Journal of Alzheimer's Disease - Volume 48, issue 1

Authors: Fereshtehnejad, Seyed-Mohammad | Johannsen, Peter | Waldemar, Gunhild | Eriksdotter, Maria

Article Type: Research Article

Abstract: Background: Two dementia quality registries have been developed in Denmark and Sweden with the aim to assess quality of dementia care based on adherence to national guidelines. Objective: To compare patient characteristics, diagnostics, treatment, and quality indicators of dementia care among patients referred to specialist units in Sweden and Denmark. Methods: Data from the Swedish Dementia Registry (SveDem) and the Danish Dementia Registry were merged. Newly diagnosed dementia cases referred to memory clinics during 2007–2012 were included (19,629 Swedish and 6,576 Danish patients). Results: The median duration between initial …assessment and confirmed diagnosis was 56 and 57 days in Sweden and Denmark, respectively. Brain imaging using MRI was twice as common in Sweden. A diagnosis of dementia was established at an average MMSE of 21. An etiological diagnosis was concluded in 89.6% of the Swedish and 87.3% of the Danish cases. Alzheimer’s disease (AD) was the most common disorder (47.7% in Denmark and 36.6% in Sweden); however, more cases were diagnosed as mixed AD in Sweden (24.7% versus 10.6% ). More than 80% of patients with AD, dementia with Lewy bodies, and Parkinson’s disease with dementia were treated with anti-dementia drugs. Conclusion: The targets of several quality indicators in both registries were met, such that structural brain imaging and MMSE were performed in >90% and an etiological diagnosis was concluded in >80% of the patients. However, there were also results of concern. The diagnosis of dementia was established at a mean MMSE of 21, which is already late in the course of most dementia disorders. A higher chance of vascular findings following the higher rate of MRI in Sweden may have resulted in more mixed AD diagnosis, which could be one explanation for diagnostic differences but also highlights the need to harmonize diagnostic criteria. Show more

Keywords: Alzheimer’s disease, dementia, diagnosis, quality indicators, quality registries, therapy

DOI: 10.3233/JAD-150144

Citation: Journal of Alzheimer's Disease, vol. 48, no. 1, pp. 229-239, 2015

Authors: Heiskanen, Jari | Hartikainen, Sirpa | Roine, Risto P. | Tolppanen, Anna-Maija

Article Type: Research Article

Abstract: Background and Objectives: Persons with Alzheimer’s disease (AD) have been suggested to receive suboptimal treatment. We studied the 30-day mortality after ischemic stroke, hemorrhagic stroke, or myocardial infarction in individuals with or without AD. Methods: An exposure matched cohort of all Finnish community-dwellers diagnosed with clinically verified AD in 2005–2012 (n  = 73,005) and 1–4 matched comparison persons/AD-affected person (n  = 215,449). Data on 30-day mortality after ischemic stroke (n  = 16,419; deaths: n  = 2,748), hemorrhagic stroke (n  = 3,570; deaths: n  = 1,224), and myocardial infarction (n  = 15,304; deaths: n  = 3,804) were obtained from the National Hospital Discharge register. The main …analyses were restricted to first-ever events. Results: Persons with AD had slightly higher 30-day mortality after ischemic stroke (adjusted HR 1.36, 95% Confidence interval (CI) 1.24,1.49), hemorrhagic stroke (adjusted HR 1.11, 95% CI 0.98,1.25), or myocardial infarction (adjusted HR, 1.40, 9% CI 1.30,1.51). The associations were not affected by age, gender, or co-morbidities and remained similar when patients with previous ischemic strokes or infarctions were included. The absolute risk increase in 30-day mortality after ischemic or hemorrhagic stroke and myocardial infarction were 4.9% (95% CI 3.3,6.5), 3.3% (95% CI – 1.6,8.2), and 7.5% (95% CI 5.0,10.0), respectively. Conclusions: Although the 30-day mortality was somewhat higher in the AD cohort, the absolute differences were small indicating that acute treatment was not notably inferior in AD patients. The slightly higher mortality was not explained by co-morbidities but may reflect the higher mortality of AD persons in general, or treatment practice of patients with severe cognitive impairment. Show more

Keywords: Alzheimer’s disease, mortality, myocardial infarction, stroke

DOI: 10.3233/JAD-150259

Citation: Journal of Alzheimer's Disease, vol. 48, no. 1, pp. 241-249, 2015

Authors: Anderkova, Lubomira | Eliasova, Ilona | Marecek, Radek | Janousova, Eva | Rektorova, Irena

Article Type: Research Article

Abstract: Background: Repetitive transcranial magnetic stimulation (rTMS) is a promising tool to study and modulate brain plasticity. Objective: Our aim was to investigate the effects of rTMS on cognitive functions in patients with mild cognitive impairment and Alzheimer’s disease (MCI/AD) and assess the effect of gray matter (GM) atrophy on stimulation outcomes. Methods: Twenty MCI/AD patients participated in the proof-of-concept controlled study. Each patient received three sessions of 10 Hz rTMS of the right inferior frontal gyrus (IFG), the right superior temporal gyrus (STG), and the vertex (VTX, a control stimulation site) in a …randomized order. Cognitive functions were tested prior to and immediately after each session. The GM volumetric data of patients were: 1) compared to healthy controls (HC) using source-based morphometry; 2) correlated with rTMS-induced cognitive improvement. Results: The effect of the stimulated site on the difference in cognitive scores was statistically significant for the Word part of the Stroop test (ST-W, p  = 0.012, linear mixed models). As compared to the VTX stimulation, patients significantly improved after both IFG and STG stimulation in this cognitive measure. MCI/AD patients had significant GM atrophy in characteristic brain regions as compared to HC (p  = 0.029, Bonferroni corrected). The amount of atrophy correlated with the change in ST-W scores after rTMS of the STG. Conclusion: rTMS enhanced cognitive functions in MCI/AD patients. We demonstrated for the first time that distinct pattern of GM atrophy in MCI/AD diminishes the cognitive effects induced by rTMS of the temporal neocortex. Show more

Keywords: Alzheimer’s disease, brain atrophy, cognitive functions, noninvasive brain stimulation; source-based morphometry

DOI: 10.3233/JAD-150067

Citation: Journal of Alzheimer's Disease, vol. 48, no. 1, pp. 251-260, 2015

Authors: Kelly, David | Coen, Robert F. | Akuffo, Kwadwo Owusu | Beatty, Stephen | Dennison, Jessica | Moran, Rachel | Stack, Jim | Howard, Alan N. | Mulcahy, Riona | Nolan, John M.

Article Type: Research Article

Abstract: Background: Macular pigment (MP) levels correlate with brain concentrations of lutein (L) and zeaxanthin (Z), and have also been shown to correlate with cognitive performance in the young and elderly. Objective: To investigate the relationship between MP, serum concentrations of L and Z, and cognitive function in subjects free of retinal disease with low MP (Group 1, n  = 105) and in subjects with AMD (Group 2, n  = 121). Methods: MP was measured using customized heterochromatic flicker photometry and dual-wavelength autofluorescence; cognitive function was assessed using a battery of validated cognition tests; serum L and Z …concentrations were determined by HPLC. Results: Significant correlations were evident between MP and various measures of cognitive function in both groups (r  = –0.273 to 0.261, p ≤0.05, for all). Both serum L and Z concentrations correlated significantly (r  = 0.187, p ≤0.05 and r  = 0.197, p ≤0.05, respectively) with semantic (animal) fluency cognitive scores in Group 2 (the AMD study group), while serum L concentrations also correlated significantly with Verbal Recognition Memory learning slope scores in the AMD study group (r  = 0.200, p  = 0.031). Most of the correlations with MP, but not serum L or Z, remained significant after controlling for age, gender, diet, and education level. Conclusion: MP offers potential as a non-invasive clinical biomarker of cognitive health, and appears more successful in this role than serum concentrations of L or Z. Show more

Keywords: Age-related macular degeneration, biomarker, cognitive function, lutein, macular pigment, zeaxanthin

DOI: 10.3233/JAD-150199

Citation: Journal of Alzheimer's Disease, vol. 48, no. 1, pp. 261-277, 2015

Authors: Matsuzono, Kosuke | Hishikawa, Nozomi | Yamashita, Toru | Ohta, Yasuyuki | Sato, Kota | Kono, Shoichiro | Deguchi, Kentaro | Morihara, Ryuta | Abe, Koji

Article Type: Research Article

Abstract: Background/Objective: To examine comprehensive clinical evaluations of frontotemporal dementia (FTD) patients compared with Alzheimer’s disease (AD) patients. Methods: We used eight batteries and the touch panel test to retrospectively analyze 41 FTD patients compared with 121 AD patients. Furthermore, 34 FTD and all 121 AD patients were evaluated with a frontotemporal dementia-Alzheimer’s disease index (FA index), which we developed for novel diagnosis with magnetic resonance imaging. Results: Frontal assessment battery, geriatric depression scale, and Abe’s behavioral and psychological symptom of dementia score were significantly worse in FTD patients than in AD patients ( ** p … <  0.01 in FAB,  ** p  <  0.01 in the geriatric depression scale, and  *** p  <  0.001 in Abe’s behavioral and psychological symptom of dementia score), although there was no significant difference in the other five scores. The finding mistakes game score of the touch panel test was worse in FTD than in AD ( * p  <  0.05). The receiver operating characteristic curve of the FA index showed 91.4% sensitivity and 89.3% specificity with the FA index ≤0.6015 to discriminate FTD from AD. Conclusion: Combining clinical scores, a computerized touch panel test, and the FA index will help to provide a more accurate diagnosis of FTD in contrast to AD. Show more

Keywords: Alzheimer’s disease, frontotemporal dementia, magnetic resonance imaging, touch panel test

DOI: 10.3233/JAD-150416

Citation: Journal of Alzheimer's Disease, vol. 48, no. 1, pp. 279-286, 2015

Article Type: Meeting Report

DOI: 10.3233/JAD-150550

Citation: Journal of Alzheimer's Disease, vol. 48, no. 1, pp. 287-291, 2015