Journal of Alzheimer's Disease - Volume 66, issue 1

Authors: Mendiratta, Priya | Wei, Jeanne Y. | Dayama, Neeraj | Li, Xiaocong

Article Type: Research Article

Abstract: Background: Patients with Down syndrome (DS) often survive into adulthood. Relatively little information is currently available regarding hospitalization outcomes among mature, older adults with DS. Objective: To identify risk factors associated with hospital mortality rates and increased costs for hospitalized older adults with DS. Methods: Data on hospitalized older adults with DS (≥65 years) were identified from the Nationwide Inpatient Sample database (6) from 2002 through 2012. Multivariate analyses were performed to evaluate risk factors associated with hospital mortality and hospitalization cost in these patients. Results: A total of 2,134 older adults with DS …were identified. A temporal increase over the 11-year period was observed in the number of older adults with DS who were hospitalized (trend p < 0.0001). However, the hospital mortality rate and post-hospital discharge to skilled nursing facilities have decreased during the same time period. Risk factors associated with increased hospital mortality included advanced age (70–79 years), female gender, admissions in the western United States, and presence of comorbid conditions (ischemic heart disease, Alzheimer’s disease, and cerebrovascular accident). The mean cost was $18,241 (SD $56,105) over the 11-year period. However, no significant temporal changes in costs were noted (trend p = 0.14). Conclusions: The number of hospitalized elderly Americans with DS has increased over the 11-year period. However, hospital mortality and discharge to skilled nursing facilities have decreased during the same time period. Several demographic and co-morbid factors are associated with increased mortality. No significant differences in temporal trends in costs were noted. Show more

Keywords: Down syndrome, elderly, outcomes

DOI: 10.3233/JAD-171067

Citation: Journal of Alzheimer's Disease, vol. 66, no. 1, pp. 377-386, 2018

Authors: Sarycheva, Tatyana | Taipale, Heidi | Lavikainen, Piia | Tiihonen, Jari | Tanskanen, Antti | Hartikainen, Sirpa | Tolppanen, Anna-Maija

Article Type: Research Article

Abstract: Background: Although antiepileptic drugs (AEDs) have a potential for adverse drug reactions in older populations, little is known about their use in relation to Alzheimer’s disease (AD) diagnosis. Objectives: In this study, we investigated the incidence and prevalence of AED use in relation to AD diagnosis. Methods: The MEDALZ–study includes all Finnish persons who received clinically verified AD diagnoses (n  = 70,718) during 2005–2011 and a matched comparison cohort without AD (n  = 70,718). AD diagnoses were identified from the Special Reimbursement Register. We used the Prescription Register to identify dispensed AEDs. Incident AED users were identified with …a one-year washout period 9-10 years before AD diagnosis, and incidence rates per 100 person-years were calculated for each six-month period from nine years before to five years after AD diagnosis. Prevalence was assessed as proportion using AEDs during each six-month time period for incident use. Results: Persons with AD were more likely to use AEDs during the study period (4.3%) than persons without AD (3.2%). The incidence and prevalence of AED use was higher among persons with AD and increased around the time of AD diagnosis. Epilepsy diagnoses did not explain these differences. Persons with AD were more likely to use older AEDs. Conclusion: Our study highlights the need to balance effective symptom control with the possible risks of treatment. Show more

Keywords: Alzheimer’s disease, antiepileptic drugs, dementia, incidence, prevalence

DOI: 10.3233/JAD-180594

Citation: Journal of Alzheimer's Disease, vol. 66, no. 1, pp. 387-395, 2018

Authors: McCade, Donna L. | Guastella, Adam J. | Chen, Nigel T.M. | Lewis, Simon J.G. | Naismith, Sharon L.

Article Type: Research Article

Abstract: Background: Research suggests that deficits in emotion recognition are evident in individuals with amnestic mild cognitive impairment (aMCI), a group ‘at risk’ of developing dementia. The mechanisms underlying this deficit, however, are unclear. Objective: In this study, we sought to determine whether there are alterations in the way in which individuals with MCI visually explore emotional facial stimuli. Methods: Eighteen healthy older controls (mean age = 64.6 years) and 32 individuals with MCI were recruited including 18 with the non-amnestic multiple domain (naMCI-md) subtype (mean age = 63.8 years) and 14 with the amnestic multiple domain (aMCI-md) subtype (mean age = 67.9 …years). All participants were given a novel eye-tracking paradigm to investigate eye gaze while viewing images of emotional faces on a computer screen. Results: Analyses of eye gaze revealed no significant difference in the percentage of time that groups spent fixating on facial and peripheral facial regions when viewing emotional faces. All participants showed a relative preference for the eye region of faces relative to all other regions. Individuals with aMCI-md were found to be less accurate than controls and naMCI-md on emotion recognition measures. For naMCI-md individuals, significant relationships were found between efficiencies in visual scanning and increased fixation time on the eye region. Conclusions: Visual processing strategies adopted by aMCI-md individuals when exploring emotional faces do not significantly differ from those of healthy controls or naMCI-md individuals. This suggests that impaired facial emotion recognition in aMCI-md is not likely accounted for by visual processing differences, but rather may reflect an eroded ability to extract meaningful cues from the eye region. Show more

Keywords: Dementia, emotion recognition, eye tracking, mild cognitive impairment

DOI: 10.3233/JAD-170175

Citation: Journal of Alzheimer's Disease, vol. 66, no. 1, pp. 397-405, 2018

Authors: Wirth, Klaus J.

Article Type: Research Article

Abstract: Background: Cerebral hypoperfusion and degeneration of the noradrenergic locus coeruleus (LC) occur early in Alzheimer’s disease (AD). Cerebral blood vessels are densely innervated by noradrenergic projections from the LC suggesting a functional role for the regulation of cerebral blood flow (CBF). Experimental LC stimulation, however, has provided no clarity as decreases or increases in CBF were reported from different experimental settings and investigators. Objective: To find out with pharmacological methods whether endogenously released norepinephrine (NE) increases or decreases carotid artery blood flow (CABF) in anesthetized pigs by investigating the effect of centrally acting alpha-2 adrenergic drugs, which increase …(atipamezole) or decrease (xylazine) NE in the brain. Methods: CABF was measured by a Doppler-flow probe placed around the left carotid artery in pentobarbital anesthetized young pigs. Results: Neither current antihypertensive drugs nor pharmacological stimulation of dopamine, histamine, serotonin or acetylcholine receptors changed CABF. The alpha-2 adrenergic-receptor agonist xylazine decreased, while the antagonist atipamezole raised CABF. This rise was abolished by a combined treatment with endothelial NO-synthase inhibitor Nω -Nitro-L-arginine methyl ester (L-NAME) and the non-selective β-receptor antagonist propranolol. Propranolol alone did not decrease CABF in contrast to L-NAME but decreased CABF after L-NAME, surprisingly. Conclusion: Pharmacological evidence suggests that NE released in the brain of anesthetized pigs raises CABF involving β-adrenergic mechanisms and nitric oxide. If in awake humans NE released from the LC had vasodilator effects early LC degeneration could be involved in early cerebral hypoperfusion of AD. Moreover, a cerebral adrenergic vascular innervation deficit, possibly resulting from LC degeneration, and systemic endothelial dysfunction together may act synergistically to reduce CBF. Show more

Keywords: Alpha-2 adrenergic drugs, Alzheimer’s disease, atipamezole, carotid artery blood flow, cerebral blood flow, cerebral hypoperfusion, degeneration, locus coeruleus, pigs, propranolol, xylazine

DOI: 10.3233/JAD-180340

Citation: Journal of Alzheimer's Disease, vol. 66, no. 1, pp. 407-419, 2018