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:

Alzheimer's Imaging Study Identifies Changes in Brain's White Matter “Results indicated that the two groups did not differ in the tissue volumes of several gray matter regions know to contribute to memory function. However, the high-risk group showed decreased integrity in white matter tracts that inter-connect gray matter regions involved in memory function. Both the axonal and myelin integrity of these white matter tracts were reduced.”

Atrophy in the parahippocampal gyrus as an early biomarker of Alzheimer's disease. (Brain Struct Funct. 2010)

Brain scans show signs of early Alzheimer's: study “Brain scans of all 42 showed that those whose parents -- either fathers or mothers -- had Alzheimer's were more likely to have amyloid plaques in their brains. This was especially true of people whose mothers had Alzheimer's. "They have pretty much 20 percent more amyloid beta deposits in their brains. In other words, they had an almost four times greater risk for amyloid beta pathology," Moscone said in a telephone interview. The finding confirms other studies that suggest having a mother with Alzheimer's may be a greater risk factor. "It looks like if you have maternal history of Alzheimer's disease, the risk of amyloid beta plaque and a reduction in brain activity is much greater as compared to having a father affected," Moscone said.”

Brain Tissue Loss in People With Alzheimer’s Disease and Mild Cognitive Impairment “People with Alzheimer's disease exhibit striking structural changes in the caudate nucleus, a brain structure typically associated with movement disorders such as Parkinson's disease, a new study has found.”

Cognitive Fluctuations Signal Onset of Alzheimer's “A total of 12% of patients experienced cognitive fluctuations, defined as having 3 or 4 indicators, including daytime somnolence, daytime sleep of more than 2 hours, illogical or disorganized thinking, and staring spells. Of the 216 participants diagnosed as having mild dementia, 25 had mental lapses. Of the 295 with no dementia, only 2 experienced such lapses. After controlling for age and alertness level, those with cognitive fluctuations were 4.6 times more likely to have dementia (95% confidence interval, 2.05 – 10.40). The risk of having a CDR of 0.5, very mild dementia, was 13.4 times higher, and the risk of having a CDR of 1, mild dementia, was 34 times higher for those with cognitive fluctuations vs those without. Performance for those with cognitive fluctuations was decreased across individual neuropsychological tests and in composite scores, the study authors note.”

Con: Can biomarkers be gold standards in Alzheimer’s disease?

Pro: Can biomarkers be gold standards in Alzheimer’s disease?

Daytime sleepiness is associated with dementia and cognitive decline in older Italian adults: A population-based study (Sleep Medicine 2010) “Insomnia, the most common sleep complaint in our sample, was not associated with the presence of cognitive decline. As opposed to insomnia, excessive daytime sleepiness was significantly related to dementia. Further studies are needed in order to investigate the direction of this association and to evaluate the possible role of daytime somnolence as an early marker of neurodegenerative disease, particularly Alzheimer’s disease, in some older adults.”

Drowsiness, Staring, And Other Mental Lapses May Signal Alzheimer's Disease “Older people who have "mental lapses," or times when their thinking seems disorganized or illogical or when they stare into space, may be more likely to have Alzheimer's disease than people who do not have these lapses, according to a study published in the January 19, 2010, print issue of Neurology®, the medical journal of the American Academy of Neurology. These mental lapses, also called cognitive fluctuations, are common in a type of dementia called dementia with Lewy bodies, but researchers previously did not know how frequently they occurred in people with Alzheimer's disease and, equally important, what effect fluctuations might have on their thinking abilities or assessment scores.”

Early Tests for Alzheimer’s Pose Diagnosis Dilemma

Hallmark Alzheimer's Disease Changes Found in Retinas of Humans and Imaged in Live Animals

Longitudinal cognitive decline is associated with fibrillar amyloid-beta measured by [11C]PiB. (Neurology. 2010)

Loss of Smell Could Be Early Sign of Alzheimer's “People with Alzheimer's are already known to suffer from loss of smell. But the new research pinpoints a direct link between development of amyloid plaques -- the bits of gunk in the brain that cause Alzheimer's disease -- and a worsening sense of smell.”

New AF Predicts Diagnosis of Alzheimer's, Other Dementias “Onset of atrial fibrillation (AF) in a community population followed for five years predicted development of dementia of any kind during the same period, and it also predicted each of four dementia subtypes independently, including Alzheimer's disease [1].”

Redefining Alzheimer Disease

Relationship between atrophy and -amyloid deposition in Alzheimer disease (Annals of Neurology 2010) “There is a strong relationship between -amyloid deposition and atrophy very early in the disease process. As the disease progresses to mild cognitive impairment and Alzheimer disease clinical stages, pathological events other than, and probably downstream from, aggregated -amyloid deposition might be responsible for the ongoing atrophic process. These findings suggest that antiamyloid therapy should be administered very early in the disease evolution to minimize synaptic and neuronal loss.”

Rules Seek to Expand Diagnosis of Alzheimer’s “The current formal criteria for diagnosing Alzheimer’s require steadily progressing dementia — memory loss and an inability to carry out day-to-day activities, like dressing or bathing — along with a pathologist’s report of plaque and another abnormality, known as tangles, in the brain after death. But researchers are now convinced that the disease is present a decade or more before dementia.”

Size of Hippocampus May Indicate Early Dementia

Spinal-Fluid Test Is Found to Predict Alzheimer’s

Taking The Guesswork Out Of Diagnosing Early-Stage Alzheimer's Disease

Three Biomarkers In Spinal Fluid Appear Helpful To Classify Patients With Alzheimer's Disease

Worsening Memory Associated With Later Alzheimer's Disease “In addition, having memory impairment at the beginning of the study and mild cognitive impairment at the first follow-up increased the risk for conversion to any dementia or dementia related to Alzheimer's disease at the second follow-up; these individuals had the greatest risk for developing dementia. "Not all subjects with subsequent dementia will experience or report subjective memory impairment at the pre-mild cognitive impairment stage," they conclude. "However, if subjective memory impairment is present in a subject without cognitive impairment as evidenced by neuropsychological test results, it may inform about the risk for dementia and may contribute to individual decisions about diagnostic procedures and interventions to lower the risk factors for Alzheimer's disease based on current knowledge." “

ARTICLES:

5 Signs of Alzheimer's

Alzheimer's Disease Cerebrospinal Fluid Test -- Useful or Useless?

Early Warning Signs: When to Call the Doctor about Alzheimer's

JOURNAL ARTICLES:

Autobiographical Memory Task in Assessing Dementia (Arch Neurol. 2010)

Brain tissue volumes in relation to cognitive function and risk of dementia (Neurobiology of Aging 2010)

Cerebrospinal Fluid Abnormalities and Rate of Decline in Everyday Function Across the Dementia Spectrum: Normal Aging, Mild Cognitive Impairment, and Alzheimer Disease. (Arch Neurol. 2010)

Progression of Atrophy in Alzheimer's Disease and Related Disorders. (Neurotox Res. 2010)

Reduced Cortical Thickness in the Posterior Cingulate Gyrus is Characteristic of Both Typical and Atypical Alzheimer's Disease. (J Alzheimers Dis. 2010)

The Reversed Clock Drawing Test Phenomenon in Alzheimer's Disease: A Perfusion SPECT Study. (Dement Geriatr Cogn Disord. 2010)

When, where, and how the corpus callosum changes in MCI and AD (NEUROLOGY 2010) “Conclusions: Callosal changes are already present in patients with amnestic mild cognitive impairment (MCI) and mild Alzheimer disease (AD). The precocious involvement of the anterior callosal subregion in amnestic MCI extends to posterior regions in mild AD. Two different mechanisms might contribute to the white matter changes in mild AD: wallerian degeneration in posterior subregions of the corpus callosum (suggested by increased axial diffusivity without fractional anisotropy modifications) and a retrogenesis process in the anterior callosal subregions (suggested by increased radial diffusivity without axial diffusivity modifications).”

White Matter Damage in Alzheimer Disease and Its Relationship to Gray Matter Atrophy. (Radiology. 2010)

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