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Sabatini S, Martyr A, Gamble LD, Matthews FE, Thom JM, Henderson C, Allan L, Pentecost C, Quinn C, Hunt A, Clare L. Identifying predictors of transition to a care home for people with dementia: findings from the IDEAL programme. Aging Ment Health 2024:1-9. [PMID: 39113585 DOI: 10.1080/13607863.2024.2383367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 07/10/2024] [Indexed: 10/09/2024]
Abstract
OBJECTIVES This study investigates factors associated with the person with dementia and the caregiver to identify those associated with an increased risk of transition to a care home. METHOD IDEAL data were collected at baseline and at 12- and 24-month follow-up for 1545 people with dementia and 1305 caregivers. Modified Poisson regressions with an offset for 'person years at risk' were used. Person with dementia factors explored were personal characteristics, cognition, health, self- and informant-rated functional ability, and neuropsychiatric symptoms. Caregiver factors explored were personal characteristics, stress, health, and quality of the dyadic relationship. RESULTS A 5% people moved into care. Risk of moving into a care home was higher among people with dementia who were ≥80 years, among people with Parkinson's disease dementia or dementia with Lewy bodies, and among those without a spousal caregiver. Poorer cognition and more self-rated or informant-rated functional difficulties increased the risk of moving into care. CONCLUSION Factors related to increased dementia severity and greater disability are the primary influences that place people with dementia at greater risk of moving into a care home. Strategies that help to maintain everyday functional ability for people with dementia could help delay people with dementia moving into care.
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Affiliation(s)
- Serena Sabatini
- School of Psychology, University of Surrey, Guildford, United Kingdom
| | - Anthony Martyr
- University of Exeter Medical School, University of Exeter, Exeter, United Kingdom
| | - Laura D Gamble
- Population Health Sciences Institute, Newcastle University, Newcastle, United Kingdom
| | - Fiona E Matthews
- Institute for Clinical and Applied Health Research, Hull York Medical School, University of Hull, Hull, United Kingdom
| | - Jeanette M Thom
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Catherine Henderson
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, United Kingdom
| | - Louise Allan
- University of Exeter Medical School, University of Exeter, Exeter, United Kingdom
- NIHR Applied Research Collaboration South-West Peninsula, Exeter, United Kingdom
| | - Claire Pentecost
- University of Exeter Medical School, University of Exeter, Exeter, United Kingdom
| | - Catherine Quinn
- Centre for Applied Dementia Studies, Bradford University, Bradford, United Kingdom
| | - Anna Hunt
- University of Exeter Medical School, University of Exeter, Exeter, United Kingdom
| | - Linda Clare
- University of Exeter Medical School, University of Exeter, Exeter, United Kingdom
- NIHR Applied Research Collaboration South-West Peninsula, Exeter, United Kingdom
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Mori E, Ikeda M, Iseki E, Katayama S, Nagahama Y, Ohdake M, Takase T. Efficacy and safety of donepezil in patients with dementia with Lewy bodies: results from a 12-week multicentre, randomised, double-blind, and placebo-controlled phase IV study. Psychogeriatrics 2024; 24:542-554. [PMID: 38439118 DOI: 10.1111/psyg.13091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/21/2024] [Accepted: 01/26/2024] [Indexed: 03/06/2024]
Abstract
BACKGROUND Donepezil has been approved in Japan for the treatment of dementia with Lewy bodies (DLB) based on clinical trials showing its beneficial effects on cognitive impairment. This phase IV study evaluated the efficacy of donepezil by focusing on global clinical status during a 12-week double-blind phase. METHODS Patients with probable DLB were randomly assigned to the placebo (n = 79) or 10 mg donepezil (n = 81) groups. The primary endpoint was changes in global clinical status, assessed using the Clinician's Interview-Based Impression of Change plus Caregiver Input (CIBIC-plus). We also assessed four CIBIC-plus domains (general condition, cognitive function, behaviour, and activities of daily living) and changes in cognitive impairment and behavioural and neuropsychiatric symptoms measured using the Mini-Mental State Examination (MMSE) and the Neuropsychiatric Inventory (NPI), respectively. RESULTS Although donepezil's superiority was not shown in the global clinical status, a significant favourable effect was detected in the cognitive domain (P = 0.006). MMSE scores improved in the donepezil group after adjustments in post hoc analysis (MMSE mean difference, 1.4 (95% confidence interval (CI), 0.42-2.30), P = 0.004). Improvements in NPIs were similar between the groups (NPI-2: -0.2 (95% CI, -1.48 to 1.01), P = 0.710; NPI-10: 0.1 (95% CI, -3.28 to 3.55), P = 0.937). CONCLUSION The results support the observation that the efficacy of 10 mg donepezil in improving cognitive function is clinically meaningful in DLB patients. The evaluation of global clinical status might be affected by mild to moderate DLB patients enrolled in this study. No new safety concerns were detected.
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Affiliation(s)
- Etsuro Mori
- Department of Behavioral Neurology and Neuropsychiatry, Osaka University United Graduate School of Child Development, Osaka, Japan
| | - Manabu Ikeda
- Department of Psychiatry, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Eizo Iseki
- Senior Mental Clinic Nihonbashi Ningyocho, Tokyo, Japan
| | | | | | - Megumi Ohdake
- Clinical Planning and Development Department, Medical HQs, Eisai Co. Ltd, Tokyo, Japan
| | - Takao Takase
- Clinical Data Science Department, Medicine Development Center, Eisai Co. Ltd, Tokyo, Japan
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Isik FB, Knight HM, Rajkumar AP. Extracellular vesicle microRNA-mediated transcriptional regulation may contribute to dementia with Lewy bodies molecular pathology. Acta Neuropsychiatr 2024; 36:29-38. [PMID: 37339939 DOI: 10.1017/neu.2023.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
OBJECTIVE Dementia with Lewy bodies (DLB) is the second most common dementia. Advancing our limited understanding of its molecular pathogenesis is essential for identifying novel biomarkers and therapeutic targets for DLB. DLB is an α-synucleinopathy, and small extracellular vesicles (SEV) from people with DLB can transmit α-synuclein oligomerisation between cells. Post-mortem DLB brains and serum SEV from those with DLB share common miRNA signatures, and their functional implications are uncertain. Hence, we aimed to investigate potential targets of DLB-associated SEV miRNA and to analyse their functional implications. METHODS We identified potential targets of six previously reported differentially expressed miRNA genes in serum SEV of people with DLB (MIR26A1, MIR320C2, MIR320D2, MIR548BA, MIR556, and MIR4722) using miRBase and miRDB databases. We analysed functional implications of these targets using EnrichR gene set enrichment analysis and analysed their protein interactions using Reactome pathway analysis. RESULTS These SEV miRNA may regulate 4278 genes that were significantly enriched among the genes involved in neuronal development, cell-to-cell communication, vesicle-mediated transport, apoptosis, regulation of cell cycle, post-translational protein modifications, and autophagy lysosomal pathway, after Benjamini-Hochberg false discovery rate correction at 5%. The miRNA target genes and their protein interactions were significantly associated with several neuropsychiatric disorders and with multiple signal transduction, transcriptional regulation, and cytokine signalling pathways. CONCLUSION Our findings provide in-silico evidence that potential targets of DLB-associated SEV miRNAs may contribute to Lewy pathology by transcriptional regulation. Experimental validation of these dysfunctional pathways is warranted and could lead to novel therapeutic avenues for DLB.
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Affiliation(s)
- Fatma Busra Isik
- School of Life Science, Queen's Medical Centre, University of Nottingham, Nottingham, UK
| | - Helen Miranda Knight
- School of Life Science, Queen's Medical Centre, University of Nottingham, Nottingham, UK
| | - Anto P Rajkumar
- Institute of Mental Health, Mental Health and Clinical Neurosciences Academic Unit, University of Nottingham, Nottingham, UK
- Mental Health Services for Older People, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
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Borda MG, Brønnick KK, Garcia-Cifuentes E, Jaramillo-Jimenez A, Reyes-Ortiz C, Patricio-Baldera J, Soennesyn H, Pérez-Zepeda MU, Vik-Mo AO, Aarsland D. Specific neuropsychiatric symptoms are associated with functional decline trajectories in Alzheimer's disease and Lewy body dementia: a five-year follow-up study. Front Med (Lausanne) 2023; 10:1267060. [PMID: 37915329 PMCID: PMC10616879 DOI: 10.3389/fmed.2023.1267060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 08/14/2023] [Indexed: 11/03/2023] Open
Abstract
Background Neuropsychiatric symptoms (NPS) are often overlooked and under-identified symptoms associated with dementia, despite their significant impact on the prognosis of individuals living with the disease. The specific role of certain NPS in functional prognosis remains unclear. Aims To determine the association of different NPS with functional decline in people living with Alzheimer's disease (AD) or Lewy body dementia (LBD). Methods This is an analysis of data from the Dementia Study of Western Norway (DemVest) with 196 patients included of which 111 had AD and 85 LBD. The Neuropsychiatric Inventory (NPI) and the Rapid Disability Rating Scale (RDRS-2) for activities of daily living were administered annually for 5 years. NPI total score and individual items with RDRS-2 trajectories were analyzed with linear mixed models. Results The LBD group exhibited higher levels of functional impairment and a greater burden of NPS at baseline. Over the 5-year follow-up, hallucinations, aggression, depression, anxiety, apathy, disinhibition, aberrant motor behavior, nighttime behavior disturbances, and abnormal eating patterns were significantly associated with the decline in functional abilities in individuals with AD, as well as irritability and aberrant motor behavior in those with LBD. Discussion These results highlight the relevance of early detection and intervention of these particularly relevant NPS, due to its potential of also impacting physical function. Better detection and management of these NPS could improve functional prognosis in people living with dementia. Conclusion Specific NPS demonstrate relevant distinct associations with Longitudinal trajectories of functional decline in AD and LBD.
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Affiliation(s)
- Miguel Germán Borda
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway
- Semillero de Neurociencias y Envejecimiento, Ageing Institute, Medical School, Pontificia Universidad Javeriana, Bogotá, Colombia
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Kolbjørn Kallesten Brønnick
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Elkin Garcia-Cifuentes
- Semillero de Neurociencias y Envejecimiento, Ageing Institute, Medical School, Pontificia Universidad Javeriana, Bogotá, Colombia
- Departamento de Neurología, Unidad de Neurociencias, Hospital Universitario de San Ignacio, Bogotá, Colombia
| | - Alberto Jaramillo-Jimenez
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- Grupo de Neurociencias de Antioquia, School of Medicine, Universidad de Antioquia, Medellín, Colombia
| | - Carlos Reyes-Ortiz
- Institute of Public Health, College of Pharmacy and Pharmaceutical Sciences, Florida A&M University, Tallahassee, FL, United States
| | - Jonathan Patricio-Baldera
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway
- Escuela de estadística de la Universidad Autónoma de Santo Domingo, Santo Domingo, Dominican Republic
| | - Hogne Soennesyn
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway
| | - Mario Ulises Pérez-Zepeda
- Instituto Nacional de Geriatría, Dirección de Investigación, Mexico City, Mexico
- Centro de Investigación en Ciencias de la Salud (CICSA), FCS, Universidad Anáhuac México Campus Norte, Huixquilucan, Estado de Mexico, Mexico
| | - Audun Osland Vik-Mo
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Dag Aarsland
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
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Chwiszczuk LJ, Breitve MH, Kirsebom BEB, Selnes P, Fløvig JC, Knapskog AB, Skogseth RE, Hubbers J, Holst-Larsen E, Rongve A. The ANeED study - ambroxol in new and early dementia with Lewy bodies (DLB): protocol for a phase IIa multicentre, randomised, double-blinded and placebo-controlled trial. Front Aging Neurosci 2023; 15:1163184. [PMID: 37304077 PMCID: PMC10250712 DOI: 10.3389/fnagi.2023.1163184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 05/09/2023] [Indexed: 06/13/2023] Open
Abstract
Background Currently, there are no disease-modifying pharmacological treatment options for dementia with Lewy bodies (DLB). The hallmark of DLB is pathological alpha-synuclein (aS) deposition. There are growing amounts of data suggesting that reduced aS clearance is caused by failure in endolysosomal and authophagic pathways, as well as and glucocerebrosidase (GCase) dysfunction and mutations in the GCase gene (GBA). The population's studies demonstrated that the incidence of GBA mutations is higher among Parkinson's disease (PD) patients, and carriers of such mutations have a higher risk of developing PD. The incidence of GBA mutations is even higher in DLB and a genome-wide association study (GWAS) confirmed the correlation between GBA mutations and DLB. In vivo experiments have shown that ambroxol (ABX) may increase GCase activity and GCase levels and therefore enhance aS autophagy-lysosome degradation pathways. Moreover, there is an emerging hypothesis that ABX may have an effect as a DLB modifying drug. The aims of the study "Ambroxol in new and early Dementia with Lewy Bodies (ANeED) are to investigate the tolerability, safety and effects of ABX in patients with DLB. Methods This is a multicentre, phase IIa, double-blinded, randomised and placebo-controlled clinical trial, using a parallel arm design for 18 months' follow-up. The allocation ratio is 1:1 (treatment:placebo). Discussion The ANeED study is an ongoing clinical drug trial with ABX. The unique, but not fully understood mechanism of ABX on the enhancement of lysosomal aS clearance may be promising as a possible modifying treatment in DLB. Trial Registration The clinical trial is registered in the international trials register - clinicaltrials.com (NCT0458825) and nationally at the Current Research Information System in Norway (CRISTIN 2235504).
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Affiliation(s)
- Luiza Jadwiga Chwiszczuk
- Department of Old Age Related Medicine, Haugesund Hospital, Helse Fonna Trust, Haugesund, Norway
- Department of Research and Innovation, Haugesund Hospital, Helse Fonna Trust, Haugesund, Norway
| | - Monica Haraldseid Breitve
- Department of Research and Innovation, Haugesund Hospital, Helse Fonna Trust, Haugesund, Norway
- Department of Clinical Neuropsychology, Haugesund Hospital, Helse Fonna Trust, Haugesund, Norway
| | | | - Per Selnes
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway
| | | | | | - Ragnhild E. Skogseth
- Department of Internal Medicine, Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Jessica Hubbers
- Department of Research and Innovation, Haugesund Hospital, Helse Fonna Trust, Haugesund, Norway
| | | | - Arvid Rongve
- Department of Research and Innovation, Haugesund Hospital, Helse Fonna Trust, Haugesund, Norway
- Sant Olavs Hospital, Trondheim, Norway
- Institute of Clinical Medicine, University in Bergen, Bergen, Norway
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Mutlay F, Kaya D, Ates Bulut E, Akpınar Söylemez B, Öntan MS, Isık AT. Validation of the Turkish version of the Lewy body composite risk score. APPLIED NEUROPSYCHOLOGY. ADULT 2023:1-7. [PMID: 37183974 DOI: 10.1080/23279095.2023.2212393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
The Lewy Body Composite Risk Score (LBCRS) has been developed to increase the sensitivity and specificity of the diagnosis attributable to Lewy body pathology outside of specialty centers. We aimed to assess the validity and reliability of the Turkish version of the LBCRS in patients with dementia with Lewy Bodies (DLB) and investigate the discriminative power of the test in Turkish patients with Alzheimer's disease (AD) and DLB, and control group. The sample population (n = 512) comprised DLB (n = 113), DLB-Mild Cognitive Impairment (MCI)(n = 12), AD (n = 42), AD-MCI (n = 21), and control group (n = 324). A significant group difference was observed in the Turkish version of the LBCRS scores of the five groups (p < .001). The Cronbach's α value was 0.82 (95% CI: 0.799-0.868). The test-retest reliability score of the scale was r = 0.94 and p < .001. The subscales of the LBCRS (motor and nonmotor subdomains of the disease) were determined to explain 65.961% of the total variance with an eigenvalue >1. In patients with DLB, the cutoff score of ≥3 showed sensitivity (92%) and specificity (81%) (area under the curve [AUC] = 0.883, 95% CI: 0.815-0.951), p < .001) compared with the AD. Compared to the control group, the cutoff score of ≥3 showed a sensitivity of 98% and specificity of 97% (AUC = 0.994, 95% CI: 0.989-0.999, p < .001). The Turkish version of LBCRS permits accurate diagnosis of DLB with high sensitivity and specificity. Also, it can be useful to inform the caregivers regarding the course of the disease during the follow-up.
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Affiliation(s)
- Feyza Mutlay
- Unit for Aging Brain and Dementia, Department of Geriatric Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
- The Geriatric Science Association, Izmir, Turkey
| | - Derya Kaya
- Unit for Aging Brain and Dementia, Department of Geriatric Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
- The Geriatric Science Association, Izmir, Turkey
| | - Esra Ates Bulut
- The Geriatric Science Association, Izmir, Turkey
- Department of Geriatric Medicine, Adana City Research and Training Hospital, Adana, Turkey
| | - Burcu Akpınar Söylemez
- Department of Internal Medicine Nursing, Faculty of Nursing, Dokuz Eylul University, Izmir, Turkey
| | - Mehmet Selman Öntan
- Unit for Aging Brain and Dementia, Department of Geriatric Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
- The Geriatric Science Association, Izmir, Turkey
| | - Ahmet Turan Isık
- Unit for Aging Brain and Dementia, Department of Geriatric Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
- The Geriatric Science Association, Izmir, Turkey
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Abdelnour C, Poston KL. Cognitive Impairment in Neurodegenerative Movement Disorders. Semin Neurol 2023; 43:81-94. [PMID: 36940727 DOI: 10.1055/s-0043-1764204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2023]
Abstract
Patients with neurodegenerative movement disorders can develop cognitive impairment during the disease. Cognitive symptoms have been associated with decreased quality of life, higher caregiver burden, and earlier institutionalization, and are therefore critical for physicians to understand and address. The evaluation of cognitive performance of patients with neurodegenerative movement disorders is important for providing adequate diagnosis, management, prognosis, and support patients and their caregivers. In this review, we discuss the features of the cognitive impairment profile of commonly encountered movement disorders: Parkinson's disease, dementia with Lewy bodies, multiple system atrophy, progressive supranuclear palsy, corticobasal syndrome, and Huntington's disease. In addition, we provide neurologists with practical guidance and evaluation tools for the assessment and management of these challenging patients.
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Affiliation(s)
- Carla Abdelnour
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California
| | - Kathleen L Poston
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
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Chen S, Price AC, Cardinal RN, Moylett S, Kershenbaum AD, Fitzgerald J, Mueller C, Stewart R, O’Brien JT. Association between antidementia medication use and mortality in people diagnosed with dementia with Lewy bodies in the UK: A retrospective cohort study. PLoS Med 2022; 19:e1004124. [PMID: 36472984 PMCID: PMC9725132 DOI: 10.1371/journal.pmed.1004124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 10/14/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Dementia with Lewy bodies (DLBs) is a common cause of dementia but has higher mortality than Alzheimer's disease (AD). The reasons for this are unclear, but antidementia drugs (including acetylcholinesterase inhibitors [AChEIs] and memantine) symptomatically benefit people with DLB and might improve outcomes. We investigated whether AChEIs and/or memantine were associated with reduced hospital admissions and mortality. METHODS AND FINDINGS We performed a retrospective cohort study of those diagnosed with DLB between 1 January 2005 and 31 December 2019, using data from electronic clinical records of secondary care mental health services in Cambridgeshire and Peterborough NHS Foundation Trust (CPFT), United Kingdom (catchment area population approximately 0.86 million), as well as linked records from national Hospital Episode Statistics (HES) data. Eligible patients were those who started AChEIs or memantine within 3 months of their diagnosis (cases) and those who never used AChEIs or memantine (controls). Outcomes included admission, length of stay, and mortality. Cox proportional hazard and linear regression models were used. Of 592 patients with DLB, 219 never took AChEIs or memantine, 100 took AChEIs only, and 273 took both AChEIs and memantine. The cohorts were followed up for an average of 896 days, 981 days, and 1,004 days, respectively. There were no significant differences in the cohorts' baseline characteristics, except for socioeconomic status that was lower in patients who never took AChEIs or memantine (χ2 = 23.34, P = 0.003). After controlling for confounding by sociodemographic factors (age, sex, marital status, ethnicity, socioeconomic status), antipsychotic use, antidepressant use, cognitive status, physical comorbidity, anticholinergic burden, and global health performance, compared with patients who never took AChEIs or memantine, patients taking AChEIs only or taking both had a significantly lower risk of death (adjusted hazard ratio (HR) = 0.67, 95% CI = 0.48 to 0.93, p = 0.02; adjusted HR = 0.64, 95% CI = 0.50 to 0.83, P = 0.001, respectively). Those taking AChEIs or both AChEIs and memantine had significantly shorter periods of unplanned hospital admission for physical disorders (adjusted coefficient -13.48, 95% CI = [-26.87, -0.09], P = 0.049; adjusted coefficient -14.21, 95% CI = [-24.58, -3.85], P = 0.007, respectively), but no difference in length of stay for planned admissions for physical disorders, or for admissions for mental health disorders. No significant additional associations of memantine on admission, length of stay, and mortality were found (all P > 0.05). The main limitation was that this was a naturalistic study and possible confounds cannot be fully controlled, and there may be selection bias resulting from nonrandom prescription behaviour in clinical practice. However, we mimicked the intention-to-treat design of clinical trials, and the majority of baseline characters were balanced between cohorts. In addition, our series of sensitivity analyses confirmed the consistency of our results. CONCLUSION In this study, we observed that use of AChEIs with or without memantine in DLB was associated with shorter duration of hospital admissions and decreased risk of mortality. Although our study was naturalistic, it supports further the use of AChEIs in DLB.
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Affiliation(s)
- Shanquan Chen
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Annabel C. Price
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, United Kingdom
| | - Rudolf N. Cardinal
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, United Kingdom
| | - Sinéad Moylett
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- Laboratory of Neuroimmunology, KU Leuven, Leuven, Belgium
| | - Anne D. Kershenbaum
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, United Kingdom
| | - James Fitzgerald
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, United Kingdom
| | - Christoph Mueller
- King’s College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Robert Stewart
- King’s College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - John T. O’Brien
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
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van de Beek M, van Unnik A, van Steenoven I, van der Zande J, Barkhof F, Teunissen CE, van der Flier W, Lemstra AW. Disease progression in dementia with Lewy bodies: A longitudinal study on clinical symptoms, quality of life and functional impairment. Int J Geriatr Psychiatry 2022; 37:10.1002/gps.5839. [PMID: 36403133 PMCID: PMC9828829 DOI: 10.1002/gps.5839] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 11/02/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND OBJECTIVES Dementia with Lewy Bodies (DLB) is a heterogeneous disease, with variable signs and symptoms across multiple domains. We aimed to identify associations with rate of change in cognition, everyday functioning (IADL) and quality of life (QoL). METHODS We included 121 DLB patients (69 ± 6 yrs, 14%F, MMSE: 25 ± 3) in our prospective cohort (follow-up 2 ± 1 yrs). We described progression of symptoms and cognitive decline over time. Mixed models were used to investigate whether changes in symptoms were associated to changes in IADL (FAQ), QoL (QoL-AD) and caregiver burden (ZBI). Last, we investigated whether baseline symptoms and biomarkers predicted decline in cognition (MMSE), IADL (FAQ) and QoL (QoL-AD). RESULTS Parkinsonism and RBD were most frequently present early in the disease course, while hallucinations were more likely to develop in a later stage. MMSE (annual change β ± SE = -2.06 ± 0.23), QoL-AD (-1.03 ± 0.20), and FAQ (3.04 ± 0.30) declined over time. Increasing severity of clinical symptoms was associated to increases in FAQ, QoL-AD and caregiver burden. Baseline clinical symptoms were not predictive for decline in these outcomes. By contrast, AD co-pathology (CSF pTau/Aβ42 ratio) was associated to steeper decline in MMSE (-1.23 ± 0.54). Medial temporal atrophy (-0.81 ± 0.26) and global cortical atrophy (-0.73 ± 0.36) predisposed for decline in QoL-AD. CONCLUSIONS Our findings imply that underlying disease processes, rather than clinical symptomatology aid in predicting decline. These findings are relevant for treatment strategies and the development of DLB specific outcome measures.
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Affiliation(s)
- Marleen van de Beek
- Department of NeurologyAlzheimer Center AmsterdamAmsterdam NeuroscienceVrije Universiteit AmsterdamAmsterdam UMCAmsterdamThe Netherlands
| | - Annemartijn van Unnik
- Department of NeurologyAlzheimer Center AmsterdamAmsterdam NeuroscienceVrije Universiteit AmsterdamAmsterdam UMCAmsterdamThe Netherlands
| | - Inger van Steenoven
- Department of NeurologyAlzheimer Center AmsterdamAmsterdam NeuroscienceVrije Universiteit AmsterdamAmsterdam UMCAmsterdamThe Netherlands
| | - Jessica van der Zande
- Department of NeurologyAlzheimer Center AmsterdamAmsterdam NeuroscienceVrije Universiteit AmsterdamAmsterdam UMCAmsterdamThe Netherlands
| | - Frederik Barkhof
- Department of Radiology and Nuclear MedicineAmsterdam UMCAmsterdamThe Netherlands
- Institutes of Neurology and Healthcare EngineeringUCLLondonEnglandUK
| | - Charlotte E. Teunissen
- Department of Clinical ChemistryNeurochemistry LaboratoryAmsterdam NeuroscienceVrije Universiteit AmsterdamAmsterdam UMCAmsterdamThe Netherlands
| | - Wiesje van der Flier
- Department of NeurologyAlzheimer Center AmsterdamAmsterdam NeuroscienceVrije Universiteit AmsterdamAmsterdam UMCAmsterdamThe Netherlands
- Department of Epidemiology and Data SciencesVrije Universiteit AmsterdamAmsterdam UMCAmsterdamThe Netherlands
| | - Afina W. Lemstra
- Department of NeurologyAlzheimer Center AmsterdamAmsterdam NeuroscienceVrije Universiteit AmsterdamAmsterdam UMCAmsterdamThe Netherlands
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Prasad S, Katta MR, Abhishek S, Sridhar R, Valisekka SS, Hameed M, Kaur J, Walia N. Recent advances in Lewy body dementia: A comprehensive review. Dis Mon 2022; 69:101441. [PMID: 35690493 DOI: 10.1016/j.disamonth.2022.101441] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Lewy Body Dementia is the second most frequent neurodegenerative illness proven to cause dementia, after Alzheimer's disease (AD). It is believed to be vastly underdiagnosed, as there is a significant disparity between the number of cases diagnosed clinically and those diagnosed via neuropathology at the time of postmortem autopsy. Strikingly, many of the pharmacologic treatments used to treat behavioral and cognitive symptoms in other forms of dementia exacerbate the symptoms of DLB. Therefore, it is critical to accurately diagnose DLB as these patients require a specific treatment approach. This article focuses on its pathophysiology, risk factors, differentials, and its diverse treatment modalities. In this study, an English language literature search was conducted on Medline, Cochrane, Embase, and Google Scholar till April 2022. The following search strings and Medical Subject Headings (MeSH) terms were used: "Lewy Body Dementia," "Dementia with Lewy bodies," and "Parkinson's Disease Dementia." We explored the literature on Lewy Body Dementia for its epidemiology, pathophysiology, the role of various genes and how they bring about the disease, biomarkers, its differential diagnoses and treatment options.
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Affiliation(s)
- Sakshi Prasad
- Faculty of Medicine, National Pirogov Memorial Medical University, 21018, Vinnytsya, Ukraine.
| | | | | | | | | | - Maha Hameed
- Alfaisal University College of Medicine, Riyadh, Saudi Arabia
| | | | - Namrata Walia
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Sciences Center, Houston, Texas, United States of America
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11
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Tsujimoto M, Suzuki K, Takeda A, Saji N, Sakurai T, Washimi Y. Differentiating Dementia with Lewy Bodies from Alzheimer's Disease Using the Fall Risk Evaluation Questionnaire. Intern Med 2022; 61:1687-1692. [PMID: 34707050 PMCID: PMC9259302 DOI: 10.2169/internalmedicine.8383-21] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective Dementia with Lewy bodies (DLB) is the second-most common form of neurodegenerative dementia after Alzheimer's disease (AD). Falls are a vital prognostic factor in patients with dementia and are a characteristic feature of DLB. This study investigated the screening potential of the fall risk evaluation for DLB and compared it with that of AD to facilitate an accurate diagnosis. Methods We enrolled patients diagnosed with DLB (n=410) and AD (n=2,683) and categorized the participants into 3 groups depending on their physical ability, age, cognitive function, and fall events. Using the Fall Risk Index-21 (FRI-21) questionnaire, we evaluated and comparatively analyzed the fall risk between DLB and AD patients in three defined groups of participants. Results The FRI-21 score was significantly higher in DLB patients than in AD patients in every group. Using this score, we were able to distinguish between DLB and AD patients in each group. Among the three groups, the group with a young age, relatively mild cognitive dysfunction, and no fall events exhibited the best specificity for DLB (0.895). Conclusions The FRI-21 is a useful tool for screening for DLB and differentiating it from AD. This questionnaire can be used at a relatively early stage of the disease in young patients with mild cognitive dysfunction and no history of falling. These preliminary results need to be validated in an interventional study to evaluate the effectiveness of rehabilitative measures and daily environmental changes carried out to prevent falls using this tool.
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Affiliation(s)
- Masashi Tsujimoto
- Innovation Center for Translational Research, National Center for Geriatrics and Gerontology, Japan
| | - Keisuke Suzuki
- Innovation Center for Translational Research, National Center for Geriatrics and Gerontology, Japan
| | - Akinori Takeda
- Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and Gerontology, Japan
| | - Naoki Saji
- Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and Gerontology, Japan
| | - Takashi Sakurai
- Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and Gerontology, Japan
| | - Yukihiko Washimi
- Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and Gerontology, Japan
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12
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Badwal K, Kiliaki SA, Dugani SB, Pagali SR. Psychosis Management in Lewy Body Dementia: A Comprehensive Clinical Approach. J Geriatr Psychiatry Neurol 2022; 35:255-261. [PMID: 33461372 DOI: 10.1177/0891988720988916] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Lewy body dementia (LBD) is asynucleinopathy that results in clinical manifestation of motor and neuropsychiatric symptoms. The disease burden associated with psychosis in LBD patients is significantly higher compared to other types of dementia or even to LBD without psychosis. Effective care management processes should include consideration of de-prescribing any offending agents including anticholinergics and dopaminergic agents, followed by nonpharmacological and low risk pharmacological approach. If addition of pharmacological agents is required, consideration should be given to acetylcholinesterase inhibitors, pimavanserin and atypical antipsychotics such as quetiapine or clozapine. Side effects of these medications should be considered prior to selection and initiation of a medication regimen. Goals of care and functional assessment are a crucial part of the optimized care plan, given overall guarded prognosis, in the context of numerous complications observed in this population. Palliative care consultation could facilitate symptom control and timely enrollment into hospice if consistent with patient's goals.
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Affiliation(s)
- Karun Badwal
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Shangwe A Kiliaki
- Division of Hospital Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Sagar B Dugani
- Division of Hospital Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Sandeep R Pagali
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Mayo Clinic, Rochester, MN, USA.,Division of Hospital Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
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13
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Mortality in nursing home residents stratified according to subtype of dementia: a longitudinal study over three years. BMC Geriatr 2022; 22:282. [PMID: 35382759 PMCID: PMC8985279 DOI: 10.1186/s12877-022-02994-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 03/29/2022] [Indexed: 11/10/2022] Open
Abstract
Background There are several subtypes of dementia caused by different pathophysiology and with different clinical characteristics. Irrespective subtype, the disease is progressive, eventually leading to the need for care and supervision on a 24/7 basis, often provided in nursing homes (NH). The progression rate and course of the disease might vary according to subtype. The aim of this study was to explore whether the mortality rate for NH residents varied according to the subtype of dementia. Methods NH residents were followed from admission to NH over a period of 36 months or until death with annual follow-up examinations. Demographic and clinical data were collected. The diagnosis of dementia and its subtype at baseline (BL) were set according to international accepted criteria. Kaplan-Meier analysis was performed to estimate median survival time. A Cox regression model was estimated to assess the impact of dementia diagnosis and demographic and clinical variables on mortality. Results A total of 1349 participants were included. When compared to persons with Alzheimer’s disease (AD), persons with frontotemporal dementia (FTD) and dementia with Lewy bodies or Parkinson’s disease dementia (DLB/PDD) were younger and had more neuropsychiatric symptoms. Median survival for the total sample was 2.3 years (95% confidence interval: 2.2–2.5). When compared to persons with AD, having no dementia or unspecified dementia was associated with higher mortality, while we found similar mortality in other subtypes of dementia. Higher age, male gender, poorer general health, higher dependency in activities of daily living, and more affective symptoms were associated with higher mortality. Conclusion Mortality did not differ across the subtypes of dementia, except in persons with unspecified dementia or without dementia, where we found a higher mortality. With a median survival of 2.3 years, NH residents are in the last stage of their lives and care and medical follow-up should focus on a palliative approach. However, identifying the subtype of dementia might help carers to better understand and address neuropsychiatric symptoms and to customize medical treatment.
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14
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Stacy KE, Perazzo J, Shatz R, Bakas T. Needs and Concerns of Lewy Body Disease Family Caregivers: A Qualitative Study. West J Nurs Res 2021; 44:227-238. [PMID: 34636259 DOI: 10.1177/01939459211050957] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Lewy body disease (LBD) is a devastating condition with cognitive and physical deficits that pose a challenge to family caregivers. The purpose of this study was to identify the needs and concerns of family caregivers of persons with LBD. A convenience sample of LBD caregivers were interviewed regarding their caregiving needs, concerns, strategies, and advice. A content analysis approach was used to organize data into themes from an existing needs and concerns framework. Findings included the need for more information about the disease, strategies for managing LBD-related emotions and behaviors, support and assistance with physical and instrumental care, and strategies for managing one's own personal responses to caregiving. Findings highlight the need for a Lewy body specific caregiver assessment tool and future caregiver interventions.
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Affiliation(s)
- Kelly E Stacy
- College of Nursing, University of Cincinnati, Cincinnati, OH, USA
| | - Joseph Perazzo
- College of Nursing, University of Cincinnati, Cincinnati, OH, USA
| | - Rhonna Shatz
- Department of Neurology and Rehabilitation, University of Cincinnati, Cincinnati, OH, USA
| | - Tamilyn Bakas
- College of Nursing, University of Cincinnati, Cincinnati, OH, USA
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15
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Borda MG, Ayala Copete AM, Tovar-Rios DA, Jaramillo-Jimenez A, Giil LM, Soennesyn H, Gómez-Arteaga C, Venegas-Sanabria LC, Kristiansen I, Chavarro-Carvajal DA, Caicedo S, Cano-Gutierrez CA, Vik-Mo A, Aarsland D. Association of Malnutrition with Functional and Cognitive Trajectories in People Living with Dementia: A Five-Year Follow-Up Study. J Alzheimers Dis 2021; 79:1713-1722. [PMID: 33459715 DOI: 10.3233/jad-200961] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND In dementia, functional status depends on multiple factors in addition to cognition. Nutritional status is a potentially modifiable factor related to homeostasis and proper functioning of body systems and may contribute to cognitive and functional decline. OBJECTIVE This paper aims to analyze the association of malnutrition with the course of cognitive and functional decline in people living with dementia. METHODS This is an analysis of a longitudinal cohort study, the Dementia Study of Western Norway. Data of 202 patients diagnosed with mild dementia were analyzed; Alzheimer's disease (AD) (n = 103), Lewy body dementia (LBD) (n = 74), and other dementias (OD) (n = 25). Cognition was assessed with the Mini-Mental State Examination and functional decline through the activities of daily living included in the Rapid Disability Rating Scale. The Global Leadership Initiative on Malnutrition Index was used to determine nutritional status. Associations of nutritional status with cognitive and functional decline were evaluated through adjusted linear mixed models. RESULTS At baseline, the prevalence of general malnutrition was 28.7%; 17.3% were classified as moderate malnutrition and 11.38% as severe malnutrition (there were no significant differences between AD and LBD). Malnutrition at diagnosis and over follow-up was a significant predictor of functional-decline, but not of cognitive decline. CONCLUSION According to our results malnutrition was associated with faster functional loss but, not cognitive decline in older adults with dementia. A more comprehensive dementia approach including nutritional assessments could improve prognosis.
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Affiliation(s)
- Miguel Germán Borda
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital. Stavanger, Norway.,Semillero de Neurociencias y Envejecimiento, Ageing Institute, Medical School, Pontificia Universidad Javeriana, Bogotá, Colombia.,Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Ana María Ayala Copete
- Semillero de Neurociencias y Envejecimiento, Ageing Institute, Medical School, Pontificia Universidad Javeriana, Bogotá, Colombia.,Geriatric Unit, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Diego Alejandro Tovar-Rios
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital. Stavanger, Norway.,Universidad del Valle, School of Statistics, Santiago de Cali, Colombia.,Universidad Autónoma de Occidente, School of Basic Sciences, Santiago de Cali, Colombia
| | - Alberto Jaramillo-Jimenez
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital. Stavanger, Norway.,Grupo de Neurociencias de Antioquia, Universidad de Antioquia, Medellín, Colombia
| | - Lasse Melvær Giil
- Department of Internal Medicine, Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Hogne Soennesyn
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital. Stavanger, Norway
| | - Camilo Gómez-Arteaga
- Semillero de Neurociencias y Envejecimiento, Ageing Institute, Medical School, Pontificia Universidad Javeriana, Bogotá, Colombia.,Geriatric Unit, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Luis Carlos Venegas-Sanabria
- Semillero de Neurociencias y Envejecimiento, Ageing Institute, Medical School, Pontificia Universidad Javeriana, Bogotá, Colombia.,Geriatric Unit, Hospital Universitario San Ignacio, Bogotá, Colombia.,Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain
| | - Ida Kristiansen
- The Norwegian Center for Movement Disorders, Stavanger University Hospital, Stavanger, Norway
| | - Diego Andrés Chavarro-Carvajal
- Semillero de Neurociencias y Envejecimiento, Ageing Institute, Medical School, Pontificia Universidad Javeriana, Bogotá, Colombia.,Geriatric Unit, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Sandra Caicedo
- Semillero de Neurociencias y Envejecimiento, Ageing Institute, Medical School, Pontificia Universidad Javeriana, Bogotá, Colombia.,Geriatric Unit, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Carlos Alberto Cano-Gutierrez
- Semillero de Neurociencias y Envejecimiento, Ageing Institute, Medical School, Pontificia Universidad Javeriana, Bogotá, Colombia.,Geriatric Unit, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Audun Vik-Mo
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital. Stavanger, Norway
| | - Dag Aarsland
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital. Stavanger, Norway.,Department of Old Age Psychiatry, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
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16
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Killen A, Flynn D, O'Brien N, Taylor JP. The feasibility and acceptability of a psychosocial intervention to support people with dementia with Lewy bodies and family care partners. DEMENTIA 2021; 21:77-93. [PMID: 34171967 PMCID: PMC8721619 DOI: 10.1177/14713012211028501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Objectives Psychosocial support for people with dementia with Lewy bodies (DLB) and family care partners is frequently lacking, despite the need expressed by those with lived experience. Our objective was to examine the feasibility and acceptability of an intervention designed to build coping capability. Design The design was non-randomised with all participants receiving the intervention. Setting The setting was a Memory Assessment and Management Service in the Northeast of England. Participants Participants comprised 19 dyads consisting of a person with DLB and a family care partner. Intervention The intervention was group-based, with weekly sessions attended for up to four successive weeks. It was informed by Social Cognitive Theory. Measurements Data were collected on recruitment, attendance and attrition, self-efficacy, mood, stress and participant experience. Results Recruitment was achieved with minimal attrition and three successive groups were delivered. Care partners felt more in control and able to cope in at least 3 of 13 areas with 73% feeling this way in eight or more areas. Three themes were identified from post-intervention interviews: people like us, outcomes from being a group member and intervention design. Conclusions A DLB-specific group intervention is acceptable to people with DLB and family care partners, and recruitment is feasible within a specialist service. Participation may enhance understanding of this condition and reduce social isolation. It may improve care partners’ coping capability particularly if targeted towards those with low prior understanding of DLB and more stress. Means of evaluating outcomes for people with DLB need further development.
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Affiliation(s)
- Alison Killen
- Translational and Clinical Research Institute, 5994Newcastle University, Newcastle upon Tyne, UK
| | - Darren Flynn
- School of Health and Life Sciences, 5462Teesside University, Middlesbrough, UK
| | - Nicola O'Brien
- Department of Psychology, 5995Northumbria University, Newcastle, UK
| | - John-Paul Taylor
- Translational and Clinical Research Institute, 5994Newcastle University, Newcastle upon Tyne, UK
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17
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Borda MG, Jaramillo-Jimenez A, Oesterhus R, Santacruz JM, Tovar-Rios DA, Soennesyn H, Cano-Gutierrez CA, Vik-Mo AO, Aarsland D. Benzodiazepines and antidepressants: Effects on cognitive and functional decline in Alzheimer's disease and Lewy body dementia. Int J Geriatr Psychiatry 2021; 36:917-925. [PMID: 33382911 DOI: 10.1002/gps.5494] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 10/13/2020] [Accepted: 12/27/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVES We aim to study the effects of the prescription of benzodiazepines and antidepressants on cognitive and functional decline in older adults living with Alzheimer's disease (AD) and Lewy body dementia (LBD) over a 5-year follow-up. METHODS This is a longitudinal analysis of a Norwegian cohort study entitled "The Dementia Study of Western Norway" (DemVest). We included 196 patients newly diagnosed with AD (n = 111) and LBD (n = 85), followed annually for 5 years. Three prescription groups were defined: only benzodiazepines (BZD), only antidepressants (ADep), and the combination of benzodiazepines and antidepressants (BZD-ADep). Linear mixed-effects models were conducted to analyze the effect of the defined groups on the outcomes. The outcomes were functional decline, measured by the Rapid Disability Rating Scale-2, and cognition measured with the Mini-Mental State Examination. RESULTS Prescription of the combination of benzodiazepines and antidepressants in LBD was associated with faster functional decline. In AD, the prescription of BZD and BZD-ADep was associated with greater functional deterioration. ADep alone did not show positive or negative significant associations with the studied outcomes. CONCLUSIONS BZD and especially the combination of BZD and ADep are associated with functional decline in AD and LBD and should be used cautiously.
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Affiliation(s)
- Miguel Germán Borda
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway.,Semillero de Neurociencias y Envejecimiento, Ageing Institute, Medical School, Pontificia Universidad Javeriana, Bogotá, Colombia.,Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Alberto Jaramillo-Jimenez
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway.,Faculty of Health Sciences, University of Stavanger, Stavanger, Norway.,Grupo de Neurociencias de Antioquia, Medical School, Universidad de Antioquia, Medellin, Colombia
| | - Ragnhild Oesterhus
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Jose Manuel Santacruz
- Semillero de Neurociencias y Envejecimiento, Ageing Institute, Medical School, Pontificia Universidad Javeriana, Bogotá, Colombia.,Cognition and Memory Center, Intellectus, Hospital Universitario San Ignacio, Bogotá, Colombia.,Psychiatry Department, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Diego Alejandro Tovar-Rios
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway.,School of Statistics, Faculty of Engineering, Universidad Del Valle, Santiago de Cali, Colombia.,Department of Mathematics and Statistics, Faculty of Basic Sciences, Universidad Autónoma de Occidente, Santiago de Cali, Colombia
| | - Hogne Soennesyn
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway
| | - Carlos Alberto Cano-Gutierrez
- Semillero de Neurociencias y Envejecimiento, Ageing Institute, Medical School, Pontificia Universidad Javeriana, Bogotá, Colombia.,Geriatric Unit, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Audun Osland Vik-Mo
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Dag Aarsland
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway.,Department of Old Age Psychiatry, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
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Torboli D, Mioni G, Bussé C, Cagnin A, Vallesi A. Subjective experience of time in dementia with Lewy bodies during COVID-19 lockdown. CURRENT PSYCHOLOGY 2021; 42:4653-4662. [PMID: 33994757 PMCID: PMC8105146 DOI: 10.1007/s12144-021-01811-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2021] [Indexed: 01/10/2023]
Abstract
Dementia with Lewy bodies (DLB) is a neurodegenerative disease characterized by cognitive, behavioral and motor symptoms and has a more challenging clinical management and poorer prognosis compared to other forms of dementia. The experience of lockdown leads to negative psychological outcomes for fragile people such as elderly with dementia, particularly for DLB, causing a worsening of cognitive and neuropsychiatric symptoms. Since an individual's feeling of time passage is strongly related to their cognitive and emotional state, it is conceivable to expect alterations of this construct in people with DLB during such a difficult period. We therefore assessed the subjective experience of the passage of time for present and past time intervals (Subjective Time Questionnaire, STQ) during the lockdown due to coronavirus disease (COVID-19) in 22 patients with DLB (17 of which were re-tested in a post-lockdown period) and compared their experience with that of 14 caregivers with similar age. Patients showed a significantly slower perception of present and past time spent under lockdown restrictions. We argue that these alterations might be related to the distinctive features of DLB and their exacerbation recorded by the patients' caregivers during the period of lockdown, though our results show that the patients' experience of time passage in a post-lockdown period remained similarly slow. Overall, we show an impairment of the subjective perception of time passage in DLB tested during the COVID-19 lockdown. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s12144-021-01811-7.
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Affiliation(s)
- Dylan Torboli
- grid.5608.b0000 0004 1757 3470Department of General Psychology, University of Padova, Padova, Italy
| | - Giovanna Mioni
- grid.5608.b0000 0004 1757 3470Department of General Psychology, University of Padova, Padova, Italy
| | - Cinzia Bussé
- grid.5608.b0000 0004 1757 3470Departiment of Neuroscience, University of Padova, Padova, Italy
| | - Annachiara Cagnin
- grid.5608.b0000 0004 1757 3470Department of Neuroscience & Padova Neuroscience Center, University of Padova, Padova, Italy
| | - Antonino Vallesi
- grid.5608.b0000 0004 1757 3470Department of Neuroscience & Padova Neuroscience Center, University of Padova, Padova, Italy
- grid.416308.80000 0004 1805 3485IRCCS San Camillo Hospital , Venice, Italy
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19
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The association between aspects of carer distress and time until nursing home admission in persons with Alzheimer's disease and dementia with Lewy bodies. Int Psychogeriatr 2021; 33:337-345. [PMID: 32524943 DOI: 10.1017/s1041610220000472] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The aim of this study was to explore the association between specific aspects of carer distress and time until nursing home admission (NHA) in people with mild dementia. DESIGN Prospective cohort study. SETTING Participants were recruited from the Dementia Study of Western Norway (DemVest). PARTICIPANTS This study included 107 participants admitted to a nursing home who were diagnosed with Alzheimer's disease (AD, n = 64) and dementia with Lewy bodies (DLB, n = 43) and their primary carers. MEASUREMENTS The Relative Stress Scale (RSS) was used to assess the level of reported distress in carers. Adjusted partial least square (PLS) prediction analysis of baseline items of the RSS was used to study the associations between individual items of the RSS and time until NHA. RESULTS Carer distress is an important contributor to early NHA, explaining 19.3% of the total variance of time until NHA in the model without covariates. In the adjusted PLS model, the most important RSS predictors of time until NHA were feeling frustrated (estimate = -137; CI, -209, -64.5), having limitations on social life (estimate = -118; CI, -172, -64), not being able to get away on vacation (estimate -116; CI, -158.3, -73.7), and feeling unable to cope with the situation (estimate = -63; CI, -122.6, -3.4). CONCLUSIONS Preservation of the informal care capacity represents important steps for improving the management of resources in dementia care. This study identifies aspects of carer distress associated with a shorter time until NHA. Looking beyond the sum score of the RSS helps promote the development of flexible and tailored interventions and perhaps delay NHA.
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20
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Giebel C, Hollinghurst J, Akbari A, Schnier C, Wilkinson T, North L, Gabbay M, Rodgers S. Socio-economic predictors of time to care home admission in people living with dementia in Wales: A routine data linkage study. Int J Geriatr Psychiatry 2021; 36:511-520. [PMID: 33045103 PMCID: PMC7984448 DOI: 10.1002/gps.5446] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 10/02/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Limited research has shown that people with dementia (PwD) from lower socio-economic backgrounds can face difficulties in accessing the right care at the right time. This study examined whether socio-economic status (SES) and rural versus urban living location are associated with the time between diagnosis and care home admission in PwD living in Wales, UK. METHODS/DESIGN This study linked routine health data and an e-cohort of PwD who have been admitted into a care home between 2000 and 2018 living in Wales. Survival analysis explored the effects of SES, living location, living situation, and frailty on the time between diagnosis and care home admission. RESULTS In 34,514 PwD, the average time between diagnosis and care home admission was 1.5 (±1.4) years. Cox regression analysis showed that increased age, living alone, frailty, and living in less disadvantaged neighbourhoods were associated with faster rate to care home admission. Living in rural regions predicted a slower rate until care home admission. CONCLUSIONS This is one of the first studies to show a link between socio-economic factors on time to care home admission in dementia. Future research needs to address variations in care needs between PwD from different socio-economic and geographical backgrounds.
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Affiliation(s)
- Clarissa Giebel
- Institute of Population Health SciencesUniversity of LiverpoolLiverpoolUK,NIHR ARC NWCLiverpoolUK
| | - Joe Hollinghurst
- Health Data Research UK (HDR‐UK)Data Science BuildingSwansea UniversitySwanseaUK
| | - Ashley Akbari
- Health Data Research UK (HDR‐UK)Data Science BuildingSwansea UniversitySwanseaUK,Administrative Data Research WalesSwansea UniversitySwanseaUK,Dementia PlatformLondonUK
| | - Christian Schnier
- Dementia PlatformLondonUK,Usher InstituteUniversity of EdinburghEdinburghUK
| | - Tim Wilkinson
- Dementia PlatformLondonUK,Usher InstituteUniversity of EdinburghEdinburghUK,Centre for Clinical Brain SciencesUniversity of EdinburghEdinburghUK
| | - Laura North
- Health Data Research UK (HDR‐UK)Data Science BuildingSwansea UniversitySwanseaUK,Dementia PlatformLondonUK
| | - Mark Gabbay
- Institute of Population Health SciencesUniversity of LiverpoolLiverpoolUK,NIHR ARC NWCLiverpoolUK
| | - Sarah Rodgers
- Institute of Population Health SciencesUniversity of LiverpoolLiverpoolUK,NIHR ARC NWCLiverpoolUK
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21
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Espinosa R, Davis M, Johnson S, Cline S, Weintraub D. A Model to Assess the Outcomes Associated With Dementia With Lewy Bodies. Alzheimer Dis Assoc Disord 2021; 35:68-74. [PMID: 33044304 DOI: 10.1097/wad.0000000000000412] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 08/24/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Research investigating outcomes associated with dementia with Lewy bodies (DLB) disease progression is scarce. Developing models of DLB disease progression will provide information on the burden of disease and facilitate the evaluation of treatments for DLB from a clinical and cost perspective. METHODS Longitudinal, cognitive evaluation data were utilized in order to identify distinct health states for DLB and to estimate transition probabilities across the DLB disease continuum. These probabilities were applied to a health state transition model to evaluate disease progression and associated outcomes for a closed cohort over a fixed time horizon. The effect of a reduction in the risk of disease progression on outcomes was assessed. RESULTS Estimated transition probabilities indicate that a patient >60 years of age with mild DLB has a 54%, 30%, 4%, and 12% chance of remaining mild, progressing to severe DLB, being institutionalized, and dying after 1 year, respectively. Reducing the annual risk of transitioning from mild to severe DLB by 40% decreased time institutionalized and increased time to death. CONCLUSIONS This study used real-world longitudinal data to create a clinically relevant DLB disease progression model. Reducing the rate of disease progression resulted in meaningful benefits with potentially significant public health implications.
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Affiliation(s)
| | | | | | - Stephanie Cline
- Department of Healthcare Leadership and Management, Medical University of South Carolina, Charleston, SC
| | - Daniel Weintraub
- Perelman School of Medicine at the University of Pennsylvania
- Parkinson's Disease Research, Education and Clinical Center (PADRECC), Philadelphia Veterans Affairs Medical Center, Philadelphia, PA
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22
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Phillips JR, Matar E, Ehgoetz Martens KA, Moustafa AA, Halliday GM, Lewis SJG. Evaluating a novel behavioral paradigm for visual hallucinations in Dementia with Lewy bodies. AGING BRAIN 2021; 1:100011. [PMID: 36911512 PMCID: PMC9997132 DOI: 10.1016/j.nbas.2021.100011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 02/08/2021] [Accepted: 03/01/2021] [Indexed: 11/29/2022] Open
Abstract
The aim of this study was to evaluate the utility of the Bistable Percept Paradigm (BPP), a computerised behavioural task that has previously been utilised for the assessment of visual hallucinations in Parkinson's Disease, in a Dementia with Lewy bodies (DLB) cohort. Dementia with Lewy bodies patients demonstrated poorer performance than healthy controls (HC) on the BPP with significantly more misperceptions and a greater failure to detect bistable percepts correctly compared to HC. Further, the number of misperceptions was also correlated with the severity of hallucinations. The findings from this study demonstrate that the BPP is a viable tool to measure misperceptions in DLB patients.
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Affiliation(s)
- Joseph R Phillips
- Faculty of Medicine and Health, Brain and Mind Centre and Central Clinical School, University of Sydney, Camperdown, Sydney, Australia.,School of Psychology & Marcs Institute for Brain and Behaviour, Western Sydney University, Sydney, New South Wales, Australia
| | - Elie Matar
- Faculty of Medicine and Health, Brain and Mind Centre and Central Clinical School, University of Sydney, Camperdown, Sydney, Australia.,Dementia and Movement Disorders Laboratory, Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Kaylena A Ehgoetz Martens
- Faculty of Medicine and Health, Brain and Mind Centre and Central Clinical School, University of Sydney, Camperdown, Sydney, Australia.,Department of Kinesiology, Faculty of Health, University of Waterloo, Waterloo, Ontario, Canada
| | - Ahmed A Moustafa
- Faculty of Medicine and Health, Brain and Mind Centre and Central Clinical School, University of Sydney, Camperdown, Sydney, Australia.,School of Psychology & Marcs Institute for Brain and Behaviour, Western Sydney University, Sydney, New South Wales, Australia
| | - Glenda M Halliday
- Faculty of Medicine and Health, Brain and Mind Centre and Central Clinical School, University of Sydney, Camperdown, Sydney, Australia.,Dementia and Movement Disorders Laboratory, Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Simon J G Lewis
- Faculty of Medicine and Health, Brain and Mind Centre and Central Clinical School, University of Sydney, Camperdown, Sydney, Australia
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23
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Mjørud M, Selbæk G, Bjertness E, Edwin TH, Engedal K, Knapskog AB, Strand BH. Time from dementia diagnosis to nursing-home admission and death among persons with dementia: A multistate survival analysis. PLoS One 2020; 15:e0243513. [PMID: 33275638 PMCID: PMC7717539 DOI: 10.1371/journal.pone.0243513] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 11/22/2020] [Indexed: 12/28/2022] Open
Abstract
Objectives To estimate transition times from dementia diagnosis to nursing-home (NH) admission or death and to examine whether sex, education, marital status, level of cognitive impairment and dementia aetiology are associated with transition times. Design Markov multistate survival analysis and flexible parametric models. Setting Participants were recruited from the Norwegian Registry of Persons Assessed for Cognitive Symptoms (NorCog) in specialist healthcare between 2008 and 2017 and followed until August 2019, a maximum of 10.6 years follow-up time (mean 4.4 years, SD 2.2). Participants’ address histories, emigration and vital status were retrieved from the National Population Registry from time of diagnosis and linked to NorCog clinical data. Participants 2,938 home-dwelling persons with dementia, ages 40–97 years at time of diagnosis (mean 76.1, SD 8.5). Results During follow-up, 992 persons (34%) were admitted to nursing-homes (NHs) and 1,556 (53%) died. Approximately four years after diagnosis, the probability of living in a NH peaked at 19%; thereafter, the probability decreased due to mortality. Median elapsed time from dementia diagnosis to NH admission among those admitted to NHs was 2.28 years (IQR 2.32). The probability of NH admission was greater for women than men due to women´s lower mortality rate. Persons living alone, particularly men, had a higher probability of NH admission than cohabitants. Age, dementia aetiology and severity of cognitive impairment at time of diagnosis did not influence the probability of NH admission. Those with fewer than 10 years of education had a lower probability of NH admission than those with 10 years or more, and this was independent of the excess mortality in the less-educated group. Conclusion Four years after diagnosis, half of the participants still lived at home, while NH residency peaked at 19%. Those with fewer than 10 years of education were less often admitted to NH.
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Affiliation(s)
- Marit Mjørud
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
- * E-mail:
| | - Geir Selbæk
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Espen Bjertness
- Faculty of Medicine, Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Trine Holt Edwin
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Knut Engedal
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | | | - Bjørn Heine Strand
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
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24
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van de Beek M, van Steenoven I, Ramakers IHGB, Aalten P, Koek HL, Olde Rikkert MGM, Manniën J, Papma JM, de Jong FJ, Lemstra AW, van der Flier WM. Trajectories and Determinants of Quality of Life in Dementia with Lewy Bodies and Alzheimer's Disease. J Alzheimers Dis 2020; 70:389-397. [PMID: 31177218 PMCID: PMC6839497 DOI: 10.3233/jad-190041] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background: Quality of Life (QoL) is an important outcome measure in dementia, particularly in the context of interventions. Research investigating longitudinal QoL in dementia with Lewy bodies (DLB) is currently lacking. Objective: To investigate determinants and trajectories of QoL in DLB compared to Alzheimer’s disease (AD) and controls. Methods: QoL was assessed annually in 138 individuals, using the EQ5D-utility-score (0–100) and the health-related Visual Analogue Scale (VAS, 0–100). Twenty-nine DLB patients (age 69±6), 68 AD patients (age 70±6), and 41 controls (age 70±5) were selected from the Dutch Parelsnoer Institute-Neurodegenerative diseases and Amsterdam Dementia Cohort. We examined clinical work-up over time as determinants of QoL, including cognitive tests, neuropsychiatric inventory, Geriatric Depression Scale (GDS), and disability assessment of dementia (DAD). Results: Mixed models showed lower baseline VAS-scores in DLB compared to AD and controls (AD: β±SE = -7.6±2.8, controls: β±SE = -7.9±3.0, p < 0.05). An interaction between diagnosis and time since diagnosis indicated steeper decline on VAS-scores for AD patients compared to DLB patients (β±SE = 2.9±1.5, p < 0.1). EQ5D-utility-scores over time did not differ between groups. Higher GDS and lower DAD-scores were independently associated with lower QoL in dementia patients (GDS: VAS β±SE = -1.8±0.3, EQ5D-utility β±SE = -3.7±0.4; DAD: VAS = 0.1±0.0, EQ5D-utility β±SE = 0.1±0.1, p < 0.05). No associations between cognitive tests and QoL remained in the multivariate model. Conclusion: QoL is lower in DLB, while in AD QoL shows steeper decline as the disease advances. Our results indicate that non-cognitive symptoms, more than cognitive symptoms, are highly relevant as they impact QoL.
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Affiliation(s)
- Marleen van de Beek
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Inger van Steenoven
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Inez H G B Ramakers
- Department of Psychiatry and Neuropsychology, Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Pauline Aalten
- Department of Psychiatry and Neuropsychology, Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Huiberdina L Koek
- Department of Geriatric Medicine, University Medical Center Utrecht, Utrecht, Netherlands
| | - Marcel G M Olde Rikkert
- Department of Geriatrics & Radboud UMC Alzheimer Center, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Janne M Papma
- Department of Neurology and Alzheimer Center, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Frank Jan de Jong
- Department of Neurology and Alzheimer Center, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Afina W Lemstra
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Wiesje M van der Flier
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
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25
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Armstrong MJ, Alliance S, Corsentino P, Maixner SM, Paulson HL, Taylor A. Caregiver-Reported Barriers to Quality End-of-Life Care in Dementia With Lewy Bodies: A Qualitative Analysis. Am J Hosp Palliat Care 2020; 37:728-737. [PMID: 31902223 PMCID: PMC7335680 DOI: 10.1177/1049909119897241] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE This study investigated barriers to quality end-of-life (EOL) care in the context of dementia with Lewy bodies (DLB), one of the most common degenerative dementias in the United States. METHODS The study consisted of telephone interviews with caregivers and family members of individuals who died with DLB in the last 5 years. Interviews used a semi-structured questionnaire. Investigators employed a qualitative descriptive approach to analyze interview transcripts and identify common barriers to quality EOL care. RESULTS Thirty participants completed interviews. Reported barriers to quality EOL experiences in DLB pertained to the DLB diagnosis itself and factors relating to the US health-care system, facilities, hospice, and health-care providers (physicians and staff). Commonly reported barriers included lack of recognition and knowledge of DLB, lack of education regarding what to expect, poor coordination of care and communication across health-care teams and circumstances, and difficulty accessing health-care resources including skilled nursing facility placement and hospice. CONCLUSION Many identified themes were consistent with published barriers to quality EOL care in dementia. However, DLB-specific EOL considerations included diagnostic challenges, lack of knowledge regarding DLB and resultant prescribing errors, difficulty accessing resources due to behavioral changes in DLB, and waiting to meet Medicare dementia hospice guidelines. Improving EOL experiences in DLB will require a multifaceted approach, starting with improving DLB recognition and provider knowledge. More research is needed to improve recognition of EOL in DLB and factors that drive quality EOL experiences.
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Affiliation(s)
- Melissa J. Armstrong
- Department of Neurology, University of Florida College of Medicine, Gainesville, FL
- McKnight Brain Institute, University of Florida, Gainesville, FL
| | - Slande Alliance
- Department of Neurology, University of Florida College of Medicine, Gainesville, FL
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26
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Ydstebø AE, Benth JŠ, Bergh S, Selbæk G, Vossius C. Informal and formal care among persons with dementia immediately before nursing home admission. BMC Geriatr 2020; 20:296. [PMID: 32811440 PMCID: PMC7436969 DOI: 10.1186/s12877-020-01703-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 08/12/2020] [Indexed: 11/14/2022] Open
Abstract
Background Dementia is a care intensive disease, especially in the later stages, implying in many cases a substantial carer burden. This study assesses the use of formal and informal care resources among persons with dementia during the last month before nursing home admission. It also describes main providers of informal care and assesses the extent of informal care rendered by the extended social network. Methods In this cross-sectional study, we collected data about persons with dementia that were newly admitted to a nursing home in Norway. Information about the amount of formal and informal care during the last 4 weeks preceding nursing home admission was collected from the primary caregivers. Clinical data were collected by examining the patients, while sociodemographic data was collected from the patients’ files. Results A total of 395 persons with dementia were included. The amount of informal care provided by the family caregiver was 141.9 h per month SD = 227.4. Co-resident patients received five times more informal care than non-co-residents. Informal care from the extended social network was provided to 212 patients (53.7%) with a mean of 5.6 (SD = 11.2) hours per month and represented 3.8% of the total informal care rendered to the patients. Formal care was provided to 52.7% of the patients with a mean of 18.0 (SD = 50.1) hours per month. Co-residency was significantly associated with more informal care, and the associations varied with respect to age, relation to the caregiver, and the caregiver’s working situation. Good/excellent general health was associated with less formal care. Conclusion Persons with dementia on the verge of admission to a nursing home are mainly supported by the family caregiver, and the use of informal care is particularly high among co-residents. In order to delay nursing home admission, future research should explore the unrealized care potential in extended social networks, as well as the potential for increasing the number of recipients of formal care services.
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Affiliation(s)
- Arnt Egil Ydstebø
- Centre for Age-related Medicine, Stavanger University Hospital, Stavanger, Norway. .,Centre for Development of Institutional and Home Care Services Rogaland, Stavanger, Norway. .,Research centre for Age-related Functional decline and Disease, Innlandet Hospital Trust, Postboks 68, N-2312, Ottestad, Norway.
| | - Jurate Šaltytė Benth
- Research centre for Age-related Functional decline and Disease, Innlandet Hospital Trust, Postboks 68, N-2312, Ottestad, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Health Services Research Unit, Akershus University Hospital, Akershus, Norway
| | - Sverre Bergh
- Research centre for Age-related Functional decline and Disease, Innlandet Hospital Trust, Postboks 68, N-2312, Ottestad, Norway.,Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
| | - Geir Selbæk
- Research centre for Age-related Functional decline and Disease, Innlandet Hospital Trust, Postboks 68, N-2312, Ottestad, Norway.,Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Corinna Vossius
- Centre for Age-related Medicine, Stavanger University Hospital, Stavanger, Norway.,Centre for Development of Institutional and Home Care Services Rogaland, Stavanger, Norway
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27
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Borda MG, Aarsland D, Tovar‐Rios DA, Giil LM, Ballard C, Gonzalez MC, Brønnick K, Alves G, Oppedal K, Soennesyn H, Vik‐Mo AO. Neuropsychiatric Symptoms and Functional Decline in Alzheimerʼs Disease and Lewy Body Dementia. J Am Geriatr Soc 2020; 68:2257-2263. [DOI: 10.1111/jgs.16709] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 06/12/2020] [Accepted: 06/12/2020] [Indexed: 01/23/2023]
Affiliation(s)
- Miguel Germán Borda
- Centre for Age‐Related Medicine Stavanger University Hospital Stavanger Norway
- Semillero de Neurociencias y Envejecimiento, Ageing Institute, Medical School Pontificia Universidad Javeriana Bogotá Colombia
- Faculty of Health Sciences University of Stavanger Stavanger Norway
| | - Dag Aarsland
- Centre for Age‐Related Medicine Stavanger University Hospital Stavanger Norway
- Department of Old Age Psychiatry Institute of Psychiatry, Psychology and Neuroscience, Kingʼs College London London United Kingdom
| | - Diego Alejandro Tovar‐Rios
- School of Statistics, Faculty of Engineering Universidad del Valle Santiago de Cali Colombia
- Department of Mathematics and Statistics, Faculty of Basic Sciences Universidad Autónoma de Occidente Santiago de Cali Colombia
| | - Lasse M. Giil
- Department of Internal Medicine Haraldsplass Deaconess Hospital Bergen Norway
| | - Clive Ballard
- University of Exeter Medical School, College of Medicine and Health Exeter University Exeter United Kingdom
| | - Maria Camila Gonzalez
- Centre for Age‐Related Medicine Stavanger University Hospital Stavanger Norway
- The Norwegian Center for Movement Disorders Stavanger University Hospital Stavanger Norway
| | - Kolbjørn Brønnick
- Centre for Age‐Related Medicine Stavanger University Hospital Stavanger Norway
- Faculty of Health Sciences University of Stavanger Stavanger Norway
| | - Guido Alves
- The Norwegian Center for Movement Disorders Stavanger University Hospital Stavanger Norway
- Department of Neurology Stavanger University Hospital Stavanger Norway
- Department of Chemistry, Bioscience and Environmental Engineering University of Stavanger Stavanger Norway
| | - Ketil Oppedal
- Centre for Age‐Related Medicine Stavanger University Hospital Stavanger Norway
- Stavanger Medical Imaging Laboratory (SMIL) Stavanger University Hospital Stavanger Norway
- Department of Electrical Engineering and Computer Science University of Stavanger Stavanger Norway
| | - Hogne Soennesyn
- Centre for Age‐Related Medicine Stavanger University Hospital Stavanger Norway
| | - Audun Osland Vik‐Mo
- Centre for Age‐Related Medicine Stavanger University Hospital Stavanger Norway
- Department of Clinical Medicine University of Bergen Bergen Norway
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28
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Oesterhus R, Dalen I, Bergland AK, Aarsland D, Kjosavik SR. Risk of Hospitalization in Patients with Alzheimer’s Disease and Lewy Body Dementia: Time to and Length of Stay. J Alzheimers Dis 2020; 74:1221-1230. [DOI: 10.3233/jad-191141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Ragnhild Oesterhus
- Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway
- The Hospital Pharmacy Enterprise of Western Norway, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Ingvild Dalen
- Department of Research, Stavanger University Hospital, Stavanger, Norway
| | - Anne Katrine Bergland
- Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Dag Aarsland
- Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Svein R. Kjosavik
- Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway
- Faculty of Health Science, University of Stavanger, Stavanger, Norway
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29
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Graff-Radford J, Lesnick TG, Savica R, Chen Q, Ferman TJ, Przybelski SA, Jones DT, Senjem ML, Gunter JL, Kremers WK, Jack CR, Lowe VJ, Petersen RC, Knopman DS, Boeve BF, Murray ME, Dickson DW, Kantarci K. 18F-fluorodeoxyglucose positron emission tomography in dementia with Lewy bodies. Brain Commun 2020; 2:fcaa040. [PMID: 32566926 PMCID: PMC7293797 DOI: 10.1093/braincomms/fcaa040] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 02/19/2020] [Accepted: 03/12/2020] [Indexed: 02/05/2023] Open
Abstract
Among individuals with dementia with Lewy bodies, pathologic correlates of clinical course include the presence and extent of coexisting Alzheimer’s pathology and the presence of transitional or diffuse Lewy body disease. The objectives of this study are to determine (i) whether 18F-fluorodeoxyglucose PET signature patterns of dementia with Lewy bodies are associated with the extent of coexisting Alzheimer’s pathology and the presence of transitional or diffuse Lewy body disease and (ii) whether these 18F-fluorodeoxyglucose pattern(s) are associated with clinical course in dementia with Lewy bodies. Two groups of participants were included: a pathology-confirmed subset with Lewy body disease (n = 34) and a clinically diagnosed group of dementia with Lewy bodies (n = 87). A subset of the clinically diagnosed group was followed longitudinally (n = 51). We evaluated whether 18F-fluorodeoxyglucose PET features of dementia with Lewy bodies (higher cingulate island sign ratio and greater occipital hypometabolism) varied by Lewy body disease subtype (transitional versus diffuse) and Braak neurofibrillary tangle stage. We investigated whether the PET features were associated with the clinical trajectories by performing regression models predicting Clinical Dementia Rating Scale Sum of Boxes. Among autopsied participants, there was no difference in cingulate island sign or occipital hypometabolism by Lewy body disease type, but those with a lower Braak tangle stage had a higher cingulate island sign ratio compared to those with a higher Braak tangle stage. Among the clinically diagnosed dementia with Lewy bodies participants, a higher cingulate island ratio was associated with better cognitive scores at baseline and longitudinally. A higher 18F-fluorodeoxyglucose PET cingulate island sign ratio was associated with lower Braak tangle stage at autopsy, predicted a better clinical trajectory in dementia with Lewy body patients and may allow for improved prognostication of the clinical course in this disease.
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Affiliation(s)
| | - Timothy G Lesnick
- Division of Biostatistics, Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.,Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Rodolfo Savica
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Qin Chen
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, China.,Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Tanis J Ferman
- Department of Psychiatry and Psychology, Mayo Clinic, 4500 San Pablo Rd S, Jacksonville, FL 32224, USA
| | - Scott A Przybelski
- Division of Biostatistics, Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.,Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - David T Jones
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Matthew L Senjem
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Jeffrey L Gunter
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Walter K Kremers
- Division of Biostatistics, Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.,Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Clifford R Jack
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Val J Lowe
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Ronald C Petersen
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - David S Knopman
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Bradley F Boeve
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Melissa E Murray
- Department of Pathology and Laboratory Medicine, Mayo Clinic, 4500 San Pablo Rd S, Jacksonville, FL 32224, USA
| | - Dennis W Dickson
- Department of Pathology and Laboratory Medicine, Mayo Clinic, 4500 San Pablo Rd S, Jacksonville, FL 32224, USA
| | - Kejal Kantarci
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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30
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Joling KJ, Janssen O, Francke AL, Verheij RA, Lissenberg-Witte BI, Visser PJ, van Hout HPJ. Time from diagnosis to institutionalization and death in people with dementia. Alzheimers Dement 2020; 16:662-671. [PMID: 32072728 PMCID: PMC7984226 DOI: 10.1002/alz.12063] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 10/14/2019] [Accepted: 01/03/2020] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Reliable estimates of time from diagnosis until institutionalization and death in people with dementia from routine nationally representative databases are lacking. METHODS We selected 9230 people with dementia and 24,624 matched controls from family physicians' electronic records linked with national administrative databases to analyze time until institutionalization and death and associated factors. RESULTS Median time from recorded diagnosis until institutionalization and until death for people with dementia was 3.9 and 5.0 years, respectively, which was considerably shorter than for controls. Once institutionalized, median time to death was longer for persons with dementia (2.5 years) than for controls (1.2 years). Older age and receiving home care were the strongest predictors of shorter time until institutionalization and death in people with dementia. Gender, cohabitation, migration status, frailty, polypharmacy, and dementia medication were other significant factors. DISCUSSION The estimates could help to inform patients, their families, and policymakers about probable trajectories.
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Affiliation(s)
- Karlijn J Joling
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of General Practice and Elderly Care Medicine, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Olin Janssen
- Alzheimer Centre Limburg, Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Anneke L Francke
- Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands.,Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Robert A Verheij
- Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Birgit I Lissenberg-Witte
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Biostatistics, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Pieter-Jelle Visser
- Alzheimer Centre Limburg, Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.,Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Neurology, Alzheimer Centre Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Hein P J van Hout
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of General Practice and Elderly Care Medicine, Amsterdam Public Health research institute, Amsterdam, The Netherlands
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31
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Terum TM, Testad I, Rongve A, Aarsland D, Svendsboe E, Andersen JR. The association between specific neuropsychiatric disturbances in people with Alzheimer's disease and dementia with Lewy bodies and carer distress. Int J Geriatr Psychiatry 2019; 34:1421-1428. [PMID: 31050041 DOI: 10.1002/gps.5134] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 04/12/2019] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Neuropsychiatric symptoms (NPSs) are identified as important care-recipient variables in terms of the impact on carer distress. The aim of this study was to determine whether specific neuropsychiatric disturbances in people with Alzheimer disease (AD) and dementia with Lewy bodies (DLB) differentially impact carer distress. METHODS This was a cross-sectional study of people diagnosed with AD and DLB and their primary carers. The Relatives' Stress Scale (RSS) was used to assess the level of reported distress in carers, and the Neuropsychiatric Inventory (NPI) was used to assess NPSs. The effect of NPSs on carer distress was analyzed using correlation analysis and partial least squares regression. RESULTS This study included 159 participants diagnosed with AD (n = 97) and DLB (n = 62) and their primary carers (spouses and adult children). The majority of people diagnosed with dementia were women (64.2%), with a mean age of 75.9 years (SD, 7.4) and a mean Mini-Mental State Examination (MMSE) score of 23.5 (SD, 2.9). The main analysis identified apathy as the most important NPS contributing to carer distress. Compared with AD, the explained variance in the DLB group was higher (r2 = 37.3 vs r2 = 53.7). In addition, more NPSs were considered clinically important in the DLB group. CONCLUSION The findings of this study identify apathy as the most important NPS contributing to carer distress among carers of people with AD and DLB. These findings help us identify the support needs of families dealing with dementia.
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Affiliation(s)
- Toril Marie Terum
- Faculty of Health and Caring Sciences, Western Norway University of Applied Sciences, Førde, Norway.,Centre for Age-related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Center of Health Research, Førde Hospital Trust, Førde, Norway
| | - Ingelin Testad
- Centre for Age-related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway.,University of Exeter Medical School, St Luke's Campus, University of Exeter, Exeter, UK.,Department of Old Age Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Arvid Rongve
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Research and Innovation, Helse Fonna, Haugesund, Norway
| | - Dag Aarsland
- Centre for Age-related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway.,Department of Old Age Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Ellen Svendsboe
- Centre for Age-related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway.,Faculty of Health and Caring Sciences, Western Norway University of Applied Sciences, Stord, Norway
| | - John Roger Andersen
- Faculty of Health and Caring Sciences, Western Norway University of Applied Sciences, Førde, Norway.,Center of Health Research, Førde Hospital Trust, Førde, Norway
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32
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Nerius M, Johnell K, Garcia-Ptacek S, Eriksdotter M, Haenisch B, Doblhammer G. The Impact of Antipsychotic Drugs on Long-term Care, Nursing Home Admission, and Death in Dementia Patients. J Gerontol A Biol Sci Med Sci 2019; 73:1396-1402. [PMID: 29228107 PMCID: PMC6132113 DOI: 10.1093/gerona/glx239] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 12/05/2017] [Indexed: 12/16/2022] Open
Abstract
Background Behavioral and psychological symptoms of dementia are commonly treated with antipsychotic drugs (APDs), which have been associated with adverse health effects. We examine the effect of APDs on long-term care (LTC), nursing home (NH) admission, and death of dementia patients. Methods We used health claims data of the largest German health insurer from 2004 to 2010 and followed newly-diagnosed dementia patients aged 60 years and older into LTC, NH, and until death. Cox proportional hazards models were estimated to explore whether the risk of these outcomes differed between patients receiving haloperidol, melperone, risperidone, or quetiapine. Results In a cohort of 6,930 dementia patients who were initially free of LTC dependency, APD users generally faced a twofold increased risk of LTC relative to nonusers. Quetiapine was the exception, showing a comparatively lower risk (HR = 1.64; CI = 1.35–1.98). Among 9,950 dementia patients initially living in private homes, the risk of moving into a NH was generally increased by about 50% among APD users relative to nonusers. Risk of death (N = 10,921) was significantly higher for haloperidol-, melperone-, and risperidone- but not for quetiapine users (HR = 0.91; CI = 0.78–1.08). The excess mortality associated with haloperidol and melperone was greater among patients living in private households. Conclusions In our study, APDs appeared to accelerate adverse health outcomes in German dementia patients. Differentiating between the effect of antipsychotic drug use among dementia patients residing in private households and in NHs, we found that excess mortality for haloperidol and melperone users was higher in private settings.
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Affiliation(s)
- Michael Nerius
- German Center for Neurodegenerative Diseases, Bonn, Germany.,Institute for Sociology and Demography, University of Rostock, Germany.,Rostock Center for the Study of Demographic Change, Germany
| | - Kristina Johnell
- Aging Research Center, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Sweden
| | - Sara Garcia-Ptacek
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden.,Department of Geriatric Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Maria Eriksdotter
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden.,Department of Geriatric Medicine, Karolinska University Hospital, Stockholm, Sweden
| | | | - Gabriele Doblhammer
- German Center for Neurodegenerative Diseases, Bonn, Germany.,Institute for Sociology and Demography, University of Rostock, Germany.,Rostock Center for the Study of Demographic Change, Germany.,Max Planck Institute for Demographic Research, Rostock, Germany
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33
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Odawara T, Manabe Y, Konishi O. A survey of doctors on diagnosis and treatment of dementia with Lewy bodies: examination and treatment of behavioural and psychological symptoms. Psychogeriatrics 2019; 19:310-319. [PMID: 30723980 PMCID: PMC6849712 DOI: 10.1111/psyg.12399] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 11/08/2018] [Accepted: 12/24/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND Dementia with Lewy bodies (DLB) is a progressive form of dementia, accompanied by a range of behavioural and psychological symptoms. The aim of this study was to identify current clinical practice for the treatment of DLB in Japan. METHODS We conducted a survey of medical doctors engaged in the management of dementia in Japan. Participants were divided into two groups: psychiatrists (Group P) and neurologists or neurosurgeons (Group NS). Doctors completed a questionnaire and we analysed their responses to compare the two groups with regard to diagnosis and treatment of DLB, and in particular the treatment of behavioural and psychological symptoms of dementia (BPSD). RESULTS Responses suggested that Group P conducted biomarker examinations less frequently and decided on their own therapeutic strategies more frequently than did Group NS. Both groups most frequently selected hallucinations/delusions as the symptoms given highest treatment priority. More than 70% of respondents in both groups reported having difficulties in treating BPSD. Atypical antipsychotics were more frequently prescribed by Group P, but were also prescribed in 70% of patients in Group NS. A third of patients received atypical antipsychotics for more than 1 year. CONCLUSIONS The responses to this survey highlighted the difficulties faced by clinicians managing patients with DLB and identified the need to effectively treat BPSD in such patients.
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Affiliation(s)
| | - Yuta Manabe
- Department of Dementia and Geriatric Internal Medicine, Kanagawa Dental University Hospital, Yokosuka, Japan.,Department of Emergency and General Internal Medicine, Fujita Health University Hospital, Toyoake, Japan
| | - Osamu Konishi
- Medical Affairs, Sumitomo Dainippon Pharma Co., Ltd, Tokyo, Japan
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34
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Zahirovic I, Torisson G, Wattmo C, Londos E. Survival among the older adults with clinical signs of Lewy body dementia in 40 Swedish nursing homes: a 6-year follow-up study. BMJ Open 2019; 9:e028010. [PMID: 31152036 PMCID: PMC6549645 DOI: 10.1136/bmjopen-2018-028010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES To investigate survival among elderly residents of Swedish nursing homes (NHs), with specific focus on those with two or more signs of Lewy body dementia (LBD). DESIGN Prospective observational study. SETTING NHs in Malmö, the third largest city in Sweden. PARTICIPANTS The study population was older adults (aged ≥65 years) living in the 40 NHs in Malmö. Clinical data were collected with a customised questionnaire assessing core clinical LBD signs. Patients were categorised based on 0-1 or 2-4 LBD signs. The head nurse at each NH collected the study data: LBD questionnaires, electronic medication lists and electronic medical records from 2012 to 2013. MAIN OUTCOME MEASURES 80-month mortality. RESULTS Five hundred and fifty-eight (96%) of the residents were deceased at follow-up; among these, mean (95% CI) overall survival time was 29 (28-31) months. Mean survival differed between the LBD groups; those with 0-1 LBD signs lived 8 months longer than those with 2-4 LBD signs. Mortality risk for residents in the LBD 2-4 group was also significantly higher. HR adjusted for age and sex was HR (95% CI) 1.60 (1.30 to 1.97). Mortality risk was also significantly higher in residents with signs of fluctuating cognition 1.36 (1.15 to 1.62), rapid eye movement sleep behaviour disorder 1.49 (1.11 to 1.98), balance problems 1.36 (1.14 to 1.61) or rigidity 1.41 (1.18 to 1.68). CONCLUSIONS This large, longitudinal study shows the important survival effects of identifying and diagnosing older adults NH residents who have two or more LBD signs.
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Affiliation(s)
- Iris Zahirovic
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Gustav Torisson
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Carina Wattmo
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Elisabet Londos
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden
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Rongve A, Witoelar A, Ruiz A, Athanasiu L, Abdelnour C, Clarimon J, Heilmann-Heimbach S, Hernández I, Moreno-Grau S, de Rojas I, Morenas-Rodríguez E, Fladby T, Sando SB, Bråthen G, Blanc F, Bousiges O, Lemstra AW, van Steenoven I, Londos E, Almdahl IS, Pålhaugen L, Eriksen JA, Djurovic S, Stordal E, Saltvedt I, Ulstein ID, Bettella F, Desikan RS, Idland AV, Toft M, Pihlstrøm L, Snaedal J, Tárraga L, Boada M, Lleó A, Stefánsson H, Stefánsson K, Ramírez A, Aarsland D, Andreassen OA. GBA and APOE ε4 associate with sporadic dementia with Lewy bodies in European genome wide association study. Sci Rep 2019; 9:7013. [PMID: 31065058 PMCID: PMC6504850 DOI: 10.1038/s41598-019-43458-2] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 04/24/2019] [Indexed: 12/27/2022] Open
Abstract
Dementia with Lewy Bodies (DLB) is a common neurodegenerative disorder with poor prognosis and mainly unknown pathophysiology. Heritability estimates exceed 30% but few genetic risk variants have been identified. Here we investigated common genetic variants associated with DLB in a large European multisite sample. We performed a genome wide association study in Norwegian and European cohorts of 720 DLB cases and 6490 controls and included 19 top-associated single-nucleotide polymorphisms in an additional cohort of 108 DLB cases and 75545 controls from Iceland. Overall the study included 828 DLB cases and 82035 controls. Variants in the ASH1L/GBA (Chr1q22) and APOE ε4 (Chr19) loci were associated with DLB surpassing the genome-wide significance threshold (p < 5 × 10-8). One additional genetic locus previously linked to psychosis in Alzheimer's disease, ZFPM1 (Chr16q24.2), showed suggestive association with DLB at p-value < 1 × 10-6. We report two susceptibility loci for DLB at genome-wide significance, providing insight into etiological factors. These findings highlight the complex relationship between the genetic architecture of DLB and other neurodegenerative disorders.
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Affiliation(s)
- Arvid Rongve
- Haugesund Hospital, Helse Fonna, Department of Research and Innovation, Haugesund, Norway.
- The University of Bergen, Department of Clinical Medicine (K1), Bergen, Norway.
| | - Aree Witoelar
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Agustín Ruiz
- Memory Clinic and Research Center of Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya (UIC), Barcelona, Spain
| | - Lavinia Athanasiu
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Carla Abdelnour
- Memory Clinic and Research Center of Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya (UIC), Barcelona, Spain
| | - Jordi Clarimon
- Department of Neurology, IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Center for Networker Biomedical Research in Neurodegenerative Diseases (CIBERNED), Madrid and Barcelona, Spain
| | - Stefanie Heilmann-Heimbach
- Institute of Human Genetics, University of Bonn, Bonn, Germany
- Department of Genomics, Life & Brain Center, University of Bonn, Bonn, Germany
| | - Isabel Hernández
- Memory Clinic and Research Center of Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya (UIC), Barcelona, Spain
| | - Sonia Moreno-Grau
- Memory Clinic and Research Center of Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya (UIC), Barcelona, Spain
| | - Itziar de Rojas
- Memory Clinic and Research Center of Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya (UIC), Barcelona, Spain
| | - Estrella Morenas-Rodríguez
- Department of Neurology, IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Center for Networker Biomedical Research in Neurodegenerative Diseases (CIBERNED), Madrid and Barcelona, Spain
| | - Tormod Fladby
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway
- University of Oslo, AHUS Campus, Oslo, Norway
| | - Sigrid B Sando
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Geir Bråthen
- Department of Neurology, St Olav's Hospital, Trondheim, Norway
| | - Frédéric Blanc
- University Hospital of Strasbourg, CMRR (Memory Resources and Research Centre), Geriatrics Department, Strasbourg, France
- University of Strasbourg and CNRS, ICube laboratory and FMTS, team IMIS/Neurocrypto, Strasbourg, France
| | - Olivier Bousiges
- University Hospital of Strasbourg, CMRR (Memory Resources and Research Centre), Laboratory of Biochemistry and Molecular Biology, Strasbourg, France
| | - Afina W Lemstra
- University of Strasbourg and CNRS, Laboratoire de Neurosciences Cognitives et Adaptatives (LNCA), UMR7364, 67000, Strasbourg, France
- Alzheimercenter & Department of Neurology VU University Medical Center, Amsterdam, the Netherlands
| | - Inger van Steenoven
- University of Strasbourg and CNRS, Laboratoire de Neurosciences Cognitives et Adaptatives (LNCA), UMR7364, 67000, Strasbourg, France
- Alzheimercenter & Department of Neurology VU University Medical Center, Amsterdam, the Netherlands
| | - Elisabet Londos
- Lund University, Skane University Hospital, Institute of Clinical Sciences, Malmö, Sweden
| | - Ina S Almdahl
- University of Oslo, AHUS Campus, Oslo, Norway
- Department of Geriatric Psychiatry, Oslo University Hospital, Oslo, Norway
| | - Lene Pålhaugen
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway
- University of Oslo, AHUS Campus, Oslo, Norway
| | - Jon A Eriksen
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Srdjan Djurovic
- Department of Medical Genetics, Oslo University Hospital, Oslo, Norway
- NORMENT, KG Jebsen Centre for Psychosis Research, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Eystein Stordal
- Department of Psychiatry, Namsos Hospital, Namsos, Norway
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ingvild Saltvedt
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Geriatrics, St. Olav's Hospital, Trondheim, Norway
| | - Ingun D Ulstein
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Geriatric Psychiatry, Oslo University Hospital, Oslo, Norway
| | - Francesco Bettella
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Rahul S Desikan
- Departments of Radiology and Biomedical Imaging, Neurology and Pediatrics, UCSF, San Francisco, USA
| | - Ane-Victoria Idland
- Oslo Delirium Research Group, Department of Geriatric Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Research Group for Lifespan Changes in Brain and Cognition, Department of Psychology, University of Oslo, Oslo, Norway
- Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Mathias Toft
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Lasse Pihlstrøm
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Jon Snaedal
- Landspitali University Hospital, Reykjavik, Iceland
| | - Lluís Tárraga
- Memory Clinic and Research Center of Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya (UIC), Barcelona, Spain
| | - Mercè Boada
- Memory Clinic and Research Center of Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya (UIC), Barcelona, Spain
| | - Alberto Lleó
- Department of Neurology, IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Center for Networker Biomedical Research in Neurodegenerative Diseases (CIBERNED), Madrid and Barcelona, Spain
| | | | | | - Alfredo Ramírez
- Division for Neurogenetics and Molecular Psychiatry, Department of Psychiatry and Psychotherapy, Medical Faculty, University of Cologne, 50924, Cologne, Germany
- Department for Neurodegenerative Diseases and Geriatric Psychiatry, University of Bonn, 53127, Bonn, Germany
| | - Dag Aarsland
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
- Center for Age-Related Diseases, Stavanger University Hospital, Stavanger, Norway.
| | - Ole A Andreassen
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
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Chin KS, Teodorczuk A, Watson R. Dementia with Lewy bodies: Challenges in the diagnosis and management. Aust N Z J Psychiatry 2019; 53:291-303. [PMID: 30848660 DOI: 10.1177/0004867419835029] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Dementia with Lewy bodies is the second most common form of neurodegenerative dementia in older age yet is often under-recognised and misdiagnosed. This review aims to provide an overview of the clinical features of dementia with Lewy bodies, discussing the frequent challenges clinicians experience in diagnosing dementia with Lewy bodies, and outlines a practical approach to the clinical management, particularly in the Australian setting. METHODS This paper is a narrative review and a semi-structured database (PubMed and MEDLINE) search strategy was implemented. Articles were screened and clinically relevant studies were selected for inclusion. RESULTS Dementia with Lewy bodies is clinically characterised by complex visual hallucinations, spontaneous motor parkinsonism, prominent cognitive fluctuations and rapid eye movement sleep behaviour disorder. Neuropsychiatric features and autonomic dysfunction are also common. The new diagnostic criteria and specific diagnostic biomarkers help to improve detection rates and diagnostic accuracy, as well as guide appropriate management. Clinical management of dementia with Lewy bodies is challenging and requires an individualised multidisciplinary approach with specialist input. CONCLUSION Dementia with Lewy bodies is a common form of dementia. It often presents as a diagnostic challenge to clinicians, particularly at early stages of disease, and in patients with mixed neuropathological changes, which occur in over 50% of people with dementia with Lewy bodies. Prompt diagnosis and comprehensive treatment strategies are important in improving patients' care.
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Affiliation(s)
- Kai Sin Chin
- 1 The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia.,2 Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, Australia
| | - Andrew Teodorczuk
- 3 School of Medicine, Griffith University, Gold Coast, QLD, Australia.,4 Metro North Mental Health, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Rosie Watson
- 1 The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia.,2 Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, Australia
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Abstract
Neurodegenerative disorders are progressive, debilitating impairments of neurologic function. Dementia affects cognition and function. Persons with cognitive deficits should undergo a full workup and may be treated with cholinesterase inhibitors and/or memantine. Behavioral and psychological symptoms of dementia may be assessed and treated individually. Parkinson disease is a disorder of movement. Levodopa is the standard treatment of dopamine-related movement symptoms. Associated symptoms should be assessed and treated. Other neurodegenerative syndromes are less common but highly debilitating. Currently, there are no curative or disease-modifying therapies for neurodegenerative disorders. Novel therapies or research are in the pipeline.
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Affiliation(s)
- Abby Luck Parish
- Vanderbilt University School of Nursing, 461 21st Avenue South, Nashville, TN 37240, USA.
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38
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FitzGerald JM, Perera G, Chang-Tave A, Price A, Rajkumar AP, Bhattarai M, O'Brien JT, Ballard C, Aarsland D, Stewart R, Mueller C. The Incidence of Recorded Delirium Episodes Before and After Dementia Diagnosis: Differences Between Dementia With Lewy Bodies and Alzheimer's Disease. J Am Med Dir Assoc 2018; 20:604-609. [PMID: 30448339 DOI: 10.1016/j.jamda.2018.09.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 09/19/2018] [Accepted: 09/20/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To describe the incidence of delirium recording before and after a diagnosis of dementia is established in patients with dementia with Lewy bodies (DLB) and compare findings to a matched cohort of patients with Alzheimer's disease (AD). DESIGN Retrospective cohort study. SETTING AND PARTICIPANTS A cohort of patients with dementia from a large mental health and dementia care database in South London, linked to hospitalization and mortality data. We identified 194 patients with DLB and 1:4 matched these with 776 patients diagnosed with AD on age, gender, and cognitive status. MEASURES We identified delirium episodes recorded in mental health and hospital records from 1 year before to 1 year after dementia diagnosis. Using dementia diagnosis as an index date we additionally followed patients until first episode of delirium, death or a censoring point without restricting the observation period. RESULTS Patients with DLB had significantly more episodes of delirium recorded in the year before dementia diagnosis than patients with AD (incidence rate 17.6 vs 3.2 per 100 person-years; P < .001). Whereas the incidence of recording of delirium episodes reduced substantially in patients with DLB after dementia diagnosis, it remained significantly higher than in patients with AD (incidence rate 6.2 vs 2.3 per 100 person-years; P = .032). Cox regression models indicate that patients with DLB remain at a higher risk of delirium than patients with AD after a dementia diagnosis. CONCLUSIONS/RELEVANCE Establishing a diagnosis of dementia reduces episodes classified as delirium in patients with DLB and might lead to fewer potentially harmful interventions such as hospitalization or use of antipsychotic medication.
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Affiliation(s)
| | - Gayan Perera
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Alexandra Chang-Tave
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | | | - Anto P Rajkumar
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Manorama Bhattarai
- Barnet, Enfield and Haringey Mental Health Trust, London, United Kingdom
| | | | - Clive Ballard
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; University of Exeter Medical School, Exeter, United Kingdom
| | - Dag Aarsland
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; Stavanger University Hospital, Stavanger, Norway
| | - Robert Stewart
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Christoph Mueller
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; South London and Maudsley NHS Foundation Trust, London, United Kingdom.
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39
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Abstract
Dementia with Lewy bodies (DLB) is the second most common neurodegenerative dementia following Alzheimer disease. It stems from the formation of Lewy bodies, which contain aggregates of the misfolded protein, α-synuclein. These deposit in areas of the nervous system and brain, leading to neuronal cell death and causing clinically apparent symptoms. Because of its clinical overlap with other forms of dementia, DLB is often underdiagnosed and misdiagnosed. There is currently no cure for DLB and treatments are aimed at ameliorating specific symptoms.
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Affiliation(s)
- Angela M Sanford
- Division of Geriatrics, Saint Louis University School of Medicine, 1402 South Grand Boulevard, M238, St Louis, MO 63104, USA.
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40
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Vergouw LJ, Salomé M, Kerklaan AG, Kies C, Roks G, van den Berg E, de Jong FJ. The Pentagon Copying Test and the Clock Drawing Test as Prognostic Markers in Dementia with Lewy Bodies. Dement Geriatr Cogn Disord 2018; 45:308-317. [PMID: 29996144 PMCID: PMC6159833 DOI: 10.1159/000490045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 05/14/2018] [Indexed: 01/18/2023] Open
Abstract
AIMS To determine whether the pentagon copying test (PCT) and the clock drawing test (CDT) are associated with nursing home admission or survival in dementia with Lewy bodies (DLB). METHODS The PCT and/or the CDT were retrospectively collected from 103 clinically diagnosed probable DLB patients at a university medical center and general hospital. Patients with high versus low scores on these tests were compared. RESULTS Kaplan-Meier analysis showed that patients with a low score on the PCT had a shorter time to nursing home admission than patients with a high score (log-rank χ2 = 6.1, p = 0.01). Patients with a low score on the PCT or the CDT had a shorter survival than patients with a high score (log-rank χ2 = 5.4, p = 0.02, and log-rank χ2 = 11.2, p < 0.001, respectively). Cox regression analyses showed the same associations with an HR of 2.2 (95% CI 1.2-4.1) for the PCT and an HR of 2.9 (95% CI 1.6-5.4) for the CDT. CONCLUSION The PCT and the CDT may function as prognostic markers in DLB. This finding is clinically relevant as these tests can be applied easily in the clinical setting and can provide valuable prognostic information. Furthermore, it may improve disease management and patient selection for research purposes.
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Affiliation(s)
- Leonie J.M. Vergouw
- Department of Neurology and Alzheimer Center, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Mariet Salomé
- Department of Neurology and Alzheimer Center, Erasmus Medical Center, Rotterdam, the Netherlands
- Department of Neurology, Elisabeth-TweeSteden Ziekenhuis, Tilburg, the Netherlands
| | - Anke G. Kerklaan
- Department of Neurology and Alzheimer Center, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Christiaan Kies
- Department of Neurology and Alzheimer Center, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Gerwin Roks
- Department of Neurology, Elisabeth-TweeSteden Ziekenhuis, Tilburg, the Netherlands
| | - Esther van den Berg
- Department of Neurology and Alzheimer Center, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Frank Jan de Jong
- Department of Neurology and Alzheimer Center, Erasmus Medical Center, Rotterdam, the Netherlands
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Svendsboe EJ, Testad I, Terum T, Jörg A, Corbett A, Aarsland D, Rongve A. Patterns of carer distress over time in mild dementia. Int J Geriatr Psychiatry 2018; 33:987-993. [PMID: 29575109 DOI: 10.1002/gps.4882] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 01/28/2018] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To study the level of carer reported distress in mild dementia, over a 3-year period. METHODS This study is part of the Norwegian DemVest-study and utilises data from carers of people with mild dementia (n = 223). Those diagnosed with dementia with Lewy bodies (DLB, n = 63) and Alzheimer's disease (AD, n = 97) were included together with other dementia types (n = 63). The Relatives' Stress Scale was used to assess the level of reported distress in carers. Descriptive and a linear mixed effects models including diagnosis, time, and the interaction between time and diagnosis were performed. RESULTS Carer distress in mild dementia increased significantly over time (P = 0.011), particularly from baseline until 2 (P = 0.001) years follow-up. Carer distress in people caring for those with AD increased significantly, from baseline until 2 (P = 0.047) and 3 (P = 0.019) years follow-up. Distress in carers of people with DLB was high at baseline and remained relatively stable across the 3-year period. However, admission to a nursing home during the first year of follow-up was associated with a significantly lower reported carer distress in those caring for a person with DLB (P = 0.002), compared with those caring for a person with DLB living at home. CONCLUSION Being a carer to a person with mild dementia is associated with increasing distress. However, the burden of distress changes with the diagnosis, time, and situation, which highlights the dynamic nature of the caring role. Findings have important implications for health services for people diagnosed with mild dementia and their carers.
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Affiliation(s)
- Ellen J Svendsboe
- Department of Health, Western Norway University of Applied Sciences, Stord, Norway.,Centre for Age-related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway.,SE-14183, Department of Neurobiology, Care Sciences and Society, NVS, Karolinska Institute, Stockholm, Sweden
| | - Ingelin Testad
- Centre for Age-related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway.,Department of Old Age Psychiatry, Institute of Psychiatry, Psychology, and Neuroscience, King's College, London, UK.,University of Exeter Medical School, St. Luke's Campus, Exeter, UK
| | - Toril Terum
- Centre for Age-related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway.,Western Norway University of Applied Sciences, Department of Health, Førde, Norway
| | - Assmus Jörg
- Haukeland University Hospital, Centre for Clinical Research, Bergen, Norway
| | - Anne Corbett
- University of Exeter Medical School, St. Luke's Campus, Exeter, UK
| | - Dag Aarsland
- Centre for Age-related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway.,SE-14183, Department of Neurobiology, Care Sciences and Society, NVS, Karolinska Institute, Stockholm, Sweden.,Department of Old Age Psychiatry, Institute of Psychiatry, Psychology, and Neuroscience, King's College, London, UK
| | - Arvid Rongve
- Helse Fonna, Department of Research and Innovation, Haugesund, Norway.,University of Bergen, Department of Clinical Medicine, Bergen, Norway
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Breitve MH, Chwiszczuk LJ, Brønnick K, Hynninen MJ, Auestad BH, Aarsland D, Rongve A. A Longitudinal Study of Neurocognition in Dementia with Lewy Bodies Compared to Alzheimer's Disease. Front Neurol 2018; 9:124. [PMID: 29559950 PMCID: PMC5845693 DOI: 10.3389/fneur.2018.00124] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 02/20/2018] [Indexed: 11/23/2022] Open
Abstract
Introduction There are relatively few longitudinal studies on the differences in cognitive decline between Alzheimer’s disease (AD) and dementia with Lewy bodies (DLB), and the majority of existing studies have suboptimal designs. Aim We investigated the differences in cognitive decline in AD compared to DLB over 4 years and cognitive domain predictors of progression. Methods In a longitudinal study, 266 patients with first-time diagnosis of mild dementia were included and followed annually. The patients were tested annually with neuropsychological tests and screening instruments [MMSE (Mini-Mental Status Examination), Clinical Dementia Rating (CDR), the second edition of California Verbal Learning Test (CVLT-II), Trail Making Test A & B (TMT A & B), Stroop test, Controlled Oral Word Associations Test (COWAT) animal naming, Boston Naming Test, Visual Object and Space Perception Battery (VOSP) Cubes and Silhouettes]. Longitudinal analyses were performed with linear mixed effects (LME) models and Cox regression. Both specific neuropsychological tests and cognitive domains were analyzed. Results This study sample comprised 119 AD and 67 DLB patients. In TMT A, the DLB patients had a faster decline over 4 years than patients with AD (p = 0.013). No other longitudinal differences in specific neuropsychological tests were found. Higher executive domain scores at baseline were associated with a longer time to reach severe dementia (CDR = 3) or death for the total sample (p = 0.032). High or low visuospatial function at baseline was not found to be associated with cognitive decline (MMSE) or progression of dementia severity (CDR) over time. Conclusion Over 4 years, patients with DLB had a faster decline in TMT A than patients with AD, but this should be interpreted cautiously. Beyond this, there was little support for faster decline in DLB patients neuropsychologically than in AD patients.
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Affiliation(s)
- Monica H Breitve
- Department of Research and Innovation, Helse-Fonna Haugesund Hospital, Haugesund, Norway.,Department of Geriatric Psychiatry, Clinic of Psychiatry, Helse-Fonna Haugesund Hospital, Haugesund, Norway.,Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Luiza J Chwiszczuk
- Department of Research and Innovation, Helse-Fonna Haugesund Hospital, Haugesund, Norway.,Department of Geriatric Psychiatry, Clinic of Psychiatry, Helse-Fonna Haugesund Hospital, Haugesund, Norway.,Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Kolbjørn Brønnick
- TIPS - Centre for Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway.,Network for Medical Sciences, University of Stavanger, Stavanger, Norway
| | - Minna J Hynninen
- Department of Clinical Psychology, University of Bergen, Bergen, Norway.,NKS Olaviken Gerontopsychiatric Hospital, Erdal, Norway
| | - Bjørn H Auestad
- Research Department, Stavanger University Hospital, Stavanger, Norway.,Department of Mathematics and Physics, University of Stavanger, Stavanger, Norway
| | - Dag Aarsland
- Center for Age-Related Diseases (SESAM), Stavanger University Hospital, Stavanger, Norway.,Department of Old Age Psychiatry, King's College, Institute of Psychiatry and Neuroscience, London, United Kingdom
| | - Arvid Rongve
- Department of Research and Innovation, Helse-Fonna Haugesund Hospital, Haugesund, Norway.,Department of Geriatric Psychiatry, Clinic of Psychiatry, Helse-Fonna Haugesund Hospital, Haugesund, Norway.,Faculty of Medicine, University of Bergen, Bergen, Norway
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Systematic review of the efficacy of non-pharmacological interventions in people with Lewy body dementia. Int Psychogeriatr 2018; 30:395-407. [PMID: 28988547 DOI: 10.1017/s1041610217002010] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
UNLABELLED ABSTRACTBackground:Pharmacological interventions for Lewy body dementia (LBD), especially for its non-cognitive symptoms, are limited in their efficacy and tolerability. Clinicians are often uncertain about non-pharmacological interventions and their efficacy in managing cognitive and non-cognitive symptoms of LBD. Therefore, we aimed to systematically review the existing literature on non-pharmacological interventions for people with LBD. METHODS We carried out a systematic search using six databases. All human studies examining impact of any non-pharmacological intervention on LBD were assessed for cognitive, physical, psychiatric, and quality-of-life outcomes. Study quality was assessed by Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies and the CARE criteria checklist. RESULTS Prevailing evidence supporting the efficacy of non-pharmacological interventions is weak. We screened 1,647 papers. Fifteen studies (n = 61) including 11 case reports were found eligible for this systematic review. Interventions and reported outcomes were heterogeneous. Deep brain stimulation of the nucleus basalis of Meynert reportedly conferred cognitive benefit. Electroconvulsive therapy and repetitive transcranial magnetic stimulation have been reported to ameliorate depressive symptoms. Transcranial direct current stimulation was observed to improve attention. Exercise-based interventions reportedly improve various clinically important outcomes. Spaced retrieval memory training and environmental intervention for "mirror sign" have also been reported. CONCLUSIONS Several non-pharmacological interventions have been studied in LBD. Although evidence supporting their efficacy is not robust, prevailing preliminary evidence and limitations of available pharmacological interventions indicate the need to consider appropriate non-pharmacological interventions, while planning comprehensive care of LBD patients. Larger trials evaluating the efficacy of non-pharmacological interventions for LBD are needed.
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Zahirovic I, Torisson G, Wattmo C, Londos E. Psychotropic and anti-dementia treatment in elderly persons with clinical signs of dementia with Lewy bodies: a cross-sectional study in 40 nursing homes in Sweden. BMC Geriatr 2018; 18:50. [PMID: 29454305 PMCID: PMC5816356 DOI: 10.1186/s12877-018-0740-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 02/01/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Elderly persons with a dementia diagnosis often suffer from different neuropsychiatric symptoms (NPS) such as delusions, hallucinations, depression, anxiety, irritability and agitation. Currently, the medical treatment for NPS consists mostly of psychotropic medication such as hypnotics/sedatives, anxiolytics and antipsychotics. In elderly persons with dementia, usage of antipsychotics is less appropriate because of the risk of side effects such as parkinsonism, rapid cognitive decline, cerebrovascular events and finally mortality. Furthermore, elderly persons with dementia with Lewy bodies (DLB) are often hypersensitive to antipsychotics with numerous serious adverse events such as somnolence, sedation, extra-pyramidal symptoms, delirium and increased mortality. The aim of this study was to investigate the usage of psychotropics with a focus on antipsychotics and anti-dementia medication (according to the Anatomical Therapeutic Chemical Classification System) in elderly persons with clinical signs of DLB living in dementia nursing homes (NHs) in Sweden. METHODS Between 2012 and 2013, we applied a specially designed questionnaire that covered the clinical DLB features according to the consensus criteria of DLB. We also collected computerized medical lists from the Swedish National Medication Dispensing System from the same period. All dementia NHs (n = 40) in Malmö, the third largest city in Sweden, were covered. Of 650 eligible residents, 610 (94%) were included with 576 medical lists. The mean age was 86 years and 76% were women. RESULTS Treatment with antipsychotics was seen in 22% of residents, hypnotics/sedatives in 41%, antidepressants in 50% and anxiolytics in 58%. We also found an increasing usage of antipsychotics from 25% to 43% in residents with the increasing number of DLB features. Anti-dementia medications were found in 45% of the elderly with a dementia diagnosis. However, residents with two or more DLB features had less anti-dementia medication (37%) than the rest of the dementia-diagnosed NH residents (62-69%). CONCLUSIONS Residents with 2-4 DLB clinical features in Swedish NHs receive an unfavourable medical treatment with high antipsychotic usage and insufficient anti-dementia medication. These findings show the importance of identifying elderly persons with DLB features more effectively and improving the collaboration with nursing care to provide better medical prescription.
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Affiliation(s)
- Iris Zahirovic
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Malmö, Sweden. .,Memory Clinic, Skåne University Hospital, SE-205 02, Malmö, Sweden.
| | - Gustav Torisson
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Malmö, Sweden.,Memory Clinic, Skåne University Hospital, SE-205 02, Malmö, Sweden
| | - Carina Wattmo
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Malmö, Sweden.,Memory Clinic, Skåne University Hospital, SE-205 02, Malmö, Sweden
| | - Elisabet Londos
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Malmö, Sweden.,Memory Clinic, Skåne University Hospital, SE-205 02, Malmö, Sweden
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Kadlec H, Dujela C, Beattie BL, Chappell N. Cognitive functioning, cognitive reserve, and residential care placement in patients with Alzheimer's and related dementias. Aging Ment Health 2018; 22:19-25. [PMID: 27612009 DOI: 10.1080/13607863.2016.1226766] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To test the hypothesis that patients with mild to moderate dementia with higher initial cognitive reserve (higher education levels exhibit faster cognitive decline at later stages of disease progression as they approach residential care (RC) placement. METHOD Two provincial administrative databases were used. One contained individuals' scores of cognitive functioning (assessed at 6- to 12-month intervals using the Standardized Mini-Mental State Examination, SMMSE, 2007-2014) and education level; the second (BC Ministry of Health Home and Community Care database, 2001-2014) contained individuals' RC placement; N = 10531. RESULTS During 2.5-0.5 years prior to placement, SMMSE scores of patients with 0-8 years of education dropped slightly (M D 20.6 to 20.0), while patients with 9-12 years and 13+ years of education started higher (M D 21.8 and 21.4), but decreased faster and ended up lower (M D 19.5 and 18.8). Six-months prior to placement, SMMSE scores of all groups dropped almost 2 points. CONCLUSIONS Once cognitive reserve of more highly educated dementia patients is depleted and they approach RC placement, their cognitive functioning deteriorates faster. Finding effective interventions that maintain or enhance cognitive reserve may increase the time in the community for dementia patients.
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Affiliation(s)
- Helena Kadlec
- a Centre on Aging , University of Victoria , Victoria , BC , Canada
| | - Carren Dujela
- a Centre on Aging , University of Victoria , Victoria , BC , Canada
| | - B Lynn Beattie
- b Clinic for Alzheimer Disease and Related Disorders , University of British Columbia , Vancouver , BC , Canada
| | - Neena Chappell
- a Centre on Aging , University of Victoria , Victoria , BC , Canada.,c Department of Sociology , University of Victoria , Victoria , BC , Canada
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Mueller C, Perera G, Rajkumar AP, Bhattarai M, Price A, O'Brien JT, Ballard C, Stewart R, Aarsland D. Hospitalization in people with dementia with Lewy bodies: Frequency, duration, and cost implications. ALZHEIMER'S & DEMENTIA: DIAGNOSIS, ASSESSMENT & DISEASE MONITORING 2017; 10:143-152. [PMID: 29780862 PMCID: PMC5956805 DOI: 10.1016/j.dadm.2017.12.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Introduction Increased hospitalization is a major component of dementia impact on individuals and cost, but has rarely been studied in dementia with Lewy bodies (DLB). Our aim was to describe the risk and duration of hospital admissions in patients with DLB, and compare these to those in Alzheimer's disease (AD) and the general population. Methods A large database of mental health and dementia care in South London was used to assemble a cohort of patients diagnosed with DLB. These were 1:4 matched with patients diagnosed with AD on age, gender, and cognitive status. Results Rates of hospital admissions in the year after dementia diagnosis were significantly higher in 194 patients with DLB than in 776 patients with AD (crude incidence rate ratio 1.50; 95% confidence interval: 1.28-1.75) or the catchment population (indirectly standardized hospitalization rate 1.22; 95% confidence interval: 1.06-1.39). Patients with DLB had on average almost four additional hospital days per person-year than patients with AD. Multivariate Poisson regression models indicated poorer physical health early in the disease course as the main driver of this increased rate of hospitalization, whereby neuropsychiatric symptoms additionally explained the higher number of hospital days. Discussion Patients with DLB are more frequently admitted to general hospitals and utilize inpatient care to a substantially higher degree than patients with AD or the general elderly population. These data highlight an opportunity to reduce hospital days by identifying DLB earlier and providing more targeted care focused on the specific triggers for hospitalization and associations of prolonged stay.
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Affiliation(s)
- Christoph Mueller
- King's College London, London, United Kingdom.,South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | | | - Anto P Rajkumar
- King's College London, London, United Kingdom.,South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Manorama Bhattarai
- Barnet, Enfield and Haringey Mental Health Trust, London, United Kingdom
| | | | | | - Clive Ballard
- King's College London, London, United Kingdom.,University of Exeter Medical School, Exeter, United Kingdom
| | - Robert Stewart
- King's College London, London, United Kingdom.,South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Dag Aarsland
- King's College London, London, United Kingdom.,Stavanger University Hospital, Stavanger, Norway
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Kramberger MG, Auestad B, Garcia-Ptacek S, Abdelnour C, Olmo JG, Walker Z, Lemstra AW, Londos E, Blanc F, Bonanni L, McKeith I, Winblad B, de Jong FJ, Nobili F, Stefanova E, Petrova M, Falup-Pecurariu C, Rektorova I, Bostantjopoulou S, Biundo R, Weintraub D, Aarsland D. Long-Term Cognitive Decline in Dementia with Lewy Bodies in a Large Multicenter, International Cohort. J Alzheimers Dis 2017; 57:787-795. [PMID: 28304294 DOI: 10.3233/jad-161109] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND/OBJECTIVE The aim of this study was to describe the rate and clinical predictors of cognitive decline in dementia with Lewy bodies (DLB), and compare the findings with Alzheimer's disease (AD) and Parkinson's disease dementia (PDD) patients. METHODS Longitudinal scores for the Mini-Mental State Examination (MMSE) in 1,290 patients (835 DLB, 198 PDD, and 257 AD) were available from 18 centers with up to three years longitudinal data. Linear mixed effects analyses with appropriate covariates were used to model MMSE decline over time. Several subgroup analyses were performed, defined by anti-dementia medication use, baseline MMSE score, and DLB core features. RESULTS The mean annual decline in MMSE score was 2.1 points in DLB, compared to 1.6 in AD (p = 0.07 compared to DLB) and 1.8 in PDD (p = 0.19). Rates of decline were significantly higher in DLB compared to AD and PDD when baseline MMSE score was included as a covariate, and when only those DLB patients with an abnormal dopamine transporter SPECT scan were included. Decline was not predicted by sex, baseline MMSE score, or presence of specific DLB core features. CONCLUSIONS The average annual decline in MMSE score in DLB is approximately two points. Although in the overall analyses there were no differences in the rate of decline between the three neurodegenerative disorders, there were indications of a more rapid decline in DLB than in AD and PDD. Further studies are needed to understand the predictors and mechanisms of cognitive decline in DLB.
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Affiliation(s)
- Milica G Kramberger
- Department of Neurology, University Medical Centre, Ljubljana, Slovenia.,Department of Neurobiology, Care Sciences and Society, Division of Neurogeriatrics, Karolinska Institutet, Stockholm, Sweden
| | - Bjørn Auestad
- Research Department, Stavanger University Hospital and Department of Mathematics and Natural Sciences, The University of Stavanger, Stavanger, Norway
| | - Sara Garcia-Ptacek
- Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden.,Department of Geriatric Medicine, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Carla Abdelnour
- Fundació ACE Institut Català de Neurociències Aplicades, Barcelona, Spain
| | | | - Zuzana Walker
- Division of Psychiatry, University College London and North Essex Partnership University NHS Foundation Trust, UK
| | - Afina W Lemstra
- Department of Neurology and Alzheimer Centre, VU University Medical Centre, Amsterdam, The Netherlands
| | - Elisabet Londos
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Frederic Blanc
- Service of Neurology and Geriatrics, University Hospital of Strasbourg and Icube laboratory, University of Strasbourg, France
| | - Laura Bonanni
- Clinical Memory Research Unit, Department of Clinical Sciences, Department of Neuroscience and Imaging and Aging Research Centre, G. d'Annunzio University, Chieti, Italy
| | - Ian McKeith
- Department of Psychiatry, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Bengt Winblad
- Department of Neurobiology, Care Sciences and Society, Division of Neurogeriatrics, Karolinska Institutet, Stockholm, Sweden
| | | | - Flavio Nobili
- Clinical Neurology, Department of Neuroscience (DINOGMI), University of Genoa, Italy
| | - Elka Stefanova
- Institute of Neurology CCS, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Maria Petrova
- University Hospital "Alexandrovska", Department of Neurology, Sofia, Bulgaria
| | - Cristian Falup-Pecurariu
- Department of Neurology, County Emergency Clinic Hospital, Faculty of Medicine, Transilvania University, Brasov, Romania
| | - Irena Rektorova
- Brain and Mind Research Program, Central European Institute of Technology, Central European Institute of Technology Masaryk University, Masaryk University, Brno, Czech Republic
| | | | - Roberta Biundo
- Center for Parkinson's disease and Movement Disorder "Fondazione Ospedale San Camillo" - Istituto di Ricovero e Cura a Carattere Scientifico, Venice-Lido, Italy
| | - Daniel Weintraub
- Departments of Psychiatry and Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Dag Aarsland
- Department of Neurobiology, Care Sciences and Society, Division of Neurogeriatrics, Karolinska Institutet, Stockholm, Sweden.,Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.,Center for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway
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Savica R, Grossardt BR, Bower JH, Ahlskog JE, Boeve BF, Graff-Radford J, Rocca WA, Mielke MM. Survival and Causes of Death Among People With Clinically Diagnosed Synucleinopathies With Parkinsonism: A Population-Based Study. JAMA Neurol 2017; 74:839-846. [PMID: 28505261 DOI: 10.1001/jamaneurol.2017.0603] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Importance To our knowledge, a comprehensive study of the survival and causes of death of persons with synucleinopathies compared with the general population has not been conducted. Understanding the long-term outcomes of these conditions may inform patients and caregivers of the expected disease duration and may help with care planning. Objective To compare survival rates and causes of death among patients with incident, clinically diagnosed synucleinopathies and age- and sex-matched referent participants. Design, Setting, and Participants This population-based study used the Rochester Epidemiology Project medical records-linkage system to identify all residents in Olmsted County, Minnesota, who received a diagnostic code of parkinsonism from 1991 through 2010. A movement-disorders specialist reviewed the medical records of each individual to confirm the presence of parkinsonism and determine the type of synucleinopathy. For each confirmed patient, an age- and sex-matched Olmsted County resident without parkinsonism was also identified. Main Outcomes and Measures We determined the age- and sex-adjusted risk of death for each type of synucleinopathy, the median time from diagnosis to death, and the causes of death. Results Of the 461 patients with synucleinopathies, 279 (60.5%) were men, and of the 452 referent participants, 272 (60.2%) were men. From 1991 through 2010, 461 individuals received a diagnosis of a synucleinopathy (309 [67%] of Parkinson disease, 81 [17.6%] of dementia with Lewy bodies, 55 [11.9%] of Parkinson disease dementia, and 16 [3.5%] of multiple system atrophy with parkinsonism). During follow-up, 68.6% (n = 316) of the patients with synucleinopathies and 48.7% (n = 220) of the referent participants died. Patients with any synucleinopathy died a median of 2 years earlier than referent participants. Patients with multiple system atrophy with parkinsonism (hazard ratio, 10.51; 95% CI, 2.92-37.82) had the highest risk of death compared with referent participants, followed by those with dementia with Lewy bodies (hazard ratio, 3.94; 95% CI, 2.61-5.94), Parkinson disease with dementia (hazard ratio, 3.86; 95% CI, 2.36-6.30), and Parkinson disease (hazard ratio, 1.75; 95% CI, 1.39-2.21). Neurodegenerative disease was the most frequent cause of death listed on the death certificate for patients, and cardiovascular disease was the most frequent cause of death among referent participants. Conclusions and Relevance Individuals with multiple system atrophy with parkinsonism, dementia with Lewy bodies, and Parkinson disease dementia have increased mortality compared with the general population. The mortality among persons with Parkinson disease is only moderately increased compared with the general population.
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Affiliation(s)
- Rodolfo Savica
- Department of Neurology, Mayo Clinic, Rochester, Minnesota2Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Brandon R Grossardt
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - James H Bower
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | - J Eric Ahlskog
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | | | | | - Walter A Rocca
- Department of Neurology, Mayo Clinic, Rochester, Minnesota2Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Michelle M Mielke
- Department of Neurology, Mayo Clinic, Rochester, Minnesota2Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
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Terum TM, Andersen JR, Rongve A, Aarsland D, Svendsboe EJ, Testad I. The relationship of specific items on the Neuropsychiatric Inventory to caregiver burden in dementia: a systematic review. Int J Geriatr Psychiatry 2017; 32:703-717. [PMID: 28317166 DOI: 10.1002/gps.4704] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 02/08/2017] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Neuropsychiatric symptoms (NPSs) are common in dementia, and they have been identified as important care-recipient variables in terms of their impact on caregiver burden. The aim of this review was to describe how individual NPSs in dementia, assessed using the Neuropsychiatric Inventory, are associated with caregiver burden. METHODS We performed a systematic review of English language, peer-reviewed articles retrieved from MEDLINE, PSYCINFO, and EMBASE. RESULTS A total of 13 studies met the inclusion criteria. Four studies examined the association between individual NPSs and caregiver burden using the Spearman rank correlation test, while three used Pearson's correlation test. Of the remaining studies, five used multiple regression analyses and one the chi-squared test. The majority of included studies did not differentiate between dementia subtypes in the analysis or mainly included only caregivers of people with Alzheimer's disease. The Clinical Dementia Rating score and mean Mini-Mental State Examination score indicate mild to moderate dementia. The majority of caregivers were women, most of whom were children (53.8%) or spouses (36%). The data indicated that irritability, followed by agitation, sleep disturbances, anxiety, apathy, and delusion seem to impact caregiver burden the most. CONCLUSION Our principal finding is that irritability, agitation, sleep disturbances, anxiety, apathy, and delusion seem to exert the most impact on caregiver burden. Heterogeneity in the measures and statistical analyses used, however, makes it difficult to make conclusive interpretations. Future research in this field would benefit from standardization of the scientific methodology in use. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Toril Marie Terum
- Westeren Norway University of Applied Science, Førde, Norway.,Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Center of Health Research, Førde Hospital Trust, Førde, Norway
| | - John Roger Andersen
- Westeren Norway University of Applied Science, Førde, Norway.,Center of Health Research, Førde Hospital Trust, Førde, Norway
| | - Arvid Rongve
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Research and Innovation, Helse Fonna, Haugesund, Norway
| | - Dag Aarsland
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway.,Wolfson Centre for Age-Related Diseases, King's College London, London, UK
| | - Ellen J Svendsboe
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway.,Department of Nursing, Westeren Norway University of Applied Science, Stord, Norway.,Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Huddinge, Sweden
| | - Ingelin Testad
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway.,Wolfson Centre for Age-Related Diseases, King's College London, London, UK
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Graff-Radford J, Aakre J, Savica R, Boeve B, Kremers WK, Ferman TJ, Jones DT, Kantarci K, Knopman DS, Dickson DW, Kukull WA, Petersen RC. Duration and Pathologic Correlates of Lewy Body Disease. JAMA Neurol 2017; 74:310-315. [PMID: 28114455 DOI: 10.1001/jamaneurol.2016.4926] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Importance Although patients with dementia with Lewy bodies (DLB) have shorter disease duration than patients with Alzheimer disease dementia, little is known about which factors influence disease duration among patients with DLB. Objective To identify pathologic correlates of disease duration in participants with Lewy body disease (LBD). Design, Setting, and Participants This observational study, performed from September 1, 2005, to June 1, 2015, using the National Alzheimer's Coordinating Center database included 807 participants with transitional or diffuse LBD. Main Outcomes and Measures The study used Braak neurofibrillary tangle (NFT) stage, frequency of neuritic plaques, and LBD stage to determine whether pathologic variables are associated with disease duration. Results This study included 807 participants with transitional or diffuse LBD (mean [SD] age, 70.0 [9.9] at the onset of cognitive decline and 79.2 [9.8] years at death; 509 male [63.1%]). Shorter disease duration from cognitive symptom onset to death was observed in men (β, -0.73; 95% CI, -1.33 to -0.14; P = .02) and in those with a later age at onset (β, -0.11; 95% CI, -0.14 to -0.08; P < .001). Diffuse (neocortical) LBD was associated with shorter disease duration compared with transitional LBD (β, -1.52; 95% CI, -2.11 to -0.93; P < .001). Braak NFT stage and the presence of neuritic plaques were not significantly associated with differences in disease duration. Conclusions and Relevance Diffuse LBD was associated with shorter disease duration compared with transitional LBD, and this effect is independent of Braak NFT stage or extent of neuritic plaque disease. Identifying antemortem biomarkers of LBD stage may provide important prognostic information to patients with DLB.
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Affiliation(s)
| | - Jeremiah Aakre
- Department of Health Sciences Research, Mayo Clinic and Foundation, Rochester, Minnesota
| | - Rodolfo Savica
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | - Bradley Boeve
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | - Walter K Kremers
- Department of Health Sciences Research, Mayo Clinic and Foundation, Rochester, Minnesota
| | - Tanis J Ferman
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, Florida
| | - David T Jones
- Department of Neurology, Mayo Clinic, Rochester, Minnesota4Department of Radiology, Mayo Clinic, Jacksonville, Florida
| | - Kejal Kantarci
- Department of Radiology, Mayo Clinic, Jacksonville, Florida
| | | | - Dennis W Dickson
- Department of Pathology and Laboratory Medicine, Mayo Clinic, Jacksonville, Florida
| | - Walter A Kukull
- National Alzheimer's Coordinating Center, Department of Epidemiology, University of Washington, Seattle
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