Journal of Alzheimer's Disease - Volume 61, issue 4

Authors: Feng, Xueyan | Zhou, Aihong | Liu, Zhixin | Li, Fangyu | Wei, Cuibai | Zhang, Guili | Jia, Jianping

Article Type: Research Article

Abstract: Background: Delayed Matching-to-Sample Task 48 (DMS48), a brief tool measuring visual recognition memory, is valid to identify the early stage of Alzheimer’s disease (AD) in Caucasians. However, little data is available in Chinese. Objective: To develop norms and optimal cutoff points for the DMS48 in Chinese elders. Methods: A cross-sectional study was conducted in seven memory clinics from five cities across China. DMS48 was applied to 369 Chinese aged 50 or older (138 cognitively normal [CN], 112 mild cognitive impairment due to AD (MCI-A), and 119 mild AD dementia). The demographic factors which influence DMS48 scores …were investigated and the norms were established considering those factors. Receiver operating characteristic (ROC) analysis was used to determine the optimal cutoff points. Results: Age was shown to influence DMS48 scores (r  = –0.36, p  < 0.05), and we presented the age-stratified normative data for the DMS48. The optimal cutoff point is 42/43 for identifying cognitive impairment (MCI-A and AD dementia) against CN (sensitivity 97.80% and specificity 89.13%) and MCI-A against CN (sensitivity 86.60% and specificity 94.20%). A cutoff of 39/40 obtained good sensitivity (100.00%) and specificity (94.90%) in discriminating AD dementia from CN. The age-stratified optimal cutoff points for identifying MCI-A were 43/44 for individuals aged 50 to 59 years old, 42/43 for 60 to 69 years old, 41/42 for 70 to 79 years old, and 40/41 for 80 or older, respectively (sensitivity 84.80% and specificity 95.70%). Conclusion: This study proved that DMS48 is of good validation in screening MCI-A in elderly Chinese. Show more

Keywords: Alzheimer’s disease, Delayed Matching-to-Sample Task 48, dementia, mild cognitive impairment, visual memory

DOI: 10.3233/JAD-170530

Citation: Journal of Alzheimer's Disease, vol. 61, no. 4, pp. 1611-1618, 2018

Authors: Ishikawa, Masatsune | Yamada, Shigeki | Yamamoto, Kazuo

Article Type: Research Article

Abstract: Background: Dilated perivascular spaces in the centrum semiovale (CSO-PVS) are closely related to small vessel disease. However, recent studies have revealed that cerebral amyloid angiopathy can cause dilation of the CSO-PVS and obstruction of interstitial fluid flow along the intramural periarterial drainage. Objective: To examine the severity and age-related prevalence of CSO-PVS through magnetic resonance imaging (MRI) and investigate their clinically relevant factors. Methods: This study included 1,060 subjects who participated in our brain program. The subjects ranged from 23 to 83 years in age and were active in society. The frequencies of the MRI abnormalities …of small vessel diseases, including CSO-PVS, were examined. The CSO-PVS severity was classified into three grades: G0, G1, G2, according to the visual rating. The subjects were divided into five age groups and their age-related frequencies were also studied. Using the clinico-laboratory data of 712 subjects, the clinically relevant factors of CSO-PVS were investigated using logistic regression analysis. Results: The frequencies of all G0 (“normal”) MRI abnormalities significantly decreased with age. A high prevalence of G2 CSO-PVS was observed (24%) in the youngest group aged≤39 years, whereas other MRI abnormalities in this group were not or rarely observed. In multivariable logistic regression analyses, G2 CSO-PVS was found to be closely associated with age, hypertension, and the estimated glomerular filtration ratio. Conclusions: This study reveals that CSO-PVS begin to develop in subjects aged less than 39 years. Age-related changes are involved. Further studies are necessary to elucidate the pathophysiological role of the CSO-PVS. Show more

Keywords: Aging, cerebral amyloid angiopathy, dementia, interstitial fluid, magnetic resonance imaging, small vessel disease, white matter

DOI: 10.3233/JAD-170755

Citation: Journal of Alzheimer's Disease, vol. 61, no. 4, pp. 1619-1626, 2018

Authors: François, Mathilde | Sicsic, Jonathan | Pelletier Fleury, Nathalie

Article Type: Research Article

Abstract: Background: The impact of adverse effects of drugs for dementia on the risk of hospitalization has not been much studied despite the impact of hospitalizations on cognitive decline. Objective: To determine if the main adverse effects of cholinesterase inhibitors and memantine may be associated with excess of hospitalization and to quantify the subsequent impact on healthcare expenditures. Methods: A representative sample of the French national health insurance beneficiaries aged 65 and older and suffering from dementia were included and followed from 2007 to 2014. Binary logit models for longitudinal data (GEE estimation technique) were used to …estimate the excess of hospitalization events related to the adverse effects of anti-dementia drugs and then to derive the additional costs of hospitalizations for the public health insurance fund. Results: In total, 7,668 patients were followed, generating 111,133 individual observations over the 8-year period. Treated patients were hospitalized significantly more than non-treated patients (adjusted Odd Ratio (OR) = 1.08, 95% confidence interval (95% CI) = [1.02 to 1.13], p  = 0.004), mainly with cholinesterase inhibitors for cardiac (OR = 1.21, 95% CI = [1.01 to 1.46], p  = 0.034) and gastrointestinal events (OR = 1.43, 95% CI = [1.01–2.05], p  = 0.045), especially with rivastigmine. When extrapolated to the entire population, this corresponded to an annual additional cost of € 55,000. Conclusion: Prescription of antidementia drugs, more specifically rivastigmine, increases the risk of hospitalizations via their cardiac and gastrointestinal adverse effects and lead to additional health care expenditures. Even though these results must be confirmed, they may encourage cautious consideration of the balance between benefits and harms before a prescription is given. Show more

Keywords: Adverse effects, cholinesterase inhibitors, dementia, hospitalization, medical overuse, memantine

DOI: 10.3233/JAD-170371

Citation: Journal of Alzheimer's Disease, vol. 61, no. 4, pp. 1627-1637, 2018

Authors: Redston, Mitchell R. | Hilmer, Sarah N. | McLachlan, Andrew J. | Clough, Alexander J. | Gnjidic, Danijela

Article Type: Research Article

Abstract: Background: Older people with cognitive impairment, including dementia and delirium, are high users of acute care services internationally. Potentially inappropriate medication (PIM) use may be associated with adverse outcomes, including hospital re-admission, functional disability, and mortality. Objective: This systematic review aimed to quantify and compare the prevalence of PIMs in older inpatients with and without cognitive impairment. Methods: A systematic search of observational studies was performed independently assessed by two reviewers in Embase, Medline, PsycINFO, International Pharmaceutical Abstracts, Scopus, and Informit. Articles published in English during the period January 2007–June 2017 that reported PIM prevalence in …hospital inpatients ≥ 65 years were included. PIMs were defined as the presence of polypharmacy (multiple medication use) and using implicit or explicit tools, such as the Beers criteria, and ‘Screening Tool of Older Person ’s Prescriptions ’ (STOPP). Results: 47 articles were included. In studies measuring polypharmacy (n  = 15), the prevalence of PIMs ranged from 53.2% to 89.8% and 30.4% to 97.1% for inpatients with and without cognitive impairment, respectively, and 24.0% to 80.0% when cognitive status was unreported. In studies employing explicit and implicit tools (n  = 35), the prevalence of PIMs when cognitive impairment was reported ranged from 20.6% to 80.5% using the Beers criteria, and 39.3% to 88.5% using STOPP. When cognitive status was unreported, the prevalence of PIMs ranged from 7.0% to 79.2% using the Beers criteria, and 20.0% to 63.4% using STOPP. Conclusion: Our findings suggest a high prevalence of PIMs in older inpatients with and without cognitive impairment. Future studies should investigate the impact of PIM use on patient-centered outcomes, such as functional status and quality of life, to inform enhanced acute care services. Show more

Keywords: Cognitive impairment, dementia, hospitalization, older people, polypharmacy, potentially inappropriate medications (PIMs), prevalence

DOI: 10.3233/JAD-170842

Citation: Journal of Alzheimer's Disease, vol. 61, no. 4, pp. 1639-1652, 2018

Authors: Suzuki, Ayuko | Shinozaki, Jun | Yazawa, Shogo | Ueki, Yoshino | Matsukawa, Noriyuki | Shimohama, Shun | Nagamine, Takashi

Article Type: Research Article

Abstract: Background: The mental rotation task is well-known for the assessment of visuospatial function; however, it has not been used for screening of dementia patients. Objective: The aim of this study was to create a simple screening test for patients with mild cognitive impairment (MCI) and Alzheimer’s disease (AD) by focusing on non-amnestic symptoms. Methods: Age-matched healthy controls (age 75.3±6.8), patients with MCI (76.5±5.5), and AD (78.2±5.0) participated in this study. They carried out mental rotation tasks targeting geometric graphics or alphabetical characters with three rotating angles (0°, 90°, and 180°) and indicated the correct answer. Response …accuracy and reaction time were recorded along with their eye movements using an eye tracker. To quantify their visual processing strategy, the run count ratio (RC ratio) was calculated by dividing the mean number of fixations in incorrect answers by that in correct answers. Results: AD patients showed lower accuracy and longer reaction time than controls. They also showed a significantly greater number of fixation and smaller saccade amplitude than controls, while fixation duration did not differ significantly. The RC ratio was higher for AD, followed by MCI and control groups. By setting the cut-off value to 0.47 in the 180° rotating angle task, we could differentiate MCI patients from controls with a probability of 80.0%. Conclusions: We established a new screening system for dementia patients by evaluating visuospatial function. The RC ratio during a mental rotation task is useful for discriminating MCI patients from controls. Show more

Keywords: Alzheimer’s disease, cognition, early diagnosis, eye movement, mild cognitive impairment

DOI: 10.3233/JAD-170801

Citation: Journal of Alzheimer's Disease, vol. 61, no. 4, pp. 1653-1665, 2018