Abstract
In Rivastigmine in Alzheimer’s Disease and Parkinson’s Disease Dementia: An ADAS-cog Factor Analysis, Weintraub et al note that Rivastigmine treatment is associated with improvements on the ADAS-cog in patients with Alzheimer’s disease and Parkinson’s disease dementia. Alzheimer’s disease and Parkinson’s disease dementia have different profiles of cognitive impairment, and Weintraub et al speculate that these may respond differentially to rivastigmine treatment. They conducted a retrospective analysis of three randomized, double-blind, rivastigmine trial databases (IDEAL, EXPRESS, and ADENA). Rivastigmine-treated patients in both the groups showed improvements on both factors and also the memory was more improved than language in both the groups. Treatment effect was greater in Parkinson’s disease dementia than Alzheimer’s disease. The comparatively greater response in Parkinson’s disease dementia is consistent with other studies and meshes with autopsy studies that show that there are greater cholinergic deficits in Parkinson’s disease dementia.
Magnetic resonance spectroscopy analyzes the biochemical composition of tissues including the levels of glutamate. This composition changes in degenerative diseases and other pathologies. Modrego et al (in Brain Glutamate Levels Are Decreased in Alzheimer Disease. A Magnetic Resonance Spectroscopy Study) hypothesized that glutamate levels are decreased in patients with Alzheimer’s disease, since this transmitter is important for memory function. They studied a series of mild-cognitive impairment and patients with Alzheimer’s disease and healthy controls. Cognitively, normal control cases had higher metabolite levels of the neuronal marker N-acetyl-aspartate than mild-cognitive impairment and patients with Alzheimer’s disease. In turn, the mild-cognitive impairment and control patients had higher levels of glutamate than the patients with Alzheimer’s disease. Modrego et al conclude that in Alzheimer’s disease, the levels of glutamate and N-acetyl-aspartate are decreased relative to those with mild-cognitive impairment and normal individuals.
In Relationships Between Late-Life Hypertension, Blood Pressure, and Alzheimer’s Disease, Yang et al examine the relationship between late-life hypertension and Alzheimer’s disease. Cross-sectional and longitudinal methods were used to determine whether systolic blood pressure, diastolic blood pressure (DBP), pulse pressure, mean arterial pressure, and self-reported hypertension in late life were associated with having/developing Alzheimer’s disease. In the cross-sectional examination, Alzheimer’s disease was not significantly associated with any of these factors. In the longitudinal examination, DBP was significantly related to the development of Alzheimer’s disease but not the other factors. Their conclusion is that further investigation is needed to understand the pathogenic mechanisms and biological relevance of late-life DBP on the likelihood of developing Alzheimer’s disease.
The ApoE e4 allele is a risk factor for Alzheimer’s disease. In a volumetric study, by Ready et al, healthy midlife children of a parent with Alzheimer’s disease participated in neuropsychological testing and magnetic resonance imaging brain volumetric analysis to look for prognostic biomarkers. The ApoE e4-positive group showed slower performances in executive function and processing speed measures and had less white matter volume than the non-e4 group. White matter volume was also associated with slower processing speed. The authors concluded that processing speed and lower levels of white matter volume may indicate preclinical decline in those at risk of developing Alzheimer’s disease.
Much current research in Alzheimer’s disease pathogenesis requires human brain tissue. Historically, minority groups have been under-represented in research and clinical trials, including autopsy. The lack of this participation is due to a mistrust of research establishments and a lack of education about the purpose of the research. The study by Danner et al (African American Participation in Alzheimer's Disease Research that Includes Brain Donation) was designed to characterize and optimize African American interest in Alzheimer’s disease research. Participants underwent recruitment interviews about their knowledge of medical procedures and their experience with research. After the recruitment interviews, 31.7% of participants agreed to yearly testing and brain donation. Their findings suggest that the communication exchanged is important. Particularly, a positive relationship between the knowledge of medical procedures used to prolong life and the willingness to donate one’s brain in the African American population was important.
Expanding upon the theme of brain donation, Guerriero et al (Frontotemporal Dementia Caregivers and Researchers: Partnering for Brain Donation) utilized a community-based, participatory research model between the Association for Frontotemporal Degeneration (AFTD) and the Education Core of the Indiana Alzheimer Disease Center to form focus groups to help spouses of frontotemporal dementia individuals. Transcript analysis revealed 7 prominent themes: willingness to participate; when/how the issue of brain donation is raised; who initiates discussion about brain donation; who is involved in decisions about brain donation; motivation for participating in brain donation; lack of effective communication; and barriers to research participation. With this uncommon disorder, the family caregivers demonstrated a consistent desire to participate in research and contribute to advancing knowledge. Similar to the study above by Danner et al, any lack of communication between clinicians and caregivers detrimentally impacted research participation.
Diagnosing mild-cognitive impairment can be time consuming. Wright et al (A Novel Technology to Screen for Cognitive Impairment in the Elderly) test “DETECT” which is a portable device that can rapidly perform cognitive testing in diverse settings. Their prospective, cross-sectional comparison study compares DETECT with formal clinical assessment using formal neuropsychological measures. Predictive modeling demonstrated the ability to discriminate between normal, mild-cognitive impairment, and dementia using DETECT. Furthermore, DETECT scores were similar to those found using traditional neuropsychological assessment. They conclude that this device is useful for screening for dementia and mild-cognitive impairment.
Calleo et al (In Characteristics of Generalized Anxiety Disorder in Patients With Dementia) note that the overlap of cognitive and anxiety symptoms in patients with dementia complicated diagnosing generalized anxiety disorders. Here, anxious dementia participants completed a psychiatric interview, the Penn State Worry Questionnaire–Abbreviated, and the Rating for Anxiety in Dementia scale. Those with generalized anxiety disorders were more likely to be male, have milder dementia, and directly endorsed more anxiety compared with patients without a generalized anxiety disorders. Additionally, muscle tension and fatigue was more common in those with generalized anxiety disorders. Their findings underscore the importance of assessing muscle tension and fatigue in anxious individuals with dementia.
Gústafsdóttir (In Keeping Up Health Promotion Practices in Specialized Daycare Units for People With Dmentia) shows that health promotion practices can be promoted in specialized day care units for individuals with dementia. Day care for elderly individuals with dementia can promote individual health practices, in as much as it is based on knowledgeable monitoring of health and well-being. The author concludes that health practices strengthen an individual’s optimal independent function which the staff members regard as a prerequisite for living at home with dementia.