Journal of Alzheimer's Disease - Volume 40, issue 3

Authors: Miners, James Scott | Jones, Ruth | Love, Seth

Article Type: Research Article

Abstract: Amyloid-β peptide (Aβ), the cerebral accumulation of which is thought to cause Alzheimer's disease (AD), is produced throughout life. The level of insoluble Aβ rises with age and is further increased in AD. In contrast, we showed previously that in mid-frontal cortex in a cohort without neurological disease, soluble Aβ declined progressively between 16 and 95 y. We speculated that the divergent changes in the levels of soluble and insoluble Aβ with age might reflect an increasing tendency to favor the production or retention within the brain of Aβ42 over Aβ40 , leading to elevation of Aβ42 : 40 …even as total soluble Aβ decreased. We have now measured Aβ40 and Aβ42 in soluble and insoluble (guanidine-extractable) fractions of human postmortem brain tissue from the same cohort studied previously. Although in normal brains the absolute level of Aβ40 in both soluble and insoluble fractions and that of Aβ42 in the soluble fraction declined with age, those declines were predominantly before about 50 y, after which Aβ42 : 40 tended to increase in both the soluble and insoluble fractions. Insoluble Aβ42 increased progressively with age. Differential production or retention of Aβ40 and Aβ42 in the over-50 s is likely to contribute to the influence of age on the risk of sporadic AD. Show more

Keywords: Aβ40, Aβ42, aging, amyloid

DOI: 10.3233/JAD-132339

Citation: Journal of Alzheimer's Disease, vol. 40, no. 3, pp. 727-735, 2014

Authors: Bracco, Laura | Bessi, Valentina | Padiglioni, Sonia | Marini, Sandro | Pepeu, Giancarlo

Article Type: Research Article

Abstract: Attention is the first non-memory domain affected in Alzheimer's disease (AD), before deficits in language and visuo-spatial function, and it is claimed that attention deficits are responsible for the difficulties with daily living in early demented patients. The aim of this longitudinal study in a group of 121 Caucasian, community-dwelling, mild-to-moderate AD patients (Mini-Mental State Examination (MMSE) score >17) was to detect which cognitive domains were most affected by the disease and whether one year treatment with cholinesterase inhibitors was more effective in preserving attention than memory. All subjects were evaluated by a neuropsychological battery including global measurements (MMSE, Information-Memory-Concentration …Test) and tasks exploring verbal long-term memory, language, attention, and executive functions. The comparison between two evaluations, made 12 months apart, shows statistically significant differences, indicating deterioration compared to baseline, in the following tests: MMSE (with no gender differences), Composite Memory Score, Short Story Delayed Recall, Trail-Making Test A, Semantic Fluency Test, and Token Test. Conversely, there were no differences in the two evaluations of the Digit Span, Corsi Tapping Test, Short Story Immediate Recall, and Phonemic Fluency Tests. It appears that the treatment specifically attenuated the decline in tests assessing attention and executive functions. A stabilization of the ability to pay attention, with the ensuing positive effects on executive functions, recent memory, and information acquisition which depend on attention, appears to be the main neuropsychological mechanism through which the activation of the cholinergic system, resulting from cholinesterase inhibition, exerts its effect on cognition. Show more

Keywords: Acetylcholine, attention, cholinergic system, donepezil, galantamine, rivastigmine

DOI: 10.3233/JAD-131154

Citation: Journal of Alzheimer's Disease, vol. 40, no. 3, pp. 737-742, 2014

Authors: van der Steen, Jenny T. | van Soest-Poortvliet, Mirjam C. | Hallie-Heierman, Meertje | Onwuteaka-Philipsen, Bregje D. | Deliens, Luc | de Boer, Marike E. | Van den Block, Lieve | van Uden, Nicole | Hertogh, Cees M.P.M. | de Vet, Henrica C.W.

Article Type: Research Article

Abstract: Background: Planning ahead may be particularly relevant in dementia considering patients’ cognitive decline and difficulty to predict the course of the dementia. Objective: To identify factors associated with initiation of advance care planning (ACP) regarding end-of-life issues in dementia. Methods: Systematic review of the PubMed, Embase, Cinahl, Psychinfo, and Cochrane databases until January 2013. We included articles reporting on empirical research, identifying factors related to initiation of ACP defined as starting a discussion, starting the decision making, or having a documented patient-written advance directive. Results: Of 4,647 unique articles, we assessed 178 as full-texts, …and included 33. Most designs (64%) were qualitative; 42% limited to moderate to severe, and 6% to mild to moderate stages. Perspectives varied: family (33%), professional caregivers (24%), patient (15%), or multiple (27%). A variety of factors with complex interplay was involved in initiating ACP. Family factors dominated, with family’s initiative or lack of it, and willingness or reluctance to engage in initiating ACP identified in a series of studies. Further, professional caregivers’ initiative or lack of it and patient’s health status were important factors that facilitated or hindered initiating ACP. Ethnic minority status of those involved and family distance may be barriers. Continuity of care and health care system factors also affected initiating of ACP. Conclusion: Professional caregivers may initiate ACP early if strategies carefully consider timing and family and patient receptiveness or reluctance, and are family and patient-centered. Interventions should address the complexity of interrelated system and personal factors affecting initiation of ACP. Show more

Keywords: advance care planning, decision making, dementia, end of life care, hospice care, long-term care, palliative care, professional-family relations, professional-patient relations

DOI: 10.3233/JAD-131967

Citation: Journal of Alzheimer's Disease, vol. 40, no. 3, pp. 743-757, 2014

Article Type: Other

DOI: 10.3233/JAD-131968

Citation: Journal of Alzheimer's Disease, vol. 40, no. 3, pp. 759-761, 2014

Article Type: Other

DOI: 10.3233/JAD-149002

Citation: Journal of Alzheimer's Disease, vol. 40, no. 3, pp. 763-763, 2014