Abstract
For caregivers and health care providers of persons with dementia, determining when the persons should be placed in long-term care is difficult. Klug et al (Deciding When to put Grandma in the Nursing Home: Measuring Inclinations to Place Persons With dementia) address this problem using data from caregivers working with the Dementia Care Services Project in North Dakota, and they show that asking the caregiver about their inclination to place can be equated to asking them for a specific time to place. They felt that inclination is easier information for the caregiver to provide, and it places fewer burdens on the caregiver and patient.
One key to improving the quality of life in individuals with dementia and their caregivers is to be sure that the caregivers understand the meanings of the words and actions of the individual with dementia. Teruo et al (Investigation of Eating Actions of People With Dementia From the Viewpoint of Self-Awareness) conducted a study that addressed this complex issue.
Hallucinations are complex, but to better understand them we need to be sure that they are not over- or underdiagnosed. In Analysis of Caregiver Perceptions of “Hallucinations in People With Dementia in Institutional Settings,” Cohen-Mansfield and Golander investigate the meaning and etiology of hallucinations in individuals with dementia in nursing home residents. Most of the reported visual and auditory hallucinations involved talking to persons who were not present and could be either visual or auditory hallucinations or both. All participants had poor vision. They note that hallucination is a term staff caregivers commonly used for phenomena they could not easily explain, demonstrating their lack of understanding of the affected individual and/or the phenomena they termed hallucination. They feel that the classification of hallucinations into subtypes may not be meaningful; most visual and auditory hallucinations were not associated with negative affect. Some hallucinations seemed to occur out of boredom, which exacerbated the sensory deprivation experienced by these persons, thereby increasing the likelihood of hallucinations.
In Loss of Synaptophysin Immunoexpression in Primary Progressive Aphasia, Rosso and Lippa note that primary progressive aphasia is characterized by progressive loss of language, unassociated with generalized cognitive loss and with no uniform pathological abnormality. To begin to address the issue of whether primary progressive aphasia is uniformly associated with synaptic loss, they compared immunoreactivity in Broca’s area with that in the adjacent gyrus from a case of progressive, nonfluent primary progressive aphasia using antibodies directed against synaptophysin. In primary progressive aphasia, synaptophysin immunoreactivity was significantly less in Broca’s area than in the adjacent area. The reduced synaptophysin immunoreactivity was significantly greater in the upper cortex than that in the regions of cortex adjacent to the white matter, suggesting that focal synaptic loss may be a common factor underlying the language deficits in primary progressive aphasia. Further studies are needed to confirm this finding.
According to Lipmawattana et al (Can Rowland Universal Dementia Assessment Scale Replace Mini-Mental State Examination for Dementia Screening in a Thai Geriatric Outpatient Setting?) the Mini-Mental State Examination is a widely used tool for dementia screening. However, several limitations are found and Rowland Universal Dementia Assessment Scale appears to be an alternative test. The objective of this study was to compare the Mini-Mental State Examination–Thai and the Rowland Universal Dementia Assessment Scale–Thai for dementia screening. They used participants from Geriatric and Neurology Outpatient Clinics. The Rowland Universal Dementia Assessment Scale–Thai and the Mini-Mental State Examination–Thai 2002 were administered to each participant. Then a specialist physician assessed each participant for dementia. Their results demonstrated that the Rowland Universal Dementia Assessment Scale–Thai can be an alternative test for dementia screening.
López-Pousa et al (Use of Antidementia Drugs in Frontotemporal Lobar Degeneration) note that there is evidence indicating that acetylcholinesterase inhibitors are not efficacious in frontotemporal lobar degeneration; The British Association for Psychopharmacology recommends avoiding the use of these agents and memantine in patients with frontotemporal lobar degeneration. They used a cross-sectional design and a population registered by the Registry of Dementias of Girona. They determined that cholinesterase inhibitors were used in 57.6% and 42.2% of patients with Alzheimer’s disease and frontotemporal lobar degeneration, respectively. Memantine was used by 17.2% and 10.9% of patients with Alzheimer’s disease and patients with frontotemporal lobar degeneration, respectively. They concluded that there is a discrepancy between clinical practice and the recommendations based upon clinical evidence. It is unclear whether this is due to a lack of alternative treatment options. The increased drug use detected in frontotemporal lobar degeneration requires multicenter studies geared toward maximizing interventions in those with frontotemporal lobar degeneration.
Tang Zhen et al (Fifty-Percent Reduced-Dose Cerebral CT Perfusion Imaging of Alzheimer's Disease: Regional Blood Flow Abnormalities) evaluated the diagnostic value of 50% reduced-dose cerebral computed tomography (CT) perfusion imaging in Alzheimer’s disease, as an attempt to develop a new imaging protocol with a better safety profile (lower radiation dose). Cognitively normal control and patients with Alzheimer’s were given a 50% reduced-dose cerebral CT perfusion imaging scan. Perfusion parameters of the bilateral frontal cortex, temporal cortex, hippocampus, and basal ganglia were measured. The cerebral blood flow and blood volume values of the measured regions were higher in the control group than that in the Alzheimer’s disease group, while the mean transit time and time to positivity values of these cerebral areas were significantly lower in the healthy control group than that in the Alzheimer’s disease group. They concluded that the 50% reduced-dose cerebral CT perfusion imaging is valuable to show comparative regional perfusion abnormalities in individuals with Alzheimer's disease.
Epstein et al (Vascular Risk Factors and Cardiovascular Outcomes in the Alzheimer’s Disease Neuroimaging Initiative) examined the association between vascular risk factors and cardiovascular events in the Alzheimer’s Disease Neuroimaging Initiative cohort in aged control cases and cases with Alzheimer’s disease and mild cognitive impairment using a longitudinal hazard model. They found that vascular events were common in all 3 groups (11 strokes, 7 myocardial infarctions, 5 revascularizations, and 8 deaths) over 31 months. Despite differences in baseline vascular risk factors, longitudinal cardiovascular event rates were similar between their 3 diagnostic groups.