Alzheimer Disease & Associated Disorders最新文献

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.

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.

Introduction: We previously followed Emory patients with neurodegenerative disease from 1993 to 2006. Here, we follow survivor and new patients for 2007 to 2018.

Methods: We studied mortality from 10 different diagnostic groups among 4322 research volunteers, and compared mortality rates to controls with normal cognition, using Cox regression. We assessed mortality through the National Death Index, controlling for sex, education, race, comorbidities, and age. Supplemental analyses considered APOE and cognitive test scores.

Results: Fifty-nine percent of patients died during follow-up. Mortality rate ratios, compared with controls (n=641) in descending order were 12.54, 6.61, 4.77, 4.92, 3.36, 2.25, 2.21 1.71, 1.39, and 1.17 for diagnostic groups ALS, (n=571), FTD (n=197), LBD (n=134), PD (n=584), AD (n=1118), MCI/dementia (n=82), dementia not specified (n=165), PD symptoms (n=256), vascular dementia (n=234), and MCI (n=340), respectively. Women, non-whites, those with higher education, with no comorbidities, and lower ages had lower mortality rates for most diagnostic groups. Mortality rates were higher in the presence of APOE4 variants for several diagnostic groups. Lower MMSEs predicted worse survival for most diseases. Overall, 41% of patients survived during 12 years of follow-up, compared with an expected 75% in the US population.

Conclusion: Survival times for different diagnostic groups have changed little over several decades.

Objectives: Many individuals with dementia with Lewy bodies (DLB) die of disease-related complications, but predicting the end of life can be challenging. We identified a phenotype associated with approaching end of life.

Methods: We present 4 exemplar cases where individuals with DLB experienced refractory psychosis before death. We reviewed codebooks and quotes from 3 studies regarding end-of-life experiences in DLB to identify experiences that aligned with this phenotype.

Results: In addition to the 4 cases, family caregivers in prior studies described prominent worsening of psychosis before death in some individuals with DLB. The worsening often occurred several months before death and was sometimes associated with rapid deterioration. Worsening psychosis was the prominent symptom and was not initially accompanied by cognitive or physical decline. In many cases, the refractory psychosis resulted in inpatient psychiatric hospitalization or residential care, but these scenarios were challenging because of the individual's behavior.

Conclusion: Refractory psychosis in DLB, particularly out of proportion to other symptoms, may be a signal of approaching the end of life. More research is needed to understand this phenomenon and to develop effective and safe treatments for psychosis in DLB.

Objective: To establish whether a virtual dementia awareness course is feasible for caregivers of people with dementia in Brazil and India.

Methods: A pre/posttest single group, multisite feasibility study, mixed methods exploratory design was applied. Primary caregivers of people with dementia in Brazil and India took a 3 to 4-hour course adapted for online delivery, with 10 to 15 caregivers. Measurements encompassed self-reports of carer competence, attitudes to dementia, and caregiver burden; satisfaction questionnaire completed immediately after the intervention; open-ended questions at 1-month follow-up to assess if caregivers applied information to caregiving role; semistructured interviews about how the intervention changed caregivers' behavior and attitudes towards dementia.

Results: Of the 70 caregivers who received the intervention (Brazil = 34; India = 36), 54 (77.1%) completed postintervention outcomes, and 39 (55.7%) completed questionnaires at 1-month follow-up assessment. Significant improvements were observed in attitudes to dementia in both countries and self-perceived carer competence (in India) postintervention. The themes from the 9 semistructured interviews were: acceptability, feasibility, change of behavior/attitude, and suggestions for future sessions.

Conclusions: Dementia awareness course was a feasible online intervention to improve dementia awareness among family caregivers across countries. It offers a standardized yet flexible methodology, with promising outcomes that need to be evaluated in a full randomized controlled trial.

Objective: Sleep disturbance is considered a risk factor for cognitive decline in elderly individuals. Our aim in the current study was to investigate whether baseline sleep parameters can predict the conversion from normal cognition to mild cognitive impairment or dementia at follow-up. The Hellenic Longitudinal Investigation of Aging and Diet is a longitudinal population-based study designed to estimate the prevalence and incidence of cognitive decline and dementia in the older Greek population.

Methods: A total of 955 cognitively normal older adults (aged ≥65 y) were drawn from the Hellenic Longitudinal Investigation of Aging and Diet study. A comprehensive neurological and neuropsychological assessment was conducted at baseline and a mean of 3.1 (SD = 0.85) years later, resulting in 160 individuals diagnosed with mild cognitive impairment and 34 with dementia at follow-up, whereas 761 remained cognitively normal.

Results: Using Cox regression analyses, no sleep parameters increased the risk of conversion status adjusting for demographics and clinical factors. Napping, however, decreased this risk by 19.3% (P < 0.001).

Conclusions: As several previous studies have proposed, napping constitutes a protective factor against cognitive decline. Thus, clinicians should encourage their elderly patients to adopt this healthy habit.

Introduction: Postoperative cognitive decline (POCD) is a common, but often unrecognized condition after surgery. We evaluate postsurgical cognitive changes in a longitudinal population-based study.

Methods: The study cohort comprises an age-stratified population-based random sample of individuals aged 65+ years from a small-town region of the United States. We identified as cases those participants who, during annual assessments, self-reported having undergone surgery under general anesthesia during the preceding year. We identified as controls those who reported no surgery for at least 6 consecutive years. The outcome variable changed over time (4 y) in annual cognitive test composite scores encompassing the domains of attention/processing speed, executive function, memory, language, and visuospatial functions, which were modeled using Generalized Estimating Equations.

Results: A total of 436 participants had the required cognitive data; 179 participants (cases) had undergone surgery, while 257 participants (controls) had not undergone surgery. After adjusting for age, years of education, gender, race, heart failure, irregular heartbeat, and stroke, participants who underwent surgery had a greater decline in executive function, memory, and attention over a 2-year period.

Discussion: Participants who underwent surgery had a significant subsequent decline in cognitive function over the long term.

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.