Abstract
Lodiana et al (Validity, Reliability, and Feasibility of Clinical Staging Scales in Dementia: A Systematic Review) believe that new staging systems of dementia require adaptation of disease management programs and adequate staging instruments. They reviewed the literature on validity and reliability of clinically applicable, dementia staging instruments. Reliability was studied in most articles and was judged moderate to good. Most articles also evaluated concurrent validity, which was good to very good, while discriminant validity was assessed in few. The scales can be applied in ±15 minutes. The Clinical Dementia Rating scale, Global Deterioration Scale/Functional Assessment Staging (GDS) and Functional Assessment Staging (FAST) have been monitored on reliability and validity, and the Clinical Dementia Rating currently is the best-evidenced scale. They conclude that there is an urgent need for global rating scales to be refined.
Kunik et al (Treating Sleep Problems in Dementia Caregivers Based on Parent–Child Interventions) explore the notion that interventions developed for improving sleep in parents might also prove effective for persons with dementia and their caregivers by reviewing the literature for interventions effective in improving sleep in parents of young children or in developmentally delayed children. Combination strategies such as extinction and sleep-enhancing medication are very effective and may be applicable for persons with dementia and their caregivers. Dementia patients' physical capabilities and degree of cognitive decline must be considered, and caregivers should adjust behavioral strategies to maximize the use of patients' intact cognitive abilities. They conclude that interventions for divergent populations might be useful.
In Psychometric Evaluation of a Proposed Alzheimer’s Aggression Scale, Wilks and Little obtained data from self-report questionnaires done by caregivers of Alzheimer’s disease. Principal axis factoring revealed a unidimensional solution with robust item loadings on the single factor. Three forms of reliability analysis indicated moderately strong internal consistency on this measure. Evidence of convergent validity analysis was suggested via the measure’s significant correlations to theoretically linked constructs. The proposed measure emerged as a reliable and valid tool for health care practitioners for the appraisal of problematic Alzheimer’s disease aggression behaviors from the caregiver perspective.
There are numerous health benefits to exercise. Venturelli et al (Six-Month Walking Program Changes Cognitive and ADL Performance in Patients With Alzheimer) determine whether a walking program could reduce the functional and cognitive decline of elderly nursing home residents in the later stages of Alzheimer’s disease. Their study provides evidence that the progressive cognitive dysfunctions in nursing home residents with Alzheimer’s disease may be impacted using a walking program.
Matteau et al (Mattis Dementia Rating Scale 2: Screening for MCI and Dementia) used the Mattis Dementia Rating scale–second edition (MDRS-2) to differentiate between controls and patients with amnestic–mild cognitive impairment (MCI), Parkinson’s disease (PD) and MCI, Parkinson’s disease with dementia and Alzheimer’s disease. The Mattis Dementia Rating scale–second edition total standardized score detected all groups of patients. The dementia groups performed worse than controls on the 5 subscales. Alzheimer’s disease scored higher than Parkinson's disease dementia (PDD) on MDRS-2 conceptualization and lower on memory. Huntington's Chorea (HC) were better than PD-MCI on MDRS-2 initiation/perseveration and memory and better than A-MCI on memory. No difference was found between the MCI groups. They conclude that this scale is suitable for distinguishing MCI and dementia but is not useful to differentiate between the MCI subgroups.
Ramdane and Daoudi-Gueddah (Mild Hypercholesterolemia, Normal Plasma Triglycerides, and Normal Glucose Levels, Across Dementia Staging in Alzheimer’s Disease: A Clinical Setting-Based Retrospective Study) examined retrospectively the concurrent relationships between fasting plasma cholesterol, triglycerides and glucose levels, and Alzheimer’s disease. Total cholesterol level was higher in Alzheimer’s disease participants compared to elderly controls; triglycerides or glucose levels did not significantly differ between the 2 groups. Respective plotted trajectories of change in cholesterol level across age were parallel. No difference in total cholesterol levels was recorded between Alzheimer’s disease participants of differing severities. They speculate that these biochemical parameters may be present before symptomatic onset.
In Maintaining Physical Fitness and Function in Alzheimer's Disease: A Pilot Study, Yu et al used a 1-group repeated-measures design to examine the potential impact of a 6-month individualized moderate intensity cycling intervention on cardiorespiratory fitness and lower extremity function. Cardiorespiratory fitness was measured using the shuttle walk and modified Young Men's Christian Association (YMCA) cycle-ergometer tests, and lower extremity function was measured using the Short Physical Performance Battery. The YMCA test showed a significant heart rate reduction while no significant changes were observed in the shuttle walk and tests. These preliminary data conclude that those with Alzheimer’s disease may improve cardiorespiratory conditioning from aerobic exercise, and note that larger, randomized, controlled trials are needed to confirm this finding.
Tsai et al note that posterior cortical atrophy may represent discrete syndromes of Alzheimer’s disease rather than being a variant of (amnestic) Alzheimer’s disease with visual deficits. They separated 30 posterior cortical atrophy patients based on ventral and dorsal visual symptom analysis and analyzed the demographic, cognitive, and functional imaging features. Their analysis revealed subgroups of 26 dorsal and 4 ventral patients. The ventral subgroup had greater confrontational naming impairment, and the dorsal subgroup had greater hypofunction in the parietal regions. The posterior cortical atrophy cohort had memory retrieval rather than encoding deficits, and clinical follow-up showed relative isolation of dorsal and ventral visual manifestations. They conclude that there are 2 posterior cortical atrophy syndromes, with the commonest variant affecting the dorsal visual pathway. Their findings suggest that posterior cortical atrophy syndromes are discrete clinical entities that can be distinguished from typical (amnestic) Alzheimer’s disease.