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

General Information

NEWS:

Alzheimer's, high blood pressure linked in study "Having high blood pressure reduces blood flow in the brains of Alzheimer's patients, making them more vulnerable to the effects of the disease, researchers reported on Wednesday."

Confronting Alzheimer's

Conscientious People Less Prone to Alzheimer's "One important factor is that conscientiousness tends to grow with age, as people take on more responsibilities, Wilson said. "If in old age you have been unable to show that kind of growth, if people are unable to learn from experience, that might have implications for brain structure." "

Greater Cardiorespiratory Fitness May Effectively Reduce Dementia Mortality "A long-term study involving 60,000 people has linked better cardiorespiratory fitness (CRF), an objective physiological measure closely related to recent physical activity habits, to a reduction in deaths from Alzheimer's disease (AD) and vascular dementia (VaD)."

Higher BMI Does Not Predict Cognitive Decline in Older Age

Higher Education Delays Dementia Onset But Is Linked to More Rapid Progression "The investigators found that each additional year of formal education delayed the time of accelerated decline on the SRT by 0.21 years. Postacceleration, the rate of memory decline was increased by 0.10 points per year for each additional year of formal education."

One in Seven Americans Age 71 and Older Has Some Type of Dementia, NIH-Funded Study Estimates "A new analysis suggests that about 3.4 million Americans age 71 and older — one in seven people in that age group — have dementia, and 2.4 million of them have Alzheimer's disease (AD). … Five percent of people ages 71 to 79, 24.2 percent of people 80 to 89, and 37.4 percent of those 90 years or older were estimated to have some type of dementia. The estimated rate of Alzheimer's also rose greatly with older age — from 2.3 percent of people ages 71 to 79 to 18.1 percent of people 80 to 89 to 29.7 percent of those age 90 and older. The ADAMS investigators found fewer years of education and the presence of at least one APOE e4 allele, a genetic risk factor for AD, to be strong predictors of AD and other dementias."

Scientists Want to Find Alzheimer’s Before a Mind Fails “Studies with the dye have already found significant deposits in 20 percent to 25 percent of seemingly normal people over 65, suggesting that they may be on the way to Alzheimer’s, though only time will tell. … The disease is by no means inevitable, but among people 85 and older, about 40 percent develop Alzheimer’s and spend their so-called golden years in a thicket of confusion, ultimately becoming incontinent, mute, bedridden or forced to use a wheelchair and completely dependent on others. “It makes people wonder whether they really want to live that long,” Dr. Klunk said.“

ARTICLES:

Alzheimer's Disease and Parkinson's Disease: a 360° view (Nature Publishing Group (a collection of papers) 2007 )

Dementia

Helping Find Lost Alzheimer's Patients

JAMA patient page. Dementia.

Training Helps Alzheimer's Caregivers

JOURNAL ARTICLES:

A longitudinal study of language decline in Alzheimer's disease and frontotemporal dementia. (J Int Neuropsychol Soc. 2007)

Age-Varying Association Between Blood Pressure and Risk of Dementia in Those Aged 65 and Older: A Community-Based Prospective Cohort Study (Journal of the American Geriatrics Society 2007) "CONCLUSION: High SBP was associated with greater risk of dementia in the young elderly (<75) but not in older subjects. Adequate control of hypertension in early old age may reduce the risk for dementia."

Ankle-to-Brachial Index and Dementia. The Honolulu-Asia Aging Study. (Circulation. 2007) "Conclusions-These results suggest that ABI, a measure of atherosclerosis, is associated with the incidence of total dementia, vascular dementia, and Alzheimer's disease in carriers of the apolipoprotein E epsilon4 allele."

Are hallucinations and extrapyramidal signs associated with a steeper cognitive decline in degenerative dementia patients? (Neurol Sci. 2007)

Brain reserve hypothesis in dementia. (J Alzheimers Dis. 2007)

Capillary beds are decreased in Alzheimer's disease, but not in Binswanger's disease. (Neurosci Lett. 2007)

Characteristics associated with falls in patients with dementia in a psychogeriatric ward. (Aging Clin Exp Res. 2007) "CONCLUSIONS: Male sex, decreased visual perception, and walking difficulties were all associated with an increased number of falls, and the model explained 1/4 of the variation in falls. Well-planned furnishing and use of color to achieve a plain, clearly defined environment, as well as training in walking ability, may decrease the risk of falling in people with dementia."

[Clinical aspects of Alzheimer disease.] (Presse Med. 2007) "Disease progression is accompanied by noncognitive complications. The 3 most frequent are psychological and behavioral symptoms, weight loss, and impaired balance and walking."

Clinical prediction of Alzheimer disease dementia across the spectrum of mild cognitive impairment. (Arch Gen Psychiatry. 2007) "CONCLUSIONS: Even in very mildly impaired individuals who do not meet strict MCI criteria as implemented in clinical trials, the degree of cognitive impairment in daily life and performance on neuropsychological testing predict likelihood of an AD diagnosis within 5 years."

Clinical predictors of progression to Alzheimer disease in amnestic mild cognitive impairment. (Neurology. 2007) "RESULTS: The model that best predicted progression from aMCI to AD over 36 months included APOE4 status, the Symbol Digit Modalities Test, Delayed 10-Word List Recall, New York University Paragraph Recall Test (Delayed), and the ADAS-cog total score. When APOE4 was removed from the analysis the resulting model had a similar estimated predictive accuracy as the full model. As determined by cross-validation, the estimated predictive accuracy of the final model was 80%. CONCLUSION: Progression from amnestic mild cognitive impairment to Alzheimer disease in this cohort was best determined by combining four common, easily administered, cognitive measures."

Clinical, Genetic, and Pathologic Characteristics of Patients With Frontotemporal Dementia and Progranulin Mutations (Arch Neurol. 2007)

Cognitive Decline and Markers of Inflammation and Hemostasis: The Edinburgh Artery Study (Journal of the American Geriatrics Society 2007) "CONCLUSION: Systemic markers of inflammation and hemostasis are associated with a progressive decline in general and specific cognitive abilities in older people, independent of major vascular comorbidity."

Daytime Sleepiness and Functional Impairment in Alzheimer Disease (Am J Geriatr Psychiatry 2007) "Conclusion: Even apart from its association with impaired cognition, daytime sleepiness was associated with functional impairment in AD patients. Although daytime sleep may represent a welcome relief for caregivers, its presence may be associated with greater impairment in instrumental activities and may warrant intervention."

Decline in Cognitive Functioning Is Associated with a Higher Mortality Risk. (Neuroepidemiology. 2007) " Conclusion:A decline in cognitive functioning is associated with a higher mortality risk."

Deficits in Facial Emotion Processing in Mild Cognitive Impairment. (Dement Geriatr Cogn Disord. 2007) "Conclusion: These data suggest that facial emotion processing can be impaired in MCI prior to the more marked cognitive deficits seen with clinically diagnosed Alzheimer disease."

Dementia, Lower Respiratory Tract Infection, and Long-Term Mortality. (J Am Med Dir Assoc. 2007) "CONCLUSION: LRI is followed by substantial mortality in the months after diagnosis, indicating high frailty of nursing home residents with dementia who develop LRI. A variety of patient characteristics, including many not directly related to LRI, were consistently associated with long-term mortality in two cohorts with differing illness severity. The results are relevant for informing families, evaluating poor long-term survival in the context of care and treatment, and balancing the potential burdens and benefits of care."

Depressive Symptoms as a Predictor of Cognitive Decline: MacArthur Studies of Successful Aging. (Am J Geriatr Psychiatry. 2007) "Conclusions: Depressive symptomatology independently predicts cognitive decline and incident cognitive impairment in previously high-functioning older persons."

Diets of Alzheimer's patients lack many nutrients “People with Alzheimer's disease eat less nutritiously than their peers without dementia, even in the early stages of the disease, new research from Canada shows. This is particularly concerning given that adequate intakes of certain nutrients, such as omega-3 fatty acids, vitamin K, and other antioxidants, could possibly help to preserve mental function, Dr. Bryna Shatenstein of the University of Montreal and her colleagues say.”

Discomfort and agitation in older adults with dementia. (BMC Geriatr. 2007)

Disruptive Behavior as a Predictor in Alzheimer Disease (Arch Neurol. 2007) "Conclusion Disruptive behavior is very common in AD and predicts cognitive decline, functional decline, and institutionalization but not mortality."

Early-onset Alzheimer's disease is associated with greater pathologic burden. ( Geriatr Psychiatry Neurol. 2007) "This analysis supports the hypothesis that early-onset AD is associated with greater pathologic burden than late-onset AD. This suggests that late-onset AD patients have less cognitive reserve than early-onset patients and require fewer pathologic changes to exhibit cognitive deterioration."

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."

[Epidemiology of dementia.] (Presse Med. 2007) "Lifestyle and health habits are a keystone for dementia: risk factors include physical, intellectual and social activity and nutritional habits. Data from well-conducted intervention studies are necessary to show whether better care for hypertension, diabetes, and dyslipidemia might decrease the incidence of dementia."

Frailty is Associated With Incident Alzheimer's Disease and Cognitive Decline in the Elderly. (Psychosom Med. 2007) "Conclusion: Increasing frailty is associated with incident AD and the rate of cognitive decline in older persons. These findings suggest that frailty and AD may share similar etiologies."

Grip Strength and the Risk of Incident Alzheimer's Disease (Neuroepidemiology 2007) "Declining strength in old age is associated with an increased risk of AD."

Height and Alzheimer's disease: findings from a case-control study. (J Alzheimers Dis. 2007) "For men, height in the highest quartile [>179.7 cm (70.75 in)] had a 59% lower risk of developing AD that in the lowest quartile [< 169.5 cm (66.75 in)], controlling for year of birth, and education (p=0.03). For women without an APOE epsilon4 allele, increasing height was associated with lower risk for AD (OR=0.88; p=0.01) but no significant association was found for women with at least one epsilon4 allele (OR=1.03; p=0.56)."

Hippocampal and entorhinal atrophy in mild cognitive impairment: prediction of Alzheimer disease. (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."

How and When Environmental Agents and Dietary Factors Affect the Course of Alzheimer's Disease: The "LEARn" Model (Latent Early-Life Associated Regulation) May Explain the Triggering of AD. (Curr Alzheimer Res. 2007)

Incidence of dementia in mild cognitive impairment in the cardiovascular health study cognition study. (Arch Neurol. 2007) "CONCLUSIONS: Subjects with MCI are at high risk for dementia. The probable MCI diagnosis identified individuals in the earliest stages of dementia, usually AD, whereas the possible MCI diagnosis identified a more heterogeneous group. However, this latter group had only a slightly lower rate of conversion to dementia than the group with probable MCI, suggesting that even with comorbid conditions, there is a high likelihood of the presence of a progressive dementing disorder."

Inflammation, Depression and Dementia: Are they Connected? (Neurochem Res. 2007) "Chronic inflammation is now considered to be central to the pathogenesis not only of such medical disorders as cardiovascular disease, multiple sclerosis, diabetes and cancer but also of major depression. If chronic inflammatory changes are a common feature of depression, this could predispose depressed patients to neurodegenerative changes in later life. Indeed there is now clinical evidence that depression is a common antecedent of Alzheimer's disease and may be an early manifestation of dementia before the cognitive declines becomes apparent."

Joint effect of stroke and APOE 4 on dementia risk. The Canadian Study of Health and Aging. (Neurology. 2007) "CONCLUSIONS: The joint presence of stroke and APOE 4 was associated with a greater risk of dementia compared with absence of these two factors. The effect of stroke on dementia does not seem to be modified by APOE 4."

Living With Alzheimer’s Before a Window Closes

Locus coeruleus neurofibrillary degeneration in aging, mild cognitive impairment and early Alzheimer's disease (Neurobiology of Aging 2007) "These results indicate that cytopathology in the LC is an early event in the age-MCI-AD continuum and that it may be listed among the numerous factors that mediate the emergence of the cognitive changes leading to dementia."

Metabolic Syndrome and Cognitive Decline in Elderly Latinos: Findings from the Sacramento Area Latino Study of Aging Study (Journal of the American Geriatrics Society 2007) "CONCLUSION: Metabolic syndrome and inflammation may both contribute to cognitive decline in older people of diverse backgrounds. The results also suggest that, in elderly Latinos, the composite measure of metabolic syndrome is a greater risk for cognitive decline than its individual components."

Midlife Pulse Pressure and Incidence of Dementia (Stroke. 2006)

Mitochondria in Aging and Alzheimer's Disease. (Rejuvenation Res. 2007) "Two significant risk factors are inextricably linked with Alzheimer's disease: advancing age, and accumulation of the amyloid-beta peptide. Over the age of 65 the risk of developing Alzheimer's disease increases almost exponentially with age, and the amyloid-beta rich neuritic plaques of the Alzheimer's disease brain are a histopathological hallmark of the disease. Since its identification as a major constituent of neuritic plaques amyloid-beta has attracted intense research focus as the primary causative agent in the development of Alzheimer's disease. … Functional decline of mitochondria with aging is well established, and growing evidence attributes this decline to loss of mitochondrial DNA integrity in postmitotic cells including neurons. Oxidative stress due to mitochondrial failure may drive increased amyloidogenic processing of the amyloid-beta precursor protein, contributing to a loss of amyloid-beta precursor protein functionality and increased amyloid-beta production."

Natural antioxidants in Alzheimer's disease. (Expert Opin Investig Drugs. 2007)

Neuropsychiatric Syndromes in Dementia Results from the European Alzheimer Disease Consortium: Part I (Dementia and Geriatric Cognitive Disorders 2007) "Results: The results showed the presence of 4 neuropsychiatric subsyndromes: hyperactivity, psychosis, affective symptoms and apathy. The subsyndrome apathy was the most common, occurring in almost 65% of the patients."

Olfaction in patients with mild cognitive impairment and Alzheimer's disease (Neurobiology of Aging 2007) " We concluded that deficits in olfactory detection thresholds and identification occur early in AD, before clinical symptoms are fully developed, and decline further over the course of the disease. High detection thresholds, together with impaired identification, may be useful as an early indicator of AD."

Oxidative DNA damage in mild cognitive impairment and late-stage Alzheimer's disease. (Nucleic Acids Res. 2007) " … suggesting that oxidative DNA damage is an early event in AD and is not merely a secondary phenomenon."

Perseveration in Alzheimer's Disease (Dementia and Geriatric Cognitive Disorders 2008)

Preclinical cognitive decline and subsequent sleep disturbance in older women. (Neurology. 2007) "CONCLUSIONS: Cognitive decline is associated with sleep disturbance in nondemented community-dwelling elderly women."

Preclinical Dementia: An Italian Multicentre Study on Amnestic Mild Cognitive Impairment (Dementia and Geriatric Cognitive Disorders 2007) "Conclusions: Elderly subjects affected by an isolated memory disorder have a high probability of developing AD. The ability of verbal and visual measures to predict incipient dementia of memory impairment may be increased by the simultaneous assessment of individual features, such as age or rate of functional impairment."

Predictors of clinical outcome in MCI. (Med Sci Monit. 2007)

Predictors of progression from mild cognitive impairment to Alzheimer disease (NEUROLOGY 2007)

Primary Progressive Aphasia: A 25-year Retrospective. (Alzheimer Disease & Associated Disorders 2007)

Progressive agraphia can be a harbinger of degenerative dementia. (Brain Lang. 2007)

Progressive Nonfluent Aphasia and Its Characteristic Motor Speech Deficits. (Alzheimer Dis Assoc Disord. 2007)

Relations between homocysteine, folate and vitamin B12 in vascular dementia and in Alzheimer disease. (Clin Biochem. 2007) "CONCLUSION:: The increase of Hcy in AD were seemed to be not related to cerebrovascular injury. It is possibly related to biochemical damages as result of oxidative stress."

Serum folate concentrations in patients with cortical and subcortical dementias. (Neurosci Lett. 2007) "Folic acid is believed to play a role in protection from oxidant stress. Low levels of folic acid had been found in serum from patients with Alzheimer disease (AD). … The highest proportion of folate-deficient patients was found in CBD, FTD and AD (respectively, 60, 48.2 and 46.3% versus 7.9% in controls; P<0.001). Folate deficiency characterizes FTD as well as AD. These differences observed among different clinical dementing syndromes may be related to neocortical damage."

Serum Magnesium Level and Clinical Deterioration in Alzheimer's Disease. (Gerontology. 2007) "Conclusion: Our data suggest that there is a relationship between serum Mg levels and the degree of Alzheimer's disease and that the determination of the Mg level at various stages may provide valuable information in further understanding the progression and treatment of Alzheimer's disease."

Social Cognition: An Early Impairment in Dementia of the Alzheimer Type. (Alzheimer Dis Assoc Disord. 2007)

Systemic Markers of Inflammation and Cognitive Decline in Old Age (Journal of the American Geriatrics Society 2007) "CONCLUSION: Systemic markers of inflammation are only moderately associated with cognitive function and decline and tend to be stronger in carriers of the APOE 4 allele. Systemic markers of inflammation are not suitable for risk stratification."

Terminal Cognitive Decline: Accelerated Loss of Cognition in the Last Years of Life (Psychosomatic Medicine 2007) " Conclusions: In old age, cognitive decline markedly accelerates during the last 3 to 4 years of life, consistent with the terminal decline hypothesis."

The Construct of Generalized Anxiety Disorder in Alzheimer Disease. (Am J Geriatr Psychiatry. 2007) "Conclusion: The authors validated a set of diagnostic criteria for anxiety in dementia. These criteria include restlessness, irritability, muscle tension, fears, and respiratory symptoms in the context of excessive anxiety and worry. Anxiety in AD is a frequent comorbid condition of major depression."

The Metabolic Syndrome and Alzheimer Disease (Arch Neurol. 2007) "Conclusions This study suggests that Alzheimer disease is associated with the metabolic syndrome. This could have implications for the prevention and treatment of Alzheimer disease."

The role of folate in depression and dementia. (J Clin Psychiatry. 2007)

Trouble identifying odors points to Alzheimer's "An inability to correctly identify familiar odors may be an early indication of the onset of Alzheimer's disease, researchers report. Dr. Robert S. Wilson told Reuters Health that difficulty identifying odors seems to be related the buildup of 'tangles' in the brain that appear early in the development of Alzheimer's disease."

Twenty-six-Year Change in Total Cholesterol Levels and Incident Dementia: The Honolulu-Asia Aging Study (Arch Neurol. 2007) "Conclusion A decline in serum total cholesterol levels may be associated with early stages in the development of dementia."

Vascular factors predict rate of progression in Alzheimer disease (NEUROLOGY 2007) "Conclusion: Atrial fibrillation, hypertension, and angina were associated with a greater rate of decline and may represent modifiable risk factors for secondary prevention in Alzheimer disease."

Vitamin B6, B12, and Folic Acid Supplementation and Cognitive Function (Arch Intern Med. 2007) " Conclusion The evidence does not yet provide adequate evidence of an effect of vitamin B6 or B12 or folic acid supplementation, alone or in combination, on cognitive function testing in people with either normal or impaired cognitive function."

Wandering Behavior and Alzheimer Disease. The REAL.FR Prospective Study. (Alzheimer Dis Assoc Disord. 2007)

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