Imaging and Neuropsychological Correlates of Cognitive and Behavioral Symptoms in Alzheimer’s Disease

Rafii et al (Neuropsychiatric Symptoms and Regional Neocortical Atrophy in Mild Cognitive Impairment and Alzheimer’s Disease) examined the relationship between regional neocortical atrophy (using longitudinal magnetic resonance imaging scans) and psychotic symptoms in adults with mild cognitive impairment and Alzheimer’s disease. They found that the atrophy rate of lateral frontal, lateral parietal, and anterior cingulate gyrus was significantly associated with the onset of psychosis including delusions, agitation, wandering and hallucinations and/or the need for chronic antipsychotic medications. The atrophy rate of the lateral frontal lobe correlated most strongly with the onset of psychotic symptoms/need for antipsychotic medications. This interesting work adds to what we know about volumetric changes and behavioral features in the elderly patients.

Tabuchi and colleagues (Reverse Fox Test for Detecting Visuospatial Dysfunction Corresponding to Parietal Hypoperfusion in Mild Alzheimer’s Disease) developed and tested a visuospatial task to detect parietal dysfunction in mild Alzheimer’s disease. They used the “Reverse Fox” test and brain single photon emission tomography. Success in the Reverse Fox test was achieved by 32% of patients with Alzheimer’s disease and 95% of cognitively normal elderly individuals. The unsuccessful Alzheimer’s disease subgroup showed hypoperfusion of the medial parietal and bilateral temporoparietal regions compared with the successful Alzheimer’s disease subgroup. Tabuchi et al concluded that failure in the Reverse Fox test was related to parietal hypoperfusion in patients with mild Alzheimer’s disease and that this test might be useful in patient assessment.

Liu et al (Cerebrospinal Fluid τ Protein in Differential Diagnosis of Alzheimer's Disease and Vascular Dementia in Chinese population: A Meta-Analysis) used meta-analysis to determine whether the cerebrospinal fluid biomarker τ could differentiate between Alzheimer’s disease and vascular dementia. They determined that patients with Alzheimer’s disease had higher cerebrospinal fluid τ levels than healthy controls or patients with vascular dementia.

Nardell and Tampi (Pharmacological Treatments for Frontotemporal Dementias: A Systematic Review of Randomized Controlled Trials) reviewed the current data on pharmacological treatments for frontotemporal dementias using 4 major databases: PubMed, Medline, PsychINFO, and Cochrane. Their analysis suggested that selective serotonin uptake inhibitors, trazodone, and amphetamines may all be effective in treating behavioral symptoms in frontotemporal dementias and they had good safety/tolerability profiles. None of the interventions had an impact on cognition. This summary data adds to what we know about the medical management of frontotemporal dementia.

In Detection of Early Cognitive Impairment Using AD8 in a Young Patient With Stroke With Cerebral Autosomal Dominant Arteriopathy With Subcortical Infarcts and Leukoencephalopathy Syndrome: A Case Report, Lin et al report a case with confirmed cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) syndrome, presenting with chronic migraine and an acute hemiparesis. Early cognitive impairment was detected using the Ascertain Dementia 8 questionnaire and confirmed by detailed neuropsychological assessment. Lin et al concluded that their screening questionnaire may be an easy screening tool to use with early cognitive impairment in patients with the CADASIL syndrome.

Han et al (Diagnosis of Posterior Cortical Atrophy Delayed by Coexisting Fuchs’ Endothelial Corneal Dystrophy) present a single case report of a rare condition. Posterior cortical atrophy (the visual variant of Alzheimer’s disease) is a rare neurodegenerative disorder that affects the visuospatial system. Due to the rarity of this condition and the presence of relatively preserved memory, its accurate diagnosis can be difficult. When accompanied by a comorbid visual disorder, the diagnostic process becomes even more challenging. Their report describes a patient whose diagnosis of Fuchs’ Endothelial Corneal Dystrophy delayed the diagnosis of posterior cortical atrophy.

In Neural Stem Cell Transplantation Improves Spatial Learning and Memory via Neuronal Regeneration in Amyloid-β Precursor Protein/Presenilin 1/τ Triple Transgenic Mice, the authors transplanted neuronal stem cells from C57BL/6 mice into the hippocampus in the 12-month-old triple transgenic model of Alzheimer’s disease. Two months after transplantation, Morris water maze tests suggested that spatial learning and memory in the transgenic mice receiving the transplant compared with the transgenic mice who did not receive a transplant. Their hippocampal neuron counts were also greater, suggesting that new neurons were generated. They conclude that neural stem cell transplantation may have potential to improve learning and memory by inducing neuronal regeneration in transgenic Alzheimer’s disease mice.

Kanaan et al (Feasibility and Efficacy of Intensive Cognitive Training in Early Stage Alzheimer’s Disease) note that cognitive training may be beneficial for individuals with Alzheimer’s disease but are limited by a lack of carryover. They test the feasibility and efficacy of intensive cognitive training with adults in the early stages of Alzheimer’s disease. Participants significantly improved in practiced computer-based tasks including those involving working memory, sustained attention, and switching attention. Outcome measures that improved included the Mini-Mental State Examination, letter fluency, and 3 of 5 trail-making tests. Gains in outcome measures were maintained at 2- and 4-month follow-up. Their conclusion was that adults in early stages of Alzheimer’s disease can benefit from intensive cognitive training.

In Practices Used in Israel by Nurses Who Care During Hospitalization for Older Patients With Dementia or Who are Bedridden, Lecovich et al examine: (1) bedside nurses’ care practices when providing care to patients with dementia or physical disability and (2) the extent to which these actions vary by type of hospital, type of ward, and nurse’s characteristics. They found that most practices were giving greater attention to these patients, locating them in a room near the nurses’ station and asking family members to stay with the patient or to hire paid carers. Use of restraints was more prevalent for patients with dementia than those who were physically disabled. Specific nursing practices and strategies were more connected with organizational characteristics than to other factors.