group. Only some NPI-Q subscales showed significantly greater improvement during the intervention than in the comparison group.

Conclusions: Our observational study is the first to present effectiveness data on Neuropsychiatric symptoms in persons suffering from dementia and suggests significantly greater improvement in CMAI scores when using safety net enclosures. However, almost no significant differences were found in other outcomes.

Introduction: Sporadic Creutzfeldt-Jakob disease (sCJD) is one of the common causes of rapidly progressive dementia. However, because of the variety of its clinical presentations, a definite diagnosis in public hospitals is not always possible. Therefore, this study will provide more information about the clinical data of probable sCJD cases in Thailand.

Methods: This case series of probable sCJD patients who visited the Neurological Institute of Thailand during 2018 to 2023 was conducted. Demographic data, clinical presentations, brain MRI, EEG, CSF analyses, and clinical course were reviewed.

Results: A total of 17 probable sCJD cases were studied. Eleven patients were female (64.71%) with a median age of 62 (IQR: 14.5) years. The median onset of symptoms was 2 months (IQR: 2) before hospital visit, in which cognitive impairment was the most common first presentation (29.41%) followed by ataxia (23.53%), and visual disturbances (17.65%). Most patients had typical high signal intensities at both caudate/putamen and cortical regions (76.47%). Generalized periodic discharges with triphasic morphology were found in 11/14 patients with EEG results (78.57%).

Conclusion: sCJD has a diverse clinical presentation that resembles other cognitive disorders. Detailed assessment of signs and symptoms, together with proper investigations, could help to differentiate this condition in a resource-limited setting.

Background: The potential of Ultra-Ma, an ultrasonic head stimulator, for the supplementary treatment of dementia with Lewy bodies (DLB) was evaluated in patients with various symptoms under poor control by drug therapy.

Methods: Patients with DLB treated with choline esterase inhibitor or L-DOPA, either alone or in combination, and who met inclusion criteria were enrolled. Four weeks of placebo stimulation was followed by 8 weeks of active ultrasonic stimulation and a 4-week follow-up. Primary endpoints were the effects of ultrasonic head stimulation on both cognitive dysfunction and behavioral and psychological symptoms of dementia (BPSD). Cognitive dysfunction was evaluated using the Japanese versions of the Mini-Mental State Examination and Montreal Cognitive Assessment, and BPSD was assessed using the Neuropsychiatric Inventory Brief Questionnaire Form. For cognitive fluctuations, the Cognitive Fluctuation Inventory served as an index. Improvements in parkinsonism, activities of daily living, and caregiver burden were examined as secondary endpoints.

Results: Twelve patients were enrolled. The primary endpoint was significantly improved during the active stimulation period, as were secondary endpoint ratings for parkinsonism and caregiver burden. No notable adverse events occurred.

Conclusions: The findings suggest that ultrasonic head stimulation has supplementary potential when combined with drug treatment in DLB.

Background: Parental education is an important determinant of late-life cognition, but the extent to which intervening on midlife risk factors, such as hypertension, mitigates the impact of early-life factors is unclear. Novel methodological approaches, such as causal decomposition, facilitate the assessment of contributors to health inequities through hypothetical interventions on mediating risk factors.

Methods: Using harmonized cohorts (Kaiser Healthy Aging and Diverse Life Experiences Study; Study of Healthy Aging in African Americans) and a ratio of mediator probability weights decomposition approach, we quantified disparities in late-life cognitive test scores (semantic memory, executive function, and verbal memory z -scores) across high versus low parental education, and evaluated whether socioeconomic disparities in late-life cognitive test scores would change if the corresponding disparity in midlife hypertension were eliminated.

Results: We observed substantial disparities across levels of parental education in late-life cognitive test scores (eg, =-0.72 95% CI: -0.84 to -0.60 for semantic memory). Hypothetical intervention on midlife hypertension did not substantially reduce disparities in any cognitive domain. Patterns were similar when stratified by race.

Conclusions: Future work should evaluate other points of intervention across the lifecourse (eg, participant education) to reduce late-life cognitive disparities across levels of parental education.

Background: We previously reported that social restrictions due to the COVID-19 pandemic led to a decline in cognitive function in patients with Alzheimer disease (AD). Here, we assessed the effects of COVID-19 restrictions on the activities of daily living (ADL) and disease severity in patients by comparing them to a control group.

Methods: We examined the impact on ADL, evaluated using disability assessment for dementia (DAD), and disease severity, evaluated using the ABC dementia scale, in patients with mild-to-moderate AD. We conducted a post hoc subgroup analysis of a double-blinded, noninferiority study of donepezil 27.5 mg patches and donepezil hydrochloride 5 mg tablets (JapicCTI-194582). After showing the noninferiority of both treatments, we combined the data from both groups for analysis.

Results: The subpopulation of the per-protocol set grouped by completing the double-blinded evaluation before and on/after the mild lockdown was balanced (n=136 and n=120). Patient demographics were similar between the subgroups. The decline in the DAD and ABC dementia scale scores [least-squares mean (SE)] was ameliorated by social restriction [-3.810 (0.743) and -1.871 (0.697) and -1.147 (0.285) and -0.419 (0.267), respectively (not significant)].

Conclusion: Normalcy and expectation biases can affect the evaluation of ADL and disease severity by caregivers under high stress and deterioration of mental conditions.