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PubMed1997

Frontotemporal dementia versus vascular dementia: differential features on mental status examination.

OBJECTIVE: After Alzheimer's disease, vascular dementia (VaD) and frontotemporal dementia (FTD) are among the most common dementing illnesses. FTD may have a neuropsychological profile similar to that of VaD, and patients with these dementias may be difficult to distinguish on clinical examination. The purpose of this study was to elucidate distinct cognitive profiles of a large group of FTD and VaD patients on a brief, clinical mental status examination. DESIGN: A comparison of 39 FTD patients and 39 VaD patients on a brief, clinical mental status examination. SETTING: A Dementia Research Center and affiliated, university hospitals. METHODS: The FTD patients were diagnosed by noncognitive clinical and neuroimaging criteria, and the VaD patients met NINDS-AIREN criteria for vascular dementia. The two dementia groups were comparable on three dementia assessment scales. MEASUREMENTS: The mental status measures included the neuropsychological battery from the Consortium to Establish a Registry for Alzheimer's Disease (CERAD), plus supplementation from the Neurobehavioral Cognitive Status Examination (NCSE) for cognitive areas not assessed by the CERAD). RESULTS: The FTD and VaD groups differed significantly on the mental status examination measures. FTD patients performed significantly better than the VaD patients on digit span and constructions, despite comparable performance by both groups on calculations. Although not statistically significant, the FTD group performed worse than the VaD group on verbal fluency and abstractions. These differences were not explained by group differences in age and education. CONCLUSION: These results suggest that cognitive differences between FTD and VaD groups reflect greater frontal pathology in contrast to relative sparing of posterior cortex and subcortical white matter in FTD. These cognitive differences as measured by a mental status examination may help distinguish between these two dementia syndromes.

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PubMed2006

Rethinking the dementia diagnoses in a population-based study: what is Alzheimer's disease and what is vascular dementia?. A study from the kungsholmen project.

OBJECTIVE: To explore the hypothesis that older adults often are affected by more than one disease, making the differential diagnosis between Alzheimer's disease (AD) and vascular dementia (VaD) difficult. METHODS: Incident dementia cases (n = 308) from a population-based longitudinal study of people 75+ years were investigated. The DSM-III-R criteria were used for the clinical diagnosis of dementia. Data on vascular disorders (hypertension, cerebrovascular and ischemic heart diseases, heart failure, atrial fibrillation, diabetes) as well as type of onset/course of dementia were used retrospectively to reclassify dementias. RESULTS: Only 47% of the AD cases were reclassified as pure AD without any vascular disorder. Among subjects with AD and with a vascular component, cerebrovascular disease was the most common (41%). Only 25% of VaD were reclassified as pure VaD. Further, 26% of the pure AD subjects developed a vascular disorder in the following 3 years. CONCLUSIONS: Both vascular and degenerative mechanisms may often contribute to the expression of dementia among the elderly. Most of the AD cases have vascular involvements, and pure dementia types in very old subjects constitute only a minority of dementia cases.

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PubMed1996

Gender comparisons of cognitive performances among vascular dementia, Alzheimer disease, and older adults without dementia.

BACKGROUND: We hypothesized that women with Alzheimer disease (AD) would perform worse on a test of semantic memory but not on tests of other cognitive domains. We did not expect that women without dementia would perform more poorly than men without dementia on the same task. OBJECTIVE: To explore the specificity of a semantic memory deficit among women with AD by exploring gender differences among a group of subjects with vascular dementia (VD). DESIGN: A case-control study in which differences between men and women were explored using regression models to control for the potentially confounding effects of age, education, duration of dementia, and severity of dementia. SETTING: Alzheimer's Disease Research Center Consortium of Los Angeles and Orange Counties, California. SUBJECTS: Volunteers, recruited from the community or clinic referrals, who met clinical criteria for AD (n = 159) or VD (n = 117) or met criteria for control status without dementia (n = 134). MAIN OUTCOME MEASURES: Five neuropsychological measures, commonly used in the diagnosis and assessment of dementia. RESULTS: Women with VD scored lower than men with VD on 3 tests. However, when controlling for potential confounds, the gender difference was maintained only for the semantic memory task. Women with AD showed a strong trend to perform worse than men with AD on the test of semantic memory only. No gender differences were found among subjects without dementia. CONCLUSIONS: Findings support the existence of a semantic memory deficit for women with AD and suggest that a similar deficit may exist among women with VD.

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PubMed2005

Economics of dementia and pharmacoeconomics of dementia therapy.

BACKGROUND: The economic impact of dementia is not well appreciated, even though Alzheimer's disease and related dementias were the third most expensive health condition in the United States in 2000. In 1997, the cost of managing patients with Alzheimer's disease and other dementias was estimated at US dollar 100 billion. Direct medical costs are compounded by indirect costs of care, including unpaid care and loss of earnings. OBJECTIVE: The aim of this review was to examine studies of the economic impact of approved treatments for dementia therapy. METHODS: Searches of the MEDLINE database were conducted to identify prospective, randomized trials and retrospective or modeling studies of the economic impact of dementia medications, as well as analyses of managed care data (years 1996-2004; English language; search terms: dementia or Alzheimer's cross-referenced with economic or costs). RESULTS: Only 3 studies directly examined the economic effects of dementia therapy. Two of these demonstrated economic benefits of treatment, whereas the third study concluded that there were no benefits; however, the conclusions of the latter study may have been weakened by such factors as the high rate of attrition and biased selection of study participants. Modeling studies and analyses of managed care data also indicate economic benefits from approved treatments. CONCLUSIONS: Therapies that are efficacious early in the disease can postpone the progression of dementia to more severe stages and may offer economic benefit to patients' families, caregivers, and society.

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PubMed1998

Absence of vascular dementia in an autopsy series from a dementia clinic.

OBJECTIVE: The role of cerebrovascular disease in dementia in older people has been the subject of controversy. This study was undertaken to examine the prevalence of vascular disease in a prospective autopsy series of patients with clinically diagnosed dementia. DESIGN: Structured review of clinical and neuropathological examinations. Clinical diagnoses were assigned in accordance with the recommendations of the NINCDS/ADRDA consensus panel. Neuropathological examinations were performed at an academic neuropathology service using published consensus criteria for the diagnosis of Alzheimer's disease and other forms of dementia. SETTING: A subspecialty, outpatient dementia clinic in a university-affiliated suburban American hospital. PARTICIPANTS: Eighty-seven unselected patients coming to autopsy who had undergone clinical dementia evaluation. RESULTS: Dementia could not be attributed to the effects of cerebrovascular disease alone in any of the 87 patients coming to autopsy. Seventy-six (87%) of the patients were found to have Alzheimer's disease (AD), 44 had AD alone, and 32 had AD in combination with cerebrovascular disease (CVD). All of the patients with signs of CVD at autopsy were also found to have some concomitant neurodegenerative disease. The absence of patients in whom vascular dementia could be diagnosed at neuropathology was not the result of recruitment bias. CONCLUSION: Clinicians should maintain a high index of suspicion of AD or other neurodegenerative process in older patients whose presenting complaint is dementia, even in the presence of well documented cerebrovascular disease.

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PubMed1990

[A clinical study on the usefulness of CT and MRI imaging in evaluating differential diagnosis and the degree of dementia in vascular dementia].

For the evaluation of differential diagnosis and estimation of the functional prognosis for vascular dementia (VD), the usefulness of computed tomography (CT) and magnetic resonance imaging (MRI) in detecting cerebro-vascular lesions was compared. Then the correlations between the degrees of mental function (Hasegawa's dementia rating scale: HDRS, activity of daily living: ADL, troublesome behaviors: TB) and the CT findings of vascular dementia were examined retrospectively. A hundred and seventeen dementia patients (male: 79 cases, female: 38 cases; mean-age 69.5 +/- 10.9 years old), diagnosed using DSM-III criteria, were scored according to Hachinski's ischemic score (I.S.) by clinical course and symptoms. Both MRI and CT were carried out on 56 dementia cases (male: 21 cases, female: 35 cases; mean-age 78.0 +/- 7.4 years old) at the chronic stage of the cerebro-vascular accidents to compare the detectiveness of vascular lesions. In 90 vascular dementia patients on whom only CT was carried out, the imagings were classified according to number, size, and localization. The correlation between these parameters and the degree of dementia were examined retrospectively. MRI was more useful and sensitive than CT for differentiating VD from DAT (dementia of Alzheimer type), since MRI was superior to CT in detecting small infarcts or lacunaes on the perforating area or white matter. Cases with positive findings on CT or MRI but clinically diagnosed as DAT by I.S. showed poorer ADL.(ABSTRACT TRUNCATED AT 250 WORDS)

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PubMed2002

Assessing HIV-associated dementia: modified HIV dementia scale versus the Grooved Pegboard.

The HIV dementia scale (HDS) previously has been shown to be sensitive in identifying persons with HIV-associated dementia (HAD). We aimed to develop a simpler version of the HDS--the Modified HDS (M-HDS)--which would be appropriate for use by nonneurologists. We sought to determine whether the M-HDS and the widely used Grooved Pegboard (GP) were comparable in identifying and staging the severity of dementia in HIV-seropositive persons. Data from 455 HIV-seropositive persons were analyzed, and patients were separated into 2 groups: demented (n = 144) and nondemented (n = 311), where the diagnosis was established by a single neurologist. Of the 144 with HAD, 13 had severe dementia, 55 had moderate dementia, 51 had mild dementia, and 25 had minor cognitive/motor disorder. We assessed the relationship between dementia severity and score on the M-HDS and GP (nondominant hand). Results showed both the M-HDS (z = -4.32; P < .05) and the GP nondominant (z = -4.08; P < .05) differentiated demented from nondemented persons. Furthermore, the M-HDS (z = -2.95; P < .05) and GP nondominant (z = -2.68; P < .05) discriminated equally well the stages of dementia severity. A cutoff score of 7.5 on the M-HDS maximized its sensitivity (70%) and specificity (71%). The M-HDS and the GP (nondominant) were found to be equally sensitive and specific in categorizing and staging HAD. However, the M-HDS requires no equipment and is simpler to administer; so it may be more useful for screening by nonneurologists.

AIDS Dementia Complex↗
PubMed1994

Relationship of behavioral complications and severity of dementia in Japanese elderly persons with dementia.

Management of behavioral symptoms in patients with age-associated dementia is essential to improve quality of life for them and their caregivers. Although many results have been reported about the burden on caregivers of demented relatives, no guidelines for managing behavioral symptoms of demented patients have been developed. One of the major reasons for the lack of practical guidelines is that dementia behavioral syndromes have been understood to be a socio-psycho-somato disorder. Also, no standardized procedures to assess behavioral symptoms are yet available. In this article, the relationship of behavioral symptoms to the severity of dementia is examined by different assessment procedures, with the aim of understanding their manifestation mechanisms. In 223 patients with age-associated dementia, including 99 with Alzheimer type dementia, 32 behavioral symptoms were assessed according to frequency, severity, and intensity, which was assessed corresponding to a value score multiplied by a frequency score multiplied by a severity score. The results by an analysis of covariance with intensity, frequency, and severity of symptoms as dependent variables; severity of dementia as an independent variable; and age, sex, and activities of daily living scores as covariates, indicated that some behavioral symptoms are significantly related to severity of dementia, which is hypothesized to correspond to organic changes in the brain, while other symptoms are not related to severity of dementia. Also, the pattern of relationship varied according to assessment procedures.(ABSTRACT TRUNCATED AT 250 WORDS)

Activities of Daily Living↗
PubMed1988

Galanin hyperinnervates surviving neurons of the human basal nucleus of Meynert in dementias of Alzheimer's and Parkinson's disease: a hypothesis for the role of galanin in accentuating cholinergic dysfunction in dementia.

This study summarizes the findings from postmortem examination of the brains of 22 control cases without neurological deficit, 12 cases of senile dementia of the Alzheimer type (SDAT), and nine cases of Parkinson's disease (three without signs of intellectual deterioration, four with dementia, and two atypical with dementia nonresponsive to L-dopa treatment). The aim of this study was to find the similarities and differences in galanin innervation of the cholinergic basal nucleus neurons in these dementing disorders as compared with controls. Immunocytochemistry with antibodies against galanin peptide and against choline acetyltransferase was applied on perfused brain preparations. Galanin peptide is present in the basal nucleus of Meynert neuron networks in the normal human brain: in local circuit neurons, in a number of galanin/cholinergic neurons, and in a feedback circuit via collaterals) that terminate upon the cholinergic neuronal somata and dendrites. Thus, peptide galanin circuits could function as powerful modulators of the activities of basal nucleus cholinergic neurons, both within the basal forebrain and in their wider projections to the neocortex and amygdala. As galanin has been shown to inhibit cholinergic activity, this galanin network could suppress the activity of cholinergic neurons. In SDAT, there is a primary loss of cholinergic neurons compounded by a secondary reaction of the remaining cholinergic neurons to the terminal degeneration in the cortex. Galanin networks demonstrate an inverse relationship to the cholinergic cell loss. Galanin axons hypertrophy and hyperinnervate the remaining cholinergic neurons. In Parkinson's disease the loss of cholinergic neurons is accentuated by the presence of dementia: the hypertrophy of the galanin axonal networks on cholinergic neurons is dramatic in Parkinson's disease with dementia. These observations throw new light on the neurotransmitter bases for these dementias. Galanin controls cholinergic mechanisms in the basal nucleus of Meynert, and dementia is accompanied by augmentation of galanin innervation onto an already depressed population of cholinergic neurons, thus demonstrating an appreciable amount of plasticity even in aged brain. These findings suggest that the present therapy of cholinergic enhancement as a means to retard intellectual deterioration can by itself have little effect at best, in these dementias. The suppressive effect of galanin peptide has to be reduced or curtailed, perhaps concurrently with the treatment of the cholinergic deficit.(ABSTRACT TRUNCATED AT 400 WORDS)

Acetylcholine↗
PubMed2002

Dementia with Lewy bodies may present as dementia and REM sleep behavior disorder without parkinsonism or hallucinations.

Rapid eye movement (REM) sleep behavior disorder (RBD) is a sleep disturbance that commonly occurs in Dementia with Lewy bodies (DLB). Retrospective examination of DLB course has shown that RBD and cognitive decline may precede the onset of parkinsonism and visual hallucinations. Therefore, some patients with DLB may initially present with dementia and RBD, but would not meet current formal criteria for probable DLB at that time. The purpose of this study is to determine whether patients with dementia and RBD, who do not have parkinsonism or visual hallucinations, have cognitive profiles that can be distinguished from autopsy-confirmed definite AD, but not from clinically probable DLB. If so, this would support the hypothesis that the presence of RBD and dementia, as the only presenting symptoms, reflects the early manifestation of DLB. Results show that early dementia in probable DLB and dementia with RBD are neuropsychologically indistinguishable. Both groups differ from definite AD of a similar early stage with significantly worse visual perceptual organization, sequencing and letter fluency but significantly better confrontation naming and verbal memory. In addition, follow-up data from a subset of patients with dementia and RBD reveal the subsequent development of parkinsonism or hallucinations 1 to 6 years later. Results indicate that the presentation of dementia and RBD is suggestive of underlying Lewy body disease and not Alzheimer's disease. This provides further evidence in support of including RBD as one of the core diagnostic features of DLB.

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PubMed2004

A synopsis of the practice parameters on dementia from the american academy of neurology on the diagnosis of dementia.

OBJECTIVE: The objective of this paper is to review the current practice guidelines as developed by the American Academy of Neurology (AAN) for the diagnosis of dementia. DATA SOURCES: The data sources were the Report of the Quality Standards Subcommittee of the American Academy of Neurology paper, which was published in the May 2001 issue of the journal Neurology. STUDY SELECTION: The studies used in this paper are those reviewed by the AAN Practice Parameter Committee, which reviewed the literature for evidence-based human studies pertaining to the diagnosis of dementia. Studies on Alzheimer's disease (AD) included had to have more than 25 subjects. Each article was classified based on the quality of evidence. After review of the evidence, the committee drafted recommendations and placed the evidence into Practice Standards, Guidelines, or Options. DATA SYNTHESIS: The main results of this review were the guidelines for diagnosing dementia of various forms. To diagnose dementia, the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised (DSM-IIIR) should be used. For AD, the NINCDS-ADRDA (National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer s Disease and Related Disorders Association) criteria should be used. The Modified Hachinski Ischemic Score criteria can be used in the diagnosis of vascular dementia. The Consortium for DLB (Dementia with Lewy Bodies) criteria may be of use in clinical practice. Neuroimaging with a noncontrast CT or MRI scan in the routine initial evaluation of persons with dementia is appropriate; other methods of neuroimaging are not recommended at this time. Genetic testing and use of apolipoprotein E (ApoE) genotyping is not recommended at this time. Depression, B12 deficiency, and hypothyroidism should be screened for and treated in patients with dementia. Unless the patient lives in an area in the United States with a high rate of syphilis, screening for tertiary syphilis is not warranted. CONCLUSION: The guidelines and their clinical applications are pertinent and important knowledge for consultant pharmacists. This practice parameter will need to be updated every few years to include new studies and information that becomes available.

Journal Article↗
PubMed1999

Mortality from dementia in advanced age: a 5-year follow-up study of incident dementia cases.

Five-year follow-up of a community-based, 77+ old cohort including incident dementia cases was used to evaluate the impact of dementia on the risk of death, taking into account other chronic conditions potentially related to death, and contrasting Alzheimer's disease (AD), and vascular dementia (VaD). In this population, 70% of the dementia cases died during the five years after diagnosis, with a mortality rate specific for dementia of 2.4 per 100 person-years. After controlling for sociodemographic variables and comorbidity, 14% of all deaths could be attributed to dementia with a risk of death among demented subjects twice as high as that for non-demented people. Mortality risk ratios were 2.0 (95% confidence interval 1.5-2.7) for AD and 3.3 (95% confidence interval 2.0-5.3) for VaD. This study confirms that dementing disorders are a major risk factor for death. Even in the oldest old (85+), dementia shortens life, especially among women.

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PubMed1996

1995 IPA/Bayer Research Awards in Psychogeriatrics. Reclassification of the vascular dementias: comparisons of infarct and noninfarct vascular dementias.

This article focuses on some of the long-standing problems that exist in the classification of the vascular dementias. To clarify the definition of vascular dementia, mental status and other cognitive processes were investigated in 12 patients with a single cerebral infarct (mean age, 74.8 years), 17 patients with multiple cerebral infarcts (mean age, 71.4 years), 21 vascular patients with no cerebral infarcts (mean age, 76.9 years), and 16 demographically equivalent normal elderly persons (mean age, 70.4 years). The following null hypotheses /hypotheses were tested: (a) The cognitive impairment of single-infarct, multiple-infarct, and noninfarct vascular patients is not/is significantly greater than and outside the range of that in normal aging, and (b) there are/are not significant differences between single-infarct, multiple-infarct, and noninfarct vascular patients on mental status and other cognitive measures. Measures used included the Mini-Mental State Examination, Dementia Rating Scale, Western Aphasia Battery, and Boston Naming Test. Results indicate that vascular disorders involve a decrement in mental status and other cognitive functions that is significantly greater than the age-associated cognitive impairment of normal aging. Also, results from the study indicate that there were no robust, reliable significant differences between single-infarct, multiple-infarct, and noninfarct patients. The validity of the distinction of focal versus generalized or diffuse cerebral lesions is questioned. The nosologic entity of noninfarct vascular dementia is introduced. The future nosology of vascular dementia should provide for noninfarct vascular dementia, defined as vascular dementia caused by underlying vascular mechanisms other than cerebral infarction.

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PubMed1994

Apo E allele frequencies in Alzheimer's disease, Lewy body dementia, Alzheimer's disease with cerebrovascular disease and vascular dementia.

Apolipoprotein (Apo E) was genotyped using a fluorescent PCR-RFLP assay in 187 patients with a probable or possible clinical diagnosis of sporadic Alzheimer's disease (AD) and in 166 autopsied patients with dementia (21 presenile AD, 70 senile AD, 18 Lewy body dementia (LBD), 38 AD with cerebrovascular disease (AD-CVD), 19 vascular dementia). The relative epsilon 4 allele frequency was 0.472 in LBD, 0.513 in AD-CVD, 0.405 in presenile AD, 0.364 in senile AD, and 0.079 in vascular dementia. The relative epsilon 2 allele frequency was 0.211 in vascular dementia, 0.083 in LBD, 0.047 in presenile AD, 0.100 in senile AD and 0.039 in AD with CVD. We infer that apo E is a major risk factor for structural phenotypes of dementia involving AD, alone or in conjunction with another pathology. In addition, the epsilon 2 allele is likely to represent a risk factor for vascular morbidity, as the relative epsilon 2 allele frequency was 0.211 in patients with vascular dementia compared with 0.144 in elderly controls.

Adolescent↗
PubMed2005

Frontal lobe dementia and subcortical vascular dementia: a neuropsychological comparison.

We compared the performance of 40 patients with frontal lobe dementia to that of 40 patients with subcortical vascular dementia (80 patients including, 46 men and 34 women) in a set of tasks assessing attentional, executive, and behavioural tasks. The frontal lobe dementia represents an important cause for degenerative disruption and is increasingly recognised as an important form (up to 25%) of degenerative dementia among individuals of late-middle-age. The main involvement is the frontal-subcortical pathway, which is the final target of impairment even in subcortical vascular dementia. A wider involvement of the cortical (decisional) layers in frontal dementia, in contrast with the prominent and widespread involvement of the subcortical pathways (refinement and corrections programs) creates the different profiles of the two groups. Frontal patients have more difficulties in abstract reasoning, focusing attention, and implementing strategies to solve problems. They exhibit more profound behavioural alterations in personality and social conduct and show only moderate depression, and a total lack of insight concerning their dinical condition. In contrast, the patients with subcortical vascular dementia have poor general cognitive functions, high insight, and important depression and apathy as the principal and most salient characteristic of their behavioral conduct.

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PubMed1994

The malignancy of dementia. Predictors of mortality in clinically diagnosed dementia in a population survey of Shanghai, China.

OBJECTIVE: To evaluate the effect of dementing illnesses on the risk of dying, taking into account other conditions that would shorten survival. DESIGN: Five-year follow-up of community survey of dementia. SETTING: Five-year data were obtained for the 3531 subjects, aged 65 years and older, who participated in the 1987 population survey of dementia in Shanghai, China. MAIN OUTCOME MEASURE: Time to death. Relative risks of dying were calculated for demographic variables, dementia diagnoses based on findings of clinical evaluations, and 15 reported prevalent medical conditions using the proportional hazards model. RESULTS: In those subjects aged 65 to 74 years, the mortality risk ratio was 5.4 (95% confidence interval, 2.0 to 14.6) for Alzheimer's disease and 7.2 (95% confidence interval, 3.6 to 14.4) for vascular dementia. The risk ratio for Alzheimer's disease was similar to the mortality risk ratio for cancer (5.6 [range, 2.9 to 10.9]). In this age group, dementing illnesses were uncommon, and few deaths were therefore attributable to the dementing illnesses. In those subjects aged 75 years and older, the mortality risk ratios were 2.8 (95% confidence interval, 2.1 to 3.6) for Alzheimer's disease, 3.5 (95% confidence interval, 2.4 to 5.1) for vascular dementia, and 3.6 (95% confidence interval, 2.0 to 6.7) for "other dementias." Because these dementing disorders were common in those subjects aged 75 years and older, 23.7% of the risk of death could be attributed to these disorders. CONCLUSIONS: Both Alzheimer's disease and vascular dementias are truly malignant and constitute major risk factors for death in persons older than 75 years.

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PubMed1997

A comparison of semantic memory in vascular dementia and dementia of Alzheimer's type.

OBJECTIVE: To determine whether semantic memory is impaired in vascular dementia and to assess the utility of semantic memory measures in differentiating vascular dementia from dementia of Alzheimer's type (DAT). DESIGN: Case-control study. PATIENTS: Ten patients with Cambridge Mental Disorders in the Elderly (CAMDEX) diagnosis of 'definite' mild or moderate vascular dementia (mean age 77) were individually matched with 10 patients with a CAMDEX diagnosis of 'definite' DAT on the basis of age, education, sex, premorbid IQ (as measured by the National Adult Reading Test) and performance on the Cambridge Cognitive Examination (CAMCOG). In addition, 10 age, sex and education matched volunteer or relative controls were assessed. OUTCOME MEASURES: A detailed semantic memory test battery consisting of five subtests: category fluency, picture naming, picture sorting, word-picture matching and generation of verbal definitions. RESULTS: Compared to normal controls, both patient groups were impaired on all subtests of the semantic battery with the exception of the word-picture matching test. No differences were found between the vascular dementia and DAT groups on any of the measures. CONCLUSIONS: Impairment of semantic memory is a feature of both vascular dementia and DAT. Tests of semantic memory appear, therefore, of little value in differentiating between these two major causes of dementia. Further work is required to determine whether the nature of the processing deficit is the same in these conditions.

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PubMed2006

Utility of the Mattis dementia rating scale to assess the efficacy of rivastigmine in dementia associated with Parkinson's disease.

INTRODUCTION: The severe, cortical, cholinergic depletion accompanying Parkinson's disease (PD) is considered as a highly probable correlate of cognitive and behavioural dysfunction. Recent studies have demonstrated that cholinesterase inhibitors (notably rivastigmine) are beneficial in patients suffering from dementia associated with PD (PDD). However, the primary efficacy variables used in such work came from scales designed for Alzheimer's disease (AD), even though the cognitive symptoms in PD and AD dementia do not overlap completely. The aim of the present study (a double-blind, placebo-controlled clinical trial) was to determine the utility of the Mattis dementia rating scale - the most commonly used scale in PD patients - to assess the efficacy of a 24-week rivastigmine treatment. METHODS: Twenty-eight patients with PD, who constituted a subgroup of patients enrolled to the EXPRESS study (Emre et al, N Engl J Med 2004) participated in this study. They suffered from mild to moderately severe dementia (MMSE scores above 10 and below 24), with an onset of cognitive symptoms occurring at least two years after the diagnosis of PD. Patients were randomly assigned to treatment with rivastigmine (3 to 12 mg per day) or placebo. The Mattis dementia rating scale was administered to patients from six centres in France at the baseline and end-point visits. RESULTS: Compared with placebo, a 24-week rivastigmine treatment led to a significant improvement in the overall score on the Mattis dementia rating scale (p = 0.031), with a trend towards a significant improvement in the "Attention" subscale score (p = 0.061). Correlation analysis showed that in the rivastigmine group, performance on the Mattis "Attention" and "Initiation" subscales appeared to contribute heavily to the improvement in the overall score. Moreover, the latter was also related to an improvement in activities of daily living and a reduction in behavioural disturbances. DISCUSSION: By using the Mattis dementia rating scale (which comprises items that are sensitive to executive dysfunction), the present study confirmed that rivastigmine has a beneficial effect on cognitive function in PDD. Despite our study's small sample size, the Mattis scale was able to detect this improvement and could thus be considered as an interesting outcome measure in further work.

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