Multidisciplinary Design and Implementation of a Day Program Specialized for the Frontotemporal Dementias1
To supervise activities for patients with frontotemporal dementias presents major challenges to day programs typically equipped to care for more elderly, frail patients. In this article, we present the development and immediate outcomes of integrating a day program specialized for patients with frontal lobe disturbances into an already established day program. Planning required new collaborations between the ambulatory memory clinic and the day program staff. Immediate outcomes have included relief of burden for an under-served group of caregivers and behavioral management that more seamlessly combines strategies for medication titration, environmental adjustments, and activity participation.
Neuritic Pathology as a Correlate of Synaptic Loss in Dementia With Lewy Bodies
Synaptic loss is present in Alzheimer’s disease and correlates with the severity of dementia. Loss of synapses in dementia with Lewy bodies (DLB) does not correlate as clearly with cognitive status and its cause is unclear. To begin to understand the relationship between cognition and synaptic loss in DLB, we assessed immunoreactivity for the synaptic-terminal specific protein, synaptophysin, in the hippocampus in 14 DLB cases. Quantitative synaptic data were obtained using an Image-Pro semiautomated analysis system. We determined Braak stage, β-amyloid, Lewy bodies (LBs), and Lewy neurites (LN). We found significant correlations (r = 0.617, P < .01) between Braak stage and synaptophysin score and marginal correlation between LN score and synaptophysin loss ( r = 0.694, P < .06). Correlations of β-amyloid and of LB density with synaptophysin score were unimpressive. These data support the hypothesis that synaptic loss in DLB is related to neuritic degeneration.
Effect of Exercise on Mood in Nursing Home Residents With Alzheimer’s Disease
The purpose oF this study was to examine the eFFects oF 3 behavioral interventions on aFFect and mood in nursing home residents with Alzheimer’s disease. In a pre—post design, 90 residents with Alzheimer’s disease were randomized to 3 groups: supervised walking, comprehensive exercise (walking plus strength training, balance, and Flexibility exercises), and social conversation (casual rather than therapeutic themes). Interventions were provided 5 days a week and progressed up to 30 minutes per session over 16 weeks. Interventions were conducted primarily indoors. Outcome measures included the Lawton Observed AFFect Scale, Alzheimer Mood Scale, and Dementia Mood Assessment. At posttest, participants receiving comprehensive exercise exhibited higher positive and lower negative aFFect and mood. The social conversation group exhibited the least positive and most negative mood and aFFect. Results suggest that exercise programs be emphasized in long-term care, particularly whole-body involvement rather than walking alone.
Provision of Morning Care to Nursing Home Residents With Dementia: Opportunity for Improvement?
Significant contact between nursing staff and nursing home residents with dementia occurs during assistance with activities of daily living during morning care; however, the content and process of morning care have received little attention in the scientific literature. To better understand the morning care process and its role in generation of pain symptoms, 51 videotaped episodes of morning care involving 17 nursing home residents from 3 long-term care facilities were coded and analyzed; each resident had a diagnosis of dementia and concern about possible pain during assistance with activities of daily living. The typical morning care episode involved performance of multiple activities of daily living during a short period of time, during which pain stimulation and expression occurred frequently. Much could be done to make morning care more an activity to be enjoyed rather than a task to be completed.
Luteolin May Reduce Brain Inflammation
What do celery, green pepper, and chamomile have in common? They all contain luteolin, an anti-inflammatory chemical that could help treat brain disorders such as Alzheimer’s and Creutzfeldt-Jacob Disease. Researchers at…
Flavonoids Show Evidence of Reducing Beta Amyloid in the Brain
Here’s another reason to eat your fruits and veggies. Researchers from the University of South Florida and Cedars-Sinai Medical Center found that certain plant molecules reduced the amount of beta…
Does a Wander Garden Influence Inappropriate Behaviors in Dementia Residents?
Background: The effect on resident behaviors of adding a wander garden to an existing dementia facility was investigated. Methods: 34 male residents were observed for 12 months before and after opening the garden. Behaviors were assessed using the Cohen-Mansfield Agitation Inventory Short Form (CMAI), incident reports, as needed medications (pro re nata [PRN]), and surveys of staff and residents’ family members as indices of affect. Results: Final CMAI scores and total PRNs employed were lower than baseline values with a trend for residents who used the garden more often to have less agitated behavior. Verbal inappropriate behaviors did not change significantly whereas physical incidents increased. Staff and family members felt that the wander garden decreased inappropriate behaviors and improved mood and quality of life of the dementia residents. Conclusions: Study design characteristics and garden management may have affected behaviors both positively and negatively. Additional studies are needed to explore the benefits of wander gardens for dementia residents.
Decision-Making Involvement Scale for Individuals With Dementia and Family Caregivers
This report describes the development and preliminary psychometric properties of the Decision-Making Involvement Scale for individuals with dementia and family caregivers. Data were collected from 217 individuals with dementia and their respective caregivers. Principal axis factor analysis, Kendall , and Pearson correlations were used to determine the Decision-Making Involvement Scale’s psychometric properties, mean differences of caregiver and individual with dementia, and the relationship between scores of Decision-Making Involvement Scale and measures of well-being. Analyses support a reliable, 1-factor solution of the Decision-Making Involvement Scale for both individuals with dementia and caregivers. Socio-demographic, impairment, and well-being variables are differentially related to the perceptions of how involved the individual with dementia is in decision making. The Decision-Making Involvement Scale provides useful information about daily decision making of an individual with dementia, and it shows promise as a means for understanding the relationship between decision-making involvement and well-being of individuals with dementia and caregivers.
A Caution Against Short-Term Use Of Antipsychotics
Antipsychotic medications are frequently prescribed to treat behavioral and psychological symptoms of Alzheimer’s and other dementias. There are two classes of antipsychotics: conventional (older) drugs, such as Haldol and Loxitane;…
Integrating Patient and Informant Reports on the Cornell-Brown Quality-of-Life Scale
Patients with mild cognitive impairment and mild to moderate Alzheimer’s disease can provide information about their quality of life. This study determined whether aggregating patient and informant quality-of-life reports on the Cornell-Brown Scale for Quality of Life in Dementia can provide a broader perspective on the quality of life relative to patient or informant reports separately. Aggregated Cornell-Brown Scale for Quality of Life in Dementia scores were hypothesized to correlate more strongly with both patient and informant perspectives of patient’s memory, function, and neuropsychiatric symptoms than the unaggregated measures. Results indicated that aggregated Cornell-Brown Scale for Quality of Life in Dementia scores reflected a blend of patient and informant perspectives on patient function. This study contributes to a growing line of research that recommends integrating patient and informant perspectives to achieve the most complete assessment of quality of life.
Review of Issue: Management Strategies, Medical Issues, and Pathobiology
Diffuse Neurofibrillary Tangles With Calcification (DNTC): Kosaka-Shibayama Disease in America
Alzheimer’s disease and Pick’s disease are representative dementias. Cases which do not fit prototypes are termed unclassifiable dementias. New dementia subtypes are identified when a conglomerate of clinical, radiologic and pathologic findings are consistently identified. One such variant is diffuse neurofibrillary tangles with calcification (DNTC), which has been reported almost exclusively from Japan. Significant pathological advances in this decade have established DNTC as a distinct entity. Although initially the diagnosis was neuropathologic, increasing knowledge about DNTC has made it possible for a clinical diagnosis to be made. We report a clinical case of DNTC in a Caucasian American. The diagnosis of DNTC was based on his atypical senile dementia, anomia, apathy and parkinsonian features, normal serum biochemistry, and evidence of basal ganglia and cerebellar calcification with predominant temporal lobe atrophy on neuroimaging. To the best of our knowledge, this is the first clinical description of DNTC from the United States.
Reliable assessment of change from previous cognitive functioning is a prerequisite for determining the possible presence of neurodegenerative diseases such as Alzheimer’s disease (AD). We investigated whether standardized change scores on the German version of the Consortium to Establish a Registry for Alzheimer’s Disease-Neuropsychological Assessment Battery (CERAD-NAB) could be used for early diagnosis of AD and whether change scores on the CERAD-NAB are superior in this respect to scores recorded on 1 occasion only. Three hundred seventy-four normal control subjects were assessed twice. Data from 95 patients with mostly mild probable AD were collected at their first entry to a memory clinic and an average of 1.1 ± 0.24 years later. It is concluded that repeated testing with the CERAD-NAB does not generally add to improved diagnostic accuracy for mild and very mild AD and cannot, therefore, be recommended as a routine clinical procedure.
Nursing Home Characteristics Related to Medicare Costs for Residents With and Without Dementia
Objectives. To evaluate the relationship of nursing home characteristics to Medicare costs overall and by dementia status. Design. New admissions followed for 2 years. Setting. Random stratified sample of 55 Maryland nursing homes. Participants. Sample of 1257 residents. Measures. Records, interview, and observation. Results. Medicare costs were lower in facilities that have a better environmental quality, hospice beds, and more food service workers; costs were higher in hospital-based facilities and those that have a higher Medicaid case mix, X-ray, and some specified types of staff. Across all characteristics, costs for residents with dementia were consistently two-thirds the cost of other residents. Discussion. In terms of dementia status, resident characteristics drive Medicare costs, as opposed to facility characteristics. Using alternative residential settings for individuals with dementia may increase Medicare costs of nursing home residents and Medicare costs of residents with dementia who are cared for in settings less able to attend to medical needs.
Diagnostic Test Available for Clinical Trials, not Clinical Practice
I was excited when I first read about the P-Tau 231 Test developed by Applied NeuroSolutions. The test analyzes cerebrospinal fluid for tau, a protein that accumulates in the brains…
New Genes, New Dilemmas: FTLD Genetics and Its Implications for Families
After Alzheimer’s disease, frontotemporal lobar degeneration (FTLD) is the second leading cause of dementia in persons less than 65 years of age. Up to 40% of FTLD cases have a positive family history. Research on these families has led to the discovery of four disease-causing genes: microtubule-associated protein tau (MAPT), progranulin (PGRN), valosin-containing protein (VCP), and charged multivesicular body protein 2B (CHMP2B). MAPT and PGRN are responsible for the largest number of familial cases. Each of these genes differs by disease mechanism. Moreover mutations in both genes are associated with significant interfamilial and intrafamilial phenotypic variation. Genetic counseling needs to address the differences between the PGRN and MAPT mutations as well as the variation in clinical symptoms. The aims of this article are to describe the genetics of the FTLD spectrum and aid in the genetic counseling of individuals who may carry genetic mutations.
Effects of a Goal-Oriented Rehabilitation Program in Mild Cognitive Impairment: A Pilot Study
Background: Memory disturbance, deficient concentration, and fatigue are symptoms seen in amnestic mild cognitive impairment (MCI) as well as in mild traumatic brain injury (TBI). The aim of this study was to assess if an established rehabilitation program commonly used in TBI can aid MCI patients to develop compensatory memory strategies that can improve their cognition, occupational performance, and quality of life (QoL). Methods: Fifteen patients with MCI participated in the program 2 days per week for 8 weeks. Cognitive function, occupational performance, and self-perceived QoL were assessed at baseline, at the end of the intervention, and at follow-up after 6 months. Results: Significant improvements were seen in cognitive processing speed, occupational performance, and in some of the QoL domains. Conclusion: As this goal-oriented rehabilitation program in MCI resulted in some improvements in cognition, occupational performance, and QoL, further randomized controlled studies are warranted.
Two-Year Old Boy in UK Has Alzheimer’s-Like Disease
Alzheimer’s disease and most other types of dementia occur primarily in older people, but a rare genetic disorder called Neimann-Pick Disease-Type C can occur in children. Taylor Smith, a 2-year-old boy…