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Dementia
Current Awareness
Newsletter
July 2015
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Contents
Your Friendly Local Librarian… ................................................................................................................ 2
New Cochrane Library Systematic Reviews on Dementia ...................................................................... 3
New from NICE ......................................................................................... Error! Bookmark not defined.
New from Department of Health and Public Health England................................................................. 5
NHS Behind the Headlines ...................................................................................................................... 5
Recent Literature Searches on Dementia ................................................ Error! Bookmark not defined.
Current Awareness Database Articles on Dementia............................................................................... 6
Dementia caring .................................................................................................................................. 6
Medical.............................................................................................................................................. 29
Therapies........................................................................................................................................... 76
Other ................................................................................................................................................. 83
Journal Tables of Contents.................................................................................................................... 96
Alzheimer’s and Dementia ................................................................................................................ 96
Dementia: The International Journal of Social Research and Practice ............................................. 96
Age and Ageing ................................................................................................................................. 96
Journal of the American Geriatrics Society ....................................................................................... 96
Your Friendly Local Librarian…
Whatever your information needs, the library is here to help. As your outreach librarian I offer
literature searching services as well as training and guidance in searching the evidence and critical
appraisal – just email me at library@uhbristol.nhs.uk
OUTREACH: Your Outreach Librarian can help facilitate evidence-based practise for all in the
dementia team, as well as assisting with academic study and research. We can help with literature
searching, obtaining journal articles and books, and setting up individual current awareness alerts.
We also offer one-to-one or small group training in literature searching, accessing electronic
journals, and critical appraisal. Get in touch: library@uhbristol.nhs.uk
LITERATURE SEARCHING: We provide a literature searching service for any library member. For
those embarking on their own research it is advisable to book some time with one of the librarians
for a 1 to 1 session where we can guide you through the process of creating a well-focused literature
research and introduce you to the health databases access via NHS Evidence. Please email requests
to library@uhbristol.nhs.uk
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New Cochrane Library Systematic Reviews on
Dementia
Regional Cerebral Blood Flow Single Photon Emission Computed Tomography for detection of
Frontotemporal dementia in people with suspected dementia
Cochrane Database of Systematic Reviews - 23 June 2015
Abstract:
Background: In the UK, dementia affects 5% of the population aged over 65 years and 25% of those
over 85 years. Frontotemporal dementia (FTD) represents one subtype and is thought to account for
up to 16% of all degenerative dementias. Although the core of the diagnostic process in dementia
rests firmly on clinical and cognitive assessments, a wide range of investigations are available to aid
diagnosis.
Regional cerebral blood flow (rCBF) single-photon emission computed tomography (SPECT) is an
established clinical tool that uses an intravenously injected radiolabelled tracer to map blood flow in
the brain. In FTD the characteristic pattern seen is hypoperfusion of the frontal and anterior
temporal lobes. This pattern of blood flow is different to patterns seen in other subtypes of
dementia and so can be used to differentiate FTD.
It has been proposed that a diagnosis of FTD, (particularly early stage), should be made not only on
the basis of clinical criteria but using a combination of other diagnostic findings, including rCBF
SPECT. However, more extensive testing comes at a financial cost, and with a potential risk to
patient safety and comfort.
Objectives:To determine the diagnostic accuracy of rCBF SPECT for diagnosing FTD in populations
with suspected dementia in secondary/tertiary healthcare settings and in the differential diagnosis
of FTD from other dementia subtypes.
Enhanced rehabilitation and care models for adults with dementia following hip fracture surgery
Cochrane Dementia and Cognitive Improvement Group
Published Online: 15 JUN 2015
Abstract
Background: Hip fracture is a major fall-related injury which causes significant problems for
individuals, their family and carers. Over 40% of people with hip fracture have dementia or cognitive
impairment, and their outcomes after surgery are poorer than those without dementia. It is not
clear which care and rehabilitation interventions achieve the best outcomes for these people.
Objectives:
(a) To assess the effectiveness of models of care including enhanced rehabilitation strategies
designed specifically for people with dementia following hip fracture surgery compared to usual
care.
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(b) To assess the effectiveness for people with dementia of models of care including enhanced
rehabilitation strategies which are designed for all older people, regardless of cognitive status,
following hip fracture surgery compared to usual care.
Opioids for agitation in dementia
UK Database of Uncertainties about the Effects of Treatments - UK DUETS - 10 June 2015 - Known
Uncertainties
Record type: Uncertainties identified in research recommendations
Source: Cochrane Dementia and Cognitive Improvement Group
Why is there uncertainty? Reliable up-to-date systematic reviews have revealed important
continuing uncertainties about treatment effects
Original uncertainty: Implications for research Randomised placebo controlled trials of opioids for
agitation in dementia are needed. Such studies should investigate the tolerability and safety of
opioids. This would be best achieved using a placebo design. Agitation is a complex phenomenon
and it would be useful for trials to seek to identify those manifestations of agitation that best
respond to the intervention and what level of agitation warrants treatment. A more challenging task
would be to identify those causes of agitation that best respond to the intervention, including how
to more reliably distinguish agitation caused by pain.
New from NICE
Supporting people who need social care, as they move between hospital and home: NICE
consults on draft guidance
25 June 2015
The National Institute for Health and Care Excellence (NICE) has published a draft health and social
care guideline to help manage the complicated needs of adults being admitted to and discharged
from hospital who are receiving or need support from social care.
The focus of the guideline is on adults with health and social care needs – and who have or will need
support from a range of practitioners such as family doctors, social workers, physiotherapists, or
community nurses.
The draft NICE social care guideline places people at the heart of decisions as they move between
hospital and their own home, a care home or other living arrangements.
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The draft guideline recommends ways to integrate effectively social care with medical support
during transition to and from hospital. It addresses how services should work together and with the
person, their family and carers, to make sure they are admitted for medical treatment in a timely
way and spend no longer in hospital than is necessary.
New from Department of Health and Public
Health England
Policy paper - Update
2010 to 2015 government policy: dementia
From: Department of Health and The Rt Hon Norman Lamb
First published: 25 March 2013
Last updated: 8 May 2015, see all updates
Part of: Dementia
This publication was published under the 2010 to 2015 Conservative and Liberal Democrat
coalition government
This policy paper shows the policy of the 2010 to 2015 Conservative and Liberal Democrat coalition
government.
NHS Behind the Headlines
Exposing the evidence behind the lurid newspaper headlines and how the media has
(mis)reported health news:
Poor sleep quality linked to Alzheimer's disease
Wednesday June 3 2015
Alzheimer's is linked to abnormal clumps of protein in the brain
"Sleepless nights … could raise your odds of developing Alzheimer's," is the claim in the Daily Mail. A
new US study did find a link between poor sleep quality and higher levels of clumps of abnormal
proteins in the brain (known as beta-amyloid plaques), but no cause and effect relationship between
sleep quality and Alzheimer’s disease was proven.
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Current Awareness Database Articles on
Dementia
Below is a selection of articles on dementia recently added to the healthcare databases, grouped
in the following categories:
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Dementia caring
Medical
Therapies
Other
If you would like any of the following articles in full text, or if you would like a more focused
search on your own topic, then get in touch: library@uhbristol.nhs.uk
Dementia caring
Title: Achieving effective dementia care in the community
Citation: British Journal of Community Nursing, Jun 2015, vol. 20, no. 6, p. 308.,
Author(s): Mendes, Aysha
Abstract: Community nurses' role in managing a patient's dementia symptoms and other
comorbidities, and devising a care plan that takes into consideration each individual's preferences
and background. [ORIGINAL] 7 references
Title: Inter-country exploration of factors associated with admission to long-term institutional
dementia care: evidence from the RightTimePlaceCare study
Citation: Journal of Advanced Nursing, Jun 2015, vol. 71, no. 6, p. 1338-1350,
Author(s): Verbeek, Hilde, Meyer, Gabriele, Challis, David, Zabalegui, Adelaida, Soto, Maria E., Saks,
Kai, Leino-Kilpi, Helena, Karlsson, Staffan, Hamers, Jan P.H.
Abstract: Aim. To explore inter-country variation of factors associated with institutionalization of
people with dementia. Background. There is an urgent need for evidence on whether factors
associated with admission to institutional dementia care are applicable across healthcare systems,
as increasing evidence suggests that these factors could be countryspecific. Design. A prospective
cohort study. Method. Primary data were collected in eight European countries, at baseline and
after 3 months follow-up (November 2010-April 2012). The sample included 2014 dyads of people
with dementia and their informal caregivers; 791 patients were recently institutionalized, 1223
patients lived at home and were at risk of institutionalization. Associations between care setting
(institution vs. home) and factors shown to influence institutionalization (e.g. cognition,
independence in activities of daily life, behaviour) were studied. Results. Considerable differences
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were found between the eight countries in characteristics of people with dementia who had been
recently admitted to ILTC. However, caregiver burden appeared the most consistent factor
associated with institutionalization in all analyses. Indications for the importance of independence in
activities of daily life were found as well, although country differences may be more prominent for
this factor. Conclusion. Evidence was found for two common factors, crucial in the process of
institutionalization across countries: caregiver burden and independency in activities of daily life.
However, this study also suggests that admission to institutional dementia care is context-specific, as
wide variation exists in factors associated with institutionalization across countries. Tailored bestpractice strategies are needed to reflect variations in response to these needs. [PUBLICATION] 37
references
Title: Predicting institutional long-term care admission in dementia: a mixed-methods study of
informal caregivers' reports
Citation: Journal of Advanced Nursing, Jun 2015, vol. 71, no. 6, p. 1351-1362,
Author(s): Afram, Basema, Verbeek, Hilde, Bleijlevens, Michel H.C., Challis, David, Leino-Kilpi,
Helena, Karlsson, Staffan, Soto, Maria E., Renom-Guiteras, Anna, Saks, Kai, Zabalegui, Adelaida,
Hamers, Jan P.H.
Abstract: Aim. To investigate agreement between: (1) expected reasons and actual reasons for
admission of people with dementia according to informal caregivers; (2) scores on measurement
instruments prior to admission and the actual reasons for admission according to informal
caregivers. Background. Timely admission of people with dementia is a crucial issue. Information is
highly warranted on whether informal caregivers are capable of prior identification of causes of
admission and, can thus be considered a reliable prospective source on causes of admission. Design.
A cohort study among informal caregivers of people with dementia who made a transition to
institutional long-term care. Methods. Qualitative data on the expected and actual reasons for
admission were collected via open-ended questions at baseline and follow-up. Furthermore, at
baseline, data were collected using measurement instruments to measure preadmission
characteristics. Interviews took place between November 2010-April 2012. After categorizing the
answers, the agreement between the expected and actual reasons was calculated. Furthermore,
bivariate associations were calculated between the actual reasons for admission and scores on
corresponding measurement instruments. Results/Findings. For most informal caregivers, there was
agreement between their statements on the expected reason and the actual reason for admission. A
third of the caregivers showed no conformity. Bivariate associations showed that there is also
agreement between the actual reasons for admission and scores on corresponding measurement
instruments. Conclusion. Informal caregivers can be considered reliable sources of information
regarding what causes the admission of a person with dementia. Professional care should anticipate
informal caregivers' statements and collaborate with them to strive for timely and appropriate
admission. [PUBLICATION] 35 references
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Title: Changes in caregiver burden and health-related quality of life of informal caregivers of older
people with Dementia: evidence from the European RightTimePlaceCare prospective cohort study
Citation: Journal of Advanced Nursing, Jun 2015, vol. 71, no. 6, p. 1378-1391,
Author(s): Bleijlevens, Michel H.C., Stolt, Minna, Stephan, Astrid, Zabalegui, Adelaida, Saks, Kai,
Sutcliffe, Caroline, Lethin, Connie, Soto, Maria E., Zwakhalen, Sandra M.G.
Abstract: Aims. To describe differences in caregiver burden and health-related quality of life of
informal caregivers of people with dementia in eight European countries and assess changes after
transition from home to institutional long-term care. Background. Country differences in the
experience of burden and health-related quality of life are rarely described. Design. Prospective
cohort study. Methods. Data on burden and health-related quality of life were collected at baseline
(conducted between November 2010-April 2012) and follow-up (after 3 months) using face-to-face
interviews. Two groups of informal caregivers included those: (1) of people with dementia recently
admitted to institutional long-term care facilities; and those (2) of people with dementia receiving
home care. Statistical analyses focused on descriptive comparisons between groups and countries.
Results. Informal caregivers of about 2014 were interviewed. Informal caregivers of people with
dementia at home experienced more burden compared with informal caregivers of recently
institutionalised people with dementia. Almost no differences in health-related quality of life were
found between groups. Large differences between countries on outcomes were found. Informal
caregivers of people with dementia who made the transition to an institutional long-term care
facility experienced a statistically significant decrease in burden and psychological distress at followup. Conclusion. Cross-country differences may be related to differences in health and social care
systems. Taking this into account, informal caregiver interventions need to be tailored to (country
specific) contexts and (individual) needs. Findings highlight the positive impact of admission to
institutional long-term care on informal caregiver well-being. [PUBLICATION] 64 references
Title: Older persons with dementia at risk for institutionalization in eight European countries: a
cross-sectional study on the perceptions of informal caregivers and healthcare professionals
Citation: Journal of Advanced Nursing, Jun 2015, vol. 71, no. 6, p. 1392-1404,
Author(s): Stephan, Astrid, Afram, Basema, Koskenniemi, Jaana, Verbeek, Hilde, Soto, Maria E.,
Bleijlevens, Michel H.C., Sutcliffe, Caroline, Lethin, Connie, Risco, Ester, Saks, Kai, Hamers, Jan P.H.,
Meyer, Gabriele
Abstract: Aims. To explore the perceptions of informal caregivers and healthcare professionals
regarding potential reasons for the institutionalization of older persons with dementia in eight
European countries. Background. Healthcare professionals may have an important role in facilitating
informal caregivers' decision-making regarding institutionalization. Little is known about the
perceptions of informal caregivers and healthcare professionals prior to institutionalization. Design.
Cross-sectional survey in eight European countries (November 2010-January 2012). Methods.
Healthcare professionals reported why they clinically judged persons with dementia at risk for
institutionalization. Informal caregivers reported potential reasons from their perspectives. Answers
were openly coded and categorized. Variation between informal caregivers and healthcare
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professionals was investigated (agreement on at least one potential reason per case/proportion of
maximum attainable kappa). Results. Judgements of healthcare professionals and informal
caregivers on 1160 persons with dementia were included. A total of 22 categories emerged.
Approximately 90% of informal caregivers reported potential reasons. In 41% of the cases, informal
caregivers and healthcare professionals agreed on at least one reason. Discrepancy was high for
potential reasons related to caregiver burden. For the most frequent categories (caregiver burden,
caregiver unable to provide care, neuropsychiatric symptoms, overall deterioration, care
dependency), 24-41% of the attainable kappa was achieved. Differences between countries emerged
indicating more favourable agreement in Finland, Sweden and Estonia and lowest agreement in
England and Spain. Conclusion. Agreement between healthcare professionals and informal
caregivers on potential reasons for institutionalization was low-to-moderate. Healthcare
professionals are challenged to develop a detailed understanding of the perspectives and perceived
burden of informal caregivers. [PUBLICATION] 46 references
Title: The association between positive-negative reactions of informal caregivers of people with
dementia and health outcomes in eight European countries: a cross-sectional study
Citation: Journal of Advanced Nursing, Jun 2015, vol. 71, no. 6, p. 1417-1434,
Author(s): Alvira, M. Carme, Risco, Ester, Cabrera, Esther, Farre, Marta, Hallberg, Ingalill Rahm,
Bleijlevens, Michel H.C., Meyer, Gabriele, Koskenniemi, Jaana, Soto, Maria E., Zabalegui, Adelaida
Abstract: Aim. To describe the associations between positive and negative reactions of informal
caregivers of people with dementia and health outcomes across eight European Countries.
Background. Caring for someone with dementia may have implications for the caregiver's own
health and for the care recipient. These consequences could be associated with caregivers' reactions
to the process of care. Design. Association study based on cross-sectional data. Methods.
Participants were people with dementia and their informal caregivers living at home or in long-term
care institutions. Data were collected between November 2010-April 2012 using the Caregiver
Reaction Assessment (with dimensions of self-esteem, lack of family support, financial problems,
disrupted schedule and health problems) and associations were sought with informal caregiver
burden, quality of life and psychological well-being and with dementia sufferers' neuropsychiatric
symptoms, comorbidity and dependency in activities of daily living using correlation coefficients.
Results. Data from 2014 participants were used. Variability across countries was noted, as well as
differences between care at home and in long-term care institutions. In general, self-esteem and
lack of family support correlated with caregiver burden and psychological well-being. Associations
were also found between disrupted schedule and caregiver burden, psychological well-being and
quality of life. Health problems were clearly associated with caregiver burden, psychological wellbeing and quality of life. Conclusion. Study results support links between the reactions of informal
caregivers of people with dementia and health outcomes. These may have implications in terms of
how services are addressed. [PUBLICATION] 55 references
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Title: Change in quality of life of people with dementia recently admitted to long-term care
facilities
Citation: Journal of Advanced Nursing, Jun 2015, vol. 71, no. 6, p. 1435-1447,
Author(s): Beerens, Hanneke C., Zwakhalen, Sandra M.G., Verbeek, Hilde, Ruwaard, Dirk, Ambergen,
Antonius W., Leino-Kilpi, Helena, Stephan, Astrid, Zabalegui, Adelaida, Soto, Maria, Saks, Kai,
Bökberg, Christina, Sutcliffe, Caroline L., Hamers, Jan P.H.
Abstract: Aim. To assess which factors are associated with change in quality of life of people with
dementia who have recently been admitted to long-term care facilities. Background. Many people
with dementia will be admitted to long-term care facilities at some point during their disease. It is
currently unknown which factors are associated with improvement and/or deterioration of quality of
life immediately following admission. Design. An observational and longitudinal survey. Methods.
Data on 343 people with dementia who have been recently admitted to long-term care facilities
across eight European countries were collected between November 2010-April 2012. Quality of life
was assessed by people with dementia and their proxies using the 'Quality of Life-Alzheimer's
Disease scale'. Explanatory variables included cognitive status, comorbidities, activities of daily living,
depressive symptoms and neuropsychiatric symptoms. Descriptive and multilevel regression
analyses were performed. Results. Better cognitive abilities at baseline were associated with a
decrease in self-reported quality of life. Greater dependency and more depressive symptoms at
baseline were associated with declined proxy-reported quality of life. Furthermore, an increased
dependency and an increase of depressive symptoms between baseline and follow-up were
associated with a decreased proxy-reported quality of life. On an individual level, three groups were
identified, namely people whose quality of life: (1) decreased; (2) stayed the same; and (3)
increased. [PUBLICATION] 56 references
Title: Self- and Carer-Rated Pain in People With Dementia: Influences of Pain in Carers
Citation: Journal of Pain and Symptom Management, Jun 2015, vol. 49, no. 6, p. 1042-1049
Author(s): Orgeta, Vasiliki, Orrell, Martin, Edwards, Rhiannon Tudor, Hounsome, Barry, Woods, Bob
Abstract: Context: Although pain is frequent in people with dementia (PwD), evidence on the
prevalence and factors influencing ratings of pain in dementia is limited. Carer variables are often
associated with bias in proxy ratings of pain, but few studies have examined the role of caregiver
pain in influencing these ratings. Objectives: This study explored the prevalence of pain in PwD in a
large U.K. sample. A secondary aim was to identify factors influencing ratings of pain in people with
mild to moderate dementia and whether carer pain systematically influences proxy ratings.
Methods: This was a cross-sectional study of 488 caregiving dyads living in the community. Self- and
carer-rated pain was assessed as part of the EuroQoL-5D (EQ-5D). Depression and anxiety for the
PwD were measured by the Cornell Scale for Depression in Dementia and the Rating of Anxiety in
Dementia Scale. The Hospital Anxiety and Depression Scale was used to measure anxiety and
depressive symptoms in carers. Using logistic regression modeling, we examined the relationship
between self- and carer-rated (proxy) pain in PwD and psychological distress, functional ability, and
health status. Carer variables included self-rated health, strain, anxiety, depression, and caregiver
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pain. Results: A total of 45% of PwD reported pain, whereas carer-rated pain was higher (59%). Selfrated pain was more frequent in those with lower self-rated health (adjusted odds ratio [AOR] 0.97;
95% CI 0.96-0.99, P = 0.001) and higher anxiety (AOR 1.07; 95% CI 1.01-1.12, P = 0.013). Carer-rated
(proxy) pain was additionally predicted by poor proxy-rated health in the PwD (AOR 0.98; 95% CI
0.96-0.99, P = 0.006) and carers' own experience of pain (AOR 0.36; 95% CI 0.21-0.63, P = 0.001).
Conclusion: Our results indicate that pain is very frequently reported in PwD and that the presence
of pain is associated with high levels of anxiety. Caregiver pain affects carers' perceptions of pain in
PwD. [PUBLICATION] 47 references
Title: Most appropriate placement for people with dementia: individual experts' vs. expert groups'
decisions in eight European countries
Citation: Journal of Advanced Nursing, Jun 2015, vol. 71, no. 6, p. 1363-1377
Author(s): Saks, Kai, Tiit, Ene-Margit, Verbeek, Hilde, Raamat, Katrin, Armolik, Angelika, Leibur,
Jelena, Meyer, Gabriele, Zabalegui, Adelaida, Leino-Kilpi, Helena, Karlsson, Staffan, Soto, Maria,
Tucker, Sue
Abstract: Aims. To investigate the extent of variability in individuals' and multidisciplinary groups'
decisions about the most appropriate setting in which to support people with dementia in different
European countries. Background. Professionals' views of appropriate care depend on care systems,
cultural background and professional discipline. It is not known to what extent decisions made by
individual experts and multidisciplinary groups coincide. Design. A modified nominal group approach
was employed in eight countries (Estonia, Finland, France, Germany, the Netherlands, Spain, Sweden
and the UK) as part of the RightTimePlaceCare Project. Methods. Detailed vignettes about 14 typical
case types of people with dementia were presented to experts in dementia care (n = 161) during
November and December 2012. First, experts recorded their personal judgements about the most
appropriate settings (home care, assisted living, care home, nursing home) in which to support each
of the depicted individuals. Second, participants worked in small groups to reach joint decisions for
the same vignettes. Results. Considerable variation was seen in individuals' recommendations for
more than half the case types. Cognitive impairment, functional dependency, living situation and
caregiver burden did not differentiate between case types generating high and low degrees of
consensus. Group-based decisions were more consistent, but country-specific patterns remained.
Conclusions. A multidisciplinary approach would standardize the decisions made about the care
needed by people with dementia on the cusp of care home admission. The results suggest that
certain individuals could be appropriately diverted from care home entry if suitable community
services were available. [PUBLICATION] 61 references
Title: Dementia care in European countries, from the perspective of people with dementia and
their caregivers
Citation: Journal of Advanced Nursing, Jun 2015, vol. 71, no. 6, p. 1405-1416, 0309-2402 (June 2015)
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Author(s): Karlsson, Staffan, Bleijlevens, Michel, Roe, Brenda, Saks, Kai, Martin, Maria Soto, Stephan,
Astrid, Suhonen, Riita, Zabalegui, Adelaida, Hallberg, Ingalill R.
Abstract: Aim. To investigate persons with dementia and their informal caregivers' views of intersectoral information, communication and collaboration throughout the trajectory of dementia care,
in eight European countries. Background. Living with dementia and being next of kin to a person
with dementia means having to live through stages that have different characteristics, needs,
challenges and requirements. Design. Qualitative research. Focus groups were conducted in England,
Estonia, Finland, France, Germany, The Netherlands, Spain and Sweden. Methods. Persons with
dementia and their informal caregivers (N = 137) participated in focus group interviews during 2011.
Content analysis generated a tentative model of information, communication and collaboration for
people with dementia and their caregivers, which was then tested. Results. The core finding was that
information, communication and collaboration were to be focused on the persons with dementia
and the informal caregivers. Entering into the trajectory of the disease and its consequences was
addressed as an important point of departure. The relation to professional care required establishing
a trusting relationship, tailor-made intervention and a single person or organization to contact.
Professional knowledge and commitment, variation in service and care adapted to needs were
important. Conclusion. As focus of care is on the person with dementia and their informal caregivers,
a dyadic approach seems most suitable for dementia care. A trusting relationship and a specific
person or organization to contact seem to be indicators of best practice, as does adaptation to the
needs of the person with dementia and their informal caregiver. [PUBLICATION] 34 references
Title: Factors influencing the degree of eating ability among people with dementia
Citation: Journal of Clinical Nursing, Jun 2015, vol. 24, no. 11-12, p. 1707-1717,
Author(s): Lee, Kyoung Min, Song, Jun-Ah
Abstract: To explore the degree of eating ability in people with dementia and identify what factors
affect their eating ability. Appropriate food consumption is important to human life. Although eating
difficulties are common among people with dementia, little is known about what factors might
influence their eating ability. Descriptive, cross-sectional study. A total of 149 people with dementia
residing in nursing facilities in Seoul or the Gyeonggi area of Korea were evaluated using the Korean
Mini-Mental State Examination, Korean Activities of Daily Living Scale and Eating Behaviour Scale.
Data were analysed using descriptive statistics, one-way analysis of variance, Pearson correlation
coefficient and multiple regression analysis. The participants showed a moderate level of
dependency with respect to eating ability and were most dependent on the use of utensils. There
were significant differences in eating ability according to general characteristics such as duration of
residence, duration of illness, degree of visual impairment, eating place, and diet type. The eating
ability of the participants was significantly correlated with cognitive function and physical function.
Cognitive function, physical function, duration of illness, eating place (living room or dining room),
and diet type (soft or liquid) significantly predicted eating ability in people with dementia. The
findings of this study suggest that it is necessary to thoroughly assess the eating ability of people
with dementia and to develop appropriate training programs to maintain or improve their remaining
eating ability. The creation of a pleasurable physical and social environment for eating might also be
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helpful. These findings would be able to serve a useful basis in the development of materials for
nursing intervention programs for people with dementia during mealtimes by improving the
techniques and care qualities of nursing caregivers. [PUBLICATION] 33 references
Title: The Impact of Living Arrangements on Dementia Caregiver's Sleep Quality.
Citation: American journal of Alzheimer's disease and other dementias, Jun 2015, vol. 30, no. 4, p.
Author(s): Simpson, Cherie, Carter, Patricia
Abstract: In the United States half of the 15 million informal caregivers of persons with Alzheimer's
disease or a related dementia (PWDs) do not live with the PWD. This paper compares the sleep
quality and health of 59 community-dwelling caregivers living with the PWD and 21 living apart from
the PWD. Variables of interest were caregiving experience (hours caregiving, problematic behaviors
of the PWD, caregivers' perception of dementia severity), sleep quality, and health (perceived
health, stress, and depressive symptoms). Parametric unpaired t tests were used to calculate the
differences between key variables. Multiple regression models were constructed, controlling for age,
gender, behavior index, and dementia severity to examine the variance explained by living
arrangements on sleep quality and health. Caregivers living apart from the PWD experienced the
same level of poor sleep quality as did caregivers living with the PWD. The living arrangements of the
caregiver did not make a unique contribution to sleep quality or health variables except for reports
of unhealthy days. Given the importance of good quality sleep for health, the findings highlight the
importance of evaluating caregivers living apart from the PWD for sleep problems with the same
level of concern as one would have for those living with the PWD. © The Author(s) 2014.
Title: Needs of informal caregivers during transition from home towards institutional care in
dementia: a systematic review of qualitative studies.
Citation: International psychogeriatrics / IPA, Jun 2015, vol. 27, no. 6, p. 891-902 (June 2015)
Author(s): Afram, Basema, Verbeek, Hilde, Bleijlevens, Michel H C, Hamers, Jan P H
Abstract: Alongside providing care, informal caregivers of people with dementia often need support
and guidance themselves, especially during difficult periods such as the care-transition from home
towards a nursing home. Knowledge on needs of informal caregivers during this period is sparse.
This study aims to provide insight into problems and needs of informal caregivers caring for people
with dementia during care-transition from home-based care to institutional long-term care. A
systematic electronic search in CINAHL, Cochrane, Medline, PsycINFO, Pubmed and Web of
Knowledge. All qualitative articles up to September 2013 were considered. The included articles
underwent a quality appraisal. Thematic analysis was used to analyze problems and needs described
in the articles. Thirteen publications were included providing 14 topics comprising needs and
problems of informal caregivers during the care-transition period. The most stated topics were:
"emotional concerns" (e.g. grief and shame about the decision), "knowledge/information" (e.g.
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understanding the care system) and "support" (e.g. need for counseling). Similar topics were found
prior and after admission, with examples specific to the either the home or nursing home situation.
The care-transition period should be considered a continuum, as similar needs and problems were
identified prior and after admission. This should be kept in mind in developing support and guidance
for informal caregivers during this process. Whereas currently the situation prior and post admission
are seen and treated as adjacent stages, they should be considered one integrated stage.
Multicomponent programmes should be offered that are designed in a continuous way, starting
prior to admission, and continuing after.
Title: Qualitative study on needs and wishes of early-stage dementia caregivers: the paradox
between needing and accepting help.
Citation: International psychogeriatrics / IPA, Jun 2015, vol. 27, no. 6, p. 927-936 (June 2015)
Author(s): Boots, Lizzy M M, Wolfs, Claire A G, Verhey, Frans R J, Kempen, Gertrudis I J M, de Vugt,
Marjolein E
Abstract: Early individualized interventions for informal dementia caregivers can prevent
overburdening in the later stages. However, the needs of early-stage dementia caregivers (EDC)
remain largely unknown. This study aimed to explore the needs and wishes and need for care of EDC
to maximize the benefit of potential programs for EDC and tailor interventions accordingly. Four
focus group interviews with 28 informal caregivers of people with dementia (PwD) were analyzed
using inductive content analysis. Both EDC and caregivers in the later stages were included to
compare perceived EDC needs from different points in the caregiver career. Four themes were
identified: the early-stage needs paradox, barriers in acceptance, facilitators in acceptance, and a
transition from loss to adaptation. The retrospective view provided by later-stage caregivers differed
from the view of EDC; EDC struggled with acknowledging needs due to fear of stigma and low
acceptance. EDC stressed the importance of acceptance as a prerequisite for adequate adaptation,
but were hindered by lack of knowledge, difficulty acknowledging changes, and focus on loss. In
contrast, better understanding of the disease, increasing personal time, structuring ones day, and
using appropriate humor can reduce negative communication, increase positive encounters and
caregiver-confidence, contributing to positive interaction with the care recipient and an increase in
well-being. Early therapeutic interventions could help caregivers identify their needs, increase
knowledge about changes in roles and relationship reciprocity, and focus on enhancement of the
positive, intact experiences to prevent caregiver burden.
Title: Evaluation of a problem-solving (PS) techniques-based intervention for informal carers of
patients with dementia receiving in-home care.
Citation: International psychogeriatrics / IPA, Jun 2015, vol. 27, no. 6, p. 937-948 (June 2015)
Author(s): Chiu, Mary, Pauley, Tim, Wesson, Virginia, Pushpakumar, Dunstan, Sadavoy, Joel
15
Abstract: The value of care provided by informal carers in Canada is estimated at $26 billion annually
(Hollander et al., 2009). However, carers' needs are often overlooked, limiting their capacity to
provide care. Problem-solving therapy (PST), a structured approach to problem solving (PS) and a
core principle of the Reitman Centre CARERS Program, has been shown to alleviate emotional
distress and improve carers' competence (Chiu et al., 2013). This study evaluated the effectiveness
of problem-solving techniques-based intervention based on adapted PST methods, in enhancing
carers' physical and emotional capacity to care for relatives with dementia living in the community.
56 carers were equally allocated to a problem-solving techniques-based intervention group or a
control arm. Carers in the intervention group received three 1 hr visits by a care coordinator (CC)
who had been given advanced training in PS techniques-based intervention. Coping, mastery,
competence, burden, and perceived stress of the carers were evaluated at baseline and postintervention using standardized assessment tools. An intention-to-treat analysis utilizing repeated
measures ANOVA was performed on the data. Post-intervention measures completion rate was 82%
and 92% for the intervention and control groups, respectively. Carers in the intervention group
showed significantly improved task-oriented coping, mastery, and competence and significantly
reduced emotion-oriented coping, burden and stress (p < 0.01-0.001). Control carers showed no
change. PS techniques, when learned and delivered by CCs as a tool to coach carers in their day-today caregiving, improves carers' caregiving competence, coping, burden, and perceived stress. This
may reduce dependence on primary, psychiatric, and institutional care. Results provide evidence
that establishing effective partnerships between inter-professional clinicians in academic clinical
health science centers, and community agencies can extend the reach of the expertise of specialized
health care institutions.
Title: Dementia care in European countries - findings from the RightTimePlaceCare study.
Citation: Journal of advanced nursing, Jun 2015, vol. 71, no. 6, p. 1336-1337 (June 2015)
Author(s): Perry, Lin
Title: Inter-country exploration of factors associated with admission to long-term institutional
dementia care: evidence from the RightTimePlaceCare study.
Citation: Journal of advanced nursing, Jun 2015, vol. 71, no. 6, p. 1338-1350 (June 2015)
Author(s): Verbeek, Hilde, Meyer, Gabriele, Challis, David, Zabalegui, Adelaida, Soto, Maria E, Saks,
Kai, Leino-Kilpi, Helena, Karlsson, Staffan, Hamers, Jan P H, RightTimePlaceCare Consortium
Abstract: To explore inter-country variation of factors associated with institutionalization of people
with dementia. There is an urgent need for evidence on whether factors associated with admission
to institutional dementia care are applicable across healthcare systems, as increasing evidence
suggests that these factors could be country-specific. A prospective cohort study. Primary data were
collected in eight European countries, at baseline and after 3 months follow-up (November 2010April 2012). The sample included 2014 dyads of people with dementia and their informal caregivers;
791 patients were recently institutionalized, 1223 patients lived at home and were at risk of
16
institutionalization. Associations between care setting (institution vs. home) and factors shown to
influence institutionalization (e.g. cognition, independence in activities of daily life, behaviour) were
studied. Considerable differences were found between the eight countries in characteristics of
people with dementia who had been recently admitted to ILTC. However, caregiver burden
appeared the most consistent factor associated with institutionalization in all analyses. Indications
for the importance of independence in activities of daily life were found as well, although country
differences may be more prominent for this factor. Evidence was found for two common factors,
crucial in the process of institutionalization across countries: caregiver burden and independency in
activities of daily life. However, this study also suggests that admission to institutional dementia care
is context-specific, as wide variation exists in factors associated with institutionalization across
countries. Tailored best-practice strategies are needed to reflect variations in response to these
needs. © 2015 John Wiley & Sons Ltd.
Title: A break-even analysis for dementia care collaboration: partners in dementia care.
Citation: Journal of general internal medicine, Jun 2015, vol. 30, no. 6, p. 804-809 (June 2015)
Author(s): Morgan, Robert O, Bass, David M, Judge, Katherine S, Liu, C F, Wilson, Nancy, Snow, A
Lynn, Pirraglia, Paul, Garcia-Maldonado, Maurilio, Raia, Paul, Fouladi, N N, Kunik, Mark E
Abstract: Dementia is a costly disease. People with dementia, their families, and their friends are
affected on personal, emotional, and financial levels. Prior work has shown that the "Partners in
Dementia Care" (PDC) intervention addresses unmet needs and improves psychosocial outcomes
and satisfaction with care. We examined whether PDC reduced direct Veterans Health
Administration (VHA) health care costs compared with usual care. This study was a cost analysis of
the PDC intervention in a 30-month trial involving five VHA medical centers. Study subjects were
veterans (N = 434) 50 years of age and older with dementia and their caregivers at two intervention
(N = 269) and three comparison sites (N = 165). PDC is a telephone-based care coordination and
support service for veterans with dementia and their caregivers, delivered through partnerships
between VHA medical centers and local Alzheimer's Association chapters. We tested for differences
in total VHA health care costs, including hospital, emergency department, nursing home, outpatient,
and pharmacy costs, as well as program costs for intervention participants. Covariates included
caregiver reports of veterans' cognitive impairment, behavior problems, and personal care
dependencies. We used linear mixed model regression to model change in log total cost postbaseline over a 1-year follow-up period. Intervention participants showed higher VHA costs than
usual-care participants both before and after the intervention but did not differ significantly
regarding change in log costs from pre- to post-baseline periods. Pre-baseline log cost (p ≤ 0.001),
baseline cognitive impairment (p ≤ 0.05), number of personal care dependencies (p ≤ 0.01), and VA
service priority (p ≤ 0.01) all predicted change in log total cost. These analyses show that PDC meets
veterans' needs without significantly increasing VHA health care costs. PDC addresses the priority
area of care coordination in the National Plan to Address Alzheimer's Disease, offering a low-cost,
structured, protocol-driven, evidence-based method for effectively delivering care coordination.
17
Title: Stability of Diagnoses of Cognitive Impairment, Not Dementia in a Veterans Affairs Primary
Care Population.
Citation: Journal of the American Geriatrics Society, Jun 2015, vol. 63, no. 6, p. 1105-1111
Author(s): Holsinger, Tracey, Plassman, Brenda L, Stechuchak, Karen M, Burke, James R, Coffman,
Cynthia J, Williams, John W
Abstract: To describe the stability of cognitive impairment, not dementia (CIND) in a longitudinal
cohort of primary care veterans. To examine the association between baseline brief cognitive
screening tests, demographic and clinical characteristics, and cognitive decline. Follow-up cognitive
assessment after an average of 2.5 years of a cohort of veterans in primary care whose baseline
status was CIND or normal cognition. Three Department of Veterans Affairs primary care clinics.
Subjects with CIND at baseline and a sampling of subjects with baseline normal cognition. Veterans
underwent a standard assessment, including neuropsychological tests and informant interview. Of
293 potentially eligible individuals, 186 enrolled in the follow-up study. Of the 131 subjects with a
baseline diagnosis of CIND, 16 (12%) progressed to dementia, 88 (67%) continued to have a
diagnosis of CIND, and 27 (21%) improved to normal cognition. Of the 55 subjects with a baseline
diagnosis of normal cognition, one (2%) progressed to dementia, 17 (31%) progressed to CIND, and
37 (67%) remained cognitively normal. In bivariate analyses, poorer performance on baseline
cognitive screening tests was associated with cognitive decline, whereas Framingham Stroke Risk
Profile (FSRP) and education were not. Similarly, higher scores on cognitive screening tests were
associated with return to normal cognition. In multivariable logistic regression models, lower
baseline Mini-Cog and Modified Mini-Mental State scores were associated with cognitive decline,
whereas Memory Impairment Screen scores, FSRP, and years of education were not. A minority of
subjects had worsening of cognitive function sufficient to change diagnostic category. Over an
average of 2.5 years, subjects diagnosed with CIND at baseline reverted to normal cognition at a
higher rate than progressed to dementia. Cognitive screening tests addressing multiple domains of
cognitive impairment were predictive of cognitive decline. © 2015, Copyright the Authors Journal
compilation © 2015, The American Geriatrics Society.
Title: Preliminary Data from the Caring for Older Adults and Caregivers at Home (COACH) Program:
A Care Coordination Program for Home-Based Dementia Care and Caregiver Support in a Veterans
Affairs Medical Center.
Citation: Journal of the American Geriatrics Society, Jun 2015, vol. 63, no. 6, p. 1203-1208
Author(s): D'Souza, Maria F, Davagnino, Judith, Hastings, S Nicole, Sloane, Richard, Kamholz,
Barbara, Twersky, Jack
Abstract: Caring for Older Adults and Caregivers at Home (COACH) is an innovative care coordination
program of the Durham Veteran's Affairs Medical Center in Durham, North Carolina, that provides
home-based dementia care and caregiver support for individuals with dementia and their family
caregivers, including attention to behavioral symptoms, functional impairment, and home safety, on
a consultation basis. The objectives of this study were to describe the COACH program in its first 2
years of operation, assess alignment of program components with quality measures, report
18
characteristics of program participants, and compare rates of placement outside the home with
those of a nontreatment comparison group using a retrospective cohort design. Participants were
community-dwelling individuals with dementia aged 65 and older who received primary care in the
medical center's outpatient clinics and their family caregivers, who were enrolled as dyads (n = 133),
and a control group of dyads who were referred to the program and met clinical eligibility criteria
but did not enroll (n = 29). Measures included alignment with Dementia Management Quality
Measures and time to placement outside the home during 12 months of follow-up after referral to
COACH. Results of the evaluation demonstrated that COACH aligns with nine of 10 clinical process
measures identified using quality measures and that COACH delivers several other valuable services
to enhance care. Mean time to placement outside the home was 29.6 ± 14.3 weeks for both groups
(P = .99). The present study demonstrates the successful implementation of a home-based care
coordination intervention for persons with dementia and their family caregivers that is strongly
aligned with quality measures. © 2015, Copyright the Authors Journal compilation © 2015, The
American Geriatrics Society.
Title: Policy Recommendation: The National Center for Prevention of Resident-to-Resident
Aggression in Dementia.
Citation: Journal of the American Medical Directors Association, Jun 2015, vol. 16, no. 6, p. 532.
Author(s): Caspi, Eilon
Title: Critical decisions for older people with advanced dementia: a prospective study in long-term
institutions and district home care.
Citation: Journal of the American Medical Directors Association, Jun 2015, vol. 16, no. 6, p. 535.e13
Author(s): Toscani, Franco, van der Steen, Jenny T, Finetti, Silvia, Giunco, Fabrizio, Pettenati,
Francesca, Villani, Daniele, Monti, Massimo, Gentile, Simona, Charrier, Lorena, Di Giulio, Paola, End
of Life Observatory-Prospective Study on DEmentia Patients Care (EoLO-PSODEC) Research Group,
End of Life Observatory-Prospective Study on DEmentia Patients Care EoLO-PSODEC Research Group
Abstract: To describe and compare the decisions critical for survival or quality of life [critical
decisions (CDs)] made for patients with advanced dementia in nursing homes (NHs) and home care
(HC) services. Prospective cohort study with a follow-up of 6 months. Lombardy Region (NHs) and
Reggio-Emilia and Modena Districts (HC), Italy. Patients (496 total; 315 in NHs and 181 in HC) with
advanced dementia (Functional Assessment Staging Tool score ≥7) and expected survival ≥2 weeks.
At baseline, the patients' demographic data, date of admission and of dementia diagnosis, type of
dementia, main comorbidities, presence of pressure sores, ongoing treatments, and current
prescriptions were abstracted from clinical records. At baseline and every 15 days thereafter,
information regarding the patients' general condition and CDs (deemed critical by the doctor or
team) was collected by an interview with the doctor. For each CD, the physician reported the
problem that led to the decision, that was eventually made, the purpose of the decision, whether
the decision had been discussed with and/or communicated to the family, who made the final
19
decision, whether the decision was maintained after 1 week, whether it corresponded to what the
doctor would have judged appropriate, and the expected survival of the patient (≤15 days). For 267
of the 496 patients (53.8%; 60.3% in NHs and 42.5% at home), 644 CDs were made; for 95 patients,
more than 1 CD was made. The problems that led to a CD were mainly infections (respiratory tract
and other infections; 46.6%, 300/644 CDs); nutritional/hydration problems (20.6%; 133 CDs); and
the worsening of a pre-existing disease (9.3%; 60 CDs). The most frequent type of decision
concerned the prescription of antibiotics (overall 41.1%, 265/644; among NH patients 44.6%,
218/488; among HC patients, 30.2%, 47/156). The decision to hospitalize the patient was more
frequently reported for HC than NH patients (25.5% vs 3.1%). The most frequent purposes of the CDs
in both settings were reducing symptoms or suffering (more so in NHs; 81.1% vs 57.0% in HC) and
prolonging survival (NH 27.5%; HC 23.1%; multiple purposes were possible). For 26 decisions (3.8%),
the purpose was to ease death or not to prolong life. Decisions critical for the survival or quality of
life of patients with advanced dementia were made for approximately one-half of the patients
during a 6-month time frame, and such decisions were made more frequently in NHs than in HC. HC
patients were more frequently hospitalized, and a sizeable minority of these patients were treated
with the goal of prolonging survival. Italian patients with advanced dementia may benefit from the
implementation of palliative care principles, and HC patients may benefit from the implementation
of measures to avoid hospitalizing patients near the end of life. Copyright © 2015 AMDA – The
Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.
Title: Are we providing the best possible care for dementia patients?
Citation: Neurodegenerative disease management, Jun 2015, vol. 5, no. 3, p. 217-224 (June 2015)
Author(s): Borisovskaya, Anna, Chen, Kathryn, Borson, Soo
Abstract: SUMMARY Healthcare for patients with dementia is often reactive, poorly organized and
fragmented. We discuss opportunities for improvements in the care of individuals living with
dementia at home that can be implemented by physicians in their practices today. In particular, we
argue that systematic identification and diagnosis of cognitive impairment and dementia in their
early stages, coupled with a coherent, evidence-informed management framework, would benefit
patients with dementia substantially and ease the burden of their caregivers. We emphasize that
dementia influences all aspects of patient care, and each medical decision must be passed through
the filter of knowledge that patients with dementia have special needs that can be identified and
addressed.
Title: Relatives' participation in everyday care in special care units for persons with dementia.
Citation: Nursing ethics, Jun 2015, vol. 22, no. 4, p. 404-416 (June 2015)
Author(s): Helgesen, Ann Karin, Athlin, Elsy, Larsson, Maria
Abstract: Research concerning relatives' participation in the everyday care related to persons living
in special care units for persons with dementia is limited. To examine relatives' participation in their
20
near one's everyday care, the level of burden experienced and important factors for participation, in
this special context. The study had a cross-sectional design, and data collection was carried out by
means of a study-specific questionnaire. A total of 233 relatives from 23 different special care units
participated. The study was approved by the Norwegian Social Science Data Services. A great
majority of relatives reported that they visited weekly and were the resident's spokesperson, but
seldom really participated in decisions concerning their everyday care. Participation was seldom
reported as a burden. This study indicated that relatives were able to make a difference to their near
one's everyday life and ensure quality of care based on their biographical expertise, intimate
knowledge about and emotional bond with the resident. Since knowing the resident is a prerequisite
for providing individualised care that is in line with the resident's preferences, information
concerning these issues is of utmost importance. This study prompts reflection about what it is to be
a spokesperson and whether everyday care is neglected in this role. Even though relatives were
satisfied with the care provided, half of them perceived their participation as crucial for the
resident's well-being. This indicated that relatives were able to offer important extras due to their
biographical expertise, intimate knowledge about and emotional bond with the resident. Good
routines securing that written information about the residents' life history and preferences is
available and used should be implemented in practice. © The Author(s) 2014.
Title: Pain and Psychological Well-Being Among People with Dementia in Long-Term Care.
Citation: Pain medicine (Malden, Mass.), Jun 2015, vol. 16, no. 6, p. 1083-1089 (June 2015)
Author(s): Lee, Kyung Hee, McConnell, Eleanor S, Knafl, George J, Algase, Donna L
Abstract: To examine the relationship between self-reported pain and psychological well-being of
people with dementia (PWD) living in residential long-term care as indicated by displays of observed
emotional expression over the daytime period. Secondary analysis using repeated measures of selfreport and observational data. A total of 177 PWD were included from 17 nursing homes and six
assisted living facilities in Michigan and Pennsylvania. Negative emotional expression was used as an
indicator of reduced psychological well-being. Pain was assessed through PWD's response to a
question about presence of pain obtained at each observation. Cognitive impairment was assessed
using the Mini-Mental Status Examination. Linear mixed models were used that accounted for
correlation of negative emotional expression measurements over time for each participant and
between participants within the same facility. Among 171 participants who were able to express
their pain, 44% of PWD reported pain once or more during the daytime period. Severity of cognitive
impairment was related to expression of negative emotion. PWD with pain displayed more negative
emotional expression than PWD without pain. Routine pain assessment is feasible among PWD with
moderate to severe dementia and positive report of pain is associated with greater observed
negative emotional expression, an indicator of reduced psychological well-being. Improving pain
management holds potential for enhancing psychological well-being among PWD living in residential
long-term care. Wiley Periodicals, Inc.
21
Title: Support for families of patients dying with dementia: A qualitative analysis of bereaved
family members' experiences and suggestions.
Citation: Palliative & supportive care, Jun 2015, vol. 13, no. 3, p. 435-442 (June 2015)
Author(s): Muders, Pia, Zahrt-Omar, Corinna Aruna, Bussmann, Sonja, Haberstroh, Julia, Weber,
Martin
Abstract: To explore and document the needs of family caregivers of patients dying with dementia
and to identify how healthcare professionals can adequately support them. We employed a crosssectional survey containing open-ended questions that were analyzed using qualitative methods.
Receiving information about the diagnosis and disease trajectory of dementia is essential for the
caregiving families of people dying with the disease. However, at present the communication of
information offered by professionals is not experienced as satisfying. Further aspects that require
improvement concern issues related to time constraints, as well as practical and emotional support
from professionals in the care setting. Family members would also like professionals to better assist
them during and after the dying process. Family members face multiple burdens while caring for
their demented relatives and need more professional support during the course of the disease
trajectory as well as in the terminal phase.
Title: Caregiver burden in end-of-life care: Advanced cancer and final stage of dementia.
Citation: Palliative & supportive care, Jun 2015, vol. 13, no. 3, p. 583-589 (June 2015)
Author(s): Costa-Requena, Gema, Espinosa Val, MaCarmen, Cristòfol, Ramon
Abstract: Considering two advanced illnesses, cancer and end-stage dementia, the aim of this study
was to describe the symptoms of caregiver psychological distress and burden. In this cross-sectional
study, regression analyses were calculated to explain the influence of psychological distress in
caregiver burden. A t test was employed to compare differences between the symptoms of caregiver
burden. The percentage of psychological distress was similar between caregivers of cancer patients
(77.6%) and caregivers of dementia patients (72.4%). In the regression analysis, cancer caregiver
distress accounted for 27.9% of the variance in symptoms of burden, while dementia caregiver
distress accounted for 24.4% of the variance in symptoms of burden. No significant differences were
revealed when comparing caregiver burden symptoms between caregivers of the two advanced
illnesses (t = 0.06; p = 0.94). In end-of-life care for patients with dementia, due to significant levels of
caregiver distress and burden symptoms, there is a need to support caregivers in the same way as is
done for caregivers of cancer patients.
Title: Comfort goal of care and end-of-life outcomes in dementia: A prospective study.
Citation: Palliative medicine, Jun 2015, vol. 29, no. 6, p. 538-546 (June 2015)
Author(s): van Soest-Poortvliet, Mirjam C, van der Steen, Jenny T, de Vet, Henrica Cw, Hertogh, Cees
Mpm, Deliens, Luc, Onwuteaka-Philipsen, Bregje D
22
Abstract: Many people with dementia die in a nursing home. A comfort care goal may be beneficial.
Little research has examined the relationship between care goals and outcome. To investigate
whether family satisfaction with end-of-life care and quality of dying is associated with whether or
not dementia patients have a comfort goal shortly after admission. Prospective data collection from
28 long-term care facilities (the Dutch End of Life in Dementia study). We included 148 patients who
died after prospective follow-up. Main outcomes were family satisfaction (End-of-Life in DementiaSatisfaction with Care scale; range: 10-40) and quality of dying (End-of-Life in Dementia-Comfort
Assessment in Dying; range: 14-42). We performed generalized estimating equations regression
analyses to analyze whether these outcomes are associated with a comfort goal established shortly
after admission compared with another or no care goal as reported by the physician. Families of
patients were more satisfied with end-of-life care when a comfort goal was established shortly after
admission. We found this pattern only for patients who died within 6 months of admission (adjusted
b: 4.5; confidence interval: 2.8, 6.3 vs -1.2; confidence interval: -3.0, 0.6 for longer stay). For quality
of dying, no such association was found. We found that family satisfaction with care is related to a
comfort care goal shortly after admission, but quality of dying did not. Establishing a comfort goal at
an early stage may be important to the family. Advance care planning interventions should be
studied for their effects on patient and family outcome. © The Author(s) 2015.
Title: Pareidolia in Parkinson's disease without dementia: A positron emission tomography study.
Citation: Parkinsonism & related disorders, Jun 2015, vol. 21, no. 6, p. 603-609 (June 2015)
Author(s): Uchiyama, Makoto, Nishio, Yoshiyuki, Yokoi, Kayoko, Hosokai, Yoshiyuki, Takeda, Atsushi,
Mori, Etsuro
Abstract: Pareidolia, which is a particular type of complex visual illusion, has been reported to be a
phenomenon analogous to visual hallucinations in patients with dementia with Lewy bodies.
However, whether pareidolia is observed in Parkinson's disease (PD) or whether there are common
underlying mechanisms of these two types of visual misperceptions remains to be elucidated. A test
to evoke pareidolia, the Pareidolia test, was administered to 53 patients with PD without dementia
and 24 healthy controls. The regional cerebral metabolic rate of glucose was measured using 18Ffluorodeoxyglucose positron emission tomography in the PD patients. PD patients without dementia
produced a greater number of pareidolic illusions compared with the controls. Pareidolia was
observed in all of the patients having visual hallucinations as well as a subset of those without visual
hallucinations. The number of pareidolic illusions was correlated with hypometabolism in the
bilateral temporal, parietal and occipital cortices. The index of visual hallucinations was correlated
with hypometabolism in the left parietal cortex. A region associated with both pareidolia and visual
hallucinations was found in the left parietal lobe. Our study suggests that PD patients without
dementia experience pareidolia more frequently than healthy controls and that posterior cortical
dysfunction could be a common neural mechanism of pareidolia and visual hallucinations. Pareidolia
could represent subclinical hallucinations or a predisposition to visual hallucinations in Lewy body
disease. Copyright © 2015 Elsevier Ltd. All rights reserved.
23
Title: Function Focused Care for Assisted Living Residents With Dementia.
Citation: The Gerontologist, Jun 2015, vol. 55 Suppl 1, p. S13. (June 2015)
Author(s): Galik, Elizabeth, Resnick, Barbara, Lerner, Nancy, Hammersla, Margaret, Gruber-Baldini,
Ann L
Abstract: Assisted living (AL) residents with dementia require assistance with activities of daily living,
encounter limited opportunities to engage in physical activity, and often exhibit challenging
behavioral symptoms. The Function Focused Care Intervention for the Cognitively Impaired (FFC-CI)
teaches and motivates direct care workers (DCWs) to engage residents with dementia in activities
that optimize function and activity while minimizing behavioral symptoms. The purpose of this study
was to test the impact of FFC-CI on function, physical activity, behavior, and falls. A clusterrandomized trial included 96 residents with dementia and 76 DCWs from 4 ALs. Generalized
estimating equations were used to evaluate outcomes at 3 and 6 months. There were no treatment
by time differences with regard to resident behavior, mood, counts of physical activity based on
actigraphy, falls, and function. There were significant increases in physical activity based on
kilocalories burned (p = .001), time spent in physical activity based on survey results (p = .001), and
time spent in repetitive behaviors, such as wandering (p = .01) among the control group over time.
There were no treatment by time differences with regard to DCW beliefs, knowledge, or
performance of FFC, except for less decline in job satisfaction among the treatment group (p = .002).
Treatment fidelity with regard to delivery and receipt were poor due to high staff attrition in the
treatment group (46% vs. 16%) and limited site support. The findings from this study can be used to
adapt future FFC intervention studies to improve treatment fidelity and optimize intervention
efficacy. © The Author 2015. Published by Oxford University Press on behalf of The Gerontological
Society of America. All rights reserved. For permissions, please e-mail:
journals.permissions@oup.com.
Title: The Association Between Characteristics of Care Environments and Apathy in Residents With
Dementia in Long-term Care Facilities.
Citation: The Gerontologist, Jun 2015, vol. 55 Suppl 1, p. S27. (June 2015)
Author(s): Jao, Ying-Ling, Algase, Donna L, Specht, Janet K, Williams, Kristine
Abstract: Apathy is highly prevalent in dementia but often overlooked. Environment-based
interventions have demonstrated positive impact on apathy, yet, influential environmental
components are largely understudied. This study examined the relationship between care
environments and apathy in long-term care residents with dementia. This study was exploratory and
employed a descriptive and repeated observation design. A sample of 40 was selected from a parent
study with 185 participants from 28 facilities. Three videos from each participant were coded to
measure apathy and environmental stimulation. Data on ambiance, crowding, staff familiarity, light,
and sounds were extracted from the parent study. Generalized linear mixed models were used for
analysis. The clarity and strength of environmental stimulation were significantly associated with a
lower apathy level. An increase of 1 point on stimulation clarity and strength corresponded to a
decrease of 1.3 and 1.9 points on apathy score, respectively (p < .0001). Other environmental factors
24
did not show significant effect on apathy. This study explored influential environmental features on
apathy in dementia. Findings suggest that care environments that contain clear and sufficient
environmental stimulation are significantly associated with lower resident apathy levels. Findings
will guide environmental design and interventions for dementia care. © The Author 2015. Published
by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved.
For permissions, please e-mail: journals.permissions@oup.com.
Title: Caregiver Person-Centeredness and Behavioral Symptoms in Nursing Home Residents With
Dementia: A Timed-Event Sequential Analysis.
Citation: The Gerontologist, Jun 2015, vol. 55 Suppl 1, p. S61. (June 2015)
Author(s): Gilmore-Bykovskyi, Andrea L, Roberts, Tonya J, Bowers, Barbara J, Brown, Roger L
Abstract: Evidence suggests that person-centered caregiving approaches may reduce dementiarelated behavioral symptoms; however, little is known about the sequential and temporal
associations between specific caregiver actions and behavioral symptoms. The aim of this study was
to identify sequential associations between caregiver person-centered actions, task-centered
actions, and resident behavioral symptoms and the temporal variation within these associations.
Videorecorded observations of naturally occurring interactions (N = 33; 724min) between 12 nursing
home (NH) residents with dementia and eight certified nursing assistants were coded for caregiver
person-centered actions, task-centered actions, and resident behavioral symptoms and analyzed
using timed-event sequential analysis. Although caregiver actions were predominantly personcentered, we found that resident behavioral symptoms were significantly more likely to occur
following task-centered caregiver actions than person-centered actions. Findings suggest that the
person-centeredness of caregivers is sequentially and temporally related to behavioral symptoms in
individuals with dementia. Additional research examining the temporal structure of these
relationships may offer valuable insights into the utility of caregiver person-centeredness as a lowcost strategy for improving behavioral symptom management in the NH setting. © The Author 2015.
Published by Oxford University Press on behalf of The Gerontological Society of America. All rights
reserved. For permissions, please e-mail: journals.permissions@oup.com.
Title: Economics of the Iceberg: Informal Care Provided to French Elderly with Dementia.
Citation: Value in health : the journal of the International Society for Pharmacoeconomics and
Outcomes Research, Jun 2015, vol. 18, no. 4, p. 368-375 (June 2015)
Author(s): Paraponaris, Alain, Davin, Bérengère
Abstract: Dementia has a substantial effect on patients and their relatives, who have to cope with
medical, social, and economic changes. In France, most elderly people with dementia live in the
community and receive informal care, which has not been well characterized. Using a sample of
4680 people aged 75 years and older collected in 2008 through a national comprehensive survey on
health and disability, we compared the economic value of the care received by 513 elderly people
25
with dementia to that received by a propensity score- matched set of older people without
dementia. More than 85% of elderly people with dementia receive informal care; the estimation of
its economic value ranges from €4.9 billion (proxy good method) to €6.7 billion (opportunity cost
method) per year. The informal care provided to people with dementia has substantial annual costs;
further work should be done to examine the social and economic roles foregone as a result of this
care. Copyright © 2015 International Society for Pharmacoeconomics and Outcomes Research
(ISPOR). Published by Elsevier Inc. All rights reserved.
Title: Leisure time activities and mental health in informal dementia caregivers.
Citation: Applied Psychology: Health and Well-Being, Jun 2015, (Jun 11, 2015),
Author(s): Schüz, Benjamin, Czerniawski, Alana, Davie, Nicola, Miller, Lisa, Quinn, Michael G., King,
Carolyn, Carr, Andrea, Elliott, Kate‐Ellen J., Robinson, Andrew, Scott, Jenn L.
Abstract: Objectives Dementia prevalence and the demand for dementia care are increasing.
Informal caregiving accounts for a large proportion of dementia care, but can come at high cost for
caregivers. Informal dementia caregivers are at higher risk for mental health problems than the
general population. This study examines whether perceived change in leisure activities is one
working mechanism linking stress and burden experience in dementia caregiving to lower mental
health (depressive symptoms, anxiety symptoms, and reduced satisfaction with life), and whether
there are group‐based leisure activities that can buffer this detrimental effect. Methods A total of
346 informal Australian dementia caregivers (88.15% female, age 18–82 years) participated in an
online study. Results Mediation and moderation analyses using multiple regression demonstrated
that perceived changes in leisure activities linked caregiving stress and burden to lower mental
health, and that membership in groups engaging in affiliation or social activities attenuates negative
effects of caregiving. Conclusion Informal dementia caregivers benefit from satisfying leisure
activities. In particular, engaging in social activities and self‐help groups buffered the negative
impact of caregiving. (PsycINFO Database Record (c) 2015 APA, all rights reserved)(journal abstract)
Title: The Sociocultural Context of Caregiving Experiences for Vietnamese Dementia Family
Caregivers.
Citation: Asian American Journal of Psychology, Jun 2015, (Jun 15, 2015), 1948-1985 (Jun 15, 2015)
Author(s): Meyer, Oanh L., Nguyen, Kim Hanh, Dao, To Nhu, Vu, Phuoc, Arean, Patricia, Hinton,
Ladson
Abstract: The goal of this qualitative study was to describe the beliefs and experiences of
Vietnamese caregivers caring for a family member with dementia and to elicit their ideas about
promising interventions. We recruited 10 caregivers from support groups, the Alzheimer’s
Association, and local community-based organizations in Northern California. We conducted
semistructured in-depth interviews with all caregivers, as well as a focus group to obtain ideas about
supportive strategies. Several themes emerged from the data: (a) Filial piety was influential in
26
caregiving; (b) A sense of loss/grief or trauma was pervasive; and (c) Caregivers had clear sources of
stress and sources of support. An overarching theme underlying these 3 topics was that cultural
beliefs, values, and expectations impacted the caregiving experience. Suggestions for promising
interventions included education, language-congruent and/or telephone support groups, case
management, inclusion of the care recipient in the intervention, and importance of credibility of the
intervention. It also may be valuable to include an understanding of cultural values and promotion of
spirituality and religion as key components. Findings highlight targets for dementia caregiver
interventions to reduce burden and distress in an understudied population. (PsycINFO Database
Record (c) 2015 APA, all rights reserved)(journal abstract)
Title: Caregiver report of apathy predicts dementia in parkinson's disease.
Citation: Parkinsonism & Related Disorders, Jun 2015, (Jun 9, 2015), 1353-8020 (Jun 9, 2015)
Author(s): Fitts, Whitney, Weintraub, Daniel, Massimo, Lauren, Chahine, Lama, Chen-Plotkin, Alice,
Duda, John E., Hurtig, Howard I., Rick, Jacqueline, Trojanowski, John Q., Dahodwala, Nabila
Abstract: INTRODUCTION: Apathy is a common, troublesome symptom in Parkinson's disease (PD).
However, little is known about its relationship with long-term cognition. We sought to determine if a
caregiver-reported apathy measure predicts the development of PD dementia. METHODS: Nondemented PD patients were recruited as part of a longitudinal study of cognition. Demographics,
medications, Dementia Rating Scale-2, Unified Parkinson's Disease Rating Scale, Geriatric Depression
Scale and the Neuropsychiatric Inventory-Questionnaire (NPI-Q) ratings were obtained. Apathy was
defined as an NPI-Q apathy score ≥1. Participants were evaluated annually with cognitive and
functional assessments until the end of the study period or a physician consensus diagnosis of
dementia was assigned. Cox proportional hazard models were used to assess the effects of baseline
apathy on dementia development while controlling for other clinical and demographic factors.
RESULTS: Of 132 PD patients 12.1% (N = 16) scored in the apathetic range at baseline. A total of
19.6% (N = 26) individuals developed dementia over the course of the study, 8 of whom (30.8% of
future dementia patients) had baseline apathy. In bivariate analyses baseline apathy, older age, and
worse cognitive, motor, and depressive symptom scores predicted the development of dementia. In
a multivariate analysis the predictive effects of baseline apathy were still significant (HR = 3.56; 95%
CI = 1.09–11.62; p = 0.04). CONCLUSIONS: A simple, caregiver-reported measure of apathy is an
independent predictor of progression to dementia in PD. This highlights the importance of apathy as
a clinical characteristic of PD and could prove useful for the prediction of future dementia. (PsycINFO
Database Record (c) 2015 APA, all rights reserved)(journal abstract)
Title: Joint Trajectories of Cognitive Functioning and Challenging Behavior for Persons Living With
Dementia in Long-Term Care.
Citation: Psychology and Aging, Jun 2015, (Jun 8, 2015), 0882-7974 (Jun 8, 2015)
Author(s): Robitaille, Annie, Garcia, Linda, McIntosh, Cameron
27
Abstract: The current study examines the longitudinal relationship between dementia-related
challenging behaviors (e.g., vocal disruption, physical aggression, repetitive behaviors, and
restlessness) and cognitive functioning in the long-term care (LTC) context. A multivariate latent
growth curve model within the structural equation modeling (SEM) framework was applied to data
collected from 16,804 older adults upon admission to LTC and every 3 months for a period of 2.5
years. Increases in challenging behaviors were characterized by a significant positive linear and
negative quadratic trend (i.e., a subtle leveling off at later assessment times), whereas increases in
cognitive impairment were characterized by a positive linear trend. On average, individuals who
were more cognitively impaired upon entry into LTC and who exhibited a steeper increase in
cognitive impairment also exhibited more challenging behaviors at entry into LTC and a steeper
increase in challenging behaviors, respectively. At the within-person level, individuals demonstrating
an increase in cognitive impairment at a specific occasion were also more likely to demonstrate an
increase in challenging behaviors at that same occasion; however, the magnitude of these effects
was very small, suggesting limited practical implications. This study provides novel empirical
evidence about the coevolution of cognitive impairment and challenging behaviors, going beyond
prior research that has been either cross-sectional in nature, examined longitudinal change in only 1
variable, or simply looked at linear trends without attempting to explore the possibility of nonlinear
change. Most importantly, this longitudinal examination of persons with dementia living in LTC has
implications for how challenging behaviors can be better managed and for how new strategies can
be implemented to prevent challenging behaviors. (PsycINFO Database Record (c) 2015 APA, all
rights reserved)(journal abstract)
Title: A pilot randomised controlled trial to compare changes in quality of life for participants with
early diagnosis dementia who attend a ‘Living Well with Dementia’ group compared to waiting-list
control.
Citation: Aging & Mental Health, Jun 2015, vol. 19, no. 6, p. 526-535, 1360-7863 (Jun 2015)
Author(s): Marshall, Ann, Spreadbury, John, Cheston, Richard, Coleman, Peter, Ballinger, Claire,
Mullee, Mark, Pritchard, Jane, Russell, Cynthia, Bartlett, Elizabeth
Abstract: Objectives: The aim of this paper is to report a pilot study in which participants who had
recently received a diagnosis of dementia were randomised to either a 10-week group intervention
or a waiting-list control. Method: Memory clinic staff with limited previous experience of group
therapy were trained to lead a 10-week group therapy intervention called ‘Living Well with
Dementia’. Fifty-eight participants, all of whom had received a diagnosis of Alzheimer's disease,
vascular or Lewy body dementia within the previous 18 months, were randomised to receive either
the intervention or treatment as usual (waiting-list control). Data collection occurred at baseline,
within two weeks after the intervention finished and at 10-week follow-up. Results: The study met
its recruitment targets, with a relatively low attrition rate for the intervention arm. The acceptability
of the intervention and research methods was examined qualitatively and will be reported on
elsewhere. For the primary outcome, measure of quality of life in Alzheimer's disease (QoL-AD), and
secondary outcome, self-esteem, there was some evidence of improvement in the intervention
group compared to the control group. There was, also, evidence of a reduction in cognitive
functioning in the treatment group compared to the control. Such reported differences should be
28
treated with caution because they are obtained from a pilot and not a definitive study. Conclusion:
This pilot study succeeded in collecting data to inform a future definitive cost effectiveness clinical
trial of Living Well with Dementia group therapy. (PsycINFO Database Record (c) 2015 APA, all rights
reserved)
Title: Hospice referral after inpatient psychiatric treatment of individuals with advanced dementia
from a nursing home.
Citation: American Journal of Hospice & Palliative Medicine, Jun 2015, vol. 32, no. 4, p. 437-439,
1049-9091 (Jun 2015)
Author(s): Epstein-Lubow, Gary, Fulton, Ana Tuya, Marino, Louis J., Teno, Joan
Abstract: This report addresses the discharge disposition following inpatient psychiatric treatment
for advanced dementia. The total population included 685 305 Medicare fee-for-service decedents
with advanced cognitive and functional impairment, with a mean age of 85.9 years who had resided
in a nursing home. In the last 90 days of life, 1027 (0.15%) persons received inpatient psychiatry
treatment just prior to the place of care where the individual died. Discharge dispositions included
132 (12.9%) persons to a medical hospital, 728 (70.9%) to nursing home without hospice services, 73
(7.1%) to hospice services in a nursing home, 32 (3.1%) to home without hospice services, and 16
(1.6%) to hospice services at home. Overall, the rate of referral to hospice services for advanced
dementia was relatively low. (PsycINFO Database Record (c) 2015 APA, all rights reserved)(journal
abstract)
Title: Using mobile devices and apps to support reflective learning about older people with
dementia.
Citation: Behaviour & Information Technology, Jun 2015, vol. 34, no. 6, p. 613-631,
Author(s): Pitts, Kristine, Pudney, Kevin, Zachos, Konstantinos, Maiden, Neil, Krogstie, Birgit, Jones,
Sara, Rose, Malcolm, MacManus, Julie, Turner, Ian
people with dementia, in spite of the growing challenges that the condition poses for society. To
design such technologies, an existing model of computer-support reflective learning was instantiated
with findings from a pre-design study in one residential home. The result was a mobile device
running an adapted enterprise social media app to support person-centred care. Evaluations of the
device and app in two residential homes revealed that use of the app both motivated and increased
different styles of care note recording, but little reflective learning was identified or reported. The
results suggest the need for more comprehensive and flexible computer-based support for reflective
learning about residents in their care—and new designs of this more comprehensive support are
also introduced. (PsycINFO Database Record (c) 2015 APA, all rights reserved)(journal abstract)
29
Medical
Title: Diagnosis of dementia
Citation: Nursing Standard, Jun 2015, vol. 29, no. 43, p. 36-41
Author(s): Sandilyan, Malarvizhi Babu, Dening, Tom
Abstract: There are two stages to making a diagnosis of dementia: establishing the presence of a
dementia syndrome and determining the likely cause. Dementia should be distinguished from mild
cognitive impairment, in which any cognitive and functional changes are less marked. Diagnosis of
dementia is essentially clinical but investigations are helpful in excluding other disorders and in
determining the underlying cause of the condition. International diagnostic criteria exist for the most
common causes of dementia and these are useful for clinical and research purposes. At and
following diagnosis, patients and their families require information, support and guidance about the
future. [PUBLICATION] 25 references
Title: Signs and symptoms of dementia
Citation: Nursing Standard, Jun 2015, vol. 29, no. 41, p. 42-51,
Author(s): Sandilyan, Malarvizhi Babu, Dening, Tom
Abstract: Dementia series 3: The clinical features of dementia are usually considered in two groups:
cognitive and non-cognitive symptoms. Among cognitive symptoms, problems with memory are
typical of most forms of dementia, but problems with language and executive functioning are also
prevalent. Non-cognitive symptoms is a somewhat unsatisfactory general term for a group of
problems that include mood disorders, psychotic symptoms and various other changes in behaviour.
In assessment and management, it is important to look for underlying causes of symptoms and try to
understand the perspective of the individual with dementia, because their behaviour may be
communicating an important message. [PUBLICATION] 39 references
Title: Australia's dementia diagnosis
Citation: Australian Nursing and Midwifery Journal, Jun 2015, vol. 22, no. 11, p. 19-23,
Author(s): Keast, Karen
Abstract: Dementia and its most common form, Alzheimer's disease, is now the second leading
cause of death in Australia. With 342,800 Australians now living with dementia and that figure
expected to rise to almost 900,000 by 2050, experts warn the nation must prepare to confront the
rising tide of Alzheimer's, writes Karen Keast. [Publication] 0 references
30
Title: Dementia with Lewy bodies
Citation: British Journal of Neuroscience Nursing, Jun 2015, vol. 11, no. 3, p. 146-149,
Author(s): Abeysuriya, Rajeeva, Walker, Zuzana
Abstract: Epidemiology, features, diagnosis and management of dementia with Lewy bodies (DLB).
[ORIGINAL] 18 references
Title: Worldwide research finds dementia affects women more than men.
Citation: Nursing older people, Jun 2015, vol. 27, no. 6, p. 9., 1472-0795 (June 25, 2015)
Author(s): Berry, Lisa
Abstract: WOMEN ARE much more likely to be affected by dementia than men, according to a global
report.
Title: Biomarkers to track progress of genetic frontotemporal dementia.
Citation: Nursing older people, Jun 2015, vol. 27, no. 6, p. 15.,
Abstract: Frontotemporal dementia is a neurodegenerative disorder characterised by loss of
neurons in the frontal and temporal lobes. It is a common cause of early-onset dementia but can
also start in older age. It presents with behavioural symptoms or language disturbance (primary
progressive aphasia), and patients can also develop symptoms of motor neurone disease. It is a
highly heritable disease with one third of patients having a family history and a mutation in one of
three genes. The ideal time to treat neurodegenerative disease may be before clinical presentation,
at a point where the minimum of irreversible neuronal loss has occurred and cognitive function is
still preserved.
Title: CLINICAL PRACTICE. Advanced Dementia.
Citation: The New England journal of medicine, Jun 2015, vol. 372, no. 26, p. 2533-2540
Author(s): Mitchell, Susan L
Title: Informing a patient they have dementia is a clinical judgement.
Citation: Nursing standard (Royal College of Nursing (Great Britain) : 1987), Jun 2015, vol. 29, no. 42,
p. 33
Author(s): Owen, Michael
31
Abstract: Although I respect Professor Jane Andrews' views on informing patients of a diagnosis of
dementia (letters June 3), I have difficulty agreeing entirely. It is important to take into account
factors such as the extent of the problem, the person's own views about wishing to know or not and,
crucially, whether any treatment can be offered.
Title: Variant of multiple sclerosis with dementia and tumefactive demyelinating brain lesions.
Citation: World journal of clinical cases, Jun 2015, vol. 3, no. 6, p. 525-532
Author(s): Hamed, Sherifa A
Abstract: We describe an unusual clinical and diagnostic feature of a patient with multiple sclerosis
(MS). A 25-year-old woman was admitted to the Neurology department (December 2009) with one
month history of rapid cognitive deterioration. She had poor cognition, dysphasia, reduction in visual
acuity and temporal pallor of the optic discs. She had prolonged latencies of P100 component of
visual evoked potentials (VEPs). Magnetic resonance imaging (MRI)-brain showed multifocal large (≥
3 cm) white-matter hypointense lesions in T1W and hyperintense in T2W and fluid-attenuated
inversion recovery images and patchy enhancement. A diagnosis of tumefactive MS was given. She
received two consecutive 5-d courses of 1 g daily intravenous methylprednisolone for 2 mo and oral
prednisolone in dose of 80 mg twice/daily in between. At the 3(rd) month, Mini Mental State
Examination and VEPs returned to normal but not the MRI. Patient continued oral steroids after
hospital discharge (March 2010) for 9 mo with significant MRI improvement after which tapering of
steroids started for a year. The patient refused immunomodulation therapy due to her low
socioeconomic status. Neither clinical relapse nor new MRI lesions were observed throughout the
next 4 years. In spite of the aggressive course of tumefactive MS variant, good prognosis may be
seen in some patients.
Title: Subcortical whiter matter hyperintensities within the cholinergic pathways of patients with
dementia and parkinsonism.
Citation: Journal of the neurological sciences, Jun 2015, vol. 353, no. 1-2, p. 44-48
Author(s): Park, Hyung-Eun, Park, In-Seok, Oh, Yoon-Sang, Yang, Dong-Won, Lee, Kwang-Soo, Choi,
Hyun-Seok, Ahn, Kook-Jin, Kim, Joong-Seok
Abstract: White matter hyperintensities (WMHs) in the cholinergic pathways are associated with
cognitive performance in Alzheimer's disease (AD) and Parkinson disease dementia (PDD). This study
aimed to evaluate the relationship between loss of white matter cholinergic pathways and cognitive
function in patients with AD, diffuse Lewy body disease (DLB), and PDD. The subjects included 20
patients with AD, 17 with DLB, 21 with PDD, and 20 healthy controls. The extent of WMHs within
cholinergic pathways was assessed using the Cholinergic Pathways Hyperintensities Scale (CHIPS)
and was compared among the different diseases. The mean CHIPS scores were similar among the
three dementia groups (AD vs. DLB vs. PDD=34.6±17.9 vs. 32.4±14.1 vs. 31.8±14.5, p=0.781 by
ANCOVA) and higher than those of controls (11.5±7.6, p=0.001 by ANCOVA). Losses of cholinergic
32
pathways were similar among AD, DLB, and PDD groups, and more severe cognitive dysfunction was
associated with elevated WMHs. These findings suggest that interruption of acetylcholine pathways
may be related to cognitive dysfunction in these three diseases, even though they have different
pathological mechanisms. Copyright © 2015 Elsevier B.V. All rights reserved.
Title: Deficiency or dementia? Exploring B12 deficiency after urostomy.
Citation: British journal of nursing (Mark Allen Publishing), Jun 2015, vol. 24, no. 11, p. 594-597
Author(s): Boucher, Michelle, Bryan, Sandra, Dukes, Suzie
Abstract: Vitamin B12 deficiency can be misdiagnosed as a variety of other illnesses, and if left
untreated can lead to irreversible damage to the brain and nervous system. This article discusses the
case of a 70-year-old female with a urostomy, well known to the stoma care department, who
shortly after a routine parastomal hernia repair developed severe confusion, immobility and was
unable to communicate. Subsequent investigations ruled out a cerebrovascular accident (CVA) and a
diagnosis of rapidly progressing vascular dementia was made. An incidental finding of a low vitamin
B12 level was identified and treatment commenced. She was transferred to a community hospital
and her family were told to 'prepare for the worst'. It was, in fact, the vitamin B12 deficiency that
was causing her symptoms of vascular dementia, and once treatment was established she
underwent a 'miraculous' improvement, returning to normal life. This article discusses vitamin B12
deficiency and why patients with a urostomy are at risk of developing it; highlights the key role of
the stoma care nurse and his or her knowledge of the patient; explores the importance of testing
vitamin B12 levels in this group of patients; and discusses key learning and recommendations for
practice.
Title: Diabetes: A risk factor for cognitive impairment and dementia?
Citation: Neurology, Jun 2015, vol. 84, no. 23, p. 2300-2301
Author(s): Singh-Manoux, Archana, Schmidt, Reinhold
Title: Tetrahydrocannabinol for neuropsychiatric symptoms in dementia: A randomized controlled
trial.
Citation: Neurology, Jun 2015, vol. 84, no. 23, p. 2338-2346
Author(s): van den Elsen, Geke A H, Ahmed, Amir I A, Verkes, Robbert-Jan, Kramers, Cees, Feuth,
Ton, Rosenberg, Paul B, van der Marck, Marjolein A, Olde Rikkert, Marcel G M
Abstract: To study the efficacy and safety of low-dose oral tetrahydrocannabinol (THC) in the
treatment of dementia-related neuropsychiatric symptoms (NPS). This is a randomized, doubleblind, placebo-controlled study. Patients with dementia and clinically relevant NPS were randomly
assigned to receive THC 1.5 mg or matched placebo (1:1) 3 times daily for 3 weeks. Primary outcome
33
was change in Neuropsychiatric Inventory (NPI), assessed at baseline and after 14 and 21 days.
Analyses were based on intention-to-treat. Twenty-four patients received THC and 26 received
placebo. NPS were reduced during both treatment conditions. The difference in reduction from
baseline between THC and placebo was not significant (mean difference NPItotal: 3.2, 95%
confidence interval [CI] -3.6 to 10.0), nor were changes in scores for agitation (Cohen-Mansfield
Agitation Inventory 4.6, 95% CI -3.0 to 12.2), quality of life (Quality of Life-Alzheimer's Disease -0.5,
95% CI -2.6 to 1.6), or activities of daily living (Barthel Index 0.6, 95% CI -0.8 to 1.9). The number of
patients experiencing mild or moderate adverse events was similar (THC, n = 16; placebo, n = 14, p =
0.36). No effects on vital signs, weight, or episodic memory were observed. Oral THC of 4.5 mg daily
showed no benefit in NPS, but was well-tolerated, which adds valuable knowledge to the scarce
evidence on THC in dementia. The benign adverse event profile of this dosage allows study of
whether higher doses are efficacious and equally well-tolerated. This study provides Class I evidence
that for patients with dementia-related NPS, low-dose THC does not significantly reduce NPS at 21
days, though it is well-tolerated. © 2015 American Academy of Neurology.
Title: Functional proteomics of synaptic plasma membrane ATP-ases of rat hippocampus: effect of
l-acetylcarnitine and relationships with Dementia and Depression pathophysiology.
Citation: European journal of pharmacology, Jun 2015, vol. 756, p. 67-74 (June 5, 2015)
Author(s): Ferrari, Federica, Gorini, Antonella, Villa, Roberto Federico
Abstract: Synaptic energy state and mitochondrial dysfunction are crucial factors in many brain
pathologies. l-acetylcarnitine, a natural derivative of carnitine, improves brain energy metabolism,
and has been proposed for the Therapy of many neurological and psychiatric diseases. The effects of
the drug on the maximum rate (Vmax) of enzymatic activities related to hippocampal synaptic
energy utilization were evaluated, in the perspective of its employment for Dementias and
Depression Therapy. Two types of synaptic plasma membranes (SPM1 and SPM2) were isolated from
the hippocampus of rats treated with l-acetylcarnitine (30 and 60mg/kg i.p., 28 days, 5 days/week).
Acetylcholinesterase (AChE); Na(+), K(+), Mg(2+)-ATP-ase; ouabain-insensitive Mg(2+)-ATP-ase;
Na(+), K(+)-ATP-ase; Ca(2+), Mg(2+)-ATP-ase activities were evaluated. In control animals, enzymatic
activities were differently expressed in SPM1 , being the evaluated enzymatic activities higher in
SPM2. Subchronic treatment with l-acetylcarnitine (i) did not modify AChE on both SPMs; (ii)
increased Na(+), K(+), Mg(2+)-ATP-ase, ouabain-insensitive Mg(2+)-ATP-ase and Na(+), K(+)-ATP-ase
at the dose of 30 and 60mg/kg on SPM1 and SPM2; (iii) increased Ca(2+), Mg(2+)-ATP-ase activity on
both SPMs at the dose of 60mg/kg. These results have been discussed considering the
pathophysiology and treatment of Dementias and Depression because, although referred to normal
healthy animals, they support the notion that l-acetylcarnitine may have positive effects in these
pathologies. Copyright © 2015 Elsevier B.V. All rights reserved.
Title: Erratum to: Sequential distribution of pTDP-43 pathology in behavioral variant
frontotemporal dementia (bvFTD).
Citation: Acta neuropathologica, Jun 2015, vol. 129, no. 6, p. 929. (June 2015)
34
Author(s): Brettschneider, Johannes, Del Tredici, Kelly, Irwin, David J, Grossman, Murray, Robinson,
John L, Toledo, Jon B, Lee, Edward B, Fang, Lubin, Van Deerlin, Vivianna M, Ludolph, Albert C, Lee,
Virginia M-Y, Braak, Heiko, Trojanowski, John Q
Title: Treatment adherence in patients with Alzheimer's disease referred to an Italian center for
dementia.
Citation: Aging clinical and experimental research, Jun 2015, vol. 27, no. 3, p. 395-396
Author(s): Sinforiani, Elena, Bernini, Sara, Picascia, Marta, Malinverni, Paola, Zucchella, Chiara
Title: SWI or T2*: Which MRI Sequence to Use in the Detection of Cerebral Microbleeds? The
Karolinska Imaging Dementia Study.
Citation: AJNR. American journal of neuroradiology, Jun 2015, vol. 36, no. 6, p. 1089-1095
Author(s): Shams, S, Martola, J, Cavallin, L, Granberg, T, Shams, M, Aspelin, P, Wahlund, L O,
Kristoffersen-Wiberg, M
Abstract: Cerebral microbleeds are thought to have potentially important clinical implications in
dementia and stroke. However, the use of both T2* and SWI MR imaging sequences for microbleed
detection has complicated the cross-comparison of study results. We aimed to determine the impact
of microbleed sequences on microbleed detection and associated clinical parameters. Patients from
our memory clinic (n = 246; 53% female; mean age, 62) prospectively underwent 3T MR imaging,
with conventional thick-section T2*, thick-section SWI, and conventional thin-section SWI.
Microbleeds were assessed separately on thick-section SWI, thin-section SWI, and T2* by 3 raters,
with varying neuroradiologic experience. Clinical and radiologic parameters from the dementia
investigation were analyzed in association with the number of microbleeds in negative binomial
regression analyses. Prevalence and number of microbleeds were higher on thick-/thin-section SWI
(20/21%) compared with T2*(17%). There was no difference in microbleed prevalence/number
between thick- and thin-section SWI. Interrater agreement was excellent for all raters and
sequences. Univariate comparisons of clinical parameters between patients with and without
microbleeds yielded no difference across sequences. In the regression analysis, only minor
differences in clinical associations with the number of microbleeds were noted across sequences.
Due to the increased detection of microbleeds, we recommend SWI as the sequence of choice in
microbleed detection. Microbleeds and their association with clinical parameters are robust to the
effects of varying MR imaging sequences, suggesting that comparison of results across studies is
possible, despite differing microbleed sequences. © 2015 by American Journal of Neuroradiology.
Title: Influence of microglial activation on neuronal function in Alzheimer's and Parkinson's
disease dementia.
35
Citation: Alzheimer's & dementia : the journal of the Alzheimer's Association, Jun 2015, vol. 11, no.
6, p. 608
Author(s): Fan, Zhen, Aman, Yahyah, Ahmed, Imtiaz, Chetelat, Gaël, Landeau, Brigitte, Ray
Chaudhuri, K, Brooks, David J, Edison, Paul
Abstract: Alzheimer's disease (AD) and Parkinson's disease (PD) are the two common
neurodegenerative diseases characterized by progressive neuronal dysfunction in the presence of
pathological microglial activation. 10 AD, 10 mild cognitive impairment (MCI), 11 PD dementia (PDD),
and 16 controls underwent magnetic resonance imaging, [11C](R)PK11195 (1-[2-chlorophenyl]-Nmethyl-N-[1-methyl-propyl]-3-isoquinoline carboxamide), [11C]PIB (11C-Pittsburgh compound B),
[18F]FDG-PET (18F-2-fluoro-2-deoxyglucose positron emission tomography) scans. Parametric
images were interrogated using region of interest (ROI), biological parametric mapping (BPM) and
statistical parametric mapping analysis, and neuropsychometric tests. Using BPM analysis, AD, MCI,
and PDD subjects demonstrated significant correlation between increased microglial activation and
reduced glucose metabolism (rCMRGlc). AD and MCI subjects also showed significant positive
correlation between amyloid and microglial activation. Levels of cortical microglial activation were
negatively correlated with Mini-Mental State Examination in both AD and PDD. The significant
inverse correlations between cortical levels of microglial activation and rCMRGlc in AD and PDD
suggest cortical neuroinflammation may drive neuronal dysfunction in these dementias. Copyright ©
2015 The Alzheimer's Association. Published by Elsevier Inc. All rights reserved.
Title: Existing data sets to support studies of dementia or significant cognitive impairment and
comorbid chronic conditions.
Citation: Alzheimer's & dementia : the journal of the Alzheimer's Association, Jun 2015, vol. 11, no.
6, p. 622-638
Author(s): Bell, Janice F, Fitzpatrick, Annette L, Copeland, Catherine, Chi, Gloria, Steinman, Lesley,
Whitney, Robin L, Atkins, David C, Bryant, Lucinda L, Grodstein, Francine, Larson, Eric, Logsdon,
Rebecca, Snowden, Mark
Abstract: Dementia or other significant cognitive impairment (SCI) are often comorbid with other
chronic diseases. To promote collaborative research on the intersection of these conditions, we
compiled a systematic inventory of major data resources. Large data sets measuring dementia
and/or cognition and chronic conditions in adults were included in the inventory. Key features of the
resources were abstracted including region, participant sociodemographic characteristics, study
design, sample size, accessibility, and available measures of dementia and/or cognition and
comorbidities. 117 study data sets were identified; 53% included clinical diagnoses of dementia
along with valid and reliable measures of cognition. Most (79%) used longitudinal cohort designs and
41% had sample sizes greater than 5000. Approximately 47% were European-based, 40% were USbased, and 11% were based in other countries. Many high-quality data sets exist to support
collaborative studies of the effects of dementia or SCI on chronic conditions and to inform the
development of evidence-based disease management programs. Copyright © 2015 The Alzheimer's
Association. Published by Elsevier Inc. All rights reserved.
36
Title: Atherosclerotic calcification is related to a higher risk of dementia and cognitive decline.
Citation: Alzheimer's & dementia : the journal of the Alzheimer's Association, Jun 2015, vol. 11, no.
6, p. 639
Author(s): Bos, Daniel, Vernooij, Meike W, de Bruijn, Renée F A G, Koudstaal, Peter J, Hofman,
Albert, Franco, Oscar H, van der Lugt, Aad, Ikram, M Arfan
Abstract: Longitudinal data on the role of atherosclerosis in different vessel beds in the etiology of
cognitive impairment and dementia are scarce and inconsistent. Between 2003-2006, 2364
nondemented persons underwent computed tomography of the coronaries, aortic arch,
extracranial, and intracranial carotid arteries to quantify atherosclerotic calcification. Participants
were followed for incident dementia (n = 90) until April 2012. At baseline and follow-up participants
also underwent a cognitive test battery. Larger calcification volume in all vessels, except in the
coronaries, was associated with a higher risk of dementia. After adjustment for relevant
confounders, extracranial carotid artery calcification remained significantly associated with a higher
risk of dementia [hazard ratio per standard deviation increase in calcification volume: 1.37 (1.05,
1.79)]. Additional analyses for Alzheimer's disease only or censoring for stroke showed similar
results. Larger calcification volumes were also associated with cognitive decline. Atherosclerosis, in
particular in the extracranial carotid arteries, is related to a higher risk of dementia and cognitive
decline. Copyright © 2015 The Alzheimer's Association. Published by Elsevier Inc. All rights reserved.
Title: Frequent use of opioids in patients with dementia and nursing home residents: A study of
the entire elderly population of Denmark.
Citation: Alzheimer's & dementia : the journal of the Alzheimer's Association, Jun 2015, vol. 11, no.
6, p. 691-699
Author(s): Jensen-Dahm, Christina, Gasse, Christiane, Astrup, Aske, Mortensen, Preben Bo,
Waldemar, Gunhild
Abstract: Pain is believed to be undertreated in patients with dementia; however, no larger studies
have been conducted. The aim was to investigate prevalent use of opioids in elderly with and
without dementia in the entire elderly population of Denmark. A register-based cross-sectional
study in the entire elderly (≥65 years) population in 2010 was conducted. Opioid use among elderly
with dementia (N = 35,455) was compared with elderly without (N = 870,645), taking age, sex,
comorbidity, and living status into account. Nursing home residents (NHRs) used opioids most
frequently (41%), followed by home-living patients with dementia (27.5%) and home-living patients
without dementia (16.9%). Buprenorphine and fentanyl (primarily patches) were commonly used
among NHRs (18.7%) and home-living patients with dementia (10.7%) but less often by home-living
patients without dementia (2.4%). Opioid use in the elderly Danish population was frequent but
particularly in patients with dementia and NHR, which may challenge patient safety and needs
further investigation.
37
Title: Summary of the evidence on modifiable risk factors for cognitive decline and dementia: A
population-based perspective.
Citation: Alzheimer's & dementia : the journal of the Alzheimer's Association, Jun 2015, vol. 11, no.
6, p. 718-726
Author(s): Baumgart, Matthew, Snyder, Heather M, Carrillo, Maria C, Fazio, Sam, Kim, Hye, Johns,
Harry
Abstract: An estimated 47 million people worldwide are living with dementia in 2015, and this
number is projected to triple by 2050. In the absence of a disease-modifying treatment or cure,
reducing the risk of developing dementia takes on added importance. In 2014, the World Dementia
Council (WDC) requested the Alzheimer's Association evaluate and report on the state of the
evidence on modifiable risk factors for cognitive decline and dementia. This report is a summary of
the Association's evaluation, which was presented at the October 2014 WDC meeting. The
Association believes there is sufficient evidence to support the link between several modifiable risk
factors and a reduced risk for cognitive decline, and sufficient evidence to suggest that some
modifiable risk factors may be associated with reduced risk of dementia. Specifically, the Association
believes there is sufficiently strong evidence, from a population-based perspective, to conclude that
regular physical activity and management of cardiovascular risk factors (diabetes, obesity, smoking,
and hypertension) reduce the risk of cognitive decline and may reduce the risk of dementia. The
Association also believes there is sufficiently strong evidence to conclude that a healthy diet and
lifelong learning/cognitive training may also reduce the risk of cognitive decline. Copyright © 2015
The Authors. Published by Elsevier Inc. All rights reserved.
Title: Delusion of pregnancy: an unusual symptom in the context of dementia.
Citation: American journal of Alzheimer's disease and other dementias, Jun 2015, vol. 30, no. 4, p.
341-345
Author(s): Cipriani, Gabriele, Di Fiorino, Mario
Abstract: Delusions can complicate practically all brain disorders. They may be dramatic and bizarre.
An example is the so-called delusion of pregnancy. To identify the characteristic of a psychotic
symptom, the phenomenon of delusion of pregnancy, in the context of dementia. MEDLINE and
Google Scholar searches were conducted for relevant articles, chapters, and books published before
2014. Search terms used included delusion of pregnancy, uncommon presentation, behavioral and
psychological symptoms, dementia, Alzheimer's disease, and frontotemporal dementia (FTD).
Publications found through this indexed search were reviewed for further relevant references. We
included case reports that highlight the relationship and overlap between dementia presenting as
schizophrenia-like psychosis and schizophrenia. Literature on delusion of pregnancy in the course of
dementia consists mostly of case reports and small samples of patients. Psychotic phenomena such
as delusion of pregnancy may be a feature in some cases of dementia. If this bizarre features of
38
dementia appears as early presentation of FTD whose usual onset is in the presenium, it may be
mistaken for schizophrenia. © The Author(s) 2014.
Title: Cognitive fluctuations as a challenge for the assessment of decision-making capacity in
patients with dementia.
Citation: American journal of Alzheimer's disease and other dementias, Jun 2015, vol. 30, no. 4, p.
360-363
Author(s): Trachsel, Manuel, Hermann, Helena, Biller-Andorno, Nikola
Abstract: Decision-making capacity (DMC) is an indispensable prerequisite for medical treatment
choices, including consent to treatment, treatment discontinuation, and refusal of treatment. In
patients with dementia, DMC is often affected. A particular challenge in assessing DMC are cognitive
fluctuations that may lead to a fluctuation in DMC as well. Cognitive fluctuations are a diagnostic
core feature of dementia with Lewy bodies and occur in Parkinson's and Alzheimer's diseases. In this
article, these challenges are discussed and suggestions for assessing the DMC of patients with
dementia with cognitive fluctuations are presented. © The Author(s) 2014.
Title: Agenesis of corpus callosum and frontotemporal dementia: a casual finding?
Citation: American journal of Alzheimer's disease and other dementias, Jun 2015, vol. 30, no. 4, p.
375-379
Author(s): Calabrò, Rocco Salvatore, Spadaro, Letteria, Marra, Angela, Balletta, Tina, Cammaroto,
Simona, Bramanti, Placido
Abstract: Agenesis of corpus callosum (AgCC) is a congenital malformation characterized by total or
partial absence of corpus callosum with a good neuropsychological profile. Frontotemporal
dementia (FTD) is the third most common cause of cortical dementia, and it is characterized by
alterations in personality and social relationship, often associated with deficits in attention,
abstraction, planning, and problem solving. Herein, we report a case of a 73-year-old woman
presenting with FTD associated with primary AgCC. The possible "causal or casual" relationship
between these 2 different conditions should be investigated in large prospective studies. © The
Author(s) 2014.
Title: Gait and apathy as relevant symptoms of subcortical vascular dementia.
Citation: American journal of Alzheimer's disease and other dementias, Jun 2015, vol. 30, no. 4, p.
390-399
Author(s): Moretti, Rita, Cavressi, Monica, Tomietto, Paola
39
Abstract: Subcortical vascular dementia relates to small-vessel disease and hypoperfusion, resulting
in focal and diffuse ischemic white matter lesions. The main target of the disease are the frontal
subcortical neural networks. There is no clinical standard definition of the pathology, on the
contrary, everyday clinical practice suggests dominant behavioral alterations and dysexecutive
syndrome. The aim of this study was to investigate gait disorders, behavioral alteration, and drug
intake of a subcortical population with dementia (n = 1155). A complete neuropsychological
examination was conducted at baseline and every 6 months, and the results were compared. Our
data suggest that there is a significant increment in apathy levels and a dramatic decrease in gait and
equilibrium control in the patients examined during follow-up. Subcortical vascular dementia may be
associated with gait and balance alteration and apathy per se; we suggest to implement clinical data
with these major aspects. © The Author(s) 2014.
Title: The Peripheral Sympathetic Neuron is Intact in Alzheimer's Disease and Behavioral Variant of
Frontotemporal Dementia.
Citation: American journal of Alzheimer's disease and other dementias, Jun 2015, vol. 30, no. 4, p.
400-404
Author(s): Struhal, Walter, Javor, Andrija, Benesch, Thomas, Vosko, Milan R, Ransmayr, Gerhard
Abstract: The study was undertaken to evaluate the postganglionic sympathetic sudomotor function
employing the quantitative sudomotor axon reflex test (QSART) in tauopathies Alzheimer's disease
(AD) and behavioral variant of frontotemporal dementia (bvFTD). Patients were recruited in a
prospective pilot study. A structured history was taken and QSART was recorded. In all, 15 patients
with AD (7 female) and 14 patients with bvFTD (9 female) were included. Mean age (±standard
deviation) of patients with AD and bvFTD was 74 ± 9 and 71 ± 10 years, respectively. Severe
sudomotor dysfunction (Composite Autonomic Severity sudomotor score 3) was present in 3 (20%)
patients with AD and 0 (0%) patients with bvFTD (P = .037). The upper extremity was only involved in
1 patient with AD and 1 patient with bvFTD. Sweat results of the 4 recording sites did not differ
between both groups. Patients' history correlated with severe autonomic symptoms as assessed
with QSART. Postganglionic sudomotor involvement in AD and bvFTD is most likely not part of the
disease. © The Author(s) 2014.
Title: Occupational exposures and risk of dementia-related mortality in the prospective
Netherlands Cohort Study.
Citation: American journal of industrial medicine, Jun 2015, vol. 58, no. 6, p. 625-635
Author(s): Koeman, Tom, Schouten, Leo J, van den Brandt, Piet A, Slottje, Pauline, Huss, Anke,
Peters, Susan, Kromhout, Hans, Vermeulen, Roel
Abstract: Occupational exposures may be associated with non-vascular dementia. We analyzed the
effects of occupational exposures to solvents, pesticides, metals, extremely low frequency magnetic
fields (ELF-MF), electrical shocks, and diesel motor exhaust on non-vascular dementia related
40
mortality in the Netherlands Cohort Study (NLCS). Exposures were assigned using job-exposure
matrices. After 17.3 years of follow-up, 682 male and 870 female cases were available. Analyses
were performed using Cox regression. Occupational exposure to metals, chlorinated solvents and
ELF-MF showed positive associations with non-vascular dementia among men, which seemed driven
by metals (hazard ratio ever high vs. background exposure: 1.35 [0.98-1.86]). Pesticide exposure
showed statistically significant, inverse associations with non-vascular dementia among men. We
found no associations for shocks, aromatic solvents, and diesel motor exhaust. Consistent positive
associations were found between occupational exposure to metals and non-vascular dementia. The
finding on pesticides is not supported in the overall literature. © 2015 Wiley Periodicals, Inc.
Title: Heart coherence: a new tool in the management of stress on professionals and family
caregivers of patients with dementia.
Citation: Applied psychophysiology and biofeedback, Jun 2015, vol. 40, no. 2, p. 75-83
Author(s): Sarabia-Cobo, C M
Abstract: We describe a stress management intervention intended to reduce the damage and stress
impact on the heart physiology and function of a group of caregivers (professional and nonprofessional) who work with patients with dementia. The intervention consisted in applying heart
coherence techniques in a population of 72 caregivers of patients with dementia (42 professional
and 29 non-professional caregivers) who had high scores in heart stress and burden tests. Six
months after the training they were able to generate appropriate patterns of heart coherence, with
a statistically significant decrease in their heart overload. We conclude that training in techniques of
heart coherence and positive psychology had effective results on the stress management of the
participant caregivers. This was a simple, inexpensive technique with lasting results. To our
knowledge this is the first research in Spain studying the application of heart coherence techniques
to caregivers of people with dementia.
Title: Drug persistency of cholinesterase inhibitors for patients with dementia of Alzheimer type in
Korea.
Citation: Archives of pharmacal research, Jun 2015, vol. 38, no. 6, p. 1255-1262,
Author(s): Ahn, So-Hyeon, Choi, Nam-Kyong, Kim, Ye-Jee, Seong, Jong-Mi, Shin, Ju-Young, Jung, SunYoung, Park, Byung-Joo
Abstract: This study examined 1-year persistency with cholinesterase inhibitors (ChEIs) for the
treatment of elderly Alzheimer's dementia (AD) patients in Korea. Korean Health Insurance Review &
Assessment Service database from January 2005 to June 2006 was used. Patients aged 65 or older
with AD diagnosis who were first prescribed a ChEI were included. The 1-year persistence,
persistency rate, and switching patterns during the follow-up period were identified. Mean time to
drug discontinuation was analyzed, and persistency rates between different patient factors were
compared. The 1-year persistency rate of newly treated 6,461 AD patients was 24.0 %, while 50 % of
41
study patients discontinued treatment by 91 days from initiation. Persistency rates of female
patients (22.8 %), patients in rural areas (12.7 %), and primary care (10.2 %) were relatively low (p <
0.001). Persistency rate differed between age groups (p < 0.001). Overall proportion of switching
was 6.6 %. The 1-year persistency rate of ChEIs for AD patients in Korea did not reach those of
previous researches in other countries. Patients less likely to remain on therapy should be especially
monitored to optimize treatment persistence.
Title: Dementia and the protective role of cognitive reserve.
Citation: Arquivos de neuro-psiquiatria, Jun 2015, vol. 73, no. 6, p. 473. (June 2015)
Author(s): Laks, Jerson
Title: PON-1 and ferroxidase activities in older patients with mild cognitive impairment, late onset
Alzheimer's disease or vascular dementia.
Citation: Clinical chemistry and laboratory medicine : CCLM / FESCC, Jun 2015, vol. 53, no. 7, p.
1049-1056,
Author(s): Cervellati, Carlo, Romani, Arianna, Bergamini, Carlo M, Bosi, Cristina, Sanz, Juana Maria,
Passaro, Angelina, Zuliani, Giovanni
Abstract: A large body of evidence suggests that not only cerebral but also systemic oxidative stress
(OxS) might be involved in the pathogenesis of late onset Alzheimer's disease (LOAD) and vascular
dementia (VAD), as well as of the prodromal phase of dementia, the so-called mild cognitive
impairment (MCI). In the present study, we evaluated whether paraoxonase 1 (PON-1) and
ferroxidase (FeOx) activities, because of their well acknowledged effectiveness as systemic
antioxidants, might be associated with dementia and/or MCI. Serum arylesterase and paraoxonase
of PON-1, along with FeOx I (ceruloplasmin-related) and II activities were assessed in 223 MCI, 162
LOAD, 65 VAD patients, and in 143 older normal cognitive controls. Among the enzymatic activities
examined, only arylesterase significantly changed across the groups (ANOVA: p<0.001), with similar
lower levels in MCI, LOAD, and VAD compared to controls. By multivariate logistic regression analysis
we showed that, in respect to controls, low levels (under the median value) of serum arylesterase
were independently associated with an increase in the likelihood of being affected by LOAD [odds
ratio (OR) 2.8, 95% confidence interval (CI) 1.5-5.0], VAD (OR 2.7, 95% CI 1.2-6.2), or MCI (OR 2.3,
95% CI 1.3-3.8). Overall, our results suggest that depression of PON-1, and in particular, of
arylesterase activity, in serum might be an early feature of dementia-related diseases. Further
longitudinal exploration of the role of this enzyme in the onset and progression of these disorders
are required.
Title: Is it time to replace the Abbreviated Mental Test Score as a screening tool for dementia?
Citation: Clinical medicine (London, England), Jun 2015, vol. 15 Suppl 3, p. s9.
42
Author(s): Willmott, Michelle
Title: Considerations during intravenous sedation in geriatric dental patients with dementia.
Citation: Clinical oral investigations, Jun 2015, vol. 19, no. 5, p. 1107-1114
Author(s): Sugimura, Mitsutaka, Kudo, Chiho, Hanamoto, Hiroshi, Oyamaguchi, Aiko, Morimoto,
Yoshinari, Boku, Aiji, Niwa, Hitoshi
Abstract: We retrospectively assessed the usability and precautions required during intravenous
sedation (IVS) for dental treatment in geriatric outpatients with dementia. We investigated the
intraoperative complications in 65 cases (25 geriatric dental patients with dementia) under IVS, from
the standpoint of local anesthesia usage, water usage during treatment, and content of treatment.
Circulatory complications occurred in 46.2 % and respiratory complications in 52.3 % of all cases (n =
65). Bradycardia occurred in 13.8 % and hypotension in 12.3 % of cases in the former, while
coughing spells occurred in 41.5 % and snoring in 16.9 % of cases in the latter. Many of the local
anesthesia usage cases did not require water usage, such as during tooth extraction (p < 0.0001).
Water usage cases, such as for caries treatment, needed longer sedation and treatment times,
resulting in more propofol usage (p < 0.001, p < 0.0001, and p < 0.01, respectively). Many coughing
spells developed in the water usage cases (p < 0.05). 81.8 % of snoring and 63.3 % of circulatory
complications, such as hypotension and bradycardia, developed in the tooth extraction cases (p <
0.05). All the scheduled dental treatments in dementia patients were smoothly performed under
IVS. However, stringent attention should be paid to the prevention of aspiration of fluids retained in
the pharynx, airway obstruction due to therapeutic maneuvers, respiratory inhibition by sedatives,
and hemodynamic fluctuations caused by invasive procedures under local anesthesia. In the future,
with the growing need for dental procedures in dementia patients, dentists will require training in
the general management of such patients.
Title: Cognitive and Functional Decline in Patients With Mild Alzheimer Dementia With or Without
Comorbid Diabetes.
Citation: Clinical therapeutics, Jun 2015, vol. 37, no. 6, p. 1195-1205
Author(s): Ascher-Svanum, Haya, Chen, Yun-Fei, Hake, Ann, Kahle-Wrobleski, Kristin, Schuster, Dara,
Kendall, David, Heine, Robert J
Abstract: Although diabetes is recognized as a risk factor for the development of cognitive
impairment and for accelerated progression to Alzheimer disease (AD), it is unclear whether patients
with diabetes who have already progressed to AD have a different rate of cognitive and functional
decline compared with that in those without diabetes. This post hoc exploratory analysis compared
cognitive and functional decline over an 18-month period in patients with mild AD dementia with
and without comorbid diabetes. Decline in quality of life was assessed as a secondary objective. In a
post hoc exploratory analysis, we analyzed data from the placebo groups of three 18-month,
randomized, placebo-controlled trials of solanezumab and semagacestat in patients with AD. Data
43
from patients with mild AD dementia (Mini-Mental State Examination [MMSE] score, 20-26) and
comorbid diabetes at baseline were compared with data from patients with mild AD dementia
without diabetes at baseline. Cognition was assessed using the 14-item AD Assessment ScaleCognitive Subscale (ADAS-Cog14) and the MMSE. Functioning was assessed with the AD Cooperative
Study-Activities of Daily Living Inventory (instrumental subset) (ADCS-iADL). Quality of life was
assessed using the European Quality of Life-5 Dimensions scale, proxy version (proxy utility score
and visual analog scale score), and the Quality of Life in AD scale, self-report and proxy (caregiver)
versions. Group comparisons of changes from baseline to 18 months in cognitive, functional, and
quality-of-life measures employed a repeated-measures model adjusted for propensity score, study,
baseline cognition score (functional or quality of life), age, sex, level of education, genotype of the
apolipoprotein E gene, and concurrent use of an acetylcholinesterase inhibitor or memantine. At
baseline, patients with mild AD dementia with and without diabetes did not significantly differ on
the cognitive measures, but those without diabetes were functioning at a significantly higher level.
At 18 months, compared with patients without diabetes, those with diabetes showed a numerically
but statistically nonsignificantly lesser cognitive decline (least squares mean between-group
differences: ADAS-Cog14 score, 1.61 [P = 0.21]; MMSE score, -0.40 [P = 0.49]) and a statistically
significantly lesser functional decline (least squares mean between-group difference in ADCS-iADL
score, -3.07; P = 0.01). The 2 groups did not differ on declines in the quality-of-life measures. The
present findings suggest that diabetes may influence the rate of functional decline among patients
with mild AD dementia. These results require replication in studies that address the limitations of
the present post hoc exploratory analysis and that explore the potential causes of the observed
differences. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.
Title: Differential Cognitive and Affective Theory of Mind Abilities at Mild and Moderate Stages of
Behavioral Variant Frontotemporal Dementia.
Citation: Cognitive and behavioral neurology : official journal of the Society for Behavioral and
Cognitive Neurology, Jun 2015, vol. 28, no. 2, p. 63-70
Author(s): Torralva, Teresa, Gleichgerrcht, Ezequiel, Torres Ardila, María Juliana, Roca, María,
Manes, Facundo F
Abstract: To study the affective and cognitive components of theory of mind (ToM) performance in
patients with behavioral variant frontotemporal dementia (bvFTD), focusing on differential
impairment at mild and moderate disease stages. ToM, a central capacity for appropriate social
behavior, is critically impaired in patients with bvFTD, even early in the disease. No previous study
has explored how the cognitive and affective components of ToM may relate differentially to disease
severity. We assessed 40 patients with an established diagnosis of bvFTD and 18 healthy controls,
using a complete neuropsychological battery that featured executive function and ToM tasks. We
used patients' Clinical Dementia Rating scores to classify them as having either mild or moderate
bvFTD. Both groups of patients showed deficits in the affective and cognitive components of ToM
relative to the controls. The patients with mild bvFTD outperformed the group with moderate bvFTD
in cognitive ToM capacities; however, affective ToM was equally impaired in both bvFTD groups. The
cognitive, but not the affective, component of ToM correlated with performance on the executive
function tests. Our results suggest that affective ToM is markedly diminished even during the initial
44
stages of bvFTD; as the disease progresses, deficits in cognitive ToM become more prominent. These
findings may relate to the pattern of cortical atrophy described for bvFTD. We also found significant
correlations between the cognitive component of ToM and executive functions.
Title: On the Relationship Between Semantic Knowledge and Prejudice About Social Groups in
Patients with Dementia.
Citation: Cognitive and behavioral neurology : official journal of the Society for Behavioral and
Cognitive Neurology, Jun 2015, vol. 28, no. 2, p. 71-79
Author(s): Carnaghi, Andrea, Silveri, Maria Caterina, Rumiati, Raffaella I
Abstract: Patterns of brain-damaged individuals' deficits in categorizing living versus non-living
things indicate separation of semantic knowledge categories in the brain. Recent work in patients
with dementia suggested that semantic knowledge about social groups differs from knowledge
about living and non-living things. In this study we analyzed patients' social appraisal by testing
whether their degree of impairment in social-group knowledge predicted their social-group
evaluative reactions (prejudice). We hypothesized that impaired knowledge about social groups
would correlate with either heightened or reduced prejudice. In Rumiati et al, Cogn Neurosci (2014)
http://dx.doi.org/10.1080/17588928.2013.876981, we had given a sorting task to 21 patients with
frontotemporal dementia or dementia of the Alzheimer type and 23 healthy controls, to test their
knowledge of social groups and living and non-living things. In this study we asked the same
participants to evaluate social groups. We used controls' evaluations to rank 20 social groups from
extremely negative to extremely positive. We used patients' severity of deficit in sorting social
groups to predict the patients' evaluations of the groups, controlling for their levels of deficit in
sorting living and non-living items. We also compared the evaluations by patients±deficits in socialgroup sorting to controls' evaluations. The patients with impaired social-group knowledge evaluated
the less-admired groups more positively than did controls, and the more-admired groups less
positively. Impaired social-group knowledge, not a general semantic loss, predicts reduced
evaluative bias. Our findings are consistent with neuroimaging evidence for a relationship between
semantic and evaluative social-group processes.
Title: Temporal Variant Frontotemporal Dementia Is Associated with Globular Glial Tauopathy.
Citation: Cognitive and behavioral neurology : official journal of the Society for Behavioral and
Cognitive Neurology, Jun 2015, vol. 28, no. 2, p. 92-97
Author(s): Clark, Camilla N, Lashley, Tammaryn, Mahoney, Colin J, Warren, Jason D, Revesz, Tamas,
Rohrer, Jonathan D
Abstract: Frontotemporal dementia (FTD) is a clinically and pathologically heterogeneous
neurodegenerative disorder associated with atrophy of the frontal and temporal lobes. Most
patients with focal temporal lobe atrophy present with either the semantic dementia subtype of FTD
or the behavioral variant subtype. For patients with temporal variant FTD, the most common cause
45
found on post-mortem examination has been a TDP-43 (transactive response DNA-binding protein
43 kDa) proteinopathy, but tauopathies have also been described, including Pick's disease and
mutations in the microtubule-associated protein tau (MAPT) gene. We report the clinical and
imaging features of 2 patients with temporal variant FTD associated with a rare frontotemporal lobar
degeneration pathology known as globular glial tauopathy. The pathologic diagnosis of globular glial
tauopathy should be considered in patients with temporal variant FTD, particularly those who have
atypical semantic dementia or an atypical parkinsonian syndrome in association with the right
temporal variant.
Title: Lost in spatial translation - A novel tool to objectively assess spatial disorientation in
Alzheimer's disease and frontotemporal dementia.
Citation: Cortex; a journal devoted to the study of the nervous system and behavior, Jun 2015, vol.
67, p. 83-94
Author(s): Tu, Sicong, Wong, Stephanie, Hodges, John R, Irish, Muireann, Piguet, Olivier, Hornberger,
Michael
Abstract: Spatial disorientation is a prominent feature of early Alzheimer's disease (AD) attributed to
degeneration of medial temporal and parietal brain regions, including the retrosplenial cortex (RSC).
By contrast, frontotemporal dementia (FTD) syndromes show generally intact spatial orientation at
presentation. However, currently no clinical tasks are routinely administered to objectively assess
spatial orientation in these neurodegenerative conditions. In this study we investigated spatial
orientation in 58 dementia patients and 23 healthy controls using a novel virtual supermarket task as
well as voxel-based morphometry (VBM). We compared performance on this task with visual and
verbal memory function, which has traditionally been used to discriminate between AD and FTD.
Participants viewed a series of videos from a first person perspective travelling through a virtual
supermarket and were required to maintain orientation to a starting location. Analyses revealed
significantly impaired spatial orientation in AD, compared to FTD patient groups. Spatial orientation
performance was found to discriminate AD and FTD patient groups to a very high degree at
presentation. More importantly, integrity of the RSC was identified as a key neural correlate of
orientation performance. These findings confirm the notion that i) it is feasible to assess spatial
orientation objectively via our novel Supermarket task; ii) impaired orientation is a prominent
feature that can be applied clinically to discriminate between AD and FTD and iii) the RSC emerges as
a critical biomarker to assess spatial orientation deficits in these neurodegenerative conditions.
Copyright © 2015 Elsevier Ltd. All rights reserved.
Title: Auditory hedonic phenotypes in dementia: A behavioural and neuroanatomical analysis.
Citation: Cortex; a journal devoted to the study of the nervous system and behavior, Jun 2015, vol.
67, p. 95-105
46
Author(s): Fletcher, Phillip D, Downey, Laura E, Golden, Hannah L, Clark, Camilla N, Slattery,
Catherine F, Paterson, Ross W, Schott, Jonathan M, Rohrer, Jonathan D, Rossor, Martin N, Warren,
Jason D
Abstract: Patients with dementia may exhibit abnormally altered liking for environmental sounds
and music but such altered auditory hedonic responses have not been studied systematically. Here
we addressed this issue in a cohort of 73 patients representing major canonical dementia syndromes
(behavioural variant frontotemporal dementia (bvFTD), semantic dementia (SD), progressive
nonfluent aphasia (PNFA) amnestic Alzheimer's disease (AD)) using a semi-structured caregiver
behavioural questionnaire and voxel-based morphometry (VBM) of patients' brain MR images.
Behavioural responses signalling abnormal aversion to environmental sounds, aversion to music or
heightened pleasure in music ('musicophilia') occurred in around half of the cohort but showed clear
syndromic and genetic segregation, occurring in most patients with bvFTD but infrequently in PNFA
and more commonly in association with MAPT than C9orf72 mutations. Aversion to sounds was the
exclusive auditory phenotype in AD whereas more complex phenotypes including musicophilia were
common in bvFTD and SD. Auditory hedonic alterations correlated with grey matter loss in a
common, distributed, right-lateralised network including antero-mesial temporal lobe, insula,
anterior cingulate and nucleus accumbens. Our findings suggest that abnormalities of auditory
hedonic processing are a significant issue in common dementias. Sounds may constitute a novel
probe of brain mechanisms for emotional salience coding that are targeted by neurodegenerative
disease. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.
Title: A Risk-Benefit Assessment of Dementia Medications: Systematic Review of the Evidence.
Citation: Drugs & aging, Jun 2015, vol. 32, no. 6, p. 453-467
Author(s): Buckley, Jacob S, Salpeter, Shelley R
Abstract: There is no cure for dementia, and no treatments exist to halt or reverse the course of the
disease. Treatments are aimed at improving cognitive and functional outcomes. Our objective was to
review the basis of pharmacological treatments for dementia and to summarize the benefits and
risks of dementia treatments. We performed a systematic literature search of MEDLINE through
November 2014, for English-language trials and observational studies on treatment of dementia and
mild cognitive impairment. Additional references were identified by searching bibliographies of
relevant publications. Whenever possible, pooled data from meta-analyses or systematic reviews
were obtained. Studies were included for review if they were randomized trials or observational
studies on dementia or mild cognitive impairment that evaluated efficacy outcomes or adverse
outcomes associated with treatment. Studies were excluded if they evaluated non-FDA approved
treatments, or if they evaluated treatment in disorders other than dementia and mild cognitive
impairment. The literature search found 540 potentially relevant studies, of which 257 were
included in the systematic review. In pooled trial data, cholinesterase inhibitors (ChEIs) produce
small improvements in cognitive, functional, and global benefits in patients with mild to moderate
Alzheimer's and Lewy body dementia, but the clinical significance of these effects are unclear. There
is no significant benefit seen for vascular dementia. The efficacy of ChEI treatment appears to wane
over time, with minimal benefit seen after 1 year. There is no evidence for benefit for those with
47
advanced disease or those aged over 85 years. Adverse effects are significantly increased with ChEIs,
in a dose-dependent manner. A two- to fivefold increased risk for gastrointestinal, neurological, and
cardiovascular side effects is related to cholinergic stimulation, the most serious being weight loss,
debility, and syncope. Those aged over 85 years have double the risk of adverse events compared
with younger patients. Memantine monotherapy may provide some cognitive benefit for patients
with moderate to severe Alzheimer's and vascular dementia, but the benefit is small and may wane
over the course of several months. Memantine exhibits no significant benefit in mild dementia or
Lewy body dementia or as an add-on treatment with ChEIs. Memantine has a relatively favorable
side-effect profile, at least under controlled trial conditions. ChEIs produce small, short-lived
improvements in cognitive function in mild to moderate dementia, which may not translate into
clinically meaningful effects. Marginal benefits are seen with severe disease, long-term treatment,
and advanced age. Cholinergic side effects, including weight loss, debility, and syncope, are clinically
significant and could be especially detrimental in the frail elderly population, in which the risks of
treatment outweigh the benefits. Memantine monotherapy may have minimal benefits in moderate
to severe dementia, balanced by minimal adverse effects.
Title: Does dementia matter: is dementia an important factor in 999 call-outs to older people?
Citation: Emergency medicine journal : EMJ, Jun 2015, vol. 32, no. 6, p. e14.
Author(s): Buswell, Marina, Amado, Sarah, Goodman, Claire, William, Julia, Fleming, Jane, Lumbard,
Phillip, Prothero, Larissa
Abstract: Care for older people with dementia (OPWD) is a major concern across all care settings.
Ambulance services are in the spotlight as pressures on emergency services and calls for admission
avoidance are policy priorities. Around 1/3 of emergency call-outs are to people 75 and over, a
significant proportion of whom may have dementia. There is a perception that dementia may be an
issue but we do not understand how much this affects use of emergency services. We reviewed 358
ambulance service paper-based patient care records (PCRs) to test the feasibility of using them as a
source of information about ambulance service use by OPWD and, conducted critical incident
reviews of 999 callouts to understand factors associated with emergency ambulance call-outs. We
took our emerging findings to a stakeholder meeting where we established areas of consensus and
key research questions. Fifty-two (14.5%) of the PCRs reviewed had dementia recorded, this is in line
with current prevalence estimates for ≥75-year-olds. However, we had to use paper PCRs as
dementia recording in ePCRs is more complex. The critical incident reviews identified a wide
spectrum of experience of emergency ambulance use by OPWD and their carers, from pre-diagnosis
through to end-of-life scenarios. It was new for many of the stakeholders to think about the role of
ambulance services in the care of OPWD. There was consensus that the contribution family and paid
carers make in decision making; explaining the OPWD's needs and changed condition, is underused.
There is little current research that understands what ambulance clinicians are doing with respect to
caring for OPWD. Research questions should focus on how communication between the person with
dementia, formal/informal carers, healthcare professionals and emergency services affects the care
provided for older people with dementia during and immediately after urgent care events. Published
by the BMJ Publishing Group Limited. For permission to use (where not already granted under a
licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
48
Title: Heart failure and dementia: survival in relation to types of heart failure and different
dementia disorders.
Citation: European journal of heart failure, Jun 2015, vol. 17, no. 6, p. 612-619
Author(s): Cermakova, Pavla, Lund, Lars H, Fereshtehnejad, Seyed-Mohammad, Johnell, Kristina,
Winblad, Bengt, Dahlström, Ulf, Eriksdotter, Maria, Religa, Dorota
Abstract: Heart failure (HF) and dementia frequently coexist, but little is known about their types,
relationships to each other and prognosis. The aims were to (i) describe patients with HF and
dementia, assess (ii) the proportion of specific dementia disorders in types of HF based on ejection
fraction and (iii) the prognostic role of types of HF and dementia disorders. The Swedish Heart
Failure Registry (RiksSvikt) and The Swedish Dementia Registry (SveDem) were record-linked.
Associations between dementia disorders and HF types were assessed with multinomial logistic
regression and survival was investigated with Kaplan-Meier analysis and multivariable Cox
regression. We studied 775 patients found in both registries (55% men, mean age 82 years). Ejection
fraction was preserved in 38% of patients, reduced in 34%, and missing in 28%. The proportions of
dementia disorders were similar across HF types. Vascular dementia was the most common
dementia disorder (36%), followed by other dementias (28%), mixed dementia (20%), and Alzheimer
disease (16%). Over a mean follow-up of 1.5 years, 76% of patients survived 1 year. We observed no
significant differences in survival with regard to HF type (P = 0.2) or dementia disorder (P = 0.5).
After adjustment for baseline covariates, neither HF types nor dementia disorders were
independently associated with survival. Heart failure with preserved ejection fraction was the most
common HF type and vascular dementia was the most common dementia disorder. The proportions
of dementia disorders were similar across HF types. Neither HF types nor specific dementia disorders
were associated with survival. © 2015 The Authors. European Journal of Heart Failure published by
John Wiley & Sons Ltd on behalf of European Society of Cardiology.
Title: Do statins cause or prevent dementia?
Citation: European journal of neurology : the official journal of the European Federation of
Neurological Societies, Jun 2015, vol. 22, no. 6, p. 885-886
Author(s): Lavie, C J, DiNicolantonio, J J, O'Keefe, J H, Milani, R V
Title: Decreased prevalence of dementia associated with statins: a national population-based
study.
Citation: European journal of neurology : the official journal of the European Federation of
Neurological Societies, Jun 2015, vol. 22, no. 6, p. 912-918 (June 2015)
Author(s): Chuang, C-S, Lin, C-L, Lin, M-C, Sung, F-C, Kao, C-H
49
Abstract: Dementia is a neurodegenerative disorder that presents a progressive decline in cognitive
function and loss of short-term memory with age. Several studies have shown that statin, an oral
lipid-lowering drug, may reduce the risk of developing dementia. The objective of this study is to
explore the association between statin and the development of dementia. The data analyzed in this
study were retrieved from the National Health Insurance Research Database in Taiwan. The sample
consisted of 123 300 patients ≥ 20 years of age, including 61 650 dementia patients with statin use
and 61 650 patients without statin use who were eligible for inclusion in this study. Univariate and
multivariate Cox proportional hazard regression analyses were performed to measure the effects of
statin use on the risk of dementia. The beneficial effect of statin on dementia was significant after
adjusting for sociodemographic factors and comorbidities (adjusted hazard ratio of 0.92, 95%
confidence interval 0.86-0.98). The sex- and age-specific analysis of adjusted hazard ratios showed a
higher beneficial effect from statin treatment in women than in men, and the effect became more
significant with age. Statin therapy may help prevent the development of dementia, and both
hydrophilic and lipophilic statins produce similar effects. However, the preventive characters and
associated mechanisms must be further explored and identified. © 2014 The Author(s) European
Journal of Neurology © 2014 EAN.
Title: Re: The association between chronic obstructive pulmonary disease and dementia: a
population-based retrospective cohort study.
Citation: European journal of neurology : the official journal of the European Federation of
Neurological Societies, Jun 2015, vol. 22, no. 6, p. e70. (June 2015)
Author(s): Liao, K-M
Title: Reply: The association between chronic obstructive pulmonary disease and dementia: a
population-based retrospective cohort study.
Citation: European journal of neurology : the official journal of the European Federation of
Neurological Societies, Jun 2015, vol. 22, no. 6, p. e71. (June 2015)
Author(s): Liao, W-C, Lin, C-L, Chang, S-N, Tu, C-Y, Kao, C-H
Title: Dementia in patients with atrial fibrillation and the value of the Hachinski ischemic score.
Citation: Geriatrics & gerontology international, Jun 2015, vol. 15, no. 6, p. 770-777
Author(s): Di Nisio, Marcello, Prisciandaro, Michele, Rutjes, Anne Ws, Russi, Ilaria, Maiorini, Luisa,
Porreca, Ettore
Abstract: To assess the prevalence of vascular dementia, mixed dementia and Alzheimer's disease in
patients with atrial fibrillation, and to evaluate the accuracy of the Hachinski ischemic score for
these subtypes of dementia. A nested case-control study was carried out. A total of 103 of 784
50
consecutive patients evaluated for cognitive status at the Ambulatory Geriatric Clinic had a diagnosis
of atrial fibrillation. Controls without atrial fibrillation were randomly selected from the remaining
681 patients using a 1:2 matching for sex, age and education. The prevalence of vascular dementia
was twofold in patients with atrial fibrillation compared with controls (21.4% vs 10.7%, P = 0.024).
Alzheimer's disease was also more frequent in the group with atrial fibrillation (12.6% vs 7.3%, P =
0.046), whereas mixed dementia had a similar distribution. The Hachinski ischemic score poorly
discriminated between dementia subtypes, with misclassification rates between 46% (95% CI 28-66)
and 70% (95% CI 55-83). In patients with atrial fibrillation, these rates ranged from 55% (95% CI 3277) to 69% (95% CI 39-91%). In patients in whom the diagnosis of dementia was excluded, the
Hachinski ischemic score suggested the presence of vascular dementia in 11% and mixed dementia
in 30%. Vascular dementia and Alzheimer's disease, but not mixed dementia, are more prevalent in
patients with atrial fibrillation. The discriminative accuracy of the Hachinski ischemic score for
dementia subtypes in atrial fibrillation is poor, with a significant proportion of misclassifications.
Geriatr Gerontol Int 2015; 15: 770-777. © 2014 Japan Geriatrics Society.
Title: Psychiatrists, mental health provision and 'senile dementia' in England, 1940s-1979.
Citation: History of psychiatry, Jun 2015, vol. 26, no. 2, p. 182-199, 0957-154X
Author(s): Hilton, Claire
Abstract: Until around 1979, 'confused' or mentally unwell people over 65 years of age tended to be
labelled as having 'senile dementia'. Senile dementia was usually regarded as a single, inevitably
hopeless condition, despite gradually accumulating clinical and pathological evidence to the
contrary. Specific psychiatric services for mental illness in older people began to emerge in the
1950s, but by 1969 there were fewer than 10 dedicated services nationally. During the 1970s, 'old
age psychiatrists' established local services and campaigned nationally for them. By 1979, about 100
old age psychiatrists were leading multi-disciplinary teams in half the health districts in England. This
paper explores the tortuous development of these new services, focusing on provision for people
with dementia. © The Author(s) 2015.
Title: Improving clinician-carer communication for safer hospital care: a study of the 'TOP 5'
strategy in patients with dementia.
Citation: International journal for quality in health care : journal of the International Society for
Quality in Health Care / ISQua, Jun 2015, vol. 27, no. 3, p. 175-182
Author(s): Luxford, Karen, Axam, Anne, Hasnip, Fiona, Dobrohotoff, John, Strudwick, Maureen,
Reeve, Rebecca, Hou, Changhao, Viney, Rosalie
Abstract: To examine the impact of implementing a clinician-carer communication tool for
hospitalized patients with dementia. Surveys were conducted with clinicians and carers about
perceptions and experiences. Implementation process and costs were explored through surveys of
local staff. Time series analysis was conducted on incident-reported falls, usage of non-regular anti-
51
psychotics and one-to-one nursing. Twenty-one hospitals in Australia. Surveys were returned by 798
clinicians, 240 carers and 21 local liaison staff involved in implementation. Implementation of a
communication tool over 12 months. The process of implementation was documented. Outcome
measures included clinician and carer perceptions, safety indicators (incident-reported falls and
usage of non-regular anti-psychotics), resource use and costs. Clinicians and carers reported high
levels of acceptability and perceived benefits for patients. Clinicians rated confidence in caring for
patients with dementia as being significantly higher after the introduction of TOP 5, (M = 2.93, SD =
0.65), than prior to TOP 5 (M = 2.74, SD = 0.75); F(1,712) = 11.21, P < 0.05. When analysed together,
there was no change in incident-reported falls across all hospitals. At one hospital with a matched
control ward, an average of 6.85 fewer falls incidents per month occurred in the intervention ward
compared with the matched control ward (B = -6.85, P < 0.05). Our findings indicate that the use of a
simple, low-cost communication strategy for patient care is associated with improvements in
clinician and carer experience with potential implications for patient safety. Minimally, TOP 5
represents 'good practice' with a low risk of harm for patients. © The Author 2015. Published by
Oxford University Press in association with the International Society for Quality in Health Care; all
rights reserved.
Title: Cognitive stimulation in cognitively impaired individuals and cognitively healthy individuals
with a family history of dementia: short-term results from the "Allena-Mente" randomized
controlled trial.
Citation: International journal of geriatric psychiatry, Jun 2015, vol. 30, no. 6, p. 631-638
Author(s): Polito, Letizia, Abbondanza, Simona, Vaccaro, Roberta, Valle, Eleonora, Davin, Annalisa,
Degrate, Alessandro, Villani, Simona, Guaita, Antonio
Abstract: We evaluated the short-term efficacy of a protocol of cognitive stimulation (CS), compared
with a sham intervention, on cognitive performance in cognitively healthy individuals with a family
history of dementia (NDFAM) and in non-demented individuals with cognitive impairment (CI). We
performed a randomized controlled trial of CS in NDFAM and CI. CS consisted in 10 twice weekly
meetings of CS focused on a specific cognitive area. CS was compared with a sham intervention (CT)
using Mini-mental state examination (MMSE), Montreal Cognitive Assessment (MoCA), and the Corsi
test. All study participants were typed for the presence of apolipoprotein E (APOE)-Ɛ4. Cognitively
healthy NDFAM showed a higher net cognitive gain after CS, as reflected in their MoCA score, and a
borderline significant net increase in visuospatial memory (Corsi test) compared with those receiving
the CT. APOE-Ɛ4 carriers showed a less significant improvement on the Corsi test with respect to
APOE-Ɛ4 non-carriers. In the CI sample, the MoCA and Corsi test results did not differ between the
cognitively stimulated subjects and the controls. No changes in MMSE scores were found in either
sample of subjects. These findings suggest that CS as structured in this study is an effective
treatment in cognitively healthy individuals, whereas it is less effective in individuals with CI.
Moreover, evaluation of APOE-Ɛ4 status provided evidence of a substantial genetic contribution to
the efficacy of CS on visuospatial memory as measured using the Corsi test. Copyright © 2014 John
Wiley & Sons, Ltd.
52
Title: Validation of the Montreal Cognitive Assessment (MoCA) in Spanish as a screening tool for
mild cognitive impairment and mild dementia in patients over 65 years old in Bogotá, Colombia.
Citation: International journal of geriatric psychiatry, Jun 2015, vol. 30, no. 6, p. 655-662 (June 2015)
Author(s): Gil, Laura, Ruiz de Sánchez, Carolina, Gil, Fabián, Romero, Sara Julieta, Pretelt Burgos,
Felipe
Abstract: The Montreal Cognitive Assessment (MoCA) was developed as a simple screening tool for
cognitive impairment. This study is the first validation in Latin America of the MoCA in Spanish
(MoCA-S), which was developed in Colombia (South America). Aiming to perform the first validation
of the MoCA-S, we developed a study of concordance by conformity to assess the MoCA-S compared
with diagnostic consensus by interdisciplinary assessment in the Memory Clinic (the best diagnostic
method available) and to evaluate the psychometric properties of the MoCA-S. A total of 193
subjects were evaluated, 109 of whom were patients, including 26 who met the mild cognitive
impairment (MCI) clinical criteria, based on neuropsychological testing, and 83 who had mild
dementia (MD). The remaining 84 participants were healthy subjects from the community. The
psychometric evaluation of the MoCA-S was appropriate. Using a cutoff score of ≥ 23, the MoCA had
sensitivities of 76.0% to detect MCI and 92.7% to detect MD and a specificity of 79.8%. The
percentage of patients clearly labeled by the MoCA-S was 85%. The MoCA-S is a valid screening tool
and is useful for identifying MCI and MD in Colombia. The MoCA-S is valid and adequate for
application in Colombia with good internal consistency, inter-observer reliability, and content
validity. However, the average educational level was high in this study; thus, caution should be
exercised when extrapolating these results to individuals with lower educational levels. Copyright ©
2014 John Wiley & Sons, Ltd.
Title: Six-item cognitive impairment test (6CIT): pragmatic diagnostic accuracy study for dementia
and MCI.
Citation: International psychogeriatrics / IPA, Jun 2015, vol. 27, no. 6, p. 991-997
Author(s): Abdel-Aziz, K, Larner, A J
Abstract: The six-item cognitive impairment test (6CIT) is a brief cognitive screening instrument (CSI)
recommended for use in primary care settings. There are very few studies of 6CIT performance in
secondary care settings. We undertook a pragmatic diagnostic accuracy study of 6CIT in consecutive
patients referred over the course of one year to a neurology-led cognitive function clinic, and
compared its performance for the diagnosis of dementia and mild cognitive impairment (MCI) to
that of the simultaneously administered Mini-Mental State Examination (MMSE). In a cohort of 245
patients with dementia prevalence around 20%, 6CIT proved quick and easy to use and acceptable
to patients. It had good sensitivity (0.88) and specificity (0.78) for dementia diagnosis; it was more
sensitive than MMSE (0.59) but less specific (0.85). For MCI diagnosis, 6CIT was again more sensitive
(0.66) than MMSE (0.51) but less specific (0.70 vs. 0.75). Weighted comparisons showed net benefit
for 6CIT compared to MMSE for both dementia and MCI diagnosis. 6CIT effect sizes (Cohen's d) were
large for dementia diagnosis and moderate for MCI diagnosis. 6CIT is an acceptable and accurate
test for the assessment of cognitive problems, its performance being more sensitive than the MMSE.
6CIT use should be considered as a viable alternative to MMSE in the secondary care setting.
53
Title: Effect of depression and diabetes mellitus on the risk for dementia: a national populationbased cohort study.
Citation: JAMA psychiatry, Jun 2015, vol. 72, no. 6, p. 612-619 (June 1, 2015)
Author(s): Katon, Wayne, Pedersen, Henrik Sondergaard, Ribe, Anette Riisgaard, Fenger-Grøn,
Morten, Davydow, Dimitry, Waldorff, Frans Boch, Vestergaard, Mogens
Abstract: Although depression and type 2 diabetes mellitus (DM) may independently increase the
risk for dementia, no studies have examined whether the risk for dementia among people with
comorbid depression and DM is higher than the sum of each exposure individually. To examine the
risk for all-cause dementia among persons with depression, DM, or both compared with persons
with neither exposure. We performed a national population-based cohort study of 2 454 532 adults,
including 477 133 (19.4%) with depression, 223 174 (9.1%) with DM, and 95 691 (3.9%) with both.
We included all living Danish citizens 50 years or older who were free of dementia from January 1,
2007, through December 31, 2013 (followed up through December 31, 2013). Dementia was
ascertained by physician diagnosis from the Danish National Patient Register or the Danish
Psychiatric Central Register and/or by prescription of a cholinesterase inhibitor or memantine
hydrochloride from the Danish National Prescription Registry. Depression was ascertained by
psychiatrist diagnosis from the Danish Psychiatric Central Research Register or by prescription of an
antidepressant from the Danish National Prescription Registry. Diabetes mellitus was identified using
the National Diabetes Register. We estimated the risk for all-cause dementia associated with DM,
depression, or both using Cox proportional hazards regression models that adjusted for potential
confounding factors (eg, demographics) and potential intermediates (eg, medical comorbidities).
During 13 834 645 person-years of follow-up, 59 663 participants (2.4%) developed dementia; of
these, 6466 (10.8%) had DM, 15 729 (26.4%) had depression, and 4022 (6.7%) had both. The
adjusted hazard ratio for developing all-cause dementia was 1.83 (95% CI, 1.80-1.87) for persons
with depression, 1.20 (95% CI, 1.17-1.23) for persons with DM, and 2.17 (95% CI, 2.10-2.24) for those
with both compared with persons who had neither exposure. The excess risk for all-cause dementia
observed for individuals with comorbid depression and DM surpassed the summed risk associated
with each exposure individually, especially for persons younger than 65 years (hazard ratio, 4.84
[95% CI, 4.21-5.55]). The corresponding attributable proportion due to the interaction of comorbid
depression and DM was 0.25 (95% CI, 0.13-0.36; P < .001) for those younger than 65 years and 0.06
(95% CI, 0.02-0.10; P = .001) for those 65 years or older. Depression and DM were independently
associated with a greater risk for dementia, and the combined association of both exposures with
the risk for all-cause dementia was stronger than the additive association.
Title: Pulmonary function as a risk factor for dementia death: an individual participant metaanalysis of six UK general population cohort studies.
Citation: Journal of epidemiology and community health, Jun 2015, vol. 69, no. 6, p. 550-556
Author(s): Russ, Tom C, Starr, John M, Stamatakis, Emmanuel, Kivimäki, Mika, Batty, G David
54
Abstract: In addition to being associated with all-cause mortality and cardiovascular disease
mortality, lung function has been linked with dementia. However, existing studies typically provide
imprecise estimates due to small numbers of outcome events and are based on unrepresentative
samples of the general population. Individual participant meta-analysis of six cohort studies from the
Health Survey for England and the Scottish Health Survey (total N=54 671). Dementia-related
mortality was identified by mention of dementia on any part of the death certificate (mean followup 11.7 years). Study-specific Cox proportional hazard models of the association between lung
function and dementia-related death were pooled using random effect meta-analysis to produce
overall results. There was a dose-response association between poorer lung function and a higher
risk of dementia-related death (age- and sex-adjusted HR compared to highest quartile of forced
expiratory volume in 1 s (FEV1), 95% CI: second quartile 1.32, 0.99 to 1.76; third quartile 1.78, 1.30
to 2.43; fourth (lowest) quartile 2.74, 1.73 to 4.32). There was no significant heterogeneity in studyspecific estimates (I(2)=0%). Controlling for height, socioeconomic status, smoking and general
health attenuated but did not remove the association (second quartile 1.15, 0.82 to 1.62; third
quartile 1.37, 0.96 to 1.94; fourth quartile 2.09, 1.17 to 3.71). Results for forced vital capacity and
peak flow were similar. In these general population samples, the relation between three measures
of lung function and dementia death followed a dose-response gradient. Being in the bottom
quartile of lung function was associated with a doubling of the risk. Published by the BMJ Publishing
Group Limited. For permission to use (where not already granted under a licence) please go to
http://group.bmj.com/group/rights-licensing/permissions.
Title: Perceptions of tissue storage in a dementia population among spouses and offspring.
Citation: Journal of genetic counseling, Jun 2015, vol. 24, no. 3, p. 503-511
Author(s): Martin, Megan M, Rothwell, Erin W, Venne, Vickie L, Foster, Norman L
Abstract: Cognitively impaired patients with dementia often rely on health advocates or guardians,
such as spouses or adult offspring, to consent for medical procedures. These family members may
also decide whether an autopsy is performed after death or whether their family member donates
tissues. However, spouses are not genetically related to the patient and may have different
perspectives than genetically related family members when making medical decisions with genetic
implications, such as participation in a tissue repository (biobank). Interviews were conducted with
spouses and adult offspring of individuals with a progressive dementing disease. Both spouses and
offspring were supportive of the patient with dementia to participate in tissue storage. The top
perceived benefits of tissue storage in both offspring and spouses were future value for family
members and advancement of medical knowledge. Concerns included misuse of the tissue and
insurance discrimination. Although the personal genetic implications differ between spouses and
offspring, they share similar attitudes about the importance of tissue banking for the individual with
a dementing disease.
Title: Clinicopathological Study of Patients With C9ORF72-Associated Frontotemporal Dementia
Presenting With Delusions.
55
Citation: Journal of geriatric psychiatry and neurology, Jun 2015, vol. 28, no. 2, p. 99-107,
Author(s): Shinagawa, Shunichiro, Naasan, Georges, Karydas, Anna M, Coppola, Giovanni, Pribadi,
Mochtar, Seeley, William W, Trojanowski, John Q, Miller, Bruce L, Grinberg, Lea T
Abstract: Several clinical studies point to a high prevalence of psychotic symptoms in frontotemporal
dementia associated with C9ORF72 mutations, but clinicopathological studies addressing the
association between C9ORF72 mutations and delusions are lacking. Seventeen patients with
pathologically proven frontotemporal lobar degeneration (FTLD) associated with C9ORF72 mutations
were identified from Neurodegenerative Disease Brain Bank. Of the 17 cases with C9ORF72
mutation, 4 exhibited well-defined delusions. The clinical history, neurological examination,
neuropsychological testing, neuroimaging analysis, and postmortem assessment of the patients with
delusions were evaluated and compared with the other cases. The content of the delusions was
mixed including persecution, infidelity, and grandiosity. All cases showed parkinsonism; voxel-based
morphometry analysis showed greater precuneus atrophy in patients with delusions than those
without delusions. All 4 had unclassifiable FTLD with TAR DNA-binding protein inclusions, with
characteristics of both type A and type B. Three cases had additional τ pathology and another had αsynuclein pathology. C9ORF72 carriers with well-defined delusions likely associated with additional
pathologies and parietal atrophy in neuroimaging. Patients presenting with middle-aged onset of
delusions should be screened for C9ORF72 mutations, especially if family history and parkinsonism
are present. © The Author(s) 2014.
Title: Risk of dementia in older adults with low versus high occupation-based motivational
processes: differential impact of frequency and proximity of social network.
Citation: Journal of geriatric psychiatry and neurology, Jun 2015, vol. 28, no. 2, p. 126-135,
Author(s): Fankhauser, Sonja, Forstmeier, Simon, Maercker, Andreas, Luppa, Melanie, Luck, Tobias,
Riedel-Heller, Steffi G
Abstract: This study investigates the impact of occupation-based motivational processes and social
network variables on the incidence of dementia over 8 years. Data were derived from the Leipzig
Longitudinal Study of the Aged (LEILA75+), a population-based longitudinal study of individuals aged
75 years and older (n=1692 at baseline). Motivational processes were estimated based on the main
occupation using the Occupational Information Network database. In a Cox proportional hazard
model, motivational processes were not associated with the risk of dementia (hazard ratio [HR]:
0.93, 95% confidence interval [CI]: 0.74-1.16). Individuals with a higher frequency of social contact at
baseline had a significantly lower risk of dementia (HR: 0.96, 95% CI: 0.91-0.99), while proximity of
social contacts was not linked to the risk of dementia (HR: 1.03, 95% CI: 0.98-1.08). In individuals
with low indices of motivational processes, the frequency of social contacts was associated with a
lower risk of dementia (HR: 0.94, 95% CI: 0.88-1.00). On the other hand, proximity of social contacts
was linked to a higher risk of dementia in individuals with high indices of motivational processes (HR:
1.09, 95% CI: 1.01-1.19). Results indicate that the frequency and proximity of social contacts have a
differential impact on the risk of dementia according to lower or higher indices of motivational
processes, while the impact of motivational processes on risk of dementia could not be confirmed.
56
Future studies should carefully disentangle different aspects of social interactions and their
association with motivational processes. © The Author(s) 2014.
Title: The Times They Are a-Changin': Clock Drawing and Prediction of Dementia.
Citation: Journal of geriatric psychiatry and neurology, Jun 2015, vol. 28, no. 2, p. 145-155,
Author(s): Amodeo, Sean, Mainland, Brian J, Herrmann, Nathan, Shulman, Kenneth I
Abstract: Identification of individuals who will eventually develop dementia is critical for early
intervention, treatment, and care planning. The clock drawing test (CDT) is a widely used cognitive
screening tool that has been well accepted among clinicians and patients for its ease of use and
short administration time. This review explores the value of the CDT for predicting the later
development of dementia in cognitively intact older adults and patients with mild cognitive
impairment (MCI). Additionally, we reviewed studies that examined the ability of the CDT to monitor
declines in cognitive functioning over time. A PubMed literature search for articles that included a
longitudinal analysis of the CDT was conducted. The search included articles published up to June
2013 and manual cross-referencing of bibliographies. Relevant studies were categorized,
summarized, and critiqued. The consensus from the studies reviewed suggests that the CDT is a
useful measure of cognitive decline over time. Conceptual clock drawing errors (eg,
misrepresentation of time) detected this decline most effectively. In addition, the CDT appears to
differentiate at baseline between cognitively intact older adults who will develop dementia up to 2
years postbaseline. Finally, the CDT has been found to differentiate between patients with MCI who
will progress to dementia up to 6 years postbaseline. The CDT appears useful for the longitudinal
assessment of cognitive impairment and together with other validated measures may be helpful for
predicting conversion to dementia. Cost-effective and practical ways of predicting risk of dementia
will become increasingly critical as we develop disease-modifying treatments. © The Author(s) 2014.
Title: Behavioral Characteristics of Bowel Movement and Urination Needs in Patients With
Dementia in Taiwan.
Citation: Journal of gerontological nursing, Jun 2015, vol. 41, no. 6, p. 22,
Author(s): Shih, Yen-Hua, Wang, Chi-Jane, Sue, En-Ping, Wang, Jing-Jy
Abstract: Patients with dementia, especially those with advanced dementia, may not be able to
express their bowel movement and urination needs using lucid language, and instead do so through
behaviors. The aim of the current study was to understand and compare the behavioral
characteristics of bowel movement and urination needs in patients with dementia. Observations
were made by caregivers of 187 patients with dementia based on the Behavior Checklist developed
by the research team for bowel movement and urination. Sixteen behavioral characteristics were
identified for both bowel movement and urination; among these, anxiety, taking off/putting on
clothes inappropriately, restlessness, attempting to go elsewhere, scratching skin, repeated
behavior, and making strange sounds were commonly reported. Facial expressions of sorrow,
57
restlessness, and anxiety were the three most common behaviors related to bowel movement
needs, whereas anxiety, taking off/putting on clothes inappropriately, and constant moaning were
the most common behaviors for urination needs. The findings suggest that the common behavioral
characteristics could be seen as indicators of excretion need and the others can be used to
distinguish between the need for bowel movement and urination. Copyright 2015, SLACK
Incorporated.
Title: Dementia and Hopfield model.
Citation: Journal of neural transmission (Vienna, Austria : 1996), Jun 2015, vol. 122, no. 6, p. 773-777
Author(s): Thuraisingham, R A
Abstract: Disruption in the neural network has been observed in the clinical studies on dementia.
This is investigated here, theoretically, via the macroscopic thermodynamic properties of the
Hopfield model to determine whether such a disruption in the network is possible. The analysis is
carried out using a mean field theory. The results show a bifurcation in the network in the absence
of direct energy input. This is seen when the average connective energy of the neuron becomes
equal to or less than its thermal energy. The number of firing neurons that exceed the inactive
neurons is then zero and the behavior of the neurons is random. The model further suggests that
direct energy input will postpone the degradation of the neural network, suggesting that external
mental stimuli will slow this disruption. However, if the neuronal connections are already weak, then
improvements will not be marked
Title: Frontomedian cortex is central for moral deficits in behavioural variant frontotemporal
dementia.
Citation: Journal of neurology, neurosurgery, and psychiatry, Jun 2015, vol. 86, no. 6, p.700-701
Author(s): Schroeter, Matthias L, Bzdok, Danilo, Eickhoff, Simon B, Neumann, Jane
Title: Second-generation antipsychotic drug use in hospital inpatients with dementia: the impact
of a safety warning on rates of prescribing.
Citation: Journal of public health (Oxford, England), Jun 2015, vol. 37, no. 2, p. 346-352
Author(s): McIlroy, Graham, Thomas, Sarah K, Coleman, Jamie J
Abstract: Behavioural and psychological symptoms of dementia are distressing for patients and are
frequently treated with second-generation antipsychotics. Concerns about the drugs' safety resulted
in a Medicines and Healthcare Products Regulatory Agency (MHRA) warning against their use in
March 2009. Second-generation antipsychotic drug use was determined amongst patients with
dementia admitted to the University Hospitals Birmingham National Health Service Foundation
Trust, between July 2005 and December 2011. An interrupted time series analysis was carried out to
investigate changes in rates of prescribing following the safety warning. Risperidone was analysed
separately, in accordance with its limited licence for use in older adults with dementia, granted in
58
October 2008. Before the safety warning, second-generation antipsychotic use was increasing in
patients with dementia. After the MHRA warning, their use fell by 1.9% per month compared with
that before. Use of risperidone continued to rise over the same period, often against the terms of its
licence. Drug safety warnings may influence prescribing practice, although continued use of
antipsychotics in dementia could reflect a lack of alternative treatment options. © The Author 2014.
Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For
permissions, please e-mail: journals.permissions@oup.com.
Title: The effect of telemedicine on the duration of treatment in dementia patients.
Citation: Journal of telemedicine and telecare, Jun 2015, vol. 21, no. 4, p. 214-218
Author(s): Cheong, Chae-Kyo, Lim, Kyu-Hyoung, Jang, Jae-Won, Jhoo, Jin Hyeong
Abstract: We studied 442 patients who met the DSM-IV-TR criteria for dementia and whose
treatment was initiated at the Kangwon National University Hospital (KNUH) in Chuncheon. Over a
five-year period, there were 259 patients who regularly visited the KNUH dementia clinic in person,
and 168 patients who received medical services from the dementia clinic via telemedicine. The
telemedicine patients attended a public health centre in Hongcheon, a facility located in a rural area
about 50 km south east of the KNUH. The mean treatment duration was significantly longer for the
telemedicine group than for the clinical visit group (P < 0.001), with durations of 26.6 and 14.6
months, respectively. Low Clinical Dementia Rating scores (hazard ratio = 1.47, 95% confidence
interval = 1.26-1.71) and use of telemedicine (hazard ratio = 0.55, 95% confidence interval = 0.420.72) were found to be independent predictive factors of increased treatment duration. These
findings suggest that telemedicine may be useful in slowing disease progression in dementia patients
in rural areas. © The Author(s) 2015 Reprints and permissions:
sagepub.co.uk/journalsPermissions.nav.
Title: Healthcare Proxy Awareness of Suspected Infections in Nursing Home Residents with
Advanced Dementia.
Citation: Journal of the American Geriatrics Society, Jun 2015, vol. 63, no. 6, p. 1084-1090
Author(s): Givens, Jane L, Spinella, Sara, Ankuda, Claire K, D'Agata, Erika, Shaffer, Michele L,
Habtemariam, Daniel, Mitchell, Susan L
Abstract: To determine healthcare proxy involvement in decision-making regarding infections in
individuals with advanced dementia. Prospective cohort study. Thirty-five Boston-area nursing
homes (NHs). NH residents with advanced dementia and their proxies (N = 362). Charts were
abstracted monthly (up to 12 months) for documentation of suspected infections and provider-proxy
discussions for each episode. Proxies were interviewed within 8 weeks of the infection to determine
their awareness and decision-making involvement. Factors associated with proxy awareness and
discussion documentation were identified. There were 496 suspected infections; proxies were
reached for interview for 395 (80%). Proxy-provider discussions were documented for 207 (52%)
episodes, yet proxies were aware of only 156 (39%). Proxies participated in decision-making for 89
(57%) episodes of which they were aware. Proxy awareness was associated with antimicrobial use
59
(adjusted odds ratio (AOR) = 3.43, 95% confidence interval (CI) = 1.94-6.05), hospital transfer (AOR =
3.00, 95% CI = 1.19-7.53), infection within 30 days of death (AOR = 3.32, 95% CI = 1.54-7.18), and
fewer days between infection and study interview (AOR = 2.71, 95% CI = 1.63-4.51). Discussion
documentation was associated with the resident residing in a dementia special care unit (AOR =
1.71, 95% CI = 1.04-2.80), the resident not on hospice (AOR = 3.25, 95% CI = 1.31-8.02), more
provider visits (AOR = 1.71, 95% CI = 1.07-2.75), proxy visits of more than 7 h/wk (AOR = 1.93, 95% CI
= 1.02-3.67), and episode within 30 days of death (AOR = 3.99, 95% CI = 1.98-8.02). Proxies are
unaware of and do not participate in decision-making for most suspected infections that NH
residents with advanced dementia experience. Proxy awareness of episodes and documentation of
provider-proxy discussions are not congruent. © 2015, Copyright the Authors Journal compilation ©
2015, The American Geriatrics Society.
Title: Dementia Diagnosis and Influenza Vaccination in French Nursing Home Residents.
Citation: Journal of the American Geriatrics Society, Jun 2015, vol. 63, no. 6, p. 1256-1258 (June
2015)
Author(s): Gallini, Adeline, Gardette, Virginie, Lapeyre-Mestre, Maryse, de Souto Barreto, Philipe,
Vellas, Bruno, Andrieu, Sandrine, Rolland, Yves
Title: Outcomes of Cognitive Fluctuations in Dementia Patients.
Citation: Journal of the American Geriatrics Society, Jun 2015, vol. 63, no. 6, p. 1258-1260
Author(s): Sin, Gwen Li, Mainland, Brian J, Lee, Jimmy, Ornstein, Tisha J, Shulman, Kenneth I,
Herrmann, Nathan
Title: Reversible Methotrexate-Induced Dementia: A Case Report.
Citation: Journal of the American Geriatrics Society, Jun 2015, vol. 63, no. 6, p. 1273-1274
Author(s): Dautzenberg, Lauren, Jessurum, Naomi, Dautzenberg, Paul L J, Keijsers, Carolina J P W
Title: From admission to death: prevalence and course of pain, agitation, and shortness of breath,
and treatment of these symptoms in nursing home residents with dementia.
Citation: Journal of the American Medical Directors Association, Jun 2015, vol. 16, no. 6, p. 475-481
Author(s): Hendriks, Simone A, Smalbrugge, Martin, Galindo-Garre, Francisca, Hertogh, Cees M P M,
van der Steen, Jenny T
Abstract: Burdensome symptoms frequently develop as part of the dementia trajectory and
influence quality of life. We explore the course of symptoms and their treatment during nursing
60
home stay to help target adequate symptom management. Data were collected as part of the Dutch
End of Life in Dementia study, a longitudinal observational study with up to 3.5 years of follow-up.
Physicians performed assessments at baseline, semiannually, and shortly after death of pain,
agitation, shortness of breath, and treatment provided for these symptoms. Long-term care facilities
(28) in the Netherlands. Newly admitted nursing home residents (372) in variable stages of
dementia. We described prevalence and course of symptoms, and treatment provided for these
symptoms. We used generalized estimating equations to evaluate the longitudinal change in
symptoms and their treatment, and the associations between the symptoms of pain and agitation,
as well as between stage of dementia and symptoms. Pain was common (varying from 47% to 68%
across the semiannual assessments) and frequently persistent (36%-41% of all residents); it
increased to 78% in the last week of life. Agitation was the most common symptom (57%-71%), and
also frequently persistent (39%-53%), yet it decreased to 35% in the last week of life. Shortness of
breath was less common (16%-26%), but it increased to 52% at the end of life. Pain was not
significantly associated with agitation. Advanced dementia was associated with more pain only.
Treatment changed in particular at the end of life. Pain was treated mostly with acetaminophen
(34%-52%), and at the end of life with parenteral opioids (44%). Agitation was mostly treated
nonpharmacologically (78%-92%), and at the end of life anxiolytics were the most frequently
prescribed treatment (62%). Overall, aerosolized bronchodilators were the most frequently
prescribed treatment for shortness of breath (29%-67%), but at the end of life, this was morphine
(69%). Pain and agitation were common and frequently persisted in residents with dementia during
nursing home stay, but symptom management intensified only at the end of life. Symptom control
may be suboptimal from admission, and a stronger focus on symptom control is needed at an earlier
stage than the end of life. Copyright © 2015 AMDA – The Society for Post-Acute and Long-Term Care
Medicine. Published by Elsevier Inc. All rights reserved.
Title: Risk of subsequent dementia among patients with bipolar disorder or major depression: a
nationwide longitudinal study in taiwan.
Citation: Journal of the American Medical Directors Association, Jun 2015, vol. 16, no. 6, p. 504-508
Author(s): Chen, Mu-Hong, Li, Cheng-Ta, Tsai, Chia-Fen, Lin, Wei-Chen, Chang, Wen-Han, Chen,
Tzeng-Ji, Pan, Tai-Long, Su, Tung-Ping, Bai, Ya-Mei
Abstract: Both major depression and bipolar disorder are associated with an increased risk of
developing dementia. However, the differential risk of dementia between major depression and
bipolar disorder is rarely investigated. Using the Taiwan National Health Insurance Research
Database, a total of 2291 patients aged ≥55 years (major depression: 1946 and bipolar disorder: 345)
and 2291 age-and sex-matched controls were enrolled between 1998 and 2008, and followed to the
end of 2011. Participants who developed dementia during the follow-up were identified. Both
patients with bipolar disorder [hazard ratio (HR) 5.58, 95% confidence interval (CI) 4.26-7.32] and
those with major depression (HR 3.02, 95% CI 2.46-3.70) had an increased risk of developing
dementia in later life, after adjusting for demographic data and medical comorbidities. The
sensitivity tests after excluding the 1-year (bipolar disorder: HR 4.73, 95% CI 3.50-6.35; major
depression: HR 2.62, 95% CI 2.11-3.25) and 3-year (HR 3.92, 95% CI 2.78-5.54; HR 2.21, 95% CI 1.732.83, respectively) follow-up duration also revealed consistent findings. Furthermore, patients with
61
bipolar disorder were associated with an 87% increased risk (HR 1.87, 95% CI 1.48-2.37) of
subsequent dementia compared with patients with major depression. Midlife individuals with
bipolar disorder or major depression were associated with an elevated risk of developing dementia
in later life. Further studies may be required to clarify the underlying mechanisms among major
depression, bipolar disorder, and dementia, and to investigate whether prompt intervention may
decrease this risk. Copyright © 2015 AMDA – The Society for Post-Acute and Long-Term Care
Medicine. Published by Elsevier Inc. All rights reserved.
Title: Pharmacologic Treatment of Behavioral and Psychological Symptoms of Dementia in Nursing
Homes: Update of the 2008 JAMDA Recommendations.
Citation: Journal of the American Medical Directors Association, Jun 2015, vol. 16, no. 6, p. 527-532
Author(s): Anguish, Isabelle, Locca, Jean-François, Büla, Christophe, Zumbach, Serge, Bugnon, Olivier
Title: Frontotemporal Dementia-Like Syndrome Following Recall of Childhood Sexual Abuse.
Citation: Journal of traumatic stress, Jun 2015, vol. 28, no. 3, p. 240-246 (June 2015)
Author(s): Cohen, Lisa J, Brody, David
Abstract: Numerous psychopathological syndromes have been attributed to posttraumatic stress,
both at the time of the trauma and many years later. To date, however, there is little literature on
pseudodementia as a delayed traumatic stress response. The authors present a case history of a 50year-old woman who developed severe cognitive impairment following retrieval of previously
forgotten memories of childhood sexual abuse. Her cognitive condition deteriorated rapidly and
dramatically. Neuropsychological assessment and clinical presentation led to a diagnosis of
frontotemporal dementia (vs. corticobasal degeneration). Detailed neurologic and medical
evaluations could not identify any underlying physical cause. Her condition progressively worsened
over 9 months, at which point memantine, an N-methyl-D-aspartate receptor antagonist, was
begun. The patient regained full functioning over the next year. Although an organic cause could not
be ruled out, it was likely that recovery of traumatic memories was contributory to the patient's
condition, as ongoing psychotherapy had begun 1 year into the course. If additional cases with
similar presentations are reported, such cases would corroborate the notion that persistent, severe,
and reversible cognitive impairment constitutes a previously unrecognized and atypical
posttraumatic response. © 2015 International Society for Traumatic Stress Studies.
Title: Increased Risk of Dementia in Patients With Chronic Obstructive Pulmonary Disease.
Citation: Medicine, Jun 2015, vol. 94, no. 23, p. e930. (June 2015)
Author(s): Liao, Kuang-Ming, Ho, Chung-Han, Ko, Shian-Chin, Li, Chung-Yi
Abstract: Neurodegenerative disease in patients with chronic obstructive pulmonary disease (COPD)
was observed. We aim to clarify the risk of dementia in patients with COPD.The study used claims
62
data from Taiwan's National Health Insurance Research Database. Subjects were those who received
a discharge diagnosis of COPD between January 1, 2002 and December 31, 2011. Only the first
hospitalization was enrolled, and the index date was the first day of admission. Patients younger
than 40 years or those with a history of Alzheimer disease (AD) or Parkinson disease (PD) before the
index date were excluded. The patients with COPD were then followed until receiving a diagnosis of
AD or PD, death, or the end of the study. Control subjects were selected from hospitalized patients
without a history of COPD, AD, or PD and were matched according to age (±3 years), gender, and the
year of admission at a 2:1 ratio. The comorbidities were measured from 1 year before the index date
based on the ICD-9-CM codes. The study included 8640 patients with COPD and a mean age of 68.76
(±10.74) years. The adjusted hazard ratio of developing dementia (AD or PD) was 1.74 (95%
confidence interval = 1.55-1.96) in patients with COPD compared with patients without COPD after
adjusting for age, gender, and comorbidities.This nationwide cohort study demonstrates that the
risk of dementia, including AD and PD, is significantly increased in patients with COPD compared
with individuals in the general population.
Title: Dementia Increases Severe Sepsis and Mortality in Hospitalized Patients With Chronic
Obstructive Pulmonary Disease.
Citation: Medicine, Jun 2015, vol. 94, no. 23, p. e967. (June 2015)
Author(s): Liao, Kuang-Ming, Lin, Tzu-Chieh, Li, Chung-Yi, Yang, Yea-Huei Kao
Abstract: Dementia increases the risk of morbidity and mortality in hospitalized patients. However,
information on the potential effects of dementia on the risks of acute organ dysfunction, severe
sepsis and in-hospital mortality, specifically among inpatients with chronic obstructive pulmonary
disease (COPD), is limited.The observational analytic study was inpatient claims during the period
from 2000 to 2010 for 1 million people who were randomly selected from all of the beneficiaries of
the Taiwan National Health Insurance in 2000. In total, 1406 patients with COPD and dementia were
admitted during the study period. Hospitalized patients with COPD and free from a history of
dementia were randomly selected and served as control subjects (n = 5334). The patient groups
were matched according to age (±3 years), gender, and the year of admission, with a
control/dementia ratio of 4. Only the first-time hospitalization data for each subject was analyzed.
Logistic regression models were used to calculate the odds ratio (OR) of outcome measures (acute
organ dysfunction, severe sepsis, and mortality), controlling for confounding factors (age, sex,
comorbidity, infection site, hospital level, and length of stay).In COPD patients with dementia, the
incidence rate of severe sepsis and hospital mortality was 17.1% and 4.8%, respectively, which were
higher than the controls (10.6% and 2.3%). After controlling for potential confounding factors,
dementia was found to significantly increase the odds of severe sepsis and hospital mortality with an
adjusted OR (OR) of 1.38 (95% confidence interval [CI] 1.10-1.72) and 1.69 (95% CI 1.18-2.43),
respectively. Dementia was also significantly associated with an increased OR of acute respiratory
dysfunction (adjusted OR 1.39, 95% CI 1.09-1.77).In hospitalized COPD patients, the presence of
dementia may increase the risks of acute respiratory dysfunction, severe sepsis, and hospital
mortality, which warrants the attention of health care professionals.
63
Title: Increased Risk of Dementia in Patients With Erectile Dysfunction: A Population-Based,
Propensity Score-Matched, Longitudinal Follow-Up Study.
Citation: Medicine, Jun 2015, vol. 94, no. 24, p. e990. (June 2015)
Author(s): Yang, Chun-Ming, Shen, Yuan-Chi, Weng, Shih-Feng, Wang, Jhi-Joung, Tien, Kai-Jen
Abstract: Erectile dysfunction (ED) is a well-known predictor for future cardiovascular and
cerebrovascular disease. However, the relationship between ED and dementia has rarely been
examined. This study investigates the longitudinal risk for Alzheimer's disease and non-Alzheimer
dementia in patients with ED.We collected a random sample of 1,000,000 individuals from Taiwan's
National Health Insurance database. From this sample, we identified 4153 patients with newly
diagnosed ED between 2000 and 2009 and compared them with a matched cohort of 20,765
patients without ED. All patients were tracked for 7 years from the index date to identify which of
them subsequently developed dementia.During the 7-year follow-up period, the incidence rate of
dementia in the ED cohort was 35.33 per 10,000 person-years. In the comparison groups, it was
21.67 per 10,000 person-years. After adjustment for patients characteristics and comorbidities,
patients with ED were 1.68-times more likely to develop dementia than patients without ED (95% CI
= 1.34-2.10, P < 0.0001). In addition, older patients and those with diabetes, hypertension, chronic
kidney disease, stroke, depression, and anxiety were found to be at increased risk for dementia.
Analyzing the data by dementia type, we found the hazard risk for Alzheimer's disease and nonAlzheimer dementia to be greater in patients with ED (adjusted HR 1.68, 95% CI = 1.31-2.16, P <
0.0001 and 1.63, 95% CI = 1.02-2.62, P = 0.0429, respectively). Log-rank test revealed that patients
with ED had significantly higher cumulative incidence rates of dementia than those without (P <
0.0001).Patients with ED are at an increased risk for dementia later in life.
Title: The effects of rasagiline on cognitive deficits in Parkinson's disease patients without
dementia: A randomized, double-blind, placebo-controlled, multicenter study.
Citation: Movement disorders : official journal of the Movement Disorder Society, Jun 2015, vol. 30,
no. 7, p. 1009. (June 2015)
Author(s): Hanagasi, Hasmet A
Title: Neurodegenerative disease: Balancing BMI-rethinking the relationships between obesity,
ageing and risk of dementia.
Citation: Nature reviews. Endocrinology, Jun 2015, vol. 11, no. 6, p. 315. (June 2015)
Author(s): Sargent, Jennifer
64
Title: White matter integrity in dementia with Lewy bodies: a voxel-based analysis of diffusion
tensor imaging.
Citation: Neurobiology of aging, Jun 2015, vol. 36, no. 6, p. 2010-2017 (June 2015)
Author(s): Nedelska, Zuzana, Schwarz, Christopher G, Boeve, Bradley F, Lowe, Val J, Reid, Robert I,
Przybelski, Scott A, Lesnick, Timothy G, Gunter, Jeffrey L, Senjem, Matthew L, Ferman, Tanis J, Smith,
Glenn E, Geda, Yonas E, Knopman, David S, Petersen, Ronald C, Jack, Clifford R, Kantarci, Kejal
Abstract: Many patients with dementia with Lewy bodies (DLB) have overlapping Alzheimer's
disease (AD)-related pathology, which may contribute to white matter (WM) diffusivity alterations
on diffusion tensor imaging (DTI). Consecutive patients with DLB (n = 30), age- and sex-matched AD
patients (n = 30), and cognitively normal controls (n = 60) were recruited. All subjects underwent
DTI, 18F 2-fluoro-deoxy-d-glucose, and (11)C Pittsburgh compound B positron emission tomography
scans. DLB patients had reduced fractional anisotropy (FA) in the parietooccipital WM but not
elsewhere compared with cognitively normal controls, and elevated FA in parahippocampal WM
compared with AD patients, which persisted after controlling for β-amyloid load in DLB. The pattern
of WM FA alterations on DTI was consistent with the more diffuse posterior parietal and occipital
glucose hypometabolism of 2-fluoro-deoxy-d-glucose positron emission tomography in the cortex.
DLB is characterized by a loss of parietooccipital WM integrity, independent of concomitant ADrelated β-amyloid load. Cortical glucose hypometabolism accompanies WM FA alterations with a
concordant pattern of gray and WM involvement in the parietooccipital lobes in DLB. Copyright ©
2015 Elsevier Inc. All rights reserved.
Title: Brain atrophy and white-matter hyperintensities are not significantly associated with
incidence and severity of postoperative delirium in older persons without dementia.
Citation: Neurobiology of aging, Jun 2015, vol. 36, no. 6, p. 2122-2129 (June 2015)
Author(s): Cavallari, Michele, Hshieh, Tammy T, Guttmann, Charles R G, Ngo, Long H, Meier, Dominik
S, Schmitt, Eva M, Marcantonio, Edward R, Jones, Richard N, Kosar, Cyrus M, Fong, Tamara G, Press,
Daniel, Inouye, Sharon K, Alsop, David C, SAGES Study Group
Abstract: Postoperative delirium is a common complication in older people and is associated with
increased mortality, morbidity, institutionalization, and caregiver burden. Although delirium is an
acute confusional state characterized by global impairments in attention and cognition, it has been
implicated in permanent cognitive impairment and dementia. The pathogenesis of delirium and the
mechanisms leading to these disabling consequences remain unclear. The present study is the first
to address the potential predisposing role of brain morphologic changes toward postoperative
delirium in a large prospective cohort of patients undergoing elective surgery using state-of-the-art
magnetic resonance imaging (MRI) techniques conducted before admission. We investigated the
association of MRI-derived quantitative measures of white-matter damage, global brain, and
hippocampal volume with the incidence and severity of delirium. Presurgical white-matter
hyperintensities (WMHs), whole brain, and hippocampal volume were measured in 146
consecutively enrolled subjects, ≥70 years old, without dementia who were undergoing elective
surgery. These 3 presurgical MRI indices were tested as predictors of incidence and severity of
subsequent delirium. Out of 146 subjects, 32 (22%) developed delirium. We found no statistically
65
significant differences in WMH, whole brain, or hippocampal volume between subjects with and
without delirium. Both unadjusted and adjusted (age, gender, vascular comorbidity, and general
cognitive performance) regression analyses demonstrated no statistically significant association
between any of the MRI measures with respect to delirium incidence or severity. In persons without
dementia, preexisting cerebral WMHs, general and hippocampal atrophy may not predispose to
postoperative delirium or worsen its severity. Copyright © 2015 Elsevier Inc. All rights reserved.
Title: Testing family-centered, function-focused care in hospitalized persons with dementia.
Citation: Neurodegenerative disease management, Jun 2015, vol. 5, no. 3, p. 203-215 (June 2015)
Author(s): Boltz, Marie, Chippendale, Tracy, Resnick, Barbara, Galvin, James E
Abstract: SUMMARY Aim: Hospital-acquired disability causes decreased quality of life for patients
with dementia and family caregivers, and increased societal costs. A comparative, repeated
measures study tested the feasibility and preliminary efficacy of the family-centered, functionfocused care intervention (Fam-FFC) in dyads of hospitalized, medical patients with dementia and
family caregivers (FCGs). The intervention group demonstrated better activities of daily living and
walking performance, and less severity/duration of delirium and hospital readmissions, but no
significant differences in gait/balance. FCGs showed increased preparedness for caregiving and less
anxiety but no significant differences in depression, strain and mutuality. Fam-FFC presents a
possible pathway to meeting the Triple Aim of improved patient care, improved patient health and
reduced costs for persons with dementia.
Title: Diagnosing dementia in adults with Down's syndrome.
Citation: Neurodegenerative disease management, Jun 2015, vol. 5, no. 3, p. 249-256 (June 2015)
Author(s): Prasher, Vee P, Sachdeva, Niyati, Tarrant, Nick
Abstract: SUMMARY Individuals with Down's syndrome (DS) are living longer and many will survive
into their fifth or sixth decade of life. Among the DS population, the prevalence of dementia in
Alzheimer's disease increases from 9.4% in age group 30-39 years to 54.5% age group 60-69 years.
The psychopathology of dementia in Alzheimer's disease is similar to that seen in the general
population although differences are apparent due to the underlying intellectual disability in DS and
on the reliance on collateral information from informants. The diagnostic workup follows accepted
practice although neuropsychological tests and neuroimaging will only be adjuncts to the clinical
assessment; such investigations have limited diagnostic value. Presently, research is focused on
identifying genetic and biological measures of Alzheimer's disease in DS.
Title: Hippocampal sclerosis in the parkinsonism-dementia complex of Guam: quantitative
examination of neurons, neurofibrillary tangles, and TDP-43 immunoreactivity in CA1.
Citation: Neuropathology : official journal of the Japanese Society of Neuropathology, Jun 2015, vol.
35, no. 3, p. 224-235
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Author(s): Oyanagi, Kiyomitsu, Yamazaki, Mineo, Hashimoto, Tomoyo, Asakawa, Mika, Wakabayashi,
Koichi, Takahashi, Hitoshi
Abstract: The cornu ammonis 1 (CA1) area in the hippocampus of the parkinsonism-dementia
complex (PDC) of Guam was examined quantitatively with special references to the number of
neurons, intraneuronal (i) and extracellular (e) neurofibirillary tangles (NFTs), and TDP-43 (43-kDa
trans-activation-responsive region DNA-binding protein)-immunopositive structures, in 24 Chamorro
patients with PDC of Guam and seven control Chamorro Guamanians (both groups having no
ischemic or anoxic complications). The results were that: (i) in the patients with mildly involved PDC,
total numbers of neurons, iNFTs and eNFTs were almost the same as those of neurons of controls;
(ii) in patients severely involved, total numbers of neurons, iNFTs and eNFTs decreased markedly;
(iii) the decrease of the number of pyramidal neurons in CA1 with positive nuclear TDP-43 was
intimately correlated with the decrease in total neuron numbers; (iv) whereas the numbers of
neurons and TDP-43-immunopositive intracytoplasmic aggregation in the CA1 area were inversely
correlated; and (v) depression of nuclear TDP-43 immuonostainability was not affected by the
presence or absence of NFTs. In conclusion, hippocampal sclerosis exists in PDC; there is a possibility
of elimination of eNFTs which appeared in the CA1 in patients with PDC and loss of the neurons
correlates with disappearance of nuclear TDP-43, but not with appearance of intraneurocytoplasmic
TDP-43 aggregation or iNFTs. © 2015 Japanese Society of Neuropathology.
Title: Autopsy case of spinocerebellar ataxia type 31 with severe dementia at the terminal stage.
Citation: Neuropathology : official journal of the Japanese Society of Neuropathology, Jun 2015, vol.
35, no. 3, p. 273-279 (June 2015)
Author(s): Adachi, Tadashi, Kitayama, Michio, Nakano, Toshiya, Adachi, Yoshiki, Kato, Shinsuke,
Nakashima, Kenji
Abstract: Spinocerebellar ataxia type 31 (SCA31) is an autosomal dominant cerebellar ataxia
commonly observed in Japan. However, few neuropathological examinations have been conducted.
Here we report the case of a 76-year-old Japanese male SCA31 patient. He noticed dysarthria and
difficulty walking at 65 years old. His symptoms subsequently deteriorated, although he could still
walk with assistance at 70 years. At 73 years, when he could no longer walk, he was admitted to our
hospital. He showed severe limb and truncal ataxia. His father and older brother had shown the
same symptoms. Brain magnetic resonance imaging showed cerebellar atrophy of the anterior lobe
and white matter hyperintensities. He was diagnosed with SCA31 by genetic analysis. Gradually, his
cognitive functions and ability to communicate declined. He died of respiratory failure at the age of
76. Neuropathological examination revealed severe Purkinje cell loss that was accentuated in the
anterior lobe of the cerebellum. Furthermore, the remaining Purkinje cells showed abnormal
processes (that is, halo-like amorphous materials), as has been reported previously. Severe
deposition of hyperphosphorylated tau-positive neurites, many senile plaques and amyloid
angiopathy were observed in the neocortex. Our findings suggest that in SCA31, accelerated tau and
amyloid pathology in the neocortex might induce dementia at the terminal stage. © 2014 Japanese
Society of Neuropathology.
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Title: Investigation of Aβ phosphorylated at serine 8 (pAβ) in Alzheimer's disease, dementia with
Lewy bodies and vascular dementia.
Citation: Neuropathology and applied neurobiology, Jun 2015, vol. 41, no. 4, p. 428-444 (June 2015)
Author(s): Ashby, Emma L, Miners, James S, Kumar, Sathish, Walter, Jochen, Love, Seth, Kehoe,
Patrick G
Abstract: Deposition of amyloid beta (Aβ) in the brain is one of the defining abnormalities of
Alzheimer's disease (AD). Phosphorylation of Aβ at serine 8 (pAβ) has been implicated in its
aggregation in vitro and pAβ level has been shown to be significantly elevated in AD. We aimed to
assess the specificity of pAβ for AD and have investigated associations of pAβ with parenchymal and
cerebrovascular accumulation of Aβ, disease progression, angiotensin-converting enzyme activity
and APOE genotype. The distribution of pAβ was studied by immunohistochemistry in sporadic and
familial AD, pure dementia with Lewy bodies (DLB), pure vascular dementia (VaD) and age-matched
controls. Soluble and insoluble (guanidine-extractable) pAβ level was measured by enzyme-linked
immunosorbent assay (ELISA) in the midfrontal and parahippocampal cortex in sporadic AD (n = 20,
10 with Braak tangle stages of III-IV and 10 of stages V-VI), DLB (n = 10), VaD (n = 10) and agematched controls (n = 20). We found pAβ to be associated with only a subset of Aβ plaques and
vascular deposits in sporadic and familial AD, with absent or minimal immunohistochemically
detectable pAβ in control, DLB and VaD brains. In both brain regions, insoluble pAβ level was
significantly elevated only in advanced AD (Braak tangle stage of V or VI) and in the
parahippocampus soluble and insoluble pAβ level increased with the number of APOE ε4 alleles.
These results indicate that pAβ accumulation in the parenchyma and vasculature is largely restricted
to late-stage AD (Braak tangle stage V-VI). © 2014 British Neuropathological Society.
Title: Synaptic protein levels altered in vascular dementia.
Citation: Neuropathology and applied neurobiology, Jun 2015, vol. 41, no. 4, p. 533-543 (June 2015)
Author(s): Sinclair, Lindsey I, Tayler, Hannah M, Love, Seth
Abstract: Cerebral ischaemia is the defining pathophysiological abnormality in most forms of
vascular dementia (VAD), but the pathogenesis of the dementia remains poorly understood. In
Alzheimer's disease (AD), there is early loss of synaptic proteins, but these have been little studied in
VAD. We measured synaptophysin, postsynaptic density protein 95 (PSD-95), drebrin, synaptosomalassociated protein 25 (SNAP-25) and vascular endothelial growth factor (VEGF) by enzyme-linked
immunosorbent assays in superior temporal cortex from 11 patients with VAD and, initially, 11 nondementia controls. We corrected for neuronal content by measurement of neuron-specific enolase.
A further 11 controls were subsequently used in a validation study. Simulation of post-mortem delay
found that PSD-95 was stable at 4°C but declined slightly at RT. SNAP-25 and drebrin showed good
post-mortem stability. Previous studies had shown good post-mortem preservation of synaptophysin
and VEGF. The VAD cases had lower synaptophysin (but P > 0.05 in initial study), significantly lower
SNAP-25 (P = 0.024) and significantly higher drebrin (P = 0.020). On comparison with the second
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control group, the reduction in synaptophysin was significant (P = 0.008), and the other results were
confirmed. There is probably a reduction in presynaptic proteins in the temporal cortex in VAD,
although not as marked as in AD. In VAD, there is also an increase in drebrin, which may be a
response to reduced synaptic input. © 2015 The Authors. Neuropathology and Applied Neurobiology
published by John Wiley & Sons Ltd on behalf of British Neuropathological Society.
Title: A theory of fine structure image models with an application to detection and classification of
dementia.
Citation: Quantitative imaging in medicine and surgery, Jun 2015, vol. 5, no. 3, p. 356-367, 22234292
Author(s): O'Neill, William, Penn, Richard, Werner, Michael, Thomas, Justin
Abstract: Estimation of stochastic process models from data is a common application of time series
analysis methods. Such system identification processes are often cast as hypothesis testing exercises
whose intent is to estimate model parameters and test them for statistical significance. Ordinary
least squares (OLS) regression and the Levenberg-Marquardt algorithm (LMA) have proven
invaluable computational tools for models being described by non-homogeneous, linear, stationary,
ordinary differential equations. In this paper we extend stochastic model identification to linear,
stationary, partial differential equations in two independent variables (2D) and show that OLS and
LMA apply equally well to these systems. The method employs an original nonparametric statistic as
a test for the significance of estimated parameters. We show gray scale and color images are special
cases of 2D systems satisfying a particular autoregressive partial difference equation which
estimates an analogous partial differential equation. Several applications to medical image modeling
and classification illustrate the method by correctly classifying demented and normal OLS models of
axial magnetic resonance brain scans according to subject Mini Mental State Exam (MMSE) scores.
Comparison with 13 image classifiers from the literature indicates our classifier is at least 14 times
faster than any of them and has a classification accuracy better than all but one. Our modeling
method applies to any linear, stationary, partial differential equation and the method is readily
extended to 3D whole-organ systems. Further, in addition to being a robust image classifier,
estimated image models offer insights into which parameters carry the most diagnostic image
information and thereby suggest finer divisions could be made within a class. Image models can be
estimated in milliseconds which translate to whole-organ models in seconds; such runtimes could
make real-time medicine and surgery modeling possible.
Title: Frontotemporal lobar dementia and amyotrophic lateral sclerosis associated with c9orf72
expansion.
Citation: Revue neurologique, Jun 2015, vol. 171, no. 6-7, p. 475-481, 0035-3787 (2015 Jun-Jul)
Author(s): Le Ber, I
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Abstract: An intronic GGGGCC repeat expansion in c9orf72 gene has been identified as the most
common genetic cause of frontotemporal lobar dementia (FTLD), amyotrophic lateral sclerosis (ALS)
and FTLD-ALS. The discovery of c9orf72 gene has led to important scientific progresses and has
considerably changed our clinical practice over the last few years. This paper summarizes the
common and less typical phenotypes associated with c9orf72 expansion, the complex pathological
pattern characterized by p62/dipeptide repeat aggregates, as well as the pathological mechanisms
by which the expansion might produce neurodegeneration implicating loss-of-function, RNA toxicity,
RNA-binding protein sequestration and accumulation of dipeptide repeats. We also discuss the
recommendations and limits for genetic testing and counseling in clinical practice. Copyright © 2015
Elsevier Masson SAS. All rights reserved.
Title: Methodological Factors in Determining Risk of Dementia After Transient Ischemic Attack and
Stroke: (II) Effect of Attrition on Follow-Up.
Citation: Stroke; a journal of cerebral circulation, Jun 2015, vol. 46, no. 6, p. 1494-1500 (June 2015)
Author(s): Pendlebury, Sarah T, Chen, Ping-Jen, Welch, Sarah J V, Cuthbertson, Fiona C, Wharton,
Rose M, Mehta, Ziyah, Rothwell, Peter M, Oxford Vascular Study
Abstract: Cognitive outcomes in cohorts and trials are often based only on face-to-face clinic
assessment. However, cognitive impairment is strongly associated with increased morbidity and
mortality, leading to substantial loss to clinic follow-up. In the absence of previous population-based
data, we determined the effect of such attrition on measured risk of dementia after transient
ischemic attack and stroke. Patients with transient ischemic attack or stroke prospectively recruited
(2002-2007) into the Oxford Vascular (OXVASC) study had baseline clinical/cognitive assessment and
follow-up to 2014. Dementia was diagnosed through face-to-face clinic interview, supplemented by
home visits and telephone assessment in patients unable to attend clinic and by hand-searching of
primary care records in uncontactable patients. Of 1236 patients (mean age/SD, 75.2/12.1 years;
582 men), 527 (43%) died by 5-year follow-up. Follow-up assessment rates (study clinic, home visit,
or telephone) of survivors were 947 in 1026 (92%), 857 in 958 (89%), 792 in 915 (87%), and 567 in
673 (84%) at 1, 6, 12 months and 5 years. Dementia developed in 260 patients, of whom 110 (42%;
n=50 primary care records, n=49 home visit, and n=11 telephone follow-up) had not been available
for face-to-face clinic follow-up at the time of diagnosis. The 5-year cumulative incidence of
postevent dementia was 29% (26%-32%) overall but was only 17% (14% to 19%) in clinic assessed
versus 45% (39%-51%) in nonclinic-assessed patients (P difference<0.001). Exclusion of patients
unavailable for clinic follow-up reduces the measured risk of postevent dementia. Use of multiple
follow-up methods, including home visits, telephone assessments, and consent, to access primary
care records substantially increases ascertainment of longer-term dementia outcomes. © 2015
American Heart Association, Inc.
Title: Re: cumulative use of strong anticholinergics and incident dementia: a prospective cohort
study.
Citation: The Journal of urology, Jun 2015, vol. 193, no. 6, p. 2035. (June 2015)
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Author(s): Wein, Alan J
Title: Oxidative stress and cognition amongst adults without dementia or stroke: Implications for
mechanistic and therapeutic research in psychiatric disorders.
Citation: Psychiatry Research, Jun 2015, vol. 227, no. 2-3, p. 127-134,
Author(s): Newton, Dwight F., Naiberg, Melanie R., Goldstein, Benjamin I.
Abstract: Oxidative stress has been implicated in cognitive deficits in disease states such as
dementia and stroke. However, growing evidence shows similar associations in individuals without
these conditions. We therefore set out to systematically review the literature on this topic. MEDLINE
searches were conducted of medical subject-headings neuropsychology, cognition, cognition
disorders, or neuropsychological tests, cross-referenced with oxidative stress, or superoxide.
Exclusion criteria were dementia and stroke studies, absence of human subjects, and absence of
quantifiable oxidative stress/cognition measures. The search yielded 883 results, of which 19 studies
(consisting of 3662 total subjects) were included in this review. The majority of studies indicated that
frontal cognitive functions were most often impaired, and lipid peroxidation was most commonly
associated with impairments. Literature on learning, memory, and general cognitive function was
less robust. A substantial proportion of the literature on this topic is based on psychiatric
populations. Frontal-executive dysfunction implicates frontal brain regions, which are known to be
susceptible to oxidative damage. Further studies are needed, and those examining psychiatric
populations may be especially fruitful. Focusing on youth may yield enhanced signal detection.
Further study is needed to identify which antioxidant interventions work best for which cognitive
functions and for which patients. (PsycINFO Database Record (c) 2015 APA, all rights
reserved)(journal abstract)
Title: Prevalence and incidence of dementia among indigenous populations: A systematic review.
Citation: International Psychogeriatrics, Jun 2015, (Jun 19, 2015), 1041-6102 (Jun 19, 2015)
Author(s): Warren, Laura A., Shi, Qiyun, Young, Kue, Borenstein, Amy, Martiniuk, Alexandra
Abstract: Background: Indigenous populations may be at increased risk, compared with majority
populations, for the development of dementia due to lower education levels and socio-economic
status, higher rates of diabetes, hypertension, cardiovascular disease and alcohol abuse, an aging
population structure, and poorer overall health. This is the first systematic review investigating the
prevalence and incidence of dementia in indigenous populations worldwide. Methods: This
systematic review was conducted in accordance with PRISMA guidelines. We searched MEDLINE,
Embase, and PsycInfo for relevant papers published up to April 2015. Studies were included if they
reported prevalence or incidence, the disease typically occurred after the age of 45, the study
population included indigenous people, and the study was conducted in the general population.
Results: Fifteen studies representing five countries (Canada, Australia, the USA, Guam, Brazil) met
the inclusion criteria. Dementia prevalence ranged from 0.5% to 20%. Retrospective studies relying
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on medical records for diagnoses had much lower prevalence rates and a higher risk of bias than
population-based prospective studies performing their own diagnoses with culturally appropriate
cognitive assessment methods. Conclusions: The prevalence of dementia among indigenous
populations appears to be higher than it is for non-indigenous populations. Despite a building body
of evidence supporting the need for dementia research among indigenous populations, there is a
paucity of epidemiological research, none of which is of high quality. (PsycINFO Database Record (c)
2015 APA, all rights reserved)(journal abstract)
Title: Medial temporal regional argyrophilic grain as a possible important factor affecting
dementia in parkinson's disease.
Citation: Neuropathology, Jun 2015, (Jun 16, 2015), 0919-6544 (Jun 16, 2015)
Author(s): Homma, Taku, Mochizuki, Yoko, Takahashi, Kazushi, Komori, Takashi
Abstract: Argyrophilic grain (ArG) is the main pathological feature of argyrophilic grain disease (AGD)
and is clinically characterized by cognitive impairment, behavioral abnormalities, personality
changes, and emotional imbalances. However, ArG can not only be found in AGD but also in various
other neurological disorders, including Parkinson's disease (PD). The association of ArG with
psychosis and/or dementia in various neurological disorders remains unknown; in this study, we
have investigated this in PD. The distribution and degree of ArG deposition, spongiform change in
the transentorhinal cortex (TER SpC), and phosphorylated alpha‐synuclein‐positive neurites in CA2/3
were assessed, and we used formalin‐fixed, paraffin‐embedded specimens obtained from the
anterior/posterior medial temporal region of 20 autopsy cases diagnosed as PD. These cases were
clinically divided into two groups: PD without dementia (PDND) and PD with dementia (PDD). Most
PDD cases revealed scattered to numerous ArG or moderate to severe TER SpC, both of which were
rarely observed in the PDND group. Furthermore, by the degree of ArG density and TER SpC, the PDD
group was further divided into three subtypes: PDD with ArG, with TER SpC and without ArG/TER
SpC. Scattered‐to‐numerous ArG and/or moderate‐to‐severe TER SpC were observed only in PDD,
which suggested that both ArG and TER SpC could be important factors affecting dementia in PD and
that their distribution and degree are equally important. (PsycINFO Database Record (c) 2015 APA,
all rights reserved)(journal abstract)
Title: Magnetization transfer MRI in dementia disorders, Huntington's disease and parkinsonism.
Citation: Journal of the Neurological Sciences, Jun 2015, vol. 353, no. 1-2, p. 1-8, 0022-510X (Jun 15,
2015)
Author(s): Tambasco, Nicola, Nigro, Pasquale, Romoli, Michele, Simoni, Simone, Parnetti, Lucilla,
Calabresi, Paolo
Abstract: Magnetic resonance imaging is the most used technique of neuroimaging. Using recent
advances in magnetic resonance application it is possible to investigate several changes in
neurodegenerative disease. Among different techniques, magnetization-transfer imaging (MTI), a
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magnetic resonance acquisition protocol assessing the magnetization exchange between protons
bound to water and those bound to macromolecules, is able to identify microstructural brain tissue
changes peculiar of neurodegenerative diseases. This review provides a report on the MTI technique
and its use in the dementia disorders, Huntington's disease and parkinsonisms, comprehensive of
the predictive values of MTI in the identification of early-phase disease. (PsycINFO Database Record
(c) 2015 APA, all rights reserved)(journal abstract)
Title: Common aging signature in the peripheral blood of vascular dementia and alzheimer’s
disease.
Citation: Molecular Neurobiology, Jun 2015, (Jun 23, 2015), 0893-7648 (Jun 23, 2015)
Author(s): Luo, Hongbo, Han, Guangchun, Wang, Jiajia, Zeng, Fan, Li, Yuanming, Shao, Shaoju, Song,
Fuhai, Bai, Zhouxian, Peng, Xing, Wang, Yan-Jiang, Shi, Xiangqun, Lei, Hongxing
Abstract: Alzheimer’s disease (AD) and vascular dementia (VaD) are the two most dominant forms of
dementia in elderly people. Due to the large overlap between AD and VaD in clinical observations,
great controversies exist regarding the distinction and connection between these two types of senile
dementia. Here for the first time, we resort to the gene expression pattern of the peripheral blood
to compare AD and VaD objectively. In our previous work, we have demonstrated that the
dysregulation of gene expression in AD is unique among the examined diseases including
neurological diseases, cancer, and metabolic diseases. In this study, we found that the dysregulation
of gene expression in AD and VaD is quite similar to each other at both functional and gene levels.
Interestingly, the dysregulation started at the early stages of the diseases, namely mild cognitive
impairment (MCI) and vascular cognitive impairment (VCI). We have also shown that this signature is
distinctive from that of peripheral vascular diseases. Comparison with aging studies revealed that
the most profound change in AD and VaD, namely ribosome, is consistent with the accelerated aging
scenario. This study may have implications to the common mechanism between AD and VaD.
(PsycINFO Database Record (c) 2015 APA, all rights reserved)(journal abstract)
Title: Divergent brain functional network alterations in dementia with lewy bodies and alzheimer's
disease.
Citation: Neurobiology of Aging, Jun 2015, (Jun 2, 2015), 0197-4580 (Jun 2, 2015)
Author(s): Peraza, Luis R., Taylor, John-Paul, Kaiser, Marcus
Abstract: The clinical phenotype of dementia with Lewy bodies (DLB) is different from Alzheimer's
disease (AD), suggesting a divergence between these diseases in terms of brain network
organization. To fully understand this, we studied functional networks from resting-state functional
magnetic resonance imaging in cognitively matched DLB and AD patients. The DLB group
demonstrated a generalized lower synchronization compared with the AD and healthy controls, and
this was more severe for edges connecting distant brain regions. Global network measures were
significantly different between DLB and AD. For instance, AD showed lower small-worldness than
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healthy controls, while DLB showed higher small-worldness (AD < controls < DLB), and this was also
the case for global efficiency (DLB > controls > AD) and clustering coefficient (DLB < controls < AD).
Differences were also found for nodal measures at brain regions associated with each disease.
Finally, we found significant associations between network performance measures and global
cognitive impairment and severity of cognitive fluctuations in DLB. These results show network
divergences between DLB and AD which appear to reflect their neuropathological differences.
(PsycINFO Database Record (c) 2015 APA, all rights reserved)(journal abstract)
Title: Sequential distribution of pTDP-43 pathology in behavioral variant frontotemporal dementia
(bvFTD): Erratum.
Citation: Acta Neuropathologica, Jun 2015, vol. 129, no. 6, p. 929., 0001-6322 (Jun 2015)
Author(s): Brettschneider, Johannes, Del Tredici, Kelly, Irwin, David J., Grossman, Murray, Robinson,
John L., Toledo, Jon B., Lee, Edward B., Fang, Lubin, Van Deerlin, Vivianna M., Ludolph, Albert C., Lee,
Virginia M.-Y., Braak, Heiko, Trojanowski, John Q.
Abstract: Reports an error in "Sequential distribution of pTDP-43 pathology in behavioral variant
frontotemporal dementia (bvFTD)" by Johannes Brettschneider, Kelly Del Tredici, David J. Irwin,
Murray Grossman, John L. Robinson, Jon B. Toledo, Lubin Fang, Vivianna M. Van Deerlin, Albert C.
Ludolph, Virginia M.-Y. Lee, Heiko Braak and John Q. Trojanowski (Acta Neuropathologica,
2014[Mar], Vol 127[3], 423-439). In the original article, one of the authors was missing from the list
of authors. The updated list of authors is present in the erratum. (The following abstract of the
original article appeared in record 2014-01257-001). We examined regional distribution patterns of
phosphorylated 43-kDa TAR DNA-binding protein (pTDP-43) intraneuronal inclusions in
frontotemporal lobar degeneration (FTLD). Immunohistochemistry was performed on 70 μm
sections from FTLD-TDP autopsy cases (n = 39) presenting with behavioral variant frontotemporal
dementia. Two main types of cortical pTDP-43 pathology emerged, characterized by either
predominantly perikaryal pTDP-43 inclusions (cytoplasmic type, cFTLD) or long aggregates in
dendrites (neuritic type, nFTLD). Cortical involvement in nFTLD was extensive and frequently
reached occipital areas, whereas cases with cFTLD often involved bulbar somatomotor neurons and
the spinal cord. We observed four patterns indicative of potentially sequential dissemination of
pTDP-43: cases with the lowest burden of pathology (pattern I) were characterized by widespread
pTDP-43 lesions in the orbital gyri, gyrus rectus, and amygdala. With increasing burden of pathology
(pattern II) pTDP-43 lesions emerged in the middle frontal and anterior cingulate gyrus as well as in
anteromedial temporal lobe areas, the superior and medial temporal gyri, striatum, red nucleus,
thalamus, and precerebellar nuclei. More advanced cases showed a third pattern (III) with
involvement of the motor cortex, bulbar somatomotor neurons, and the spinal cord anterior horn,
whereas cases with the highest burden of pathology (pattern IV) were characterized by pTDP-43
lesions in the visual cortex. We interpret the four neuropathological patterns in bvFTD to be
consistent with the hypothesis that pTDP-43 pathology can spread sequentially and may propagate
along axonal pathways. (PsycINFO Database Record (c) 2015 APA, all rights reserved)
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Title: Parkinson’s disease dementia: A neural networks perspective.
Citation: Brain: A Journal of Neurology, Jun 2015, vol. 138, no. 6, p. 1454-1476
Author(s): Gratwicke, James, Jahanshahi, Marjan, Foltynie, Thomas
Abstract: In the long-term, with progression of the illness, Parkinson’s disease dementia affects up
to 90% of patients with Parkinson’s disease. With increasing life expectancy in western countries,
Parkinson’s disease dementia is set to become even more prevalent in the future. However, current
treatments only give modest symptomatic benefit at best. New treatments are slow in development
because unlike the pathological processes underlying the motor deficits of Parkinson’s disease, the
neural mechanisms underlying the dementing process and its associated cognitive deficits are still
poorly understood. Recent insights from neuroscience research have begun to unravel the
heterogeneous involvement of several distinct neural networks underlying the cognitive deficits in
Parkinson’s disease dementia, and their modulation by both dopaminergic and non-dopaminergic
transmitter systems in the brain. In this review we collate emerging evidence regarding these
distinct brain networks to give a novel perspective on the pathological mechanisms underlying
Parkinson’s disease dementia, and discuss how this may offer new therapeutic opportunities.
(PsycINFO Database Record (c) 2015 APA, all rights reserved)(journal abstract)
Title: Olfactory function and neuropsychological profile to differentiate dementia with lewy bodies
from alzheimer's disease in patients with mild cognitive impairment: A 5-year follow-up study.
Citation: Journal of the Neurological Sciences, Jun 2015, (Jun 10, 2015), 0022-510X (Jun 10, 2015)
Author(s): Yoon, Jung Han, Kim, Min, Moon, So Young, Yong, Seok Woo, Hong, Ji Man
Abstract: BACKGROUND: Mild cognitive impairment (MCI) is a well-known precursor of Alzheimer's
disease (AD) but often also precedes dementia with Lewy bodies (DLB). The early differentiation of
DLB from AD is important to delay disease progression. Olfactory dysfunction is a well-known early
sign of both AD and Lewy body disorders, including Parkinson's disease (PD) and DLB. Thus, the aim
of the present study was to determine whether olfactory and neuropsychological tests can aid in the
differentiation of DLB from AD at the MCI stage. METHODS: The present study included 122 MCI
patients who were monitored until they developed dementia or until their condition stabilized; the
follow-up period averaged 4.9years (range: 3.9–6.2years). Baseline olfactory function as measured
with the Cross-Cultural Smell Identification (CCSI) test and neuropsychological data were compared.
RESULTS: During the follow-up period, 32 subjects developed probable AD (MCI-AD), 18 had
probable DLB (MCI-DLB), 45 did not convert to dementia (MCI-stable), and eight developed a nonAD/DLB dementia. The mean CCSI score (95% confidence interval [CI]) in patients with MCI-DLB (4.6;
95% CI: 4.0–5.3) was significantly lower than that of MCI-AD patients (6.4; 95% CI: 6.0–6.7, p<0.001)
and MCI-stable patients (7.3; 95% CI: 6.9–7.8, p<0.001). The area under the curve of the receiver
operating characteristic to discriminate MCI-DLB from MCI-AD using CCSI scores was (0.84; 95% CI:
0.72–0.97). Frontal-executive function and visuospatial ability was worse in patients with MCI-DLB,
while verbal recognition memory impairment was greater in those with MCI-AD. CONCLUSION:
Olfactory and neuropsychological tests can help predict conversion to DLB or AD in patients with
MCI. (PsycINFO Database Record (c) 2015 APA, all rights reserved)(journal abstract)
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Title: Identifying phenomenological differences and recovery of cognitive and non-cognitive
symptomatology among delirium superimposed upon dementia patients (dsd) versus those
without dementia (dad) in an acute geriatric care setting.
Citation: International Psychogeriatrics, Jun 2015, (Jun 9, 2015), 1041-6102 (Jun 9, 2015)
Author(s): Chong, Edward, Tay, Laura, Chong, Mei Sian
Abstract: ABSTRACT Background: Phenomenological differences between delirium superimposed on
dementia (DsD) versus delirium in the absence of dementia (DaD) remain poorly understood. We
aimed to identify phenomenological differences in delirium symptoms (cognitive and non-cognitive)
and compare delirium recovery trajectories between DsD and DaD. Methods: We conducted a
prospective observational study on individuals admitted to the Geriatric Monitoring Unit (GMU), a
five-bed unit specializing in managing older adults with delirium, between December 2010 and
August 2012 (n = 234; mean age 84.1 ± 7.4). We collected data on demographics, comorbidities,
severity of illness, cognitive and functional scores, and number of precipitants. Cognitive status was
assessed using locally validated Chinese Mini-Mental State Examination (CMMSE) and delirium
severity assessed using Delirium Rating Scale-Revised-98 (DRS-R98). Delirium disease trajectory was
plotted over five days. Results: DsD patients had a longer duration of delirium with slower recovery
in terms of cognition and delirium severity scores compared with DaD patients (0.33 (0.0–1.00) vs.
1.0 (0.36–2.00) increase in CMMSE per day, p < 0.001, and 1.49 ± 1.62 vs. 2.63 ± 2.28 decrease in
DRS-R98 severity per day, p < 0.001). When cognitive and non-cognitive sub-scores of DRS-R98 were
examined separately, we observed steeper recovery in both sub-scores in DaD patients. These
findings remained significant after adjusting for significant baseline differences. Conclusions: Our
findings of slower cognitive symptom recovery in DsD patients suggest cognitive reserve play a role
in delirium syndrome development and recovery. This merits further studies to potentially aid in
appropriate discharge planning and to identify potential pharmacological and non-pharmacological
cognitive interventions for hospitalized older persons with delirium. (PsycINFO Database Record (c)
2015 APA, all rights reserved)(journal abstract)
Title: Lost in spatial translation—A novel tool to objectively assess spatial disorientation in
Alzheimer's disease and frontotemporal dementi
Citation: Cortex: A Journal Devoted to the Study of the Nervous System and Behavior, Jun 2015, vol.
67, p. 83-94, 0010-9452 (Jun 2015)
Author(s): Tu, Sicong, Wong, Stephanie, Hodges, John R., Irish, Muireann, Piguet, Olivier,
Hornberger, Michael
Abstract: Spatial disorientation is a prominent feature of early Alzheimer's disease (AD) attributed to
degeneration of medial temporal and parietal brain regions, including the retrosplenial cortex (RSC).
By contrast, frontotemporal dementia (FTD) syndromes show generally intact spatial orientation at
presentation. However, currently no clinical tasks are routinely administered to objectively assess
spatial orientation in these neurodegenerative conditions. In this study we investigated spatial
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orientation in 58 dementia patients and 23 healthy controls using a novel virtual supermarket task as
well as voxel-based morphometry (VBM). We compared performance on this task with visual and
verbal memory function, which has traditionally been used to discriminate between AD and FTD.
Participants viewed a series of videos from a first person perspective travelling through a virtual
supermarket and were required to maintain orientation to a starting location. Analyses revealed
significantly impaired spatial orientation in AD, compared to FTD patient groups. Spatial orientation
performance was found to discriminate AD and FTD patient groups to a very high degree at
presentation. More importantly, integrity of the RSC was identified as a key neural correlate of
orientation performance. These findings confirm the notion that i) it is feasible to assess spatial
orientation objectively via our novel Supermarket task; ii) impaired orientation is a prominent
feature that can be applied clinically to discriminate between AD and FTD and iii) the RSC emerges as
a critical biomarker to assess spatial orientation deficits in these neurodegenerative conditions.
(PsycINFO Database Record (c) 2015 APA, all rights reserved)(journal abstract)
Therapies
Title: Starting out - I learned that music is a great way to converse with dementia patients.
Citation: Nursing standard (Royal College of Nursing (Great Britain) : 1987), Jun 2015, vol. 29, no. 42,
p. 29. (June 17, 2015)
Author(s): Seikiera, Leanne
Abstract: In my second year of nurse training, I applied to become a dementia champion at the trust
where I was completing most of my clinical placements.
Title: Review: In patients with dementia who live in care homes, some nondrug interventions
reduce agitation.
Citation: Annals of internal medicine, Jun 2015, vol. 162, no. 12, p. JC3. (June 16, 2015)
Author(s): Lim, Lionel S
Title: Chores and sense of self: gendered understandings of voices of older married women with
dementia.
Citation: International journal of older people nursing, Jun 2015, vol. 10, no. 2, p. 127-135
Author(s): Hellström, Ingrid, Eriksson, Henrik, Sandberg, Jonas
Abstract: Marital relationships in dementia are forged between the person with dementia and the
care partner, and such relationships have an impact on the way in which dementia is understood
and experienced. The everyday work that underpins the relationship is usually divided between
spouses and based on traditional divisions of household chores. The aim was to describe how older
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women with dementia express the importance of their homes and their chores in everyday life.
Seven women with dementia, who were cohabiting with their husbands, were interviewed on up to
five occasions at home during a five-to-six-year period on the following themes: the home, their
dementia illness, everyday life, their relationships with their husbands and dignity and autonomy.
The qualitative analysis showed three different patterns in the women's narratives: keeping the core
of the self through the home, keeping the self through polarising division of labour and keeping the
self through (re-) negotiations of responsibilities. The feeling of one's home and home-related
chores is an essential way to express who you are. The women stated that household chores are the
centre of their lives despite their dementia disease and that the home, even though it shrinks, still
makes the women see themselves as an important person, namely the 'competent wife'. Nurses
need to be aware that 'doing gender' may be a means of preserving personhood as well as of
sustaining couplehood in dementia. © 2014 John Wiley & Sons Ltd.
Title: What carers and family said about music therapy on behaviours of older people with
dementia in residential aged care.
Citation: International journal of older people nursing, Jun 2015, vol. 10, no. 2, p. 146-157
Author(s): Tuckett, Anthony G, Hodgkinson, Brent, Rouillon, Lisa, Balil-Lozoya, Tania, Parker,
Deborah
Abstract: This study sought to evaluate the effectiveness of group music therapy (MT) intervention
on behaviours of older people with dementia. Reported here are qualitative data from five, semistructured focus groups; two comprising a total of seven family members and three comprising a
total of 23 staff members. A number of core themes emerged: temporality, effect and policy with a
number of subthemes. The MT effect is tempered by the temporality of (i) the older person's
dementia state, (ii) the session and (iii) the psychosomatic effect on the older person. Music therapy
is perceived to (i) evoke memories and facilitate reminiscence, (ii) act as a diversion (has an
instrumental value) and it is contentious to discount the (iii) dichotomy between music and therapist
in terms of the overall effect. Finally, policymakers need to know that MT is (i) highly prized and
more, not less, MT is recommended. Findings from this study illustrate that the timing of the MT
session has consequences for the workflow in the residential aged care facility; MT has a
psychosomatic effect and participants here evaluate this as temporal. Care providers and family
members acknowledge the instrumental value of MT and its helping with cognition and exercise.
They have mixed views about the effects of the music and the effect on the older person by the
therapist but most definitely want policymakers to ensure more, not less, planned and better funded
MT is part of ongoing care in the residential aged care context. Areas for future research and policy
are also highlighted. These views on group MT in residential aged care can initiate critical reflection
on current practices and systems. Research is needed exploring the timing and scheduling of MT
sessions at different times in the day for older person with dementia exhibiting negative behaviours.
© 2014 John Wiley & Sons Ltd.
78
Title: Replication and extension of a check-in procedure to increase activity engagement among
people with severe dementia.
Citation: Journal of applied behavior analysis, Jun 2015, vol. 48, no. 2, p. 460-465 (June 2015)
Author(s): Engstrom, Elin, Mudford, Oliver C, Brand, Denys
Abstract: Engelman, Altus, and Mathews (1999) evaluated a procedure to ensure that staff checked
in with elderly residents in a nursing home and offered activity choices. We report findings of a
replication, with some additional components, to increase appropriate activity engagement among 5
residents (aged 77 to 83 years) with severe dementia. Evaluated in a concurrent multiple baseline
design across participants that incorporated partial withdrawal phases, activity engagement
increased for 3 participants, with modest improvement for 1 other participant. The 4 responders all
engaged in a wider variety of activities during intervention. © Society for the Experimental Analysis
of Behavior.
Title: Working memory binding and episodic memory formation in aging, mild cognitive
impairment, and Alzheimer's dementia.
Citation: Journal of clinical and experimental neuropsychology, Jun 2015, vol. 37, no. 5, p. 538-548
(June 2015)
Author(s): van Geldorp, Bonnie, Heringa, Sophie M, van den Berg, Esther, Olde Rikkert, Marcel G M,
Biessels, Geert Jan, Kessels, Roy P C
Abstract: Recent studies indicate that in both normal and pathological aging working memory (WM)
performance deteriorates, especially when associations have to be maintained. However, most
studies typically do not assess the relationship between WM and episodic memory formation. In the
present study, we examined WM and episodic memory formation in normal aging and in patients
with early Alzheimer's disease (mild cognitive impairment, MCI; and Alzheimer's dementia, AD). In
the first study, 26 young adults (mean age 29.6 years) were compared to 18 middle-aged adults
(mean age 52.2 years) and 25 older adults (mean age 72.8 years). We used an associative delayedmatch-to-sample WM task, which requires participants to maintain two pairs of faces and houses
presented on a computer screen for short (3 s) or long (6 s) maintenance intervals. After the WM
task, an unexpected subsequent associative memory task was administered (two-alternative forced
choice). In the second study, 27 patients with AD and 19 patients with MCI were compared to 25
older controls, using the same paradigm as that in Experiment 1. Older adults performed worse than
both middle-aged and young adults. No effect of delay was observed in the healthy adults, and pairs
that were processed during long maintenance intervals were not better remembered in the
subsequent memory task. In the MCI and AD patients, longer maintenance intervals hampered the
task performance. Also, both patient groups performed significantly worse than controls on the
episodic memory task as well as the associative WM task. Aging and AD present with a decline in
WM binding, a finding that extends similar results in episodic memory. Longer delays in the WM task
did not affect episodic memory formation. We conclude that WM deficits are found when WM
capacity is exceeded, which may occur during associative processing
79
Title: 'There's a letter called ef' on Challenges and Repair in Interpreter-Mediated Tests of
Cognitive Functioning in Dementia Evaluations: A Case Study.
Citation: Journal of cross-cultural gerontology, Jun 2015, vol. 30, no. 2, p. 163-187 (June 2015)
Author(s): Plejert, Charlotta, Antelius, Eleonor, Yazdanpanah, Maziar, Nielsen, T Rune
Abstract: In the Scandinavian countries Sweden, Denmark, Norway, and Finland, the number of first
generation migrants reaching an old age, who will be in need of age-related health-care, is rapidly
increasing. This situation poses new demands on health-care facilities, such as memory clinics,
where patients with memory problems and other dementia symptoms are referred for examination
and evaluation. Very many elderly people with a foreign background require the assistance of an
interpreter in their encounter with health-care facilities. The use of, and work by an interpreter is
crucial in facilitating a smooth assessment. However, interpreters, clinicians, as well as patients and
their companions, may be faced with many challenges during the evaluation procedure. The aim of
this case-study is to highlight some of the challenges that occur in relation to a specific activity
within the dementia evaluation, namely the test of cognitive functioning. Special attention will be
paid to the phenomenon 'repair', i.e., participants' joint attempts to solve upcoming difficulties
during the course of interaction. Results show that sources of trouble may be related to the lack of
cultural, linguistic, and educational adaptation of the test to the patient, and to interpreter and
clinician practises. Findings will be discussed in terms of test-validity, clinician and interpreter
training, and the institutional goals and constraints of the dementia evaluation. The methodology
Conversation Analysis has been used to conduct a highly detailed analysis of participants' practices
and actions during the administration of the test.
Title: Cognitive impairment and its consequences in everyday life: experiences of people with mild
cognitive impairment or mild dementia and their relatives.
Citation: International psychogeriatrics / IPA, Jun 2015, vol. 27, no. 6, p. 949-958 (June 2015)
Author(s): Johansson, Maria M, Marcusson, Jan, Wressle, Ewa
Abstract: The aim of this study was to explore experiences of cognitive impairment, its
consequences in everyday life and need for support in people with mild cognitive impairment (MCI)
or mild dementia and their relatives. A qualitative approach with an explorative design with
interviews was chosen. The participants included five people with MCI and eight people with mild
dementia and their relatives. All participants were recruited at a geriatric memory clinic in Sweden.
The Grounded Theory method was used. The following categories emerged: noticing cognitive
changes; changed activity patterns; coping strategies; uncertainty about own ability and
environmental reactions; support in everyday life; support from the healthcare system;
consequences in everyday life for relatives; and support for relatives. The main findings were that
people with MCI and dementia experienced cognitive changes that could be burdensome and
changed activity patterns. Most of them, however, considered themselves capable of coping on their
own. The relatives noticed cognitive changes and activity disruptions to a greater extent and tried to
80
be supportive in everyday life. Degree of awareness varied and lack of awareness could lead to many
problems in everyday life. Perceived cognitive impairment and its consequences in everyday life
were individual and differed among people with MCI or dementia and their relatives. Thus,
healthcare professionals must listen to both people with cognitive impairment and their relatives for
optimal individual care planning. Support such as education groups and day care could be more
tailored towards the early stages of dementia.
Title: Development of an exercise intervention to improve cognition in people with mild to
moderate dementia: Dementia And Physical Activity (DAPA) Trial, registration ISRCTN32612072.
Citation: Physiotherapy, Jun 2015, vol. 101, no. 2, p. 126-134 (June 2015)
Author(s): Brown, Deborah, Spanjers, Katie, Atherton, Nicky, Lowe, Janet, Stonehewer, Louisa,
Bridle, Chris, Sheehan, Bart, Lamb, Sarah E
Abstract: More than 800000 people in the UK have dementia, and it is a government priority to
improve dementia care. Drug treatment options are relatively limited. The Dementia And Physical
Activity (DAPA) study is a randomised trial which targets cognition in people with dementia, using an
exercise programme. There is evidence to suggest that both aerobic and resistance exercise may be
useful in improving cognition. Hence the intervention comprises a supervised part of twice-weekly
exercise classes of one hour duration for 4 months, including aerobic exercise at moderate intensity
on static bicycles, and resistance (weight training) exercise using weight vests, weight belts and
dumbbells. Thereafter participants progress to unsupervised, independent exercise. Aids to
behaviour modification have been incorporated into the intervention. The DAPA intervention has
been designed to maximise likelihood of effectiveness and cost-effectiveness, and for delivery in the
UK National Health Service. Copyright © 2015 Chartered Society of Physiotherapy. Published by
Elsevier Ltd. All rights reserved.
Title: Cognitive-behavioural therapy for anxiety in dementia: pilot randomised controlled trial.
Citation: The British journal of psychiatry : the journal of mental science, Jun 2015, vol. 206, no. 6, p.
509-516
Author(s): Spector, Aimee, Charlesworth, Georgina, King, Michael, Lattimer, Miles, Sadek, Susan,
Marston, Louise, Rehill, Amritpal, Hoe, Juanita, Qazi, Afifa, Knapp, Martin, Orrell, Martin
Abstract: Background Anxiety is common and problematic in dementia, yet there is a lack of
effective treatments. Aims To develop a cognitive-behavioural therapy (CBT) manual for anxiety in
dementia and determine its feasibility through a randomised controlled trial. Method A ten-session
CBT manual was developed. Participants with dementia and anxiety (and their carers) were
randomly allocated to CBT plus treatment as usual (TAU) (n = 25) or TAU (n = 25). Outcome and cost
measures were administered at baseline, 15 weeks and 6 months. Results At 15 weeks, there was an
adjusted difference in anxiety (using the Rating Anxiety in Dementia scale) of (-3.10, 95% CI -6.55 to
0.34) for CBT compared with TAU, which just fell short of statistical significance. There were
significant improvements in depression at 15 weeks after adjustment (-5.37, 95% CI -9.50 to -1.25).
81
Improvements remained significant at 6 months. CBT was cost neutral. Conclusions CBT was feasible
(in terms of recruitment, acceptability and attrition) and effective. A fully powered RCT is now
required. © The Royal College of Psychiatrists 2015.
Title: Computer Activities for Persons With Dementia.
Citation: The Gerontologist, Jun 2015, vol. 55 Suppl 1, p. S40. (June 2015)
Author(s): Tak, Sunghee H, Zhang, Hongmei, Patel, Hetal, Hong, Song Hee
Abstract: The study examined participant's experience and individual characteristics during a 7-week
computer activity program for persons with dementia. The descriptive study with mixed methods
design collected 612 observational logs of computer sessions from 27 study participants, including
individual interviews before and after the program. Quantitative data analysis included descriptive
statistics, correlational coefficients, t-test, and chi-square. Content analysis was used to analyze
qualitative data. Each participant averaged 23 sessions and 591min for 7 weeks. Computer activities
included slide shows with music, games, internet use, and emailing. On average, they had a high
score of intensity in engagement per session. Women attended significantly more sessions than
men. Higher education level was associated with a higher number of different activities used per
session and more time spent on online games. Older participants felt more tired. Feeling tired was
significantly correlated with a higher number of weeks with only one session attendance per week.
More anticholinergic medications taken by participants were significantly associated with a higher
percentage of sessions with disengagement. The findings were significant at p < .05. Qualitative
content analysis indicated tailoring computer activities appropriate to individual's needs and
functioning is critical. All participants needed technical assistance. A framework for tailoring
computer activities may provide guidance on developing and maintaining treatment fidelity of
tailored computer activity interventions among persons with dementia. Practice guidelines and
education protocols may assist caregivers and service providers to integrate computer activities into
homes and aging services settings. © The Author 2015. Published by Oxford University Press on
behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail:
journals.permissions@oup.com.
Title: Therapeutic drug monitoring for patients with Alzheimer dementia to improve treatment
with donepezil.
Citation: Therapeutic drug monitoring, Jun 2015, vol. 37, no. 3, p. 353-361 (June 2015)
Author(s): Hefner, Gudrun, Brueckner, Anne, Hiemke, Christoph, Fellgiebel, Andreas
Abstract: Aiming to verify that therapeutic drug monitoring has the potential to optimize treatment
with acetylcholine esterase inhibitors of patients with Alzheimer dementia, this study investigated
whether serum concentrations of donepezil are associated with clinical improvement. Clinical
improvement was measured using the clinical global impression (CGI) scale, and donepezil
concentrations were measured in serum by a high-performance liquid chromatographic method
82
with spectrophotometric detection. In total, 206 serum samples from 106 patients (49.5% female)
were retrospectively available for analysis. Patients included were treated under everyday
conditions. Their mean ± SD age was 72 ± 9 years, daily doses of donepezil were 5 and 10 mg, and
their mean ± SD serum concentrations were 23 ± 9 and 47 ± 18 ng/mL, respectively. Serum
concentrations correlated significantly (P < 0.001) with CGI scores (Pearson's correlation coefficient r
= 0.511, P < 0.01). In patients who were "very much improved," according to their CGI score, the
mean serum concentration was 66 ± 20 ng/mL and thus significantly higher (P < 0.01) than in
patients with "minimal improvement" (29 ± 12 ng/mL). Receiver operating characteristics analysis
suggests that donepezil serum concentrations of at least 50 ng/mL may be recommended for
maximal clinical benefit. Because donepezil serum concentrations were highly variable between
individual patients and the majority of patients exhibited concentrations that were below 50 ng/mL
at therapeutic doses of 5 and 10 mg/d, it can be concluded that therapeutic drug monitoring may be
used to enhance the effectiveness of donepezil treatment.
Title: Cognitive–Behavioral Therapy (CBT) Versus Acceptance and Commitment Therapy (ACT) for
Dementia Family Caregivers With Significant Depressive Symptoms: Results of a Randomized
Clinical Trial.
Citation: Journal of Consulting and Clinical Psychology, Jun 2015,
Author(s): Losada, Andrés, Márquez-González, María, Romero-Moreno, Rosa, Mausbach, Brent T.,
López, Javier, Fernández-Fernández, Virginia, Nogales-González, Celia
Abstract: Objective: The differential efficacy of acceptance and commitment therapy (ACT) and
cognitive–behavioral therapy (CBT) for dementia family caregivers’ is analyzed through a
randomized controlled trial. Method: Participants were 135 caregivers with high depressive
symptomatology who were randomly allocated to the intervention conditions or a control group
(CG). Pre-, postintervention, and follow-up measurements assessed depressive symptomatology,
anxiety, leisure, dysfunctional thoughts, and experiential avoidance. Results: Depression: Significant
effects of interventions compared with CG were found for CBT (p < .001, d = 0.98, number needed to
treat [NNT] = 3.61) and ACT (p < .001, d = 1.17, NNT = 3.53) at postintervention, but were
maintained only at follow-up for CBT (p = .02, d = 0.74, NNT = 9.71). Clinically significant change was
observed in 26.7% participants in CBT, 24.2% in ACT, and 0% in CG. At follow-up, 10.53% in CBT and
4% in ACT were recovered (0% CG). Anxiety: At postintervention, ACT participants showed lower
anxiety than CBT participants (p < .05, d = 0.50) and CG participants (p < .01, d = 0.79, NNT = 3.86),
with no effects at follow-up. At postintervention, 23.33% in CBT, 36.36% in ACT, and 6.45% in CG
showed clinically significant change. At follow-up, 26.32% in CBT, 36% in ACT, and 13.64% in CG were
recovered. Significant changes at postintervention were found in leisure and dysfunctional thoughts
in both ACT and CBT, with changes in experiential avoidance only for ACT. Conclusion: Similar results
were obtained for ACT and CBT. ACT seems to be a viable and effective treatment for dementia
caregivers. (PsycINFO Database Record (c) 2015 APA, all rights reserved)(journal abstract)
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Title: Implementing living room theatre activities for people with dementia on nursing home
wards: A process evaluation sudy.
Citation: Aging & Mental Health, Jun 2015, vol. 19, no. 6, p. 536-547, 1360-7863 (Jun 2015)
Author(s): van Haeften-van Dijk, A. Marijke, van Weert, Julia C. M., Dröes, Rose-Marie
Abstract: Objectives: A new communication method, the ‘Veder Method’, was implemented in the
Netherlands. This method uses theatrical stimuli in combination with proven person-centred
communication methods. Care staff was trained to apply the Veder Method in a ‘living room theatre
activity’ for people with dementia. This study evaluates the implementation of the Veder Method on
psychogeriatric nursing home wards. Methods: Facilitators and barriers to train staff and implement
the Veder Method in psychogeriatric nursing homes were identified by conducting semi-structured
interviews with 12 stakeholders who were involved in the implementation, and five focus groups
with 35 trained care staff. The interviews and focus groups were transcribed verbatim, and two
independent researchers analysed the content of the transcripts. The Implementation Process
Evaluation (IPE) Framework was used to categorize the data and the 7s-model to contextualize the
qualitative findings. Results: A structured overview of facilitators and barriers in different stages of
the implementation process is presented. Positive reactions in residents and more reciprocity in
caregiver-resident contact motivated trained care staff to work with the Veder Method. An action
plan, executive support, the visibility of the method in the organization and a pioneer group that
initiated implementation were essential for successful implementation. High work pressure for the
care staff was a hindering factor. Conclusion: Respondents experienced the added value of the
Veder Method. The facilitators and barriers to implementation we identified in this study can help to
implement and disseminate the successful Veder Method and other person-centred communication
methods in psychogeriatric nursing homes effectively. (PsycINFO Database Record (c) 2015 APA, all
rights reserved)(journal abstract)
Other
Title: Suicidal ideation and related factors among dementia patients.
Citation: Journal of affective disorders, Jun 2015, vol. 178, p. 66-70 (June 1, 2015)
Author(s): Koyama, Asuka, Fujise, Noboru, Matsushita, Masateru, Ishikawa, Tomohisa, Hashimoto,
Mamoru, Ikeda, Manabu
Abstract: It is generally thought that people with dementia are not able to attempt suicide because
of impaired executive function. Little research is available about suicidal ideation among dementia
patients. The present study examines 1) the sociodemographic and clinical features of dementia
patients with suicidal ideation and 2) the effect of suicidal ideation on caregiver burden. A total of
634 dementia outpatients and their family caregivers participated in this study. Comparisons of
variables were made among three groups: patients with suicidal ideation, patients with depression
without suicidal ideation, and patients with neither suicidal ideation nor depression. Data were
collected between April 2007 and July 2013. Suicidal ideation was seen in 64 patients (10.1%).
Patients with suicidal ideation had a significantly higher rate of behavioural and psychological
84
symptoms of dementia (BPSD) (P<0.001). Caregivers of patients with suicidal ideation felt a higher
caregiver burden, even after adjusting for BPSD score (P<0.01). Suicidal ideation was assessed by
interview with caregivers, so we may have overlooked people who had suicidal ideation but did not
express it to their caregivers. Suicidal ideation among dementia patients should receive greater
attention. Adequate assessment of suicidal ideation and psychological support for both patients with
suicidal ideation and their caregivers are needed. Copyright © 2015 Elsevier B.V. All rights reserved.
Title: Driving safely with dementia.
Citation: Journal of neurology, neurosurgery, and psychiatry, Jun 2015, vol. 86, no. 6, p. 593-594
Author(s): Warlow, Charles
Title: The neural correlates of road sign knowledge and route learning in semantic dementia and
Alzheimer's disease.
Citation: Journal of neurology, neurosurgery, and psychiatry, Jun 2015, vol. 86, no. 6, p. 595-602
Author(s): Luzzi, S, Cafazzo, V, Damora, A, Fabi, K, Fringuelli, F M, Ascoli, G, Silvestrini, M, Provinciali,
L, Reverberi, C
Abstract: Although there is a growing body of research on driving and Alzheimer's disease (AD), focal
dementias have been understudied. Moreover, driving has never been explored in semantic
dementia (SD). An experimental battery exploring road sign knowledge and route learning was
applied to patients with SD and AD selected in the early-moderate stage of disease and to a group of
healthy participants. Neuropsychological data were correlated to cerebral hypometabolism
distribution, investigated by means of positron emission tomography. The two dementias showed
opposite profiles. Patients with SD showed poor road sign knowledge and normal performance in
route learning. By contrast, patients with AD showed low performance in route learning test with
preservation of semantic knowledge of road signs. In SD, there was a correlation of semantic
knowledge impairment with hypometabolism in the left temporolateral cortex. No correlation
between the AD region of interests (ROIs) and the relevant behavioural indices was found, while in
the whole-brain analysis there was a significant correlation between route learning and the superior
frontal gyrus. For the first time, driving skills were explored in SD, and it is showed a differential
profile from the one detected in AD. We demonstrate that the left anterior temporal cortex is
implicated in road sign knowledge, while a distributed cortical network, including the frontal cortex,
is likely to process route learning. Published by the BMJ Publishing Group Limited. For permission to
use (where not already granted under a licence) please go to http://group.bmj.com/group/rightslicensing/permissions.
Title: Dementia education in Higher Education Institutions.
Citation: Nurse education today, Jun 2015, vol. 35, no. 6, p. 731-732 (June 2015)
85
Author(s): Collier, Elizabeth, Knifton, Chris, Surr, Claire
Abstract: This article is a contemporary issues piece which discusses the challenges in providing
dementia education in Higher Education Institutions. Copyright © 2015 Elsevier Ltd. All rights
reserved.
Title: An investigation of nursing students' knowledge of dementia: A questionnaire study.
Citation: Nurse education today, Jun 2015, vol. 35, no. 6, p. 800-805 (June 2015)
Author(s): Eccleston, Claire E A, Lea, Emma J, McInerney, Fran, Crisp, Elaine, Marlow, Annette,
Robinson, Andrew L
Abstract: Globally, rising rates of dementia indicate the need for more nurses skilled in caring for
people with this condition. However nursing students may not acquire the requisite knowledge from
existing undergraduate curricula. To investigate the dementia knowledge of second-year nursing
students before and after a supported placement in a residential aged care facility. Assessment of
the level of knowledge of dementia is important to provide evidence of the need to enhance
dementia learning in the nursing curriculum. A pre-post control-intervention questionnaire study. 16
Tasmanian residential aged care facilities (RACFs). 99 Tasmanian second-year nursing undergraduate
students (52 intervention, 47 control). Second year nursing students were engaged in a three week
RACF clinical placement at one of the 14 control facilities or one of the 2 involved in the
development of teaching aged care facilities. Pre/post data were collected using the 21-item
'Dementia Knowledge Assessment Tool 2.0' and demographic survey questions, and analysed using
descriptive analyses and nonparametric significance tests. The data showed that these nursing
students had a poor knowledge of dementia, with limited understanding of key items relevant to
their clinical practice. Knowledge of dementia was significantly improved after students'
participation in supported clinical placements at an intervention residential aged care facility. This
knowledge improvement was significantly higher than that of students who attended clinical
placements at control facilities. A well-supported clinical placement at a residential aged care facility
can improve nursing students' knowledge of dementia, in particular in relation to aspects directly
relevant to their clinical practice. Copyright © 2015 Elsevier Ltd. All rights reserved.
Title: A review of contemporary work on the ethics of ambient assisted living technologies for
people with dementia.
Citation: Science and engineering ethics, Jun 2015, vol. 21, no. 3, p. 707-765 (June 2015)
Author(s): Novitzky, Peter, Smeaton, Alan F, Chen, Cynthia, Irving, Kate, Jacquemard, Tim,
O'Brolcháin, Fiachra, O'Mathúna, Dónal, Gordijn, Bert
Abstract: Ambient assisted living (AAL) technologies can provide assistance and support to persons
with dementia. They might allow them the possibility of living at home for longer whilst maintaining
their comfort and security as well as offering a way towards reducing the huge economic and
personal costs forecast as the incidence of dementia increases worldwide over coming decades.
86
However, the development, introduction and use of AAL technologies also trigger serious ethical
issues. This paper is a systematic literature review of the on-going scholarly debate about these
issues. More specifically, we look at the ethical issues involved in research and development, clinical
experimentation, and clinical application of AAL technologies for people with dementia and related
stakeholders. In the discussion we focus on: (1) the value of the goals of AAL technologies, (2) the
special vulnerability of persons with dementia in their private homes, (3) the complex question of
informed consent for the usage of AAL technologies.
Title: Folk and biological perceptions of dementia among Asian ethnic minorities in Hawaii.
Citation: The American journal of geriatric psychiatry : official journal of the American Association
for Geriatric Psychiatry, Jun 2015, vol. 23, no. 6, p. 589-595 (June 2015)
Author(s): Suzuki, Rika, Goebert, Deborah, Ahmed, Iqbal, Lu, Brett
Abstract: To study if Asian ethnic groups in Hawaii today maintain folk-based beliefs about
dementia, have inadequate biomedical understanding of dementia, and differ among each other
regarding perceptions of dementia. The study adapts and expands a 2004 survey of ethnic groups on
perceptions of Alzheimer disease demonstrating that ethnic minority groups hold more folk
perceptions and less biomedical perceptions of dementia than Caucasians. This study surveys
particular ethnic minority family members of elders admitted to four long-term care and inpatient
facilities in Hawaii. Seventy-one family members completed surveys, including 23 Chinese, 18
Filipino, and 30 Japanese participants. Elders may or may not have had the diagnosis of dementia,
though an estimated half of elders in all four facilities already held the diagnosis of dementia.
Findings indicated that Japanese and Chinese respondents in this study held perceptions about
dementia that were more consistent with current biomedical understanding compared with their
Filipino counterparts (mean differences/percent correct for Japanese: 57%, Chinese: 56% versus
Filipino: 38%; F = 6.39, df = 2,55, p = 0.003). Filipino respondents were less likely than Japanese and
Chinese respondents to report that persons with dementia can develop physical and mental
problems-97% of Japanese participants and 82% of Chinese participants responded correctly
compared with 63% of Filipino participants (Fisher's Exact test p = 0.009). With regard to folk beliefs
about dementia, variation occurred with no consistent trend among the groups. Low levels of
biomedical understanding of dementia were reflected by all three subgroups of Asians living in
Hawaii with less prominence of folk beliefs compared with prior studies of ethnic minority
perceptions. Education did not predict variability in dementia perceptions among the groups. Lower
levels of acculturation, suggested by primary home language other than English, may correlate with
a perception of dementia that is less consistent with current biomedical understanding of dementia.
Persisting folk beliefs about dementia and the evident lack of biomedical understanding, particularly
the belief that dementia is a normal part of aging, emphasizes the need for more culturally tailored
strategies in patient education about dementia and the importance of early intervention. Copyright
© 2015 American Association for Geriatric Psychiatry. All rights reserved.
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Title: Sleep Quality and Risk of Dementia Among Older Male Veterans.
Citation: The American journal of geriatric psychiatry : official journal of the American Association
for Geriatric Psychiatry, Jun 2015, vol. 23, no. 6, p. 651-654 (June 2015)
Author(s): Yaffe, Kristine, Nettiksimmons, Jasmine, Yesavage, Jerome, Byers, Amy
Abstract: To determine whether a diagnosis of sleep disturbance is associated with dementia in
older veterans. For this retrospective cohort study, we obtained medical record data from the
Department of Veterans Affairs National Patient Care Database for 200,000 randomly selected
veterans aged 55 years and older. Prevalent cases of dementia from the baseline period (2000-2003)
were excluded, leaving an analytic sample of 179,738 male veterans. Follow-up took place from
2004 to 2011. The primary outcome was all-cause dementia, ascertained using International
Classification of Disease, Ninth Revision codes. Sleep disturbance, the primary predictor, was also
ascertained using these codes. After adjusting for potential confounders, those with sleep
disturbance had a 27% increased risk of dementia (hazard ratio: 1.27; 95% confidence interval: 1.201.34). Sleep disturbance was associated with increased risk of dementia among a large cohort of
older, primarily male veterans. Copyright © 2015. Published by Elsevier Inc.
Title: Clinical features of delusional jealousy in elderly patients with dementia.
Citation: The Journal of clinical psychiatry, Jun 2015, vol. 76, no. 6, p. 691-695 (June 2015)
Author(s): Hashimoto, Mamoru, Sakamoto, Shinichi, Ikeda, Manabu
Abstract: Delusional jealousy is a psychotic syndrome characterized by a belief in the infidelity of
one's spouse that reaches delusional intensity. Although delusional jealousy has been described in
relation to organic psychosis, little is known concerning the actual role of delusional jealousy in
dementia. The aim of the present study was to investigate the clinical features of delusional jealousy
and possible mechanisms whereby delusional jealousy arises in patients with dementia. We studied
208 consecutive outpatients with dementia (diagnosis based on DSM-III-R criteria; mean [SD] age of
77.0 [8.0] years; study period: September 2011-August 2012). Delusional jealousy was defined as a
false belief derived from a pathological jealousy that makes the patient believe that his or her
spouse is unfaithful. The prevalence of delusional jealousy was compared between Alzheimer's
disease, dementia with Lewy bodies, and vascular dementia. Patients with and without delusional
jealousy were compared in terms of general characteristics. In addition, each patient with delusional
jealousy and their primary caregivers were interviewed about the clinical features of the syndrome.
Of the 208 patients with dementia, 18 (8.7%) showed delusional jealousy. The prevalence of
delusional jealousy in patients who had dementia with Lewy bodies (26.3%) was significantly higher
than that in patients with Alzheimer's disease (5.5%) (P < .01). There were no significant differences
between patients with and without delusional jealousy in regard to gender (P = 1.00), age (P = .81),
educational attainment (P = .29), presence of other persons living with the couple (P = .22), and
Mini-Mental State Examination score (P = .47). On the other hand, delusional jealousy was preceded
by the onset of serious physical diseases in nearly half of the patients. Delusional jealousy resolved
within 12 months after treatment in 15 of 18 patients (83%). Although delusional jealousy is a
considerable problem in dementia, the prognosis of delusional jealousy in demented patients
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appears to be relatively benign. In dementia, delusional jealousy may develop more easily in patients
who have dementia with Lewy bodies and those with coexisting serious physical disorders. ©
Copyright 2015 Physicians Postgraduate Press, Inc.
Title: BMI and dementia: feast or famine for the brain?
Citation: The lancet. Diabetes & endocrinology, Jun 2015, vol. 3, no. 6, p. 397-398 (June 2015)
Author(s): Gustafson, Deborah
Title: BMI and risk of dementia in two million people over two decades: a retrospective cohort
study.
Citation: The lancet. Diabetes & endocrinology, Jun 2015, vol. 3, no. 6, p. 431-436 (June 2015)
Author(s): Qizilbash, Nawab, Gregson, John, Johnson, Michelle E, Pearce, Neil, Douglas, Ian, Wing,
Kevin, Evans, Stephen J W, Pocock, Stuart J
Abstract: Dementia and obesity are increasingly important public health issues. Obesity in middle
age has been proposed to lead to dementia in old age. We investigated the association between BMI
and risk of dementia. For this retrospective cohort study, we used a cohort of 1 958 191 individuals
derived from the United Kingdom Clinical Practice Research Datalink (CPRD) which included people
aged 40 years or older in whom BMI was recorded between 1992 and 2007. Follow-up was until the
practice's final data collection date, patient death or transfer out of practice, or first record of
dementia (whichever occurred first). People with a previous record of dementia were excluded. We
used Poisson regression to calculate incidence rates of dementia for each BMI category. Our cohort
of 1 958 191 people from UK general practices had a median age at baseline of 55 years (IQR 45-66)
and a median follow-up of 9·1 years (IQR 6·3-12·6). Dementia occurred in 45 507 people, at a rate of
2·4 cases per 1000 person-years. Compared with people of a healthy weight, underweight people
(BMI <20 kg/m(2)) had a 34% higher (95% CI 29-38) risk of dementia. Furthermore, the incidence of
dementia continued to fall for every increasing BMI category, with very obese people (BMI >40
kg/m(2)) having a 29% lower (95% CI 22-36) dementia risk than people of a healthy weight. These
patterns persisted throughout two decades of follow-up, after adjustment for potential confounders
and allowance for the J-shape association of BMI with mortality. Being underweight in middle age
and old age carries an increased risk of dementia over two decades. Our results contradict the
hypothesis that obesity in middle age could increase the risk of dementia in old age. The reasons for
and public health consequences of these findings need further investigation. None. Copyright ©
2015 Elsevier Ltd. All rights reserved.
Title: Mobility and safety issues in drivers with dementia.
Citation: International Psychogeriatrics, Jun 2015, (Jun 26, 2015), 1041-6102 (Jun 26, 2015)
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Author(s): Carr, David B., O’Neill, Desmond
Abstract: Although automobiles remain the mobility method of choice for older adults, late-life
cognitive impairment and progressive dementia will eventually impair the ability to meet transport
needs of many. There is, however, no commonly utilized method of assessing dementia severity in
relation to driving, no consensus on the specific types of assessments that should be applied to older
drivers with cognitive impairment, and no gold standard for determining driving fitness or
approaching loss of mobility and subsequent counseling. Yet, clinicians are often called upon by
patients, their families, health professionals, and driver licensing authorities to assess their patients’
fitness-to-drive and to make recommendations about driving privileges. We summarize the
literature on dementia and driving, discuss evidenced-based assessments of fitness-to-drive, and
outline the important ethical and legal concerns. We address the role of physician assessment,
referral to neuropsychology, functional screens, dementia severity tools, driving evaluation clinics,
and driver licensing authority referrals that may assist clinicians with an evaluation. Finally, we
discuss mobility counseling (e.g. exploration of transportation alternatives) since health
professionals need to address this important issue for older adults who lose the ability to drive. The
application of a comprehensive, interdisciplinary approach to the older driver with cognitive
impairment will have the best opportunity to enhance our patients’ social connectedness and quality
of life, while meeting their psychological and medical needs and maintaining personal and public
safety. (PsycINFO Database Record (c) 2015 APA, all rights reserved)(journal abstract)
Title: A review of ethical issues in dementia.
Citation: International Psychogeriatrics, Jun 2015, (Jun 10, 2015), 1041-6102 (Jun 10, 2015)
Author(s): Johnson, Rebecca A., Karlawish, Jason
Abstract: ABSTRACT Dementia raises many ethical issues. The present review, taking note of the fact
that the stages of dementia raise distinct ethical issues, focuses on three issues associated with
stages of dementia's progression: (1) how the emergence of preclinical and asymptomatic but at-risk
categories for dementia creates complex questions about preventive measures, risk disclosure, and
protection from stigma and discrimination; (2) how despite efforts at dementia prevention,
important research continues to investigate ways to alleviate clinical dementia's symptoms, and
requires additional human subjects protections to ethically enroll persons with dementia; and (3)
how in spite of research and prevention efforts, persons continue to need to live with dementia. This
review highlights two major themes. First is how expanding the boundaries of dementias such as
Alzheimer's to include asymptomatic but at-risk persons generate new ethical questions. One
promising way to address these questions is to take an integrated approach to dementia ethics,
which can include incorporating ethics-related data collection into the design of a dementia research
study itself. Second is the interdisciplinary nature of ethical questions related to dementia, from
health policy questions about insurance coverage for long-term care to political questions about
voting, driving, and other civic rights and privileges to economic questions about balancing an
employer's right to a safe and productive workforce with an employee's rights to avoid
discrimination on the basis of their dementia risk. The review highlights these themes and emerging
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ethical issues in dementia. (PsycINFO Database Record (c) 2015 APA, all rights reserved)(journal
abstract)
Title: Napping in older people ‘at risk’ of dementia: Relationships with depression, cognition,
medical burden and sleep quality.
Citation: Journal of Sleep Research, Jun 2015, (Jun 21, 2015), 0962-1105 (Jun 21, 2015)
Author(s): Cross, Nathan, Terpening, Zoe, Rogers, Naomi L., Duffy, Shantel L., Hickie, Ian B., Lewis,
Simon J.G., Naismith, Sharon L.
Abstract: Summary Sleep disturbance is prevalent in older adults, particularly so in those at a greater
risk of dementia. However, so far the clinical, medical and neuropsychological correlates of daytime
sleep have not been examined. The aims of this study were to investigate the characteristics and
effects of napping using actigraphy in older people, particularly in those ‘at risk’ of dementia. The
study used actigraphy and sleep diaries to measure napping habits in 133 older adults ‘at risk’ of
dementia (mean age = 65.5 years, SD = 8.4 years), who also underwent comprehensive medical,
psychiatric and neuropsychological assessment. When defined by actigraphy, napping was present in
83.5% (111/133) of participants; however, duration and timing varied significantly among subjects.
Nappers had significantly greater medical burden and body mass index, and higher rates of mild
cognitive impairment. Longer and more frequent naps were associated with poorer cognitive
functioning, as well as higher levels of depressive symptoms, while the timing of naps was associated
with poorer nocturnal sleep quality (i.e. sleep latency and wake after sleep onset). This study
highlights that in older adults ‘at risk’ of dementia, napping is associated with underlying
neurobiological changes such as depression and cognition. Napping characteristics should be more
routinely monitored in older individuals to elucidate their relationship with psychological and
cognitive outcomes. (PsycINFO Database Record (c) 2015 APA, all rights reserved)(journal abstract)
Title: Optimizing eating performance for older adults with dementia living in long‐term care: A
systematic review.
Citation: Worldviews on Evidence-Based Nursing, Jun 2015, (Jun 29, 2015), 1545-102X (Jun 29, 2015)
Author(s): Liu, Wen, Galik, Elizabeth, Boltz, Marie, Nahm, Eun‐Shim, Resnick, Barbara
Abstract: ABSTRACT Background Review of research to date has been focusing on maintaining
weight and nutrition with little attention on optimizing eating performance. Objective To evaluate
the effectiveness of interventions on eating performance for older adults with dementia in long‐
term care (LTC). Methods A systematic review was performed. Five databases including Pubmed,
Medline (OVID), EBM Reviews (OVID), PsychINFO (OVID), and CINAHL (EBSCOHost) were searched
between January 1980 and June 2014. Keywords included dementia, Alzheimer, feed(ing), eat(ing),
mealtime(s), oral intake, autonomy, intervention. Intervention studies that optimize eating
performance and evaluate change of self‐feeding or eating performance among older adults (≥65
years) with dementia in LTC were eligible. Studies were screened by title and abstract, and full‐texts
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were reviewed for eligibility. Eligible studies were classified by intervention type. Study quality was
accessed using the Quality Assessment Tool for Quantitative Studies, and level of evidence using the
2011 Oxford Centre for Evidence‐Based Medicine (OCEBM) Levels of Evidence. Results Eleven
intervention studies (five randomized controlled trials; RCTs) were identified, and classified into four
types: Training program, mealtime assistance, environmental modification, and multicomponent
intervention. The quality of the 11 studies was generally moderate, with the main threats as weak
designs, lack of blinding and control for confounders, and inadequate psychometric evidence for
measures. Training programs targeting older adults (Montessori methods and spaced retrieval)
demonstrated good evidence in decreasing feeding difficulty. Mealtime assistance offered by
nursing staff (e.g., verbal prompts and cues, positive reinforcement, appropriate praise and
encouragement) also showed effectiveness in improving eating performance. Linking evidence to
action This review provided preliminary support for using training and mealtime assistance to
optimize eating performance for older adults with dementia in LTC. Future effectiveness studies may
focus on training nursing caregivers as interventionists, lengthening intervention duration, and
including residents with varying levels of cognitive impairment in diverse cultures. The effectiveness
of training combined with mealtime assistance may also be tested to achieve better resident
outcomes in eating performance. (PsycINFO Database Record (c) 2015 APA, all rights
reserved)(journal abstract)
Title: Towards diagnostic conversational profiles of patients presenting with dementia or
functional memory disorders to memory clinics.
Citation: Patient Education and Counseling, Jun 2015, (Jun 11, 2015), 0738-3991 (Jun 11, 2015)
Author(s): Elsey, Christopher, Drew, Paul, Jones, Danielle, Blackburn, Daniel, Wakefield, Sarah,
Harkness, Kirsty, Venneri, Annalena, Reuber, Marku
Abstract: OBJECTIVE: This study explores whether the profile of patients’ interactional behaviour in
memory clinic conversations with a doctor can contribute to the clinical differentiation between
functional memory disorders (FMD) and memory problems related to neurodegenerative diseases.
METHODS: Conversation Analysis of video recordings of neurologists’ interactions with patients
attending a specialist memory clinic. “Gold standard” diagnoses were made independently of CA
findings by a multi-disciplinary team based on clinical assessment, neuropsychological testing and
brain imaging. RESULTS: Two discrete conversational profiles for patients with memory complaints
emerged, including (i) who attends the clinic (i.e., whether or not patients are accompanied), and (ii)
patients’ responses to neurologists’ questions about memory problems, such as difficulties with
compound questions and providing specific and elaborated examples and frequent “I don’t know”
responses. CONCLUSION: Specific communicative difficulties are characteristic of the interaction
patterns of patients with a neurodegenerative pathology. Those difficulties are manifest in memory
clinic interactions with neurologists, thereby helping to differentiate patients with dementia from
those with FMD. PRACTICAL IMPLICATIONS: Our findings demonstrate that conversational profiles
based on patients’ contributions to memory clinic encounters have diagnostic potential to assist the
screening and referral process from primary care, and the diagnostic service in secondary care.
(PsycINFO Database Record (c) 2015 APA, all rights reserved)(journal abstract)
92
Title: A consensus guideline for antipsychotic drug use for dementia in care homes. Bridging the
gap between scientific evidence and clinical practice.
Citation: International Psychogeriatrics, Jun 2015, (Jun 10, 2015), 1041-6102 (Jun 10, 2015)
Author(s): Zuidema, Sytse U., Johansson, Alice, Selbaek, Geir, Murray, Matt, Burns, Alistair, Ballard,
Clive, Koopmans, Raymond T. C. M.
Abstract: ABSTRACT Background: To produce a practice guideline that includes a set of detailed
consensus principles regarding the prescription of antipsychotics (APs) amongst people with
dementia living in care homes. Methods: We used a modified Delphi consensus procedure with
three rounds, where we actively specified and optimized statements throughout the process,
utilizing input from four focus groups, carried out in UK, Norway, and the Netherlands. This was
done to identify relevant themes and a set of statement that experts agreed upon using the
Research and Development/University of California at Los Angeles (RAND/UCLA) methodology.
Results: A total of 72 scientific and clinical experts and 14 consumer experts reached consensus upon
150 statements covering five themes: (1) General prescription stipulations, (2) assessments prior to
prescription, (3) care and treatment plan, (4) discontinuation, and (5) long-term treatment.
Conclusions: In this practice guideline, novel information was provided about detailed indication and
thresholds of symptoms, risk factors, circumstances at which APs should be stopped or tapered,
specific criteria for justifying long-term treatment, involvement of the multidisciplinary team, and
family caregiver in the process of prescription. The practice guideline is based on formal consensus
of clinicians and consumer experts and provides clinicians relevant practical information that is
lacking in current guidelines. (PsycINFO Database Record (c) 2015 APA, all rights reserved)(journal
abstract)
Title: Achieving consensus and controversy around applicability of palliative care to dementia.
Citation: International Psychogeriatrics, Jun 2015, (Jun 10, 2015), 1041-6102 (Jun 10, 2015)
Author(s): van der Steen, Jenny T., Radbruch, Lukas, de Boer, Marike E., Jünger, Saskia, Hughes,
Julian C., Larkin, Phil, Gove, Dianne, Francke, Anneke L., Koopmans, Raymond T.C.M., Firth, Pam,
Volicer, Ladislav, Hertogh, Cees M.P.M.
Abstract: ABSTRACT Background: People with dementia may benefit from palliative care which
specifically addresses the needs of patients and families affected by this life-limiting disease. On
behalf of the European Association for Palliative Care (EAPC), we recently performed a Delphi study
to define domains for palliative care in dementia and to provide recommendations for optimal care.
An international panel of experts in palliative care, dementia care or both, achieved consensus on
almost all domains and recommendations, but the domain concerning the applicability of palliative
care to dementia required revision. Methods: To examine in detail, the opinions of the international
panel of 64 experts around the applicability of palliative care, we explored feedback they provided in
the Delphi process. To examine which experts found it less important or less applicable, ordinal
regression analyses related characteristics of the panelists to ratings of overall importance of the
93
applicability domain, and to agreement with the domain's four recommendations. Results: Some
experts expressed concerns about bringing up end-of-life issues prematurely and about relabeling
dementia care as palliative care. Multivariable analyses with the two outcomes of importance and
agreement with applicability indicated that younger or less experienced experts and those whose
expertise was predominantly in dementia care found palliative care in dementia less important and
less applicable. Conclusions: Benefits of palliative care in dementia are acknowledged by experts
worldwide, but there is some controversy around its early introduction. Further studies should
weigh concerns expressed around care receiving a “palliative” label versus the benefits of applying
palliative care early. (PsycINFO Database Record (c) 2015 APA, all rights reserved)(journal abstract)
Title: Religiosity and quality of life: A dyadic perspective of individuals with dementia and their
caregivers.
Citation: Aging & Mental Health, Jun 2015, vol. 19, no. 6, p. 500-506, 1360-7863 (Jun 2015)
Author(s): Nagpal, Neha, Heid, Allison R., Zarit, Steven H., Whitlatch, Carol J.
Abstract: Objectives: Dyadic coping theory purports the benefit of joint coping strategies within a
couple, or dyad, when one dyad member is faced with illness or stress. We examine the effect of
religiosity on well-being for individuals with dementia (IWDs). In particular, we look at the effect of
both dyad members’ religiosity on perceptions of IWDs’ quality of life (QoL). Neither of these issues
has been extensively explored. Method: One hundred eleven individuals with mild-to-moderate
dementia and their family caregivers were interviewed to evaluate IWDs’ everyday-care values and
preferences, including religious preferences. Using an actor–partner multi-level model to account for
the interdependent relationship of dyads, we examined how IWD and caregiver ratings of religiosity
(attendance, prayer, and subjective ratings of religiosity) influence perceptions of IWDs’ QoL.
Results: After accounting for care-related stress, one's own religiosity is not significantly related to
IWDs’ or caregivers’ perceptions of IWD QoL. However, when modeling both actor and partner
effects of religiosity on perceptions of IWDs’ QoL, caregivers’ religiosity is positively related to IWDs’
self-reports of QoL, and IWDs’ religiosity is negatively associated with caregivers’ perceptions of
IWDs’ QoL. Conclusion: These findings suggest that religiosity of both the caregiver and the IWD
affect perception of the IWD's QoL. It is important that caregivers understand IWDs’ values
concerning religion as it may serve as a coping mechanism for dealing with dementia. (PsycINFO
Database Record (c) 2015 APA, all rights reserved)(journal abstract)
Title: Preventing aggression and other secondary features of dementia in elderly persons: Three
case studies.
Citation: Bulletin of the Menninger Clinic, Jun 2015, vol. 79, no. 2, p. 95-115, 0025-9284 (Jun 2015)
Author(s): Fowler, Jane H., Dannecker, Kerry, Stanley, Melinda, Wilson, Nancy, Snow, A. Lynn, Kunik,
Mark E.
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Abstract: Dementia and Alzheimer’s disease are associated with behavioral symptoms that can be
costly and troublesome to caregivers. Behavioral strategies to prevent aggression in people with
dementia (PWDs) are necessary to decrease caregiver burden and relieve other behavioral
disturbances in PWDs, such as depression. On the basis of their previous study that identified pain as
a possible cause of aggression, the authors developed a behavioral in-home intervention designed to
teach caregiver(s) how to recognize signs of pain and distress in PWDs. The authors present a
description of the Preventing Aggression in Veterans with Dementia (PAVeD) intervention and
illustrate its use and results with three case studies. Results indicate that this intervention may help
prevent the development of aggression and pain in PWDs, reduce caregiver burden, and help
manage other behavioral symptoms associated with dementia. (PsycINFO Database Record (c) 2015
APA, all rights reserved)(journal abstract)
Title: Nutrition in dementia
Citation: Nursing Standard, Jun 2015, vol. 29, no. 42, p. 61., 0029-6570 (June 17, 2015)
Author(s): O'Reilly-Foley, Georgina
Abstract: A CPD article prompted Georgina O'Reilly-Foley to consider ways of improving mealtimes
for patients with dementia[Reflection on Continuing Professional Development, NS784 on managing
malnutrition in patients with dementia] [PUBLICATION] 1 reference
Title: Oral and enteral nutrition in dementia: an overview.
Citation: British journal of nursing (Mark Allen Publishing), Jun 2015, vol. 24, no. 12, p. 624-628,
Author(s): Brooke, Joanne, Ojo, Omorogieva
Abstract: The number of people currently living with dementia in the UK is estimated to be 850 000
and this is expected to rise to over 1 million by the year 2025. Dementia is a progressive terminal
disease and the rate of decline is unique to each person; however, cognitive deterioration can be
accelerated by undernutrition. This article discusses evidence-based approaches in the use of oral
and enteral nutrition interventions for people living with dementia and ways to support their
caregivers. The discussion of interventions to improve oral nutrition includes changes to the
environment, support with feeding difficulties, nutritional supplements and education and training
for caregivers.
Title: Promoting collaborative dementia care via online interprofessional education.
Citation: Australasian journal on ageing, Jun 2015, vol. 34, no. 2, p. 88-94 (June 2015)
Author(s): Cartwright, Jade, Franklin, Diane, Forman, Dawn, Freegard, Heather
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Abstract: This study aimed to develop, implement and evaluate an online interprofessional
education (IPE) dementia case study for health science students. The IPE initiative aimed to develop
collaborative interprofessional capabilities and client-centred mindsets that underpin high-quality
dementia care. A mixed methods research design was used to assess students' values, attitudes and
learning outcomes using an interprofessional socialization and valuing scale (ISVS) completed pre
and post the online case study and via thematic analysis of free text responses. Students' ISVS scores
improved significantly following online participation, and the qualitative results support a shift
towards interprofessional collaboration and client-centred care. This online IPE case study was
successful in developing the collaborative mindsets and interprofessional capabilities required by a
future workforce to meet the complex, client-centred needs of people living with dementia. © 2013
ACOTA
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Journal Tables of Contents
The most recent issues of the following journals:




Alzheimer’s and Dementia
Dementia: The International Journal of Social Research and Practice
Age and Ageing
Journal of the American Geriatrics Society
Click on the covers for the most recent tables of contents. If you would like any of the papers from
these journals in full text then get in touch: bennet.jones@uhbristol.nhs.uk
Alzheimer’s and Dementia
Vol.11, iss. 6, June 2015
Dementia: The International Journal of
Social Research and Practice
Vol. 14, iss. 3, May 2015
Age and Ageing
Vol.44, iss. 4, July 2015
Journal of the American Geriatrics
Society
Vol. 63, iss. 6, June 2015
97
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