Journal of Alzheimer's Disease - Volume 69, issue 4

Authors: Robillard, Julie M. | Wu, Julia M. | Feng, Tanya L. | Tam, Mallorie T.

Article Type: Review Article

Abstract: Background: As the global prevalence of dementia rises, care costs impose a large burden on healthcare systems. Technology solutions in dementia care have the potential to ease this burden. While policies exist to guide and govern the use of dementia care technologies, little is known about how ethical considerations are incorporated into these documents. Objective: The goal of this study was to examine ethics-related content in dementia care technology policies. Methods: We used a two-step data mining approach to collect a sample of dementia technology policies. Policy documents were analyzed using emergent content analysis. Following the …coding of the sample, thematic categories were organized using the principles of biomedical ethics as a framework. Results: A total of 23 policy documents from four Alzheimer associations in four countries were included in our analysis. General ethics considerations and themes related to beneficence were mentioned in 96% of the documents. Thematic categories related to justice were present in 74% of the sample, themes related to non-maleficence appeared in 52% of documents, and themes related to autonomy appeared in 43% of the sample. Conclusion: While ethical considerations are present in existing policies for dementia care technology, these considerations revolve primarily around the benefit of the technologies. Further efforts are needed to provide formal guidance that incorporates both benefits and potential harms. Show more

Keywords: Dementia, ethics, healthcare, technology

DOI: 10.3233/JAD-180938

Citation: Journal of Alzheimer's Disease, vol. 69, no. 4, pp. 897-904, 2019

Authors: Koulousakis, Philippos | Andrade, Pablo | Visser-Vandewalle, Veerle | Sesia, Thibaut

Article Type: Review Article

Abstract: The nucleus basalis of Meynert (nbM) was first described at the end of the 19th century and named after its discoverer, Theodor Meynert. The nbM contains a large population of cholinergic neurons that project their axons to the entire cortical mantle, the olfactory tubercle, and the amygdala. It has been functionally associated with the control of attention and maintenance of arousal, both key functions for appropriate learning and memory formation. This structure is well-conserved across vertebrates, although its degree of organization varies between species. Since early in the investigation of its functional and pathological significance, its degeneration has been linked …to various major neuropsychiatric disorders. For instance, Lewy bodies, a hallmark in the diagnosis of Parkinson’s disease, were originally described in the nbM. Since then, its involvement in other Lewy body and dementia-related disorders has been recognized. In the context of recent positive outcomes following nbM deep brain stimulation in subjects with dementia-associated disorders, we review the literature from an historical perspective focusing on how the nbM came into focus as a promising therapeutic option for patients with Alzheimer’s disease. Moreover, we will discuss what is needed to further develop and widely implement this approach as well as examine novel medical indications for which nbM deep brain stimulation may prove beneficial. Show more

Keywords: Acetylcholine, Alzheimer’s disease, deep brain stimulation, nucleus basalis of Meynert

DOI: 10.3233/JAD-180133

Citation: Journal of Alzheimer's Disease, vol. 69, no. 4, pp. 905-919, 2019

Authors: Fischer, Anna | Landeira-Fernandez, Jesus | Sollero de Campos, Flavia | Mograbi, Daniel C.

Article Type: Review Article

Abstract: Empathy is essential for social interaction and a crucial trait to understand the intentions and behaviors of others and to react accordingly. Alzheimer’s disease (AD) affects both cognitive and emotional processes and can lead to social dysfunction. Empathy results from the interaction of four components: shared neural representation, self-awareness, mental flexibility, and emotion regulation. This review discusses the abilities and deficits of patients with AD from the perspective of subcomponents of empathy and integrates these facets into a model of human empathy. The aim was to investigate the components that are affected by AD and the ways in which patients …are still able to empathize with others in their social environment. It concludes that AD patients show a pattern of relatively preserved affective aspects and impairments in cognitive components of empathy and points out specific areas with the need for further research. Show more

Keywords: Affective sharing, awareness, dementia, emotion regulation, mental flexibility

DOI: 10.3233/JAD-180730

Citation: Journal of Alzheimer's Disease, vol. 69, no. 4, pp. 921-933, 2019

Authors: Casson, Ira R. | Viano, David C.

Article Type: Review Article

Abstract:  The long-term effects of repetitive head trauma on the brain have often been studied in boxers and American football players. The medical literature on this topic was reviewed in order to compare the findings related to boxing with those related to football. The evidence gathered from this review indicates that there are significant differences between the clinical and neuropathological descriptions of the chronic brain damage reported in retired boxers compared to those reported in retired football players. Differing biomechanics of head impacts in the two sports may help explain the different clinical and neuropathological consequences of participation in boxing versus …football. Show more

Keywords: Boxing, brain injury, concussion, football, head injury, neuropathology

DOI: 10.3233/JAD-190115

Citation: Journal of Alzheimer's Disease, vol. 69, no. 4, pp. 935-952, 2019

Authors: Bayram, Ece | Shan, Guogen | Cummings, Jeffrey L.

Article Type: Short Communication

Abstract:  More than half of the patients with Alzheimer’s disease (AD) have comorbidities including TDP-43 and Lewy bodies, which are also associated with frontotemporal lobar degeneration and dementia with Lewy bodies, respectively. These comorbidities may help explain the overlapping neuropsychiatric symptoms between AD and other dementias. Data on 221 AD patients with Neuropsychiatric Inventory-Questionnaire were obtained from the National Alzheimer’s Coordinating Center. TDP-43 was associated with aberrant motor activity, whereas Lewy bodies were associated with anxiety, irritability, sleep behavior, and appetite problems. The associations between these comorbidities and neuropsychiatric symptoms were more significant for patients with sparse diffuse plaques.

Keywords: Alzheimer’s disease, Lewy body, neuropsychiatric symptoms, TDP-43

DOI: 10.3233/JAD-181285

Citation: Journal of Alzheimer's Disease, vol. 69, no. 4, pp. 953-961, 2019

Authors: Tan, Rachel H. | Yang, Yue | McCann, Heather | Shepherd, Claire | Halliday, Glenda M.

Article Type: Short Communication

Abstract: The selective loss of von Economo neurons has been linked to the behavioral deficits in behavioral variant frontotemporal dementia (bvFTD) but whether these neurons are affected in bvFTD patients with underlying Alzheimer’s disease (AD) has yet to be established. The present study assesses the von Economo neurons in pathological AD cases clinically diagnosed with either AD or bvFTD. Our results demonstrate no significant loss of von Economo neurons in all pathological AD cases, irrespective of clinical diagnosis or co-existing Lewy body pathology. These results suggest that the behavioral deficits in patients with clinical bvFTD and underlying pathological AD are not …driven by the loss of von Economo neurons. Show more

Keywords: Alzheimer’s disease, behavioral variant frontotemporal dementia, Lewy body pathology, Von Economo neurons

DOI: 10.3233/JAD-180900

Citation: Journal of Alzheimer's Disease, vol. 69, no. 4, pp. 963-967, 2019

Authors: Torres-Lista, Virginia | Giménez-Llort, Lydia

Article Type: Short Communication

Abstract: Modeling of Alzheimer’s disease (AD), classically focused on the subject-environment interaction, foresees current social neuroscience efforts as improving the predictive validity of new strategies. Here we studied social functioning among congeners in 13–14-month-old mice with normal aging in naturalistic and experimental conditions and depicted behavioral signatures of dysfunction in age-matched 3xTg-AD mice. The most sensitive variables were vibrating tail, digging, body/face and self-grooming, that can be easily used in housing routines and the assessment of strategies. Sex-specific signatures (vibrating tail, digging, and grooming) defined female 3xTg-AD mice ethogram. All animals sleep huddled while barbering was only found in females with …normal aging. Show more

Keywords: Barbering, behavioral and psychological symptoms of dementia, Dalila effect, digging, ethogram markers, monitoring, sleeping behavior, social behavior, Social Interaction Test, Tube-dominance test

DOI: 10.3233/JAD-190253

Citation: Journal of Alzheimer's Disease, vol. 69, no. 4, pp. 969-977, 2019

Authors: Zegarra-Valdivia, Jonathan A. | Santi, Andrea | Fernández de Sevilla, Maria Estrella | Nuñez, Angel | Torres Aleman, Ignacio

Article Type: Research Article

Abstract: Increasing evidence supports the notion that Alzheimer’s disease (AD), a condition that presents heterogeneous pathological disturbances, is also associated to perturbed metabolic function affecting insulin and insulin-like growth factor I (IGF-I). While impaired insulin activity leading to insulin resistance has been associated to AD, whether altered IGF-I function affects the disease is not entirely clear. Despite the limitations of mouse models to mimic AD pathology, we took advantage that serum IGF-I deficient mice (LID mice) present many functional perturbations present in AD, most prominently cognitive loss, which is reversed by treatment with systemic IGF-I. We analyzed whether these mice display …other pathological traits that are usual co-morbidities of AD. We found that LID mice not only display cognitive disturbances, but also show altered mood and sociability, increased susceptibility to epileptiform activity, and a disturbed sleep/wake cycle. Collectively, these data suggest that reduced IGF-I activity contributes to heterogeneous deficits commonly associated to AD. We suggest that impaired IGF-I activity needs to be taken into consideration when modeling this condition. Show more

Keywords: Alzheimer’s disease, animal models of disease, co-morbidities, insulin-like growth factor 1

DOI: 10.3233/JAD-190241

Citation: Journal of Alzheimer's Disease, vol. 69, no. 4, pp. 979-987, 2019

Authors: Picard, Gaëtane | Bier, Jean-Christophe | Capron, Isabelle | De Deyn, Peter Paul | Deryck, Olivier | Engelborghs, Sebastiaan | Hanseeuw, Bernard | Lemper, Jean-Claude | Mormont, Eric | Petrovic, Mirko | Salmon, Eric | Segers, Kurt | Sieben, Anne | Thiery, Evert | Ventura, Manfredi | Versijpt, Jan | Ivanoiu, Adrian

Article Type: Research Article

Abstract: Background: Palliative care and Advance Care Planning (ACP) are increasingly recommended for an optimal management of late-stage dementia. In Belgium, euthanasia has been decriminalized in 2002 for patients who are “mentally competent” (interpreted as non-demented). It has been suggested that advance directives for euthanasia (ADE) should be made possible for dementia patients. Objective: This study presents the results of an internet survey among Belgian dementia specialists. Methods: In 2013, the Belgian Dementia Council (BeDeCo) organized a debate on end of life decisions in dementia. Participants were medical doctors who are specialists in the dementia field. After …the debate, an anonymous internet survey was organized. The participation rate was 55%. The sample was representative of the BeDeCo members. Results: The results showed consensus in favor of palliative care and ACP, although ACP is not systematically addressed in practice. Few patients with dementia have requested euthanasia, but for those who did the participants had agreed to implement it for some patients. A majority of participants (94%) believe that most patients and their families are poorly informed about euthanasia. Although most participants (77%) said they approved the Law on euthanasia, 65% said they were against an extension of the Law to allow ADE for dementia. Conclusion: Palliative care and ACP are clearly accepted by professionals, although a gap between recommendation and practice remain. Euthanasia is a much more debated issue, even if a majority of professionals are, in principle, in favor of the current Law and seem to disapprove with a Law change allowing ADE for dementia. A better education for both health professionals and the lay public will be a key element in the future. Show more

Keywords: Advance directive, Alzheimer’s disease, dementia, end of life, euthanasia, expert opinion

DOI: 10.3233/JAD-181277

Citation: Journal of Alzheimer's Disease, vol. 69, no. 4, pp. 989-1001, 2019

Authors: Hardcastle, Cheshire | Huang, Hua | Crowley, Sam | Tanner, Jared | Hernaiz, Carlos | Rice, Mark | Parvataneni, Hari | Ding, Mingzhou | Price, Catherine C.

Article Type: Research Article

Abstract: Background: Research shows that older adults can have a decline in three key resting state networks (default mode network, central executive network, and salience network) after total knee arthroplasty and that patients’ pre-surgery brain and cognitive integrity predicts decline. Objectives: First, to assess resting state network connectivity decline from the perspective of nodal connectivity changes in a larger older adult surgery sample. Second, to compare pre-post functional connectivity changes in mild cognitive impairment (MCI) versus non-MCI. Methods: Surgery (n  = 69) and non-surgery (n  = 65) peers completed a comprehensive preoperative neuropsychological evaluation and pre- and acute (within …48 hours) post-surgery/pseudo-surgery functional brain magnetic resonance imaging scan. MCI was classified within both (MCI surgery, n  = 13; MCI non-surgery, n  = 10). Using standard coordinates, we defined default mode network, salience network, central executive network, and the visual network (serving as a control network). The functional connectivity of these networks and brain areas (nodes) that make up these networks were examined for pre-post-surgery changes through paired samples t -test and ANOVA. Results: There was a decline in RSN connectivity after surgery (p  < 0.05) only in the three cognitive networks (not the visual network). The default mode and salience network showed nodal connectivity changes (p  < 0.01). MCI surgery had greater functional connectivity decline in DMN and SN. Non-surgery participants showed no significant functional connectivity change. Conclusion: Surgery with general anesthesia selectively alters functional connectivity in major cognitive resting state networks particularly in DMN and SN. Participants with MCI appear more vulnerable to these functional changes. Show more

Keywords: Anesthesia, cognitive dysfunction, dementia, functional magnetic resonance imaging, mild cognitive impairment, orthopedics, surgery

DOI: 10.3233/JAD-180932

Citation: Journal of Alzheimer's Disease, vol. 69, no. 4, pp. 1003-1018, 2019