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At least 19 recordsLinked to original sources
PubMed2003

Association of plasma homocysteine in elderly persons with atherosclerotic vascular disease and dementia, atherosclerotic vascular disease without dementia, dementia without atherosclerotic vascular disease, and no dementia or atherosclerotic vascular disease.

BACKGROUND: Increased plasma homocysteine has been associated with atherosclerotic vascular disease in elderly persons. The Framingham Study found that plasma homocysteine was a risk factor for dementia and Alzheimer's disease. METHODS: We investigated in an academic nursing home the association of plasma homocysteine with atherosclerotic vascular disease plus dementia (group 1), atherosclerotic vascular disease without dementia (group 2), dementia without atherosclerotic vascular disease (group 3), and no dementia or atherosclerotic vascular disease (group 4). RESULTS: The mean plasma homocysteine level was 15.3 +/- 3.0 micromol/L in 50 group 1 patients, 15.1 +/- 2.7 micromol/L in 50 group 2 patients, 14.4 +/- 2.7 micromol/L in 50 group 3 patients, and 10.6 +/- 3.2 micromol/L in 50 group 4 patients (p <.0001 for group 1 vs group 4, for group 2 vs group 4, and for group 3 vs group 4). CONCLUSIONS: The mean plasma homocysteine level was significantly higher in elderly patients with atherosclerotic vascular disease plus dementia, atherosclerotic vascular disease without dementia, and dementia without atherosclerotic vascular disease than in patients with no dementia or atherosclerotic vascular disease.

Aged↗
PubMed2003

Association of abnormal serum lipids in elderly persons with atherosclerotic vascular disease and dementia, atherosclerotic vascular disease without dementia, dementia without atherosclerotic vascular disease, and no dementia or atherosclerotic vascular disease.

BACKGROUND: Observational data have shown that the use of statins was associated with a lower prevalence of vascular dementia and of Alzheimer's disease. METHODS: We investigated in an academic nursing home the association of dyslipidemia with atherosclerotic vascular disease (group 1), atherosclerotic vascular disease without dementia (group 2), dementia without atherosclerotic vascular disease (group 3), and no dementia or atherosclerotic vascular disease (group 4). RESULTS: Increased serum low-density lipoprotein (LDL) cholesterol was present in 36 of 50 group 1 patients (72%), in 34 of 50 group 2 patients (68%), in 34 of 50 group 3 patients (68%), and in 18 of 50 group 4 patients (36%) (p =.0003 for 1 versus 4; p = 0.001 for 2 versus 4 and 3 versus 4). Decreased serum high-density lipoprotein (HDL) cholesterol was present in 34 of 50 group 1 patients (68%), in 35 of 50 group 2 patients (70%), in 32 of 50 group 3 patients (64%), and in 16 of 50 group 4 patients (32%) (p =.0003 for 1 versus 4; p =.0001 for 2 versus 4; p =.001 for 3 versus 4). Hypertriglyceridemia was not significantly different in the 4 groups. CONCLUSIONS: The prevalence of increased serum LDL cholesterol and decreased serum HDL cholesterol were significantly higher in elderly patients with atherosclerotic vascular disease plus dementia, atherosclerotic vascular disease without dementia, and dementia without atherosclerotic vascular disease than in patients with no dementia or atherosclerotic vascular disease.

Age Distribution↗
PubMed2005

Neuropsychiatric symptoms in dementia-frequency, relationship to dementia severity and comparison in Alzheimer's disease, vascular dementia and frontotemporal dementia.

Noncognitive behavioral and psychiatric disturbances are common in dementia and help in the clinical differentiation of the various subtypes. We studied the frequency of neuropsychiatric disturbances, their relationship to dementia severity and compared these disturbances in Alzheimer's disease (AD), vascular dementia (VaD) and frontotemporal dementia (FTD) using the 12-item Neuropsychiatric Inventory (NPI). A total of 98 patients (AD-44, VaD-31, FTD-23) were evaluated. All subjects were community dwelling at the time of evaluation. The three groups were comparable on global dementia severity and functional ability. All patients had clinically significant scores on the NPI with apathy, irritability and agitation being very common (>90% of patients). AD and VaD patients in Clinical Dementia Rating (CDR) stage 2 had significantly higher scores on the total NPI, agitation and disinhibition subscales compared to those in CDR stage 1. Mean scores in the domains of aberrant motor behavior, disinhibition and appetite/eating behavior differentiated FTD from AD and VaD. Neuropsychiatric disturbances in dementia appear to be universal with agitation, disinhibition and irritability being more frequent in the later stages. In this cohort disinhibition, aberrant motor behavior and appetite/eating disturbances could reliably differentiate AD and VaD from FTD. There were no significant differences between the neuropsychiatric profiles of AD and VaD.

Aged↗
PubMed2000

Nimodipine for primary degenerative, mixed and vascular dementia.

BACKGROUND: Dementia is an age-related condition in which Alzheimer's disease (AD) and cerebrovascular disease account for the bulk of cases. The role played by calcium in regulating brain functions is well known - the calcium ion links membrane excitation to subsequent intracellular enzymatic response. Change in calcium homeostasis is one important effect of aging with repercussions on higher cortical functions. Nimodipine is an isopropyl calcium channel blocker which can easily cross the blood brain barrier. Its primary action is to reduce the number of open channels, thus restricting influx of calcium ions into the cell. The usefulness of nimodipine in patients with Alzheimer's disease and vascular dementia and unspecified dementia is still controversial with mixed results. In spite of the uncertainties about its efficacy in dementia, nimodipine is currently a frequently prescribed drug for cognitive impairment and dementia in several European countries. This review will be conducted in two phases; the current review is based on evidence from published data only. The second phase will be based on individual-patient data analysed centrally and added to this review in due course. OBJECTIVES: To determine the clinical efficacy of nimodipine for the symptoms of dementia, either unclassified or according to the major subtypes - Alzheimer's disease, vascular, or mixed Alzheimer's and vascular dementia. SEARCH STRATEGY: The Cochrane Dementia Group Register of Clinical Trials was searched using the terms 'nimodipine' and 'isopropyl (2-methoxy-ethyl) 1,4-dihydro-2, 6-dimethyl-4-(3-nitrophenyl)-3, 5-pyridinedicarboxylate'. SELECTION CRITERIA: All unconfounded, double-blind, randomised trials in which treatment with nimodipine was administered for more than a day and compared to placebo in patients with dementia, either unclassified or according to the major subtypes - Alzheimer's disease, vascular, or mixed Alzheimer's and vascular dementia. DATA COLLECTION AND ANALYSIS: Data were extracted independently by the reviewers and the odds ratio (95%CI) or the average difference (95%CI) were estimated. Both intention-to-treat and on-treatment results were extracted. MAIN RESULTS: This review produced no clear results. Many of the data published were not capable of being sensibly pooled. The data were compatible with nimodipine producing improvement, no change or even harm for those with Alzheimer's disease, vascular dementia, or mixed Alzheimer's and vascular dementia. It was not possible to use many of the published results in a combined analysis. For measures of overall clinical improvement, the intention-to-treat analysis, based on one study only, failed to detect any difference between nimodipine and placebo (OR 0.53; 95%CI 0.25 - 1.13). An on-treatment analysis, based on one study only, produced a statistically significant difference in favour of nimodipine (SMD 4.4; 95%CI 3.9 - 5.0). For cognitive function, the effect of nimodipine was statistically significantly different from placebo for the Mini Mental State Examination score (0-30; high =good) (SMD 0.9; 95%CI 0.59 - 1.22) and there was a statistically significant effect in favour of treatment for the Wechsler Memory Scale (SMD 0.47; 95%CI 0.17 - 0.77). These analyses were based only on those who completed the study and not intention-to-treat analyses. There were no results presented in a form suitable for pooling for functional autonomy, behaviour, quality of life dependency (eg institutionalization), effect on carer, death, acceptability of treatment (as measured by withdrawal rate, safety (as measured by the incidence of adverse effects, including side effects, leading to withdrawal). REVIEWER'S CONCLUSIONS: This review provides no convincing evidence that nimodipine is a useful treatment for the symptoms of dementia, either unclassified or according to the major subtypes - Alzheimer's disease, vascular, or mixed Alzheimer's and vascular dementia. (ABSTRACT TRUNCATED)

Alzheimer Disease↗
PubMed2000

Lecithin for dementia and cognitive impairment.

BACKGROUND: People with Alzheimer's disease have been found to have a relative lack of the enzyme responsible for converting choline into acetylcholine within the brain. Lecithin is a major dietary source of choline, so extra consumption may assist in the production of acetylcholine and reduce some of the symptoms of dementia. OBJECTIVES: To determine the efficacy of lecithin in the treatment of dementia or cognitive impairment. SEARCH STRATEGY: The Cochrane Dementia and Cognitive Impairment Group Register of Clinical Trials has been searched, as have the electronic databases MEDLINE, EMBASE, Psychlit, ISI and Current Contents. Reference lists and relevant books have been examined. SELECTION CRITERIA: All unconfounded, randomised trials comparing lecithin with placebo in a treatment period longer than one day, in patients with dementia of the Alzheimer type, vascular dementia, mixed vascular and Alzheimer's disease, unclassified or other dementia or unclassified cognitive impairment not fulfilling the criteria for dementia are eligible for inclusion. DATA COLLECTION AND ANALYSIS: Data are extracted by two independent reviewers and cross checked. Meta-analyses are performed when more than one trial provide data on a comparable outcome on sufficiently similar patients. Random effects analyses are performed whenever heterogeneity between results appears to be present. Standardised mean difference are used due do the use of different scales and periods of treatment. Odds ratios for dichotomous data are pooled using the Mantel-Haenszel or DerSimonian and Laird methods. MAIN RESULTS: Eleven randomised trials have been identified involving patients with Alzheimer's disease (265 patients) and Parkinsonian dementia (21 patients). No trials reported any clear clinical benefit of lecithin. Few trials contributed data to meta-analyses. The only statistically significant result was in favour of placebo for adverse events, based on one trial, which appears likely to be a spurious result. REVIEWER'S CONCLUSIONS: Evidence from randomised trials does not support the use of lecithin in the treatment of patients with dementia or cognitive impairment. A moderate effect cannot be ruled out, but results from the small trials to date do not indicate priority for a large randomised trial.

Alzheimer Disease↗
PubMed2003

Performance on the dementia rating scale in Parkinson's disease with dementia and dementia with Lewy bodies: comparison with progressive supranuclear palsy and Alzheimer's disease.

BACKGROUND: The relation between dementia with Lewy bodies (DLB) and Parkinson's disease with dementia (PDD) is unknown. OBJECTIVES: To compare the cognitive profiles of patients with DLB and PDD, and compare those with the performance of patients with a subcortical dementia (progressive supranuclear palsy) and a cortical dementia (Alzheimer's disease). DESIGN: Survey of cognitive features. SETTING: General community in Rogaland county, Norway, and a university dementia and movement disorder research centre in the USA. PATIENTS: 60 patients with DLB, 35 with PDD, 49 with progressive supranuclear palsy, and 29 with Alzheimer's disease, diagnosed by either standardised clinical procedures and criteria (all PDD and Alzheimer cases and 76% of cases of progressive supranuclear palsy), or necropsy (all DLB cases and 24% of cases of progressive supranuclear palsy). Level of dementia severity was matched using the total score on the dementia rating scale adjusted for age and education. MAIN OUTCOME MEASURES: Dementia rating scale subscores corrected for age. RESULTS: No significant differences between the dementia rating scale subscores in the PDD and DLB groups were found in the severely demented patients; in patients with mild to moderate dementia the conceptualisation subscore was higher in PDD than in DLB (p = 0.03). Compared with Alzheimer's disease, PDD and DLB had higher memory subscores (p < 0.001) but lower initiation and perseveration (p = 0.008 and p=0.021) and construction subscores (p = 0.009 and p = 0.001). DLB patients had a lower conceptualisation subscore (p = 0.004). Compared with progressive supranuclear palsy, PDD and DLB patients had lower memory subscores (p < 0.001). CONCLUSIONS: The cognitive profiles of patients with DLB and PDD were similar, but they differed from those of patients with Alzheimer's disease and progressive supranuclear palsy. The cognitive pattern in DLB and PDD probably reflects the superimposition of subcortical deficits upon deficits typically associated with Alzheimer's disease.

Aged↗
PubMed2006

Neurocognitive differential diagnosis of dementing diseases: Alzheimer's Dementia, Vascular Dementia, Frontotemporal Dementia, and Major Depressive Disorder.

Similarities in presentation of Dementia of Alzheimer's Type, Vascular Dementia, Frontotemporal Dementia, and Major Depressive Disorder, pose differential diagnosis challenges. The current study identifies specific neuropsychological patterns of scores for Dementia of Alzheimer's Type, Vascular Dementia, Frontotemporal Dementia, and Major Depressive Disorder. Neuropsychological domains directly assessed in the study included: immediate memory, delayed memory, confrontational naming, verbal fluency, attention, concentration, and executive functioning. The results reveal specific neuropsychological comparative profiles for Dementia of Alzheimer's Type, Vascular Dementia, Frontotemporal Dementia, and Major Depressive Disorder. The identification of these profiles will assist in the differential diagnosis of these disorders and aid in patient treatment.

Aged↗
PubMed2003

[Are the Danish Society of General Practitioners' clinical guidelines concerning "Identification and investigation of dementia and dementia-like conditions" useful as the basis of dementia investigation in general practice?].

INTRODUCTION: During the last five years better possibilities have appeared for investigation and medical treatment of dementia. Society and the national health authorities have a growing demand for systematical identification of dementia. In 1999, DSAM published a clinical guideline for identifying dementia. The aim of the study was to test the usefulness of that guideline. MATERIAL AND METHODS: A total of 22 out of 29 general practitioners (GPs) agreed to use the guidelines of the Danish Society of General Practitioners (DSAM) and the questionnaires from three consultations in order to systematically identify dementia. At the same time, the GPs gave their opinion about the usefulness of the guidelines. RESULTS: A total of 22 GPs sent results from 69 patients. A group of 49 patients had been CT-scanned, 13 patients had been examined by neuropsychologists, and nine patients had started acetylcholinesterase inhibitor treatment. CONCLUSION: Some GPs found it embarrassing to offer dementia identifying to their patients. Identifying dementia was complicated and time-consuming. Identifying dementia offered opportunities to look further into polypharmacy and cooperation with other health sectors. Necessary but not sufficient preconditions for starting identifying dementia in general practice will be fees, direct admission to CT-scanning and neuropsychologist, and possibly right to prescribe acetylcholinesterase inhibitors. The conclusion was that all GPs found the guidelines of DSAM useful for identifying dementia in general practice.

Adult↗
PubMed2003

Health characteristics of elderly residents in personal care homes. Dementia, possible early dementia, and no dementia.

Personal care homes are becoming an integral part of the gerontological health care environment. This exploratory descriptive study compares the health characteristics of elderly personal care home residents without dementia or cognitive impairment, residents with possible early dementia, and residents with dementia. Results indicate a number of residents with possible early dementia, but without a diagnosis of dementia, may be residing in personal care homes. Additionally, the three groups may have distinctly different service needs. Residents with dementia were particularly at risk for problems with decision-making, communication, and impaired instrumental activities of daily living (IADL). Medication management for residents with dementia emerged as a particular concern. Most physical health characteristics, such as health care usage, were not significantly different in the three groups. Suggestions for strategies to promote the health and well-being of this growing population are discussed.

Activities of Daily Living↗
PubMed2001

The factor structure in the cognitive battery of the structured interview for the diagnosis of dementia of the Alzheimer type, multi-infarct dementia, and dementias of other aetiology.

The Structured Interview for the Diagnosis of Dementia of the Alzheimer Type, MultiInfarct Dementia, and Dementias of Other Aetiology (SIDAM) includes the Mini-Mental State Examination extended by a number of additional items and allows the diagnosis of dementia according to ICD-10 and DSM-III-R criteria. The authors proposed to summarize selected items to form syndrome scores. These syndrome scores are supposed to measure different aspects of cognition. However, these syndrome scores have not been empirically confirmed. The present article presents a principal component analysis performed on the SIDAM test performances of 456 elderly subjects. The subjects were recruited in the course of a family study on dementia of the Alzheimer's type and depression in the elderly. One hundred four of these subjects met the criteria of dementia according to the ICD-10 criteria. Thus, the sample represents the population in which the SIDAM is frequently used in routine clinical and epidemiological studies. We found a six-factor structure accounting for 57.1% of the variance with some similarities to the predefined structure of different syndrome scores proposed by the authors of the SIDAM. The first factor found in principal component analysis represented different higher cortical functions that all depend on language and comprehension. Three factors covered three different aspects of memory, i.e., orientation for time, orientation for place, and short-term memory. One factor represented visuoconstructive skills and, finally, there was a factor representing intellectual abilities and education. This empirically found factor structure characterizes the dimensions of cognitive deficits in demented subjects measured by the SIDAM. Syndrome scores should reflect these dimensions. Consequently, we propose to consider the empirically found factor structure in a new version of the SIDAM.

Aged↗
PubMedDate not supplied

[Dementia and internal diseases: incidence of internal diseases in Alzheimer dementia, vascular dementia and other dementing diseases].

The medical histories and postmortems of 30 patients with neuropathologically verified Alzheimer's disease were compared with a group of 20 patients suffering from vascular dementia and a group of 10 patients with other forms of dementia. The total numbers of clinically or pathologically diagnosed medical disorders did not show significant differences between the different forms of dementia. Metabolic, infectious, degenerative, and malignant disorders occurred with similar frequency in all investigated groups. Cardiovascular diseases were only slightly more common in patients with vascular dementia. In contrast to several earlier clinical or epidemiological studies, it has to be concluded that patients with Alzheimer's dementia cannot be considered physically "healthier" than patients with other forms of dementia. Therefore, they need the same medical attention as do other elderly demented patients.

Aged↗
PubMed2001

Dementia and neurodevelopmental predisposition: cognitive dysfunction in presymptomatic subjects precedes dementia by decades in frontotemporal dementia.

Dementia is typically thought of as a disease caused by the process of aging. Few studies have addressed the premorbid neuropsychological alterations in subjects at risk for the disease--an issue of great importance for the understanding and treatment of degenerative dementias. We used knowledge of the mutation carrier status in a family with inherited dementia to address this issue more efficiently than is possible in the general population, or in cases of inherited dementia where the mutational basis is unknown. Standard neuropsychological tests were used to detect evidence of dysfunction in frontal executive systems in 10 presymptomatic subjects with known mutation carrier status in the highly penetrant condition, frontotemporal dementia and parkinsonism linked to chromosome 17. Presymptomatic carriers demonstrated cognitive dysfunction that was not present in 6 nonmutation-carrying relatives. Strikingly, frontal-executive dysfunction was apparent in some of the youngest mutation carriers many decades prior to the predicted onset of dementia. Thus, this dysfunction may reflect the native cognitive capacities of affected subjects. These results suggest a potentially important neurodevelopmental component to a dementing condition that has been predominantly considered to be a disease of aging; accordingly, this issue warrants study in other families to assess the applicability of these findings.

Adolescent↗
PubMed1995

[Rest-activity and body-temperature rhythm disorders in elderly patients with dementia--senile dementia of Alzheimer's type and multi-infarct dementia].

We simultaneously monitored rest-activity and body temperature (BT) rhythm in demented patients with sleep and behavior disorders using ambulatory wrist-worn actigraph and long-term monitoring system for 5-7 consecutive days. Subjects consisted of 19 patients with senile dementia of Alzheimer's type (SDAT) (M/F = 7/12, mean age = 71.7 years), 16 patients with multi-infarct dementia (MID) (M/F = 9/7, mean age = 75.2 years) and 9 normal controls (M/F = 4/5, mean age = 70.4 years). Both dementia groups showed a significant increase in percentage of nighttime activity. In the SDAT group, a significant positive correlation between the degree of dementia and total activity was observed, but not observed in the MID group. A significant high amplitude of BT rhythm was observed in the SDAT group comparing that in the MID or the control group. These findings indicate that the SDAT patients had a disrupted rest-activity rhythm with the severity of intellectual deterioration and increased night activity, while the circadian BT rhythm was remarkably well preserved, i.e. there was a dissociation between rest-activity and BT rhythms in the SDAT group. On the other hand, the disruption of the rest-activity and BT rhythm in the MID patients was characterized by a concomitant decrease of amplitude, which seems to have no relation with the severity of dementia. Different mechanisms could be involved in characteristic disruption of the circadian rhythms in the 2 dementia groups.

Aged↗
PubMed2002

[Age- and education-specific reference values for the cognitive test of the SIDAM (Structured interview for the diagnosis of dementia of the Alzheimer type, multi-infarct dementia and dementias of other etiology according to ICD-10 and DSM-IV)].

The SIDAM (Structured Interview for the diagnosis of Dementia of the Alzheimer type, Multi-infarct dementia and dementias of other etiology according to ICD-10 and DSM-IV) is a standardized interview for the diagnosis of dementia. It can also be used as a screening instrument for the diagnosis of different syndromes of dementia and mild cognitive impairment. At present there is no age- or education-specific standardization. This report presents age- and education-specific norms for the cognitive assessment of the SIDAM, obtained in a population-based sample of elderly people aged 75 and over (n=1001).

Age Factors↗
PubMed1998

Cognitive deficits of mild dementia: A comparison between dementia of the Alzheimer's type and vascular dementia.

This study was designed to examine the profiles of cognitive deficits in 11 mildly demented patients with dementia of Alzheimer's type (DAT), five with vascular dementia with multiple subcortical lacunar infarcts (VDS), and seven with vascular dementia with extensive white matter lesions (VDW) in comparison with 23 aged individuals without dementia. Memory, attention, abstract thinking, and visuospatial function were assessed using the Japanese translation of the Wechsler Memory Scale-Revised (WMS-R) and the Japanese version of the Wechsler Adult Intelligence Scale-Revised (WAIS-R). Compared with normal aged individuals, three dementia groups were significantly impaired in the memory and abstract thinking. However, the performances on several tests on attention (i.e. Mental Control and Visual Memory Span Backward from WMS-R) and visuospatial function (i.e. Object Assembly from WAIS-R) differed significantly between the DAT and VDS groups, with VDS being the worst in terms of performance than was DAT. This study suggests that, in the mildly demented stage, the patients with DAT have few problems in the attention and visuospatial function, but those with VDS have impairments in these cognitive abilities.

Adult↗
PubMed1995

Design fluency in dementia of Alzheimer's type, multi-infarct dementia and dementia associated with alcoholism.

Design fluency was assessed in four age and education matched groups 16 medical controls, 17 dementia of the Alzheimer's type (DAT), 15 multi-infarct dementia (MID) and six patients with dementia associated with alcoholism (DAA). In comparison with the control group, the three dementia groups distinctly demonstrated impaired production of novel designs with a significant tendency towards perseveration. Also the four groups were assessed on word fluency, with similar findings obtained. Word fluency and design fluency performance was most interrelated within the DAT group. Although the nonspecific effects of the dementing process in each group contributed to impaired design fluency production, in the DAT group it appeared that visuoconstructive deficits, in particular, negatively impacted design fluency. Results are discussed in terms of the clinical utility of the design fluency measure and its relationship to impaired novel and creative responding in dementia.

Journal Article↗
PubMed2002

[Adaptation of a dementia test for use in visually handicapped persons exemplified by SIDAM (Structured Interview for the Diagnosis of Alzheimer disease, Multi-Infarct Dementia and Dementias of other Etiology)].

In epidemiological field studies on the prevalence and incidence of dementia, the problem of cognitive testing of visually impaired individuals is rarely discussed. In the Leipzig Longitudinal Study of the Aged (LEILA 75+) a version of the SIDAM (SIDAM-Structured Interview for the Diagnosis of dementia of the Alzheimer type, Multi-infarct dementia and dementias of other etiology) for the visually impaired was employed from which all items requiring image processing had been omitted (SIDAM-blind). In order to be able to interpret the test results, the final scores for the full SIDAM were estimated by linear transformation of the scores in the blind-version. The method of linear transformation is based on certain theoretical assumptions which are examined in this paper. Linear transformation of scores has proved to be a valid procedure only for individuals with high cognitive performances. Thus, an evaluation of estimated scores based on the norms for the original SIDAM has limitations. Consequently, age-specific norms for the SIDAM-blind are presented. Sensitivities and specificities for different cut-off points used to discriminate between demented and non-demented vision-impaired individuals are given.

Aged↗