Abstract
There are few studies comparing the effects of interventions in US clinical trial groups with those in other parts of the world. In Subgroup Analysis of US and Non-US Patients in a Global Study of High-dose Donepezil (23 mg) in Moderate and Severe Alzheimer’s Disease post hoc exploratory analyses were performed on US-based patients in a clinical trial of donepezil 23 mg/d (vs 10 mg/d) for moderate-to-severe Alzheimer’s disease, to assess the efficacy and safety in US- and non-US patient subgroups. In both subgroups, donepezil 23 mg/d was associated with greater cognitive benefits than the 10-mg dose. Significant global function benefits were also observed in the US subgroup. In both subgroups, donepezil had acceptable tolerability, however, the adverse events was higher in patients receiving donepezil 23 mg/d compared with the 10 mg dose. These results demonstrate the similarities and differences in medication responses between US populations and the participants with AD from other parts of the world. Further studies are needed to determine whether their trend is specific to this agent or more generalizable.
Cedric Annweiler et al (Contribution of Brain Imaging to the Understanding of Gait Disorders in Alzheimer’s Disease. A Systematic Review) note that gait disorders are common in Alzheimer’s disease; however, the brain regions involved are not well understood. Their objective was to review published data that examined associations between gait disorders and brain imaging in Alzheimer’s disease. Quantitative gait disorders (ie, slower gait velocity explained by shorter stride length) were associated with white matter lesions, mainly in the medial frontal lobes and basal ganglia. The nigrostriatal dopamine system was unaffected. Qualitative gait disorders (ie, higher stride length variability) correlated with lower hippocampal volume and function. They speculate that gait disorders in Alzheimer’s disease are explained by subcortical hyperintensities in frontal–subcortical circuits combined with hippocampal atrophy and hypometabolism.
McHugh et al (Teleconferencing as a Source of Social Support for Older Spousal Caregivers: Initial Explorations and Recommendations for Future Research) conducted a 6-week pilot support group for spousal caregivers, which was delivered via teleconferencing software. Semistructured interviews were conducted and analyzed using grounded theory analysis. Themes of “group processes” and “barriers,” containing subcategories of “functions of the group” and “responsibilities of facilitators,” and “barriers to communication” were discussed. According to caregivers, teleconferencing support groups would optimally acknowledge the caregiver as the expert, allow participants to meet before the support group, provide facilitation and leadership via the researcher, employ user-friendly technologies, and facilitate for the group to self-maintain.
Van Gorp et al (Towards a More Nuanced Perception of Alzheimer’s Disease: Designing and Testing a Campaign Advertisement) evaluated campaign advertisements for Alzheimer’s disease education. This revealed that all of the versions tested achieved a high average evaluation. The ad in which the heading referred to the fear of death and degeneration was judged to be most attention grabbing, easier to understand, and more credible than the alternative heading with the idea that someone with Alzheimer’s could still enjoy playing cards. Together, these findings provided a basis for the use of counterframes to generating a more nuanced image of Alzheimer’s disease.
In Feasibility and Perception of the Impact From Aerobic Exercise in Older Adults With Alzheimer’s Disease, Yu and Swartwood evaluated the subjective experience of participating in aerobic exercise in Alzheimer’s disease. They identified 4 themes: “there was no perceived positive change in cognitive symptoms,” “the exercise program was socially rewarding,” “the exercise program increased physical strength,” and “participation in aerobic exercise was a positive experience.” Family caregivers further identified 2 additional themes: “the exercise program led to improved attitude in older adults with Alzheimer’s disease” and “the exercise program reduced caregiver stress.” They conclude that aerobic exercise is a feasible and well-perceived intervention for older adults with Alzheimer’s disease and their family caregivers.
In The Effects of Evacuation on Nursing Home Residents With Dementia, Brown et al examined the effects of evacuation on residents who were cognitively impaired. Their data set included 21 255 residents residing in 119 at risk nursing homes over 3 years. Relative to the 2 years before the storm, there was a 2.8% increase in death at 30 days and a 3.9% increase in death at 90 days for residents with severe dementia who evacuated. Their data underscore the deleterious effects of evacuation on residents with severe dementia.
Mendez et al note that early-onset Alzheimer’s disease (beginning before age 65) may differ from late-onset Alzheimer’s disease in clinical course and in the frequency of the nonamnestic presentations. In their 10-year retrospective review, they confirmed previous trends showing that early-onset Alzheimer’s disease differs from late-onset Alzheimer’s disease in having a more aggressive course and in having more nonamnestic presentations.
In Stage-Specific Gender Differences in Cognitive and Neuropsychiatric Manifestations of Vascular Dementia, Xing et al examines gender differences in the clinical manifestations of vascular dementia. They found that females performed better on immediate verbal recall than males in the mild stages. Also, delusions, hallucinations, and depression were more prevalent in females, there was a male predominance in apathy in later stages. Further studies are needed to determine whether these interesting gender trends are consistent.
Suzuki et al (Impact of Fall-Related Behaviors as Risk Factors for Falls Among the Elderly Patients With Dementia in a Geriatric Facility in Japan) clarify potential fall-related behaviors in elderly patients with dementia at a geriatric facility. They found that the total score for fall-related behaviors was significantly related to falls. It was suggested that 11 fall-related behaviors may be effective indicators that predict fall risk among participants with dementia.