American Journal of Alzheimer's Disease and Other Dementias
How Statins Could Be Evaluated Successfully in Clinical Trials for Alzheimer's Disease?
Over the last decade, a large number of experimental observations have suggested a relationship between alterations in cholesterol homeostasis and Alzheimer’s disease (AD). Moreover, epidemiological studies have pointed an association between statin treatment and a decrease in the risk of having AD. For these reasons, a large number of clinical trials have been carried out to determine whether the statins can prevent the progression of AD. However, these studies did not provide clear evidence for the therapeutic efficacy in AD. We consider that there are a number of explanations for this failure that may provide guidance for selecting and clinically developing statins with therapeutic efficacy in AD.
A Clinical Approach to Early-Onset Inheritable Dementia
Early-onset dementia, presenting before age 65 years, is increasingly recognized. It is often difficult to diagnose, since non-Alzheimer’s etiologies and unusual dementias are common. These conditions are more commonly genetic, and important potentially inherited causes of early-onset dementia include early-onset Alzheimer’s disease, frontotemporal dementia, Kufs’ disease, and Niemann-Pick disease type C. For each of these diseases, this review provides information on common clinical presentations, etiology, pathophysiology, and current and experimental treatments. A discussion of the diagnosis and workup for early-onset dementia is included with an emphasis on conditions that may have other involved family members.
Conditions Associated With Wandering in People With Dementia From the Viewpoint of Self-Awareness: Five Case Reports
The conditions associated with wandering in people with dementia include purposeless activity, purposeful actions, irritation, and symptoms of depression. The words and actions of 5 people admitted to long-term health care facilities who often exhibited wandering behavior were observed, and the above conditions were studied based on our self-awareness model (consisting of "theory of mind," "self-evaluation," and "self-consciousness"). One person who had not passed the theory of mind task but had passed the self-evaluation task was aware of her wandering. However, she could not understand where she wanted to go or for what purpose. Four persons who had not passed the self-evaluation tasks were not aware of their wandering and had no purpose for their wandering.
Which Cholinesterase Inhibitor is the Safest for the Heart in Elderly Patients With Alzheimer's Disease?
Objective: Cholinesterase inhibitors (ChEIs) are widely used for the treatment of Alzheimer’s disease (AD); however, their cholinergic side effects on the cardiovascular system are still unclear. In this study, we aimed to examine the side effects caused by donepezil, rivastigmine, and galantamine on cardiac rhythm and postural blood pressure changes in elderly patients with AD. Methods: Of 204 consecutive elderly patients who were newly diagnosed with AD, 162 were enrolled and underwent comprehensive geriatric assessments. The electrocardiographs (ECGs) and blood pressures were recorded at the baseline and 4 weeks after the dose of 10 mg/d of donepezil, 10 cm2/d of rivastigmine, and 24 mg/d of galantamine. Results: There were no changes relative to the baseline in any of the ECG parameters or arterial blood pressure with any of the administered ChEIs. Conclusion: It was demonstrated that none of the 3 ChEIs were associated with increased negative chronotropic, arrhythmogenic, and hypotensive effects for the elderly patients with AD.
Predicting Current Memory With the Modified Telephone Interview for Cognitive Status
The modified Telephone Interview for Cognitive Status (mTICS) is a commonly used screening tool for categorizing mental status of older adults. Recently, prediction equations have been developed to estimate performance on an in-person memory composite based on the mTICS; however, these equations need validation. The current study compared predicted memory functioning based on these equations with observed memory functioning in 101 community-dwelling older adults. Observed and predicted memory composites were comparable for 2 of 6 equations (mTICS total score and immediate recall item), indicating that these equations adequately predict observed memory scores. The predicted memory composite based on the total score was also most highly correlated with the observed memory composite. These results further validate the mTICS, as well as some of the prediction equations, and continue to point out this measure as an efficient tool for screening of cognitive functioning in later life.