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Senile Dementia (senile + dementia)
Selected AbstractsQuantitative analysis of neurofibrillary pathology in a general population to reappraise neuropathological criteria for senile dementia of the neurofibrillary tangle type (tangle-only dementia): The Hisayama studyNEUROPATHOLOGY, Issue 6 2006Kazuhito Noda Senile dementia of the neurofibrillary tangle type (SD-NFT) is characterized by numerous neurofibrillary tangles (NFT) in the hippocampal region and the absence or minimal presence of senile plaques throughout the brain. We analyzed 207 demented subjects and 68 non-demented subjects autopsied in the Hisayama study to investigate the clinicopathological aspects of SD-NFT in the general Japanese population. The prevalence of SD-NFT in the consecutive autopsy cases was 8/207 (3.9%), comprising three men and five women. The average age at onset and death was 83.8 ± 6.8 (mean ± SD; standard deviation) and 88.1 ± 7.6 years, respectively. A mild memory disturbance preceded a decrease in the ability to undertake the activities of daily living and the diagnosis of dementia. Focal cerebral symptoms, such as aphasia and paralysis, did not appear during the disease course of any subject. Gross examination of the brains showed moderate to severe diffuse cerebral atrophy with brain weight loss (mean ± SD; standard deviation: 1118.1 ± 124.0 g). Histologically, there were abundant NFT and neuropil threads predominantly in or limited to the limbic cortex. The density of NFT in the CA1/subiculum in SD-NFT was much higher than the densities in the other hippocampal regions. The average density of NFT in CA1 in SD-NFT subjects was 115.4 per 100× field (range 23,247), that in Alzheimer disease (AD) subjects was 80.1 (range 1,227), and that in non-demented elderly subjects was 37.2 (range 0,203). Although many previous papers have reported that the densities of NFT in the limbic system in SD-NFT were significantly higher than those in AD, there was considerable overlap of NFT densities in CA1 among the non-demented elderly, AD subjects and SD-NFT subjects. [source] Prediction of transition from cognitive impairment to senile dementia: a prospective, longitudinal studyACTA PSYCHIATRICA SCANDINAVICA, Issue 5 2003S. Artero Objective: The purpose of this investigation was to replicate the statistical approach used in a previous investigation (Toronto study) within a French population to determine the best predictive model for Alzheimer's disease (AD). Method: Data from neuropsychological tests from two prospective studies were entered into a regression model. Results: Replication of the statistical approach in the Montpellier sample produced a three-test model with a specificity of 99% and sensitivity of 73%. This model consisted of a delayed auditory verbal recall test, a construction test, a category fluency test and provides probability estimates for the transition to dementia in individual cases. Conclusion: The models derived from these two longitudinal studies provide an empirical basis for the selection of tests for the definition of mild cognitive impairment of the Alzheimer type (MCI-A). The small set of tests derived are suitable for use in general practice. [source] Optimizing Coding and Reimbursement to Improve Management of Alzheimer's Disease and Related DementiasJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 11 2002Howard Fillit MD The objectives of this study were to review the diagnostic, International Classification of Disease, 9th Revision, Clinical Modification (ICD-9-CM), diagnosis related groups (DRGs), and common procedural terminology (CPT) coding and reimbursement issues (including Medicare Part B reimbursement for physicians) encountered in caring for patients with Alzheimer's disease and related dementias (ADRD); to review the implications of these policies for the long-term clinical management of the patient with ADRD; and to provide recommendations for promoting appropriate recognition and reimbursement for clinical services provided to ADRD patients. Relevant English-language articles identified from MEDLINE about ADRD prevalence estimates; disease morbidity and mortality; diagnostic coding practices for ADRD; and Medicare, Medicaid, and managed care organization data on diagnostic coding and reimbursement were reviewed. Alzheimer's disease (AD) is grossly undercoded. Few AD cases are recognized at an early stage. Only 13% of a group of patients receiving the AD therapy donepezil had AD as the primary diagnosis, and AD is rarely included as a primary or secondary DRG diagnosis when the condition precipitating admission to the hospital is caused by AD. In addition, AD is often not mentioned on death certificates, although it may be the proximate cause of death. There is only one ICD-9-CM code for AD,331.0,and no clinical modification codes, despite numerous complications that can be directly attributed to AD. Medicare carriers consider ICD-9 codes for senile dementia (290 series) to be mental health codes and pay them at a lower rate than medical codes. DRG coding is biased against recognition of ADRD as an acute, admitting diagnosis. The CPT code system is an impediment to quality of care for ADRD patients because the complex, time-intensive services ADRD patients require are not adequately, if at all, reimbursed. Also, physicians treating significant numbers of AD patients are at greater risk of audit if they submit a high frequency of complex codes. AD is grossly undercoded in acute hospital and outpatient care settings because of failure to diagnose, limitations of the coding system, and reimbursement issues. Such undercoding leads to a lack of recognition of the effect of AD and its complications on clinical care and impedes the development of better care management. We recommend continuing physician education on the importance of early diagnosis and care management of AD and its documentation through appropriate coding, expansion of the current ICD-9-CM codes for AD, more appropriate use of DRG coding for ADRD, recognition of the need for time-intensive services by ADRD patients that result in a higher frequency of use of complex CPT codes, and reimbursement for CPT codes that cover ADRD care management services. [source] Quantitative analysis of neurofibrillary pathology in a general population to reappraise neuropathological criteria for senile dementia of the neurofibrillary tangle type (tangle-only dementia): The Hisayama studyNEUROPATHOLOGY, Issue 6 2006Kazuhito Noda Senile dementia of the neurofibrillary tangle type (SD-NFT) is characterized by numerous neurofibrillary tangles (NFT) in the hippocampal region and the absence or minimal presence of senile plaques throughout the brain. We analyzed 207 demented subjects and 68 non-demented subjects autopsied in the Hisayama study to investigate the clinicopathological aspects of SD-NFT in the general Japanese population. The prevalence of SD-NFT in the consecutive autopsy cases was 8/207 (3.9%), comprising three men and five women. The average age at onset and death was 83.8 ± 6.8 (mean ± SD; standard deviation) and 88.1 ± 7.6 years, respectively. A mild memory disturbance preceded a decrease in the ability to undertake the activities of daily living and the diagnosis of dementia. Focal cerebral symptoms, such as aphasia and paralysis, did not appear during the disease course of any subject. Gross examination of the brains showed moderate to severe diffuse cerebral atrophy with brain weight loss (mean ± SD; standard deviation: 1118.1 ± 124.0 g). Histologically, there were abundant NFT and neuropil threads predominantly in or limited to the limbic cortex. The density of NFT in the CA1/subiculum in SD-NFT was much higher than the densities in the other hippocampal regions. The average density of NFT in CA1 in SD-NFT subjects was 115.4 per 100× field (range 23,247), that in Alzheimer disease (AD) subjects was 80.1 (range 1,227), and that in non-demented elderly subjects was 37.2 (range 0,203). Although many previous papers have reported that the densities of NFT in the limbic system in SD-NFT were significantly higher than those in AD, there was considerable overlap of NFT densities in CA1 among the non-demented elderly, AD subjects and SD-NFT subjects. [source] Argyrophilic grain disease: A late-onset dementia with distinctive features among tauopathiesNEUROPATHOLOGY, Issue 4 2004Markus Tolnay Argyrophilic grain disease (AgD) is a late-onset dementia morphologically characterized by the presence of abundant spindle-shaped argyrophilic grains (ArG) in neuronal processes and coiled bodies in oligodendrocytes. AgD changes consist of the microtubule-associated protein tau in an abnormally and hyperphosphorylated state and are mainly found in limbic regions, for example, in the hippocampus, the entorhinal and transentorhinal cortices and the amygdala. AgD shows a significant correlation with advancing age, and it became apparent from recent clinicopathological studies that it might account for approximately 5% of all dementia cases. Further immunohistochemical and biochemical studies revealed that AgD is a four-repeat (4R) tauopathy similar to PSP and corticobasal degeneration (CBD), but distinct from Alzheimer's disease (AD) and Pick's disease. Moreover, a common genetic background regarding the tau gene haplotype has been suggested for AgD, PSP and CBD. However, although there are currently only limited data available, AgD seems to be clinically distinct from PSP and CBD and shares rather features of (mild) AD or other forms of ,limbic' dementias, among them senile dementia with tangles and the localized form of AD. [source] Behavioral and endocrinological evaluation of music therapy for elderly patients with dementiaNURSING & HEALTH SCIENCES, Issue 1 2004Mizue Suzuki rn Abstract The present study investigated the effectiveness of music therapy for dementia patients using endocrinological and behavioral evaluations. The study comprised 10 patients with senile dementia who received music therapy; six had Alzheimer's dementia and four had vascular dementia. Music therapy was performed twice a week for 8 consecutive weeks (16 sessions). As a result, total scores on the Mini-Mental State Examination (MMSE) did not significantly change, but the scores of a subscale, ,language', improved significantly. According to the Multidimensional Observation Scale For Elderly Subjects (MOSES), scores for ,irritability' decreased significantly. Regarding changes in salivary chromogranin A (CgA) levels, the average was significantly decreased before session 16 compared to after this. These results suggest that the combination of endocrinological measurements, behavioral evaluations and functional assessment methods are useful in evaluating the effects of music therapy in persons with senile dementia. [source] Physical complications for elderly inpatients with senile dementia in the Imaise Branch of Ichinomiya City HospitalPSYCHOGERIATRICS, Issue 4 2009Katsuyuki UKAI Abstract Background:, In the present study, we investigated the physical complications of elderly patients with senile dementia in the Department of Psychogeriatrics, Imaise Branch, Ichinomiya City Hospital. Methods:, Physical complications that occurred in our ward in the 12 months from April 2007 to March 2008 were recorded. Our ward has 50 beds and, over the 12 months, the average occupation rate was approximately 90%. We subdivided physical complications into two categories: (i) serious emergencies occurring in the ward with a possible high risk of mortality within a few days (e.g. pneumonia and upper airway obstruction); and (ii) life-threatening complications arising in the ward that required diagnosis and treatment by specialists from other medical departments (e.g. bone fracture and cancer). Results:, Serious emergencies with a high risk of mortality occurred 56 times. Six patients died. Life-threatening complications requiring diagnosis and treatment by specialists from other departments occurred 44 times. Both categories of physical complications in occurred at a high rate, with various types of diseases recorded. Conclusions:, The present study confirms the high frequency of physical complications that require treatment in facilities for patients with senile dementia. It is necessary to diagnose and treat these various physical complications and to cooperate with specialists from other medical departments. [source] Preliminary application of processed electroencephalogram monitoring to differentiate senile dementia from depressionPSYCHOGERIATRICS, Issue 3 2009Norihito OSHIMA Abstract Background:, It is difficult, but important, to distinguish between dementia and depression in old age because senile depression has atypical symptoms, including cognitive impairment and memory disorder. Now brain computed tomography, magnetic resonance imaging, single photon emission computed tomography, and positron emission tomography can be used to differentiate between these two conditions. However, these methods are expensive and not always available. In the present case series, we assessed the potential of monitoring the bispectral index to distinguish between dementia and depression. Methods:, A processed electroencephalogram monitor (bispectral index (BSI) monitor) was used to assess brain activity during relaxed wakefulness in 12 participants (seven with Alzheimer's disease (AD), three with depression, and two healthy volunteers). Each recording lasted 5 min and four variables (i.e. BSI, 95% spectral edge frequency, electromyogram activity, and signal quality index) were monitored. Results:, The BSI was significantly smaller in AD patients than in patients with depression (P < 0.05) and the 95% spectral edge frequency tended to be lower in AD patients than in patients with depression (P = 0.26). Slow waves were found in patients with AD and beta waves were predominant in patients with depression and healthy volunteers. Conclusion:, In conclusion, the BSI and 95% spectral edge frequency were slightly smaller in dementia patients than in patients with depression. Paroxysmal slow waves may account for the low bispectral index. Thus, BSI monitoring may become a useful tool with which to distinguish AD from depression. [source] A Risk of Alzheimer's Disease and Aluminum in Drinking WaterPSYCHOGERIATRICS, Issue 4 2002Shunsuke Meshitsuka Abstract: The epidemiological studies on the relation between Alzheimer's disease and aluminum in drinking water are reviewed. In descriptive studies, case-control studies, and also cohort studies aluminum in drinking water turned out to be positive for the senile dementia of Alzheimer type. Negative results were obtained in the studies of presenile dementia or alminum levels lower than 0.1 mg/L. Aluminum is the third abundant element on earth, therefore, exposure to aluminum is inevitable in daily life. It is known that as over 95% of cases with Alzheimer's disease are sporadic, some environmental factors are expected to be etiological. Aluminum has been so far studied as a candidate for a neurotoxic factor. It is not known why attention has been given to only aluminum in drinking water as the cause of the neuro-degenerative disease other than aluminum in foods or medications, and how aluminum acts as a toxicant in brain. Nonetheless, reduction of aluminum in drinking water is recommended, as well as investigations on the mechanism of neurotoxicity of aluminum to find out the way to be free from the fear of aluminum. [source] Prevalence of Dementia Among the Elderly in a Japanese Community Population,Comparative Study on the 1983 and 1996 Survey: The Aichi StudyPSYCHOGERIATRICS, Issue 4 2001Hiroto Shibayama Background:An epidemiological survey of dementia among community residents over 65 years of age in Aichi Prefecture (Japan) was conducted in 1983 and 1996. We compared the prevalence rates of dementia in 1996, with the previously published rates of 1983. Methods:The study employed a two-stage design. First stage: A test based on the DSM-III-R criteria for dementia was administered to all participating residents, who were randomly drawn from the resident register (856,879) of Aichi Prefecture in 1995 (495,923 in 1983). Second stage: A detailed clinical and cognitive evaluation (including MMSE and neurological examination) of the subjects identified in the first stage was carried out by trained psychiatrists. Results:The prevalence rate for dementia in 1996 was 4.8% (moderate and severe 2.1%) compared with 5.8% (2.2%) in 1983; for senile dementia of Alzheimer type (SDAT) it was 2.8% in 1996 and 2.4% in 1983; for cerebrovascular dementia (CVD), 1.8% in 1996 and 2.8% in 1983. Conclusion:Up to this time, the cases of CVD have been more frequent than those of SDAT in Japan, especially in the urban areas. However, the relationship between CVD and SDAT has now reversed. These data suggest that SDAT is a common condition and that its public health impact will continue to increase with the increasing longevity of the population in Japan. [source] | ||||||||||