Journal of Alzheimer's Disease - Volume 76, issue 2

Article Type: Editorial

DOI: 10.3233/JAD-209005

Citation: Journal of Alzheimer's Disease, vol. 76, no. 2, pp. 443-444, 2020

Authors: Portacolone, Elena | Halpern, Jodi | Luxenberg, Jay | Harrison, Krista L. | Covinsky, Kenneth E.

Article Type: Review Article

Abstract: Due to the high costs of providing long-term care to older adults with cognitive impairment, artificial companions are increasingly considered as a cost-efficient way to provide support. Artificial companions can comfort, entertain, and inform, and even induce a sense of being in a close relationship. Sensors and algorithms are increasingly leading to applications that exude a life-like feel. We focus on a case study of an artificial companion for people with cognitive impairment. This companion is an avatar on an electronic tablet that is displayed as a dog or a cat. Whereas artificial intelligence guides most artificial companions, this application …also relies on technicians “behind” the on-screen avatar, who via surveillance, interact with users. This case is notable because it particularly illustrates the tension between the endless opportunities offered by technology and the ethical issues stemming from limited regulations. Reviewing the case through the lens of biomedical ethics, concerns of deception, monitoring and tracking, as well as informed consent and social isolation are raised by the introduction of this technology to users with cognitive impairment. We provide a detailed description of the case, review the main ethical issues and present two theoretical frameworks, the “human-driven technology” platform and the emancipatory gerontology framework, to inform the design of future applications. Show more

Keywords: Dementia, ethics, robots, technology

DOI: 10.3233/JAD-190952

Citation: Journal of Alzheimer's Disease, vol. 76, no. 2, pp. 445-455, 2020

Authors: Robillard, Julie M. | Goldman, Ian P. | Prescott, Tony J. | Michaud, François

Article Type: Research Article

Abstract: Portacolone et al.’s Ethics Review highlights the ethical challenges associated with the implementation of telepresence devices and applications in the context of aging and dementia. In this response, we review ethical considerations as they relate to specific modalities of telepresence, with an emphasis on the continuum of potential interaction agents, from known individuals to fully automated and intelligent interlocutors. We further discuss areas in need of empirical evidence to inform regulatory efforts in telepresence. We close with a call for meaningful end-user engagement at all stages of technology development.

Keywords: Alzheimer’s disease, ethics, patient engagement, robotics, telepresence

DOI: 10.3233/JAD-200154

Citation: Journal of Alzheimer's Disease, vol. 76, no. 2, pp. 457-460, 2020

Authors: Robillard, Julie M. | Kabacińska, Katarzyna

Article Type: Review Article

Abstract: Socially assistive robots have the potential to improve aged care by providing assistance through social interaction. While some evidence suggests a positive impact of social robots on measures of well-being, the adoption of robotic technology remains slow. One approach to improve technology adoption is involving all stakeholders in the process of technology development using co-creation methods. To capture relevant stake holders’ priorities and perceptions on the ethics of robotic companions, we conducted an interactive co-creation workshop at the 2019 Geriatric Services Conference in Vancouver, BC. The participants were presented with different portrayals of robotic companions in popular culture and answered …questions about perceptions, expectations, and ethical concerns about the implementation of robotic technology. Our results reveal that the most pressing ethical concerns with robotic technology, such as issues related to privacy, are critical potential barriers to technology adoption. We also found that most participants agree on the types of tasks that robots should help with, such as domestic chores, communication, and medication reminders. Activities that robots should not help with, according to the stakeholders, included bathing, toileting, and managing finances. The perspectives that were captured contribute to a preliminary outline of the areas of importance for geriatric care stake holders in the process of ethical technology design and development. Show more

Keywords: Aging, engagement, ethics, technology

DOI: 10.3233/JAD-200214

Citation: Journal of Alzheimer's Disease, vol. 76, no. 2, pp. 461-466, 2020

Authors: Marston, Louise | Livingston, Gill | Laybourne, Anne | Cooper, Claudia

Article Type: Short Communication

Abstract: Care home residents with dementia often have accompanying agitation. We investigated agitation’s course at 5 time-points in 1,424 people with dementia over 16 months in 86 English care homes. We categorized baseline agitation symptoms on the Cohen-Mansfield Agitation Inventory (CMAI) into none (CMAI = 29; 15%), subclinical (CMAI = 30–45; 45%), or clinically-significant (CMAI > 45; 40%). 88% of those with no agitation at baseline remained free of clinically-significant agitation at all follow-ups. Seventy percent of those exhibiting clinically-significant agitation at baseline had clinically-significant agitation at some follow-ups. Over a 16-month observation period, this study finds many care home residents with dementia never develop clinically significant …agitation and interventions should be for treatment not prevention. Show more

Keywords: Agitation, dementia, neuropsychiatric symptoms, nursing homes

DOI: 10.3233/JAD-191195

Citation: Journal of Alzheimer's Disease, vol. 76, no. 2, pp. 467-473, 2020

Authors: Tousi, Babak

Article Type: Article Commentary

Abstract: Patients with dementia are particularly vulnerable during the COVID-19 pandemic. The initial response to COVID-19 promoted behavioral changes in both society and healthcare, while a long-term solution is sought by prioritizing societal values. In addition, there has been disruption to clinical care and clinical research. This pandemic might have significantly changed the care for our patients with dementia toward increased acceptance of telemedicine by the patients and providers, and its utilization in both clinical care and research.

Keywords: Access, Alzheimer’s disease, caregivers, clinical trial, coronavirus, COVID-19, dementia, health care, pandemic, telehealth, telemedicine

DOI: 10.3233/JAD-200461

Citation: Journal of Alzheimer's Disease, vol. 76, no. 2, pp. 475-479, 2020

Authors: Capozzo, Rosa | Zoccolella, Stefano | Frisullo, Maria Elisa | Barone, Roberta | Dell’Abate, Maria Teresa | Barulli, Maria Rosaria | Musio, Marco | Accogli, Miriam | Logroscino, Giancarlo

Article Type: Research Article

Abstract: Background: The COVID-19 pandemic is changing clinical practice in neurology, after the governments decided the introduction of social distancing and interruption of medical non-emergency services in many countries. Teleneurology is an effective tool for the remote evaluation of patients but its adoption for frontotemporal lobar dementia (FTD) is in a preliminary stage. Objective: We evaluated multidisciplinary assessment of patients with FTD using telehealth during the COVID-19 pandemic. Methods: All patients received a diagnosis of FTD during 2018-2019 according to international criteria. A structured questionnaire and Clinical Dementia Rating Scale (CDR)–FTD were used by the neurologist with …patients and/or caregivers. Index symptoms of COVID-19 infection were searched. Results: Twenty-eight clinical interviews were completed with caregivers and four with both patients/caregivers. Most patients and caregivers were satisfied with the neurological interview and expressed their willingness to continue to be included in remote evaluation programs (90%). Fifty percent of patients experienced significant worsening of clinical picture and quality of life since the start of social distancing. The CDR-FTD scale revealed a significant worsening of behavior (p  = 0.01) and language functions (p  = 0.009), compared to the last in-person evaluation at the center. One patient presented index symptoms of COVID-19 infection and was confirmed to be positive for COVID-19 with pharyngeal swab. Conclusion: The study was conducted in Italy, one of the countries hit particularly hard by the COVID-19 pandemic, with interruption of all non-emergency medical services. Our study indicates that telemedicine is a valid tool to triage patients with FTD to increase practice outreach and efficiency. Show more

Keywords: COVID-19, frontotemporal lobar dementia, multidisciplinary care, pandemic, quality life, telemedicine

DOI: 10.3233/JAD-200589

Citation: Journal of Alzheimer's Disease, vol. 76, no. 2, pp. 481-489, 2020

Authors: Liu, Yi | Bian, Huijie | Xu, Siyi | Shu, Shu | Jia, Junqiu | Chen, Jian | Cao, Xiang | Bao, Xinyu | Gu, Yue | Xia, Shengnan | Yang, Hui | Yu, Linjie | Xu, Yun | Zhu, Xiaolei

Article Type: Research Article

Abstract: Background: Dysfunction of synaptic plasticity leads to memory impairment in Alzheimer’s disease (AD). Muscone (Mus) has shown neuroprotective effects in cerebral ischemic models. However, little is known of Mus effects on AD. Objective: To investigate the effects of Mus on memory functions and synaptic plasticity in 6-month-old APP/PS1 double-transgenic mice and explore the potential mechanisms. Methods: Mus was intraperitoneally injected into APP/PS1 or wild-type mice, and cognitive function was assessed by Novel object recognition and Morris water maze tests. The levels of amyloid-β (Aβ) were evaluated by immunofluorescence staining and ELISA. Synaptic morphology and plasticity were …evaluated by Golgi staining and long-term potentiation. Cell viability was examined by Cell Counting Kit-8 assay. The protein levels of histone deacetylase 2 (HDAC2) were accessed by western blotting and Immunofluorescence staining. The protein levels of microtubule associated protein 2 and synaptophysin were analyzed by immunofluorescence staining. The ubiquitination of HDAC2 was examined by co-immunoprecipitation. The interaction of Mus with HDAC2 was predicted by molecular docking analysis. Results: Mus treatment attenuated memory dysfunction, reduced Aβ level, and enhanced synaptic plasticity in APP/PS1 mice. In addition, Mus treatment decreased the level of HDAC2 in the hippocampus of APP/PS1 mice and Aβ1–42 -induced primary neurons, which might be associated with increased HDAC2 ubiquitination induced by HDAC2 and Mus interaction. Conclusion: Mus protected against synaptic plasticity and memory impairment in APP/PS1 mice, and enhanced HDAC2 degradation via ubiquitination, indicating that Mus was a potential drug for AD treatment. Show more

Keywords: Alzheimer’s disease, amyloid-β, HDAC2, muscone, synaptic plasticity

DOI: 10.3233/JAD-200188

Citation: Journal of Alzheimer's Disease, vol. 76, no. 2, pp. 491-504, 2020

Authors: Lu, Hanna | for the Open Access Series of Imaging Studies

Article Type: Research Article

Abstract: Background: Cortical complexity plays a central role in the diagnosis and prognosis of age-related diseases. However, little is known about the regional cortical complexity in the context of brain atrophy. Objective: We aimed to systematically examine the age-related changes of the cortical complexity of left dorsolateral prefrontal cortex (DLPFC) and its subregions. Methods: Two hundred and fourteen cognitively normal adults drawn from the Open Access Series of Imaging Studies (OASIS) were divided into four age groups: young, middle-aged, young-old, and old-old. Based on structural magnetic resonance imaging (sMRI) scans, the multiscale measures of cortical complexity included …cortical thickness (mm), surface area (mm2 ), grey matter volume (mm3 ), density, gyrification index (GI), and fractal dimension (FD). Results: Advancing age was associated with reduced grey matter volume, pial surface area, density, and FD of left DLPFC, but correlated with increased cortical thickness and GI. Volumetric measures, cerebrospinal fluid volume in particular, showed better performance to discriminate young-old adults from old-old adults, while FD was more sensitive than the volumetric measures to discriminate young adults and middle-aged adults. Conclusion: This is the first demonstration that chronological age has a pronounced and differential effect on the cortical complexity of left DLPFC. Our findings suggest that surface-based measures of cortical region, thickness, and gyrification in particular, could be considered as valuable imaging markers for the studies of aging brain and neurodegenerative diseases. Show more

Keywords: Cortical complexity, cortical thickness, dorsolateral prefrontal cortex, folding, fractal dimension, grey matter, gyrification

DOI: 10.3233/JAD-200102

Citation: Journal of Alzheimer's Disease, vol. 76, no. 2, pp. 505-516, 2020

Authors: Cerami, Chiara | Dodich, Alessandra | Iannaccone, Sandro | Magnani, Giuseppe | Marcone, Alessandra | Guglielmo, Priscilla | Vanoli, Giovanna | Cappa, Stefano F. | Perani, Daniela

Article Type: Research Article

Abstract: Background: Corticobasal syndrome (CBS) is the usual clinical presentation of patients with corticobasal degeneration pathology. Nevertheless, there are CBS individuals with postmortem neuropathology typical of Alzheimer’s disease (AD). Objective: In this study, we aim to detect FDG-PET metabolic signatures at the single-subject level in a CBS sample, also evaluated with cerebrospinal fluid (CSF) markers for AD pathology. Methods: 21 patients (68.9±6.4 years; MMSE score = 21.7±6.3) fulfilling current criteria for CBS were enrolled. All underwent a clinical-neuropsychological assessment and an instrumental evaluation for biomarkers of neurodegeneration, amyloid and tau pathology (i.e., FDG-PET imaging and CSF Aβ42 and …tau levels) at close intervals. CBS subjects were classified according to the presence or absence of CSF markers of AD pathology (i.e., low Aβ42 and high phosphorylated tau levels). Optimized voxel-based SPM procedures provided FDG-PET metabolic patterns at the single-subject and group levels. Results: Eight CBS had an AD-like CSF profile (CBS-AD), while thirteen were negative (CBS-noAD). The two subgroups did not differ in demographic characteristics or global cognitive impairment. FDG-PET SPM t-maps identified different metabolic signatures. Namely, all CBS-AD patients showed the typical AD-like hypometabolic pattern involving posterior cingulate cortex, precuneus and temporo-parietal cortex, whereas CBS-noAD cases showed bilateral hypometabolism in fronto-insular cortex and basal ganglia that is typical of the frontotemporal lobar degeneration spectrum. Discussion: These results strongly suggest the inclusion of FDG-PET imaging in the diagnostic algorithm of individuals with CBS clinical phenotype in order to early identify functional metabolic signatures due to different neuropathological substrates, thus improving the diagnostic accuracy. Show more

Keywords: Alzheimer’s disease, corticobasal degeneration, corticobasal syndrome, FDG-PET, positron emission tomography

DOI: 10.3233/JAD-200153

Citation: Journal of Alzheimer's Disease, vol. 76, no. 2, pp. 517-528, 2020