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PubMed1989

[Reality orientation training: a method of group therapy of patients with dementia. Problems and possibilities of evaluating the effect of treatment of patients with various forms of dementia].

Authors describe a method called reality orientation training, a possibility of group treatment for patients suffering from dementia. They summarize the main statements of the literature and give account of their own battery for diagnostic classification and treatment. They outline the practical difficulties in the measurement of the effectivity of the treatment employed in demented patients.

Dementia↗
PubMedDate not supplied

[Early detection of senile dementia. Apropos of the congress on "Current problems in senile dementia"].

While research in neurochemistry, genetics and molecular biology progresses in understanding Alzheimer's disease, no therapeutic strategy has hitherto been demonstrated useful. Early detection and diagnosis of dementias are thus equally important. The major part of this symposium was devoted to advances of research in this field. New techniques of clinical assessment, metabolic imaging and brain mapping are promising tools for early diagnosis.

Aged↗
PubMed1994

[Experimental techniques for developing new drugs acting on dementia (8)--Characteristics of behavioral disorders in senescence-accelerated mouse (SAMP8): possible animal model for dementia].

Experimental methods to assess age-related behavioral disorders such as impairments of learning and memory, emotional disorder and abnormality of circadian rhythms in senescence-accelerated mice (SAMP8), and the characteristics of the behavioral disorders are described. SAMP8 shows age-related impairments of learning and memory assessed by passive avoidance, two-way active avoidance and Morris water maze tasks, and the impairments are significant even at 2 months of age and become obvious with aging. Age-related emotional disorder is also observed in SAMP8 mice. SAMP8 mice exhibit age-related emotional changes as compared with the SAMR1 control; they show apparent increases in the number of entries into open arms and time spent on open arms in the elevated plus-maze test. In addition, punished drinking in SAMP8 is markedly increased in the water-drinking conflict test. It is implicated that the reduced anxiety-like behavior is closely related to learning impairments in the strain. Cholinergic drugs and a sustained formulation of thyrotropin-releasing hormone ameliorate impairments of learning behavior and the emotional disorder in SAMP8. Furthermore, SAMP8 shows an age-dependent abnormality of circadian rhythms of spontaneous motor activity (SMA) and ingestive behavior compared with the SAMR1 control, diurnal SMA and water intake in SAMP8 being higher than those of SAMR1. These findings suggest that the SAMP8 strain is a useful animal model for learning and memory impairments, emotional disorder and abnormality of circadian rhythms in patients with dementia.

Aging↗
PubMed1997

Clinical global measures of dementia. Position paper from the International Working Group on Harmonization of Dementia Drug Guidelines.

Following is the report of the committee working on clinical global measures for antidementia drug guidelines. The concepts involved in global scales, the distinctions between change and severity scales, advantages and disadvantages of structured interviews, and anchoring of change scores are discussed, and selected existing clinical global scales are described. In addition, the committee assessed the utility of global scales in clinical trials for antidementia drugs. There was a consensus among the members of the working group on the following: (1) Clinical global scales are interview based; in most cases, they include information obtained from caregivers as well as directly from patients, but they can rely on information from the subject only. (2) Clinicians' global ratings are intended to assess clinically meaningful change based on multidimensional clinical assessment and take into account the clinical heterogeneity of dementia by assessing at least cognition, behavior, and functioning. (3) There are two distinct types of clinical global measures: (a) clinicians' interview-based global severity scales, which generally incorporate classification by stage or severity of illness and (b) clinicians' interview-based global change scales, which incorporate global assessment ratings of clinical change. The committee could not reach a consensus on whether global scales should be required in phase II and phase III clinical trials, or whether other specific assessments such as well-designed activities of daily living, cognition, and behavior measures could, when used in appropriate combinations, replace the global as assessments of clinical meaningfulness.

Activities of Daily Living↗
PubMed1994

Pancreastatin-like immunoreactivity of cerebrospinal fluid in patients with Alzheimer type dementia: evidence of aberrant processing of pancreastatin in Alzheimer type dementia.

The concentrations of pancreastatin-like immunoreactivity (PST-LI) of the cerebrospinal fluid (CSF) were measured in the patients with Alzheimer type dementia (ATD) and in age-matched normal subjects. The mean PST-LI concentration in the CSF of ATD patients was significantly lower than that of normal subjects. Gel chromatographic analysis revealed that the main PST-LI peak of ATD's CSF eluted at molecular weight (MW) 13.5 kDa. However, the age-related change of the molecular forms of PST-LI in CSF was observed in normal subjects as following; PST-LI in neonatal CSF showed one peak at MW 13.5 kDa, that of 16-64-year-old showed two peaks at MW 13.5 and 5.4 kDa, however, only one main peak was shown at MW 5.4 kDa in the CSFs of 72-85-year-old. These findings suggest that the production of PST-LI was decreased and the proteolytic cleavage, which should process big PST to PST (1-52) in normal subjects, was altered to that of neonatal type in the CNS of the patients with ATD.

Aged↗
PubMed2000

Depression in the carers of dementia sufferers: a comparison of the carers of patients suffering from dementia with Lewy bodies and the carers of patients with Alzheimer's disease.

BACKGROUND: Depression has not previously been studied in the carers of patients suffering from dementia with Lewy Bodies (DLB). METHOD: Twenty-five DLB carers were matched with 75 AD carers, according to carer characteristics. A standardised assessment incorporated measures of cognition, depression, psychosis and behavioural disturbance. DLB (consensus criteria), and AD (NINCDS ADRDA criteria) were diagnosed using operationalised clinical criteria. Carer depression was diagnosed using the Research Diagnostic Criteria. RESULTS: The overall frequency of depression was similar in DLB and AD carers (28% vs. 31%). DLB carers were significantly more likely to experience a major depressive disorder (3/25 - 12% vs. 0/75 - 0% chi(2)=9.3, P=0.002, df 1), although the numbers were small. The severity of behavioural disturbance was associated with carer depression in the DLB carers and in the total sample. CONCLUSION: The severity of behavioural disturbance was significantly associated with depression in DLB carers.

Alzheimer Disease↗
PubMed2003

Clinical validity of the Chinese version of Mattis Dementia Rating Scale in differentiating dementia of Alzheimer's type in Hong Kong.

The present study aimed to examine the clinical validity and applicability of the Chinese version of Mattis Dementia Rating Scale (CDRS) for elderly Chinese individuals. The scale was found to have good reliability with internal consistency ranging from 0.7 to 0.9. Its significant correlation with the Chinese version of Mini-Mental State Examination (CMMSE) suggested satisfactory construct validity of the scale. The discriminant validity of the CDRS in differentiating Alzheimer's disease (AD) patients and Normal Control (NC) elderly was also supported by the Receiver Operating Characteristics (ROC) analysis. Several cut-off points were presented for different clinical or research applications, and formulas to adjust for the age and educational level of the CDRS total score were provided. The Initiation/Perseveration and Memory subscales were suggested to be an abbreviated version of the CDRS for a quick screening. The present results also showed the association between the impairment of the CDRS performance and the progress of the AD.

Age Factors↗
PubMed1989

Alzheimer's dementia: performance on parallel forms of the dementia assessment battery.

Fifty-four patients with Alzheimer's disease performed on the Dementia Assessment Battery that comprised of finger tapping, forward digit span, naming, verbal memory, visual memory, Token Test, digit cancellation, word-list generation, symbol-digit substitution, and copying geometric designs. Four forms of the battery were administered at weekly intervals. The equivalence of the forms, the relative difficulty of the tests, retest reliability, and factorial composition of the battery are presented. Performance improved with repetition. Impairments in visuo-spatial and verbal abilities were independent of each other. The fragility of the patients' working memory was identified as a main cause for their poor recall. The importance of "component analysis" in individual assessment is illustrated.

Aged↗
PubMed1995

Pharmacokinetics and Safety of a Potential Antidementia Compound, CL 275,838, after Multiple Oral Doses in Patients with Dementia of Alzheimer Type or Vascular Dementia.

The multiple-dose pharmacokinetics and safety of a new potential antidementia compound, CL 275,838, were examined in two randomized, double-blind, parallel-group, placebo-controlled studies. The Alzheimer Disease Assessment Scale (ADAS) was employed to preliminarily assess the patients' cognitive and the behavioral profiles. In the first study, nine patients with Alzheimer type or vascular dementia were treated for 2 weeks with daily doses of 50 mg. In the second study, nine other patients, selected with the same inclusion/exclusion criteria and treated following the same experimental design, were given 100 mg day(minus sign1) CL 275,838. At the lower dose, no side effects were detected; in the 100-mg day(minus sign1) study, mild drowsiness (one patient) and moderate agitation (two patients) were observed. Laboratory tests showed no changes in either study, apart from a slight, transient increase in serum bilirubin in one patient given 100 mg. At the dose of 50 mg, no patients showed any modification on the ADAS, whereas three patients given 100 mg showed some improvement. During the 2 weeks of oral dosing, predose plasma concentrations of the parent compounds and its metabolites II and IV increased but not in proportion to the dose, although at both doses, accumulation was essentially complete within 10 days. At 50 mg, the mean steady-state C(max) and C(ss) of the parent compound were similar to those reached in young males after a comparable regimen. Mean steady-state metabolite-to-parent drug ratios were higher in patients than in healthy individuals, although there was wide variation in our patient group. Mean washout t(1/2) of the parent compound (34 h) and its metabolites II (37 h) and IV (41 h) were longer than in young men and were similar in all cases to those observed after single doses in healthy elderly subjects. After 100 mg, mean C(max) and C(ss) of the unchanged compound rose more than proportionally and the apparent t(1/2) tended to rise, compared with the lower dose. Mean steady-state oral clearance decreased, changing the metabolite-to-parent drug ratios, suggesting nonlinear kinetics after several relatively high oral doses. This might explain why the higher dose was less well tolerated.

Journal Article↗
PubMedDate not supplied

Early stage dementia group: an innovative model of support for individuals in the early stages of dementia.

Traditionally, supports and services for people diagnosed with Alzheimer's disease have focused on the caregivers. The increase in early diagnosis of Alzheimer's disease has resulted in greater numbers of older adults that have some insight and awareness of their deficits and are capable of dealing with the ramifications of their illness. Yet there are few places to turn for support and education. Circle of Care, a community-based home support agency in Toronto, has developed a support group for individuals with early stage dementia. Comprehensive Rehabilitation and Mental Health Services (COTA), a community-based rehabilitation agency, was invited to provide a co-facilitator for this group. To date, three groups have been held, each one having a fixed membership and meeting for eight sessions of one and a quarter hours. Topics focused on causation, coping with memory problems, loss, grief, and daily living skills. Positive themes emerged to reveal feelings of affirmation, camaraderie, and improved confidence, while feelings of helplessness and frustration were also raised. Implications for future planning and interventions also will be discussed in this paper.

Adaptation, Psychological↗
PubMedDate not supplied

The tropicamide test in patients with dementia of Alzheimer type and frontotemporal dementia.

The tropicamide test was applied to 30 patients with probable Alzheimer's disease (pAD), 12 with frontotemporal dementia (FTD) and 46 healthy subjects. One drop of 0.01% tropicamide was instilled in one eye and one drop of saline solution in the other. The pupil diameter was measured with a Goldmann pupillometer in its basal condition and 10, 15, 20, 25, 30, 35, 45 and 55 minutes afterwards. The results do not show differences between pupil dilation observed in pAD and in FTD; in both groups, from the beginning of the test, the pupil dilated more than in healthy people. A high interindividual variability was observed. The best cutoff point is 38% of interpupillary difference at minute 25 (sensitivity = 63%, specificity = 80%). If we consider the prevalence of AD in a population over 40 years old to be 1.4%, the adjusted positive predictive value of the test would be 4.2%. According to these results, the test is not a true diagnostic marker of AD.

Adult↗
PubMed2001

Factor structure of the Cornell Scale for Depression in Dementia for Anglo and Hispanic patients with dementia.

The authors assessed the equivalence of the factor structure of the Cornell Scale for Depression in Dementia (CSDD) in samples of Anglo and Hispanic patients with Alzheimer's disease (AD). Comparing the factor structure of the CSDD in these groups helps establish its validity and aids in its clinical interpretation with Hispanic patients. CSDD ratings were first subjected to preliminary exploratory factor analyses; then the factor structure of the CSDD across groups of English- and Spanish-speaking patients was tested using structural equation modeling. Analyses showed overall similarity in the CSDD factor structure for the two groups but also revealed differences in factor content for several items. The authors discuss the relevance of these differences for those using the CSDD with Hispanic AD patients.

Aged↗