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1
Mohr, E., P. Brouwers, J. J. Claus, S. E. Purdon, M. Gagnon, and T. N. Chase. "Differential Classification of Dementia." Behavioural Neurology 8, no. 1 (1995): 23–30. http://dx.doi.org/10.1155/1995/391254.
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In the absence of biological markers, dementia classification remains complex both in terms of characterization as well as early detection of the presence or absence of dementing symptoms, particularly in diseases with possible secondary dementia. An empirical, statistical approach using neuropsychological measures was therefore developed to distinguish demented from non-demented patients and to identify differential patterns of cognitive dysfunction in neurodegenerative disease. Age-scaled neurobehavioral test results (Wechsler Adult Intelligence Scale—Revised and Wechsler Memory Scale) from Alzheimer's (AD) and Huntington's (HD) patients, matched for intellectual disability, as well as normal controls were used to derive a classification formula. Stepwise discriminant analysis accurately (99% correct) distinguished controls from demented patients, and separated the two patient groups (79% correct). Variables discriminating between HD and AD patient groups consisted of complex psychomotor tasks, visuospatial function, attention and memory. The reliability of the classification formula was demonstrated with a new, independent sample of AD and HD patients which yielded virtually identical results (classification accuracy for dementia: 96%; AD versus HD: 78%). To validate the formula, the discriminant function was applied to Parkinson's (PD) patients, 38% of whom were classified as demented. The validity of the classification was demonstrated by significant PD subgroup differences on measures of dementia not included in the discriminant function. Moreover, a majority of demented PD patients (65%) were classified as having an HD-like pattern of cognitive deficits, in line with previous reports of the subcortical nature of PD dementia. This approach may thus be useful in classifying presence or absence of dementia and in discriminating between dementia subtypes in cases of secondary or coincidental dementia.
2
Zanni, Guido, and Jeannette Wick. "Differentiating Dementias in Long-Term Care Patients." Consultant Pharmacist 22, no. 1 (October 1, 2007): 14–28. http://dx.doi.org/10.4140/tcp.n.2007.14.
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Many long-term care residents are diagnosed with dementia, but dementia appears in many forms. Alzheimer's disease, the most common, is typified by a slow onset and relentless progression to complete incapacitation. Vascular dementia usually appears somewhat abruptly, is associated with vascular comorbidities, and has an unpredictable progression pattern. Lewy body dementia shares features of both Alzheimer's and Parkinson's disease; its hallmarks include fluctuating cognitive performance, visual hallucinations, and extrapyramidal motor symptoms. Frontotemporal dementias are associated less with memory disorders and more with behavioral and language aberrations. Mixed dementia covers those patients who do not have an apparent singular cause of dementia. Pseudodementia is a dementia resulting from underlying causes and is reversible, unlike the aforementioned dementias.
3
Mohr, Erich, Denise Walker, Christopher Randolph, Margaret Sampson, and Tilak Mendis. "Utility of Clinical Trial Batteries in the Measurement of Alzheimer's and Huntington's Dementia." International Psychogeriatrics 8, no. 3 (September 1996): 397–411. http://dx.doi.org/10.1017/s1041610296002761.
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Tests used as outcome measures in clinical trials of antidementia agents are not typically employed as part of diagnostic evaluations, and little information exists as to the sensitivity of these tests in terms of either differentiating demented patients from normal individuals or in distinguishing dementias of various types and etiologies. Sensitivity to mild dementia and sensitivity to impairment of various neuropsychological domains are, however, prerequisites for valid use of an instrument as an outcome measure in this context. The present study was undertaken to directly compare six different tests (three traditional psychometric tests and three clinical trial batteries) in terms of their sensitivity to detect and distinguish between mild dementia in patients with either Alzheimer's disease (n = 15) or Huntington's disease (n = 15), when compared to normal controls (n = 15). Tests included the Mattis Dementia Rating Scale, the Mini-Mental State Examination, the Wechsler Memory Scale-Revised, the Alzheimer's Disease Assessment Scale-Cognitive Subscale, the Computerized Drug Research (CDR) Cognitive Assessment System, and the Repeatable Battery for the Assessment of Dementia (RBAD). All of the tests were roughly equivalent in terms of their ability to discriminate normal subjects from mildly demented patients. Only the CDR and RBAD, however, were able to reliably discriminate between the two patient groups. The results are discussed in terms of the applicability of these tests as outcome measures for clinical trials in dementing disorders.
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Langhorne, Samuel. "Patients with dementia and depression-complexity." Psychology and Mental Health Care 2, no. 3 (July 6, 2018): 01–03. http://dx.doi.org/10.31579/2637-8892/030.
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For a long time researchers and clinicians have been trying to clarify the possible existing relationships between Alzheimer’s disease and the depression in the elderly. This article tries to take stock of these complex links. It seems that often depression is clinically confused with apathy.
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Cummings, Jeffrey L. "Neuropsychiatric Assessment and Intervention in Alzheimer's Disease." International Psychogeriatrics 8, S1 (October 1996): 25–30. http://dx.doi.org/10.1017/s1041610296003043.
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Dementia is a major public health problem in the United States and the world, requiring the expenditure of enormous economic and human resources. Dementia is common in the elderly, and, as the size of the aged population increases, the number of dementia victims will rise. Many dementias are fatal, producing the gradual erosion of intellectual abilities and eventual death of the patient. Demands made on family members and caregivers of dementia patients are extraordinary and often result in their emotional and financial exhaustion. Although basic science efforts are devoted to finding a cure for Alzheimer's disease (AD) and other dementing illnesses, there is an urgent need for research that has immediate applicability to the 4 million current dementia patients.
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Cipriani, Gabriele, Sabrina Danti, Lucia Picchi, Angelo Nuti, and Mario Di Fiorino. "Daily functioning and dementia." Dementia & Neuropsychologia 14, no. 2 (June 2020): 93–102. http://dx.doi.org/10.1590/1980-57642020dn14-020001.
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Abstract. Dementia is characterized by a decline in memory, language, problem-solving and in other cognitive domains that affect a person’s ability to perform everyday activities and social functioning. It is consistently agreed that cognitive impairment is an important risk factor for developing functional disabilities in patients with dementia. Functional status can be conceptualized as the ability to perform self-care, self- maintenance and physical activity. A person with dementia usually requires help with more complex tasks, such as managing bills and finances, or simply maintaining a household. Good functional performance is fundamental for elderly people to maintain independency and avoid institutionalization. The purpose of this review is to describe functional changes in demented patients, evaluating the variability in subgroups of dementias.
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Eloniemi-Sulkava, Ulla, Irma-Leena Notkola, Kaija Hämäläinen, Terhi Rahkonen, Petteri Viramo, Maija Hentinen, Sirkka-Liisa Kivelä, and Raimo Sulkava. "Spouse Caregivers' Perceptions of Influence of Dementia on Marriage." International Psychogeriatrics 14, no. 1 (March 2002): 47–58. http://dx.doi.org/10.1017/s104161020200827x.
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Objectives: To investigate what kind of changes spouse caregivers of demented patients experience after the onset of dementia (a) in the general atmosphere, happiness, and relations of marriage and (b) in the sexual side of marriage. Design: Semistructured telephone interviews of spouse caregivers of demented patients. Setting: Community-living demented patients and their spouse caregivers in eastern Finland. Participants: The spouse caregivers of 42 demented patients recruited from a previous intervention study. Measures: The questionnaire covered different areas of marriage from the time before and after the onset of dementia. Results: A statistically significant decline had occured in extent of happiness (p = .012), in equal relations (p = .001), and in patients' expressions of sexual needs (p < .001) when compared the time before and after dementia. Twenty-five (60%) of the caregivers reported that the demented patient had shown at least one negative sexual behavioral change during the course of dementia. Seven male patients (24%) had shown the behavioral symptom of constantly expressing need for making love. One in 10 caregivers had experienced positive sexual behavioral changes. In one third of the patients, the expressions of tenderness towards the caregiver had increased. Dementia did not affect significantly the general atmosphere of the marriage. Out of those still in home care, at 3 years from the onset of dementia, 19 couples (46%) continued to practice intercourse, at 5 years the number was 15 couples (41%), and at 7 years it had declined to 7 couples (28%). Conclusions: Dementing illness has a major negative impact on many dimensions of marriage. However, there are also positive changes and preserved aspects of marriage. Dementia seems to have a surprisingly little impact on whether the couple continues to have intercourse when compared with the general aging population.
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Hershey, Linda A., David F. Jaffe, P. Gregg Greenough, and Shu-Li An Yang. "Validation of Cognitive and Functional Assessment Instruments in Vascular Dementia." International Journal of Psychiatry in Medicine 17, no. 2 (June 1988): 183–92. http://dx.doi.org/10.2190/af5l-ah89-llv7-xen4.
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Vascular dementia is a common and potentially reversible type of dementing illness. Simple, yet valid, assessment instruments are needed to quantitate the severity of cognitive and functional impairment in vascular dementia patients seen in consultation or studied in therapeutic trials. Among sixty-three patients with known ischemic cerebrovascular disease, we found thirteen who satisfied research criteria for vascular dementia, nineteen who were “borderline” and thirty-one who were not demented. We administered the Cognitive Capacity Screening Examination and the Functional Activities Questionnaire to these patients and found both tests capable of distinguishing demented from nondemented groups with a high degree of sensitivity and specificity. This battery of assessment instruments was especially helpful in evaluating patients who fell into the “borderline” category. Both tests can be easily administered at the bedside or during routine office visits.
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Torian, Lucia, Emily Davidson, George Fulop, Laura Sell, and Howard Fillit. "The Effect of Dementia on Acute Care in a Geriatric Medical Unit." International Psychogeriatrics 4, no. 2 (September 1992): 231–39. http://dx.doi.org/10.1017/s1041610292001066.
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Treatment of dementia costs billions of dollars in long-term care and community services every year. Dementia also burdens the acute care system and may contribute to financial problems for hospitals serving large numbers of demented elderly. In a specialized geriatric medical unit devoted to acute care of the frail elderly, Alzheimer's disease and vascular and mixed dementias afflicted 63% of inpatients and were associated with excess consumption of nursing resources, complications of treatment, nosocomial infections, lengthy hospitalizations, and financial losses to the hospital. Due in part to the effects of dementia on mobility, continence, and nutrition, demented patients suffered more frequently from life-threatening infections, sepsis, iatrogenic disease, and prolonged hospital stays. Hospital losses were 75% higher for demented patients than for nondemented patients.Dementia affected the majority of acute care patients in this study. However, it was rarely coded as an admitting diagnosis, even though it may have been the proximate cause of the medical morbidity which led to the acute hospitalization. In addition, despite the significant impact of dementia on the hospital course and costs, it was a factor in hospital reimbursement in less than one third of cases. The results indicate that dementia was not considered to be an acute diagnosis, nor was it recognized as a complex medical illness. The impact of dementia on acute hospitalization, including the mechanisms by which dementia prolongs the hospital stay, requires further investigation.
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Brouwers, P., E. Mohr, K. Hildebrand, M. Hendricks, J. J. Claus, I. S. Baron, M. Young, and P. Pierce. "A Novel Approach to the Determination and Characterization of HIV Dementia." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 23, no. 2 (May 1996): 104–9. http://dx.doi.org/10.1017/s0317167100038804.
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ABSTRACT:Background: Neuropsychological studies of the pattern and extent of cognitive impairment in HIV-infected patients have mostly used deviations from control values and/or cut-off scores as criteria for classification of dementia. There is, however, no agreement as to how to define impairment, and classification is imprecise. Method: The current study used a dementia classification matrix, developed with a step-wise linear discriminant analysis of neuropsychological data from patients with primary neurodegenerative dementias, to classify symptomatic HIV patients as demented or non-demented, and further to differentiate cortical and subcortical dementia patterns. Thirty-two male and 2 female patients (mean age 39 ± 2) with symptomatic HIV disease (mean absolute CD4 count 195 ±41) participated in the study. Results: Thirty-five per cent of patients were classified as demented. Of these, 83% showed a subcortical pattern and 17% a cortical profile of deficits. Significant differences between patients classified as subcortically demented and those categorized as normal on neuropsychological measures associated with subcortical integrity further validated the classification. Measures of psychiatric status between subgroups were similar. Conclusion: Since certain treatments may delay or reverse cognitive deficits, the use of an objective classification method based on discriminant analysis may help to identify patients who may benefit from therapy.
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Jelastopulu, Eleni, Evangelia Giourou, Konstantinos Argyropoulos, Eleftheria Kariori, Eleftherios Moratis, Angeliki Mestousi, and John Kyriopoulos. "Demographic and Clinical Characteristics of Patients with Dementia in Greece." Advances in Psychiatry 2014 (November 17, 2014): 1–7. http://dx.doi.org/10.1155/2014/636151.
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Introduction. Dementia’s prevalence increases due to population aging. The purpose of this study was to determine the demographic profile of Greek patients with dementia and the differences in management between the urban and rural population. Methods. A cross sectional study was carried out including 161 randomly selected specialists from different regions in Greece who filled in a structured questionnaire relating to patients with dementia, regarding various sociodemographic and clinical characteristics. Results. A total of 4580 patients (52% males) with dementia were recorded. Mean age was 73.6 years and 31% lived in rural areas. The Mini Mental Status Examination (MMSE) was used in 87% of cases. In the urban areas the diagnosis of dementia was made in an earlier stage of the disease in comparison to the rural areas (P=0.013). Higher comorbidity and a higher percentage of low education were evident in rural residents (P<0.001), while higher medication usage was observed in urban patients (P=0.04). Conclusions. The results implicate the need for improvement in health care delivery in Greek rural areas and health care professionals’ training to achieve a proper treatment of dementias and increase the quality of life among the elderly habitants of remote areas.
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Custodio, Nilton, David Lira, Eder Herrera-Perez, Liza Nuñez del Prado, José Parodi, Erik Guevara-Silva, Sheila Castro-Suarez, and Rosa Montesinos. "Cost-of-illness study in a retrospective cohort of patients with dementia in Lima, Peru." Dementia & Neuropsychologia 9, no. 1 (March 2015): 32–41. http://dx.doi.org/10.1590/s1980-57642015dn91000006.
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Dementia is a major cause of dependency and disability among older persons, and imposes huge economic burdens. Only a few cost-of-illness studies for dementia have been carried out in middle and low-income countries. OBJECTIVE: The aim of this study was to analyze costs of dementia in demented patients of a private clinic in Lima, Peru. Methods. We performed a retrospective, cohort, 3-month study by extracting information from medical records of demented patients to assess the use of both healthcare and non-healthcare resources. The total costs of the disease were broken down into direct (medical and social care costs) and indirect costs (informal care costs). Results. In 136 outpatients, we observed that while half of non-demented patients had total care costs of less than US$ 23 over three months, demented patients had costs of US$ 1500 or over (and more than US$ 1860 for frontotemporal dementia). In our study, the monthly cost of a demented patient (US$ 570) was 2.5 times higher than the minimum wage (legal minimum monthly wage in Peru for 2011: US$ 222.22). Conclusion. Dementia constitutes a socioeconomic problem even in developing countries, since patients involve high healthcare and non-healthcare costs, with the costs being especially high for the patient's family.
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Bello, Valeska Maria Eboli, and Rodrigo Rizek Schultz. "Prevalence of treatable and reversible dementias: A study in a dementia outpatient clinic." Dementia & Neuropsychologia 5, no. 1 (March 2011): 44–47. http://dx.doi.org/10.1590/s1980-57642011dn05010008.
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Abstract Dementia is a syndrome characterized by the development of multiple cognitive deficits and behavioral changes that leads to impairment of functional activities. There are primary degenerative, progressive and irreversible dementias, and other dementias resulting from a progressive but potentially reversible dementia of secondary origin. Objective: To assess the prevalence of cases with a diagnosis of potentially reversible dementia at a Behavioral Neurology Outpatient Unit. Methods: A retrospective study based on a review of 340 medical records of patients seen from 1999 to 2009 was conducted. All patients received a thorough diagnostic assessment to verify the etiological hypothesis proposed. Results: Of the 340 patients seen in the study period, 172 (50.5%) were females and 168 (49.5%) males, 90 patients (26.4%) were under 60 years of age, and 250 (73.6%) were over 60 years of age. Alzheimer's disease, with 89 cases (26%), followed by vascular dementia with 39 cases (11.47%), were the leading etiological diagnoses. A total of 193 patients had dementia and 37 of these (19.17%) were found to have potentially reversible dementias, distributed as follows: head injury: 15 patients; alcohol-related dementias: 11 patients; meningoencephalitis: 2 patients; hypothyroidism: 2 patients; neurosyphilis: 2 patients; normal pressure hydrocephalus: 2 patients; AIDS: 1 patient; Korsakoff's syndrome: 1 patient, and Post-anoxic dementia: 1 patient. Conclusions: A significant number of patients were found to have potentially reversible dementias (19.17%). These data show an urgent need for more extensive diagnostic investigation, and indicate the possibility of reversing some dementias, especially cases detected early.
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Lyu, Jiyoung, and Yeon Ok Lim. "Exploring Direct Care Workers' Experiences with Dementia Patients." Crisis and Emergency Management: Theory and Praxis 12, no. 4 (April 30, 2022): 19–26. http://dx.doi.org/10.14251/jscm.2022.4.19.
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This study aimed to elicit and understand the experience of direct care workers involved with dementia patients. Conventional content analysis was used in this study. Fifteen direct care workers, associated with either nursing homes or elderly daycare centers in Korea, were recruited. Semi-structured, in-depth interviews were conducted to collect data. All interviews were recorded using digital devices, transcribed, and qualitatively analyzed. Four key areas were identified: (1) confusion due to ignorance and inexperience; (2) difficulties due to personal, familial, and environmental obstacles; (3) accustomed care skills learned from one's own experience; and (4) unintentional discrimination. The results suggest that even though direct care workers are educated on dementia, their knowledge and caring skills are not adequate to manage diverse dementia symptoms.
Therefore, it is necessary and important to develop scientific and systematic dementia education programs and care skills to improve the quality of care.
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Leroi, I., C. Steele, and C. G. Lyketsos. "The care of patients with dementia." Reviews in Clinical Gerontology 9, no. 3 (August 1999): 235–55. http://dx.doi.org/10.1017/s0959259899009351.
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The dementias which affect the elderly are chronic diseases with protracted courses, substantial morbidity, complicated presentations and serious effects on families and caregivers. The care of a patient with dementia is therefore complex, requiring a rational model of treatment including careful multidisciplinary evaluation, a treatment plan, and ongoing reassessment. The aim of this article is to provide a framework for any clinician involved in the management of patients with dementia. Dementia has been thought of as untreatable by some health professionals: however, in many ways it can be managed effectively and its consequences reversed or stabilized, even though the disease process may be irreversible. With evolving knowledge in basic research and with the development of new intervention strategies, more effective treatments will be available over the next several years. Therefore we provide a guide to the management of patients with dementia which is responsive to the introduction of future treatments.
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Lautenschlager, Nicola T., and Ralph N. Martins. "Common versus uncommon causes of dementia." International Psychogeriatrics 17, s1 (September 2005): S27—S34. http://dx.doi.org/10.1017/s1041610205002000.
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When patients present with a dementia syndrome at a young age, the experienced clinician will automatically include uncommon dementias in the diagnostic considerations, as familial uncommon dementias due to genetic mutations frequently present as early-onset dementias. This paper highlights why uncommon dementias due to genetic mutations, although marginal in terms of prevalence numbers in the total population, are of significance in the quest to unravel the underlying cause of common dementias such as Alzheimer's disease (AD), dementia with Lewy bodies (DLB), frontotemporal dementias (FTD) and vascular dementia (VaD).
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Jones, R. W. "Dementia." Scottish Medical Journal 42, no. 5 (October 1997): 151–53. http://dx.doi.org/10.1177/003693309704200512.
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Dementia in general and Alzheimer's disease in particular represent conditions where new findings are being made rapidly. Some of these developments will lead to progress of increasing clinical value to patients and their carers. This review will begin with some general points about dementia before considering current developments in Alzheimer's disease and other specific dementias in more detail.
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Hogan, David B., Daniel E. Thierer, Erika M. Ebly, and Irma M. Parhad. "Progression and Outcome of Patients in a Canadian Dementia Clinic." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 21, no. 4 (November 1994): 331–38. http://dx.doi.org/10.1017/s0317167100040919.
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Abstract:Five hundred and fifty-three patients were referred to a Canadian dementia clinic for standardized evaluation. The majority (83.5%) had a dementia with Alzheimer’s disease (AD) accounting for 89% of dementias. Patients with probable AD who were followed for five years had variable rates of progression, increased mortality (37.1%, 2.5 times the expected rate) and a high rate of institutionalization (79%). Simple demographic (age) and social factors (marital status) were strong predictors for institutionalization. It was extremely difficult at presentation to predict the rate of progression. The prevalence of AD in autopsied cases was 62.5%. Clinic patients were younger, had milder dementias, and were more likely to have AD than patients identified in the course of a contemporaneous population-based dementia prevalence study.
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Davis, Laura, Zarina Karim, and Tom Dening. "Diagnostic, management and nursing challenges of less common dementias: Frontotemporal dementia, alcohol-related dementia, HIV dementia and prion diseases." British Journal of Neuroscience Nursing 18, no. 1 (February 2, 2022): 26–37. http://dx.doi.org/10.12968/bjnn.2022.18.1.26.
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Background: Most cases of dementia are due to Alzheimer's disease or vascular dementia, but attention on these disorders means that other important causes of dementia may be relatively neglected. About 10–15% of people with dementia have other diagnoses, and there are numerous causes of the less common types of dementia. Aims: This paper provides information about the causes, symptoms, diagnosis and nursing management of some of the different types of less common dementias, with the aim of helping nurses to provide better care to patients and families affected. Methods: This is one of two connected papers and provides a narrative review of the literature on the clinical presentation of frontotemporal dementia, HIV dementia, prion dementias and alcohol-related dementia. Findings: Frontotemporal dementia has important clinical subtypes with distinct different presentations; for example, predominantly behavioural symptoms or progressive language dysfunction. Alcohol-related dementia is one of several types of alcohol-related brain damage. This is important as, with abstinence, its progression may be halted or even to some extent improved. HIV dementia has become less common since the introduction of effective antiretroviral therapy, but, nonetheless, the less severe picture of HIV-associated cognitive dysfunction remains prevalent despite treatment. Prion dementias encompass sporadic, familial and acquired Creutzfeldt-Jakob disease and are incurable, therefore requiring extensive palliative care. Conclusions: These forms of dementia all have different symptoms and courses from common types of dementia, such as Alzheimer's disease. It is important for nurses to be aware that dementia may have several causes and that people with different dementias will have different needs. Nonetheless, the general skills of nurses in supporting patients and families remain essential in order to develop appropriate care plans and to provide individualised, person-centred care.
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Elmståhl, Sölve, Ingegerd Stenberg, Lena Annerstedt, and Bengt Ingvad. "Behavioral Disturbances and Pharmacological Treatment of Patients With Dementia in Family Caregiving: A 2-Year Follow-Up." International Psychogeriatrics 10, no. 3 (September 1998): 239–52. http://dx.doi.org/10.1017/s1041610298005353.
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Behavioral disturbances are common in dementia. Polypharmacy due to progression of disease and fluctuation of symptoms among patients might increase risk of overtreatment and/or undertreatment. Drug prescription habits were studied in relationship to symptoms of dementia after relocation of patients to group-living care units (GC). Seventy-six demented patients (mean age 81 years) were assessed before, 12 months after, and 24 months after relocation to GC. Vascular dementia was found in 47%, Alzheimer's dementia in 46%, and other dementias in 7%. Medications, regular or as required, were recorded from medication lists. Repeated observations of symptoms like depressive mood and lack of vitality were made with validated scales. Eighty percent of the patients were prescribed drugs; 40% were given neuroleptics and 9% were given antidepressants. During the 2-year follow-up, polypharmacy increased; patients with five drugs or more increased from 15% to 35%; usage of neuroleptics or sedatives, as required, increased from 8% to 25%, p < .01. Depressive mood was noted in 86% after 2 years and 74% showed aggressiveness and anxiety, but only 12% of the patients with depressive symptoms were on antidepressants. Analgesics were prescribed to 26% of patients. In conclusion, a high proportion of patients with dementia had depressive mood and undertreatment of depressive disorder might be suspected. Polypharmacy increased during the 2-year follow-up; this finding calls for careful monitoring of adverse drug reactions, because of the deteriorating cognitive function of these patients.
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Zupanic, Eva, Mia von Euler, Bengt Winblad, Hong Xu, Juraj Secnik, Milica Gregoric Kramberger, Dorota Religa, Bo Norrving, and Sara Garcia-Ptacek. "Mortality After Ischemic Stroke in Patients with Alzheimer’s Disease Dementia and Other Dementia Disorders." Journal of Alzheimer's Disease 81, no. 3 (June 1, 2021): 1253–61. http://dx.doi.org/10.3233/jad-201459.
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Background: Stroke and dementia are interrelated diseases and risk for both increases with age. Even though stroke incidence and age-standardized death rates have decreased due to prevention of stroke risk factors, increased utilization of reperfusion therapies, and other changes in healthcare, the absolute numbers are increasing due to population growth and aging. Objective: To analyze predictors of death after stroke in patients with dementia and investigate possible time and treatment trends. Methods: A national longitudinal cohort study 2007–2017 using Swedish national registries. We compared 12,629 ischemic stroke events in patients with dementia with matched 57,954 stroke events in non-dementia controls in different aspects of patient care and mortality. Relationship between dementia status and dementia type (Alzheimer’s disease and mixed dementia, vascular dementia, other dementias) and death was analyzed using Cox regressions. Results: Differences in receiving intravenous thrombolysis between patients with and without dementia disappeared after the year 2015 (administered to 11.1% dementia versus 12.3% non-dementia patients, p = 0.117). One year after stroke, nearly 50% dementia and 30% non-dementia patients had died. After adjustment for demographics, mobility, nursing home placement, and comorbidity index, dementia was an independent predictor of death compared with non-dementia patients (HR 1.26 [1.23–1.29]). Conclusion: Dementia before ischemic stroke is an independent predictor of death. Over time, early and delayed mortality in patients with dementia remained increased, regardless of dementia type. Patients with≤80 years with prior Alzheimer’s disease or mixed dementia had higher mortality rates after stroke compared to patients with prior vascular dementia.
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Sunderland, Trey, and Marcia Minichiello. "Dementia Mood Assessment Scale." International Psychogeriatrics 8, S3 (May 1997): 329–31. http://dx.doi.org/10.1017/s1041610297003578.
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The behavioral symptoms seen in patients with dementia are diverse, ranging from agitation to hallucinations and paranoid delusions. Many patients with dementia have affective disturbances, including depressed mood. To provide a means of assessing the severity of depression and mood changes in demented patients, the authors and colleagues at the National Institute of Mental Health developed the Dementia Mood Assessment Scale.
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Verhey, Frans R. J., and Pieter Jelle Visser. "Phenomenology of Depression in Dementia." International Psychogeriatrics 12, S1 (July 2000): 129–34. http://dx.doi.org/10.1017/s1041610200006906.
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Dementia and depression are the two most prevalent psychiatric disorders in the elderly. Although dementia has traditionally been viewed as a disorder of cognition, and depression as a disorder of mood, this simple classification has recently been questioned, and the complex interrelationship between depression and dementia is being elucidated (Emery & Oxman, 1992; Raskind, 1998). Patients with depression may show cognitive deficits, simulating dementia (Berrios, 1989), and patients with dementing disorders may show symptoms of depression (Allen & Burns, 1995; Burns, 1991). In addition, depression may precede dementia and represent the very first signs of dementing illness, or may be a risk factor for subsequent dementia.
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Fu, Catherina, Dennis J. Chute, Emad S. Farag, Justine Garakian, Jeffrey L. Cummings, and Harry V. Vinters. "Comorbidity in Dementia." Archives of Pathology & Laboratory Medicine 128, no. 1 (January 1, 2004): 32–38. http://dx.doi.org/10.5858/2004-128-32-cid.
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Abstract Context.—There is a paucity of accurate postmortem data pertinent to comorbid medical conditions in patients with dementia, including Alzheimer disease. Objectives.—The purposes of this study were (a) to examine general autopsy findings in patients with a dementia syndrome and (b) to establish patterns of central nervous system comorbidity in these patients. Design.—Review of autopsy reports and selected case material from 202 demented patients who had “brain-only” autopsies during a 17-year period (1984–2000) and from 52 demented patients who had general autopsies during a 6-year period (1995–2000). Setting.—Large academic medical center performing approximately 200 autopsies per year. Results.—Among the 52 patients who underwent complete autopsy, the most common cause of death was bronchopneumonia, which was found in 24 cases (46.1%). Other respiratory problems included emphysema, found in 19 (36.5%) of 52 patients, and pulmonary thromboembolism, found in 9 (17.3%) of 52 patients. In 6 cases, pulmonary thromboembolism was the proximate cause of death. Twenty-one (40.3%) of the 52 patients had evidence of a myocardial infarct (varying ages) and 38 (73.1%) had atherosclerotic cardiovascular disease, 27 of a moderate to severe degree. Four clinically unsuspected malignancies were found: 1 each of glioblastoma multiforme, diffusely infiltrative central nervous system lymphoma, pancreatic adenocarcinoma, and adenocarcinoma of the lung. One patient with frontotemporal dementia and amyotrophic lateral sclerosis died of severe meningoencephalitis/ventriculitis, probably secondary to seeding of the central nervous system by an infected cardiac valve. Of the 202 demented patients who underwent brain-only autopsies, the following types of dementia were found: 129 (63.8%) cases showed changes of severe Alzheimer disease, 21 (10.4%) showed combined neuropathologic abnormalities (Alzheimer disease plus another type of lesion, such as significant ischemic infarcts or diffuse Lewy body disease), 12 (5.9%) cases of relatively pure ischemic vascular dementia, 13 (6.4%) cases of diffuse Lewy body disease, and 8 (4.0%) cases of frontotemporal dementia. The remaining 19 (9.4%) patients showed miscellaneous neuropathologic diagnoses, including normal pressure hydrocephalus and progressive supranuclear palsy. Among the demented patients, 92 (45.5%) had cerebral atherosclerosis, which was moderate to severe in 65 patients (32.2%). Conclusions.—Some of the conditions found at autopsy, had they been known antemortem, would likely have affected clinical management of the patients. Autopsy findings may be used as a quality-of-care measure in patients who have been hospitalized in chronic care facilities for a neurodegenerative disorder.
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Wright, Christine E., and Paul L. Furlong. "Visual Evoked Potentials in Elderly Patients with Primary or Multi-Infarct Dementia." British Journal of Psychiatry 152, no. 5 (May 1988): 679–82. http://dx.doi.org/10.1192/bjp.152.5.679.
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Flash and pattern-reversal visual evoked potentials (VEP) were recorded in 35 elderly patients with dementia, and 19 controls of equivalent age. Dementia produced a slowing of the major positive (P2) component of the flash VEP but did not affect the latency of the flash P1 component or the P100 pattern-reversal component. This unusual type of abnormality was found in both primary and multi-infarct types of dementia, and has previously been found in primary presenile dementia. The results show that the VEP can be used for the diagnosis of multi-infarct, and primary presenile and senile dementias.
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STERN, YAAKOV, MING-XIN TANG, DIANE M. JACOBS, MARY SANO, KAREN MARDER, KAREN BELL, GEORGE DOONEIEF, PETER SCHOFIELD, and LUCIEN CÔTÉ. "Prospective comparative study of the evolution of probable Alzheimer's disease and Parkinson's disease dementia." Journal of the International Neuropsychological Society 4, no. 3 (May 1998): 279–84. http://dx.doi.org/10.1017/s1355617798002793.
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No previous comparison of test performance in probable Alzheimer's disease (pAD) and Parkinson's disease (PD) dementia has provided information about potential differences in the dementing process. This study compared the evolution of cognitive changes associated with these dementias. Generalized estimating equations (GEE) applied to regression analyses with repeated measures were used to evaluate cognitive changes over 1 to 3 years prior to the point when dementia was diagnosed in 40 matched pairs of patients with incident pAD and PD dementia. Both groups' performance declined on the Short Blessed, Selective Reminding Test (SRT; total recall, long-term retrieval, and delayed recall), Boston Naming Test, Category Fluency, and Similarities. The decline on naming and SRT delayed recall was more rapid in the PD dementia group, suggesting that these performance deficits emerge earlier in the development of pAD. The PD dementia group performed worse on Category Fluency throughout the follow-up period, suggesting either that dementia is overlaid on this preexisting performance deficit or that this type of executive deficit is an early manifestation of dementia in PD. The pAD group performed more poorly throughout the follow-up period on SRT delayed recognition, consistent with a pAD-specific encoding deficit. We conclude that while pAD and PD dementia are similar in many respects, differences in their evolution support previous observation of unique features in the 2 dementias and suggest different underlying pathologies. (JINS, 1998, 4, 279–284.)
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Goldberg, Terry E., Joel E. Kleinman, David G. Daniel, Michael S. Myslobodsky, John D. Ragland, and Daniel R. Weinberger. "Dementia Praecox Revisited." British Journal of Psychiatry 153, no. 2 (August 1988): 187–90. http://dx.doi.org/10.1192/bjp.153.2.187.
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Thirty-nine patients with DSM–III diagnoses of schizophrenia were examined for age disorientation, an inability to produce one's correct chronological age upon request. Six patients were age-disoriented and demented (as defined by Mini-Mental State evaluation), while two patients had delusions concerning their age, but were not demented. Age-disoriented, demented patients had very large cerebral ventricles and very low Mini-Mental State scores. This group differed on the cognitive and neuroanatomic variables from other demented, but not age-disoriented, patients, as well as from non-demented patients who were age-oriented. The age-disoriented patients appeared to be at an extreme end of the dementia spectrum in schizophrenia.
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Sánchez Iglesias, Ana, José Antonio Del Barrio, Josefa González-Santos, Florencio Vicente Castro, Jerónimo González, David Padilla Góngora, Alfredo Jiménez, et al. "MINDFULNESS Y REHABILITACIÓN NEUROCOGNITIVA." International Journal of Developmental and Educational Psychology. Revista INFAD de Psicología. 1, no. 1 (October 2, 2017): 21. http://dx.doi.org/10.17060/ijodaep.2017.n1.v1.895.
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Abstract.MINDFULNESS AND NEUROCOGNITIVE REHABILITATION.Nowadays approximately fifty million persons are suffering from dementia throughout the world according to the latest statistics of the European Commission (2016). Moreover, every year new 7.7 million instances of this disease are detected. At this moment, Alzheimer’s disease would be the most common mental disorder in terms of world population health, in other words, this disease can signify 70% of all dementia. Even now pharmacological treatments are ineffective. Consequently, utilization of non pharmacological therapies is opening a wide range of possibilities aimed to increase prevention and, at the same time, improvement in living standards of careers and relatives of patients with dementia who are usually overburdened. This presentation contains a review about researches on mindfulness (MF) and its implementation like potentially strategies aimed to treat this disorder.Keywords: Dementias, Mindfulness, Neuroimagen, meta-analysis.Resumen.Los últimos datos aportados por la Comisión Europea señalan que la demencia afecta actualmente a casi cincuenta millones de personas en todo el mundo y que cada año se detectan 7.7 millones de nuevos casos. A día de hoy, el Alzheimer es la demencia más padecida por la población mundial pudiendo constituir en términos relativos el 70% de las demencias. En la actualidad no existen tratamientos farmacológicos que den una respuesta definitiva a este tipo de patologías. Las utilizaciones de terapias no farmacológicas abren un amplio abanico de posibilidades desde el ámbito de la prevención, y de la mejora de la calidad de vida en cuidadores y familiares de enfermos con demencia, básicamente con sintomatología de “sobrecarga”. En este articulo hacemos una revisión sobre investigaciones relacionadas con la “atención plena” ( MF) y de su implementación como estrategias potenciales en el abordaje de este tipo de patologías. Los últimos trabajos aportados con técnicas morfométricas por neuroimagen constituyen un importante avance a la hora de intentar aportar evidencia científica en este campo.Palabras clave: Demencias, Mindfulness, Neuroimagen, Meta-análisis, Rehabilitación.
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Kim, Seon-Jip, Sang Min Park, Hyun-Jae Cho, and Ji Woon Park. "Primary headaches increase the risk of dementias: An 8-year nationwide cohort study." PLOS ONE 17, no. 8 (August 18, 2022): e0273220. http://dx.doi.org/10.1371/journal.pone.0273220.
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Background Headache, a highly prevalent neurological disorder, has consistently been linked with an elevated risk of dementia. However, most studies are focused on the relationship with migraine in limited age groups. Therefore, the objective of this research was to look at the link between various type of headaches and dementias based on longitudinal population-based data. Methods and results Participants diagnosed with headache from 2002 to 2005 were selected and major covariates were collected. The diagnoses of Alzheimer’s disease, vascular dementia, and other dementias were observed from 2006 until 2013. The adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) of dementias according to headache type were calculated by Cox proportional hazards regression. A number of 470,652 participants were observed for a mean of 7.6 years (standard deviation: 1.2), for approximately 3.6 million person-years. Both tension type headache (TTH) and migraine elevated the risk of all-cause dementias (TTH, aHR 1.18, 95% CI 1.13–2.24; migraine, aHR 1.18, 95% CI 1.13–2.24). Headaches had a greater influence in females and non-smokers as a risk factor of dementias. Patients with migraine who consumed alcohol had a higher risk of dementia, however this was not true with TTH patients. Among participants without comorbidities, TTH patients were more susceptible to dementia than migraine patients. Headache patients had a higher proportion of females regardless of headache type and approximately 1.5 times more individuals had three or more comorbidities compared to those without headache. Conclusions Headache could be an independent predictor for subsequent dementia risk. Future studies should focus on clarifying pathogenic pathways and possible dementia-related preventive measures in headache populations.
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Sá Esteves, P., D. Loureiro, E. Albuquerque, F. Vieira, L. Lagarto, S. Neves, and J. Cerejeira. "Dementia in acutely-ill medical elderly patients." European Psychiatry 33, S1 (March 2016): S190. http://dx.doi.org/10.1016/j.eurpsy.2016.01.429.
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IntroductionDementia is one of the leading causes of disability and burden in Western countries. In Portugal, there is a lack of data regarding dementia prevalence in hospitalized elderly patients and factors associated with in-hospital adverse outcomes of these patients.ObjectivesDetermine dementia prevalence in acutely-ill medical hospitalized elderly patients and its impact in health outcomes.MethodsAll male patients (> 65 years) admitted to a medical ward (> 48 h) between 1.03.2015 to 31.08.2015 were included in the study. Patients were excluded if unable to be assessed due to sensorial deficits, communication problems or severity of the acute medical condition. Baseline evaluation included socio-demographic variables, RASS, NPI, Barthel Index and Confusion Assessment Method.ResultsThe final sample consisted of 270 male subjects with a mean age of 80.9 years, 116 (43%) having prior dementia. Dementia patients were significantly older (83.5 vs 78.9; P < 0.001) and had lower values of Barthel Index (dementia: 34.8 vs non-dementia: 85.8; P < 0.001). Mortality rate (9,3%) and length of hospitalization (11.2 days) were similar between groups (12.1 vs 7.1; P = 0.204 and 11.9 vs 10.6; P = 0.218, respectively). Patients with dementia had higher rates of all neuropsychiatric symptoms except depression, anxiety and mood elation. The level of consciousness (measured by RASS) was impaired in 50% of patients with dementia, which was significantly higher than in non-demented subjects (12.3%; P < 0.001). Delirium rates were 29.5% in dementia compared with 7.1% in controls (P < 0.001).ConclusionsThere is a high prevalence of dementia and an appreciable rate of delirium among these patients.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Gan, Jinghuan, Meng Wang, Shuai Liu, Zhichao Chen, Xiao-Dan Wang, and Yong Ji. "Effect of Multiple Medicines on Dementia Initial Treatment: Experience and Thinking." American Journal of Alzheimer's Disease & Other Dementias® 36 (January 2021): 153331752110531. http://dx.doi.org/10.1177/15333175211053134.
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Little is known about multiple medicines and initial therapy among people with dementia. To examine the effect of multiple medicines on the initiation of anti-dementia therapy in patients diagnosed with cognitive impairment (CI), a retrospective study with 2742 CI patients was conducted based on the outpatients’ medical records. The dementias receiving 1–2 drugs were more likely to be prescribed with anti-dementia (one drug: OR = 1.877; two drugs: OR = 1.770) and psychotropic (one drug: OR = 1.980) treatment, whereas had lower chances of receiving psychotropic medication with the combinations of more than three drugs (Alzheimer’s disease: OR = .365; vascular dementia: OR = .940; frontotemporal lobe degeneration: OR = .957; and dementia with Lewy bodies/Parkinson’s disease dementia: OR = .952). Multiple medicines can affect anti-dementia therapy initiation in dementia patients and should be paid extreme caution.
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Johansson, Alf, and Lars Gustafson. "Psychiatric Symptoms in Patients With Dementia Treated in a Psychogeriatric Day Hospital." International Psychogeriatrics 8, no. 4 (December 1996): 645–58. http://dx.doi.org/10.1017/s1041610296002955.
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Sixty-five consecutive patients with dementia, treated at a psychogeriatric day hospital, were studied regarding prevalence of psychiatric symptoms. The clinical diagnoses were dementia of the Alzheimer type (n = 19), vascular dementia (n = 27), mixed Alzheimer's disease and vascular dementia (n = 13), vascular dementia of frontal type (n = 2), and other diseases (n = 4). Mean age at referral was 75.6 ± 6.6 years and the average treatment time was 21 ± 14 months. About 90% of the patients showed one or several significant psychiatric symptoms during the course of dementia. Most common were delirious episodes, anxiety, sleep distrubances, and depressed mood. The relationship between clinical features and the type and duration of dementia was analyzed. Sleep disturbances and depressed mood often appeared early, whereas misidentification and delusions became more prevalent later in the course of dementia. The results indicate that the psychogeriatric day hospital may offer effective and flexible care and support to demented persons living at home.
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Hasna Imami, Nabilah, Yudha Haryono, Anggraini Dwi Sensusiati, Muhammad Hamdan, and Hanik Badriyah Hidayati. "DEMENTIA IN DR. SOETOMO GENERAL HOSPITAL SURABAYA: A SYNTHETIC REVIEW OF ITS CHARACTERISTICS." MNJ (Malang Neurology Journal) 7, no. 1 (January 1, 2021): 12–16. http://dx.doi.org/10.21776//ub.mnj.2021.007.01.3.
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Background: Dementia is a clinical syndrome characterized by progressive loss of cognitive function in elderly people interferes the ability to function independently. The number of elderly patients increased so fast in worldwide. The prevalence of dementia rapidly increases due to increasing of population. Aging demographic transition is proceeding rapidly especially in China, India, and Latin America, where dementia is rapidly becoming the major public health problem. Demographic data of elderly patients of dementia in Indonesia is still a little. Dementia’s research data in Indonesia were only obtained from Bali and Yogyakarta, while data from Surabaya were not obtained. Our research data is taken from Dr. General Hospital Soetomo Surabaya, East Java, Indonesia. This study is important for dementia epidemiological data and baseline data for further treatment of dementia patients in Surabaya. Objective: The purpose of this study to determine the characteristics profile of elderly patients with dementia in Dr. Soetomo General Hospital Surabaya, East Java, Indonesia. Methods: Sampling was done with purposive sampling by observing the medical records of patients in the period of January 2017 to December 2017 based on inclusion and exclusion criterias that have been set. The data was taken from the patient's medical record which had been written and examined by neurologists from the neurology department in the neurobehaviour sub-department of Dr. Soetomo Surabaya. Results: The majority of dementia patients are men (51,7%); the age group which is most at risk for dementia is between age of 75-79 years; most of the patients are jobless; more than half of patients are high school graduates; and Vascular Dementia (VaD) is the type of dementia that most people suferred Conclusion: This characteristic’s data of dementia can be used for providing information about dementia to make public health care provides a better facillities and treatment for elderly patients to prevent dementia burden.
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Velayudhan, Latha, Seung-Ho Ryu, Malgorzata Raczek, Michael Philpot, James Lindesay, Matthew Critchfield, and Gill Livingston. "Review of brief cognitive tests for patients with suspected dementia." International Psychogeriatrics 26, no. 8 (March 31, 2014): 1247–62. http://dx.doi.org/10.1017/s1041610214000416.
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ABSTRACTBackground:As the population ages, it is increasingly important to use effective short cognitive tests for suspected dementia. We aimed to review systematically brief cognitive tests for suspected dementia and report on their validation in different settings, to help clinicians choose rapid and appropriate tests.Methods:Electronic search for face-to-face sensitive and specific cognitive tests for people with suspected dementia, taking ≤ 20 minutes, providing quantitative psychometric data.Results:22 tests fitted criteria. Mini-Mental State Examination (MMSE) and Hopkins Verbal Learning Test (HVLT) had good psychometric properties in primary care. In the secondary care settings, MMSE has considerable data but lacks sensitivity. 6-Item Cognitive Impairment Test (6CIT), Brief Alzheimer's Screen, HVLT, and 7 Minute Screen have good properties for detecting dementia but need further validation. Addenbrooke's Cognitive Examination (ACE) and Montreal Cognitive Assessment are effective to detect dementia with Parkinson's disease and Addenbrooke's Cognitive Examination-Revised (ACE-R) is useful for all dementias when shorter tests are inconclusive. Rowland Universal Dementia Assessment scale (RUDAS) is useful when literacy is low. Tests such as Test for Early Detection of Dementia, Test Your Memory, Cognitive Assessment Screening Test (CAST) and the recently developed ACE-III show promise but need validation in different settings, populations, and dementia subtypes. Validation of tests such as 6CIT, Abbreviated Mental Test is also needed for dementia screening in acute hospital settings.Conclusions:Practitioners should use tests as appropriate to the setting and individual patient. More validation of available tests is needed rather than development of new ones.
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Camargos, Einstein Francisco, Marcela Basso Pandolfi, Marco Polo Dias Freitas, Juliana Lima Quintas, Juliana de Oliveira Lima, Leandra Camapum Miranda, Luciano Wanderley Pimentel, and Patricia Medeiros-Souza. "Trazodone for the treatment of sleep disorders in dementia: an open-label, observational and review study." Arquivos de Neuro-Psiquiatria 69, no. 1 (February 2011): 44–49. http://dx.doi.org/10.1590/s0004-282x2011000100010.
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Sleep disorders (SD) in patients with dementia are very common in clinical practice. The use of antidepressants with hypnotic actions, such as trazodone, plays an important role in these cases. The aim of this study is to present a profile of the use of trazodone in demented patients with SD, as well as a review of trazodone hydrochloride in SD. We evaluated 178 elderly patients with Alzheimer's disease and other dementias, clinically presenting SD and treated with hypnosedative medications. In the one-year period comprising the study, 68 (38.2%) of the 178 had sleep disorders. Most patients (114; 64%) had a diagnosis of Alzheimer's disease. Approximately 85% of patients with SD used hypnosedative drugs. Trazodone was the most commonly used drug among patients (N = 35), with an effectiveness of 65.7%. Trazodone has been shown to be a good option for treatment of the elderly with dementia and associated SD.
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Khalil, Mohammad Ibrahim, Narayan Chandra Kundu, Serajoom Munira, Mahmood-uz Jahan, and Md Ridwanur Rahman. "Predictors of Parkinson’s disease Dementia in a Sample of Bangladeshi Patients." Bangladesh Medical Research Council Bulletin 47, no. 2 (May 17, 2022): 192–98. http://dx.doi.org/10.3329/bmrcb.v47i2.57779.
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Background: Parkinson’s disease dementia (PDD) is a common consequence during the course of the disease. It deeply influences patients’ prognosis, quality of life, caregiver burden and economic strain. However, effective treatment for PDD is currently unclear. Clinical and demographic predictors for this comorbidity are not well studied. Objectives: To investigate putative risk factors for the development of dementia in patients with Parkinson’s disease (PD) attending a tertiary care and teaching hospital in Bangladesh. Methods: One hundred thirty-one consecutive PD cases were enrolled in this cross-sectional study; whose disease duration was more than a year. Comparison was done between demented and non-demented PD cases. Structural CNS diseases including secondary parkinsonism were excluded by clinically and MRI of brain for all cases. Dementia was evaluated based by DSM-IV and assessed using mini-mental state examination (MMSE) score and Parkinson’s disease dementia short screen (PDD-SS) score. Severity of disease was evaluated by Hoehn and Yahr stage (H-Y I to V). Depression was assessed using DSM-IV. Data were analysed on a logistic regression model using SPSS v 23. Results: The overall frequency of dementia was 38%. The mean (SD) age of the demented and non-demented PD cases was 73.32(8.86) and 63.98 (6.19) years respectively. On multivariate logistic regression model, age ³70 years [OR=4.25, p=0.031], diabetes [OR=5.37, p=0.019], hypertension [OR=7.63, p=0.011], disease duration ³5 years [OR=10.01, p<0.001], H-Y stage e” 3 [OR= 9.52, p<0.001] and depression [OR=8.79, p<0.001] were significantly associated with PDD. Conclusion: In this study of PD cases, overall risks of dementia were advancing age, diabetes, hypertension, longer disease duration, higher disease stage and presence of depressive illness. Bangladesh Med Res Counc Bull 2021; 47(2): 192-198
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Rana, Md Masud, Imran Sarker, Md Shahadat Hossain, Md Rezaul Karim Khan, Md Rafiqul Islam, Abu Naser Rizvi, Md Ahsan Habib, Md Nazrul Islam, Anis Ahmed, and Md Bahadur Ali Miah. "Etiological Pattern of Dementia in Patients Attending Dementia Clinic in a Referal Hospital." Bangladesh Journal of Neuroscience 30, no. 2 (July 31, 2014): 77–83. http://dx.doi.org/10.3329/bjn.v30i2.57390.
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Background and objectives: Dementia is characterized by loss of or decline in memory and other cognitive abilities and reduces the lifespan of affected people. The number of people with Alzheimer’s Disease and other dementias is increasing every year because of the steady growth in the older population and stable increment in life expectancy and it is expected to increase two-fold by 2030 and three-fold by 2050.In addition to Alzheimer’s disease there are so many reversible and irreversible causes of dementia. This study was aimed to explore the different etiological factors related to dementia patients. Risk factors for dementia, co-morbid conditions were also included.
Methods: This cross sectional study was carried out from 2009 to 2014 at dementia clinic (OPD), department of Neurology, Bangabandhu Sheikh Mujib Medical University (BSMMU). A total number of 166 dementia patients, as diagnosed by Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and confirmed by Mini Mental State Examination(MMSE) score were recruited in this study. Diagnosis of specific type of dementia was made on the basis of established criteria.
Results: Alzheimer’s disease(32.5%) and Vascular dementia(31.9%) were the most common etiological factor followed by Mixed dementia(19.9%), PD with dementia(8.4%) and others(7.2%) like hypothyroidism, head injury, epilepsy etc. Increasing age, hypertension, diabetes mellitus, dyslipidemia, IHD, smoking are potential risk factors for dementia.
Conclusion: This study concludes Alzheimer’s disease and Vascular dementia are almost equally occurring dementia. There are also some potential risk factors for development of dementia whose modification can bring a great change in dementia treatment and functional outcome of this group of elderly people of Bangladesh.
Bangladesh Journal of Neuroscience 2014; Vol. 30 (2): 77-83
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Hamdy, R. C., A. Kinser, A. Depelteau, T. Kendall-Wilson, J. V. Lewis, and K. Whalen. "Patients with Dementia Are Easily Distracted." Gerontology and Geriatric Medicine 3 (January 1, 2017): 233372141773593. http://dx.doi.org/10.1177/2333721417735938.
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Mild cognitive impairment (MCI) is the middle ground between normal, age-appropriate memory impairment, and dementia. Whereas patients with MCI are able to cope with the memory deficit, those with dementia are not: Their memory impairment and other cognitive deficits are of sufficient magnitude to interfere with the patients’ ability to cope independently with daily activities. In both MCI and dementia, there is evidence of declining cognitive functions from a previously higher level of functioning. In both the conditions, there is also an evidence of dysfunction in one or more cognitive domains. There are two subtypes of MCI depending on whether memory is predominantly affected: amnestic type and nonamnestic/behavioral type. Not all patients with MCI transition to dementia, some recover. In this case scenario, we present a 68-year-old man with MCI who lives with his wife. They are getting ready to host dinner. His wife asks him to vacuum the dining room while she runs an urgent errand. We describe how this simple task vacuuming a room ended in a catastrophe with the patient spending the night in jail and his wife hospitalized. We discuss what went wrong in the patient/wife interaction and how the catastrophic ending could have been avoided. Objectives At the end of this case discussion readers will know the following: The differences between mild cognitive impairment (MCI), normal aging, and dementia. MCI is often a precursor of dementia and has an amnestic or nonamnestic/behavioral presentation. However, not all patients with MCI develop dementia, some even recover. MCI is an opportunity to discuss with the patient various issues that may arise, should it progress to dementia such as preparing a will, transitioning from driver to passenger, and addressing various financial and legal issues including end-of-life issues and selecting someone to have power of attorney. Patients with MCI should be regularly followed up to determine whether and when they will transition to dementia as this changes the level of care needed. Patients with MCI are at an increased risk of triggering accidents because of their cognitive impairment and often impaired judgment. It may be hazardous to leave patients with MCI alone, without supervision. The importance of support groups, social media, and cameras when providing care to patients with MCI and dementias.
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Starkstein, S. E., S. Vázquez, G. Petracca, L. Sabe, M. Merello, and R. Leiguarda. "SPECT Findings in Alzheimer’s Disease and Parkinson’s Disease with Dementia." Behavioural Neurology 10, no. 4 (1997): 121–27. http://dx.doi.org/10.1155/1997/379683.
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We examined, with single photon emission tomography (SPECT) and (99mTc)-HMPAO, 18 patients with idiopathic Parkinson's disease and no dementia (PD), 12 patients with PD and dementia, 24 patients with probable Alzheimer's disease (AD), and 14 controls. While the three patient groups showed significantly lower perfusion in frontal inferior and temporal inferior areas as compared to controls, both demented groups showed significantly more severe bilateral hypoperfusion in superior frontal, superior temporal and parietal areas as compared to non-demented PD patients and controls. On the other hand, no significant differences in cerebral perfusion were found between patients with AD and patients with PD and dementia. In conclusion, our findings demonstrated specific but similar cerebral perfusion deficits in demented patients with either AD or PD.
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Miller, T. Bryce. "Helping dementia patients." Canadian Pharmacists Journal / Revue des Pharmaciens du Canada 149, no. 4 (July 2016): 194. http://dx.doi.org/10.1177/1715163516651813.
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Potashkin, Judith A., Virginie Bottero, Jose A. Santiago, and James P. Quinn. "Bioinformatic Analysis Reveals Phosphodiesterase 4D-Interacting Protein as a Key Frontal Cortex Dementia Switch Gene." International Journal of Molecular Sciences 21, no. 11 (May 27, 2020): 3787. http://dx.doi.org/10.3390/ijms21113787.
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The mechanisms that initiate dementia are poorly understood and there are currently no treatments that can slow their progression. The identification of key genes and molecular pathways that may trigger dementia should help reveal potential therapeutic reagents. In this study, SWItch Miner software was used to identify phosphodiesterase 4D-interacting protein as a key factor that may lead to the development of Alzheimer’s disease, vascular dementia, and frontotemporal dementia. Inflammation, PI3K-AKT, and ubiquitin-mediated proteolysis were identified as the main pathways that are dysregulated in these dementias. All of these dementias are regulated by 12 shared transcription factors. Protein–chemical interaction network analysis of dementia switch genes revealed that valproic acid may be neuroprotective for these dementias. Collectively, we identified shared and unique dysregulated gene expression, pathways and regulatory factors among dementias. New key mechanisms that lead to the development of dementia were revealed and it is expected that these data will advance personalized medicine for patients.
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Snowden, Julie S., David Neary, and David M. A. Mann. "Frontotemporal dementia." British Journal of Psychiatry 180, no. 2 (February 2002): 140–43. http://dx.doi.org/10.1192/bjp.180.2.140.
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BackgroundFrontotemporal dementia accounts for up to 20% of cases of dementia in the presenium, yet remains poorly recognised. Diagnostic criteria have been devised to aid clinical diagnosis.AimsTo provide an overview of clinical and pathological characteristics of frontotemporal dementia and its nosological status.MethodsThe review summarises consensus diagnostic criteria for frontotemporal dementia and draws on the authors'clinical experience of 300 frontotemporal dementia cases, and pathological experience of 50 autopsied cases.ResultsFrontotemporal dementia is characterised by pronounced changes in affect and personal and social conduct. Some patients also develop motor neuron disease. Mutations in the tau gene account for some but not all familial cases of frontotemporal dementia.ConclusionsFrontotemporal dementia is a focal form of dementia, which is clinically and pathologically distinct from other dementias. It represents an important model for understanding the functions of the frontotemporal lobes.
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Tan, Lynnette Pei Lin, Nathan Herrmann, Brian J. Mainland, and Kenneth Shulman. "Can clock drawing differentiate Alzheimer's disease from other dementias?" International Psychogeriatrics 27, no. 10 (July 3, 2015): 1649–60. http://dx.doi.org/10.1017/s1041610215000939.
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ABSTRACTBackground:Studies have shown the clock-drawing test (CDT) to be a useful screening test that differentiates between normal, elderly populations, and those diagnosed with dementia. However, the results of studies which have looked at the utility of the CDT to help differentiate Alzheimer's disease (AD) from other dementias have been conflicting. The purpose of this study was to explore the utility of the CDT in discriminating between patients with AD and other types of dementia.Methods:A review was conducted using MEDLINE, PsycINFO, and Embase. Search terms included clock drawing or CLOX and dementia or Parkinson's Disease or AD or dementia with Lewy bodies (DLB) or vascular dementia (VaD).Results:Twenty studies were included. In most of the studies, no significant differences were found in quantitative CDT scores between AD and VaD, DLB, and Parkinson's disease dementia (PDD) patients. However, frontotemporal dementia (FTD) patients consistently scored higher on the CDT than AD patients. Qualitative analyses of errors differentiated AD from other types of dementia.Conclusions:Overall, the CDT score may be useful in distinguishing between AD and FTD patients, but shows limited value in differentiating between AD and VaD, DLB, and PDD. Qualitative analysis of the type of CDT errors may be a useful adjunct in the differential diagnosis of the types of dementias.
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Hasegawa, N., M. Hashimoto, S. Yuuki, K. Honda, Y. Yatabe, K. Araki, and M. Ikeda. "Prevalence of delirium among outpatients with dementia." International Psychogeriatrics 25, no. 11 (July 22, 2013): 1877–83. http://dx.doi.org/10.1017/s1041610213001191.
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ABSTRACTBackground:Delirium and dementia are highly interrelated. However, few comprehensive epidemiological studies have examined this altered state of consciousness superimposed on dementia. We investigated the frequency of delirium in patients with dementia, its prevalence in patients with each dementia type, and its association with cerebrovascular disease (CVD) in patients with neurodegenerative dementias.Methods:We studied 261 consecutive outpatients in the memory clinic of a psychiatric hospital between April 2010 and September 2011. All patients underwent routine laboratory tests and computed tomography (CT), and their Mini-Mental State Examination, Neuropsychiatric Inventory (NPI), Physical Self-Maintenance Scale (PSMS), and Delirium Rating Scale – Revised 98 scores were recorded. The diagnosis of delirium was based on the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision. CVD was detected by CT.Results:Among the 206 patients with dementia, delirium was present in 40 (19.4%). The proportion of patients who experienced episodes of delirium was 14.7% in the Alzheimer's disease, 34.4% in the vascular dementia, 31.8% in the dementia with Lewy bodies, and none in frontotemporal lobar degeneration. Delirium was frequently observed in patients with dementia and CVD. The NPI total and agitation subscale scores were significantly higher in dementia patients with delirium than in those without delirium. PSMS scores were significantly lower for patients with delirium than for patients without delirium.Conclusions:The frequency of delirium varies with each dementia type. In addition, delirium decreases activities of daily living, exaggerates behavioral and psychological symptoms dementia, and is associated with CVD in patients with neurodegenerative dementias.
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Camicioli, Richard, and Nancy Fisher. "Progress in Clinical Neurosciences: Parkinson's Disease with Dementia and Dementia with Lewy Bodies." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 31, no. 1 (February 2004): 7–21. http://dx.doi.org/10.1017/s0317167100002791.
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Dementia occurs in up to 30% of people with Parkinson's disease and is a major cause of disability. Pathologically, Parkinson's dementia, where dementia follows the onset of parkinsonism by at least one year, overlaps with dementia with Lewy bodies. We review the functional impact, definitions, neuropsychology, epidemiology and pathophysiology of Parkinson's dementia, dementia with Lewy bodies and their overlap. Associated psychiatric and imaging findings are also considered. Lastly, current and emerging approaches to assessment and treatment in patients with these Lewy body associated dementias are presented.
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Rockwood, Kenneth. "Mixed Dementia: Alzheimer's and Cerebrovascular Disease." International Psychogeriatrics 15, S1 (July 2003): 39–46. http://dx.doi.org/10.1017/s1041610203008949.
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“Mixed dementia” is traditionally defined as Alzheimer's disease with cerebrovascular disease (CVD). Because the risks of both neurodegenerative dementias and cerebrovascular disease increase with age, the mixed dementias are likely the most common. In practice, patients with mixed dementia are diagnosed by one of two routes: Either they have evidence of a neurodegenerative dementia and CVD at the outset, or, they have a classical neurodegenerative presentation but are found to have ischemic lesions by neuroimaging. These facts have implications for the development of evidence-based diagnostic criteria.
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Godinho, Cláudia, Iulek Gorczevski, Andréa Heisler, Maria Otília Cerveira, and Márcia Lorena Chaves. "Clinical and demographic characteristics of elderly patients with dementia assisted at an outpatient clinic in Southern Brazil." Dementia & Neuropsychologia 4, no. 1 (March 2010): 42–46. http://dx.doi.org/10.1590/s1980-57642010dn40100007.
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Abstract The aging of the population is a worldwide phenomenon, where 60% of elders live in developing areas of the world such as Brazil, regions in which few studies have been carried out. Objectives: The goal of this study was to evaluate the clinical and demographic profile of patients with dementing disorders seen at a specialized outpatient clinic in South Brazil. Methods: A sample of 105 demented patients seen at the Dementia Outpatient Clinic from Hospital de Clínicas de Porto Alegre (HCPA), Brazil between June 2004 and June 2008. Evaluation of patients consisted of medical history, cognitive testing, assessment of functional status (Activities of Daily Living Scale - ADL; Instrumental Activities Daily Living - IADL) and application of the Neuropsychiatry Inventory (NPI) for behavioral symptoms. Severity of dementia was evaluated based on the CDR scale. All patients underwent laboratory screening tests and brain imaging exams to define etiology of dementia. Results: Of the whole sample, 71% were female. Age was 79±8 years (mean±SD). Educational level was 4±3 years (mean±SD). Sixty-four patients (60%) presented the diagnosis of Alzheimer's disease. Of the whole sample, 26.7% were classified as CDR=1, 44% as CDR=2 and 29. 3% as CDR=3. A significant difference on the Mini Mental State Examination (MMSE) and functional status scores was observed among the CDR categories (severity). No significant association was found between severity and impairment on memory tests and behavioral symptoms. Conclusions: Alzheimer's disease was the most common etiology, followed by vascular dementia. At diagnosis, most patients presented mild to moderate severity of dementia, independent of cause.
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Singh, Atar, Abhay Paliwal, and V. S. Pal. "Comparative study of electroencephalography changes in dementia." International Journal of Research in Medical Sciences 7, no. 8 (July 25, 2019): 2970. http://dx.doi.org/10.18203/2320-6012.ijrms20193379.
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Background: Dementia affected about 46 million people in 2015and this number will roughly triple within the next 40 years. In 2011 Alzheimer's Disease International argue that dementia has become one of the most urgent health and social care challenges of the 21st century and its potential effect on economies around the world is attracting global attention. Predicting dementia in the early stages would be essential for better treatment before significant brain damage occurs. Current difficulty is the lack of specific biomarkers. In some previous studies electroencephalography (EEG) have shown the capability to identify dementia early and even classify the degree of its severity at a lower cost for mass screening. The aim and objective of this study was to EEG changes in vascular dementia and Alzheimer's Disease Related Dementias (ADRD) or dementia where no cause is identifiable, to measure severity of dementia by using DSR scale in different subjects and to correlate DSRS with EEG findings.Methods: Study sample was the 40 patients in each three groups- Dementia patients without any known cause of dementia or Alzheimer's Disease Related Dementias (ADRD), Vascular dementia (VaD) patients and Controls (age and sex matched subjects scoring more than the cut of score on dementia Scale). Written informed consent will be taken after explaining the objectives and procedure of study in detail. EEG were recorded in eyes closed, on intermittent photic stimulation and hyperventilation, only eyes closed data was used in study and these data were entered in excel sheet and analyzed using SPSS Software, appropriate statistical test was applied wherever necessary.Results: Participants with VaD have theta waves while ADRD group have delta waves preponderance as compare to control.Conclusions: EEG can have additive value in diagnosing VaD as well as it alone can be helpful in differentiating healthy individuals from dementia patients.
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Testa, H. J., J. S. Snowden, D. Neary, R. A. Shields, A. W. I. Burjan, M. C. Prescott, B. Northen, and P. Goulding. "The Use of [99mTc]-HM-PAO in the Diagnosis of Primary Degenerative Dementia." Journal of Cerebral Blood Flow & Metabolism 8, no. 1_suppl (December 1988): S123—S126. http://dx.doi.org/10.1038/jcbfm.1988.42.
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The clinical value of single photon emission computed tomography (SPECT) in the differential diagnosis of dementia due to cerebral atrophy was evaluated by comparing the pattern of distribution [99mTc]–HM-PAO in three dementing conditions. Imaging was carried out in 26 patients with suspected Alzheimer's disease, 14 with dementia of the frontal-lobe type, and 13 with progressive supranuclear palsy. Images were evaluated and reported without knowledge of clinical diagnosis with respect to regions of reduced uptake of tracer. Reduced uptake in the posterior cerebral hemispheres was characteristic of Alzheimer's disease, while selective anterior hemisphere abnormalities characterized both dementia of the frontal-lobe type and progressive supranuclear palsy. The latter conditions could be distinguished on the basis of the appearance of integrity of the rim of the frontal cortex. The technique has an important role in the differentiation of degenerative dementias.
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Villa, Paola, Paolo Bosco, Raffaele Ferri, Concetta Perri, Rosanna Suriano, Barbara Costantini, Francesca Macrì, Caterina Proto, Rosa Maria Cento, and Antonio Lanzone. "Fasting and Post-methionine Homocysteine Levels in Alzheimers Disease and Vascular Dementia." International Journal for Vitamin and Nutrition Research 79, no. 3 (May 1, 2009): 166–72. http://dx.doi.org/10.1024/0300-9831.79.3.166.
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The aim of the study is to compare the basal homocysteine levels in patients with impairment of cognitive status, and in controls, to evaluate if the methionine loading test is able to identify any differences between patients with Alzheimers disease and patients with vascular dementia. We enrolled 56 subjects, 20 with Alzheimers disease, 18 with vascular dementia, and 18 normal controls. The data shown that plasma homocysteine levels both basal and post-methionine load were significantly higher in the two groups of demented patients than in the control group. No significant differences were found between Alzheimers patients and vascular dementia patients. The homocysteine percent increase after a methionine loading test was significantly higher in the controls with respect to the two groups of demented patients. Only in Alzheimers patients were vitamin B12 basal levels negatively correlated with basal homocysteine levels (p<0.05), while positively correlated with the homocysteine percent increase after load (p<0.05). The study confirms the possible role of chronically elevated homocysteinemia in neuronal degeneration in demented patients. Even if the methionine loading test revealed an abnormal homocysteine metabolism in demented patients, it didnt show any difference among patients with Alzheimers disease and vascular dementia.