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Wertman E. Essential New Complexity-Based Themes for Patient-Centered Diagnosis and Treatment of Dementia and Predementia in Older People: Multimorbidity and Multilevel Phenomenology. J Clin Med 2024; 13:4202. [PMID: 39064242 PMCID: PMC11277671 DOI: 10.3390/jcm13144202] [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: 06/10/2024] [Revised: 07/12/2024] [Accepted: 07/13/2024] [Indexed: 07/28/2024] Open
Abstract
Dementia is a highly prevalent condition with devastating clinical and socioeconomic sequela. It is expected to triple in prevalence by 2050. No treatment is currently known to be effective. Symptomatic late-onset dementia and predementia (SLODP) affects 95% of patients with the syndrome. In contrast to trials of pharmacological prevention, no treatment is suggested to remediate or cure these symptomatic patients. SLODP but not young onset dementia is intensely associated with multimorbidity (MUM), including brain-perturbating conditions (BPCs). Recent studies showed that MUM/BPCs have a major role in the pathogenesis of SLODP. Fortunately, most MUM/BPCs are medically treatable, and thus, their treatment may modify and improve SLODP, relieving suffering and reducing its clinical and socioeconomic threats. Regrettably, the complex system features of SLODP impede the diagnosis and treatment of the potentially remediable conditions (PRCs) associated with them, mainly due to failure of pattern recognition and a flawed diagnostic workup. We suggest incorporating two SLODP-specific conceptual themes into the diagnostic workup: MUM/BPC and multilevel phenomenological themes. By doing so, we were able to improve the diagnostic accuracy of SLODP components and optimize detecting and favorably treating PRCs. These revolutionary concepts and their implications for remediability and other parameters are discussed in the paper.
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Affiliation(s)
- Eli Wertman
- Department of Neurology, Hadassah University Hospital, The Hebrew University, Jerusalem 9190500, Israel;
- Section of Neuropsychology, Department of Psychology, The Hebrew University, Jerusalem 9190500, Israel
- Or’ad: Organization for Cognitive and Behavioral Changes in the Elderly, Jerusalem 9458118, Israel
- Merhav Neuropsychogeriatric Clinics, Nehalim 4995000, Israel
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Jrolf CM. Dementia with Lewy bodies: Primary care PAs can make this difficult diagnosis. JAAPA 2024; 37:22-29. [PMID: 38747894 DOI: 10.1097/01.jaa.0000000000000019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2024]
Abstract
ABSTRACT Lewy body dementia is an umbrella term for dementia with Lewy bodies (DLB) and Parkinson disease dementia. These progressive, degenerative brain disorders link dementia with psychosis and parkinsonism and are difficult to diagnose. The diagnosis of DLB is challenging, especially in its early phase, because the presentation is variable. Relevant screening tools and a complete physical examination are essential. Making the correct diagnosis lets patients and caregivers make arrangements, have more timely access to services, improve patient quality of life, and lessen the burden on caregivers.
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Affiliation(s)
- Cheri M Jrolf
- Cheri M. Jrolf is a principal faculty member in the PA program at Lincoln Memorial University, based in Tampa, Fla. The author has disclosed no potential conflicts of interest, financial or otherwise
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Dodel R, Berg D, Duning T, Kalbe E, Meyer PT, Ramirez A, Storch A, Aarsland D, Jessen F. [Dementia with Lewy bodies: old and new knowledge - Part 1: clinical aspects and diagnostics]. DER NERVENARZT 2024; 95:353-361. [PMID: 38092983 PMCID: PMC11014876 DOI: 10.1007/s00115-023-01576-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/26/2023] [Indexed: 04/13/2024]
Abstract
BACKGROUND Dementia with Lewy bodies (DLB) is the second most common neurodegenerative dementia after Alzheimer's disease. Patients with DLB often have a poor prognosis, with worse outcomes than patients with Alzheimer's disease in terms of important parameters, such as quality of life, caregiver burden, health-related costs, frequency of hospital and nursing home admissions, shorter time to severe dementia, and lower survival. The DLB is frequently misdiagnosed and often undertreated. Therefore, it is critical to diagnose DLB as early as possible to ensure optimal care and treatment. OBJECTIVE The aim of this review article is to summarize the main recent findings on diagnostic tools, epidemiology and genetics of DLB. RESULTS Precise clinical diagnostic criteria exist for DLB that enable an etiologic assignment. Imaging techniques are used as standard in DLB, especially also to exclude non-neurodegenerative causes. In particular, procedures in nuclear medicine have a high diagnostic value. DISCUSSION The diagnosis is primarily based on clinical symptoms, although the development of in vivo neuroimaging and biomarkers is changing the scope of clinical diagnosis as well as research into this devastating disease.
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Affiliation(s)
- Richard Dodel
- Lehrstuhl für Geriatrie, Universität Duisburg-Essen, Virchowstraße 171, 45147, Essen, Deutschland.
| | - Daniela Berg
- Neurologische Klinik, Universität Kiel, Kiel, Deutschland
| | - Thomas Duning
- Neurologische Klinik, Universität Münster, Münster, Deutschland
| | - Elke Kalbe
- Medizinische Psychologie, Neuropsychologie und Gender Studies & Centrum für Neuropsychologische Diagnostik und Intervention (CeNDI), Universität Köln, Köln, Deutschland
| | - Philipp T Meyer
- Klinik für Nuklearmedizin, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
| | - Alfredo Ramirez
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universität Köln, Köln, Deutschland
| | - Alexander Storch
- Klinik für Neurologie, Universität Rostock, Rostock, Deutschland
| | - Dag Aarsland
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norwegen
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, Großbritannien
| | - Frank Jessen
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universität Köln, Köln, Deutschland
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Manoj M, Sowmyanarayan S, Kowshik AV, Chatterjee J. Identification of Potentially Repurposable Drugs for Lewy Body Dementia Using a Network-Based Approach. J Mol Neurosci 2024; 74:21. [PMID: 38363395 DOI: 10.1007/s12031-024-02199-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Accepted: 02/06/2024] [Indexed: 02/17/2024]
Abstract
The conventional method of one drug being used for one target has not yielded therapeutic solutions for Lewy body dementia (LBD), which is a leading progressive neurological disorder characterized by significant loss of neurons. The age-related disease is marked by memory loss, hallucinations, sleep disorder, mental health deterioration, palsy, and cognitive impairment, all of which have no known effective cure. The present study deploys a network medicine pipeline to repurpose drugs having considerable effect on the genes and proteins related to the diseases of interest. We utilized the novel SAveRUNNER algorithm to quantify the proximity of all drugs obtained from DrugBank with the disease associated gene dataset obtained from Phenopedia and targets in the human interactome. We found that most of the 154 FDA-approved drugs predicted by SAveRUNNER were used to treat nervous system disorders, but some off-label drugs like quinapril and selegiline were interestingly used to treat hypertension and Parkinson's disease (PD), respectively. Additionally, we performed gene set enrichment analysis using Connectivity Map (CMap) and pathway enrichment analysis using EnrichR to validate the efficacy of the drug candidates obtained from the pipeline approach. The investigation enabled us to identify the significant role of the synaptic vesicle pathway in our disease and accordingly finalize 8 suitable antidepressant drugs from the 154 drugs initially predicted by SAveRUNNER. These potential anti-LBD drugs are either selective or non-selective inhibitors of serotonin, dopamine, and norepinephrine transporters. The validated selective serotonin and norepinephrine inhibitors like milnacipran, protriptyline, and venlafaxine are predicted to manage LBD along with the affecting symptomatic issues.
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Affiliation(s)
- Megha Manoj
- Department of Biotechnology, PES University, Bangalore, 560085, India
| | | | - Arjun V Kowshik
- Department of Biotechnology, PES University, Bangalore, 560085, India
| | - Jhinuk Chatterjee
- Department of Biotechnology, PES University, Bangalore, 560085, India.
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Wong ET, Rosenberg H, Dawood O, Hertan L, Vega RA, Anderson M, Uhlmann EJ. Lewy body disease as a potential negative outcome modifier of glioblastoma treatment: a case report. BMC Neurol 2023; 23:257. [PMID: 37403078 DOI: 10.1186/s12883-023-03313-4] [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: 03/30/2022] [Accepted: 06/16/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Elderly patients with glioblastoma are particularly susceptible to the adverse effects of ionizing radiation to the brain. This population also has an increasing prevalence of dementia in the successive seventh, eighth and nineth decade of life, and dementia with Lewy bodies is characterized by pathologic α-synucleins, proteins that take part in neuronal DNA damage repair. CASE PRESENTATION We report a 77-year-old man, with a history of coronary artery disease and mild cognitive impairment, who experienced subacute behavioral changes over 3 months with wording-finding difficulty, memory loss, confusion, perseveration, and irritable mood. Neuroimaging studies disclosed a 2.5 × 2.4 × 2.7 cm cystic enhancing mass with central necrosis in the left temporal lobe of the brain. Gross total resection of the tumor revealed IDH-1 wild-type glioblastoma. After treatment with radiation and temozolomide chemotherapy, his cognitive status deteriorated rapidly, and he died from unexpected sudden death 2 months after radiation. Autopsy of his brain revealed (i) tumor cells with atypical nuclei and small lymphocytes, (ii) neuronal cytoplasmic inclusions and Lewy bodies that were positive for α-synuclein in the midbrain, pons, amygdala, putamen and globus pallidus, and (iii) no amyloid plaques and only rare neurofibrillary tangles near the hippocampi. CONCLUSIONS This patient most likely had pre-clinical limbic subtype of dementia with Lewy bodies prior to his diagnosis of glioblastoma. The radiation and temozolomide that was used to treat his tumor may have accelerated neuronal damage due to induction of DNA breakage when his brain was already compromised by pathologic α-synucleins. α-Synucleinopathy could be a negative outcome modifier in glioblastoma patients.
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Affiliation(s)
- Eric T Wong
- Brain Tumor Center & Neuro-Oncology Unit, Department of Neurology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, 02215, United States.
- Department of Neurology, Medicine (Division of Hematology/Oncology), Neurosurgery & Radiation Oncology, Rhode Island Hospital, 593 Eddy St, Providence, 02903, United States.
| | - Harry Rosenberg
- Division of Neuropathology, Department of Pathology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, 02215, United States
| | - Olivia Dawood
- Department of Radiation Oncology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, 02215, United States
| | - Lauren Hertan
- Department of Radiation Oncology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, 02215, United States
| | - Rafael A Vega
- Division of Neurosurgery, Department of Surgery, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, 02215, United States
| | - Matthew Anderson
- Division of Neuropathology, Department of Pathology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, 02215, United States
- Present Address: Regeneron Pharmaceutical Company, 777 Old Saw Mill Rive Road, Tarrytown, NY, 10591, United States
| | - Erik J Uhlmann
- Brain Tumor Center & Neuro-Oncology Unit, Department of Neurology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, 02215, United States
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Role of Tau in Various Tauopathies, Treatment Approaches, and Emerging Role of Nanotechnology in Neurodegenerative Disorders. Mol Neurobiol 2023; 60:1690-1720. [PMID: 36562884 DOI: 10.1007/s12035-022-03164-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022]
Abstract
A few protein kinases and phosphatases regulate tau protein phosphorylation and an imbalance in their enzyme activity results in tau hyper-phosphorylation. Aberrant tau phosphorylation causes tau to dissociate from the microtubules and clump together in the cytosol to form neurofibrillary tangles (NFTs), which lead to the progression of neurodegenerative disorders including Alzheimer's disease (AD) and other tauopathies. Hence, targeting hyperphosphorylated tau protein is a restorative approach for treating neurodegenerative tauopathies. The cyclin-dependent kinase (Cdk5) and the glycogen synthase kinase (GSK3β) have both been implicated in aberrant tau hyperphosphorylation. The limited transport of drugs through the blood-brain barrier (BBB) for reaching the central nervous system (CNS) thus represents a significant problem in the development of drugs. Drug delivery systems based on nanocarriers help solve this problem. In this review, we discuss the tau protein, regulation of tau phosphorylation and abnormal hyperphosphorylation, drugs in use or under clinical trials, and treatment strategies for tauopathies based on the critical role of tau hyperphosphorylation in the pathogenesis of the disease. Pathology of neurodegenerative disease due to hyperphosphorylation and various therapeutic approaches including nanotechnology for its treatment.
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Topçuoğlu ES, Akdemir ÜÖ, Atay LÖ. What is New in Nuclear Medicine Imaging for Dementia. Noro Psikiyatr Ars 2022; 59:S17-S23. [PMID: 36578980 PMCID: PMC9767133 DOI: 10.29399/npa.28155] [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: 03/13/2022] [Accepted: 04/02/2022] [Indexed: 12/31/2022] Open
Abstract
Advances in the molecular biology, pathology and genetics of Alzheimer's disease (AD) and other degenerative dementias have led to the development of biomarkers specific to these diseases and radiotracers that are used in nuclear medicine. Imaging and non-imaging markers have enabled very early recognition of these diseases and have caused significant changes in their definitions. Amyloid positron emission tomography (PET) and tau PET, which are molecular imaging methods, [F18]fluorodeoxyglucose (FDG) PET showing the glucose metabolism pattern in the brain, dopamine transporter single photon emission computerized tomography (SPECT) that marks dopaminergic terminals are valuable tools for early recognition and differentiation of AD and its atypical variants, frontotemporal dementias and dementia with Lewy bodies. These imaging methods, which have different advantages over each other, have different indications for use and sometimes provide complementary information. In addition, research on radiotracers targeting neuroinflammation, astrocytes, synaptic density, and cholinergic terminals is ongoing. In this review, routinely used and newly developed nuclear imaging methods in AD and other neurodegenerative dementias, the agents used and their diagnostic features will be presented together with case examples.
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Affiliation(s)
- Esen Saka Topçuoğlu
- Hacettepe University Faculty of Medicine, Department of Neurology, Ankara, Turkey,Correspondence Address: Esen Saka Topçuoğlu, Maidan İş Merkezi, B-blok, 146 no’lu ofis, Mustafa Kemal Mah. Ankara, Turkey • E-mail:
| | - Ümit Özgür Akdemir
- Gazi University Faculty of Medicine, Department of Nuclear Medicine, Ankara, Turkey
| | - Lütfiye Özlem Atay
- Gazi University Faculty of Medicine, Department of Nuclear Medicine, Ankara, Turkey
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8
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Orthostatic hypotension with nondipping: phenotype of neurodegenerative disease. Hypertens Res 2022; 45:1514-1516. [PMID: 35836000 DOI: 10.1038/s41440-022-00980-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 06/12/2022] [Indexed: 11/08/2022]
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Manzanza NDO, Sedlackova L, Kalaria RN. Alpha-Synuclein Post-translational Modifications: Implications for Pathogenesis of Lewy Body Disorders. Front Aging Neurosci 2021; 13:690293. [PMID: 34248606 PMCID: PMC8267936 DOI: 10.3389/fnagi.2021.690293] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 05/24/2021] [Indexed: 12/16/2022] Open
Abstract
Lewy Body Disorders (LBDs) lie within the spectrum of age-related neurodegenerative diseases now frequently categorized as the synucleinopathies. LBDs are considered to be among the second most common form of neurodegenerative dementias after Alzheimer's disease. They are progressive conditions with variable clinical symptoms embodied within specific cognitive and behavioral disorders. There are currently no effective treatments for LBDs. LBDs are histopathologically characterized by the presence of abnormal neuronal inclusions commonly known as Lewy Bodies (LBs) and extracellular Lewy Neurites (LNs). The inclusions predominantly comprise aggregates of alpha-synuclein (aSyn). It has been proposed that post-translational modifications (PTMs) such as aSyn phosphorylation, ubiquitination SUMOylation, Nitration, o-GlcNacylation, and Truncation play important roles in the formation of toxic forms of the protein, which consequently facilitates the formation of these inclusions. This review focuses on the role of different PTMs in aSyn in the pathogenesis of LBDs. We highlight how these PTMs interact with aSyn to promote misfolding and aggregation and interplay with cell membranes leading to the potential functional and pathogenic consequences detected so far, and their involvement in the development of LBDs.
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Affiliation(s)
- Nelson de Oliveira Manzanza
- Translational and Clinical Research Institute, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Lucia Sedlackova
- Biosciences Institute, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Raj N. Kalaria
- Translational and Clinical Research Institute, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, United Kingdom
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Patel KP, Wymer DT, Bhatia VK, Duara R, Rajadhyaksha CD. Multimodality Imaging of Dementia: Clinical Importance and Role of Integrated Anatomic and Molecular Imaging. Radiographics 2021; 40:200-222. [PMID: 31917652 DOI: 10.1148/rg.2020190070] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Neurodegenerative diseases are a devastating group of disorders that can be difficult to accurately diagnose. Although these disorders are difficult to manage owing to relatively limited treatment options, an early and correct diagnosis can help with managing symptoms and coping with the later stages of these disease processes. Both anatomic structural imaging and physiologic molecular imaging have evolved to a state in which these neurodegenerative processes can be identified relatively early with high accuracy. To determine the underlying disease, the radiologist should understand the different distributions and pathophysiologic processes involved. High-spatial-resolution MRI allows detection of subtle morphologic changes, as well as potential complications and alternate diagnoses, while molecular imaging allows visualization of altered function or abnormal increased or decreased concentration of disease-specific markers. These methodologies are complementary. Appropriate workup and interpretation of diagnostic studies require an integrated, multimodality, multidisciplinary approach. This article reviews the protocols and findings at MRI and nuclear medicine imaging, including with the use of flurodeoxyglucose, amyloid tracers, and dopaminergic transporter imaging (ioflupane). The pathophysiology of some of the major neurodegenerative processes and their clinical presentations are also reviewed; this information is critical to understand how these imaging modalities work, and it aids in the integration of clinical data to help synthesize a final diagnosis. Radiologists and nuclear medicine physicians aiming to include the evaluation of neurodegenerative diseases in their practice should be aware of and familiar with the multiple imaging modalities available and how using these modalities is essential in the multidisciplinary management of patients with neurodegenerative diseases.©RSNA, 2020.
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Affiliation(s)
- Kunal P Patel
- From the Department of Radiology, Mount Sinai Medical Center, 4300 Alton Rd, Miami Beach, FL 33140
| | - David T Wymer
- From the Department of Radiology, Mount Sinai Medical Center, 4300 Alton Rd, Miami Beach, FL 33140
| | - Vinay K Bhatia
- From the Department of Radiology, Mount Sinai Medical Center, 4300 Alton Rd, Miami Beach, FL 33140
| | - Ranjan Duara
- From the Department of Radiology, Mount Sinai Medical Center, 4300 Alton Rd, Miami Beach, FL 33140
| | - Chetan D Rajadhyaksha
- From the Department of Radiology, Mount Sinai Medical Center, 4300 Alton Rd, Miami Beach, FL 33140
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Kao SL, Chen SC, Li YY, Lo RY. Diagnostic diversity among patients with cognitive complaints: A 3-year follow-up study in a memory clinic. Int J Geriatr Psychiatry 2019; 34:1900-1906. [PMID: 31486134 DOI: 10.1002/gps.5207] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 08/24/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To describe the distribution and estimate the mortality risks of degenerative dementias and nondegenerative conditions in a memory clinic. METHODS We enrolled 727 consecutive patients with cognitive complaints who visited the memory clinic in Buddhist Tzu Chi General Hospital during 2013 to 2016. Three main diagnostic groups were defined: pure type dementia, in which only one type of dementia was diagnosed, such as Alzheimer disease (AD), vascular dementia (VaD), Parkinson disease with dementia (PDD), dementia with Lewy bodies (DLB), and frontotemporal dementia (FTD); mixed type dementia; and nondegenerative conditions. We described the frequency of different diagnoses and employed Cox proportional hazards regression models to examine the mortality risks for each diagnostic group after adjusting for age, sex, education, and cognitive status. All patients alive on or after September 30, 2018, were censored in the analysis. RESULTS Two-thirds of patients (n = 496, 68.2%) were diagnosed with degenerative dementias. Pure type to mixed type dementia ratio was about 2: 1. AD remained the most common pure dementia subtype, followed by VaD and PDD. Among all nondegenerative conditions, depression/anxiety and subjective cognitive decline were the most common diagnoses. During a mean follow-up of 3.4 years, 150 deaths were documented, and the mortality risk was 61 deaths/1000 person-years. Mortality risks were associated with age, sex, education, and cognitive function at diagnosis but did not differ by diagnostic group. CONCLUSIONS Clinical diagnoses for patients with cognitive complaints are diverse, and nearly one-third are of nondegenerative conditions. Baseline cognitive function is a stronger predictor for survival than clinical diagnosis.
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Affiliation(s)
- Sheng-Lun Kao
- Division of Geriatric Medicine, Department of Family Medicine, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan.,Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
| | - Shu-Cin Chen
- Division of Cognitive and Geriatric Neurology, Department of Neurology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
| | - Yu-Ying Li
- Division of Cognitive and Geriatric Neurology, Department of Neurology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
| | - Raymond Y Lo
- Division of Cognitive and Geriatric Neurology, Department of Neurology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan.,Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
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12
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Wahl D, Solon-Biet SM, Cogger VC, Fontana L, Simpson SJ, Le Couteur DG, Ribeiro RV. Aging, lifestyle and dementia. Neurobiol Dis 2019; 130:104481. [PMID: 31136814 DOI: 10.1016/j.nbd.2019.104481] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 05/13/2019] [Accepted: 05/22/2019] [Indexed: 12/21/2022] Open
Abstract
Aging is the greatest risk factor for most diseases including cancer, cardiovascular disorders, and neurodegenerative disease. There is emerging evidence that interventions that improve metabolic health with aging may also be effective for brain health. The most robust interventions are non-pharmacological and include limiting calorie or protein intake, increasing aerobic exercise, or environmental enrichment. In humans, dietary patterns including the Mediterranean, Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) and Okinawan diets are associated with improved age-related health and may reduce neurodegenerative disease including dementia. Rapamycin, metformin and resveratrol act on nutrient sensing pathways that improve cardiometabolic health and decrease the risk for age-associated disease. There is some evidence that they may reduce the risk for dementia in rodents. There is a growing recognition that improving metabolic function may be an effective way to optimize brain health during aging.
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Affiliation(s)
- Devin Wahl
- Charles Perkins Centre, University of Sydney, Sydney 2006, Australia; Aging and Alzheimers Institute, ANZAC Research Institute, Concord Clinical School/Sydney Medical School, Concord 2139, Australia.
| | - Samantha M Solon-Biet
- Charles Perkins Centre, University of Sydney, Sydney 2006, Australia; Aging and Alzheimers Institute, ANZAC Research Institute, Concord Clinical School/Sydney Medical School, Concord 2139, Australia
| | - Victoria C Cogger
- Charles Perkins Centre, University of Sydney, Sydney 2006, Australia; Aging and Alzheimers Institute, ANZAC Research Institute, Concord Clinical School/Sydney Medical School, Concord 2139, Australia
| | - Luigi Fontana
- Charles Perkins Centre, University of Sydney, Sydney 2006, Australia
| | - Stephen J Simpson
- Charles Perkins Centre, University of Sydney, Sydney 2006, Australia; School of Life and Environmental Sciences, University of Sydney, Sydney 2006, Australia
| | - David G Le Couteur
- Charles Perkins Centre, University of Sydney, Sydney 2006, Australia; Aging and Alzheimers Institute, ANZAC Research Institute, Concord Clinical School/Sydney Medical School, Concord 2139, Australia
| | - Rosilene V Ribeiro
- Charles Perkins Centre, University of Sydney, Sydney 2006, Australia; School of Life and Environmental Sciences, University of Sydney, Sydney 2006, Australia
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Lee CY, Cheng SJ, Lin HC, Liao YL, Chen PH. Quality of Life in Patients with Dementia with Lewy Bodies. Behav Neurol 2018; 2018:8320901. [PMID: 30073037 PMCID: PMC6057352 DOI: 10.1155/2018/8320901] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 06/06/2018] [Indexed: 11/17/2022] Open
Abstract
Dementia with Lewy bodies (DLB) is a complex, multisymptom disorder. When making decisions regarding the treatment of DLB, the patient's quality of life (QoL) should always be the main consideration. To our knowledge, this is the first review article focusing on the QoL in DLB patients. We searched the PubMed database using the keywords "quality of life" and "dementia with Lewy bodies." Previously, no specific instrument had been developed for assessing the QoL in DLB patients. Patients with DLB have a decreased QoL compared to patients with Alzheimer's disease, which is reportedly caused by several factors including level of independence in instrumental activities of daily living, whether the patient is living with the caregiver, apathy, delusion, and dysautonomia. The direct effect of visual hallucination, sleep, and movement disorders on the QoL in DLB patients has not been previously studied. The role of cognitive function on the QoL is still controversial. In a randomized controlled study, memantine may improve the QoL in PDD or DLB patients. We concluded that it is important to develop a specific instrument to assess the QoL in DLB patients. Furthermore, there is an urgent need for large clinical trials to identify factors associated with the QoL and how they can be managed.
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Affiliation(s)
- Chuo-Yu Lee
- Department of Neurology, Mackay Memorial Hospital, Taipei, Taiwan
- Graduate Institute of Chemistry, Tamkang University, New Taipei City, Taiwan
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
| | - Shih-Jung Cheng
- Department of Neurology, Mackay Memorial Hospital, Taipei, Taiwan
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan
| | - Hui-Chi Lin
- Department of Neurology, Mackay Memorial Hospital, Taipei, Taiwan
| | - Yu-Lu Liao
- Department of Accounting Information, Takming University of Science and Technology, Taipei, Taiwan
| | - Pei-Hao Chen
- Department of Neurology, Mackay Memorial Hospital, Taipei, Taiwan
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
- Graduate Institute of Mechanical and Electrical Engineering, National Taipei University of Technology, Taipei, Taiwan
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