Abstract
There is need for new and better scales for all aspects of dementia, including caregiver issues. Haim et al (A New Measure of Caregiver Burden in Alzheimer’s Disease: The Caregiver-Perceived Burden Questionnaire [CPBQ]) validate the CPBQ and report its psychometric properties. They used a double-blind randomized trial comparing extended-release memantine to placebo to do this. Overall, the CPBQ appeared to be a reliable, valid, and responsive measure that enables linking caregiver’s perceptions about burden and patient function in patients with moderate-to-severe Alzheimer’s disease.
Long et al (Development of the Questionnaire on Palliative Care for Advanced Dementia [qPAD]) introduce the Questionnaire on Palliative Care for Advanced Dementia which is a 2-part instrument that measures long-term care staff knowledge and beliefs, perceptions, and attitudes about palliative and end-of-life care for persons with advanced dementia. Their initial findings indicate that there may be promise for such an instrument that measures both knowledge and attitudes of long-term care staff in the care of persons with advanced dementia.
Coin et al assess the influence of body mass index on the progression of dementia. They concluded that a body mass index cutoff of 25 kg/m2 may identify frail demented patients who are prone to experience a more rapid global impairment. This is a simple measure that may help to identify those who need extra care and monitoring.
With respect to management strategies, Massimo et al (From Alzheimer’s Disease Retrogenesis: A New Care Strategy for Patients With Advanced Dementia) note that exercise may slow the progressive cognitive dysfunction in those with Alzheimer’s disease. They specifically investigate the effect of adapted games on patients with Alzheimer’s disease. Their study examined the acute effects of adapted games on the agitated behavior and cognitive performance of patients with advanced Alzheimer’s disease. A total of 20 patients participated in adapted games and placebo activities. Agitated behavior and cognitive performance were compared before and after 30 minutes of activity. Agitated behavior decreased and cognitive performance increased compared with no change in agitated behavior or cognitive performance in the placebo group. These data indicate that adapted games can momentarily reduce agitated behavior and increase the cognitive performance in patients with Alzheimer’s disease.
In “Taking Care of a Loved One Who Has Alzheimer's Disease,” Wegierek notes that Alzheimer’s disease is a devastating disorder and millions of Americans provide hands-on care for affected individuals. Ways in which this process may affect the caregiver are discussed and strategies to reduce caregiver stress are reviewed.
Eduardo et al (Agitation and Psychosis Associated With Dementia With Lewy Bodies Exacerbated by Modafanil Use) note that modafinil is a wakefulness-promoting agent that has limited interaction with the dopaminergic system. As individuals with dementia with Lewy bodies often encounter psychotic symptoms (exacerbated by dopaminergic stimulation), modafinil seems an option for intervention. They described 2 cases in which administration of modafinil exacerbated agitation and hallucinations in dementia with Lewy bodies and reviewed data explaining possible mechanisms underlying the effect. In both cases, psychotic symptoms emerged concomitantly with modafinil administration and remitted following its discontinuation. Although definitive data regarding the benefits and adverse effects of modafinil for the treatment of excessive sleepiness in dementia with Lewy bodies await controlled prospective studies, their observations indicate that we use it with caution.
In An fMRI Study of Prefrontal Cortical Function in Subcortical Ischemic Vascular Cognitive Impairment, Li et al use functional magnetic resonance imaging (fMRI) to investigate the frontal lobe function of subcortical ischemic vascular cognitive impairment. Compared to controls, the participants with subcortical ischemic vascular cognitive impairment showed increased activation in the prefrontal cortex.
In Gene Environment Interaction in Alzheimer’s Disease, Singh et al examine the gene–environment interaction with reference to APOE genotypes, serum lipids, and organochlorine pesticides as one of the factors in the etiology of Alzheimer’s disease. They found that gene–environment interactions exist with APOE ∊4 allele status.
Kalaitzali et al (Identification, Emotional Reactions, and Perceived Threat to Persons With Alzheimer’s Disease) examine emotional reactions and the perceived threat to Alzheimer’s disease were compared across 3 Greek samples. Their findings underscore the importance of implementing education and training actions to increase Alzheimer’s disease identification, reduce negative emotions, and optimize care.
Kaiser et al note that early-onset Alzheimer’s disease may have less hippocampal memory presentations and more focal neocortical localization early on in the disease course. They explored Fluodeoxyglucose-Positron Emission Tomography (FDG-PET) scan findings in participants with early- and late-onset Alzheimer’s disease. Kaiser et al found that the early onset patients had worse executive function and greater hypometabolism in the parietal regions. In contrast, late-onset Alzheimer’s disease patients had worse confrontation naming and verbal recognition memory with greater hypometabolism in inferior frontotemporal regions. Their findings suggest that there may be early disturbances of the parietal–frontal network in patients with early-onset Alzheimer’s disease.
Garcia-Rodriguez et al (The Effects of Different Attentional Demands in the Identification of Emotional Facial Expressions in Alzheimer’s Disease) note that patients with Alzheimer’s disease experience impairment of emotional functions, including the processing of emotional facial expression. In daily life, emotional facial expression decoding takes place simultaneously with other activities, and information from 2 or more sources may be processed simultaneously. To assess the effects of different attentional demands on emotional facial expression processing, we analyzed the ability of patients and old adults with Alzheimer’s disease when they were simultaneously performing another task. They determined that the decoding of emotional facial expressions was impaired in patients with Alzheimer’s disease when they were simultaneously processing additional visuospatial information, yet not when performed in conjunction with a verbal task. These findings suggest that attentional demands affect the capacity to interpret emotional states, especially when simultaneously processing other visual information.