Pacing and lapping movements among institutionalized patients with dementia

Wandering is a complex behavior, and defining wandering has been challenging. The current study used the integrated circuit (IC) tag monitoring system to describe the distance moved per day and the spatial movements of patients with dementia. The study was conducted in a 60-bed semiacute dementia care unit in a general hospital in Japan over a 3-month period in 2006. The distance moved per day, the numbers of pacing and lapping movements, and the proportions of the distance moved that was paced or lapped were tabulated in 23 patients diagnosed with dementia. The distance moved per day and the numbers of pacing and lapping movements varied greatly within and among study participants. The median distance moved per day was inversely correlated with participants' age and Mini-Mental State Examination (MMSE) scores (adjusted r(2) = .34, P = .01). Consecutive lapping and pacing movements were rare patients with in Alzheimer's disease (AD), while 2 patients with frontotemporal dementia paced or lapped repeatedly.

[Dementia and pain]

Dementia has been associated with disturbed pain processing and an impaired ability to provide self-reported ratings on pain. Patients with cognitive impairment have been shown to receive pain treatment less frequently than cognitively unimpaired individuals. Comorbidity is common in patients with dementia and a major factor contributing to pain. This demonstrates that a structured evaluation and categorisation of pain is mandatory for the treatment of older patients and that care should be taken to note indirect signs of pain. The appropriate scales are available and we propagate their application. Multimodal pain therapy is superior to one-dimensional approaches. A discussion of the effects and interactions of the analgesics presently available for geriatric care forms an integral part of this review.

[Vinpotropil in the treatment of dyscirculatory encephalopathy with cognitive impairment without dementia]

The fixed combination containing 5 mg of vinpocetine and 400 mg of pyracetam (vinpotropil) was prescribed to 349 patients with dyscirculatory encephalopathy, I-II stages in dose one capsule three times a day during 3 months. After this treatment, repeated neuropsychological testing showed significant diminishing of dysexecutive cognitive impairment linked with frontal lobes dysfunction. The cognitive improvement was associated with the regress of subjective neurological symptoms like headache, dizziness, tinnitus, fatigue and insomnia. Vinpotropil was safe and well tolerated in elderly patients with chronic cerebral vascular insufficiency.

VASCULAR DEMENTIA AND ALZHEIMER'S DISEASE: THE UNSOLVED PROBLEM OF CLINICAL AND NEUROPSYCHOLOGICAL DIFFERENTIAL DIAGNOSIS

The definition of clinical criteria for differential diagnosis of Vascular Dementia (VaD) and Alzheimer's disease (AD) remains controversial. A large group of patients selected was affected by chronic cerebrovascular disease classified as VaD or not (VND), according to DSM IV criteria. Neuropsychological performances of VaD patients were compared with a group of patients affected by probable AD, matched for age, education, and severity of disease. The comparison of performances did not reach statistical significance in single neuropsychological tasks. The results suggest that neuropsychological examination might not clearly differentiate between VaD and AD patients; the similar pattern of cognitive impairment is probably indicative of several common pathogenetic mechanisms.

DIFFERENTIAL PERFORMANCE OF ALZHEIMER'S AND VASCULAR DEMENTIA PATIENTS ON A BRIEF BATTERY OF NEUROPSYCHOLOGICAL TESTS

The purpose of this article was to examine the differences in neuropsychological test performance between groups with Alzheimer's and vascular dementia. Patients included in this study were those diagnosed with Alzheimer's Disease (AD) or Vascular Dementia (VAD) through a series of neuroradiological tests that included at a minimum a CT or MRI scan and a SPECT scan. Of the 113 AD patients, the average age was 80.08 (SD = 5.91) years and average education was 12.85 (SD = 2.88). Of the 109 VAD patients, average age was 78.67 (SD = 5.35) and average education was 13.10 (SD = 2.65). Tests included selected subtests of the WAIS-R, Word Fluency, Rey Figure, Boston Naming Test, Math, Reading, and subtests from the WMS-R. Five tests showed significant differences in favor of the VAD group: Information, Similarities, Picture Completion, WRAT Mathematics, and the Boston Naming Test. Both groups did well on Reading, while both did poorly on the Rey and Word Fluency. Although both groups did poorly on memory measures, the VAD patients showed better performance. Overall, the two groups did not differ significantly on the more complex tests, but did differ on more basic tests and all the memory tests. This pattern of similar score on complex tests and different scores on basic tests demonstrates the theory that both types of dementia affected higher, more complex skills. Differences between the groups were only apparent when basic skills were compared and were not reflected in more complex and neuropsychologically "sensitive" tests.

Microvasculature changes and cerebral amyloid angiopathy in Alzheimer's disease and their potential impact on therapy

The introduction of immunotherapy and its ultimate success will require re-evaluation of the pathogenesis of Alzheimer's disease particularly with regard to the role of the ageing microvasculature and the effects of APOE genotype. Arteries in the brain have two major functions (a) delivery of blood and (b) elimination of interstitial fluid and solutes, including amyloid-beta (Abeta), along perivascular pathways (lymphatic drainage). Both these functions fail with age and particularly severely in Alzheimer's disease and vascular dementia. Accumulation of Abeta as plaques in brain parenchyma and artery walls as cerebral amyloid angiopathy (CAA) is associated with failure of perivascular elimination of Abeta from the brain in the elderly and in Alzheimer's disease. High levels of soluble Abeta in the brain correlate with cognitive decline in Alzheimer's disease and reflect the failure of perivascular drainage of solutes from the brain and loss of homeostasis of the neuronal environment. Clinically and pathologically, there is a spectrum of disease related to functional failure of the ageing microvasculature with "pure" Alzheimer's disease at one end of the spectrum and vascular dementia at the other end. Changes in the cerebral microvasculature with age have a potential impact on therapy with cholinesterase inhibitors and especially on immunotherapy that removes Abeta from plaques in the brain, but results in an increase in severity of CAA and no clear improvement in cognition. Drainage of Abeta along perivascular pathways in ageing artery walls may need to be improved to maximise the potential for improvement of cognitive function with immunotherapy.

Cholinergic deficiency involved in vascular dementia: possible mechanism and strategy of treatment

Vascular dementia (VaD) is a progressive neurodegenerative disease with a high prevalence. Several studies have recently reported that VaD patients present cholinergic deficits in the brain and cerebrospinal fluid (CSF) that may be closely related to the pathophysiology of cognitive impairment. Moreover, cholinergic therapies have shown promising effects on cognitive improvement in VaD patients. The precise mechanisms of these cholinergic agents are currently not fully understood; however, accumulating evidence indicates that these drugs may act through the cholinergic anti-inflammatory pathway, in which the efferent vagus nerve signals suppress pro-inflammatory cytokine release and inhibit inflammation, although regulation of oxidative stress and energy metabolism, alleviation of apoptosis may also be involved. In this paper, we provide a brief overview of the cholinergic treatment strategy for VaD and its relevant mechanisms of anti-inflammation.Acta Pharmacologica Sinica (2009) 30: 879-888; doi: 10.1038/aps.2009.82.

Higher level gait disorders in subcortical chronic vascular encephalopathy: a single photon emission computed tomography study

BACKGROUND

the so-called higher level gait disorders include several types of gait disorders in which there are no major modifications in strength, tone, sensitivity, coordination and balance. Brain activation sites related to walking have been investigated using SPECT in humans. The aim of the study was to investigate brain activation during walking in subjects with high-level gait disorders due to chronic subcortical vascular encephalopathy.

SUBJECTS

twelve patients with a chronic vascular encephalopathy were enrolled in the study. Seven subjects had apraxic gait while in the other five the gait was normal. All patients had undergone a recent cerebral magnetic resonance that revealed diffused chronic ischemic lesions within the white matter.

METHODS

all 12 patients underwent a regional cerebral blood flow (rCBF) brain SPECT study with (99m)Tc-Bicisate on two separate days and under two different conditions: at rest (baseline) and while walking (functional).

RESULTS

the rCBF increase induced by the treadmill test (functional-baseline), bilaterally in the medial frontal gyrus and in the anterior lobes of the cerebellum, resulted significantly (P < 0.001) lower in patients with gait apraxia versus those without it.

CONCLUSIONS

this study of the brain with SPECT records the areas of perfusion deficit that appear in apraxic subjects when they walk, compared with the recordings obtained with the same investigation performed at rest.

Blood–brain barrier: Ageing and microvascular disease – systematic review and meta-analysis

Cerebral "microvascular" disease occurs in lacunar stroke, leukoaraiosis, vascular dementia and Alzheimer's disease. It may arise from or contribute to insidious damage to the blood-brain barrier (BBB). We systematically reviewed the literature for evidence that BBB permeability is altered in patients with manifestations of cerebral microvascular disease. We found 31 BBB permeability studies (1953 individuals) of normal ageing or cerebral microvascular disease. In healthy humans, increasing age (10 comparisons, controls(C):subjects(S)=357:336) was associated with increased BBB permeability (standardised mean difference (S.M.D.) 1.21, 95% confidence interval (CI) 0.60, 1.81, p<0.01). BBB permeability was increased further in patients with either vascular or Alzheimer's dementia compared with age-matched controls (26 comparisons, C:S=510:547, S.M.D. 0.81, 99% CI 0.37, 1.26, p<0.01); in vascular compared with Alzheimer's dementia (10 comparisons, C:S=291:165, S.M.D. 0.71, 99% CI 0.12, 1.29, p<0.01); and with worsening leukoaraiosis (5 comparisons, C:S=122:88, S.M.D. 0.60, 99% CI 0.30, 0.89, p<0.01). BBB permeability increases with normal ageing and may be an important mechanism in the initiation or worsening of cerebral microvascular disease. Further studies on the role of BBB permeability are urgently needed.

Progression of mild cognitive impairment to dementia: contribution of cerebrovascular disease compared with medial temporal lobe atrophy

BACKGROUND AND PURPOSE

We sought to determine the predictive value of magnetic resonance imaging measures of vascular disease (white matter hyperintensities [WMHs], lacunes, microbleeds, and infarcts) compared with atrophy on the progression of mild cognitive impairment to dementia.

METHODS

We included 152 consecutive patients with mild cognitive impairment. Baseline magnetic resonance imaging was used to determine the presence of medial temporal lobe atrophy and vascular disease (presence of lacunes, microbleeds, and infarcts was determined, and WMHs were rated on a semiquantitative scale). Patients were followed up for 2+/-1 years.

RESULTS

Seventy-two (47%) patients progressed to dementia during follow-up. Of these, 56 (37%) patients were diagnosed with Alzheimer's disease, and 16 (10%) patients were diagnosed with a non-Alzheimer dementia (including vascular dementia, frontotemporal lobar degeneration, and Parkinson dementia). Converters were older and had a lower Mini-Mental State Examination score at baseline. On baseline magnetic resonance imaging, patients who progressed to a non-Alzheimer dementia showed more severe WMHs and had a higher prevalence of lacunes in the basal ganglia and microbleeds compared with nonconverters. Cox proportional-hazard models showed that, adjusted for age and sex, baseline medial temporal lobe atrophy (hazard ratio=2.9; 95% CI, 1.7 to 5.3), but not vascular disease, was associated with progression to Alzheimer's disease. By contrast, deep WMHs (hazard ratio=5.7; 95% CI, 1.2 to 26.7) and periventricular hyperintensities (hazard ratio=6.5; 95% CI, 1.4 to 29.8) predicted progression to non-Alzheimer dementia. Furthermore, microbleeds (hazard ratio=2.6; 95% CI, 0.9 to 7.5) yielded a >2-fold increased, though nonsignificant, risk of non-Alzheimer dementia.

CONCLUSIONS

Medial temporal lobe atrophy and markers of cerebrovascular disease predict the development of different types of dementia in mild cognitive impairment patients.

The concept of vascular cognitive impairment

Vascular cognitive impairment (VCI) is the modern term related to vascular burden of the brain,reflecting all encompassing effects of cerebrovascular disease (CVD) on cognition. VCI include all levels of cognitive decline from mild deficits in one or more cognitive domains to a broad dementia-like syndrome. VCI incorporates the complex interactions between vascular risk factors, CVD etiologies and cellular changes within the brain and cognition. Vascular risk factors towards VCI include,e.g. arterial hypertension, high cholesterol, and diabetes. VCI includes the common poststroke dementia and vascular dementia (VaD). The main subtypes of VaD include the cortical VaD or multi-infarct dementia also referred as poststroke VaD and subcortical ischemic vascular disease and dementia or small vessel dementia. Traditional vascular risk factors and stroke are also independent factors for the clinical presentation of Alzheimer's disease. In addition to these vascular factors, CVD/strokes, infarcts and white matter lesions may trigger and modify progression of Alzheimer's disease.Whilst CVD is preventable and treatable, it clearly is a major factor in the prevalence of cognitive impairment in the elderly worldwide.

[Hydrogen proton MR spectroscopy of posterior portion cingulate gyrus of patients with Alzheimer's disease: a case control study]

OBJECTIVE

To investigate the characteristics of hydrogen proton magnetic resonance spectroscopy (H-MRS) in posterior portion cingulate gyrus and the correlations thereof with the results of mini-mental state examination (MMSE), Alzheimer disease assessment scale-cognitive (ADAS-cog) in patients with mild-moderate Alzheimer's disease (AD).

METHODS

H-MRS in posterior portion cingulate gyrus was conducted in gender, age, and educational background-matched 24 patients with AD, 8 patients with vascular dementia (VD), and 11 normal controls (NC group) to measure the values of NAA (N-acetyl aspartate)myo-inositol (mI), and creatine and phosphocreatine (Cr). All the 4 subjects underwent MMSE and assessment with ADAS-cog as well. The correlations among these results were assessed.

RESULTS

The NAA/Cr ratios in posterior portion cingulate gyrus of the AD and VD groups were (1.24 +/- 0.12) and (1.25 +/- 0.15) respectively, both significantly lower than that of the NC group [(1.46 +/- 0.19), P = 0.003, P = 0.017] without significant difference between the AD and VD groups (P = 0.800). The mI/Cr value of the AD group was (0.74 +/- 0.15), not significantly different from that of the VD group [(0.65 +/- 0.15), P = 0.153], and significantly higher than that of the NC group [(0.62 +/- 0.09), P = 0.007], however, the mI/Cr value of the VD group was not significantly different from that of the NC group (P = 0.662). If the NAA/Cr ratio < 1.31 was used as criteria of AD, the positive predictive value of AD was 73% and negative predictive value was 71%. The NAA/Cr ratio was positively correlated with the MMSE score (r = 0.731, P = 0.000), and negatively correlated with the ADAS-cog score (r = -0.541, P = 0.011).

CONCLUSIONS

The NAA/Cr ratio decreases in the posterior portion cingulate gyrus of AD patients, and has statistical significant correlations with the score of MMSE and ADAS-cog. The H-MRS characteristics of posterior portion cingulate gyrus cannot effectively differentiate the early AD from early VD.

[The pupillary response test as a method to differentiate various types of dementia]

AIM

Pupillometry is a non-invasive measurement technique based on the pupillary response to specific sensoric, mental and emotional variables. After topical application of a cholinergic antagonist (tropicamide) an increased pupillary dilatation response in Alzheimers s disease patients was described ("receptor test"). The aim of the present study was to evaluate the usefulness of the 0.01% tropicamide receptor test in differentiating types of dementia.

METHOD

425 patients (159 men, 266 women, mean age 75 years) of the Memory Clinic of the SMZ Ost Vienna, Austria were included in the study. 195 patients suffered from a dementia in Alzheimer's disease with late onset (ICD-10: F00.1), 42 from dementia in Alzheimer's disease with early onset (F00.0), 71 from vascular dementia (F01), 34 from Lewy-Body dementia (F03) and 83 from mixed dementia (F00.2). All patients were investigated by means of a computer-assisted pupillometer. The pupillary diameter of the left eye was measured 4 times (baseline=0 minutes, after 20, 40 and 60 minutes). 4 minutes after baseline one drop of 0.01% tropicamide solution was installed onto the left eye of the patients.

RESULTS

At baseline the pupillary diameter was largest in Lewy-Body dementia, smallest in vascular dementia. Significant differences were observed between vascular dementia and early-onset dementia in Alzheimer's disease as well as between Lewy-Body dementia and all other dementia syndromes (except dementia in Alzheimer's disease with early onset). The 0.01% tropicamide receptor test made it possible to differentiate early-onset dementia in Alzheimer's disease from vascular and mixed dementia.

CONCLUSION

Utilizing pupillometry in combination with the 0.01% tropicamide receptor test allows to discriminate between different dementia types of, as demonstrated in our study.

Validation of a fully automated hippocampal segmentation method on patients with dementia

We describe a fully automated method for hippocampal segmentation. The method uses SPM5 (http://www.fil.ion.ucl.ac.uk/spm/) software to segment the brain into grey/white matter, and spatially normalize the images to standard space. Grey matter pixels within a predefined hippocampal region in standard space are identified to segment the hippocampi. The method was validated on 36 subjects (9 each of Alzheimer's disease, dementia with Lewy bodies, vascular dementia, and healthy controls). The mean absolute difference in volume compared with manual segmentation was 11% (SD 9%). Linear regression between manual and automated volume gave V(auto) = V(manual) x 0.83 + 401 ml. The method provides an acceptable automated alternative to manual segmentation which may be of value in large studies.

[Effect of electroacupuncture on apoptosis of hippocampus tissue in mice with vascular dementia]

OBJECTIVE

To observe the effect of electroacupuncture (EA) on hippocampal apoptosis and learning-memory ability in vascular dementia (VD) mice so as to investigate its underlying mechanism in the treatment of VD patients.

METHODS

Kunming mice were randomly divided into sham-operation (sham, n = 13), model (n = 15), EA (n = 16) and Nimodipine (intragastric gavage, 30 mg/kg for 15 days, n = 15) groups. VD model was duplicated by occlusion of bilateral carotid arteries and reperfusion. EA (2-80 Hz, 2 mA) was applied to "Dazhui" (GV 14), "Baihui" (GV 20), "Geshu" (BL 17) and "Zusanli" (ST 36) for 10 min, once daily for 15 days. Step-down and step-up tests were performed to assess the animal's memory and learning abilities separately; and the terminal deoxynucleotidyl transferase-mediated dUTP-nick end-labeling (TUNEL) method was used to display the apoptotic cells of the hippocampus tissue.

RESULTS

In comparison with sham group, the animals' reaction time upon electric shock stimulation, both step-up and step-down error times, and hippocampal apoptosis number in model, EA and Nimodipine groups increased significantly (P<0.01), while the reaction latency upon electric shock of model, EA and Nimodipine groups decreased significantly (P<0.01). Compared with model group, the reaction time, both step-up and step-down error times and hippocampal apoptosis number of both EA and Nimodipine groups decreased significantly (P<0.05, P<0.01); while the reaction latency of EA and Nimodipine groups increased considerably (P<0.01). Comparison between EA and Nimodipine groups showed that the reaction latency of EA group was obviously longer than that of the later group (P<0.01), and the step-down error times of EA group was markedly lower than that of Nimodipine group (P<0.05). No significant differences were found between these two groups in other indexes (P>0.05).

CONCLUSION

EA can ameliorate VD mice's learning-memory ability, which may be closely related to its effect in reducing hippocampal apoptosis.

Vascular compliance is reduced in vascular dementia and not in Alzheimer's disease

OBJECTIVE

to determine whether functional changes in the vasculature differ between Alzheimer's disease (AD) and vascular dementia (VAD).

DESIGN

we determined vascular stiffness in patients with a clinical and radiological diagnosis of either AD or VAD and compared them to normal age- and sex-matched controls.

METHODS

In all, 16 patients with late onset AD, 13 subjects with VAD and 16 age- and sex-matched controls were recruited to this study. Central arterial compliance (CAC), augmentation index (AI) and pulse wave velocity (PWV) (measures of arterial stiffness) were measured.

RESULTS

the mean age was 77.7 +/- 8.3 years (mean +/- SD) in the AD group, 79.7 +/- 8.9 years in the VAD group and 76.4 +/- 6.9 in the controls (P = 0.44). CAC was significantly lower in subjects with VAD compared to both the AD and the control groups (0.57 +/- 0.46 ml/mm Hg versus 1.12 +/- 0.57 and 1.1 +/- 0.47 ml/mm Hg respectively, P = 0.01). AI was significantly higher in the subjects with VAD compared to both the AD and the control groups (13.3 +/- 9.0 versus 3.5 +/- 11.4 and 4.2 +/- 9.7% respectively, P = 0.03). PWV in the muscular and elastic arteries were not statistically different between the three groups but tended to be highest in the VAD group for carotid-radial measurements.

CONCLUSIONS

the reduced CAC and increased AI in VAD subjects indicate that the disease process is associated with less vascular compliance of the large elastic arteries in these patients, but not in patients with AD.

[Clinically multi-central randomized controlled study on scalp electroacupuncture for treatment of vascular dementia]

OBJECTIVE

To provide reliable evidence for acupuncture treatment of vascular dementia (VD).

METHODS

Multi-central randomized controlled trial method was adopted and 270 cases enrolled were randomly assigned to an acupuncture-medicine group, an electroacupuncture group and a medication group. The acupuncture-medicine group were treated by scalp electroacupuncture on Sishencong (EX-HN 1), Baihui (GV 20), Shenting (GV 24), Fengchi (GB 20) and oral administration of Nimodipine; the electroacupuncture group were treated with scalp electroacupuncture; the medication group were treated with simple oral administration of Nimodipine. They were treated for 6 weeks. Mini-mental state scale (MMSE), ability of daily life-rating scale (ADL-R) and P300 were detected before and after treatment.

RESULTS

The total effective rate for cognition improvement was 86.59% in the acupuncture-medicine group, 82.05% in the electroacupuncture group and 43.21% in the medication group, the electroacupuncture group and the acupuncture-medicine group being better than the medication group; and their total effective rates for improvement of ability of daily life were 59.76%, 65.38% and 32.10%, respectively, the electroacupuncture group and the acupuncture-medicine group being better than the medication group. Scores for MMSE and ADL-R and P300 examination indicated that there were significant differences as the acupuncture-medicine group and the electroacupuncture group compared with the medication group (P < 0.01).

CONCLUSION

Scalp electroacupuncture or scalp electroacupuncture combined with oral administration of Nimodipine has a better therapeutic effect in improvement of recognition function and the ability of life activity than simple oral administration of Nimodipine with a higher safety.

[Effect of long-time retention of scalp needle on the abilities of cognition, daily living activity and P300 in vascular dementia patients]

OBJECTIVE

To observe the curative effect of long-time retention of scalp needle in the treatment of vascular dementia (VD) patients, and its influence on P300.

METHODS

Sixty-five cases of VD patients were randomly divided into acupuncture group (n = 33) and medication group (n = 32). For patients of acupuncture group, Duxil tablets were taken orally, scalp-points Dingzhongxian (MS 5), Ezhongxian (MS 1) and bilateral Dingpangxian I (MS 8) were punctured separately with the filiform needles retained for 10 h, once daily for 8 weeks. Patients of medication group were asked to take Duxil tablets orally, one tablet/time, twice daily for 8 weeks. Mini-mental state examination (MMSE), Hastgawa dementia scale (HDS) were used to evaluate the patients' abilities of orientation, calculation, immediate and remote memory and speech. Activity of Daily Living (ADL) Scale was used to evaluate their daily life ability. The latency and amplitude of event-related potential P300 of electroencephalograph (EEG) were analyzed before and after the treatment.

RESULTS

After the treatment, of the 33 and 32 cases in acupuncture and medication groups, the controlled, markedly effective, effective and ineffective cases were 2 and 1, 9 and 4, 18 and 16, 4 and 11, respectively; with the total effective rates being 87.88% and 68.75% separately. The total effective rate of acupuncture group was obviously higher than that of medication group. Self-comparison showed that MMSE and HDS scores of both acupuncture and medication groups increased significantly in comparison with their individual pre-treatment values (P < 0.05, P < 0.01), while ADL of both groups decreased significantly (P < 0.05, P < 0.01). Before treatment, compared with normal people, the latencies of P300 in two groups increased significantly (P < 0.01), while the amplitudes of two groups decreased significantly (P < 0.01). After the treatment, the situations of two groups were corrected apparently (P < 0.05). The effects of acupuncture group were significantly superior to those of medication group in MMSE, HDS and ADL scores and the latency of P300 (P < 0.05).

CONCLUSION

Long-term retention of scalp acupuncture needles can improve VD patients' intelligence, ADL ability and EEG.

[Effect of electroacupuncture on NMDAR-2 B mRNA expression in hippocampal tissue in vascular dementia rats]

OBJECTIVE

To study the underlying mechanism of electroacupuncture (EA) in improving learning-memory ability in vascular dementia (VD) rats.

METHODS

SD rats were randomized into control, sham operation (sham), VD model, non-acupoint and acupoint groups, with 10 cases in each. VD model was established by occlusion of the bilateral common carotid arteries. Morris water maze test was performed to detect the rats' learning-memory ability. The expression of N-methyl-D-aspartate receptor (NMDAR)-2 B mRNA in hippocampal CA 1 region and dentate gyrus was measured by hybridization in situ. EA (2 Hz, 1-2 mA)was applied to "Baihui" (GV 20), "Dazhui" (GV 14) and bilateral "Shenshu"(BL 23) and non-acupoint (the chest-abdominal juncture between the first and the second lumbar vertebrae) for 20 min, once daily for 30 days.

RESULTS

Self-comparison showed that 6 weeks after modeling, the escape latencies of control and sham groups, and the lingering duration in the 3rd quadrant of water pool of model, non-acupoint and acupoint groups decreased significantly (P < 0.05), while the escape latencies of model, non-acupoint and acupoint groups, and the lingering duration of control and sham groups increased considerably (P < 0.5). No significant differences were found between control and sham groups, and among model, non-acupoint and acupoint groups in the escape latency and the lingering duration in the 3rd quadrant (P > 0.05). On the 11th week after modeling, compared to their individual escape latencies and lingering duration on the 6th week, the escape latencies of controll sham and acupoint groups shortened obviously (P < 0.05), while the lingering duration in the 3"rd quadrant of the same 3 groups postponed significantly (P < 0.05). Compared with model group, the escape latency of acupoint group shortened obviously and the lingering duration increased significantly (P < 0.05). No significant differences were found between control and sham groups, and between model and non-acupoint groups in these two indexes (P > 0.05). Compared to control/sham group, the grey values of NMDAR-2 BmRNA expression in hippocampal CA 1 region and dentate gyrus in model and non-acupoint groups decreased significantly (P < 0.05). Compared to model group, the grey values of NMDAR-2 B mRNA expression in these two brain regions increased markedly (P < 0.05). No significant difference was found between control and sham groups, and between model and non-acupoint groups (P > 0.05).

CONCLUSION

Acupoint-EA is able to improve VD rats' learning-memory ability which may be related to its effect in upregulating the expression of NMDAR-2 B mRNA in hippocampal and dentate gyrus.

[Changes of encephalic contents of neuropeptides in rats with vascular dementia]

OBJECTIVE

To investigate the changes of encephalic contents of somatostatin (SS) and arginine vasopressin (AVP) in rats with vascular dementia.

METHODS

Twenty-four male Sprague-Dawley rats were randomly divided into three groups: vascular dementia group (VDMG), sham operation group (SOG) and control group (CG). The vascular dementia model was established by permanent bilateral vertebral artery occlusion through electric coagulation and shut-off the bilateral carotid arteries. The remember behavior of animals was tested and the contents of SS and AVP in various encephalic region (frontal cortex, temporal lobe, hippocampus, cerebral ganglion and corpora striatum) were determined with radioimmunoassay.

RESULT

During the 15-day-long remembering test, the frequency of making mistakes in the VDMG was higher remarkably than that in SOG and CG (P<0.05); and the relative contents of SS were decreased in frontal area cortex, temporal lobe, hippocampus, cerebral ganglion and corpora striatum (P<0.01), while decrease of AVP contents was only detected in temporal lobe and corpora striatum (P<0.05).

CONCLUSION

The disturbance of learning and memory function might be associated with SS and AVP after multiple cerebral infarction in the animals.

Ameliorative role of Atorvastatin and Pitavastatin in L-Methionine induced vascular dementia in rats

BACKGROUND

Statins, HMG-CoA reductase inhibitors, are widely prescribed drugs for dyslipidemias. Recent studies have indicated number of cholesterol independent actions of statins including their beneficial effects on vascular endothelial dysfunction and memory deficits associated with dementia of Alzheimer's type. However the potential of statins in dementia of vascular origin still remains to be explored. Therefore, the present study has been designed to investigate the effect of Atorvastatin & Pitavastatin on vascular endothelial dysfunction associated memory deficits in rats. In this study L-Methionine induced vascular dementia was assessed by Morris water-maze (MWM) test. Biochemical analysis was also performed to unfold possible mechanism of statins mediated modulation of vascular dementia.

RESULTS

L-Methionine produced endothelial dysfunction as reflected by significant decrease in serum nitrite concentration. L-Methionine treated rats performed poorly on MWM indicating impairment of memory as well. These rats also showed a significant rise in brain oxidative stress, acetylcholinesterase (AChE) activity and serum total cholesterol levels. Both Atorvastatin as well as Pitavastatin attenuated L-Methionine induced endothelial dysfunction associated memory deficits. Statins also reversed L-Methionine induced rise in brain oxidative stress, AChE activity and serum cholesterol.

CONCLUSION

The beneficial effects of statins may be attributed to their multiple effects and the study highlights the potential of these drugs in vascular dementia.

Vascular smooth muscle function is associated with initiation and processing speed in patients with atherosclerotic vascular disease

We previously reported a relationship between forearm resistance vessel function and global neuropsychological performance in patients with atherosclerotic vascular disease (AVD). This study was conducted to determine the relationships among vascular smooth muscle function, endothelial function, and initiation and processing speed in this sample. Participants were 80 individuals with AVD. Resistance vessel function was measured before and after infusion of vasoactive agents. Neuropsychological assessment included measures of estimated premorbid cognitive function, current global cognitive function, initiation, and processing speed. Vascular smooth muscle function was significantly associated with the initiation/processing speed composite score [R-Square Change = .152; F Change (1,71) = 16.61; p < .001], above and beyond the variance accounted for by age, education, premorbid cognitive function, and endothelium-dependent vascular function. This relationship remained significant when controlling for current level of global cognitive functioning and 10 vascular risk factors. Endothelium-dependent vascular function was not significantly associated with test performance. Decreased vascular smooth muscle function in forearm resistance vessels was significantly associated with relatively poor initiation and processing speed in individuals with AVD. With additional research, measures of vascular function might become useful in the early identification of those individuals at greatest risk for vascular-related cognitive dysfunction.

Mucosal tolerization to E-selectin protects against memory dysfunction and white matter damage in a vascular cognitive impairment model

Vascular cognitive impairment (VCI) is the second most prevalent type of dementia in the world. The white matter damage that characterizes the common subcortical ischemic form of VCI can be modeled by ligating both common carotid arteries in the Wistar rat to induce protracted cerebral hypoperfusion. In this model, we find that repetitive intranasal administration of recombinant E-selectin to induce mucosal tolerance and to target immunomodulation to activating blood vessels potently suppresses both white matter (and possibly gray matter) damage and markers of vessel activation (tumor necrosis factor and E-selectin); it also preserves behavioral function in T-maze spontaneous alternation, T-maze spatial discrimination memory retention, and object recognition tests. Immunomodulation may be an effective novel strategy to prevent progression of VCI.

[Effects of EGb761 on hippocamal synaptic plasticity of vascular dementia rats]

AIM

To investigate the effects of ginkgo biloba extract 761 (EGb761) on synaptic plasticity in hippocampus of vascular dementia (VD) rats.

METHODS

The escape latency (EL) of Morris water maze (MWM) task was measured at different time points (4 W, 8 W and 16 W), and the population spikes (PS) of granule cell layer in the dentate gyrus were induced by single pulse stimulation to perfo rate path fibers before and after high frequency stimulation (HFS) in vivo.

RESULTS

MWM test showed that the escape latency (EL) of VD model group were highly longer than that of the sham-operated group, while the EL of EGb761-treated group was significantly shorter than that of model group, but still longer than that of the sham-operated group. The incidence rates of LTP induction in 1 m, 2 m and 4 m subgroups of model group were significantly lower than that of sham-operated group and EGb761-treated group at different time point. The relative amplitudes of PS after HFS in 1 m, 2 m and 4 m subgroups of model group were obviously reduced compared with that of the corresponding subgroups of sham-operated group and EGb761-treated group. There was no obvious significance in the peak latency of PS between different subgroups and different LTP-tested time point.

CONCLUSION

VD model rats had apparent and long-lasting dysfunction of learning and memory, EGb761 could accelerate the recovery of the pathological synaptic plasticity. This suggested that EGb761 played an important and improving role on learning and memory dysfunction of VD.

[Megalencephalic leukoencephalopathy with subcortical cysts (van der Knaap disease)]

A history of the discovery, hypotheses of the pathogenesis, neuromorphologic data, clinical appearances, differential diagnostics and an own description of a single case of rare hereditary children leukoencephalopathy, with megalencephaly, changes of myelin structure and formation of subcortical cysts are presented. Taking into account non-specific clinical appearances of this disease and difficulties of genetic analysis, a priority role of MRI-diagnostics revealing typical signs of the disease is emphasized.

Central nervous system neurodegeneration and tinnitus: a clinical experience. Part II: translational neurovascular theory of neurodegenerative CNS disease and tinnitus

The translation of a neurovascular hypothesis for Alzheimer's disease to subjective idiopathic tinnitus (SIT) is presented as a challenge to the predominantly sensorineural view of SIT and its clinical application for tinnitus treatment. The concept of neurovascular dysfunction and neurodegeneration (ND) in SIT patients has been proposed and reported as an etiology in a particular subset of tinnitus patients with a diagnosis of medical-audiological tinnitus, through a medical-audiological tinnitus patient protocol, to be a predominantly central-type, severe, disabling SIT (n = 54 of 96). A medical-audiological ND tinnitus profile was the basis for selection of 18 SIT patients (n = 18 of 54) for nuclear medicine brain imaging (i.e., single-photon emission computed tomography or positron emission tomography, or both). Objective findings were reported in 16 of this cohort of 18 SIT patients selected for nuclear medicine imaging (88.9%). Classification of central nervous system (CNS) ND and tinnitus differentiated between (1) ND, nonspecific and of unknown etiology; (2) ND manifested by perfusion asymmetries in brain associated with ischemia (n = 11 of 18); and (3) ND CNS disease consistent with nuclear medicine criteria for senile dementia Alzheimer's-type disease (n = 5 of 18). The diagnosis was associated with cerebrovascular disease (n = 16 of 18). The identification of pathological processes of inflammation and ischemia, linked to ND, in a particular cohort of SIT patients may provide a basis for establishing the medical significance and treatment of SIT and influence the clinical course of the tinnitus.

[P300 in mild cognitive impairment and in dementia]

OBJECTIVES

The late component of the event-related potential (ERP), P300 is a marker for cognitive brain functions. The objective of this study was to examine P300 parameters in dementia and in mild cognitive impairment (MCI), to examine whether there is a correlation between the changes in P300 parameters and the type and severity of dementia, and to determine P300 abnormalities in MCI in relation to the presence/absence of CT/MRI abnormalities.

METHOD

Auditory event-related potentials, P300 were recorded in 28 MCI patients (14 of them with normal CT/MRI findings and 10 subjects with mild ventricular enlargement). In another group of patients, 31 demented patients were examined, of whom 17 patients were diagnosed with Alzheimer's dementia (AD), and 14 patients with vascular dementia (VD). Forty healthy volunteers served as the control group.

RESULTS

Mean P300 latency was significantly increased for both demented patient-groups. We found that prolongation of P300 latency was correlated with the severity of dementia. Mean P300 amplitude was significantly decreased in both groups of demented patients. In MCI, the mean latency of P300 was significantly longer among patients with mild cerebral atrophy compared to control volunteers and no significant changes were found for MCI patients with normal CT/MRI findings. Mean P300 amplitude was decreased only in demented patients.

CONCLUSIONS

The prolongation of P300 latency was significant among patients with both vascular and Alzheimer's dementia, and also among MCI patients with mild cerebral atrophy. The severity of dementia is positively correlated with P300 latency; however, this prolongation is independent of the type of dementia. The structural brain changes in MCI are related to P300 latency prolongation and thus may indicate an increased risk for developing dementia in MCI patients.

[The role of chronic brain hypoperfusion in the pathogenesis of Alzheimer's disease--facts and hypotheses]

In Alzheimer's disease, which belongs to the neurodegenerative disorders, the ethiopathogenetic role of several risk factors has been proved. A considerable number of them are mainly known as cardiovascular risk factors and can precipitate chronic brain hypoperfusion. Using functional imaging techniques, this hypoperfusion and the resulting hypometabolism become detectable in the watershed areas of the brain as early as in the stage of mild cognitive impairment. Hypoperfusion leads to the degeneration of capillaries in this area causing the deterioration of diffusion. The further reduction of nutrient and oxygen support of neurons is capable to initiate a neurodegenerative process which spreads along the glutaminergic system arising from the neurons of the association cortices. The neuropathological lesions of this neuronal system, such as the neurofibrillary tangles and the beta-amyloid plaques, are known to be the characteristic markers of Alzheimer's disease. In our review we present the development of hypoperfusion and its consequences in the watershed areas of the brain and describe the neurodegenerative process of the neuronal system arising from the neurons of the association cortices in the early stage of Alzheimer's disease. Considering the previous hypotheses and the neuropathological lesions of Alzheimer's disease we give a new consensus model to characterize the pathomechanism of the disorder.

The role of higher-level cognitive function in gait: executive dysfunction contributes to fall risk in Alzheimer's disease

Alzheimer's disease (AD) is generally understood as primarily affecting cognition while sparing motor function, at least until the later stages of the disease. Studies reported over the past 10 years, however, have documented a prevalence of falls in AD patients significantly higher than in age-matched normal elders; also persons with AD have been observed to have different walking patterns with characteristics that increase gait instability. Recent work in cognitive neuroscience has begun to demonstrate the necessity of intact cognition, particularly executive function, for competent motor control. We put the pieces of this puzzle together and review the current state of knowledge about gait and cognition in general along with an exploration of the association between dementia, gait impairment and falls in AD. We also briefly examine the current treatment of gait instability in AD, mainly exercise, and propose a new approach targeting cognition.

Differentiating Dementias in Long-Term Care Patients

Many long-term care residents are diagnosed with dementia, but dementia appears in many forms. Alzheimer's disease, the most common, is typified by a slow onset and relentless progression to complete incapacitation. Vascular dementia usually appears somewhat abruptly, is associated with vascular comorbidities, and has an unpredictable progression pattern. Lewy body dementia shares features of both Alzheimer's and Parkinson's disease; its hallmarks include fluctuating cognitive performance, visual hallucinations, and extrapyramidal motor symptoms. Frontotemporal dementias are associated less with memory disorders and more with behavioral and language aberrations. Mixed dementia covers those patients who do not have an apparent singular cause of dementia. Pseudodementia is a dementia resulting from underlying causes and is reversible, unlike the aforementioned dementias.

Atypical dementia: when it is not Alzheimer's disease

Dementia represents the most common neurodegenerative disorders affecting approximately 5% of the elderly population over age 65 years. At present, different forms of dementia are distinguished, including Alzheimer's disease (AD), dementia with Lewy bodies, frontotemporal dementia, and dementia secondary to diseases, such as AIDS dementia. Unlike AD, these atypical dementias are often associated with neurological symptoms, reflecting the localization of the degenerative process rather than the nature of the underlying histopathology. The present article provides an overview of the clinical evaluation of patients with atypical dementia and reviews distinguishing features of atypical dementias that may be confused with AD. The laboratory and imaging evaluation of various types of dementias are described. Current practice guidelines and practice parameters are reviewed as relevant for primary care practitioner.

Selective Impairment of Working Memory in a Mouse Model of Chronic Cerebral Hypoperfusion

BACKGROUND AND PURPOSE

We recently designed a mouse model of chronic cerebral hypoperfusion, in which the cerebral white matter is damaged without significant gray matter lesions. The behavioral characteristics of these mice were studied using a test battery for neurological and cognitive functions.

METHODS

Adult C57Bl/6 male mice were subjected to either sham-operation or bilateral common carotid artery stenosis (BCAS) using microcoils with an internal diameter of 0.18 mm. At 30 days after BCAS, 70 animals were divided into 3 groups and subjected to behavioral test batteries. The first group underwent comprehensive behavioral test, including the neurological screen, prepulse inhibition, hot plate, open field, light/dark transition, Porsolt forced swim and contextual and cued fear conditioning (BCAS n=13; sham-operated n=11). The second group was for the working memory task of the 8-arm radial maze test (BCAS n=12; sham-operated n=10), and the third for the reference memory task of the 8-arm radial maze test (BCAS n=13; sham-operated n=11). Another batch of animals were examined for histological changes (BCAS n=11; sham-operated n=12).

RESULTS

The white matter including the corpus callosum was consistently found to be rarefied without clear ischemic lesions in the hippocampus. No apparent differences were observed in the comprehensive test batteries between the control and BCAS mice. However, in the working memory tasks tested with the 8-arm radial maze, the BCAS mice made significantly more errors than the control mice (P<0.0001). Again, there were no detectable differences in the reference memory tasks between the groups.

CONCLUSIONS

At 30 days after BCAS, working memory deficits as well as white matter changes were apparent in the mice. Working memory deficit was attributable to damage of the frontal-subcortical circuits, suggesting the BCAS model is useful to evaluate the substrates of subcortical vascular dementia.

Japanese version of the Frontal Assessment Battery for dementia

The Frontal Assessment Battery (FAB) was developed as a short bedside cognitive and behavioral battery to assess frontal lobe functions. The purpose of this study was to evaluate the validity and reliability of a Japanese version of the FAB to measure cognitive dysfunction in patients with dementia. We studied 25 normal subjects and 105 patients with Alzheimer's disease, n=58, vascular dementia, n=24, and frontotemporal dementia, n=23. The neuropsychological test battery included the FAB, the Mini Mental State Examination (MMSE), a memory test, and the Wisconsin Card Sorting Test (Keio version: KWCST). Patients with dementia performed significantly more poorly than controls on all tests. The FAB showed a good correlation with other cognitive measures: MMSE (r=0.725), KWCST number of categories completed (r=0.654), KWCST number of perseveration errors (r=-0.484), and memory test (r=0.643). Patients with more severe Clinical Dementia Rating scores showed lower scores on the FAB. There was good inter-rater reliability (r=0.972), test-retest reliability (r=0.769), and internal consistency (Cronbach's coefficient alpha=0.715). The FAB is a valid and reliable screening test to evaluate cognitive dysfunction among patients with dementia.

Subcortical hyperintensities are associated with cognitive decline in patients with mild cognitive impairment

BACKGROUND AND PURPOSE

It has been suggested that subcortical lesions may influence cognitive performances at early stages of cognitive impairment but not in late stages of dementia. We aimed to test whether cognitive decline is associated with subcortical hyperintensities in patients with mild cognitive impairment (MCI).

METHODS

We included 170 consecutive MCI patients (mean follow-up, 3.8+/-1.6 years). We assessed subcortical hyperintensities on a baseline magnetic resonance imaging scan with a semiquantitative rating scale. The mean annual cognitive decline was calculated with the Mini-Mental State Examination and the Dementia Rating Scale at baseline and the end of follow-up.

RESULTS

Compared with patients whose cognitive performances remained stable or improved during follow-up, patients whose cognitive performances declined often had a larger amount (greater than the median of the distribution) of periventricular (PVH) (P=0.0005) and white-matter (P=0.02) hyperintensities. The rate of cognitive decline was higher with increasing PVH: mean change in the Mini-Mental State Examination score=0.16 vs -0.66 points/year in patients with PVH in the first versus third tertile (P=0.0002). The rate of decline in executive functioning was also higher with increasing PVH: mean change in the Dementia Rating Scale initiation subscore=-0.05 vs -1.42 points/year in patients with PVH in the first versus third tertile (P=0.04). These associations were independent of vascular risk factors, temporal lobe atrophy, and MCI subtype and were stronger in patients with baseline executive dysfunction.

CONCLUSIONS

White-matter hyperintensities and especially PVH were significantly associated with cognitive decline in MCI patients. This result was independent of the MCI subtype but stronger in cases of executive dysfunction at baseline.

The Tbilisi paper and pencil dual-task

One function of the central executive component of the working memory model is the coordination of two simultaneous tasks (the dual-task method). The concept of a coordination function has proved effective in identifying brain damaged patients with severe behavioural problems and in discriminating the performance of patients with mild Alzheimer's disease from that of healthy elderly. A computerised version of the dual-task method was successfully used in previous laboratory studies but it is not suited to use in a practical, clinical setting. Thus a paper and pencil version of the dual-task method was devised. The present study was aimed at refining the paper and pencil dual-task method; investigating whether or not age per se affects performance; assessing its test-retest reliability and providing norms for the Georgian population. The new paper and pencil version of the dual-task was administered to 64 young and 64 middle-age and elderly participants. A new, modified, simpler version of the paper and pencil dual-task, the "Tbilisi paper and pencil motor task" was developed. This task has high test-retest reliability and correlates with the established computerised version of the task. No age or education effects were detected.

Magnetic resonance imaging predictors of cognition in mild cognitive impairment

OBJECTIVES

To describe magnetic resonance imaging characteristics in a large sample of subjects with mild cognitive impairment (MCI) and to investigate associations between these characteristics and cognition.

DESIGN

Cohort study.

SETTING

Baseline data of a randomized, double-blind, placebo-controlled clinical trial of galantamine in MCI.

PATIENTS

Included in the study were 896 subjects with MCI (age [mean +/- SD], 70 +/- 9 years; 54% women) with available clinical and magnetic resonance imaging data.

MAIN OUTCOME MEASURES

Neuropsychology: Alzheimer Disease Assessment Scale, cognitive subscale, MCI version, assessing global cognition; delayed recall on the New York University Paragraph Recall Test, assessing episodic memory; and Digit Symbol Substitution Test, assessing executive function. Neuroimaging: Medial Temporal Lobe Atrophy (MTA) Rating Scale (0-4) and Age-Related White Matter Changes Scale (0-30), assessing white matter hyperintensities (WMHs); and lacune counts.

RESULTS

Median MTA score was 2 (range, 0-4), and mean (+/- SD) Age-Related White Matter Changes Scale score 6.0 (+/- 4.7). Lacunes were present in 33% of subjects. In unadjusted models, increasing MTA and WMHs were associated with poorer performance on all cognitive tests, and lacunes with poorer performance on the Alzheimer Disease Assessment Scale, cognitive subscale, MCI version, and the Digit Symbol Substitution Test. In multivariable models, including magnetic resonance imaging measures simultaneously, MTA remained a predictor of cognition, whereas WMH had no independent predictive value. There was an interaction between MTA and lacunes: the strength of the association with the Digit Symbol Substitution Test increased with decreasing MTA.

CONCLUSIONS

Medial temporal lobe atrophy seems to be a more important predictor of cognition than small-vessel disease in MCI. Lacunes were associated with performance on the Digit Symbol Substitution Test, especially in subjects with milder MTA. Although WMHs were prevalent and associated with cognition in unadjusted analyses, there was no discernible association between WMHs and the cognitive measures in this study after adjustment for age.

A review of the association between congestive heart failure and cognitive impairment

Heart failure is a growing epidemic with an estimated 5 million Americans suffering from this condition. Several clinical trials have demonstrated a high correlation between congestive heart failure (CHF) and cognitive impairment. The severity of cognitive impairment correlates positively with the degree of CHF. The underlying mechanism for cognitive impairment remains unclear but appears to be related to cerebral hypoperfusion and impaired cerebral reactivity with selective impairment of verbal memory and attention domains. Furthermore, cognitive dysfunction represents one aspect of frailty, a novel concept that encompasses a range of clinical conditions that results in functional impairment in patients with heart failure. In addition, frailty independently predicts mortality in CHF patients. Cognitive impairment is a common and predictable effect of CHF that contributes with social and behavioral problems to decreased compliance to prescribed therapy and increased hospital readmissions. A multidisciplinary approach is necessary to deal with the complexity of this clinical syndrome.

Frequency of subclinical heart disease in elderly persons with dementia

The authors compared the frequency of structural and functional heart abnormalities assessed using transthoracic echocardiography among persons with Alzheimer's disease, vascular dementia, stroke, and healthy control subjects. Compared with controls, patients with Alzheimer's disease were more likely to have aortic valve thickening, aortic valve regurgitation, left ventricular wall motion abnormalities, left ventricular hypertrophy, and reduced ejection fraction. Persons with vascular dementia were more likely to have aortic valve regurgitation, but mitral valve thickening and tricuspid valve regurgitation were also more frequent. In the absence of dementia, persons with stroke differed from controls by more frequent mitral valve calcifications. With the increasing prevalence of Alzheimer's disease and vascular dementia, clinicians have to be more attentive to the presence of structural heart disease and its complications in persons with these conditions.

Arterial hypertension and cognitive dysfunction in physiologic and pathologic aging of the brain

Arterial hypertension is the most important modifiable cerebrovascular risk factor; its relationship with cerebrovascular disease is continuous, consistent, and independent. Different and probably converging pathophysiologic mechanisms explain the role of arterial hypertension in causing cognitive dysfunction in pathologic aging of the brain, specifically, vascular dementia and Alzheimer's disease.

Comparative study of the specificities of needling acupoints DU20, DU26 and HT7 in intervening vascular dementia in different areas in the brain on the basis of scale assessment and cerebral functional imaging

OBJECTIVE

Using methods of clinical scale assessment and cerebral functional imaging to compare the relative specificity of needling acupoints Baihui (DU20), Shuigou (DU26) and Shenmen (HT7) in intervening vascular dementia (VD) in different areas in the brain.

METHODS

Fifty patients with VD were randomized into 5 groups. Needling on conventionally used acupoints of hand and foot three Yang-meridians aiming at hemiplegia was applied to the patients in Group A, and needling on DU20 to Group B, on DU26 to Group C, on HT7 to Group D and on all the three to Group E was applied additionally. Assessments of Mini Mental State Examination (MMSE), Activities of Daily Living (ADL) and Family Attitude Questionnaire (FAQ) were made. And the positron emission computerized tomography (PET) and single photon emission computerized tomography (SPECT) examinations were conducted in 5 selected patients from each group before and after treatment.

RESULTS

Needling on conventional acupoints plus DU20 could effect the inner temporal system, thalamencephalon system and prefrontal cortical system to improve memory and executive capacity of VD patients; conventional acupoints plus DU26 could effect more to the prefrontal cortical system to obviously elevate the executive capacity; that plus HT7 would reveal an effect similar to but rather weaker than plus DU20, and effect more to memory; and that plus all the three simultaneously could effect rather roundly multiple aspects of the nervous system related to intellectual activities, to elevate the recognition and enhance the executive capacity.

CONCLUSION

Needling on various acupoints like DU20, DU26 and HT7 have effects on different brain areas.

Asymptomatic spontaneous cerebral emboli predict cognitive and functional decline in dementia

BACKGROUND

Spontaneous cerebral emboli (SCE) are frequent in Alzheimer's disease (AD) and vascular dementia (VaD). We investigated the effect of SCE on the rates of cognitive and functional decline in AD and VaD.

METHODS

One hundred thirty-two patients with dementia (74 AD, National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association [NINCDS/ADRDA] criteria; 58 VaD, National Institute of Neurological Disorders and Stroke-Association Internationale pour la Recherche et l'Enseignement en Neurosciences [NINDS/AIREN] criteria) underwent 1-hour transcranial Doppler for detection of SCE (mean [SD] age 75.5 (7.4) years; 46% female). Neuropsychological tests (Mini-Mental State Examination [MMSE], Alzheimer's Disease Assessment Scale-Cognitive subscale [ADAS-Cog], and Neuropsychiatric Inventory [NPI]) and assessment of activities of daily living (Interview for Deterioration in Daily Living Activities in Dementia [IDDD]) were performed initially and 6 months later. SCE positive (SCE+ve, n = 47) and SCE negative (SCE-ve, n = 85) patients were compared using repeated measures analyses of variance (ANOVAs) adjusted for age, gender, and cardiovascular risk factors.

RESULTS

SCE+ve patients with dementia, both AD and VaD, suffered a more rapid decline in cognitive functioning over 6 months (ADAS-cog, mean increase 7.1 for SCE+ve compared with 3.3 for SCE-ve, p = .006) and activities of daily living (IDDD, mean increase 24.4 for SCE+ve compared with 10.8 for SCE-ve, p = .014).

CONCLUSIONS

Asymptomatic SCE are associated with an accelerated cognitive and functional decline in dementia. SCE may be a potentially treatable cause of disease progression in dementia.

Risk factors and type of dementia: vascular or Alzheimer?

The most efficient strategy for combating Alzheimer's disease (AD) is to prevent the onset of clinically significant symptoms. Determining the clinical characteristics, risk factors, and indices of cognitive reserve would help in achieving this goal. The aim of this study was to determine the risk factors for AD and vascular dementia (VD) in the elderly and to highlight the importance of risk factor modification in the early diagnosis. Consecutive 1436 patients (mean age=72.7+/-6.9 years, 34.2% male) were enrolled in the study. After a comprehensive geriatric and cognitive assessment, patients were grouped as AD group (n=203), VD group (n=73) and normal cognitive status (NCS) group (n=1160). Thirty-three possibly related factors including demographic characteristics, co-existing diseases and laboratory parameters were examined. The results revealed that female sex, advanced age, depression, and intake of vitamin supplements were independent related factors for AD; whereas depression and low-density lipoprotein-cholesterol (LDL-C) were independent related factors for VD. For every geriatric patient admitted for any reason, cognitive assessment should be performed, risk factors should be determined and the patients at high risk should be followed up carefully.