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Tan KP, Ang JK, Koh EBY, Pang NTP, Mat Saher Z. Relationship of Psychological Flexibility and Mindfulness to Caregiver Burden, and Depressive and Anxiety Symptoms in Caregivers of People with Dementia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4232. [PMID: 36901243 PMCID: PMC10002240 DOI: 10.3390/ijerph20054232] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 02/15/2023] [Accepted: 02/16/2023] [Indexed: 06/18/2023]
Abstract
Caregivers of People with dementia (PwD) commonly experience burdens and other mental health issues, e.g., depression and anxiety. At present, there are limited studies that examine the relationships between caregiver psychological factors and caregiver burden, and depressive and anxiety symptoms. Therefore, this study's objectives were to examine the relationships between psychological flexibility and mindfulness in caregivers of PwD, and to determine the predictors of these three outcomes. This was a cross-sectional study conducted in the geriatric psychiatry clinic of Kuala Lumpur Hospital, Malaysia, and the sample (n = 82) was recruited via a universal sampling method over three months. The participants completed a questionnaire that consisted of the sociodemographics of the PwD and caregivers, illness characteristics of the PwD, Acceptance and Action Questionnaire-II (AAQ-II), Mindful Attention Awareness Scale (MAAS), Zarit Burden Interview Scale (ZBI), Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7). The results show that despite significant relationships between psychological flexibility and mindfulness and lower levels of caregiver burden, and depressive and anxiety symptoms (p < 0.01), only psychological inflexibility (p < 0.01) remained as a significant predictor of the three outcomes. Therefore, in conclusion, intervention programs that target the awareness of the caregiver's psychological inflexibility should be implemented to alleviate these adverse outcomes in dementia caregivers.
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Affiliation(s)
- Khai Pin Tan
- Department of Psychiatry and Mental Health, Hospital Tengku Ampuan Afzan, Kuantan 25100, Pahang, Malaysia
| | - Jin Kiat Ang
- Department of Psychiatry, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia
| | - Eugene Boon Yau Koh
- Department of Psychiatry, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia
| | - Nicholas Tze Ping Pang
- Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu 88400, Sabah, Malaysia
| | - Zanariah Mat Saher
- Department of Psychiatry and Mental Health, Kuala Lumpur General Hospital, Kuala Lumpur 50586, Federal Territory of Kuala Lumpur, Malaysia
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2
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Beneath the Top of the Iceberg: Financial Capacity Deficits in Mixed Dementia with and without Depression. Healthcare (Basel) 2023; 11:healthcare11040505. [PMID: 36833039 PMCID: PMC9956589 DOI: 10.3390/healthcare11040505] [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: 12/24/2022] [Revised: 02/01/2023] [Accepted: 02/07/2023] [Indexed: 02/11/2023] Open
Abstract
Nowadays, controversy exists regarding the influence of comorbid depression on cognition in old age. Additionally, we still know little about the influence of depression in mixed dementia (MD), that is, in cases where there is the co-existence of Alzheimer's disease and vascular dementia (VaD). Given that the assessment of financial capacity is pivotal for independent living as well as in the prevention of financial exploitation and abuse in old age, in this pilot study, we aimed to examine whether comorbid depression in MD patients can influence financial capacity performance. A total of 115 participants were recruited. They were divided into four groups: MD patients with and without depressive symptoms and healthy elderly without depression as well as older adults suffering from depression. Participants were examined with a number of neuropsychological tests, including the Mini-Mental State Examination (MMSE), Geriatric Depression Scale (GDS-15), and Legal Capacity for Property Law Transactions Assessment Scale (LCPLTAS). The results of this study suggested that financial capacity as measured with LCPLTAS in MD patients was severely impaired when depression co-existed compared to patients suffering only from depression and healthy controls. Deficits in financial capacity in MD and comorbid depression should be a point on which healthcare professionals should focus during neuropsychological assessment in order to prevent financial exploitation.
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3
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Brain imaging abnormalities in mixed Alzheimer's and subcortical vascular dementia. Neurol Sci 2022:1-14. [PMID: 35614521 DOI: 10.1017/cjn.2022.65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Mimenza-Alvarado AJ, Bombón-Albán P, Duarte-Flores JO, Gutiérrez-Gutiérrez L, Ávila-Funes JA, Aguilar-Navarro SG. Five-Word Test, Screening of Mixed Dementia in Older Adults. Validation Study. REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2021; 52:S0034-7450(21)00085-8. [PMID: 34226035 DOI: 10.1016/j.rcp.2021.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 03/31/2021] [Accepted: 04/21/2021] [Indexed: 11/20/2022]
Abstract
INTRODUCTION AND OBJECTIVES The prevalence of mixed dementia (MixD), defined as the coexistence of Alzheimer's disease (AD) and vascular dementia (VaD), is likely to increase as the population ages. The five-word test (5WT) is a neuropsychological test that differentiates between major and mild neurocognitive disorder (NCD). The objective of the study is to validate 5WT for the detection of MixD. METHODS 230 participants were evaluated: cognitively healthy (CH) (n=70), mild NCD (n=70), and major NCD (n=90): AD (n=30), VaD (n=30), and MixD (n=30). The Spearman's coefficient, d Sommer and ROC curves were used to determine the construct validity of the 5WT. The linear regression model was performed to determine the association between age and education with 5WT performance. RESULTS The mean age was 79 ±7.7 years (P≤.001), 58% were female (P=.252), and the mean education was 9 ±5.3 years (P≤.001). Construct validity when comparing 5WT and MMSE was: Spearman's correlation ρ=.830 (P<.001) and d Sommer=.41 (P<.001). The area under the curve in the total weighted score (TWS) for MixD was .985, with 98% sensitivity (95%CI, 0.96-1.00) and 99% specificity (95%CI, 0.94-1.00), PPV of 88% (95%CI, 0.82-0.89), NPV of 100% (95%CI, 0.96-1.00), and cut-off point ≤16/20 (P<.001). CONCLUSIONS 5WT is a rapid test with neuropsychological validation for the exploration of cognitive characteristics in major NCD type MixD, regardless of age and education.
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Affiliation(s)
- Alberto J Mimenza-Alvarado
- Departamento de Geriatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - Paulina Bombón-Albán
- Departamento de Geriatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - J Octavio Duarte-Flores
- Departamento de Geriatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - Lidia Gutiérrez-Gutiérrez
- Departamento de Neurología y Psiquiatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - J Alberto Ávila-Funes
- Departamento de Geriatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México; Bordeaux Population Health Research Center, University of Bordeaux, Inserm, UMR 1219, F-33000 Bordeaux, France
| | - Sara G Aguilar-Navarro
- Departamento de Geriatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México.
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5
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Tian X, Qin Y, Tian Y, Ge X, Cui J, Han H, Liu L, Yu H. Identification of vascular dementia and Alzheimer's disease hub genes expressed in the frontal lobe and temporal cortex by weighted co-expression network analysis and construction of a protein-protein interaction. Int J Neurosci 2021; 132:1049-1060. [PMID: 33401985 DOI: 10.1080/00207454.2020.1860966] [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: 01/02/2023]
Abstract
Background: It is difficult to distinguish cognitive decline due to AD from that sustained by cerebrovascular disease in view of the great overlap. It is uncertain in the molecular biological pathway behind AD and VaD.Objective: Our study aimed to explore the hub molecules and their associations with each other to identify potential biomarkers and therapeutic targets for the AD and VaD.Methods: We screened the differentially expressed genes of AD and VaD, used weighted gene co-expression network analysis and then constructed a VaD-AD-specific protein-protein interaction network with functional annotation to their related metabolic pathways. Finally, we performed a ROC curve analysis of hub proteins to get an idea about their diagnostic value.Results: In the frontal lobe and temporal cortex, hub genes were identified. With regard to VaD, there were only three hub genes which encoded the neuropeptides, SST, NMU and TAC1. The AUC of these genes were 0.804, 0.768 and 0.779, respectively. One signature was established for these three hub genes with AUC of 0.990. For the identification of AD and VaD, all hub genes were receptors. These genes included SH3GL2, PROK2, TAC3, HTR2A, MET, TF, PTH2R CNR1, CHRM4, PTPN3 and CRH. The AUC of these genes were 0.853, 0.859, 0.796, 0.775, 0.706, 0.677, 0.696, 0.668 and 0.652, respectively. The other signature was built for eleven hub genes with AUC of 0.990.Conclusion: In the frontal lobe and temporal cortex regions, hub genes are used as diagnostic markers, which may provide insight into personalized potential biomarkers and therapeutic targets for patients with VaD and AD.
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Affiliation(s)
- Xiaodou Tian
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, P.R. China
| | - Yao Qin
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, P.R. China
| | - Yuling Tian
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, P.R. China
| | - Xiaoyan Ge
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, P.R. China
| | - Jing Cui
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, P.R. China
| | - Hongjuan Han
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, P.R. China
| | - Long Liu
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, P.R. China
| | - Hongmei Yu
- Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, P.R. China.,Shanxi Provincial Key Laboratory of Major Diseases Risk Assessment, Shanxi Medical University, Taiyuan, P.R. China
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Zhang L, Biessels GJ, Hilal S, Chong JSX, Liu S, Shim HY, Xu X, Chong EJY, Wong ZX, Loke YM, Venketasubramanian N, Yeow TB, Chen CLH, Zhou JH. Cerebral microinfarcts affect brain structural network topology in cognitively impaired patients. J Cereb Blood Flow Metab 2021; 41:105-115. [PMID: 31986957 PMCID: PMC7747167 DOI: 10.1177/0271678x20902187] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Cerebral microinfarcts (CMIs), a novel cerebrovascular marker, are prevalent in Alzheimer's disease (AD) and associated with cognitive impairment. Nonetheless, the underlying mechanism of how CMIs influence cognition remains uncertain. We hypothesized that cortical-CMIs disrupted structural connectivity in the higher-order cognitive networks, leading to cognitive impairment. We analyzed diffusion-MRI data of 92 AD (26 with cortical-CMIs) and 110 cognitive impairment no dementia patients (CIND, 28 with cortical-CMIs). We compared structural network topology between groups with and without cortical-CMIs in AD/CIND, and tested whether structural connectivity mediated the association between cortical-CMIs and cognition. Cortical-CMIs correlated with impaired structural network topology (i.e. lower efficiency/degree centrality in the executive control/dorsal attention networks in CIND, and lower clustering coefficient in the default mode/dorsal attention networks in AD), which mediated the association of cortical-CMIs with visuoconstruction dysfunction. Our findings provide the first in vivo human evidence that cortical-CMIs impair cognition in elderly via disrupting structural connectivity.
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Affiliation(s)
- Liwen Zhang
- Centre for Cognitive Neuroscience, Neuroscience and Behavioural Disorders Program, Duke-National University of Singapore Medical School, Singapore.,Department of Pharmacology, National University of Singapore, Singapore.,Memory Ageing and Cognition Centre, National University Health System, Singapore
| | - Geert Jan Biessels
- Department of Neurology, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Saima Hilal
- Department of Pharmacology, National University of Singapore, Singapore.,Memory Ageing and Cognition Centre, National University Health System, Singapore
| | - Joanna Su Xian Chong
- Centre for Cognitive Neuroscience, Neuroscience and Behavioural Disorders Program, Duke-National University of Singapore Medical School, Singapore.,Centre for Sleep and Cognition, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Siwei Liu
- Centre for Cognitive Neuroscience, Neuroscience and Behavioural Disorders Program, Duke-National University of Singapore Medical School, Singapore.,Centre for Sleep and Cognition, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Hee Youn Shim
- Centre for Cognitive Neuroscience, Neuroscience and Behavioural Disorders Program, Duke-National University of Singapore Medical School, Singapore
| | - Xin Xu
- Department of Pharmacology, National University of Singapore, Singapore.,Memory Ageing and Cognition Centre, National University Health System, Singapore
| | - Eddie Jun Yi Chong
- Department of Pharmacology, National University of Singapore, Singapore.,Memory Ageing and Cognition Centre, National University Health System, Singapore
| | - Zi Xuen Wong
- Department of Pharmacology, National University of Singapore, Singapore.,Memory Ageing and Cognition Centre, National University Health System, Singapore
| | - Yng Miin Loke
- Centre for Cognitive Neuroscience, Neuroscience and Behavioural Disorders Program, Duke-National University of Singapore Medical School, Singapore
| | | | | | - Christopher Li-Hsian Chen
- Department of Pharmacology, National University of Singapore, Singapore.,Memory Ageing and Cognition Centre, National University Health System, Singapore
| | - Juan Helen Zhou
- Centre for Cognitive Neuroscience, Neuroscience and Behavioural Disorders Program, Duke-National University of Singapore Medical School, Singapore.,Centre for Sleep and Cognition, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Clinical Imaging Research Centre, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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7
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Choi S, Mukherjee S, Gibbons LE, Sanders RE, Jones RN, Tommet D, Mez J, Trittschuh EH, Saykin A, Lamar M, Rabin L, Foldi NS, Sikkes S, Jutten RJ, Grandoit E, Mac Donald C, Risacher S, Groot C, Ossenkoppele R, Crane PK. Development and validation of language and visuospatial composite scores in ADNI. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2020; 6:e12072. [PMID: 33313380 PMCID: PMC7718716 DOI: 10.1002/trc2.12072] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 07/28/2020] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Composite scores may be useful to summarize overall language or visuospatial functioning in studies of older adults. METHODS We used item response theory to derive composite measures for language (ADNI-Lan) and visuospatial functioning (ADNI-VS) from the cognitive battery administered in the Alzheimer's Disease Neuroimaging Initiative (ADNI). We evaluated the scores among groups of people with normal cognition, mild cognitive impairment (MCI), and Alzheimer's disease (AD) in terms of responsiveness to change, association with imaging findings, and ability to differentiate between MCI participants who progressed to AD dementia and those who did not progress. RESULTS ADNI-Lan and ADNI-VS were able to detect change over time and predict conversion from MCI to AD. They were associated with most of the pre-specified magnetic resonance imaging measures. ADNI-Lan had strong associations with a cerebrospinal fluid biomarker pattern. DISCUSSION ADNI-Lan and ADNI-VS may be useful composites for language and visuospatial functioning in ADNI.
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Affiliation(s)
- Seo‐Eun Choi
- Department of MedicineUniversity of WashingtonSeattleWashingtonUSA
| | | | - Laura E. Gibbons
- Department of MedicineUniversity of WashingtonSeattleWashingtonUSA
| | | | - Richard N. Jones
- Department of NeurologyBrown UniversityProvidenceRhode IslandUSA
| | - Douglas Tommet
- Department of NeurologyBrown UniversityProvidenceRhode IslandUSA
| | - Jesse Mez
- Department of NeurologyBoston UniversityBostonMassachusettsUSA
| | - Emily H. Trittschuh
- Department of PsychiatryUniversity of WashingtonSeattleWashingtonUSA
- Puget Sound Veterans AdministrationGeriatric Research Education and Clinical CenterVA Puget Sound Health Care SystemSeattleWashingtonUSA
| | - Andrew Saykin
- Department of Radiology and Alzheimer's Research CenterIndiana UniversityIndianapolisIndianaUSA
| | - Melissa Lamar
- Rush Alzheimer's Disease Center and Department of Behavioral Sciences and PsychiatryRush University Medical CenterChicagoIllinoisUSA
| | - Laura Rabin
- Department of PsychologyCity University of New York–BrooklynNew YorkUSA
| | - Nancy S. Foldi
- Department of PsychologyCity University of New York–Queens CollegeNew YorkUSA
| | - Sietske Sikkes
- Alzheimer CenterAmsterdam UMC ‐ VU University Medical CenterAmsterdamthe Netherlands
| | - Roos J. Jutten
- Alzheimer CenterAmsterdam UMC ‐ VU University Medical CenterAmsterdamthe Netherlands
| | - Evan Grandoit
- Department of PsychologyNorthwestern UniversityEvanstonIllinoisUSA
| | | | - Shannon Risacher
- Department of Radiology and Alzheimer's Research CenterIndiana UniversityIndianapolisIndianaUSA
| | - Colin Groot
- Alzheimer CenterAmsterdam UMC ‐ VU University Medical CenterAmsterdamthe Netherlands
| | - Rik Ossenkoppele
- Alzheimer CenterAmsterdam UMC ‐ VU University Medical CenterAmsterdamthe Netherlands
- Clinical Memory Research UnitLund UniversityLundSweden
| | | | - Paul K. Crane
- Department of MedicineUniversity of WashingtonSeattleWashingtonUSA
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Eckerström C, Eckerström M, Göthlin M, Molinder A, Jonsson M, Kettunen P, Svensson J, Rolstad S, Wallin A. Characteristic Biomarker and Cognitive Profile in Incipient Mixed Dementia. J Alzheimers Dis 2020; 73:597-607. [PMID: 31815692 PMCID: PMC7029359 DOI: 10.3233/jad-190651] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Background: Research has shown that mixed dementia is more common than previously believed but little is known of its early stages. Objective: To examine if incipient mixed dementia can be differentiated from incipient Alzheimer’s disease (AD) and subcortical ischemic vascular dementia (SVD) using neuropsychological tests, cerebrospinal fluid (CSF) markers, and magnetic resonance imaging markers. Methods: We included 493 patients and controls from the Gothenburg MCI study and used the dementia groups for marker selection (CSF total-tau (T-tau), phospho-tau (P-tau), and amyloid-β42 (Aβ42), 11 neuropsychological tests, and 92 regional brain volumes) and to obtain cut-off values which were then applied to the MCI groups. Results: Incipient mixed dementia was best differentiated from incipient AD by the Word fluency F-A-S test and the Trail making test A. CSF T-tau, P-tau, and Aβ42 differentiated incipient mixed dementia from incipient SVD. Conclusion: Incipient mixed dementia is characterized by an AD-like biomarker profile and an SVD-like cognitive profile. Incipient mixed dementia can be separated from incipient AD and incipient SVD using CSF markers and cognitive testing.
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Affiliation(s)
- Carl Eckerström
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Immunology and Transfusion Medicine, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Marie Eckerström
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mattias Göthlin
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anna Molinder
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Michael Jonsson
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Petronella Kettunen
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Johan Svensson
- Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Sindre Rolstad
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anders Wallin
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Mixed dementia: Neglected clinical entity or nosographic artifice? J Neurol Sci 2019; 410:116662. [PMID: 31911281 DOI: 10.1016/j.jns.2019.116662] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 12/02/2019] [Accepted: 12/27/2019] [Indexed: 11/20/2022]
Abstract
Clinical and pathological data show that Alzheimer's disease (AD) and vascular dementia (VaD) are the most prevalent types of dementia in the elderly. Medically speaking, mixed dementia (MxD) is a heterogenous disorder mostly referred to the coexistence of AD and VaD. The weight of vascular contribution to AD phenotype is nowadays matter of debate. Despite great efforts in the field of neurodegeneration and cerebrovascular disease, controversy over the exact nature of their relation still remains, hampering progress in the specialty and raising doubts about the MxD concept validity. Is MxD a neglected clinical entity or a nosographic artifice? Starting from the assumption that recent advances in dementia classification and diagnostic criteria make this a propitious time to set up preventive and therapeutic strategies, this narrative review and opinion paper summarizes the literature concerning the questioned etiopathogenic overlap between AD and VaD and challenges the traditional view of MxD as the mere co-occurrence of different pure forms of dementia.
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10
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Yoon G, Song J. Intermittent Fasting: a Promising Approach for Preventing Vascular Dementia. J Lipid Atheroscler 2019; 8:1-7. [PMID: 32821694 PMCID: PMC7379085 DOI: 10.12997/jla.2019.8.1.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 01/30/2019] [Accepted: 03/22/2019] [Indexed: 01/04/2023] Open
Abstract
Vascular dementia is the most common neuropsychiatric syndrome and is characterized by synaptic dysfunction, neuroinflammation, and cognitive dysfunction. Vascular dementia is associated with various environmental, genetic, and lifestyle risk factors. Recent research has focused on the association between vascular dementia and dietary patterns, suggesting that dietary regulation leads to better control of energy metabolism, improvements in brain insulin resistance, and the suppression of neuroinflammation. Intermittent fasting is a calorie-restriction method known to be more effective in promoting fat loss and regulating the impairment of glucose metabolism as compared with other dietary restriction regimens. Herein, the authors review the effects of intermittent fasting with regard to vascular dementia based on recent evidence and propose that intermittent fasting could be a therapeutic approach for ameliorating vascular dementia pathology and preventing its onset.
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Affiliation(s)
- Gwangho Yoon
- Department of Anatomy, Chonnam National University Medical School, Gwangju, Korea.,Department of Biochemistry, Chonnam National University, Gwangju, Korea
| | - Juhyun Song
- Department of Anatomy, Chonnam National University Medical School, Gwangju, Korea
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11
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Dong Y, Ling MTY, Ng KET, Wang A, Wan EYS, Merchant RA, Venketasubramanian N, Chen CLH, Mahendran R, Collinson SL. The Clinical Utility of the TYM and RBANS in a One-Stop Memory Clinic in Singapore: A Pilot Study. J Geriatr Psychiatry Neurol 2019; 32:68-73. [PMID: 30630388 DOI: 10.1177/0891988718824034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND We aimed to examine the discriminant validity of a brief self-administered cognitive screening test, the Test Your Memory (TYM) and a brief neuropsychological test, the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), supplemented with executive and language tests (Color Trail Test [CTT] and modified Boston Naming Test [mBNT], respectively), in detecting cognitive impairment (CI) in a one-stop memory clinic in Singapore. METHODS Ninety patients ≥50 years old with a diagnosis of no cognitive impairment, mild cognitive impairment, and mild Alzheimer disease were recruited from memory clinic. They received the TYM, Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), RBANS, CTT, mBNT, and a gold-standard formal neuropsychological test battery. RESULTS The TYM had a significantly larger area under the curve (AUC) than MMSE (0.96 vs 0.88, P = .03) and was equivalent to MoCA in detecting CI (0.96 vs 0.95, P = .80). At the optimal cutoff points, the TYM (<38) was significantly more sensitive than the MMSE (<24) and MoCA (<20; P < .001). The RBANS had an AUC equivalent to the RBANS supplemented with CTT and mBNT (0.92 vs 0.86, P = .22) in detecting CI. The RBANS supplemented with CTT and mBNT was more sensitive than RBANS alone in detecting CI (sensitivity: 0.98 vs 0.93, P = .016) among patients screened negative using TYM. CONCLUSION The self-administered TYM is superior to MMSE and equivalent to MoCA in detecting CI and could be implemented routinely. The RBANS supplemented with CTT and mBNT is more sensitive in detecting CI than RBANS alone therefore could be used for diagnostic purposes.
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Affiliation(s)
- YanHong Dong
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Memory Clinic Programme, Department of Psychological Medicine, National University Hospital, Singapore, Singapore.,Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, UNSW Medicine, The University of New South Wales, Sydney, Australia
| | - Melissa Tan Yi Ling
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Kelly Ee Teng Ng
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Aijing Wang
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Esther Yee Shuang Wan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Reshma A Merchant
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Medicine, Division of Geriatrics Medicine, National University Hospital, Singapore, Singapore
| | | | - Christopher Li-Hsian Chen
- Memory Clinic Programme, Department of Psychological Medicine, National University Hospital, Singapore, Singapore.,Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Rathi Mahendran
- Memory Clinic Programme, Department of Psychological Medicine, National University Hospital, Singapore, Singapore
| | - Simon Lowes Collinson
- Department of Psychology, Faculty of Arts and Social Sciences, National University of Singapore, Singapore, Singapore
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Lee T, Thalamuthu A, Henry JD, Trollor JN, Ames D, Wright MJ, Sachdev PS. Genetic and Environmental Influences on Language Ability in Older Adults: Findings from the Older Australian Twins Study. Behav Genet 2018; 48:187-197. [PMID: 29619677 DOI: 10.1007/s10519-018-9897-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 03/29/2018] [Indexed: 01/24/2023]
Abstract
We used a sub-sample from the Older Australian Twins Study to estimate the heritability of performance on three tests of language ability: Boston Naming Test (BNT), Letter/Phonemic Fluency (FAS) and Category/Semantic Fluency (CFT) Tests. After adjusting for age, sex, education, mood, and global cognition (GC), heritability estimates obtained for the three tests were 0.35, 0.59, and 0.20, respectively. Multivariate analyses showed that the genetic correlation were high for BNT and CFT (0.61), but low for BNT and FAS (0.17), and for FAS and CFT (0.28). Genetic modelling with Cholesky decomposition indicated that the covariation between the three measures could be explained by a common genetic factor. Environmental correlations between the language ability measures were low, and there were considerable specific environmental influences for each measure. Future longitudinal studies with language performance and neuroimaging data can further our understanding of genetic and environmental factors involved in the process of cognitive aging.
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Affiliation(s)
- T Lee
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, NSW, Australia. .,Neuropsychiatric Institute, Prince of Wales Hospital, Randwick, NSW, Australia. .,Centre for Healthy Brain Ageing (CHeBA), NPI Euroa Centre, Prince of Wales Hospital, UNSW Sydney, Barker St., Randwick, NSW, 2031, Australia.
| | - A Thalamuthu
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - J D Henry
- School of Psychology, University of Queensland, St Lucia, QLD, Australia
| | - J N Trollor
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, NSW, Australia.,Department of Developmental Disability Neuropsychiatry, University of New South Wales, Sydney, NSW, Australia
| | - D Ames
- St George's Hospital, University of Melbourne Academic Unit for Psychiatry of Old Age, Victoria, Australia
| | - M J Wright
- School of Psychology, University of Queensland, St Lucia, QLD, Australia.,Queensland Brain Institute, University of Queensland, St Lucia, QLD, Australia
| | - P S Sachdev
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, NSW, Australia.,Neuropsychiatric Institute, Prince of Wales Hospital, Randwick, NSW, Australia
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13
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Custodio N, Montesinos R, Lira D, Herrera-Pérez E, Bardales Y, Valeriano-Lorenzo L. Mixed dementia: A review of the evidence. Dement Neuropsychol 2017; 11:364-370. [PMID: 29354216 PMCID: PMC5769994 DOI: 10.1590/1980-57642016dn11-040005] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Mixed dementia is the coexistence of Alzheimer's disease and cerebrovascular disease (CVD) in the same demented patient. Currently, its diagnosis and treatment remains a challenge for practitioners. To provide an overview of the epidemiology, pathogenesis, natural history, diagnosis, and therapy of Mixed Vascular-Alzheimer Dementia (MVAD). The literature was reviewed for articles published between 1990-2016 by using the keywords linked to MVAD. Neuropathological studies indicate that MVAD is a very common pathological finding in the elderly with a prevalence about of 22%. The distinction between Alzheimer's dementia and vascular dementia (VD) is complex because their clinical presentation can overlap. There are international criteria for the MVAD diagnosis. The pharmacologic therapy shows modest clinical benefits that are similar among all drugs used in patients with Alzheimer's dementia and VD. The non-pharmacologic therapy includes the rigorous management of cardiovascular risk factors (especially hypertension) and the promotion of a healthy diet. The diagnosis and treatment of MVAD cannot be improved without further studies. Currently available medications provide only modest clinical benefits once a patient has developed MVAD. In subjects at risk, the antihypertensive therapy and healthy diet should be recommend for preventing or slowing the progression of MVAD.
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Affiliation(s)
- Nilton Custodio
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia. Instituto Peruano de Neurociencias. Lima, Perú.,Servicio de Neurología. Instituto Peruano de Neurociencias. Lima, Perú
| | - Rosa Montesinos
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia. Instituto Peruano de Neurociencias. Lima, Perú.,Servicio de Medicina de Rehabilitación. Instituto Peruano de Neurociencias. Lima, Perú
| | - David Lira
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia. Instituto Peruano de Neurociencias. Lima, Perú.,Servicio de Neurología. Instituto Peruano de Neurociencias. Lima, Perú
| | - Eder Herrera-Pérez
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia. Instituto Peruano de Neurociencias. Lima, Perú.,Unidad de Diseño y Elaboración de Proyectos de Investigación. Instituto Nacional de Salud del Niño. Lima, Perú.,GESID. Lima, Peru
| | - Yadira Bardales
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia. Instituto Peruano de Neurociencias. Lima, Perú.,Unidad de Geriatría. Instituto Peruano de neurociencias. Lima, Perú
| | - Lucía Valeriano-Lorenzo
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia. Instituto Peruano de Neurociencias. Lima, Perú.,Unidad de Neuropsicología. Instituto Peruano de Neurociencias. Lima. Perú
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14
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Kimchi EY, Hshieh TT, Guo R, Wong B, O'Connor M, Marcantonio ER, Metzger ED, Strauss J, Arnold SE, Inouye SK, Fong TG. Consensus Approaches to Identify Incident Dementia in Cohort Studies: Systematic Review and Approach in the Successful Aging after Elective Surgery Study. J Am Med Dir Assoc 2017; 18:1010-1018.e1. [PMID: 28927945 PMCID: PMC5701828 DOI: 10.1016/j.jamda.2017.07.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 07/19/2017] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To survey the current methods used to ascertain dementia and mild cognitive impairment (MCI) in longitudinal cohort studies, to categorize differences in approaches and to identify key components of expert panel methodology in current use. METHODS We searched PubMed for the past 10 years, from March 6, 2007 to March 6, 2017 using a combination of controlled vocabulary and keyword terms to identify expert panel consensus methods used to diagnose MCI or dementia in large cohort studies written in English. From these results, we identified a framework for reporting standards and describe as an exemplar the clinical consensus procedure used in an ongoing study of elective surgery patients (the Successful Aging after Elective Surgery study). RESULTS Thirty-one articles representing unique cohorts were included. Among published methods, membership of experts panel varied significantly. There was more similarity in what types of information was use to ascertain disease status. However, information describing the diagnostic decision process and resolution of disagreements was often lacking. CONCLUSIONS Methods used for expert panel diagnosis of MCI and dementia in large cohort studies are widely variable, and there is a need for more standardized reporting of these approaches. By describing the procedure in which our expert panel achieved consensus diagnoses, we hope to encourage the development and publication of well-founded and reproducible methods for diagnosis of MCI and dementia in longitudinal studies.
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Affiliation(s)
- Eyal Y Kimchi
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Tammy T Hshieh
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Ray Guo
- Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, MA
| | - Bonnie Wong
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Margaret O'Connor
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Edward R Marcantonio
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Eran D Metzger
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Jason Strauss
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA; Harvard Medical School, Boston, MA
| | - Steven E Arnold
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Sharon K Inouye
- Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, MA; Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Tamara G Fong
- Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, MA; Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
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15
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Marie Dit Asse L, Fabrigoule C, Helmer C, Laumon B, Berr C, Rouaud O, Auriacombe S, Lafont S. Gender effect on driving cessation in pre-dementia and dementia phases: results of the 3C population-based study. Int J Geriatr Psychiatry 2017; 32:1049-1058. [PMID: 27550076 DOI: 10.1002/gps.4565] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 06/24/2016] [Accepted: 07/14/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Aging entails deterioration in sensory, physical, and cognitive functions, raising doubt in the driving capacity of older drivers, especially when the deficits are severe, as in dementia. Many older drivers, especially women, adapt their driving habits in order to compensate for these deficits and eventually stop driving. The present prospective study assessed driving cessation in men and women throughout the dementia process, including a 2-year pre-dementia phase. METHODS The study was based on a three-city cohort of subjects who were aged 65 years and older in 2000 and followed for more than 10 years. Active dementia detection was conducted at each follow-up. The probability of driving cessation was assessed in men and women during the 2-year pre-dementia phase and until 5 years after diagnosis. RESULTS In the 2-year pre-dementia phase, both men and women ceased driving earlier than drivers with no central nervous system pathology (p < 0,001), and women ceased driving earlier than men. A total of 45% of men and 74% of women had already ceased driving at dementia diagnosis. In contrast, the probability of cessation within 3 years after diagnosis was similar between men and women. CONCLUSION The study showed that, in this French urban population, few demented drivers, especially women, were still driving after diagnosis. Those who continued to drive 3 years after the diagnosis all had Alzheimer-type dementia. There is certainly a need for physicians to help these drivers to adapt their driving activity to their deficits and to prepare them to stop driving. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
| | | | - Catherine Helmer
- Centre INSERM U897-Epidemiologie-Biostatistique, ISPED, Bordeaux, France
| | - Bernard Laumon
- Univ Lyon, Université Claude Bernard Lyon1, Ifsttar, UMRESTTE, Bron, France
| | - Claudine Berr
- INSERM U1061 - Hôpital La Colombière, Montpellier Cedex 5, France
| | - Olivier Rouaud
- Centre Mémoire de Ressources et de Recherche, Bocage Central, Dijon, France
| | - Sophie Auriacombe
- Centre Mémoire de Ressources et de Recherche, Bordeaux Cedex, France
| | - Sylviane Lafont
- Univ Lyon, Université Claude Bernard Lyon1, Ifsttar, UMRESTTE, Bron, France
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16
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Edwards JD, Ramirez J, Callahan BL, Tobe SW, Oh P, Berezuk C, Lanctôt K, Swardfager W, Nestor S, Kiss A, Strother S, Black SE. Antihypertensive Treatment is associated with MRI-Derived Markers of Neurodegeneration and Impaired Cognition: A Propensity-Weighted Cohort Study. J Alzheimers Dis 2017; 59:1113-1122. [DOI: 10.3233/jad-170238] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Jodi D. Edwards
- LC Campbell Cognitive Neurology Research Unit, Sunnybrook Health Sciences Centre, Toronto, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute>, University of Toronto, Toronto, Canada
- Heart & Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Site, Toronto, Canada
| | - Joel Ramirez
- LC Campbell Cognitive Neurology Research Unit, Sunnybrook Health Sciences Centre, Toronto, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute>, University of Toronto, Toronto, Canada
- Heart & Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Site, Toronto, Canada
| | - Brandy L. Callahan
- LC Campbell Cognitive Neurology Research Unit, Sunnybrook Health Sciences Centre, Toronto, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute>, University of Toronto, Toronto, Canada
| | | | - Paul Oh
- Toronto Rehabilitation Institute, Toronto, Canada
| | - Courtney Berezuk
- LC Campbell Cognitive Neurology Research Unit, Sunnybrook Health Sciences Centre, Toronto, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute>, University of Toronto, Toronto, Canada
- Heart & Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Site, Toronto, Canada
| | - Krista Lanctôt
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute>, University of Toronto, Toronto, Canada
- Geriatric Psychiatry, University of Toronto, Toronto, Canada
- Pharmacology and Toxicology, University of Toronto, Toronto, Canada
| | - Walter Swardfager
- LC Campbell Cognitive Neurology Research Unit, Sunnybrook Health Sciences Centre, Toronto, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute>, University of Toronto, Toronto, Canada
- Heart & Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Site, Toronto, Canada
- Pharmacology and Toxicology, University of Toronto, Toronto, Canada
| | - Sean Nestor
- LC Campbell Cognitive Neurology Research Unit, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Alexander Kiss
- Institute for Clinical Evaluative Sciences, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Stephen Strother
- Medical Biophysics, University of Toronto, Toronto, Canada
- Rotman Research Institute, Toronto, Canada
| | - Sandra E. Black
- LC Campbell Cognitive Neurology Research Unit, Sunnybrook Health Sciences Centre, Toronto, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute>, University of Toronto, Toronto, Canada
- Heart & Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Site, Toronto, Canada
- Department of Medicine (Neurology), Sunnybrook Health Sciences and University of Toronto, Toronto, Canada
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17
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Park JJ, Choi SH, Kim S, Lee AY, Moon SY, Lee JH, Kwon JC, Park KW, Ku BD, Han HJ, Kim EJ, Shim YS. Effect of galantamine on attention in patients with Alzheimer's disease combined with cerebrovascular disease. Geriatr Gerontol Int 2016; 17:1661-1666. [PMID: 27935239 DOI: 10.1111/ggi.12934] [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: 04/26/2016] [Revised: 06/14/2016] [Accepted: 09/22/2016] [Indexed: 12/01/2022]
Abstract
AIM Patients with Alzheimer's disease (AD) and cerebrovascular disease (CVD) show greater attentional deficits compared with AD patients without CVD. The aim of the present study was to investigate the effect of galantamine on attention in AD patients with CVD. METHODS In this open trial, 1512 patients with AD and CVD were recruited from 71 nationwide hospitals. The patients were given galantamine for 16 weeks. The primary outcome measure was the score on the Attention Questionnaire Scale (AQS), which measures the patients' attention in their daily lives. The secondary outcome measures were the scores on the Korean Mini-Mental State Examination, the Clinical Dementia Rating scale and the Global Deterioration Scale. Efficacy measures were calculated both at baseline and at the end of the treatment (week 16). RESULTS The responders rate on the AQS (change of the AQS from baseline >0) was 60.6% in AD patients with CVD. At the end of the treatment, both the AQS (15.0 ± 5.7 vs 16.3 ± 5.8, P < 0.001) and the Korean Mini-Mental State Examination scores (17.8 ± 4.8 vs 18.1 ± 5.1, P < 0.001) showed a significant improvement relative to the baseline performance. The Clinical Dementia Rating (1.25 ± 0.59 vs 1.22 ± 0.63 P = 0.025) and Global Deterioration Scale (3.82 ± 0.94 vs 3.76 ± 0.96, P = 0.002) scores also showed a significant decrease at the end of the treatment. CONCLUSIONS Galantamine is effective in improving attention in the daily lives of AD patients with CVD. Geriatr Gerontol Int 2017; 17: 1661-1668.
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Affiliation(s)
- Jeong Jin Park
- Department of Neurology, Konkuk University Hospital, Konkuk University School of Medicine, Seoul, Korea
| | - Seong Hye Choi
- Department of Neurology, Inha University School of Medicine, Incheon, Korea
| | - SangYun Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul, Korea
| | - Ae Young Lee
- Department of Neurology, Chungnam National University School of Medicine, Daejeon, Korea
| | - So Young Moon
- Department of Neurology, Ajou University School of Medicine, Suwon, Korea
| | - Jun Hong Lee
- Department of Neurology, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea
| | - Jae Cheol Kwon
- Department of Neurology, Changwon Fatima Hospital, Changwon, Korea
| | - Kyung Won Park
- Department of Neurology, Dong-A Medical Center, Dong-A University College of Medicine, Busan, Korea
| | - Bon D Ku
- Department of Neurology, International St. Mary's Hospital, College of Medicine, Catholic Kwandong University, Incheon, Korea
| | - Hyun Jeong Han
- Department of Neurology, Myongji Hospital, Seonam University College of Medicine, Goyang, Korea
| | - Eun-Joo Kim
- Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute, Busan, Korea
| | - Yong S Shim
- Department of Neurology, The Catholic University of Korea, Bucheon St. Mary's Hospital, Bucheon, Korea
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18
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Biesbroek JM, Weaver NA, Hilal S, Kuijf HJ, Ikram MK, Xu X, Tan BY, Venketasubramanian N, Postma A, Biessels GJ, Chen CPLH. Impact of Strategically Located White Matter Hyperintensities on Cognition in Memory Clinic Patients with Small Vessel Disease. PLoS One 2016; 11:e0166261. [PMID: 27824925 PMCID: PMC5100905 DOI: 10.1371/journal.pone.0166261] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 10/25/2016] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND AND PURPOSE Studies on the impact of small vessel disease (SVD) on cognition generally focus on white matter hyperintensity (WMH) volume. The extent to which WMH location relates to cognitive performance has received less attention, but is likely to be functionally important. We examined the relation between WMH location and cognition in a memory clinic cohort of patients with sporadic SVD. METHODS A total of 167 patients with SVD were recruited from memory clinics. Assumption-free region of interest-based analyses based on major white matter tracts and voxel-wise analyses were used to determine the association between WMH location and executive functioning, visuomotor speed and memory. RESULTS Region of interest-based analyses showed that WMHs located particularly within the anterior thalamic radiation and forceps minor were inversely associated with both executive functioning and visuomotor speed, independent of total WMH volume. Memory was significantly associated with WMH volume in the forceps minor, independent of total WMH volume. An independent assumption-free voxel-wise analysis identified strategic voxels in these same tracts. Region of interest-based analyses showed that WMH volume within the anterior thalamic radiation explained 6.8% of variance in executive functioning, compared to 3.9% for total WMH volume; WMH volume within the forceps minor explained 4.6% of variance in visuomotor speed and 4.2% of variance in memory, compared to 1.8% and 1.3% respectively for total WMH volume. CONCLUSIONS Our findings identify the anterior thalamic radiation and forceps minor as strategic white matter tracts in which WMHs are most strongly associated with cognitive impairment in memory clinic patients with SVD. WMH volumes in individual tracts explained more variance in cognition than total WMH burden, emphasizing the importance of lesion location when addressing the functional consequences of WMHs.
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Affiliation(s)
- J. Matthijs Biesbroek
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Nick A. Weaver
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Saima Hilal
- Memory Aging & Cognition Centre, National University Health System, Singapore, Singapore
- Department of Pharmacology, National University of Singapore, Singapore, Singapore
| | - Hugo J. Kuijf
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Mohammad Kamran Ikram
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
- Memory Aging & Cognition Centre, National University Health System, Singapore, Singapore
- Academic Medicine Research Institute, Duke-NUS Graduate Medical School, National University of Singapore, Singapore, Singapore
| | - Xin Xu
- Memory Aging & Cognition Centre, National University Health System, Singapore, Singapore
- Department of Pharmacology, National University of Singapore, Singapore, Singapore
| | | | | | - Albert Postma
- Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, the Netherlands
| | - Geert Jan Biessels
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
- * E-mail:
| | - Christopher P. L. H. Chen
- Memory Aging & Cognition Centre, National University Health System, Singapore, Singapore
- Department of Pharmacology, National University of Singapore, Singapore, Singapore
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19
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Chen C, Homma A, Mok VCT, Krishnamoorthy E, Alladi S, Meguro K, Abe K, Dominguez J, Marasigan S, Kandiah N, Kim SY, Lee DY, De Silva HA, Yang YH, Pai MC, Senanarong V, Dash A. Alzheimer's disease with cerebrovascular disease: current status in the Asia-Pacific region. J Intern Med 2016; 280:359-74. [PMID: 26992016 DOI: 10.1111/joim.12495] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND There is growing awareness of the coexistence of Alzheimer's disease and cerebrovascular disease (AD+CVD), however, due to lack of well-defined criteria and treatment guidelines AD+CVD may be underdiagnosed in Asia. METHODS Sixteen dementia specialists from nine Asia Pacific countries completed a survey in September 2014 and met in November 2014 to review the epidemiology, diagnosis and treatment of AD+CVD in Asia. A consensus was reached by discussion, with evidence provided by published studies when available. RESULTS AD accounts for up to 60% and AD+CVD accounts for 10-20% of all dementia cases in Asia. The reasons for underdiagnosis of AD+CVD include lack of awareness as a result of a lack of diagnostic criteria, misdiagnosis as vascular dementia or AD, lack of diagnostic facilities, resource constraints and cost of investigations. There is variability in the tools used to diagnose AD+CVD in clinical practice. Diagnosis of AD+CVD should be performed in a stepwise manner of clinical evaluation followed by neuroimaging. Dementia patients should be assessed for cognition, behavioural and psychological symptoms, functional staging and instrumental activities of daily living. Neuroimaging should be performed using computed tomography or magnetic resonance imaging. The treatment goals are to stabilize or slow progression as well as to reduce behavioural and psychological symptoms, improve quality of life and reduce disease burden. First-line therapy is usually an acetylcholinesterase inhibitor such as donepezil. CONCLUSION AD+CVD is likely to be under-recognised in Asia. Further research is needed to establish the true prevalence of this treatable and potentially preventable disease.
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Affiliation(s)
- C Chen
- Department of Pharmacology, National University of Singapore, Singapore, Singapore. .,Memory Aging and Cognition Center, National University Health System, Singapore, Singapore.
| | - A Homma
- Research Institute for Dementia Care, Tokyo, Japan
| | - V C T Mok
- Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | | | - S Alladi
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - K Meguro
- Division of Geriatric Behavioral Neurology, CYRIC, Tohoku University, Sendai, Japan
| | - K Abe
- Department of Neurology, Okayama University, Okayama, Japan
| | - J Dominguez
- Memory Center, St Luke's Medical Center, Quezon City, Philippines
| | - S Marasigan
- Department of Neurology and Psychiatry, University of Santo Tomas Hospital, Manila, Philippines
| | - N Kandiah
- Department of Neurology, National Neuroscience Institute and Duke-NUS Singapore, Singapore, Singapore
| | - S Y Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul, Korea.,Neurocognitive Behavior Center, Seoul National University Bundang Hospital, Seoul, Korea
| | - D Y Lee
- Department of Psychiatry, Seoul National University, College of Medicine, Seoul, Korea
| | - H A De Silva
- Clinical Trials Unit, Department of Pharmacology, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka.
| | - Y-H Yang
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan.,Master's Program in Neurology, Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - M-C Pai
- Division of Behavioral Neurology, Department of Neurology, Alzheimer's Disease Research Center, Medical College and Hospital, National Cheng Kung University, Tainan City, Taiwan
| | - V Senanarong
- Division of Neurology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - A Dash
- Eisai Co. Ltd, Mumbai, India
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20
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Brookes RL, Hollocks MJ, Tan RYY, Morris RG, Markus HS. Brief Screening of Vascular Cognitive Impairment in Patients With Cerebral Autosomal-Dominant Arteriopathy With Subcortical Infarcts and Leukoencephalopathy Without Dementia. Stroke 2016; 47:2482-7. [PMID: 27625375 PMCID: PMC5049939 DOI: 10.1161/strokeaha.116.013761] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 08/04/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a monogenic form of cerebral small vessel disease leading to early-onset stroke and dementia, with younger patients frequently showing subclinical deficits in cognition. At present, there are no targeted cognitive screening measures for this population. However, the Brief Memory and Executive Test (BMET) and the Montreal Cognitive Assessment (MoCA) have shown utility in detecting cognitive impairment in sporadic small vessel disease. This study assesses the BMET and the MoCA as clinical tools for detecting mild cognitive deficits in CADASIL. METHODS Sixty-six prospectively recruited patients with CADASIL, and 66 matched controls completed the BMET, with a subset of these also completing the MoCA. Receiver operating characteristic curves were calculated to examine the sensitivity and specificity of clinical cutoffs for the detection of vascular cognitive impairment and reduced activities of daily living. RESULTS Patients with CADASIL showed more cognitive impairment overall and were poorer on both executive/processing and memory indices of the BMET relative to controls. The BMET showed good accuracy in predicting vascular cognitive impairment (85% sensitivity and 84% specificity) and impaired instrumental activities of daily living (92% sensitivity and 77% specificity). The MoCA also showed good predictive validity for vascular cognitive impairment (80% sensitivity and 78% specificity) and instrumental activities of daily living (75% sensitivity and 76% specificity). The most important background predictor of vascular cognitive impairment was a history of stroke. CONCLUSIONS The results indicate that the BMET and the MoCA are clinically useful and sensitive screening measures for early cognitive impairment in patients with CADASIL.
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Affiliation(s)
- Rebecca L Brookes
- From the Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Biomedical Campus, United Kingdom (R.L.B., M.J.H., R.Y.Y.T., H.S.M.); and Department of Psychology, Psychology and Neurosciences, Institute of Psychiatry, King's College London, London, United Kingdom (R.G.M.).
| | - Matthew J Hollocks
- From the Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Biomedical Campus, United Kingdom (R.L.B., M.J.H., R.Y.Y.T., H.S.M.); and Department of Psychology, Psychology and Neurosciences, Institute of Psychiatry, King's College London, London, United Kingdom (R.G.M.)
| | - Rhea Y Y Tan
- From the Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Biomedical Campus, United Kingdom (R.L.B., M.J.H., R.Y.Y.T., H.S.M.); and Department of Psychology, Psychology and Neurosciences, Institute of Psychiatry, King's College London, London, United Kingdom (R.G.M.)
| | - Robin G Morris
- From the Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Biomedical Campus, United Kingdom (R.L.B., M.J.H., R.Y.Y.T., H.S.M.); and Department of Psychology, Psychology and Neurosciences, Institute of Psychiatry, King's College London, London, United Kingdom (R.G.M.)
| | - Hugh S Markus
- From the Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Biomedical Campus, United Kingdom (R.L.B., M.J.H., R.Y.Y.T., H.S.M.); and Department of Psychology, Psychology and Neurosciences, Institute of Psychiatry, King's College London, London, United Kingdom (R.G.M.)
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Kang HS, Kwon JH, Kim S, Na DL, Kim SY, Lee JH, Han SH, Choi SH, Kim S, Carroll BJ, Kim DK. Comparison of neuropsychological profiles in patients with Alzheimer's disease and mixed dementia. J Neurol Sci 2016; 369:134-138. [PMID: 27653879 DOI: 10.1016/j.jns.2016.08.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 07/15/2016] [Accepted: 08/09/2016] [Indexed: 11/29/2022]
Abstract
OBJECTS We designed this study to extensively compare the neuropsychological profiles of Alzheimer's disease (AD) and mixed dementia (MD) in a large multicenter cohort of patients. Specifically, we performed subgroup analyses to examine group differences associated with dementia severity. METHODS A total of 1021 AD patients and 577 MD patients were included from the Clinical Research Center for Dementia of South Korea (CREDOS) Study. All patients underwent comprehensive neuropsychological and functional ratings, as well as complete physical and neurological examinations. To avoid floor confounds, only patients with Clinical Dementia Rating (CDR) scores of 0.5-2.0 were included. RESULTS Overall, MD patients showed worse performance in frontal/executive function than those with AD. Stratification by dementia severity revealed a significant difference in global cognitive function scores between AD and MD patients only in the low severity groups (CDR 0.5). Also, MD patients showed worse performance in frontal/executive function domains in the CDR 0.5 groups whereas they had better performance in the memory domain in the CDR 1 groups than did AD patients. Additionally, AD patients showed better performance than MD patients with respect to activities of daily living at CDR levels 0.5 and 1. All differences had disappeared at the CDR 2 level of global dementia severity. CONCLUSION This study suggests that there are significant differences in neuropsychological profiles between AD and MD patients, with the pattern of this difference varying distinctively according to dementia severity.
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Affiliation(s)
- Hyo Shin Kang
- Center for Clinical Research, Samsung Biomedical Research Institute, Seoul, Republic of Korea; Department of Clinical and Counseling Psychology, Korea University, Seoul, Republic of Korea
| | - Jung Hye Kwon
- Department of Clinical and Counseling Psychology, Korea University, Seoul, Republic of Korea
| | - Sangha Kim
- Department of Psychiatry, The Catholic University of Korea College of Medicine, Seoul, Republic of Korea
| | - Duk L Na
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seong Yoon Kim
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae-Hong Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seol-Heui Han
- Department of Neurology, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Seong Hye Choi
- Department of Neurology, Inha University School of Medicine, Incheon, Republic of Korea
| | - SangYun Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | | | - Doh Kwan Kim
- Center for Clinical Research, Samsung Biomedical Research Institute, Seoul, Republic of Korea; Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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Seow DCC, Gao Q, Yap P, Gan JM, Chionh HL, Lim SC, Feng L, Ng TP. Profile of the Paraoxonase 1 (PON1) Gene 192Q/R Polymorphism and Clinical Associations among Older Singaporean Chinese with Alzheimer's and Mixed Dementia. Dement Geriatr Cogn Dis Extra 2016; 6:43-54. [PMID: 27293416 PMCID: PMC4899677 DOI: 10.1159/000442382] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND To examine the prevalence of the Paraoxonase1 (PON1) gene 192Q/R polymorphism amongst Singaporean Chinese with Alzheimer's disease (AD) and mixed dementia and possible clinical associations. METHODS We examined the presence of the PON1 192Q/R polymorphism together with cognitive status, functional status and neuropsychiatric symptoms among 186 older Singaporean Chinese with AD (n = 109) and mixed dementia (n = 77). RESULTS The R allele predominated in 67% of the AD patients and 63.1% of the patients with mixed dementia. Within the mixed dementia subgroup, the R allele was significantly associated with a higher BADLS score, NPI-Q scores and CDR scores. CONCLUSION Among older Singaporean Chinese with AD and mixed dementia, the R allele was predominant. In particular, within the mixed dementia subgroup, the R allele carrier status was associated with poorer functional status, greater presence of neuropsychiatric symptoms and a more severe stage of dementia. Further studies should be conducted.
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Affiliation(s)
- Dennis C C Seow
- Geriatric Medicine, Singapore General Hospital, SingHealth, Singapore
| | - Qi Gao
- Gerontological Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Psychological Medicine, National University Health System, Singapore
| | - Philip Yap
- Geriatric Medicine, Khoo Teck Puat Hospital, Alexandra Health, Singapore
| | - Jia Min Gan
- Institute of Medical Biology, ASTAR/Singapore OncoGenome Laboratory, Singapore
| | - Hui Ling Chionh
- Nursing, Khoo Teck Puat Hospital, Alexandra Health, Singapore
| | - Su Chi Lim
- Endocrinology, Khoo Teck Puat Hospital, Alexandra Health, Singapore
| | - Lei Feng
- Gerontological Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Psychological Medicine, National University Health System, Singapore
| | - Tze Pin Ng
- Gerontological Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Psychological Medicine, National University Health System, Singapore
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Almeida-Brasil CC, Costa JDO, Aguiar VCFDS, Moreira DP, Moraes END, Acurcio FDA, Guerra Júnior AA, Álvares J. Acesso aos medicamentos para tratamento da doença de Alzheimer fornecidos pelo Sistema Único de Saúde em Minas Gerais, Brasil. CAD SAUDE PUBLICA 2016; 32:e00060615. [DOI: 10.1590/0102-311x00060615] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 02/18/2016] [Indexed: 01/22/2023] Open
Abstract
Resumo: Avaliou-se as barreiras de acesso ao tratamento da doença de Alzheimer com base nos processos administrativos de medicamentos inibidores da colinesterase (IChE), enviados à Secretaria de Estado de Saúde de Minas Gerais, Brasil, entre 2012 e 2013. Utilizando-se informações de 165 processos selecionados aleatoriamente, abordaram-se as dimensões de acesso: acessibilidade geográfica, acomodação, aceitabilidade, disponibilidade e capacidade aquisitiva. O trâmite administrativo para o fornecimento dos IChE levou em média 39 dias e foi influenciado por características do trajeto percorrido pelo usuário. A maioria dos prescritores cumpriu menos de 80% dos critérios exigidos pelo Protocolo Clínico e Diretrizes Terapêuticas (PCDT) da doença de Alzheimer. Como resultado, 38% dos processos não foram deferidos. A capacidade aquisitiva para o tratamento privado mensal com IChE foi de cerca de 21 dias de salário mínimo. Conclui-se que a burocracia do trâmite administrativo e a dificuldade de seguimento do PCDT pelos prescritores prejudicam o acesso ao tratamento da doença de Alzheimer e constituem uma grande carga para o orçamento dos pacientes.
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Nizetic D, Chen CL, Hong W, Koo EH. Inter-Dependent Mechanisms Behind Cognitive Dysfunction, Vascular Biology and Alzheimer's Dementia in Down Syndrome: Multi-Faceted Roles of APP. Front Behav Neurosci 2015; 9:299. [PMID: 26648852 PMCID: PMC4664698 DOI: 10.3389/fnbeh.2015.00299] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Accepted: 10/27/2015] [Indexed: 01/05/2023] Open
Abstract
People with Down syndrome (DS) virtually all develop intellectual disability (ID) of varying degree of severity, and also have a high risk of early Alzheimer's disease (AD). ID prior to the onset of dementia, and its relationship to the onset of dementia in DS is a complex phenomenon influenced by many factors, and scarcely understood. Unraveling the causative factors and modulators of these processes remains a challenge, with potential to be informative for both ID and AD, for the development of early biomarkers and/or therapeutic approaches. We review the potential relative and inter-connected roles of the chromosome 21 gene for amyloid precursor protein (APP), in both pathological conditions. Rare non-DS people with duplication of APP (dupAPP) get familial early onset AD (FEOAD) with virtually 100% penetrance and prominent cerebrovascular pathology, but don't suffer from ID before dementia onset. All of these features appear to be radically different in DS. On the other hand, rare individuals with partial trisomy 21 (T21) (with APP, but not DS-critical region in trisomy) have been described having ID. Likewise, partial T21 DS (without APP trisomy) show a range of ID, but no AD pathology. We review the multi-faceted roles of APP that might affect cognitive functioning. Given the fact that both Aβ secretion and synaptic maturation/plasticity are dependent on neuronal activity, we explore how this conflicting inter-dependency might affect cognitive pathogenesis in a dynamic way in DS, throughout the lifespan of an individual.
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Affiliation(s)
- Dean Nizetic
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore Singapore ; The LonDownS Consortium, Wellcome Trust London, UK ; The Blizard Institute, Barts and The London School of Medicine, Queen Mary University of London London, UK
| | - Christopher L Chen
- Department of Psychological Medicine and Memory Aging and Cognition Centre, National University Health System, Singapore Singapore ; Department of Pharmacology, National University of Singapore, Singapore Singapore
| | - Wanjin Hong
- Agency for Science, Technology and Research (AStar), Institute of Molecular Cell Biology, Singapore Singapore
| | - Edward H Koo
- Departments of Medicine and Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore Singapore ; Department of Neurosciences, University of California, San Diego San Diego, CA, USA
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25
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Li R, Singh M. Sex differences in cognitive impairment and Alzheimer's disease. Front Neuroendocrinol 2014; 35:385-403. [PMID: 24434111 PMCID: PMC4087048 DOI: 10.1016/j.yfrne.2014.01.002] [Citation(s) in RCA: 333] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Revised: 12/31/2013] [Accepted: 01/06/2014] [Indexed: 12/15/2022]
Abstract
Studies have shown differences in specific cognitive ability domains and risk of Alzheimer's disease between the men and women at later age. However it is important to know that sex differences in cognitive function during adulthood may have their basis in both organizational effects, i.e., occurring as early as during the neuronal development period, as well as in activational effects, where the influence of the sex steroids influence brain function in adulthood. Further, the rate of cognitive decline with aging is also different between the sexes. Understanding the biology of sex differences in cognitive function will not only provide insight into Alzheimer's disease prevention, but also is integral to the development of personalized, gender-specific medicine. This review draws on epidemiological, translational, clinical, and basic science studies to assess the impact of sex differences in cognitive function from young to old, and examines the effects of sex hormone treatments on Alzheimer's disease in men and women.
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Affiliation(s)
- Rena Li
- Center for Hormone Advanced Science and Education (CHASE), Roskamp Institute, Sarasota, FL 34243, United States.
| | - Meharvan Singh
- Department of Pharmacology and Neuroscience, Institute for Aging and Alzheimer's Disease Research (IAADR), Center FOR HER, University of North Texas, Health Science Center, Fort Worth, TX 76107, United States
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Serino S, Cipresso P, Morganti F, Riva G. The role of egocentric and allocentric abilities in Alzheimer's disease: a systematic review. Ageing Res Rev 2014; 16:32-44. [PMID: 24943907 DOI: 10.1016/j.arr.2014.04.004] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Revised: 04/18/2014] [Accepted: 04/25/2014] [Indexed: 11/17/2022]
Abstract
A great effort has been made to identify crucial cognitive markers that can be used to characterize the cognitive profile of Alzheimer's disease (AD). Because topographical disorientation is one of the earliest clinical manifestation of AD, an increasing number of studies have investigated the spatial deficits in this clinical population. In this systematic review, we specifically focused on experimental studies investigating allocentric and egocentric deficits to understand which spatial cognitive processes are differentially impaired in the different stages of the disease. First, our results highlighted that spatial deficits appear in the earliest stages of the disease. Second, a need for a more ecological assessment of spatial functions will be presented. Third, our analysis suggested that a prevalence of allocentric impairment exists. Specifically, two selected studies underlined that a more specific impairment is found in the translation between the egocentric and allocentric representations. In this perspective, the implications for future research and neurorehabilitative interventions will be discussed.
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Affiliation(s)
- Silvia Serino
- IRCCS Istituto Auxologico Italiano, Via Pellizza da Volpedo, 41, 20149 Milan (MI), Italy.
| | - Pietro Cipresso
- IRCCS Istituto Auxologico Italiano, Via Pellizza da Volpedo, 41, 20149 Milan (MI), Italy
| | - Francesca Morganti
- Department of Human and Social Sciences, University of Bergamo, Piazzale S. Agostino 2, 24129 Bergamo (BG), Italy
| | - Giuseppe Riva
- IRCCS Istituto Auxologico Italiano, Via Pellizza da Volpedo, 41, 20149 Milan (MI), Italy; Università Cattolica del Sacro Cuore, Largo Gemelli, 1, 20100 Milan (MI), Italy
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27
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Li R, Cui J, Shen Y. Brain sex matters: estrogen in cognition and Alzheimer's disease. Mol Cell Endocrinol 2014; 389:13-21. [PMID: 24418360 PMCID: PMC4040318 DOI: 10.1016/j.mce.2013.12.018] [Citation(s) in RCA: 97] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 12/31/2013] [Accepted: 12/31/2013] [Indexed: 02/06/2023]
Abstract
Estrogens are the primary female sex hormones and play important roles in both reproductive and non-reproductive systems. Estrogens can be synthesized in non-reproductive tissues such as liver, heart, muscle, bone and the brain. During the past decade, increasing evidence suggests that brain estrogen can not only be synthesized by neurons, but also by astrocytes. Brain estrogen also works locally at the site of synthesis in paracrine and/or intracrine fashion to maintain important tissue-specific functions. Here, we will focus on the biology of brain estrogen and its impact on cognitive function and Alzheimer's disease. This comprehensive review provides new insights into brain estrogens by presenting a better understanding of the tissue-specific estrogen effects and their roles in healthy ageing and cognitive function.
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Affiliation(s)
- Rena Li
- Center for Hormone Advanced Science and Education (CHASE), Roskamp Institute, Sarasota, FL 34243, United States.
| | - Jie Cui
- Center for Hormone Advanced Science and Education (CHASE), Roskamp Institute, Sarasota, FL 34243, United States
| | - Yong Shen
- Center for Advanced Therapeutic Strategies for Brain Disorders (CATSBD), Roskamp Institute, Sarasota, FL 34243, United States
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28
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Goh DA, Dong Y, Lee WY, Koay WI, Tay SZ, Soon D, Chen C, Brittain CF, Lowe SL, Wong BS. A pilot study to examine the correlation between cognition and blood biomarkers in a Singapore Chinese male cohort with type 2 diabetes mellitus. PLoS One 2014; 9:e96874. [PMID: 24816647 PMCID: PMC4016130 DOI: 10.1371/journal.pone.0096874] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Accepted: 04/12/2014] [Indexed: 12/19/2022] Open
Abstract
Background Diabetes is reported to be linked to poorer cognitive function. The purpose of this study is to examine (a) clinical correlation between cognitive function and the biochemical perturbations in T2DM, and (b) the impact of statin treatment on cognitive function in diabetic subjects. Methods Forty Singaporean Chinese males with diabetes and twenty Singaporean Chinese males without diabetes were recruited for this study. Twenty-two of the diabetic subjects were on statin therapy and all subjects were non-demented. This was a 2-period non-interventional case-control study in which subjects were assessed for cognitive function in period 1 and blood samples taken over 2 periods, approximately 1 week apart. Blood was collected to determine the level of total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglycerides, glucose and insulin. Cognitive performance was measured by a neuropsychological battery covering domains of attention, language, verbal and visual memory, visuomotor speed and executive function. Z-scores were derived for each cognitive domain using the mean and standard deviations (SDs), and they were used to compare between (a) diabetic and non-diabetic groups, and (b) diabetic subjects with and without statin treatment. ANCOVAs with age, education, BMI, and the duration of diabetes as covariates were employed to examine differences in mean score of cognitive domains and subtests between the two groups. Results Overall cognitive function was similar among diabetics and age matched non-diabetic controls. Among diabetic statin users, HDL, LDL and total cholesterol were negatively correlated with executive function, whereas peripheral insulin levels and insulin resistance were negatively associated with attention. Conclusion Diabetic statin users were likely to have poorer performance in attention and executive function. Increasing levels of the peripheral biomarkers are likely to contribute to poorer cognitive performance.
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Affiliation(s)
- Deborah Amanda Goh
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yanhong Dong
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Memory Ageing and Cognition Centre (MACC), National University Health System (NUHS), Singapore, Singapore
- Centre for Healthy Brain Ageing and Dementia Collaborative Research Centre, School of Psychiatry, The University of New South Wales, Sydney, New South Wales, Australia
- * E-mail: (YD); (BW)
| | - Wah Yean Lee
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Memory Ageing and Cognition Centre (MACC), National University Health System (NUHS), Singapore, Singapore
| | - Way Inn Koay
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Memory Ageing and Cognition Centre (MACC), National University Health System (NUHS), Singapore, Singapore
| | - Stephen Ziyang Tay
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Memory Ageing and Cognition Centre (MACC), National University Health System (NUHS), Singapore, Singapore
| | - Danny Soon
- Lilly-NUS Centre for Clinical Pharmacology, Singapore, Singapore
| | - Christopher Chen
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Memory Ageing and Cognition Centre (MACC), National University Health System (NUHS), Singapore, Singapore
| | | | | | - Boon-Seng Wong
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- * E-mail: (YD); (BW)
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