American Journal of Alzheimer's Disease and Other Dementias current issue

Review of Issue: Barriers to Hospice in Patients With Alzheimer

Lippa, C. F. — Wed, 18 Nov 2009 17:03:27 PST

Review: Obesity and Alzheimer's Disease: A Link Between Body Weight and Cognitive Function in Old Age

Naderali, E. K., Ratcliffe, S. H., Dale, M. C. — Wed, 18 Nov 2009 17:03:27 PST

Obesity is now a global health hazard. It not only predisposes to an array of risk factors leading to increased morbidity and mortality amongst adults but it also has a major negative impact on children’s health. The deleterious effects of obesity on cardiovascular system have now been well acknowledged. It causes insulin resistance that in turn leads to diabetes, hypertension and cardiovascular abnormalities. The vascular effects of obesity may have a role in the development of a rapidly growing disease of late life, Alzheimer’s disease. The precise mechanisms of the association between adiposity and impairment of cognitive performance remain to be elucidated. However, negative impact of obesity on cognitive function may be, at least in part, due to vascular defects, impaired insulin metabolism and signaling pathway or a defect in glucose transport mechanisms in brain. This review examines the available data regarding the impact of obesity on cognitive function.

The Effect of Multisensory Stimulation on Persons Residing in an Extended Care Facility

Ward-Smith, P., Llanque, S. M., Curran, D. — Wed, 18 Nov 2009 17:03:27 PST

Background: Non-pharmacological interventions, such as multisensory stimulation environments (MSSE), have demonstrated the ability to reduce inappropriate behavior among individuals with Alzheimer’s disease. Methods: In this study, we compared the incidences of problematic behavior among individuals with Alzheimer’s disease residing in a long-term care facility who were and were not exposed to an MSSE. Retrospective data were obtained using the Psychotic Behavior Assessment Record (PBAR), mandated by Medicare to be used when antipsychotic medications are administered. Psychotic Behavior Assessment Record data were collected using the first and sixth month of admission for residents after appropriate consent was secured. Results: Documented disruptive behavior included pacing, exit-seeking activities, hitting, yelling, and aggressive talking. The use of the MSSE resulted in a decrease in the number of incidences of disruptive behavior, but not the behaviors present. Conclusion: The use of MSSE, as a non-pharmacological intervention, demonstrates the ability to decrease the number of incidences of disruptive or problematic behavior. The use of these interventions, where feasible, should be considered prior to the use of pharmacological methods.

Progranulin and {beta}-Amyloid Distribution: A Case Report of the Brain From Preclinical PS-1 Mutation Carrier

Gliebus, G., Rosso, A., Lippa, C. F. — Wed, 18 Nov 2009 17:03:27 PST

Background: Progranulin (PGRN) is a multifunctional growth factor that is found in many tissues. Mutations in the PGRN gene cause familial frontotemporal dementia with ubiquitin-positive inclusions. PGRN plaque-like structures have been described in Alzheimer’s disease (AD), in association with β-amyloid (Aβ) plaques. Objective: To investigate PGRN and aggregated Aβ immunolabeling distribution in autopsied brain tissue from the participant with confirmed PS-1 (A246E) mutation, who died prior to clinical symptom onset. Results: Immunolabeling for PGRN was positive and accumulated/formed plaque-like structures in all studied regions. These structures most frequently colocalized with Aβ though there were some that did not. PGRN plaques were most dense in medial temporal and frontal regions and predominated over aggregated Aβ. Conclusions: This case report illustrates PGRN accumulation and Aβ aggregation in preclinical PS-1 AD case and raises the question whether this phenomenon coincides with or precedes Aβ aggregation.

Longitudinal Verbal Fluency in Normal Aging, Preclinical, and Prevalent Alzheimer's Disease

Clark, L. J., Gatz, M., Zheng, L., Chen, Y.-L., McCleary, C., Mack, W. J. — Wed, 18 Nov 2009 17:03:27 PST

Background: Few longitudinal studies evaluate differences in patterns of change of category compared to letter fluency across the spectrum of cognitive impairment. Methods: We compared change in category (animal and supermarket) and letter (F, A, S) fluency among 239 participants in 3 groups: remained cognitively normal throughout follow-up (n = 96), developed Alzheimer’s Disease (AD; preclinical AD, n = 21), and with AD at initial testing (prevalent AD, n = 122). Results: At baseline, prevalent and preclinical AD groups scored lower on animal than letter fluency. On all fluency measures, the prevalent AD declined faster than other groups (all P < .0001), and preclinical AD declined faster than unimpaired (all P ≤ .02). Overall, animal fluency declined faster than letter fluency; animal fluency declined significantly faster than letter fluency among cognitively normal and prevalent AD participants. Conclusion: Greater longitudinal declines in category compared to letter fluency are consistent with cross-sectional studies. Steeper declines on both fluency measures distinguish preclinical AD from cognitively unimpaired individuals.

The Role of Caregiver Prosody in Conversations With Persons Who Have Alzheimer's Disease

Small, J. A., Huxtable, A., Walsh, M. — Wed, 18 Nov 2009 17:03:27 PST

This research was supported in part by funding from the British Columbia Medical Services Foundation (BCM02-0115). The funding source had no role in the design, methods, participant recruitment, data collection, interpretation of the study, or in the preparation of the manuscript for publication. Approval for the study was granted by the University of British Columbia Behavioural Ethics Review Board, and participants provided informed consent. This study investigated whether aspects of family caregivers’ prosody (pitch and loudness) would be associated with successful or unsuccessful conversations with spouses who have Alzheimer’s disease (AD). Secondary analysis was conducted of 12 caregivers’ speech when interacting with spouses who have AD. Acoustic analyses were conducted to calculate the fundamental frequency (pitch) and intensity (loudness) of caregivers’ speech. The results showed no significant overall differences between the caregivers’ pitch or loudness in either successful or unsuccessful conversations. However, for 1 subgroup of caregivers, an increase in pitch variation and loudness was associated with unsuccessful communication, whereas for another subgroup the opposite pattern was observed—reduced pitch variation and loudness with unsuccessful communication. The results provide preliminary directions for helping family caregivers become aware of how characteristics of their speech prosody may relate to the quality of communication when interacting with persons who have AD.

Hospice Access for Individuals With Dementia

McCarty, C. E., Volicer, L. — Wed, 18 Nov 2009 17:03:27 PST

Involvement in a hospice program is important because it may allow individuals with dementia to delay or prevent institutionalization as well as provide psychosocial support for their families. Once used mostly by patients with a terminal cancer, now more than one half of the hospice patients have diagnoses other than cancer. Yet hospice is still underused for individuals dying with advanced dementia. We conducted a pilot study of hospice agencies to determine barriers and characteristics of dementia hospice enrollment. Using a mailed questionnaire and interview, we looked at demographics, accessibility, training, referral sources, and marketing. Our analysis divided the agencies based on dementia census and availability to non-Medicare eligible individuals. Results showed hospices having Bridge and Transition programs had on average 4 times higher Alzheimer’s disease (AD) and dementia census than hospices without these programs. The highest rated barriers to hospice use for individuals with dementia were prognosis, education, and finance.

News Briefs

Wed, 18 Nov 2009 17:03:27 PST