Journal of Alzheimer's Disease - Volume 51, issue 3

Authors: Nakanishi, Miharu | Nakashima, Taeko | Shindo, Yumi | Niimura, Junko | Nishida, Atsushi

Article Type: Research Article

Abstract: Background: Dementia-related societies worldwide have called for palliative end-of-life care for those suffering dementia; meanwhile, the Japanese dementia plan was revised on January 2015 to introduce into its objectives the support for end-of-life care via increased social and health care collaboration. Objective: The study focus was the use of medical procedures in the last month of life among dementia patients in different care locations in Japan. Methods: This study was conducted using a retrospective study design. Data from the Survey of Institutions and Establishments for Long-Term Care, which is a nationally representative cross-sectional survey of the …public long-term care insurance services, were used. The 6,148 patients who received end-of-life care in their own home, nursing homes, or hospitals in September 2007, 2010, and 2013 were included for analysis. The primary disease of each patient was based on the ICD-10 code; a diagnosis of dementia included F00 (Alzheimer’s), F01 (vascular), F02 (other), and F03 (unspecified). Results: Of 6,148 patients, 886 (14.4%) had dementia as a primary disease; most received care in the last month of life in nursing homes (48.0%) or hospitals (44.8%) rather than in their own home (7.2%). Patients were less likely to undergo pain management when their primary disease was dementia (adjusted odds ratio, 0.44; 95% confidence interval, 0.21–0.91). Conclusion: Education and policy efforts are required to provide palliative end-of-life care to people with dementia at home. The national dementia plan should also explore possible approaches regarding pain management for dying people who have dementia. Show more

Keywords: Dementia, hospice care, nursing homes, pain management, palliative care

DOI: 10.3233/JAD-150898

Citation: Journal of Alzheimer's Disease, vol. 51, no. 3, pp. 747-755, 2016

Authors: Granger, Matthew W. | Franko, Bettina | Taylor, Matthew W. | Messier, Claude | George-Hyslop, Peter St. | Bennett, Steffany A.L.

Article Type: Research Article

Abstract: Cognitive decline is sexually dimorphic in Alzheimer’s disease (AD). Men show higher incidences of amnestic mild cognitive impairment yet women disproportionally phenoconvert to AD. It is hypothesized that men maintain greater cognitive reserve than women under comparable amyloid-β (Aβ) challenge. One behavioral aspect of cognitive reserve in mice is the capacity to cope with Aβ-associated stereotypies by switching to increasingly effective navigational search strategies in the Morris water maze. To explore inherent sex differences in this paradigm, however, we require an AβPP mouse model wherein behavioral flexibility is impaired earlier in females than males despite equivalent Aβ load. Here, we …show that when F1 C57Bl/6×C3H/HeJ TgCRND8 mice are placed on C57Bl/6 background, N5 Tg males and females exhibit equivalent Aβ pathologies at 2, 4, 6, and 8 months of age yet females display learning and memory deficits earlier than males. We further show that this N5 line does not carry the autosomal recessive pde6brd 1 mutation that impairs visual acuity and that the estrous cycle is not disrupted on this genetic background. At 5.5 months of age, Tg males, but not females, compensate for Aβ-associated stereotypic behaviors (i.e., hyperactive tight circling) by alternating navigational search strategies and adopting increasingly productive spatial search strategies. Females fail to overcome Aβ-associated stereotypies and do not efficiently switch from systematic to spatial learning strategies. Together, these data identify a novel AβPP mouse model that can be used for preclinical testing of interventions targeting sexual dimorphisms in behavioral indices of cognitive reserve. Show more

Keywords: Alzheimer’s disease, amyloid-β cognitive reserve, learning, memory, Morris water maze, search strategy, stereotypy, transgenic mouse, visual acuity

DOI: 10.3233/JAD-150587

Citation: Journal of Alzheimer's Disease, vol. 51, no. 3, pp. 757-773, 2016

Authors: Schubert, Samantha | Leyton, Cristian E. | Hodges, John R. | Piguet, Olivier

Article Type: Research Article

Abstract: Background: Alzheimer’s disease (AD) and behavioral-variant of frontotemporal dementia (bvFTD) can present with an overlapping neuropsychological profile, which often hinders their clinical differentiation. Objective: To compare changes over time in memory, general cognition tasks, and functional scales between bvFTD and AD. Methods: Consecutive cases diagnosed with probable bvFTD (n  = 22) and typical AD (n  = 31) with at least two clinical visits were selected. Of these, 13 (9 AD, 4 bvFTD) underwent Pittsburgh compound B PET scan, which supported the clinical diagnosis in all cases. Mixed-model regressions were used to estimate the differential rate of decline on …selected tasks between cohorts. Results: Analyses demonstrated that, despite equivalent baseline performance, bvFTD patients experienced a more rapid functional deterioration and a steeper decline in global cognition than AD patients. At baseline, both groups were impaired on executive function and memory tasks compared to controls, but these deficits were more marked in the bvFTD group. In addition, performance on these domains continued to decline more rapidly in this group. Conclusions: Neither the initial neuropsychological assessment nor projected performances can reliably distinguish the totality of bvFTD and AD individuals. Nevertheless, annual rates of progression on cognitive tasks provide valuable information and will potentially help establish the impact of future therapeutic treatments in these dementia syndromes. Show more

Keywords: Alzheimer’s disease, assessment of cognitive disorders/dementia, cohort study, executive function, frontotemporal dementia, memory

DOI: 10.3233/JAD-150802

Citation: Journal of Alzheimer's Disease, vol. 51, no. 3, pp. 775-782, 2016

Authors: Krishna, Kumar | Behnisch, Thomas | Sajikumar, Sreedharan

Article Type: Research Article

Abstract: Neurodegenerative diseases such as Alzheimer’s disease (AD) are associated with alterations in epigenetic factors leading to cognitive decline. Histone deacetylase 3 (HDAC3) is a known critical epigenetic negative regulator of learning and memory. In this study, attenuation of long-term potentiation by amyloid-β oligomer, and its reversal by specific HDAC3 inhibitor RGFP966, was performed in rat CA1 pyramidal neurons using whole cell voltage-clamp and field recording techniques. Our findings provide the first evidence that amyloid-β oligomer-induced synaptic plasticity impairment can be prevented by inhibition of HDAC3 enzyme both at the single neuron as well as in a population of neurons, thus …identifying HDAC3 as a potential target for ameliorating AD related plasticity impairments. Show more

Keywords: Amyloid-β oligomer, epigenetics, HDAC3, long-term potentiation, RGFP966, synaptic plasticity

DOI: 10.3233/JAD-150838

Citation: Journal of Alzheimer's Disease, vol. 51, no. 3, pp. 783-791, 2016

Authors: Andriuta, Daniela | Moullart, Véronique | Schraen, Susanna | Devendeville, Agnes | Meyer, Marc-Etienne | Godefroy, Olivier | for the Alzheimer’s Disease Neuroimaging

Article Type: Research Article

Abstract: The aim of this study was to examine the relationship between cerebrospinal fluid (CSF) levels of biomarkers for Alzheimer’s disease (AD) (Aβ1–42 , t-tau, and p-tau) and 18 Fluorodeoxyglucose positron emission tomography (FDG-PET) hypometabolism in subjects from the Alzheimer’s Disease Neuroimaging Initiative, and specifically to determine which index of neurodegeneration was most frequently affected. The secondary objective was to determine the most frequently hypometabolic region in patients with a CSF AD signature (abnormal Aβ1–42 and abnormal p-tau). We included the 372 subjects (85 normal subjects, 212 patients with mild cognitive impairment, and 75 patients with AD) with a CSF …biomarker dosage (Aβ1–42 , t-tau, and p-tau) and brain FDG-PET. The relationship between FDG-PET metabolism (in five regions of interest (ROI) known to be damaged in AD) and CSF t-tau and p-tau levels was studied as a function of CSF Aβ1–42 status. FDG-PET hypometabolism and CSF t-tau and p-tau levels were correlated only in patients with an abnormal CSF Aβ1–42 level (t-tau: R2  = 0.044, p  = 0.001; p-tau: R2  = 0.02, p  = 0.03). In the latter patients, CSF p-tau was the most frequently (p  = 0.0001) abnormal neurodegeneration marker (p-tau: 92.8%; FDG-PET: 56.5%; CSF t-tau: 59.1%). Within the five ROI of FDG PET, the angular gyrus metabolism (R2  = 0.149; p  = 0.0001) was selected as the most tightly associated with CSF AD signature. The relation between CSF markers of neurodegeneration (p-tau and t-tau) and brain hypometabolism (in FDG-PET) is conditioned by presence of amyloid abnormality. This finding supports the current physiopathological model of AD. P-tau is the most frequently impaired biomarker. Using FDG PET angular gyrus hypometabolism is the most sensitive to CSF-biomarker-defined AD. Show more

Keywords: Alzheimer’s disease, cerebrospinal fluid biomarkers, FDG-PET metabolism, neurodegeneration markers, tau

DOI: 10.3233/JAD-150829

Citation: Journal of Alzheimer's Disease, vol. 51, no. 3, pp. 793-800, 2016

Authors: Dingova, Dominika | Fazekas, Tomas | Okuliarova, Petra | Strbova, Jaroslava | Kucera, Matej | Hrabovska, Anna

Article Type: Research Article

Abstract: Alzheimer’s disease (AD) is a progressive and irreversible neurodegenerative disorder characterized by a central cholinergic deficit. Non-neuronal cholinergic changes are, however, described as well. Here we focused on possible changes in the activity of the plasma cholinesterases, acetylcholinesterase (AChE) and butyrylcholinesterase (BChE), in hospitalized AD patients. We analyzed plasma AChE and BChE activities with regards to age, gender, body mass index (BMI), cognitive functions, and ability to perform activities of daily living in AD patients in comparison to healthy subjects. We observed lower AChE activity and trend toward lower BChE activity in AD patients, which both correlated with low BMI. …AD patients unable to perform basic activities of daily living (feeding, bathing, dressing, and grooming) showed reduced plasma AChE activities, while worse spatial orientation was linked to lower BChE activities. Three out of four AD patients with the lowest BChE activities died within one year. In conclusion, progressed AD was accompanied by lower plasma AChE activity and trend toward lower BChE activity, which correlated with BMI and deficits in different components of the AD. Show more

Keywords: Activities of daily living, Alzheimer’s disease, body mass index, cholinesterases, cognition, spatial orientation

DOI: 10.3233/JAD-151060

Citation: Journal of Alzheimer's Disease, vol. 51, no. 3, pp. 801-813, 2016

Authors: Godefroy, Olivier | Bakchine, Serge | Verny, Marc | Delabrousse-Mayoux, Jean-Philippe | Roussel, Martine | Pere, Jean-Jacques | REFLEX study group:

Collaborators: Larrieu, JL | Kubler, C | Filippi, M | Gaida, P | Abdulnayef, A | Nachar, H | Benoit, C | Galletti, P | Stehlin, P | Malkoun, I | Chanel Soulier, MP | Augustin, J | Rigal, B | Boge, T | Balasoiu, R | Lubeau, M | Haddad, V | Fromager, G | Kerouanton, A | Cufi, MN | Dussaux, P | Doury, E | Zai, L | Saad, S | Delamarre Damier, F | Michel, J | Dami, M | Mousnier Lompre, A | Le Fevre, G | Rahioui Sidki, L | Benhabib Benelhadj, H | Liagre, A | Kinugawa Bourron, K | Berrani, D | Gire Couret, P | Anguenot, A | Trefouret, S | Gaida Rostane, T | Jammes, JF | Desclaux, F | Abied, R | Chatot-Henry, C | Senechal, O | Pujol, JF | Huvent Grelle, D | David, JP | Chekroud, H | Gallice, I | Rochefort, N | Denis, B | Paquot Chaudron, C | Angibaud, G | Maillet Vioud, M | Cervantes, C | Ollier, J | David, R | Mechkour, A | Ghiba, B | Castelnovo, G | Le Bras, F | Delfiner, B | Defontaines, B | Volpe Gillot, L | Bailbe, M | Richard Harston, S | Durantay, F | Diraison, P | Vaillant, S | Gugenheim, M | Hinault, P | Hadjout, K | Bautrant, T | Hemet Francois, C | Schmidt, N | Beaudout Agbo, C | Seiller, N | Edouard, T | Sophoclis, C | Badr, A | Saudreau Furgier, C | Del Mazo, F | Pin, JC | Moreau Perrein, F | Deyrolle, AM | Baudin, V | Crauser, C | Gallopin, V | Pariente, J | Gallouj, K | Awad, R | Renard, P | Schott Geisert, C | Hascar, T | Burlaud Laumond, A | Guichardon, M

Article Type: Research Article

Abstract: Background: Executive dysfunctions in Alzheimer’s disease (AD) have been assessed using variable batteries and/or in selected populations. Objective: The primary objective of this observational study was to determine the prevalence and severity of executive dysfunction in AD patients using a previously validated battery. The secondary objective was to determine the characteristics including treatment outcomes of AD patients with severe executive dysfunction. Methods: The study included AD patients with mild-to-moderate dementia aged 60 or over, consulting in various clinical settings including memory clinics and requiring the introduction of an antidementia drug. Executive dysfunction was examined using a …validated, shortened executive battery. Results: 381 patients were included. Executive dysfunctions were observed in 88.2% of the patients (95% CI: 84.9–91.4) and were severe (defined as ≥2/3 impaired scores) in 80.4% (95% CI: 76.9–84.8). Global hypoactivity with apathy was more frequent (p  = 0.0001) than impairment in executive function tests. The 308 patients with severe executive dysfunction were older (p  = 0.003) and had more severe dementia (p  = 0.0001). Similarly, in the subset of 257 patients with mild dementia, individuals with severe executive dysfunction were older (p  = 0.003) and had more severe dementia. Global hypoactivity was independently associated with difficulties in IADL and a higher caregiver burden (p  = 0.0001 for both). The severity of executive dysfunction did not significantly influence the patients’ outcomes at 6 months. Conclusions: Executive dysfunction is a very common disorder in a representative population of patients with mild-to-moderate AD. It was independently correlated with impaired autonomy and increased caregiver burden but did not significantly influence treatment outcomes. Show more

Keywords: Alzheimer’s disease, apathy, cognitive disorders, control function, executive function, treatment

DOI: 10.3233/JAD-150971

Citation: Journal of Alzheimer's Disease, vol. 51, no. 3, pp. 815-825, 2016

Authors: Sánchez-Valle, Raquel | Monté, Gemma C. | Sala-Llonch, Roser | Bosch, Beatriz | Fortea, Juan | Lladó, Albert | Antonell, Anna | Balasa, Mircea | Bargalló, Nuria | Molinuevo, José Luis

Article Type: Research Article

Abstract: PSEN1 mutations are the most frequent cause of autosomal dominant Alzheimer’s disease (ADAD), and show nearly full penetrance. There is presently increasing interest in the study of biomarkers that track disease progression in order to test therapeutic interventions in ADAD. We used white mater (WM) volumetric characteristics and diffusion tensor imaging (DTI) metrics to investigate correlations with the normalized time to expected symptoms onset (relative age ratio ) and group differences in a cohort of 36 subjects from PSEN1 ADAD families: 22 mutation carriers, 10 symptomatic (SMC) and 12 asymptomatic (AMC), and 14 non-carriers (NC). Subjects underwent a …3T MRI. WM morphometric data and DTI metrics were analyzed. We found that PSEN1 MC showed significant negative correlation between fractional anisotropy (FA) and the relative age ratio in the genus and body of corpus callosum and corona radiate (p  <  0.05 Family-wise error correction (FWE) at cluster level) and positive correlation with mean diffusivity (MD), axial diffusivity (AxD), and radial diffusivity (RD) in the splenium of corpus callosum. SMC presented WM volume loss, reduced FA and increased MD, AxD, and RD in the anterior and posterior corona radiate, corpus callosum (p  <  0.05 FWE) compared with NC. No significant differences were observed between AMC and NC in WM volume or DTI measures. These findings suggest that the integrity of the WM deteriorates linearly in PSEN1 ADAD from the early phases of the disease; thus DTI metrics might be useful to monitor the disease progression. However, the lack of significant alterations at the preclinical stages suggests that these indexes might not be good candidates for early markers of the disease. Show more

Keywords: Alzheimer’s disease, diffusion tensor imaging, magnetic resonance imaging, presenilin 1, white matter

DOI: 10.3233/JAD-150899

Citation: Journal of Alzheimer's Disease, vol. 51, no. 3, pp. 827-835, 2016

Authors: Chau, Sarah A. | Chung, Jonathan | Herrmann, Nathan | Eizenman, Moshe | Lanctôt, Krista L.

Article Type: Research Article

Abstract: Background: Apathy, one of the most prevalent neuropsychiatric symptoms in Alzheimer’s disease (AD), can be difficult to assess as cognition deteriorates. There is a need for more objective assessments that do not rely on patient insight, communicative capacities, or caregiver observation. Objective: We measured visual scanning behavior, using an eye-tracker, to explore attentional bias in the presence of competing stimuli to assess apathy in AD patients. Methods: Mild-to-moderate AD patients (Standardized Mini-Mental Status Examination, sMMSE >10) were assessed for apathy (Neuropsychiatric Inventory [NPI] apathy, Apathy Evaluation Scale [AES]). Participants were presented with 16 slides, each containing …4 images of different emotional themes (2 neutral, 1 social, 1 dysphoric). The duration of time spent, and fixation frequency on images were measured. Results: Of the 36 AD patients (14 females, age = 78.2±7.8, sMMSE = 22.4±3.5) included, 17 had significant apathy (based on NPI apathy ≥4) and 19 did not. These groups had comparable age and sMMSE. Repeated-measures analysis of covariance models, controlling for total NPI, showed group (apathetic versus non-apathetic) by image (social versus dysphoric) interactions for duration (F1,32  = 4.31, p  = 0.046) and fixation frequency (F1,32  = 11.34, p  = 0.002). Apathetic patients demonstrated reduced duration and fixation frequency on social images compared with non-apathetic patients. Additionally, linear regression models suggest that more severe apathy predicted decreasing fixation frequency on social images (R2  = 0.26, Adjusted R2  = 0.19, F3,32  = 3.65, p  = 0.023). Conclusion: These results suggest that diminished attentional bias toward social-themed stimuli is a marker of apathy in AD. Measurements of visual scanning behavior may have the potential to predict and monitor treatment response in apathy. Show more

Keywords: Alzheimer’s disease, apathy, attention, cognition, eye movements

DOI: 10.3233/JAD-151026

Citation: Journal of Alzheimer's Disease, vol. 51, no. 3, pp. 837-846, 2016

Authors: Eichler, Tilly | Thyrian, Jochen René | Hertel, Johannes | Richter, Steffen | Wucherer, Diana | Michalowsky, Bernhard | Teipel, Stefan | Kilimann, Ingo | Dreier, Adina | Hoffmann, Wolfgang

Article Type: Research Article

Abstract: Background: To provide an optimal care for persons with dementia (PWD), their individual unmet needs have to be identified and comprehensively addressed. Objectives: Present analyses aim to describe the number and types of unmet needs of German primary care patients screened positive for dementia and factors associated with the number of unmet needs. Methods: DelpHi-MV (Dementia: life- and person-centered help in Mecklenburg-Western Pomerania) is a general practitioner-based, cluster-randomized controlled intervention trial. Analyses are based on the baseline data of 227 PWD (≥70 years, living at home) of the intervention group who had screened positive for dementia …(DemTect<9) and received a standardized computer-assisted needs assessment. Results: PWD had on average 8.77±5.04 unmet needs (Range = 0–31). More than 90% of the PWD had three or more unmet needs. Unmet needs were identified across all predefined 26 subcategories. The majority of unmet needs occurred in the domains “nursing treatment and care” (38%), “social counseling and legal support” (20%), and “pharmacological treatment and care” (15%). More impairment in the activities of daily living was the only factor that was significantly associated with a higher number of unmet needs, independent of age, gender, living situation, presence of an informal caregiver, cognitive impairment, and depression. Conclusions: Present results demonstrate that community-dwelling PWD had a broad range of varying unmet needs. These findings emphasize the importance of a comprehensive needs assessment that allows the identification of individual needs as the basis for a tailored intervention— such as Dementia Care Management— that can address these needs. Show more

Keywords: Dementia, needs assessment, primary health care, randomized controlled trial

DOI: 10.3233/JAD-150935

Citation: Journal of Alzheimer's Disease, vol. 51, no. 3, pp. 847-855, 2016