Abstract
Family caregiver issues vary dramatically depending on the dementia subtype. One of the most difficult disorders for caregivers is frontotemporal dementia. Since this condition often occurs at a relatively early age, children are an integral part of the family unit caring for the affected individual. Denny et al (Caring for Children of Parents With Frontotemporal Degeneration: A Report of the AFTD Task Force on Families With Children) report that the Association for Frontotemporal Degeneration (AFTD) organized a 7-person task force on families with children to explore the concerns of families when a parent of young children or teens is diagnosed with frontotemporal degeneration. Their report summarizes the findings of the task force and highlights the need for additional attention to this topic. The task force conducted a review of the related literature and existing resources and compiled issues identified by spouses/partners, teens, and adult children within an affected family. The project confirmed a significant lack of information and support for parents caring for a spouse with frontotemporal degeneration and for their children. Recommendations included developing resources and strategies that promote comprehensive family support, including those that build resiliency in the well parent and the children and strengthen the changing family unit. Avenues for additional research in this area of need in the frontotemporal degeneration community are suggested. The AFTD is the key association for caregivers with issues about this “related dementia.”
In “What is Wrong With Grandma?”: Depictions of Alzheimer's Disease in Children’s Storybooks, Sakai et al also note that dementia affects the entire family system, including young children. Storybooks are used to educate children about diseases and so they examined the depiction of Alzheimer’s disease in 33 children’s storybooks written specifically about Alzheimer’s disease. As a group, storybooks present Alzheimer’s disease as a brain disease but provide little information about the diagnostic process or treatments. Clinical presentations are diverse among characters with Alzheimer’s disease, and no single book presents a comprehensive depiction of the cognitive, behavioral, affective, and functional symptoms of the disease. In fact, the prevalence of some symptoms in this “population” of storybook characters diverges substantially from the epidemiological reports. They conclude that books designed to familiarize children about Alzheimer’s disease could be improved to ensure health literacy about Alzheimer’s disease.
Bou Khalil (Direct Thrombin Inhibitors’ Potential Efficacy in Alzheimer’s Disease) reminds us that Alzheimer’s disease is a neurodegenerative disease with no available disease-modifying treatments. However, it has been postulated that neurovascular damage may be important in this disease. Neurovascular damage is the result of hypoxia, oxidative stress, and metabolic changes that activate the endothelial cells of the brain microvasculature, resulting in angiogenesis and secretion of proinflammatory cytokines and growth factors such as thrombin. Heparin and related oligosaccharides may improve symptoms of Alzheimer’s disease; however, their efficacy may be limited by their nonselective inhibitory effect of thrombin activity. Direct thrombin inhibitors, such as dabigatran, might be efficient in the treatment of patients having Alzheimer’s disease because of their high selectivity for the inhibition of thrombin’s activity while having safer side effects’ profile than heparin. This novel approach to intervention needs to be tested in controlled clinical trials.
In Caring for a Loved One With Alzheimer’s Disease: Views From the Population About Hiring a Health Care Advocate, Van Liew and Cronan reiterate that Alzheimer’s disease is associated with considerable caregiver and social burden. Health care advocates may be one means of limiting the aversive effects of Alzheimer’s disease. Here, participants completed a survey that assessed their perceptions of the impact of comorbid Alzheimer’s disease on health status and their likelihood of hiring a health care advocate to assist in managing it. A meditational model was proposed: cognitive status (Alzheimer’s disease vs cognitively healthy) was the independent variable, perception of severity was the mediator, and the probability of hiring a health care advocate was the dependent variable. Their results indicated that the relationship between cognitive status and probability of hiring a health care advocate was fully mediated by perceptions of severity. Their study demonstrated that participants appreciated the impact of Alzheimer’s disease on health status, and this translated into a greater probability of hiring a health care advocate.
Zakrzewska Pniewska et al (Clinical and Functional Assessment of Dysautonomia and Its Correlation in Alzheimer’s Disease) assessed dysautonomia in Alzheimer’s disease, clinically and electrophysiologically, using sympathetic skin response (SSR) test and R-R interval variation test (RRIV). They also analyzed the relationship between symptoms of dysautonomia and SSR/RRIV results. Clinical dysautonomia was observed in 2of 3 patients (eg, orthostatic hypotension in 34.5%, constipation in 17.2%, and urinary incontinence in 13.8%). Sympathetic skin response was abnormal in 26%, but the RRIV test was abnormal in 97.7% of the cases; there was significant difference in the RRIV results between patients with Alzheimer’s disease and controls (R mean 8.05%; 14.6%, respectively). In Alzheimer’s disease clinical dysautonomia occurs variably, and the abnormal SSR and RRIV results were not always related to the presence of clinical dysautonomia. They conclude these tests could be used as a useful tool in the assessment of subclinical dysautonomia.
In Promoting Cognitive Health: A Web Site Review of Health Systems, Public Health Departments, and Senior Centers, Laditka et al refer to numerous studies showing that healthy behaviors such as being physically active, having a heart-healthy diet, and being socially involved promote cognitive health. The United States has recently begun encouraging such behaviors by examining Web sites of large health care systems, the health departments of all 50 states, the 20 largest US cities, and 181 nationally accredited senior centers, to identify information, products, programs, or services recommended for cognitive health. Among the health care systems, 40% promoted cognitive health, 24% recommended mental activity, 20% healthy diets, 20% physical activity, and 16% social involvement. Among the health departments, 30% promoted cognitive health in the same ways. Among senior centers, 21% offered strategies, primarily mental activity. We (as a country) need to encourage patients to exercise more and lead a healthier lifestyle. This will be easier as visibility for the importance of these important activities is improved.
Mendiratta et al (Trends in Percutaneous Endoscopic Gastrostomy Placement in the Elderly From 1993 to 2003) investigated the national trends in percutaneous endoscopic gastrostomy (PEG) tube placement for hospitalized elderly patients by doing a retrospective analysis of patients over 65 years of age from the Nationwide Inpatient Sample database and was utilized to calculate PEG placement rates per 1000 people.
They found that PEG tube placement increased by 38% in elderly patients during the study period, from 2.71 procedures during hospitalization per 1000 people to 3.75 procedures during hospitalization per 1000 people. They conclude that over a 10-year period, PEG tube use in hospitalized elderly patients increased significantly. More importantly, approximately 1 in 10 PEG tube placements occurred in patients with dementia. More education to families about the expectations of PEG placement and to health care providers is needed to determine whether PEG placement is in the best interest of these patients.
Petrova et al notes that there is a strong interest in recognizing Parkinson’s disease dementia at an early stage. However, the specific profile of the earliest stages of Parkinson’s disease dementia is still unclear. The objective was to identify early neuropsychological markers for progression of dementia in this population. Patients with Parkinson’s disease dementia were divided into 2 subgroups on the basis of the Mini-Mental State Examination (MMSE): very mild and mild. The comparison with 26 normal controls showed that very mild Parkinson’s disease dementia had deficits on attention/executive functions, naming, visiospatial/constructional abilities, and retrieval of the episodic memory. Patients with mild Parkinson’s disease dementia showed additional deficits on the coding of episodic memory. They confirmed that in early Parkinson’s disease dementia the progression of dementia is mainly related to deterioration of attention/executive functions as well as retrieval and coding of episodic memory.
In Clock Drawing Test in Elderly Individuals With Different Educational Levels: Correlation With Clinical Dementia Rating, Bartholomeu et al compared the Clock Drawing Test performance in elderly individuals with different schooling levels among Clinical Dementia Scale (CDR) rating categories. In this large study, they determined that for elderly individuals with high education levels, the Clock Drawing Test is not an effective test to detect cognitive impairment.
Nordgren (Effects of Animal-Assisted Therapy on Behavioral and/or Psychological Symptoms in Dementia—A Case Report) describes an animal-assisted therapy case report where an 84-year-old woman with vascular dementia was systematically trained with a therapy dog team for 8 weeks. Some effects on the woman’s ability to walk and on her cognition were identified. Nordgren concludes that physical, psychological, and/or social training with certified therapy dog teams may have effects on the behavioral and psychological symptoms in people living with dementia.
Steffen and Mangum (Predicting Attendance at Dementia Family Support Groups) conducted a longitudinal study to examine the predictors of dementia family caregivers’ attendance at support group meetings over 6 months. First-time attendees were contacted after their first meeting and assessed for (a) perceptions of the similarity between themselves and other members, (b) depressive symptoms, and (c) perceptions of social support from the facilitator and other members. Participants were re-contacted 6 months later to obtain self-reports of attendance patterns. Self-reported attendance at any meeting during this follow-up period was predicted by perceived similarity in care recipient’s stage of dementia and perceived support from group members as assessed at the first interview. Greater perceived support from the group members and fewer depressive symptoms at time 1 predicted a higher frequency of support group attendance over the follow-up period. Their results have implications for orienting new support group members as well as training and supporting group facilitators.