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Burzhunova MG, Garabova NI, Katyba YN, Strutsenko AA, Shkolnikova EE. [Historical aspects of the study of dementia]. Zh Nevrol Psikhiatr Im S S Korsakova 2022; 122:122-126. [PMID: 35485074 DOI: 10.17116/jnevro2022122041122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Currently, life expectancy is increasing every year, and with it the diseases that are characteristic of the elderly. Dementia is one such condition. According to statistics, there are 9 people with dementia per 100 healthy people aged 60 and over. However, it is important to understand that dementia can also be viewed in a historical context. Over time, ideas about this condition, approaches to its management, as well as the attitude of society towards patients with dementia have changed. The article describes the history of the study of dementia, which went along with the development of medicine, anatomy, neurology and psychiatry. In different historical periods, people's understanding of the mechanisms of development, etiology and pathogenesis of this condition has changed. Ethics and deontology gradually developed, which undoubtedly played an important role in improving the life of not only patients with dementia, but also the relationship between the doctor and the patient as a whole. The main stages in the study of dementia have become the basis for the modern understanding of this condition.
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Affiliation(s)
- M G Burzhunova
- Peoples' Friendship University of Russia, Moscow, Russia
| | - N I Garabova
- Peoples' Friendship University of Russia, Moscow, Russia
| | - Yu N Katyba
- Peoples' Friendship University of Russia, Moscow, Russia
| | - A A Strutsenko
- Peoples' Friendship University of Russia, Moscow, Russia
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Poptsi E, Moraitou D, Eleftheriou M, Kounti-Zafeiropoulou F, Papasozomenou C, Agogiatou C, Bakoglidou E, Batsila G, Liapi D, Markou N, Nikolaidou E, Ouzouni F, Soumpourou A, Vasiloglou M, Tsolaki M. Normative Data for the Montreal Cognitive Assessment in Greek Older Adults With Subjective Cognitive Decline, Mild Cognitive Impairment and Dementia. J Geriatr Psychiatry Neurol 2019; 32:265-274. [PMID: 31159629 DOI: 10.1177/0891988719853046] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The aim of the study was to provide normative data for the MoCA in a Greek cohort of people older than 60 years who meet criteria for subjective cognitive decline (SCD), mild cognitive impairment (MCI), or dementia in order to optimize cutoff scores for each diagnostic group. METHOD Seven hundred forty-six community-dwelling older adults, visitors of the Day Center of Alzheimer Hellas were randomly chosen. Three hundred seventy-nine of them met the criteria for dementia, 245 for MCI and 122 for SCD. RESULTS Initial statistical analyses showed that the total MoCA score is not affected by gender (P = .164), or age (P = .144) but is affected by educational level (P < .001). A cutoff score of 23 for low educational level (≤6 years) can distinguish people with SCD from MCI (sensitivity 71.4%, specificity 84.2%), while 26 is the cutoff score for middle educational level (7-12 years; sensitivity 73.2%, specificity 67.0%) and high educational level (≥13 years; sensitivity 77.6%, specificity 74.7%). Montreal Cognitive Assessment can discriminate older adults with SCD from dementia, with a cutoff score of 20 for low educational level (sensitivity 100%, specificity 92.3%) and a cutoff score 23 for middle educational level (sensitivity 97.6%, specificity 92.7%) and high educational level (sensitivity 98.5%, specificity 100%). CONCLUSION Montreal Cognitive Assessment is not affected by age or gender but is affected by the educational level. The discriminant potential of MoCA between SCD and MCI is good, while the discrimination of SCD from dementia is excellent.
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Affiliation(s)
- Eleni Poptsi
- 1 Greek Association of Alzheimer's Disease and Related Disorders, Thessaloniki, Greece.,2 Laboratory of Psychology, Section of Cognitive and Experimental Psychology, School of Psychology, Aristotle University of Thessaloniki (AUTh), Thessaloniki, Greece
| | - Despina Moraitou
- 1 Greek Association of Alzheimer's Disease and Related Disorders, Thessaloniki, Greece.,2 Laboratory of Psychology, Section of Cognitive and Experimental Psychology, School of Psychology, Aristotle University of Thessaloniki (AUTh), Thessaloniki, Greece
| | - Marina Eleftheriou
- 1 Greek Association of Alzheimer's Disease and Related Disorders, Thessaloniki, Greece
| | | | - Chrysa Papasozomenou
- 1 Greek Association of Alzheimer's Disease and Related Disorders, Thessaloniki, Greece
| | - Christina Agogiatou
- 1 Greek Association of Alzheimer's Disease and Related Disorders, Thessaloniki, Greece
| | - Evaggelia Bakoglidou
- 1 Greek Association of Alzheimer's Disease and Related Disorders, Thessaloniki, Greece
| | - Georgia Batsila
- 1 Greek Association of Alzheimer's Disease and Related Disorders, Thessaloniki, Greece
| | - Despina Liapi
- 1 Greek Association of Alzheimer's Disease and Related Disorders, Thessaloniki, Greece
| | - Nefeli Markou
- 1 Greek Association of Alzheimer's Disease and Related Disorders, Thessaloniki, Greece
| | - Evdokia Nikolaidou
- 1 Greek Association of Alzheimer's Disease and Related Disorders, Thessaloniki, Greece
| | - Fani Ouzouni
- 1 Greek Association of Alzheimer's Disease and Related Disorders, Thessaloniki, Greece
| | - Aikaterini Soumpourou
- 1 Greek Association of Alzheimer's Disease and Related Disorders, Thessaloniki, Greece
| | - Maria Vasiloglou
- 1 Greek Association of Alzheimer's Disease and Related Disorders, Thessaloniki, Greece
| | - Magda Tsolaki
- 1 Greek Association of Alzheimer's Disease and Related Disorders, Thessaloniki, Greece.,4 1st Department of Neurology, Medical School, Aristotle University of Thessaloniki (AUTh), Thessaloniki, Greece
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Claveau JS, Presse N, Kergoat MJ, Villalpando JM. The Lost Years: Delay Between the Onset of Cognitive Symptoms and Clinical Assessment at a Memory Clinic. Can Geriatr J 2018; 21:152-156. [PMID: 29977430 PMCID: PMC6028170 DOI: 10.5770/cgj.21.297] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Early assessment of cognitive symptoms is an issue in geriatrics. This study investigated the delay from the onset of cognitive symptoms to initial clinical assessment and its associations with patients’ sociodemographic and clinical characteristics. Methods This is a cross-sectional retrospective study using medical chart review of 316 patients referred for assessment to a university-affiliated memory clinic. Symptom duration was self-reported by patients/carers. Severity of symptoms assessed by the MoCA and FAST instruments was compared according to delay duration (≥3 years vs. <3 years) using chi-squared tests. Logistic regression was used to determine the association between patients’ characteristics and long symptom duration (≥3 years). Results At the initial assessment, 29.4% of patients reported experiencing cognitive symptoms for ≥3 years. They were more likely to have MoCA scores ≤17 (47.8 vs. 34.1%; p=.023) and FAST scores ≥5 (21.5 vs. 10.8%; p=.012). They were also significantly older than 75 years (75–84 yr: OR=2.22 [95%CI: 1.11–4.41]; ≥85 yr: 4.36 [2.08–9.11]), presented more depressive symptoms (2.37 [1.40–4.02]), and were less likely to live alone (0.55 [0.31–0.96]). Conclusions A significant proportion of patients had cognitive symptoms for years when initially assessed, which delayed diagnosis and management. Stigma, depression, and compensatory help from carers may contribute to this delay.
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Affiliation(s)
- Jean-Sébastien Claveau
- Département de médecine, Faculté de médecine, Université de Montréal, Montréal QC, Canada
| | - Nancy Presse
- Centre de recherche, Institut universitaire de gériatrie de Montréal, Montréal QC, Canada
| | - Marie-Jeanne Kergoat
- Département de médecine, Faculté de médecine, Université de Montréal, Montréal QC, Canada.,Centre de recherche, Institut universitaire de gériatrie de Montréal, Montréal QC, Canada
| | - Juan Manuel Villalpando
- Département de médecine, Faculté de médecine, Université de Montréal, Montréal QC, Canada.,Centre de recherche, Institut universitaire de gériatrie de Montréal, Montréal QC, Canada
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Mikhaylova NM. [Organization of out-patient psychiatric care in dementia and cognitive impairment in aged. Part II: Clinical and economic efficacy of memory clinics and Alzheimer's disease centers]. Zh Nevrol Psikhiatr Im S S Korsakova 2017; 117:89-98. [PMID: 28805768 DOI: 10.17116/jnevro20171177189-98] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The part II of the review is focused on a history of developing of memory clinics and Alzheimer's disease centers as well as on the indices of their activity in various countries and in Russia. Approaches to the evaluation of clinical and economic efficacy of new technologies of organization of care and a role of the national programs in solving of the problem of old age dementias were considered.
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Mikhaylova NM. [Organization of out-patient psychiatric care in dementia and cognitive impairment. Part I: Memory clinics and Alzheimer's disease centers]. Zh Nevrol Psikhiatr Im S S Korsakova 2017; 117:111-119. [PMID: 28745681 DOI: 10.17116/jnevro201711761111-119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The review of publications on an influence of demographic changes in the population on the prevalence of old age dementias and a scale of burden of dementias in modern society are presented. This paper is the first part of the review. It presents the necessity of new forms of out-patient care to the aged with cognitive impairment. The author reviews the history of creation of memory clinics and Alzheimer's disease centers.
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Boccardi V, Baroni M, Smirne N, Clodomiro A, Ercolani S, Longo A, Ruggiero C, Bruni AC, Mecocci P. Short-Term Response is not Predictive of Long-Term Response to Acetylcholinesterase Inhibitors in Old Age Subjects with Alzheimer’s Disease: A “Real World” Study. J Alzheimers Dis 2017; 56:239-248. [DOI: 10.3233/jad-160904] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Virginia Boccardi
- Institute of Gerontology and Geriatrics, Department of Medicine, University of Perugia, Italy
| | - Marta Baroni
- Institute of Gerontology and Geriatrics, Department of Medicine, University of Perugia, Italy
| | - Nicoletta Smirne
- Regional Neurogenetic Centre, ASP CZ, Lamezia Terme, Catanzaro, Italy
| | | | - Sara Ercolani
- Institute of Gerontology and Geriatrics, Department of Medicine, University of Perugia, Italy
| | - Annalisa Longo
- Institute of Gerontology and Geriatrics, Department of Medicine, University of Perugia, Italy
| | - Carmelinda Ruggiero
- Institute of Gerontology and Geriatrics, Department of Medicine, University of Perugia, Italy
| | - Amalia C. Bruni
- Regional Neurogenetic Centre, ASP CZ, Lamezia Terme, Catanzaro, Italy
| | - Patrizia Mecocci
- Institute of Gerontology and Geriatrics, Department of Medicine, University of Perugia, Italy
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Ravona-Springer R, Luo X, Schmeidler J, Wysocki M, Lesser GT, Rapp MA, Dahlman K, Grossman HT, Haroutunian V, Beeri MS. The association of age with rate of cognitive decline in elderly individuals residing in supporting care facilities. Alzheimer Dis Assoc Disord 2012; 25:312-6. [PMID: 21572311 DOI: 10.1097/wad.0b013e31820d880e] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES This study examines the effect of age on rate of cognitive decline in different stages of dementia, of nursing home and assisted-living residents. METHODS In this longitudinal study, the Mini Mental State Examination (MMSE) was used to measure rate of cognitive decline in subjects who were nondemented [Clinical Dementia Rating (CDR)=0; n=353], questionably demented (CDR=0.5; n=121), or frankly demented (CDR≥1; n=213) at baseline. RESULTS A generalized estimating equation was used to model the MMSE scores over time (mean follow-up 2.9±2.0 y). The generalized estimating equation model had the MMSE scores at successive follow-up time points as dependent variables and had linear and quadratic age, follow-up time from baseline, CDR at baseline, and all the interactions among them as independent variables, controlling for MMSE at baseline, sex, race, and education. The mean age of the entire sample was 85.2±7.4 years at baseline. There were no significant interactions of linear age effects with rate of cognitive decline. The analysis of interaction of quadratic age with rate of cognitive decline showed complex relationships: in the nondemented group, there was no substantial quadratic association of age with the rate of cognitive decline (P=0.13); in the questionable demented group, the oldest subjects declined relatively faster (P=0.02); and in the demented group, the youngest and oldest subjects tended to decline relatively less than subjects in the intermediate ages (P=0.07). CONCLUSIONS This study adds an additional aspect to the complexity of the association between age and rate of cognitive decline, showing that the direction and amplitude of this effect differs according to the stage along the course of cognitive decline.
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McCarten JR, Anderson P, Kuskowski MA, McPherson SE, Borson S. Screening for Cognitive Impairment in an Elderly Veteran Population: Acceptability and Results Using Different Versions of the Mini-Cog. J Am Geriatr Soc 2011; 59:309-13. [DOI: 10.1111/j.1532-5415.2010.03249.x] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Neuropsychiatric symptoms and syndromes in a large cohort of newly diagnosed, untreated patients with Alzheimer disease. Am J Geriatr Psychiatry 2010; 18:1026-35. [PMID: 20808086 DOI: 10.1097/jgp.0b013e3181d6b68d] [Citation(s) in RCA: 132] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Neuropsychiatric symptoms are common in patients with Alzheimer disease (AD). Treatment for both AD and psychiatric disturbances may affect the clinical observed pattern and comorbidity. The authors aimed to identify whether particular neuropsychiatric syndromes occur in untreated patients with AD, establish the severity of syndromes, and investigate the relationship between specific neuropsychiatric syndromes and AD disease severity. DESIGN Cross-sectional, multicenter, clinical study. PARTICIPANTS A total of 1,015 newly diagnosed, untreated outpatients with AD from five Italian memory clinics were consecutively enrolled in the study from January 2003 to December 2005. MEASUREMENTS All patients underwent thorough examination by clinical neurologists/geriatricians, including neuropsychiatric symptom evaluation with the Neuropsychiatric Inventory. RESULTS Factor analysis revealed five distinct neuropsychiatric syndromes: the apathetic syndrome (as unique syndrome) was the most frequent, followed by affective syndrome (anxiety and depression), psychomotor (agitation, irritability, and aberrant motor behavior), psychotic (delusions and hallucinations), and manic (disinhibition and euphoria) syndromes. More than three quarters of patients with AD presented with one or more of the syndromes (N = 790, 77.8%), and more than half exhibited clinically significant severity of symptoms (N = 603, 59.4%). With the exception of the affective one, all syndromes showed an increased occurrence with increasing severity of dementia. CONCLUSIONS The authors' study supports the use of a syndrome approach for neuropsychiatric evaluation in patients with AD. Individual neuropsychiatric symptoms can be reclassified into five distinct psychiatric syndromes. Clinicians should incorporate a thorough psychiatric and neurologic examination of patients with AD and consider therapeutic strategies that focus on psychiatric syndromes, rather than specific individual symptoms.
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Ravona-Springer R, Luo X, Schmeidler J, Wysocki M, Lesser G, Rapp M, Dahlman K, Grossman H, Haroutunian V, Schnaider Beeri M. Diabetes is associated with increased rate of cognitive decline in questionably demented elderly. Dement Geriatr Cogn Disord 2010; 29:68-74. [PMID: 20130405 PMCID: PMC2840245 DOI: 10.1159/000265552] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/27/2009] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND This study examines whether the association of diabetes with the rate of cognitive decline varies according to dementia severity. METHODS Longitudinal study on subjects residing in nursing homes and assisted living (n = 342). The Mini Mental State Examination (MMSE) was used to measure the rate of cognitive decline in diabetic and nondiabetic subjects who were nondemented (Clinical Dementia Rating, CDR = 0; n = 125), questionably demented (CDR = 0.5; n = 58) or frankly demented (CDR > or =1; n = 89) at baseline. Diagnosis of diabetes was ascertained by review of medical records and history. RESULTS Diabetes was associated with an increased rate of decline in the MMSE score of questionably demented subjects (p < 0.0001). In frankly demented subjects, diabetes tended to be associated with less cognitive decline (p = 0.04). Diabetes was not associated with the rate of MMSE decline in nondemented subjects (p = 0.89). CONCLUSION In individuals with questionable dementia (CDR = 0.5), diabetes is associated with a faster rate of cognitive decline as measured by the MMSE, but not in nondemented (CDR = 0) or frankly demented (CDR > or =1) individuals.
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Affiliation(s)
| | - Xiaodong Luo
- Department of Psychiatry, Mount Sinai School of Medicine, New York, N.Y., USA
| | - James Schmeidler
- Department of Psychiatry, Mount Sinai School of Medicine, New York, N.Y., USA
| | - Michael Wysocki
- Department of Psychiatry, Mount Sinai School of Medicine, New York, N.Y., USA
| | | | - Michael Rapp
- Department of Psychiatry, Campus Charité Mitte, Humboldt University, Berlin, Germany
| | - Karen Dahlman
- Department of Psychiatry, Mount Sinai School of Medicine, New York, N.Y., USA
| | - Hillel Grossman
- Department of Psychiatry, Mount Sinai School of Medicine, New York, N.Y., USA
| | - Vahram Haroutunian
- Department of Psychiatry, Mount Sinai School of Medicine, New York, N.Y., USA
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Henry RG, Smith BJ. Managing older patients who have neurologic disease: Alzheimer disease and cerebrovascular accident. Dent Clin North Am 2009; 53:269-94, ix. [PMID: 19269397 DOI: 10.1016/j.cden.2008.12.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Neurologic diseases represent some of the most common disabling and costly conditions in older age. Alzheimer disease and cerebrovascular accidents (strokes) are two of the most common neurologic conditions, and represent the leading causes of nursing home placement. Dental professionals will be caring for older patients who have age-associated neurologic diseases, including Alzheimer disease and stroke because of the increased longevity of the United States population coupled with improved survivorship of these conditions as a result of advanced medical diagnosis and treatment. Understanding the clinical manifestations of these two common, but distinctly different, neurologic conditions will enable dental professionals to provide safe and rational dental care.
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Affiliation(s)
- Robert G Henry
- Department of Dental Services (160), Veterans Affairs Medical Center, Cooper Dr. Division, Lexington, KY 40502, USA.
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Abstract
Over the past century, truly remarkable changes have been observed in the health of older persons throughout the world, and these changes have strongly impacted society. The growth of the older population has resulted mostly from a general increase in the overall population size but is also strongly influenced by major declines in leading causes of mortality. These demographic transformations reverberate in society, increasing medical care and social needs, which are expected to increase steeply in the years to come. Based on demographic and epidemiologic perspectives, these changes were already detectable decades before and should have prompted radical changes in the structure and function of our system of health and social protection at that time. We come to this enormous challenge unprepared.
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Affiliation(s)
- Luigi Ferrucci
- Longitudinal Studies Section, Clinical Research Branch, National Institute on Aging, National Institutes of Health, MD, USA.
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