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Dementia Severity (dementia + severity)

Distribution by Scientific Domains

Medical Sciences	91%

Distribution within Medical Sciences

Psychiatry	63%
Neurology	17%

Selected Abstracts

Risk factors for neuropsychiatric symptoms in dementia: the Cache County Study

INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 9 2006
M. Steinberg
Abstract Objective To investigate the probability of individual neuropsychiatric symptoms in dementia patients as a function of eight risk factors. Methods In the Cache County Study, we administered the Neuropsychiatric Inventory (NPI) to 328 dementia patients at baseline. Approximately 18 months later, we re-administered the NPI to 184 participants available for follow-up. Generalized estimating equation methods were used to model the probability of individual neuropsychiatric symptoms as a function of: gender, age, education, dementia type and severity, APOE status, time of observation, and general medical health. Results Women showed increased tendency toward anxiety, [odds ratio (OR) 2.22, 95% confidence interval (CI) 1.31,3.76] and delusions (OR 2.15, CI 1.22,3.78), but older persons of both sexes showed less tendency toward anxiety. Dementia severity increased the tendency toward hallucinations and agitation (OR 2.42, CI 1.81,3.23) and decreased risk of depression. Positive APOE ,4 status increased the tendency toward aberrant motor behavior (OR 1.84, CI 1.05,3.22). Among dementia diagnoses, those with Alzheimer's disease showed decreased tendency toward agitation (OR 0.58, CI 0.35,0.95), depression (OR 0.56, CI 0.33,0.96) and disinhibition (OR 0.46, CI 0.24,0.88). Later time of observation increased risk of aberrant motor behavior and delusions, and more serious medical comorbidity increased risk of, agitation, irritability, disinhibition, and aberrant motor behavior. Conclusions Gender, age, dementia severity, APOE ,4, dementia diagnosis, time of observation, and general medical health appear to influence the occurrence of individual neuropsychiatric symptoms. Copyright © 2006 John Wiley & Sons, Ltd. [source]

Gender difference and caregivers' burden in early-onset Alzheimer's disease

PSYCHOGERIATRICS, Issue 3 2005
Maki TAKANO
Abstract Background: Caregiver burden is the stress experienced as a result of caregiving. Despite the increasing number of Alzheimer's disease (AD) patients who are cared for at home, little has been published about the caregiver burden pertaining to caregivers of early-onset AD patients. The objective of this study was to examine the difference between the genders with respect to the careburden of early-onset AD caregivers. Methods: Twenty-four patients with early-onset AD and their caregivers participated in this study. Dementia severity, caregiver's burden, depressive mood and behavioral disturbance were measured and examined. Results: There was no significant difference between female and male caregivers in terms of careburden or depressive mood. However, when correlations were considered, female caregivers showed significant associations between careburden and the patient's age. Associations between the subscales of careburden were also shown for female caregivers. However. there was no significant correlation between the subscales of careburden and dementia severity and the number of behavioral problems for either female or male caregivers. Depression scores showed only correlations with the subscales of careburden for female caregivers. Conclusion: The present study examined the difference between the genders with respect to the care burden experienced by caregivers of early-onset AD patients. The results reinforce those of previous studies in that female caregivers are more likely to experience careburden than male caregivers. The present study indicates the importance of mental health support for female caregivers. [source]

Patient versus informant reported quality of life in the earliest phases of Alzheimer's disease

INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 12 2006
Asmus Vogel
Abstract Objectives The study investigated if patient and informant reported Quality of Life (QoL) differed in early Alzheimer's disease (AD). In addition, we examined whether anosognosia had an impact on the agreement between patient and informant ratings of QoL and whether anosognosia, dementia severity, depression and behavioural symptoms were significantly correlated to QoL in early AD. Methods From a prospective research program including newly referred patients (age >60 years and MMSE,,,20), 48 patients with very early AD were included. QoL was assessed using the QoL-AD and EQ-5D scales. Anosognosia was rated on a categorical scale by an examiner. MMSE, Geriatric Depression Scale, Danish Adult Reading Test and Frontal Behavioural Inventory were also administered. Results On most QoL measures patients rated their QoL higher than their informants. Anosognosia was not associated with QoL but significantly with an inverse impact on the agreement between patient and informant ratings of QoL. Self-reported QoL was significantly correlated to depression but not to age, dementia severity, behavioural symptoms or memory impairment. Informant ratings of QoL were significantly correlated to behavioural symptoms and informant ratings on the EQ-5D Visual Analogue Scale were significantly correlated to patient reported depression. Conclusion Patients with early AD generally reported higher QoL than their informants. This disagreement was associated with the presence of anosognosia. Self-reported QoL did not correlate with the MMSE score. Behavioural changes and depressive symptoms may be associated with low QoL. Copyright © 2006 John Wiley & Sons, Ltd. [source]

Risk factors for neuropsychiatric symptoms in dementia: the Cache County Study

A SPECT study of wandering behavior in Alzheimer's disease

INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 9 2005
Yves Rolland
Abstract Background Among behavior disturbance during Alzheimer's disease (AD), wandering is one of the most common. Different psychological processes have been suggested to explain the wandering behavior. The aim of this study was to examine whether wandering during AD was associated with cerebral perfusion patterns measured by (99,m)Tc-labeled bicisate (ECD) brain SPECT. Methods We compared SPECT scans of 13 AD subjects with wandering behavior (sex ratio M/F, 4/9; age, 73.1 years, SD 7.4; Mini Mental Status Examination score, median 20 interquartile range [16,23]), 13 AD subjects without wandering behavior (matched for age [,±,2 years], sex and MMSE score [,±,2 points]) and 13 healthy controls (matched for age [,±,2 years] and sex) without cognitive impairment. Wandering was defined on the Neuro-Psychiatric Inventory. Score of leukoaraiosis, assessed with the scale of Blennow and number of lacuna infarction were compared on CT scan. SPECT imaging was compared using statistical parametric mapping (SPM 2). Results There were no significant differences between the groups in term of educational level and CT scan analysis. SPECT imaging was consistent with the diagnosis of AD in both wanderers and AD subjects without wandering behavior. Despite similar clinical dementia severity, wanderers had more severely reduced regional cerebral blood flow (rCBF) in the left parietal-temporal lobe than AD subjects without wandering behavior. Conclusion Wandering behavior could be facilitated by a specific patterns of cerebral blood flow. Wandering, as a physical activity, could also enhance the recruitment of the cortical network. Copyright © 2005 John Wiley & Sons, Ltd. [source]

Neuropsychological performance in early and late onset Alzheimer's disease: comparisons in a memory clinic population

INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 12 2004
Srinivas Suribhatla
Abstract Objectives To compare the neuropsychological performance associated with early and late onset Alzheimer's disease (AD), in order to identify differences and compare these with previous reports. Methods Patients attending a memory clinic were given a detailed multi-disciplinary diagnostic assessment, including a battery of neuropsychological tests. From those meeting ICD-10 criteria for Alzheimer's disease (AD), an early-onset (EO) group (n,=,40) and a late-onset (LO) group (n,=,90) were identified, and their performances compared. Patients with mixed dementia and co-morbid depression were excluded. Results After adjustment, the EO and LO groups performed at a comparable level on the majority of the neuropsychological tests. The LO group performed better on the WAIS digit span test, AMIPB Complex Design and the written picture description, and the EO group performed better on the WAIS similarities test and the Boston naming test. Conclusions These findings suggest that, after adjusting for overall dementia severity and pre-morbid IQ, there is greater fronto-parietal/right hemisphere involvement in early-onset AD, and greater temporal/left hemisphere involvement in late-onset AD. This may be due to different genetic risk profiles for AD at different ages. Copyright © 2004 John Wiley & Sons, Ltd. [source]

Depression in dementia: a comparative and validation study of four brief scales in the elderly Chinese

INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 5 2004
Chee Kum Lam
Abstract Aim The study aimed to determine: (i) the diagnostic accuracy of four brief depression scales, the Geriatric Depression Scale (GDS), Even Briefer Assessment Scale for Depression (EBAS DEP), Single Question and Cornell Scale for Depression in Dementia (Cornell) in an elderly Chinese population with varying dementia severity; and (ii) which scale had the best diagnostic performance. Method All four scales were administered to 88 elderly outpatients with dementia: 66 without and 22 with depression. Receiver Operating Characteristic (ROC) analysis was used to establish the optimal cut-off scores of the GDS, EBAS DEP and Cornell scales. The patients' dementia-severity was dichotomously categorized into mild and moderate-severe dementia, and the above analysis was repeated in both these groups to look at changes in the scales' diagnostic performance as dementia advances. Results The best diagnostic scale for detecting depression in dementia was the Cornell scale. Its optimal cut-off score was 6/7 (sensitivity 91.7%, specificity 80.0%) in the mild dementia group and 12/13 (sensitivity 70.0%, specificity 87.0%) in the more advanced dementia group. The optimal cut-off scores of the GDS and EBAS DEP also shifted to higher values when moving from the mild to the more advanced dementia groups, indicating the increasing difficulty on all these scales to detect depression with worsening cognitive impairment. The Single Question, however, was more robust with much less changes in its diagnostic parameters in both dementia cohorts: sensitivity 58.3%, specificity 90.0% for mild dementia, and 60.0 and 84.8%, respectively, for more advanced dementia. Conclusion An efficient strategy to diagnose depression in dementia amongst elderly Chinese patients is to administer the Single Question followed by, when necessary, the Cornell scale. Copyright © 2004 John Wiley & Sons, Ltd. [source]

Synapse loss in dementias

JOURNAL OF NEUROSCIENCE RESEARCH, Issue 10 2010
Ryan Clare
Abstract Synaptic transmission is essential for nervous system function, and its dysfunction is a known major contributing factor to Alzheimer's-type dementia. Antigen-specific immunochemical methods are able to characterize synapse loss in dementia through the quantification of various synaptic proteins involved in the synaptic cycle. These immunochemical methods applied to the study of Alzheimer's disease (AD) brain specimens have correlated synaptic loss with particularly toxic forms of amyloid-, protein and have also established synapse loss as the best correlate of dementia severity. A significant but comparatively circumscribed amount of literature describes synaptic decline in other forms of dementia. Ischemic vascular dementia (IVD) is quite heterogeneous, and synapse loss in IVD seems to be variable among IVD subtypes, probably reflecting its variable neuropathologic correlates. Loss of synaptic protein has been identified in vascular dementia of the Binswanger type and Spatz-Lindenberg's disease. Here we demonstrate a significant loss of synaptophysin density within the temporal lobe of frontotemporal dementia (FTD) patients. © 2010 Wiley-Liss, Inc. [source]

Brain atrophy rates in Parkinson's disease with and without dementia using serial magnetic resonance imaging

MOVEMENT DISORDERS, Issue 12 2005
Emma J. Burton PhD
Abstract Increased rates of brain atrophy are seen in Alzheimer's disease, but whether rates are similarly increased in other dementias such as Parkinson's disease dementia (PDD) has not been well examined. We determined the rates of brain atrophy using serial magnetic resonance imaging (MRI) in PDD and compared this finding to rates seen in cognitively intact Parkinson's disease (PD) patients and age-matched control subjects. Thirty-one patients (PD = 18, PDD = 13) and 24 age-matched controls underwent serial volumetric 1.5 T MRI scans, approximately 1 year apart. Baseline and repeat scans were registered and quantification of the brain boundary shift integral was used to determine whole-brain atrophy rates. Rates of brain atrophy were significantly increased in PDD (1.12 ± 0.98%/year) compared to PD (0.31 ± 0.69%/year; P = 0.018) and control subjects (0.34 ± 0.76%/year; P = 0.015). There were no differences in atrophy rates between controls and PD (P = 0.79). No correlations between increased atrophy rates and age or dementia severity (Mini-Mental State Examination score) were observed. Serial MRI may be a useful tool for monitoring disease progression in PDD and further studies should investigate its utility for early diagnosis. © 2005 Movement Disorder Society [source]

Gender difference and caregivers' burden in early-onset Alzheimer's disease

Circulating cholesterol levels, apolipoprotein E genotype and dementia severity influence the benefit of atorvastatin treatment in Alzheimer's disease: results of the Alzheimer's Disease Cholesterol-Lowering Treatment (ADCLT) trial

ACTA NEUROLOGICA SCANDINAVICA, Issue 2006
D. L. Sparks
Context,,, Recent evidence suggests that treatment of mild-to-moderate Alzheimer's disease (AD) with atorvastatin provides significant benefit on the Alzheimer Disease Assessment Scale-Cognitive (ADAS-cog) after 6 months. Objective,,, To determine if benefit on ADAS-cog performance produced by atorvastatin is influenced by severity of cognitive impairment, circulating cholesterol levels, or apolipoprotein E genotype. Design,,, A double-blind, placebo-controlled, randomized (1:1) trial with a 1-year exposure to atorvastatin calcium or placebo. Setting,,, A single-site study at the clinical research center of the Sun Health Research Institute. Participants,,, Ninety-eight individuals with mild-to-moderate AD (MMSE score of 12,28) provided informed consent, and 67 were randomized. Stable dose use of cholinesterase inhibitors, estrogen and vitamin E was allowed, as was the use of many other medications in the treatment of co-morbidities. Participants using cholesterol-lowering medications or being treated for major depression or a psychiatric condition were excluded. Intervention,,, Once daily atorvastatin calcium (80 mg; two 40 mg tablets) or placebo. Main outcome measures,,, A primary outcome measure was change ADAS-cog sub-scale score. Secondary outcome measures included scores on the MMSE, and circulating cholesterol levels. The Apolipoprotein E genotype was established for each participant. Results,,, A significant positive effect on ADAS-cog performance occurred after 6 months of atorvastatin therapy compared with placebo. This positive effect was more prominent among individuals entering the trial with, (i) higher MMSE scores, (ii) cholesterol levels above 200 mg/dl or (iii) if they harbored an apolipoprotein-E-4 allele compared with participants not responding to atorvastatin treatment. Individuals in the placebo group tended to experience more pronounced deterioration if their cholesterol levels exceeded 200 mg/dl or they harbored an apolipoprotein-E-4 allele. Conclusion,,, Atorvastatin therapy may be of benefit in the treatment of mild-to-moderately affected AD patients, but the level of benefit produced may be predicated on earlier treatment, an individual's apolipoprotein E genotype or whether the patient exhibits elevated cholesterol levels. [source]

Relation between neuritic plaques and depressive state in Alzheimer's disease

ACTA NEUROPSYCHIATRICA, Issue 1 2010
Gerben Meynen
Meynen G, Van Stralen H, Smit JH, Kamphorst W, Swaab DF, Hoogendijk WJG. Relation between neuritic plaques and depressive state in Alzheimer's disease. Background: To investigate for the first time in a prospective study the relationship between depressive state and the neuropathological hallmarks of Alzheimer's disease, using a scale for depressive symptoms in dementia, while controlling for clinical severity of dementia. Method: Within the framework of a prospective longitudinal study of depression in Alzheimer's disease, patients with dementia underwent a clinical evaluation every six months during the last years of their lives, using the Cornell scale for depression in dementia to assess depressive symptoms and using the Functional Assessment Staging scale to control for clinical severity of dementia. The brains of 43 Alzheimer patients were obtained. The last clinical evaluations prior to death together with post-mortem neuropathology measures were analysed. Results: We found a correlation between the Cornell scores and the sum score for the density of neuritic plaques in the entire cortex (p = 0.027), and even stronger in the temporal cortex (p = 0.012). The observed correlations were independent of sex, age of death, clinical dementia severity and duration of Alzheimer's disease. Conclusions: This study shows a positive relationship between depressive state at time of death and the presence of neuritic plaques in Alzheimer's disease, which is independent of the clinical severity of dementia. [source]