Alzheimer's Disease - Dementia

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Alzheimer's Disease - Dementia

NIH - Medical Encyclopedia Alzheimer's Disease

"Alzheimer's disease (AD), one form of dementia, is a progressive, degenerative brain disease. It affects memory, thinking, and behavior. Memory impairment is a necessary feature for the diagnosis of this or any type of dementia. Change in one of the following areas must also be present: language, decision-making ability, judgment, attention, and other areas of mental function and personality. The rate of progression is different for each person. If AD develops rapidly, it is likely to continue to progress rapidly. If it has been slow to progress, it will likely continue on a slow course. There are two types of AD -- early onset and late onset. In early onset AD, symptoms first appear before age 60. Early onset AD is much less common, accounting for only 5-10% of cases. However, it tends to progress rapidly. The brain tissue shows "neurofibrillary tangles" (twisted fragments of protein within nerve cells that clog up the cell), "neuritic plaques" (abnormal clusters of dead and dying nerve cells, other brain cells, and protein), and "senile plaques" (areas where products of dying nerve cells have accumulated around protein). Although these changes occur to some extent in all brains with age, there are many more of them in the brains of people with AD."

Highlighted Articles

Education and Alzheimer disease without dementia: support for the cognitive reserve hypothesis. (Neurology. 2007)

"CONCLUSIONS: Regardless of the neuropathologic criteria used, education is predictive of dementia status among individuals with neuropathologic Alzheimer disease. These results support the theory that individuals with greater cognitive reserve, as reflected in years of education, are better able to cope with AD brain pathology without observable deficits in cognition."

Nutritional factors, cognitive decline, and dementia. (Brain Res Bull. 2006)

"Nutritional factors and nutritional deficiencies have been repeatedly associated with cognitive impairment. … Deficiencies of several B vitamins have been associated with cognitive dysfunction in many observational studies. More recently, deficiencies of folate (B(9)) and cobalamine (B(12)) have been studied in relation to hyperhomocysteinemia as potential determinants of cognitive impairment, dementia, and Alzheimer's disease (AD). A small number of studies assessed the association between intake of macronutrients and cognitive function or dementia. Among the others, the intake of fatty acids and cholesterol has received particular attention. Although the results are not always consistent, most studies have reported a protective role of dietary intakes of poly- and mono-unsaturated fatty acids against cognitive decline and AD."

Exercise Is Associated with Reduced Risk for Incident Dementia among Persons 65 Years of Age and Older (Annals of Internal Medicine 2006)

"Conclusion: These results suggest that regular exercise is associated with a delay in onset of dementia and Alzheimer disease, further supporting its value for elderly persons."

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Alzheimer's Disease - Dementia

Diagnosis, Imaging, and Screening

NEWS:

Bad sense of smell may be first Alzheimer's sign "Other studies have linked loss of smell to Alzheimer’s, Franks said, but this is the first to measure healthy people’s olfactory powers and follow them for five years, testing along the way for signs of mental decline. In the study, 600 people between the ages of 54 and 100 were asked to identify a dozen familiar smells: onion, lemon, cinnamon, black pepper, chocolate, rose, banana, pineapple, soap, paint thinner, gasoline and smoke. … The people who made at least four errors on the odor test were 50 percent more likely to develop problems than people who made no more than one error. Difficulty identifying odors also was associated with a higher risk of progressing from mild cognitive impairment to Alzheimer’s."

Diffusion Tensor Imaging of Normal-Appearing White Matter in Mild Cognitive Impairment and Early Alzheimer Disease: Preliminary Evidence of Axonal Degeneration in the Temporal Lobe (American Journal of Neuroradiology 2007) "CONCLUSIONS: We found evidence for functionally relevant microstructural changes in the NAWM of patients with AD and MCI. These changes were present in brain regions serving higher cortical functions, but not in regions serving primary functions, and are consistent with a hypothesized loss of axonal processes in the temporal lobe."

MRI may detect early Alzheimer's disease

PET Scan Distinguishes Alzheimer's From Other Dementia "The scan, FDG-PET, helped six doctors from three national Alzheimer's disease centers correctly diagnose frontotemporal dementia (FTD) and Alzheimer's in almost 90 percent of cases in the study--an improvement of as much as 14 percent from usual clinical diagnostic methods. FDG stands for fluorodeoxyglucose, a short-lived radioactive form of sugar injected into people during PET scans to show activity levels in different parts of the brain. In Alzheimer's, low activity is mostly in the back part of the brain; in FTD, low activity is mostly in the front of the brain."

Structural Brain Changes Precede Mild Cognitive Impairment "While it is widely accepted that amnestic MCI is a frequent precursor to Alzheimer's disease (AD), this is the first study to show anatomical changes occur well before MCI symptoms appear."

ARTICLES:

JOURNAL ARTICLES:

Atypical Dementia: When It Is Not Alzheimer’s Disease (Journal of The Medical Association of Thailand 2007)

Can an 18-point clock-drawing scoring system predict dementia in elderly individuals with mild cognitive impairment? (J Clin Exp Neuropsychol. 2007) "The 18-point clock-drawing scoring system may have advantages in better indicating MCI individuals more likely to progress to dementia."

Cerebrospinal Fluid tau/ -Amyloid42 Ratio as a Prediction of Cognitive Decline in Nondemented Older Adults (Arch Neurol. 2007) "Conclusions The very mildest symptomatic stage of AD exhibits the same CSF biomarker phenotype as more advanced AD. In addition, levels of CSF A 42, when combined with amyloid imaging, augment clinical methods for identifying in individuals with brain amyloid deposits whether dementia is present or not. Importantly, CSF tau/A 42 ratios show strong promise as antecedent (preclinical) biomarkers that predict future dementia in cognitively normal older adults."

Characterization of the lipid profile in dementia and depression in the elderly. (J Geriatr Psychiatry Neurol. 2007)

Clinical and Neuropsychological Features Associated with Structural Imaging Patterns in Patients with Mild Cognitive Impairment. (Dement Geriatr Cogn Disord. 2007) "Conclusion: Structural neuroimaging can identify subgroups of MCI patients with specific clinical and neuropsychological features."

CSF and MRI markers independently contribute to the diagnosis of Alzheimer's disease. (Neurobiol Aging. 2007) "CONCLUSIONS: MTA and CSF biomarkers seem to be of incremental value for the diagnosis AD. CSF analysis is most sensitive in the absence of MTA, and especially among early-onset AD patients."

CSF tau/Abeta42 ratio for increased risk of mild cognitive impairment: a follow-up study. (Neurology. 2007) "BACKGROUND: Processes of Alzheimer disease (AD) likely begin years prior to the onset of cognitive impairment (latent AD), progress though a prodromal phase of mild cognitive impairment (MCI), and culminate in dementia."

[Dementias: diagnostic contribution of imaging and proton magnetic resonance spectroscopy.] (Neurologia. 2007) "Conclusions. Combination of both MR techniques significantly improved AD diagnosis versus MR imaging alone. More studies are needed to enhance VD classification. Metabolic data found by MRS can be useful to differentiate cognitive impairment."

Diagnosing dementia with confidence by GPs. (Fam Pract. 2007)

Differentiating dementias in long-term care patients. (Consult Pharm. 2007)

Diffusion tensor imaging of cingulum fibers in mild cognitive impairment and Alzheimer disease. (Neurology. 2007) "CONCLUSION: Assessment of the cingulum fibers using diffusion tensor imaging may aid early diagnosis of Alzheimer disease."

Episodic memory impairment in patients with Alzheimer's disease is correlated with entorhinal cortex atrophy : A voxel-based morphometry study. (J Neurol. 2007) "Findings on the entorhinal cortex and the delayed memory scores support the role of the entorhinal cortex in episodic memory. Damage to the entorhinal cortex, deafferenting the hippocampus from neocortical inputs, interferes with episodic memory consolidation in AD patients."

FDG-PET and CSF phospho-tau for prediction of cognitive decline in mild cognitive impairment. (Psychiatry Res. 2007) "Pathological FDG-PET and elevated p-tau(181) levels both predicted deterioration. While p-tau(181) was highly sensitive for cognitive decline, FDG-PET was superior in predicting conversion to clinical dementia in MCI patients."

Hippocampal and entorhinal atrophy in mild cognitive impairment (NEUROLOGY 2007) "Conclusions: Smaller hippocampal and entorhinal cortex volumes each contribute to the prediction of conversion to Alzheimer disease. Age and cognitive variables also contribute to prediction, and the added value of hippocampal and entorhinal cortex volumes is small. Nonetheless, combining these MRI volumes with age and cognitive measures leads to high levels of predictive accuracy that may have potential clinical application."

Hippocampal atrophy and disconnection in incipient and mild Alzheimer's disease. (Prog Brain Res. 2007)

Hippocampal volume is an independent predictor of cognitive performance in CADASIL. (Neurobiol Aging. 2007) "These findings strengthen the view that hippocampal atrophy is an important pathway of cognitive impairment in vascular as well as degenerative disease."

Incident dementia in women is preceded by weight loss by at least a decade (NEUROLOGY 2007) "Conclusions: Even accounting for delays in diagnosis, weight loss precedes the diagnosis of dementia in women but not in men by several years. This loss may relate to predementia apathy, loss of initiative, and reduced olfactory function."

Is Functional Decline Necessary for a Diagnosis of Alzheimer's Disease? (Dementia and Geriatric Cognitive Disorders 2007) "Conclusions: Our study suggests that functional decline should not be required for the diagnosis of mild AD."

Lacunar Infarcts Are the Main Correlate With Cognitive Dysfunction in CADASIL. (Stroke. 2007) "CONCLUSIONS: Lacunar infarct lesion load is the most important MRI parameter associated with cognitive dysfunction in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy."

Lewy body variant of Alzheimer's disease or cerebral type lewy body disease? Two autopsy cases of presenile onset with minimal involvement of the brainstem. (Neuropathology. 2007)

MRI confirms mild cognitive impairments prodromal for Alzheimer's, vascular and Parkinson-Lewy body dementias. (J Neurol Sci. 2007) "CONCLUSIONS: This study confirms different MCI subtypes prior to conversion to different dementias listed, recognizable by specific MRI abnormalities."

MRI of hippocampus and entorhinal cortex in mild cognitive impairment: A follow-up study (Neurobiology of Aging 2007) "… the baseline volumes of the right hippocampus, the right entorhinal cortex and CDR sum of boxes predicted the progression of MCI to dementia during the follow-up."

[Neuroimaging in dementia.] (Presse Med. 2007)

Patterns of atrophy differ among specific subtypes of mild cognitive impairment. (Arch Neurol. 2007)

Qualitative Estimates of Medial Temporal Atrophy as a Predictor of Progression From Mild Cognitive Impairment to Dementia (Arch Neurol. 2007) " Conclusions Adjusted estimates of MTA were associated with significantly increased risk of developing dementia within 3 years, suggesting that obtaining a magnetic resonance image during the evaluation of MCI may offer additional independent information about the risk of progression to dementia. Given the relatively high prevalence of MCI in the general population, use of this method as part of routine clinical evaluation may help identify individuals who might benefit from increased surveillance and future treatment."

Quantitative estimations of the entorhinal cortex in Alzheimer's disease. (Anal Quant Cytol Histol. 2007) "Thus the EC decreases in size and neuron number in AD and minor changes in number per volume were noted."

Rates of brain atrophy over time in autopsy-proven frontotemporal dementia and Alzheimer disease. (Neuroimage. 2007)

Reduced olfactory bulb and tract volume in early Alzheimer's disease—A MRI study (Neurobiology of Aging 2007) "Manual tracing on MRI images revealed OBT atrophy to be present early in the course of AD. Since the respective findings were associated with cognitive impairment, they may contribute to early recognition and diagnosis of the disease."

Research criteria for the diagnosis of Alzheimer's disease: revising the NINCDS-ADRDA criteria. (Lancet Neurol. 2007)

Risk of Rapid Global Functional Decline in Elderly Patients With Severe Cerebral Age-Related White Matter Changes (Arch Intern Med. 2007) " Conclusion Elderly patients who are functionally independent and who have severe ARWMCs are at considerable risk of becoming more dependent in a short period, mostly owing to motor and cognitive deterioration."

Symptoms of Preclinical Dementia in General Practice up to Five Years before Dementia Diagnosis. (Dement Geriatr Cogn Disord. 2007) "Conclusion:Preclinical dementia is associated with an increased contact frequency between patient and GP at least 5 years prior to the diagnosis of dementia. Gait disturbances and cognitive complaints are the earliest symptoms of preclinical dementia."

The dentate gyrus in Alzheimer's disease. (Prog Brain Res. 2007)

The Genetics of Very Early Onset Alzheimer Disease. (Cogn Behav Neurol. 2007) "OBJECTIVE: This study was undertaken to clarify the genetics of very early onset Alzheimer disease (VEOAD), defined as AD beginning before age 35. BACKGROUND: Early onset AD (EOAD) is defined by onset of symptoms before age 65, and affected individuals may harbor a mutation in presenilin 1 (PSEN1), presenilin 2 (PSEN2), or amyloid precursor protein. VEOAD is exceedingly rare, and PSEN1 mutations have been implicated."

The role of neuroimaging in mild cognitive impairment. (Neuropathology. 2007)

The utility of PET brain imaging in the initial evaluation of dementia. (J Am Med Dir Assoc. 2007)

Three-Dimensional Gray Matter Atrophy Mapping in Mild Cognitive Impairment and Mild Alzheimer Disease (Arch Neurol. 2007) "Background Alzheimer disease (AD) is the most common form of dementia worldwide. Mild cognitive impairment (MCI) is the recent terminology for patients with cognitive deficiencies in the absence of functional decline. Most patients with MCI harbor the pathologic changes of AD and demonstrate transition to dementia at a rate of 10% to 15% per year. Patients with AD and MCI experience progressive brain atrophy. … Results We observed significantly greater cortical atrophy in patients with mild AD. The entorhinal cortex, right more than left lateral temporal cortex, right parietal cortex, and bilateral precuneus showed 15% more atrophy and the remainder of the cortex primarily exhibited 10% to 15% more atrophy in patients with mild AD than in patients with amnestic MCI."

White matter lesions - age-adjusted values for cognitively healthy and demented subjects. (Acta Neurol Scand. 2007) "Conclusions - Age-corrected WML load was significantly higher in vascular dementia as compared to MCI, AD and cognitively normals over a wide age range."

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