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Unraveling Alzheimers Disease

Unraveling Alzheimers Disease

I leave absolutely nothing out! Everything that I learned about Alzheimer’s I share with you. This is the most comprehensive report on Alzheimer’s you will ever read. No stone is left unturned in this comprehensive report.

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Evidence for a Role in Alzheimers Disease

Alzheimer's disease (AD) is a progressive, often insidious, dementing disease occurring in mid- to late life. Its incidence increases with age, such that at age 85+ approximately 20 of people suffer from the condition. AD causes neurone death and a reduction in brain volume. The progression of the disease (which in most cases means approximately 7 years of intellectual and personal decline until death) cannot be arrested and eventually patients become bedridden. At this stage, concomitant bedsores, feeding difficulties, and pneumonia result in death. The etiology of nonfamilial, sporadic AD is unknown. However, cases have been attributed to head injury and environmental factors, including aluminum. Involvement of aluminum in AD has been suggested because (1) of the similar symp-tomologies of AD and dialysis dementia (2) the administration of aluminum to animals produces histological changes within the brain that are, in some respects, similar to those seen in the brains of AD patients...

Selecting the Instrumentation to Evaluate the QoL in Clients with Dementia

A key aim of the client interview (CLINT) in Care Keys is to provide a client perspective on QoL and satisfaction with services. However, people with communication difficulties, including people with cognitive impairment, are a significant group of clients who are often unable to respond to the interview format of instruments such as the PGCMS and the WHOQOL-Bref. In a study by Balcombe, Ferry, and Saweirs (2001), 46 of patients admitted to an acute care of the elderly hospital ward were excluded from taking part in a study using the PGCMS because of cognitive impairment or communication difficulties, effectively making them voiceless within the research process. Deficits in attention, orientation, memory, judgement, insight and communication may affect their ability to understand or respond to questions, or to communicate subjective states. As the Care Keys project did not want to exclude the clients with dementia, there was a need to determine valid measures to give them also a...

Neuropsychological Dysfunction in Parkinsons Disease Without Dementia

In reviewing the PD literature, Lieberman (29) reported that 17 to 53 of treated and untreated PD patients without dementia demonstrate cognitive dysfunction. Unfortunately, few of the studies reported formal criteria for determining what did or did not constitute dementia, thus making it difficult to determine whether patients were in the early stages of dementia. As noted earlier, more recent studies suggest that formal neuropsychological testing may uncover mild cognitive deficits in 25 to 36 of PD patients at the time of diagnosis (22,23). When present in early PD, cognitive dysfunction is typically mild and most commonly involves bradyphre-nia (a slowness of thought) and subtle deficits in executive functions, recall, and or visuoperceptual spatial functions (30).

Neuropsychological Dysfunction in Parkinsons Disease with Dementia

The annual incidence of clinically diagnosed dementia in PD (PDD) is about 3 for individuals younger than 60 years and 15 or less for those 80 years and older (66,67). Estimates of dementia prevalence in patients with PD vary between 9 and 93 , depending on which diagnostic criteria, ascertainment methods, and sampling methods are implemented (24). The methodologically soundest studies yield prevalence estimates of about 25 (68). Dementia is very rarely present early in the disease course moreover, dementia that precedes or accompanies the evolution of motor symptoms should raise concern that the dementia might be related to factors other than PD, for example, AD, LBD, or depression. Recently revised diagnostic criteria for LBD (69) propose that the clinical diagnostic term PD with dementia be reserved for individuals who have a clinical diagnosis of PD and have had only motor symptoms for at least 12 months before developing fluctuating cognition and other neuropsychiatric symptoms...

Mounting evidence for a BAlzheimers link

We differentiate in this chapter between true dementias, such as Alzheimer's and Pick's, and the often reversible dementia symptoms produced by B12 deficiency. Yet preliminary evidence indicates that deficient B12 levels worsen Alzheimer's symptoms, and that B12 deficiency may even play some role in causing the disease. Alzheimer's is the most common type of dementia, affecting up to one-fifth of people over eighty and hundreds of thousands of people in their fifties, sixties, and seventies. The diagnosis is confirmed only after patients' deaths, when autopsies reveal the plaques (chemical deposits) and tangles (malformed nerve cells) that are hallmarks of the disease. While patients are alive, doctors make a tentative diagnosis by excluding other causes of dementia, and using clues provided by brain scans and tests of mental functioning. Several years ago, Dr. Robert Clarke and colleagues measured the levels of B12, folate, and homocysteine in 164 patients diagnosed with Alzheimer's,...

Risk Factors for Dementia in Parkinsons Disease

TABLE 3 Risk Factors for Dementia in Parkinson's Disease Lower socioeconomic status Family history of Parkinson's dementia patients with PD on verbal fluency, attentional, and visuospatial tasks was associated with subsequent development of dementia. Woods and Tr ster (93) found that nondemented PD patients who met criteria for dementia at one-year follow-up evaluation demonstrated poorer baseline performance on measures of word-list learning and recognition, complex auditory attention, and executive function.

Pathophysiology of Dementia

There is controversy regarding which features are the primary contributors to dementia in PD. PD is characterized by cell loss in the substantia nigra pars compacta (SNc), resulting in loss of dopaminergic input into the striatum. Several pathological and functional imaging studies have shown that in PD, there is greater depletion in the lateral compartment of the SNc, which projects to the putamen, than in the medial compartment, which projects to the caudate (139-141). Cognitive impairment is associated with loss of dopaminergic projections to the caudate (142). This functional division of the striatum is, perhaps, the main reason for the predominance of motor, over cognitive symptoms in PD and is likely why dopaminergic agents do not markedly improve cognition in PD (143). A relationship between cholinergic deficiency and dementia in PD has also been reported (144). Striking cell loss is seen in the nucleus basalis of Meynert, which provides projections to the amygdala and...

Parkinsons Disease Dementia

Pathological findings considered to account for dementia in PD include severe pathology in monoaminergic and cholinergic nuclei that project to the cortex producing a subcortical dementia (39 ), coexistent Alzheimer's disease (AD) (29 ), and diffuse cortical Lewy bodies (26 ) (22). The basal forebrain cholinergic system is the subcortical region most often implicated in dementia, and neurons in this region are damaged in both AD and Lewy body dementia. Neuronal loss in the basal nucleus is consistently found in PD, especially PD with dementia (23). Cholinergic deficits are common in PD (24) and they may contribute to dementia in PD in those cases that do not have concurrent AD or cortical Lewy bodies. While virtually all PD brains have a few cortical Lewy bodies (22), they are usually neither widespread nor numerous in PD patients who were not demented. Several studies have shown, however, that cortical Lewy bodies are numerous and widespread in PD with dementia (25-27) and that the...

Guam Parkinsondementia Complex

A characteristic parkinsonism with dementia Parkinson dementia complex (PDC) with a number of features that overlap with PSP (50) has been reported in the native Chamorro population of Guam since the 1950s (51). The frequency of PDC is declining in recent years for unknown reasons, and the etiology is unknown. The gross findings in PDC are notable for cortical atrophy affecting frontal and temporal lobes, as well as atrophy of the hippocampus and the tegmentum of the rostral brainstem (52). These areas typically have neuronal loss and gliosis with many NFTs in residual neurons.

What is the most common type of dementia

It is crucial that you do not miss a delirium or a depression. In the elderly, it is not uncommon for them to report multiple memory complaints. If you misdiagnose this as dementia, you will miss a potentially reversible cause of memory impairment. Likewise, if you miss a delirium, you may miss a potentially serious medical problem. Additionally, there are several potentially reversible causes of dementia that you should look for, including neurosyphilis, vitamin B12, thiamine, and folate deficiencies, and normal pressure hydrocephalus. Alzheimer Disease (AD) represents about 50 to 60 of dementias. The second most common form is vascular dementia (formerly multi-infarct dementia) Others include front temporal (Pick and Creutzfeldt-Jakob), Parkinson, Huntington, and human immunodeficiency virus (HIV) dementias.

What is the classical clinical course for Alzheimer disease

How does this differ from the course of vascular dementia Slow, gradual onset of memory loss and cognitive impairment (often there are problems with judgment, mood symptoms, and behavioral disturbances as well). The disease is progressive and death usually occurs within 3 years after diagnosis. Vascular dementia classically has a stepwise decline, as opposed to the slow and steady decline in Alzheimer. Onset of deficits may be abrupt, and with good control of cardiovascular risk factors the course may remain relatively stable.

Homocysteine Cognitive Function and Dementia

As the relationship between homocysteine and vascular disease became increasingly apparent, researchers also addressed the hypothesis that hyper-homocysteinemia may affect cognitive function and the risk of dementia in older adults. This was based primarily on the recognized association between homocysteine and cerebrovascular disease, but also the observation that homocysteine and its metabolite, homocysteic acid, can induce excitotoxicity in neurons. Throughout the 1990s and into the new century, many cohort studies revealed significant inverse correlations between plasma homocysteine concentration and performance on a variety of cognitive function tests. Moreover, individuals with Alzheimer's disease were found to have higher plasma homocysteine than age- and gender-matched controls, while baseline homocysteine levels predicted the risk of incident dementia.

The Challenge of Dementia

The term 'dementia' is associated with a range of diseases and disorders that affect the structure and function of the brain leading to deterioration in cognitive function. Common symptoms of dementia include loss of short-term memory, reduced vocabulary (aphasia), impaired motor functions (apraxia), a failure to identify and recognise objects (agnosia), and increased difficulty with planning, ordering or abstracting tasks (American Psychiatric Association, 2000 Thomas & O'Brien, 2002). There may also be behavioural and personality changes such as emotional outbursts or mood disturbances. Symptoms in most cases are progressive and terminal, although usually a person will die from other factors, exacerbated by the dementia. In some cases dementia-like symptoms may be caused by other health problems not classified as dementia, including depression and alcohol dependency. Dementia is used as a general descriptive term for over 100 different specific illnesses and disorders. The most...

Care Keys Survey of Care and QoL of People with Dementia

One of the aims of the CareKeys survey approach (see Chapter 1) was to ensure that the instrumentation and procedures for people with dementia matched as closely as possible those for people without dementia in both homecare and institutional care settings. The general approach was identical with data collected using the CLINT, InDEX and ManDEX instrumentation.

Iipathophysiology Of Alzheimers Disease

Alzheimer's disease (AD) is the prototypical adult neurode-generative disease. It is the most common cause of dementia in the elderly. With advancing age, AD becomes epidemic it doubles in prevalence every 5 years after age 60, so that by age 95, 48 of individuals are affected (1). With lifespan lengthening in many societies in the world, an increasing number of individuals will live to confront the stark reality of this disease in themselves or someone they know (2,3). AD occurs in both sporadic and inherited forms (4). A similar disease also appears in individuals with Down syndrome (5). Clinically, AD manifests as a progressive dementia, affecting higher-order cognitive functions such as memory, attention, language, judgment, and spatial reasoning. Patients often experience depression, irritability, aggression, and delusions. With time, the disease progresses to severe impairment of cognitive function, with preservation of the

Xicurcumin Affects Alzheimers Disease

Inflammation in Alzheimer's disease (AD) patients is characterized by increased cytokines and activated microglia. Epidemiological studies suggest reduced AD risk is associated with long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs). Whereas chronic ibuprofen suppressed inflammation and plaque-related pathology in an Alzheimer transgenic APPSw mouse model (Tg2576), excessive use of NSAIDs targeting cyclooxygenase can cause gastrointestinal, liver, and renal toxicity. One alternative NSAID is curcumin, which has an extensive history as a food additive and herbal medicine in India and is also a potent polyphenolic antioxidant. Lim et al. found that curcumin reduces oxidative damage and amyloid pathology in an Alzheimer transgenic mouse model (114). To evaluate whether it could affect Alzheimer-like pathology in the APPSw mice, they tested the effect of a low (160 ppm) and a high dose of dietary curcumin (5000 ppm) on inflammation, oxidative damage, and plaque pathology. Low...

QoL in Older Persons with Dementia

A very important result of the Care Keys research certainly is that it proved to be possible and practical to include persons with dementia in the study, as demonstrated by Sixsmith, Hammond and Gibson (Chapter 10). Although severe cases were often excluded from the study by care managers and, therefore, the sample may not be representative, the study still rendered some interesting results. And it drew a lot of interest from professional carers, since this group of clients increases, and poses a great challenge to care not only in institutions. Several scales were considered and tested in pilot studies, and the QUALID scale by Weiner and associates (2000) turned out to correspond best to the theoretical framework of Care Keys (see Chapter 4), but also the PGCMS yielded a satisfying measurement of QoL for persons with mild and medium dementia. The analyses focused on two issues predictors of well-being for people with moderate to severe cognitive impairment, and differences in...

Care of Older Persons with Dementia

A key issue to consider in the quality of care for older people is the care and services provided to people with dementia. Care concepts have an impact on the way a person's needs are conceptualised and the kind of care that is provided. In the biomedical model, dementia is characterised primarily in terms of the deterioration of the brain, which in turn results in deterioration of cognitive ability and attendant decline in the person's social and personal skills. This concept of dementia has been a powerful force that has not only shaped the way dementia is defined, conceptualised and studied, but also has had a major impact on care. If dementia is seen solely as an outcome of irreversible changes in the brain, then care becomes little more than warehousing (Sixsmith, Stilwell, & Copeland, 1993), providing basic support and making the person as comfortable as possible. The pervasive nature of the biomedical model and its underlying assumptions have been reflected in, and...

Neurodegenerative diseases of the central nervous system and SDB 41 Alzheimer disease

Searching for links between Alzheimer's disease and sleep-disordered breathing has already started in the eighties. Cognitive deficits observed in individuals with SDB was seen as a preliminary stage in the development of dementia. Cognitive deficits in individuals with impaired respiratory function were found on both verbal, spatial and executive functions as well as short-term memory (Naegele, 1995 Alchanatis, 2005). A number of pathomechanisms may contribute to cognitive impairment in patients with respiratory disorders. The important part play episodes of hypoxia and subsequent oxidative stress resulting in impaired cholinergic transmission in the central nervous system (Gibson, 1981 Shimada, 1981). Another pathomechanism may be associated with changes in cerebral blood flow, observed during sleep -significant hypoperfusion after an episode of apnea. Studies using magnetic resonance spectroscopy showed a decrease in metabolism in the frontal lobes in people with severe respiratory...

Alzheimers Disease AD

A typical patient, a 75-year-old retired professor living in a senior living center, began to have difficulty finding his room when returned from meals. He kept asking What's my room number Later, he couldn't remember names, or what people had said to him 2 minutes before. He began to forget mealtimes, became less active and at times seemed agitated and depressed. He lost all self-esteem and confidence. Despite his increasing memory loss, he maintained a good spirit, but eventually began to have bad days. He could no longer to carry out activities that he enjoyed so much in the past, such as reading and listening to concerts. After several years, he lost control of his body functions, and died soon afterward. Alois Alzheimer presented a key paper to the meeting of the South West German Society of Alienists on the 3rd November 1906. He described a patient, Frau Auguste D, whom he had taken care of in 1901. She was a 51-year-old woman who had entered a mental hospital in Frankfurt,...

Alzheimers Disease

Alzheimer's is a progressive brain disease characterized by impaired memory, mood swings, confusion, and mental deterioration in how the brain receives and processes information. Symptoms include fatigue, depression, fear, aggressive behavior, restlessness, and repetitive actions. An accurate medical diagnosis is important because other diseases can have the same symptoms. The cause of Alzheimer's is unknown. Oxidative damage is part of the disease progression. Patients often have an acetylcholine deficiency. Acetyl-choline is a neurotransmitter that plays a role in cognition and reasoning. The only treatment now available for Alzheimer's is to maintain quality of life. Relaxation and deep breathing improve circulation and help memory. Ginkgo biloba has been found to increase the blood flow to the brain affecting cognitive function. High blood levels of vitamin E correlate with improved brain function in older individuals.15 Music therapy has been found to be of great benefit as other...

Dementia

Cognitive impairment is common in PD, especially in the domain of executive function (28). Such deficits are usually the earliest cognitive signs in PD (117). Patients or caregivers often report difficulties with decision making, planning, and completion of goal-directed behaviors. When these cognitive deficits worsen, and patients have impairment of occupational or social functioning, a diagnosis of dementia is made (13). At this point, it is unclear whether the presence of early cognitive deficits leads to dementia. The rate of cognitive decline in PD can be variable depending upon the population subset. A recent community-based study estimated that the mean overall annual rate of cognitive decline in PD patients was one point on the Mini-Mental State Examination (MMSE) (118). However, patients with PD and dementia declined faster, at a rate of 2.3 points, whereas PD patients who did not develop dementia progressed at the same rate as age-matched controls. Complicating the picture...

Dementia Pugilistica

An akinetic-rigid syndrome with dysarthria and dementia is sometimes a long-term outcome of repeated closed-head trauma, as seen in professional boxers. The pathology on gross examination, other than lesions that can be attributed to trauma, for example, subdural membranes and cortical contusions, is nonspecific. The substantia nigra may also show pigment loss. Microscopically, there are NFTs similar to those in AD in the brainstem monoaminergic nuclei, cortex and hippocampus and some cases also have amyloid plaques (55,56). At the electron microscopic level, they are composed of paired helical filaments and biochemically composed of 68, 64, and 60 kDa forms (57).

Effects of Alcohol on the Central Nervous System

The effects of ethanol are dose dependent (Table 9) and further intake causes agitation, slurred speech, memory loss, double vision, and loss of coordination. This may progress to depression of consciousness and loss of airway protective reflexes, with danger of aspiration, suffocation, and death.

Bioavailability of Ingested Aluminum

More precise measurements of absorption have been made using the isotope 26Al. The first reported study utilizing 26Al indicated that in the presence of excess citrate, 1 of the metal was absorbed. This result was considered consistent with the ability of citrate to complex metal ions, holding them in solution at physiological pH values, but unrepresentative because of the large amount of citrate employed. Moreover, the study estimated aluminum uptake from the results of single blood analyses, which may not provide a true measure of uptake. Later studies employing this method have indicated lower uptake values, typically 0.0005. They have also shown that some subpopulations, including those suffering from Alzheimer's disease and some 'normal' individuals, absorb more aluminum than average members of the population and that the coingestion of silicic acid inhibits aluminum absorption by a factor of approximately 3.

Deficiency Signs And Symptoms

Low serum beta-carotene and or low beta-carotene intake has also been associated with a number of clinical conditions, such as type 2 diabetes and poor glycaemic control (Abahusain et al 1999, Coudray et al 1997), non-melanoma and melanoma skin cancer (Gollnick & Siebenwirth 2002), breast cancer (Hacisevki et al 2003), rheumatoid arthritis (Kacsur et al 2002), Alzheimers dementia (Jimenez-Jimenez et al 1999) and age-related macular degeneration (Cooper et al 1999a).

What does Oxidant Stress Cause

Oxidant stress, through its effects on key biological sites and structures, is implicated in chronic noncommunicable diseases such as coronary heart disease, cancer, cataract, dementia, and stroke (Figure 4). Oxidant stress is also thought to be a key player in the aging process itself. A cause-and-effect relationship between oxidant stress and aging and disease has not been confirmed, however, and it is very unlikely that oxidant stress is the sole cause of aging and chronic degenerative disease. Nonetheless, there is evidence that oxidant stress contributes substantially to age-related physiological decline and pathological changes. Consequently, if it is accepted that oxidant stress is associated with aging and degenerative disease, then opposing oxidant stress by increasing antiox-idant defense offers a potentially effective means of delaying the deleterious effects of aging, decreasing the risk of chronic disease, and achieving functional longevity. For this reason, there has...

The Observational View of Dietary Antioxidants

Cancer and cardiovascular disease (CVD) are the two leading causes of death worldwide, diabetes mellitus is reaching epidemic proportions, and dementia and maculopathy are largely untreatable irreversible disorders that are increasingly common in our aging population. The prevalence and standardized mortality rates of these diseases vary considerably between and within populations. Mortality from CVD varies more than 10-fold amongst different populations, and incidences of specific cancers vary 20-fold or more across the globe. This enormous variation highlights the multiple factors at play in the etiology of chronic age-related diseases. These factors include smoking habit, socioeconomic status, exposure to infectious agents, cholesterol levels, certain genetic factors, and diet. Dietary factors have long been known to play an important role in determining disease risk. Indeed, 30-40 of overall cancer risk is reported to be diet-related, and there is a wealth of compelling...

Aging Memory and the Brain

Quantitative data on neuron number in aging are not yet available for all of the brain systems known to participate in LEARNING and MEMORY. However, like the hippocampus, a variety of other cortical regions also appear to maintain a normal complement of neurons during non-pathological aging. This includes dorsolateral aspects of the prefrontal cortex that participate in processing spatiotemporal attributes of memory (Peters et al. 1994), and unimodal visual areas implicated in certain forms of implicit memory function (Peters, Nigro, and McNally 1997). By contrast, aging is accompanied by substantial subcortical cell loss, particularly among neurochemically specific classes of neurons that originate ascending projections to widespread regions of the cortex. Acetylcho-line containing neurons in the basal forebrain have been studied intensively in this regard, based partly on the observation that this system is the site of profound degeneration in pathological disorders of aging such as...

Caveats in Interpreting Electrophysiologic Data in Substance Abuse Research

Similarly, even though the reductions in P300 amplitude observed during withdrawal from either heroin, cocaine or ethanol (Poijesz et al., 1987 Kouri et al., 1996 Bauer, 1997 Noldy and Carlen, 1997) are very similar to those observed in a number of psychiatric disorders including dementia (Pfefferbaum et al., 1984) schizophrenia (Roth et al., 1980), depression (Diner et al., 1985) and borderline personality disorder (Kutcher et al., 1987), this lack of diagnostic specificity of the P300 has provided important information on the similarities between acute withdrawal from drugs of abuse and these other psychiatric disorders.

Measuring Subjective QoC

For quality of home care, there was no single, validated, commonly used European scale available. A crosswalk exercise was carried out using a broad range of sources to address the domains and indicators of quality of established importance within home care, nursing care and residential care. Sources included the Picker Institute (www.pickereurope. org), SERVQUAL (Parasuraman, Zeithaml, & Berry, 1985, 1986, 1994 Parasuraman, Berry, & Zeithaml, 1988), home care satisfaction measures (Geron, Smith, Tennstedt, Sette, Chassler, & Kasten, 2000 Raynes, Temple, Glenister, & Coulthard, 2001), the CUES model (Lelliot, Beevor, Hogman, Hyslop, Lathlean, & Ward, 2001), QUOTE methodology (Sixma, van Campen, Kerssens, & Peters, 2000), Lawton's indicators of quality for dementia care services (Lawton, 2001), Urman and Urman's nursing home satisfaction indicators (1997), Duffy's study of long-term care satisfaction (Duffy, Duffy, & Kilbourne, 1997), RAI (Morris et al., 1994) and...

Micronutrients and Mental Function

Much recent work, however, has concentrated on the use of vitamins in the treatment of age-related cognitive decline and dementia and, to varying degrees, is more scientifically rigorous than the earlier work. The overwhelming majority of the experimental work has targeted the action of two

Essential Fatty Acids

There is a body of evidence suggesting that dietary supplementation with docosahexanoic acid (DHA 22 6, n-3) and arachidonic acid (AA 20 4, n-6) is effective in reducing the symptoms of clinical depression and schizophrenia. These fatty acids are also important for the development of the central nervous system in mammals. Recent work has demonstrated that maternal supplementation with these particular fatty acids during pregnancy significantly improves children's IQ at age 4 compared with children whose mothers took corn oil during pregnancy. There is no convincing evidence yet concerning the effects of essential-fatty-acid supplementation on the cognitive function of the elderly, although one study has found a correlational link between n-3 fatty-acid intake and the risk of developing Alzheimer's dementia. The proposed modes of action of these fatty acids involve their antithrom-botic and anti-inflammatory properties in addition to their being a primary component of membrane...

The Fourstage Intervention

In the second intervention, the therapist sets the safety parameters by outlining that the group will be addressing difficult issues and personal stories. Confidentiality will be expected and individual members and their stories will be respected. Sometimes a written confidentiality contract will be signed by the patients. In addition, the therapist also needs to pledge to respond honestly to situations. For example, if dementia or a loss of cognitive functioning is a possible outcome of the disease or the treatments, the therapist needs to be the one person who agrees to discuss honestly what he or she observes and not surrender to platitudes like everything is fine. Establishing safety and trust are of paramount importance in working with this population.

Ginkgo Ginkgo Bloba

Ginkgo biloba is the top-selling herb in the United States. It has been used for a variety of medical conditions including asthma, deafness, and male impotence (68). It is predominantly used currently for the treatment of dementia, memory impairment, symptomatic peripheral vascular disease, and tinnitus. It is thought to have a number of biological effects including increasing blood flow, inhibiting platelet-activating factor, altering neuronal metabolism, and working as an antioxidant (69). Its most promising use to date seems to be for the treatment of dementia. Mild improvements in cognitive performance and social functioning in patients with Alzheimer's and multi-infarct dementia were seen in one highly publicized trial that used the ginkgo extract Egb 761 (70). A systematic review of nine randomized, double-blind, placebo-controlled trials of ginkgo for the treatment of dementia similarly showed a mild but clinically significant effect in delaying cognitive decline (71). The...

Developing the Instrument for Quality of Management ManDEX

The structure of the items for evaluation of the quality of management of care and the three instruments for data collection are summarised in Table 2.1. The organisation of the data in the CK quality matrix for practical purposes is described elsewhere (Chapters 6 and 13). In addition, QUALID and Cornell Scale for Depression in Dementia were used with cognitively impaired clients.

Different Mechanisms Of Action Of Bioactive Constituents

Observed effects may be the sum total of different classes of compounds having diverse mechanisms of action. The most widely used herbal medicine in Germany and Western countries is Gingko biloba (see Chapter 7). It is prescribed for ''brain dysfunction and to improve memory and cognition. In randomized placebo-controlled trials, the herb has been shown to improve memory impairment, cognitive performance, dementia, tinnitus, and intermittent claudication (9-11). The bioactive components of gingko are believed to include flavonoids and unique diterpenes called ginkolides. Gingkolides are potent inhibitors of the actions of platelet-activating factors, which are important for platelet activation and clotting (12). In addition, gingko

Water Soluble Vitamins

Niacin (vitamin B3) is transported into brain as niacinamide, primarily via the BBB. Most niacin in brain is derived from the circulation, though brain may be able to synthesize small amounts. Niacin is taken up into neurons and glia and rapidly converted to nicotinamide adenine dinucleotide. The half-life of nicotinamide adenine dinucleotide in brain is considerably longer than in other tissues. Nicotinamide adenine dinucleotide and nicotin-amide adenine dinucleotide phosphate are involved in numerous oxidation-reduction reactions. Dietary niacin deficiency in the presence of a low intake of TRP causes pellagra in humans, a deficiency disease that includes mental depression and dementia, loss of motor coordination, and tremor. The mecha-nism(s) for these effects have not been identified.

Neuropsychological Findings In Parkinsons Disease

Parkinson (20) contended that patients with shaking palsy did not exhibit significant intellectual changes however, by the late 1800s, investigators had begun to recognize the presence of cognitive deficits in patients with PD (21). Mild neuropsychological changes are widely accepted to occur in early PD. Increasingly, it is recognized that cognitive alterations, especially in executive functions and or memory, may already be present at the time of disease diagnosis. Recent studies estimate that one-quarter to one-third of patients may have deficits detectable on careful neuropsychological testing at the time of disease diagnosis (22,23). Cognitive declines early in the disease most often include deficient information processing speed, visuospatial abilities, verbal fluency, recall, and executive functions (24,25). The neuropsychological dysfunction associated with early PD is hypothesized to reflect nigrostriatal dopamine depletion and disruption of mesocortical and mesolimbic...

Effects on the Central Nervous System

Epidemiology and laboratory studies suggest beneficial effects of caffeine consumption in the development of Parkinson's disease and the mechanisms involved may be mediated through adenosine A2A receptors. The role of these receptors in neuronal injury and degeneration, as well as in other diseases such as Alzheimer's disease, has important therapeutic potential but needs further investigation.

Summary of the Care Keys Instrumentation

QUALID and Cornell Scale for Depression in Dementia are internationally validated scales to collect data from third-party observers on QoL of persons with dementia. 5. With the decision to include dementia clients, the pilot research highlighted the need to collect information from relatives, and the RELINFO instrument was created for this.

Issues Of Diversity Culture And The Needs Of Older People With Learning Disabilities

Deterioration in both physiological and mental health can be a feature of older age. Some conditions associated with age can be more prevalent for people with learning disabilities adults with Down's syndrome, cardiovascular disease and problems with thyroid function, for example, have some potential physiological health implications, as well as a higher risk of early-onset dementia or Alzheimer's disease (Moss & Lee, in Thompson & Pickering 2001). As carers and students involved in supporting people, you need to be aware of this potential, and ensure that you are informed of the signs and symptoms to look for, and from whom to seek appropriate help and support for the individual.

The long darkness when low b12 destroys the mind

This is the tragic pattern of dementia, a relentless decline in memory and mental ability. Striking more than five million Americans, dementia turns victims' golden years into years of torment, devastates families emotionally and financially, transforms loving spouses and children into exhausted full-time caretakers, and fills America's nursing homes with sad, bewildered patients with no hope of recovery. If you're dealing with someone suffering from dementia, you know the pain of watching a vibrant individual become a different person one who becomes agitated, inconsolably sad, paranoid, or even violent or hateful. You know the agony of watching a friend or relative stare at you vacantly, wondering who you are. And you know the guilt of hoping for a loved one to die, because dying is preferable to the slow and inexorable loss of self that dementia causes. But what you may not know is that dementia isn't always incurable even when doctors say it is. As neurologist Sydney Walker III,...

Transduction of the Brain

Stable, long-term transgene expression, in the absence of tox-icity, is critical for the use of gene therapy to treat central nervous system (CNS) structural and functional deficits, such as aging-related memory loss, Parkinson's disease, Alzheimer's disease, or amyotrophic lateral sclerosis. Zou et al. (85) compared the efficiency, toxicity, and persistence of HDAd and FGAd vector-mediated gene transfer into the CNS of 20-month-old rats. An FG Ad vector or an HDAd-expressing p-galactosidase (5 X 108 particles) was stereotactically injected into the hippocampus or lateral ventricle. Transgene expression peaked 6 days postinjection for both vectors. In the hippocampus, transgene expression from the FGAd decreased rapidly after day 6, being significantly lower than HDAd-injected hippocampus by day 16, and undetectable by day 183. In the ventricle, transgene expression from FGAd was significantly lower than HDAd by day 33 and undetectable by day 66. In contrast, transgene expression from...

Neuropsychological Aspects Of Parkinsonplus Syndromes And Essential Tremor

TABLE 4 Comparison of Neurobehavioral Features of Parkinson's Disease with Dementia, Lewy Body Dementia, Corticobasal Degeneration, Progressive Supranuclear Palsy, and Multiple System Atrophy TABLE 4 Comparison of Neurobehavioral Features of Parkinson's Disease with Dementia, Lewy Body Dementia, Corticobasal Degeneration, Progressive Supranuclear Palsy, and Multiple System Atrophy Abbreviations 0, impairment absent -, mild to moderate impairment --, moderate to severe impairment , questionable PDD, Parkinson's disease with dementia LBD, Lewy body dementia CBD, corticobasal degeneration PSP, progressive supranuclear palsy MSA, multiple system atrophy. Abbreviations 0, impairment absent -, mild to moderate impairment --, moderate to severe impairment , questionable PDD, Parkinson's disease with dementia LBD, Lewy body dementia CBD, corticobasal degeneration PSP, progressive supranuclear palsy MSA, multiple system atrophy.

Progressive Supranuclear Palsy

Prevalence rates of dementia in PSP range from 50 to 80 , but some authors contend that these numbers reflect over-diagnosis due to bradyphrenia, emotional problems, and visual dysfunction that accompany PSP. Cognitive deficits are seen in approximately 50 of patients with PSP (172), with the neuropsychological profile being typical of diseases with subcortical involvement, including slowed information processing, executive dysfunction, and information retrieval deficits (173). As compared to patients with PD, cognitive slowing and executive dysfunction in PSP emerges earlier in the disease course, is more severe, and progresses more rapidly (174-177), and this differential executive dysfunction may reflect radiographically demonstrated differences in frontal atrophy between the two conditions (178). Executive dysfunction in PSP may also differ qualitatively from that in PD (179). Memory and attention are relatively intact in PSP, although retrieval deficits and accelerated rates of...

Multiple System Atrophies

The MSA nomenclature subsumes several different diseases, including olivoponto-cerebellar atrophy (OPCA), striatonigral degeneration (SND), and Shy-Drager syndrome (SDS). Cognitive deficits are relatively mild in most forms of MSA, and dementia is not a common feature of these conditions (183), except perhaps in OPCA, in which 40 to 60 of patients may develop dementia, which is more prevalent in familial forms of the disease (184). Mild executive and memory deficits have been reported in MSA (SND and SDS) (185), but are considered to be of similar severity

Corticobasal Degeneration

The prevalence of cognitive impairment and or dementia in CBD is not established. Neuropsychological functions appear to be relatively preserved in the early stages of CBD, at least within an average of five years of diagnosis (188), with dementia emerging as a more common feature later in the disease course (189). Although the neuropsychological profile of CBD reveals both cortical and subcortical features (190), it is possible to differentiate CBD from AD and PSP (176,191). The neuropsychological profile associated with CBD is marked by significant executive dysfunction, which is comparable in severity to PSP, but relatively milder than is observed in patients with AD. Also evident in CBD is asymmetric apraxia (not evident in PSP or AD), alienhand sign (not reported in PSP or AD), impairment in motor programming and speed (similar to PSP but unlike AD), attentional dysfunction, and deficits in verbal fluency (comparable to AD). When aphasia is present it is most often of the...

Allocating Clients to Cognition Groups

Table 3.6 indicates that 407 clients had a completed Dementia QoL measure (at least partly) and 917 clients had (at least partly) at least one of the instruments measuring QoL of people with normal cognition. These instruments were not completed, or inadequately completed for 248 clients (16.7 ) and both were completed for 52 clients (3.4 ). Subsequently, all cases were divided into three files Normal HC, Normal IC and Dementia based on instruments used 3. Dementia InDEX (IC or HC), DementiaQL, ManDEX.

Neutral Cues Cocaine Cues

Other studies of the dopaminergic system have also been performed. Wu et al. (1997) measured striatal 6- 18F fluorodopa uptake (an index of presynaptic dopaminergic activity) in abstinent cocaine addicts. They found that in early abstinence (1-10 d), striatal dopamine nerve terminal function in addicts was similar to that in controls, although in later abstinence (11-30 d) it was significantly reduced (Wu et al., 1997). This would imply that dopaminergic dysfunction develops with prolonged abstinence. Volkow et al. assessed the capacity for abstinent cocaine-dependent subjects to increase synaptic dopamine by using PET to assess binding of a competitive postsynaptic dopamine D2 receptor ligand, 11C raclopride, in association with iv injection of methylphenidate. Striatal dopamine release and methylphenidate high were impaired in the addicts relative to controls. However, thalamic dopamine release was slightly augmented in the addicts. These findings raise the issue of the relative...

Brain Function in Adults

In some patients with Alzheimer's disease, choline or phosphatidylcholine has beneficial effects, but this effect is variable. Both verbal and visual memory may be impaired in other patients who require long-term intravenous feeding and this may be improved with choline supplementation.

Indications Horseradish

Abrasion (f HOO) Allergy (f1 LIB PED) Alzheimer's (1 COX X15231456) Anorexia (f APA DEM) Arthrosis (f1 APA BGB CAN COX X15231456) Asthma (f1 BGB DEM FNF) Atony (f FEL) Bacillus (1 X10548758) Bacteria (12 HHB HH2 KOM X17260672 X10548758) Bronchosis (f12 APA PHR PH2 SKY X16618018) Bruise (f HOO) Cancer (1 FNF JLH) Cancer, abdomen (f1 FNF JLH) Cancer, breast (f1 FNF) Cancer, colon (f1 FNF JLH X15231456) Cancer, liver (f1 FNF JLH) Cancer, nose (f1 FNF JLH) Cancer, spleen (f1 FNF JLH) Cancer, stomach (f1 FNF JLH) Cancer, skin (f1 FNF JLH WO2) Catarrh (1 KOM PHR X17260672) Chilblain (f GMH) Cholecystosis (f PHR PH2) Cold (f1 DEM SKY) Colic (f APA PH2) Congestion (f1 APA) Cough (f12 GMH PHR PH2) Cramp (f1 HHB WIN) Cystosis (1 LIB PHR) Debility (f BOW) Dental Plaque (f FAD) Diabetes (f DEM LIB) Dropsy (f FEL GMH HHB) Dysmenorrhea (f DEM) Dyspepsia (f PHR PH2 SKY) Dysuria (CAN PED fi PHR) Edema (f BGB CAN) Enterosis (1 PH2 WO2) Epistaxis (f HOO) Escherichia (1 HH2 X17260672 X10548758) Fever (f...

Diagnosis of Cobalamin Deficiency

Cobalamin deficiency is suspected in individuals who display the typical manifestations of deficiency of the vitamin as described in the section above on the effects of deficiency. In addition to the symptoms that may be experienced by individuals that are related to anemia (easy fatigue, shortness of breath, palpitations) and neuropathy (sensory and motor disturbances and memory loss) there are features that may be detected by a physician, including skin pallor (from anemia), abnormalities in neurological examination (sensory loss, abnormal balance and reflexes, mental changes), and epithelial changes (skin pigmentation, smooth tongue). On the basis of any combination of such changes, cobalamin

Wernicke and Korsakoffs Syndromes

The anatomical change most widely associated with the Wernicke-Korsakoff syndrome is mamillary body atrophy (Fig. 5). This abnormality has been suggested to be a basis for differential diagnosis of alcoholic and nonalcoholic forms of dementia (Charness and DeLaPaz, 1987 Bigler et al., 1989 Squire et al., 1990). However, mamillary body abnormalities are absent in some Korsakoff's cases (Welch et al., 1996 Matsuda et al., 1997) but are present in alcoholics who do not have the Wernicke-Korsakoff syndrome and who are not memory impaired (Davila et al., 1994).

Screening experiments for antiinflammatory properties

This chapter describes some examples of screening experiments aimed at identifying antiinflammatory constituents of plants. A large number of plants and herbs are known for their anti-inflammatory properties. Well-known examples are willow bark (contains salicin, from which aspirin is derived), Boswellia serrata (boswellic acids) and turmeric (curcumin). In addition to these, many other herbs have been suggested to be anti-inflammatory. Inflammation plays a role in many different clinical disorders. In addition to the obvious inflammatory diseases such as arthritis, asthma, Crohn's disease, psoriasis and so on, inflammation also plays an important role in diseases such as atherosclerosis, diabetes, Alzheimer's and many other diseases. In many of these, a disordered immune system contributes to the onset and or progression of the disease.

Effect of Tea Polyphenols on ROS and Aging

Premature agingmay also be a result of cellular ROS (114-116). The green tea polyphenol epigallocatechin gallate inhibited the markers for ROS and nitrogen species (116-118). It can be concluded that regular intake of 6 or more cups of tea per day facilitates healthy aging, which has been demonstrated on cellular systems, in animal models, and also, through studies of humans where regular tea intake is part of a health-promoting lifestyle, as in Japan and India (119). In that part of the world, one does find populations at advanced ages in good health, and a lower incidence of Alzheimer's disease in the aged (120-124).

Pathophysiology of Psychosis and Risk Factors

The presence of dementia, advancing age, impaired vision, depression, sleep disorders, and longer disease duration have all been associated with the development of drug-induced psychosis (15,45-48). Although psychosis has been reported to occur with all of the antiparkinsonian medications (22-25), the dopamine agonists are more likely to cause psychosis than levodopa (49,50). The duration or dose of antiparkinsonian drug therapy, however, has not been found to be associated with an increased risk for psychosis (45,51,52).

Applications To Health Promotion And Disease Prevention

Elettaria cardamomum seed extract is one of the ingredients of the polyherbal formulation for treating the dementia of Alzheimer's disease (Aaishwarya et al., 2005).The extract is also used in herbal combinations utilized in the treatment of anxiety, tension, and insomnia (Prema-latha & Rajgopal, 2005). An in vivo study of an ayurvedic formulation containing cardamom as one of the ingredients shows that the formulation has CNS-depressant and anticonvulsant activity in mice (Achliya et al., 2004). A multi-ingredient herbal formulation with Elettaria cardamomum as one of the ingredients is found to be useful in the treatment of sore throats (Prakash, 2001). Cardamom is one of the ingredients of a Tibetan herbal formulation that was found to inhibit cell proliferation accompanied by the accumulation of CEM-C7H2 cells in subGl phase, fragmentation of poly (ADP-ribose) polymerase (PARP), and nuclear body formation (Jenny et al., 2005). The volatile oils from Elettaria cardamomum are...

Atypical Antipsychotics

Atypical antipsychotics are typically used to treat psychosis in PD. Table 1 provides a summary of atypical antipsychotic studies in PD. The United States Food and Drug Administration (FDA) recently asked all atypical antipsychotic manufacturers to add a boxed warning to their product labels, saying that atypical antipsychotics, when used in elderly patients with dementia, were associated with a higher risk of mortality (54). However, since the deaths were primarily due to cardiovascular or infectious causes, it is unclear how the atypical antipsychotics cause increased mortality. Since psychosis can be difficult to treat in PD, it is likely that these agents will continue to be utilized until a direct cause and effect relationship is uncovered. In terms of long-term efficacy and safety, a retrospective analysis of 39 parkin-sonian patients on a mean dose of 47mg d of clozapine for 60 months showed that 85 had continued response to the medication, whereas 13 had complete resolution of...

Cholinesterase Inhibitors

Fabbrini et al. (104) administered donepezil (5 mg qhs) to eight nondemented PD patients with visual hallucinations, with or without delusions. At the end of two months, subjects had decreased PPRS scores with hallucinations and paranoid ideation, being the most responsive. However, two patients experienced clinically significant motor decline. Another small open-label study enrolled six patients with PD, dementia, and psychotic symptoms and treated them with 10 mg d of donepezil (105). Five patients showed moderate-to-significant improvement in psychosis and one showed minimal improvement. None had worsening of motor symptoms. Finally, Kurita et al. (106) reported three PD patients who had improvement of visual hallucinations with 5 mg d of donepezil without worsening of motor function, but one patient had treatment emergent delusions that resolved, after donepezil was discontinued. Only one placebo-controlled trial of donepezil has been reported for PD psychosis (107). This was a...

Biological Proofs Of Efficacy

Alzheimer's disease To these ubiquitous effects we can add some that are much more specific, revealed by numerous studies, especially in vivo, in various pathophysiolog-ical models. For example, EGb 761 acts in vivo in models of various nervous system diseases Alzheimer's disease (transgenic mice overexpressing a histo-pathological mutation of amyloid precursor protein), amyotrophic lateral sclerosis (transgenic mice expressing a harmful mutation to the superoxide dismutase gene, SOD1), Parkinson's disease (animals exposed to MPTP), stroke, head trauma, etc. EGb 761 also acts against cardiovascular disease, affecting various models of arrhythmia, myocardial ischemia and hypoxia, cerebral edema, etc. (12,14,15). Finally, several clinical studies have confirmed its effect in the corresponding human diseases. These studies, as well as experimental research, justify expansive, large-scale prospective studies to determine whether EGb 761, which is associated with a lower prevalence of...

An Adaptive Effect

The effect of EGb 761 on the cerebral metabolism exemplifies another of these adaptive mechanisms. EGb 761 promotes oxygen and glucose consumption in the brains of animals in ischemic situations (40), but, inversely, facilitates metabolic economy in healthy subjects (41). PET imaging studies in humans have shown that the most gifted subjects tend to expend only a limited amount of brain energy for a given task compared with other individuals (42), and, inversely, that individuals with dementia use more energy than normal subjects (43). Economical energy metabolism is thus essential for optimal brain operations.

Incidence Prevalence and Risk Factors

Estimates of incidence and prevalence of dementia in PD vary widely because of different definitions, methods of ascertainment, and study designs. Prevalence rates of dementia in hospital- or clinic-based cohort studies range from 11 to 22 (123-125), whereas population-based estimates are somewhat higher, ranging from 18 to 44 (9,126-129), perhaps reflecting referral bias. A recent systematic review of the literature estimated that the prevalence of dementia in PD ranges from 25 to 31 (130). This review also found that dementia in PD accounted for 3 to 4 of the total dementia population. Incidence rates for PD dementia range from 4 to 11 per year, with a relative risk for the development of dementia in PD of 2 to 6 (12,129,131-133). Age and severity of extrapyramidal symptoms were associated with an overall risk of developing dementia. One study demonstrated that age and severity of disease by themselves were not associated with a greater risk of dementia, but the combination of these...

Neuropsychiatric Disorder Genetics

Which chromosome has three copies in Down syndrome, and is also implicated in some cases of Alzheimer disease What other chromosome(s) have been identified to be associated with Alzheimer disease Which gene has been implicated in many cases of Alzheimer disease Alzheimer disease Chromosome 21 Note Down syndrome patients often develop early-onset Alzheimer.

Other Pharmacologic Agents

Few other pharmacologic strategies for specifically treating dementia in PD have even been reported. Because noradrenergic depletion could contribute to executive dysfunction in PD, Bedard et al. (170) conducted a trial of naphtoxazine (SDZ-NVI-085), a selective noradrenergic alpha 1 agonist, versus placebo in nondemented patients with PD. The results of the study demonstrated improved performance on tasks of set-shifting and cognitive flexibility, such as the Stroop and Odd-Man-Out tests. Furthermore, specific evoked potentials (Nd1 and Nd2 curves), thought to reflect attentional processes and known to be affected in PD, were improved with naphtoxazine. Memantine, an N-methyl-D-aspartate antagonist, has been approved for AD but to date there are no published studies of memantine for PD dementia. Estrogen replacement therapy (ERT) may be a reasonable protective strategy for the development of dementia in women who have PD. The effect of ERT on the risk of development of dementia was...

Substance Abuse And Other Complications

A variety of organic brain syndromes, including DELIRIUM and dementia are associated with acute and chronic use of drugs and alcohol. Abrupt WITHDRAWAL from alcohol or sedative-hypnotic drugs can cause withdrawal delirium (DTs). These organic effects from drug use must be carefully separated from the psychiatric conditions discussed earlier, and from neurologic conditions which can overlap their symptoms. The impact of chronic drug use and personality is an area in need of further study. Acquired Immunodeficiency Syndrome (AIDS). Intravenous drug use, needle sharing, and high-risk sexual practices among drug users are major risk factors for AIDS. Psychiatric manifestations of AIDS may present in a number of ways, including mood disorders, dementia, psychosis, and behavioral impairment. Suicide risk among AIDS victims is high. In evaluating the substance abuser with neuropsychiatric changes, HIV testing should be completed and treatment for AIDS should...

Alcohol Chronic Effects

Many investigators recognize a more severe and global impairment in mental functioning that is different from both the ''typical'' picture of chronic alcoholic brain dysfunction and from WKS. This is generally referred to as alcoholic dementia, to underscore the severe and global nature of the cognitive deficits. However, it is not known whether alcoholic dementia exists as a separate pathological entity, which represents the end point of chronic alcoholism in some older individuals, or is an extension of WKS to other brain regions and cognitive domains. Some research at the end of the 1990s suggested that alcoholic dementia may be a more severe form of WKS. There is no clear set of clinical diagnostic or neuropathological criteria for alcoholic dementia. However, a relatively high prevalence of alcohol-related dementias among residents of several long-term care institutions in northern Ontario were found. In that study, 24 percent of cognitively impaired residents fit this diagnostic...

Indications Frankincense

Abscess (f HAD) Alzheimer's (1 COX FNF) Anxiety (f BOW) Arthrosis (1 COX FNF) Asthma (f1 HHB X12244881) Backache (f HAD) Bilharzia (f BIB) Bleeding (f BIB HAD) Boil (f DEP) Bronchosis (f1 BIB DEP X12244881) Bruise (f HAD) Callus (f BIB) Cancer (1 COX FNF JLH) Cancer, anus (1 BIB COX) Cancer, breast (1 BIB COX) Cancer, eye (1 BIB COX) Cancer, penis (1 BIB COX) Cancer, spleen (1 BIB COX) Cancer, teat (1 BIB COX) Cancer, testicle (1 BIB COX) Carbuncle (f DEP JLH) Cerebrosis (1 X12244881) Chest ache (f BIB) Colitis (1 FNF X12244881) Congestant (f HAD) Corn (f JLH) Cough (f HAD) Crohn's Diseases (1 X12244881) Dermatosis (f GMH) Dysentery (f BIB) Dysmenorrhea (f BOW) Dyspepsia (f HAD) Edema (1 FNF) Fever (f BIB) Gingivosis (f BOW) Gonorrhea (f BIB) Hemorrhoid (f HAD) Hepatosis (1 PR14 510) Infection (f BOW) Laryngitis (f BIB DEP) Leprosy (f BIB) Leukemia (1 FNF) Mastosis (f GHA JLH) Meningioma (1 FNF) Myelosis (f HAD) Neurosis (f BIB GHA HAD) Ophthalmia (f GHA JLH) Orchosis (f JLH) Pain (f...

Clinical Vignettes

A 41-year-old Down syndrome patient has had a gradual deterioration in cognitive functioning. Lately, she has been unable to remember her home address, and her daughter has noticed that she has difficulty remembering names of people she has known throughout the duration of her life. Her primary care physician diagnoses her with Alzheimer disease. Which chromosome has been implicated in Alzheimer disease in Down syndrome patients

Parkinsons Disease Diagnosis Accuracy

Prevalence studies of parkinsonism suggest a diagnostic accuracy of 80 after examination and application of clinical diagnostic criteria (49-51). Long-term clinico-pathologic studies evaluating the diagnostic accuracy of PD demonstrate that the diagnoses most commonly mistaken for PD are progressive supranuclear palsy (PSP) and multiple system atrophy (MSA) (52,53). However, early in the course of PD, the most common misdiagnoses include essential tremor, vascular parkinsonism, drug-induced parkinsonism, and Alzheimer's disease (54,55). It has been estimated that the diagnosis is incorrect in as many as 35 of those initially diagnosed as PD by generalists (56). In addition, symptoms of parkinsonism are relatively common in elderly subjects, making the diagnosis most challenging in this population. Subtle extrapyramidal signs on neurological evaluation are common in the elderly with recorded prevalences of 32 (57) and 35 (58). Prevalence estimates for clinically evident parkinsonism in...

Communication and Negotiation of Care Content and Goals

Considering the meaning of care relatedness as referring to the processes of communication and negotiation of care content and goals, there is a growing body of literature emphasising the importance of the autonomy of the client of strengthening his or her capacities for self-help, and of involvement in the decision-making process in care, even in the case of dementia care (Adams & Gardiner, 2005 Kitwood & Bredin, 1992 Owen & NCHRDF, 2006 Secker, Hill, Villeneau, & Parkman, 2003 Tanner, 2001). The person's involvement in the decision-making process on the level of care, on the management level and even on a social policy level (if only through representatives) can have a major impact on the way services are evaluated by the person (satisfaction with services) and in terms of a sense of well-being (Owen & NCHRDF, 2006). Although much of the policy on older people emphasises the promotion of independence, research literature suggests that older people are less likely than...

Violence and Aggression

A better understanding of brain chemistry and its relation to behavior may facilitate addressing these societal factors. We can try to find out the influence of brain chemistry in producing violent behavior. We can detect regional biochemical difference in the brain between patients with depression and dementia (Fig 6.8). In Parkinson's disease, there is degeneration of neurons in the substantia nigra. DA is deficient in the basal ganglia, especially the putamen, but also in the caudate nucleus. Administration of the DA precursor, L- dopa, to patients with Parkinson's disease increases DA synthesis, decreasing their difficulty in moving and stiffness, a striking example of how therapy can be based on detecting molecular abnormalities. Dopaminergic neurons in the frontal lobes are also involved in Parkinson's disease, resulting in difficulty in memory, attention, and problem solving. This shows how there is no clear-cut boundary between Parkinson's disease, and Alzheimer's disease....

The Speech Therapist ST

The ST is a communications expert who can also evaluate cognitive difficulties such as fibro-fog and differentiate them from cognitive deficits related to dementia, post-stroke, or head trauma. FM patients often report great distress about their perceived cognitive decline, so the ability to improve cognitive function is typically welcomed as life-enhancing. The ST will recommend a variety of nonpharmacologic strategies to maximize cognitive abilities and provide mental exercises to help enhance memory. Some of these strategies include establishing easily recalled routines, placing reminder notes, forming memory associations, decreasing multitasking, and reducing distractions.

Pharmacological Uses of Vitamin E

Been some suggestions that Alzheimer's disease maybe as well (Sun and Chen, 1998 Grundman, 2000). The neurological damage associated with Down's syndrome (trisomy 21) may also be related to radical damage the gene for superoxide dismutase is on chromosome 21, and overexpression in mice is associated with increased lipid peroxidation in the brain, apparently as a result of increased formation of hydrogen peroxide. However, controlled trials show no beneficial effects of vitamin E supplementation in any of these conditions (Shoulson, 1998 Tabet et al., 2000).

Neurological Effects

Cognitive function Low serum DHA level is considered a significant risk factor for the development of Alzheimer's dementia (Conquer et al 2000). Additionally, both DHA and total n-3 fatty acid levels are significantly lower in cognitively impaired but non-demented people and people with other dementias. One of the first interventional studies was a small RCT of 4.3 g day DHA in 20 elderly nursing home residents, assessing the efficacy of fish oil in the treatment of vascular dementia. DHA supplementation resulted in a small improvement in dementia rating scores within 3 months of treatment (Terano et al 1994). Alzheimer's dementia A 2003 prospective study conducted with a random sample of 81 5 older volunteers (aged 65-94 years) who initially were unaffected by Alzheimer's dementia (AD) found that consumption of fish once weekly was associated with a 60 reduced risk of developing the disease compared with those who rarely or never ate fish, after adjustment for age and other risk...

Complications And Prognosis

Herpes simplex encephalitis accounts for 10 to 20 of all cases of acute necrotizing encephalitis in the United States. The condition most often occurs after primary infection and, as has been suggested, by reinfection with a different strain of HSV-1. Herpes simplex encephalitis produces nonspecific findings headache, meningeal irritation, altered mental status, and seizures. In affected patients, magnetic resonance imaging (MRI) often shows focal necrosis of the temporal and orbital frontal region. This necrosis causes symptoms of anosmia, memory loss, and olfactory hallucinations. PCR imaging is the most sensitive noninvasive method of showing HSV-1 DNA. Untreated patients have an estimated mortality rate of 70 . Even with treatment, patients with herpes simplex encephalitis have a high incidence of neurological sequelae (6).

What are the side effects of Sinemet

Some of the side effects are not entirely side effects of Sinemet. Some (wearing off or on-off) result from progression of PD and the short duration of action of Sinemet some (dystonia, freezing) can be symptoms of PD (unrelated to drugs) or a side effect of Sinemet some (dyskinesia) are side effects of Sinemet and some (psychosis) are the effects of Sinemet and dopamine agonists temporarily unmasking an underlying dementia. Psychosis. Hallucinations, delusions (believing things that don't exist are real) confusion, daytime drowsiness, nighttime insomnia, agitation, obsessions and compulsions including obsessive interest in sex, eating, gambling, and shopping occurs in people on PD drugs (see Question 55). The people are usually older, 70 plus years of age, and may be incubating a dementia. Amantadine, the anticholinergic drugs, selegiline, the dopamine agonists, and Sinemet, in that order, may unmask the underlying dementia. The psychosis may be decreased by stopping or decreasing...

Antiinflammatory Aspects of n3 Fatty Acids

Earlier studies in rodents showed that ALA intake improved learning, memory and cognition. In Zell-weger's syndrome (a genetic neurodegenerative disease) high amounts of DHA early in life decreased somewhat the rate of progression of the disease. A number of studies have suggested that people who eat a diet rich in fish are less likely to develop Alzheimer's disease. Learning and memory depend on dendritic spine action assembly and DHA. High DHA consumption is associated with reduced risk for Alzheimer's disease, yet mechanisms and therapeutic potential remain elusive. In an Alzheimer's disease mouse model, reduction of dietaty n-3 fatty acid resulted in 80 -90 losses of the p85 alpha subunit of phosphoinositol 3-kinase and the postsy-naptic action-regulating protein drebrin as in the brain of patients with Alzheimer's disease. The loss of postsynaptic proteins was associated with increased oxidation without concomitant neuron or presynaptic protein loss. Treatment of the n-3 fatty...

Adverse Effects And Reactions Allergies And Toxicity

Guadeloupe (French West Indies), such patients account for two-thirds of all cases of parkinsonism, compared to approximately 30 of atypical forms in European countries. They display a combination of movement disorders and dementia, the disease being thoroughly characterized. Autopsies performed in three patients revealed accumulation of neuronal Tau-fibrils (see references cited in Camuzat et al., 2008 Champy et al., 2009). ACGs were identified as candidate toxins using PC12 cells (unpublished data), as confirmed for annonacin (3) in mesencephalic primary cultures. In striatal primary cultures, ACGs induced ATP loss, Tau hyperphosphorylation and redistribution, microtubular disruption, and cell death at low nanomolar concentrations (Table 51.2 Hollerhage et al., 2009).

Electroconvulsive Therapy

For some individuals, medications and therapy may be less helpful for treating their symptoms of bipolar disorder. In such cases, doctors sometimes prescribe electroconvulsive therapy (ECT), a medical treatment that involves sending a low-level electric current through the brain for about one minute to induce a small seizure. This is commonly conducted in a hospital under the care of physicians. ECT is usually tried when other treatments don't work, and it can be especially helpful for those experiencing severe depression. Researchers don't fully understand why this treatment works, but it seems to help balance mood and decrease mood symptoms. It is also used to treat acute mania and usually results in rapid improvements without the side effects associated with taking mood stabilizing medications. However, short-term memory loss may occur, which usually lasts only a few short weeks after treatment. If you are interested in learning more about the benefits and side effects of ECT, talk...

Neurotoxicantinduced Models Of Parkinsons Disease 6Hydroxydopamine

A distinctive behavioral feature of the unilateral lesioned model is rotation (12,13). This motor feature is due to asymmetry in dopaminergic neurotransmission between the lesioned and intact sides. Specifically, animals rotate away from the side of greater dopaminergic activity. Nomenclature describes the direction of rotation as either ipsilateral (toward) or contralateral (away) to the lesioned side. Initial reports of rotation examined both spontaneous and pharmacologically induced rotation. Spontaneous rotation consists of ipsilateral rotation, whereas pharmacologically induced rotation may be either contralateral or ipsilateral. For example, apomor-phine and other dopamine agonists induce contralateral rotation. This is due to their direct action on super-sensitized dopaminergic receptors on the lesioned side. Conversely, d-amphetamine phenylisopropylamine (AMPH) induces ipsilateral rotation by blocking dopamine re-uptake and increasing dopamine receptor activity on the...

Methyl4Phenyl1236Tetrahydropyridine

The MPTP-lesioned mouse model has proven valuable to investigate potential mechanisms of neurotoxic-induced dopaminergic cell death. For example, mechanisms under investigation have included mitochondrial dysfunction, energy (ATP) depletion, free-radical production, apoptosis, and glutamate excitotoxicity (51). In addition to its utility in studying acute cell death, the MPTP-lesioned model also provides an opportunity to study injury-induced neuroplasticity. The MPTP-lesioned mouse displays the return of striatal dopamine several weeks to months after lesion-ing (45,47,59,60). The molecular mechanism of this neuroplasticity of the injured basal ganglia is an area of investigation in our laboratory and in others, and appears to encompass both neurochemical and morphological components. In addition, it has been shown that this plasticity may be facilitated through activity-dependent processes using treadmill training (61,62). The administration of MPTP through a number of different...

Description Of Intervention

In the support group, the facilitator's role at first was somewhat open ended. The laissez faire leadership was problematic. The group was chaotic, members did not listen to one another, and there was yelling, absenteeism, and a high drop-out rate. The leader recognized members' cognitive difficulties such as short attention span, memory loss, and difficulty modulating affect. The leader decided to change the structure from a Type 4 to a Type 2 group. The leader set down specific requirements for participation in a pregroup interview and in the group. The group contract included being on time, putting thoughts and feelings into words, taking turns, and regular attendance. In the group the leader took on brain executive functions such

Transgenic Mouse Models

A review of the transgene construction parameters (species and or mutant forms), promoter selection (neuron or glia specific), and gene and protein expression patterns or levels demonstrates a high degree of variability in the resulting trans-genic strains. Some transgenic mouse lines show neurochemical or pathological changes in dopaminergic neurons (including inclusions, decreased striatal dopamine, and loss of striatal tyrosine hydroxylase immunoreactivity) and behavioral deficits (rotarod and attenuation of dopamine-dependent locomotor response to amphetamine), whereas other lines show no deficits. No group has reported the specific loss of substantia nigra dopaminergic neurons despite inclusion pathology or cell death in other areas of the brain. This range of results with different alpha-synuclein constructs from different laboratories underscores the important link between protein expression (mutant vs. wild-type alleles) and pathological and behavioral outcome. Important...

Tauopathies Including Progressive Supranuclear Palsy and Other Tau Related Disorders

The low molecular weight microtubule-associated protein tau has been implicated in a number of neurodegenerative diseases, including Alzheimer's disease, PSP, Pick's disease, frontotemporal dementia with parkinsonism (FTDP), and amyotrophic lateral sclerosis parkinsonism-dementia complex (ALS PDC) of Guam. Together these neurodegenerative diseases are referred to as tauopathies since they share common neuropathological features, including abnormal hyper-phosphorylation and filamentous accumulation of aggregated tau proteins (224). Reports have implicated either alternative RNA splicing (generating different isoforms) or missense mutations as mechanisms underlying many of the tauopathies. Therefore, transgenic mice have been generated that over-express specific splice variants or missense mutation

Organophosphorus compounds

Acute effects of sublethal doses of organopho-sphates in man include sweating, salivation, abdominal cramps, vomiting, muscular weakness, and breathing difficulties. Concern has also been expressed about long-term effects following acute exposure. Research suggests that some victims may show reductions in some neurobehavioral tests when tested some months after exposure. There are also concerns that people who do not appear to have suffered acute poisoning have subsequently developed debilitating illnesses. Symptoms include extreme exhaustion, mood changes, memory loss, depression, and severe muscle weakness.

Evaluation Of Kindreds

Eleven monogenetic PARK loci have been identified (Table 1). The PARK4 locus was reclassified because it shares the same gene (SNCA a-synuclein) as the PARK1 locus (34). The PARK9 locus has been described in the Kufor-Rakeb kindred, with affected family members having atypical parkinsonism associated with dementia, spasticity, and supranuclear palsy (35). Mutations in six genes have been implicated in parkinsonism SNCA (PARK1) in 1997 (34), parkin (PARK2) in 1998 (36), UCHL1 (PARK5) in 1998 (37), DJ-1 (PARK7) in 2001 (38), PINK (PARK6) in 2004 (39), and LRRK2 (PARK8) in 2004 (40,41). Additional PARK loci and contributing genes are likely to be identified through family studies, ultimately facilitating a molecular rather than a clinico-pathologic diagnosis. Mutations in genes implicated in parkinsonism have already been used to create in vivo models. These gene mutations can recapitulate the pathogenesis as well as the symptoms of disease, and they may provide powerful insight into...

Monitoring Mental Activity

Oxygen-15 water and F-18 deoxyglucose ( 18F-FDG) studies of global and regional brain activity help direct attention to activated regions of the brain, which can then be the focus for the study of specific neurochemical processes, such as neurotransmission. The patterns of the abnormalities of neuronal activity in the brain help differentiate benign forgetfulness from mild cognitive impairment (MCI), Pick's disease, or Alzheimer's disease (senile dementia of the Alzheimer type). Elderly subjects who suffered from dementia improved their communication skills and motor function by participating in a program of mathematical and reading-out-loud exercises (Yuta Kawashima,Tohoku University, Japan). The mental exercise program called Learning Therapy has been published. The Nintendo Co. has developed a training video

Special Syndromes Associated with Alcoholism

J., Kaye, W. H., Ebert, M. H., Weingartner, H. and Gillin, J. C., Sleep EEG in Korsakoff's psychosis and Alzheimer's disease. Neurology 36 411-414, 1986. Blackwood, D. H., St. Clair, D. M., Blackburn, I. M. and Tyrer, G. M., Cognitive brain potentials and psychological deficits in Alzheimer's dementia and Korsakoff's amnesic syndrome. Psychol. Med. 17 349-358, 1987.

Quality Management in Ltc A Summary

Management will find itself in different organisational and legal contexts and has to adapt its strategies appropriately. In larger organisations, the focus will be more on improving and integrating services within the organisation, although integration with external services grows in importance whereas in smaller services the manager will have a networking role in order to ensure that a comprehensive set of services is in place for frail older people with typically complex and diverse needs. The tasks and influence of management will also vary with the service setting. In home care, the services will cover only part of the life situation of the client, and cooperation with, and support by, informal care and other community services is an inherent part of home care services. In institutional care, the influence of management is stronger, but there is also an increased obligation to create a home-like setting and a community of care that respects the nature of the care triad in the...

Dangers Of Inhalant Abuse

As reported in the Texas study, the solvent toluene is identified frequently in inhalant-abuse deaths and injuries because it is a common component of many paints, lacquers, glues, inks, and cleaning fluids. A 1986 study of twenty chronic abusers of toluene-containing spray paints found that after one month of abstinence from sniffing the paint, 65 percent of the abusers had damage to the nervous system. Such damage can lead to impaired perception, reasoning, and memory, as well as defective muscular coordination and, eventually, dementia.

Electroconvulsive Therapy ECT

ECT (formerly known as electric shock therapy) is one of the oldest and most effective treatments for major depression. ECT also has some efficacy in refractory mania and in psychoses with prominent mood components or catatonia. ECr appears to work via the induction of generalized seizure activity in the brain. The peripheral manifestations of seizuie activity aie blocked by the use of paralytics, and memory for the event is blocked by the use of anesthetics and by seizure activity. Modern ECT produces short-term memory loss and confusion. Bilateral ECT is more effective than unilateral ECT but produces more cognitive side effects.

The Postprandial Syndrome

Symptoms wax and wane during middle life but often remit completely for years or may never recur. They are not progressive and never cause severe neurological dysfunction such as coma, psychosis, or dementia. Hypoglycemia cannot be demonstrated during spontaneous symptomatic episodes in most people with the postprandial syndrome and some other explanation should be sought for them.

Fat Craving Snack Food

Trans fat is vegetable oil that has been heated and hydrogen added. This fat was developed in volume to lower cholesterol levels but in actuality it raises the LDL cholesterol and lowers the HDL cholesterol. You cannot fool mother nature. Trans fat is incorporated into cell membranes causing the cells to become hardened. The metabolism of other fat pathways are sabotaged with trans fat snack food consumption for up to 102 days. ADHD, depression, Alzheimer's, and pain can all result because of trans fat. But don't overdo safflower or sunflower oil for snacks either. Even though they are not trans fat and are healthier, over-consuming these oils can result in pain.

Motor Fluctuations And Dyskinesia Definitions

There is a loss of 50 to 60 of nigrostriatal neurons or a reduction in striatal dopamine concentrations of approximately 70 associated with the onset of clinical symptoms of PD (24). The surviving neurons can initially compensate with increased dopamine synthesis, but subsequently, with continued disease progression and neuronal loss, these mechanisms fail. What follows is the loss of the ability of nigrostri-atal neurons to store and release dopamine appropriately, followed by postsynaptic changes, both of which lead to a fluctuating response to levodopa (25). Glial cells can also convert levodopa to dopamine, but they lack the machinery for appropriate regulation (23). Hence, levodopa therapy leads to a substantial release of dopamine in the synapse in a pulsatile fashion. The levels of dopamine have been shown to be four-fold higher in the striatum of lesioned animals compared to normal, suggesting that a large pulse occurs in the synapse with oral medications in advanced disease...

Clinical Trials Of Levodopa

The initial therapeutic studies of levodopa in PD were carried out in the 1960s and early 1970s. The subjects were of varying disease durations, some quite advanced with dementia, and standard measures such as the Unified Parkinson's Disease Rating Scale (UPDRS) were not yet devised however, the results were dramatic (3). In 1967, Cotzias et al. (11) demonstrated the definitive effectiveness of high-dose Many studies followed which supported these findings (13,42-44). An example is that by Sweet and McDowell (45) who studied 100 patients treated for up to five years in an open-label fashion. Forty-seven of them completed the whole five years. All signs of PD improved remarkably by six months (60 of patients were more than 50 improved) and despite worsening over the next 4.5 years, the Cornell-weighted scores remained significantly better than baseline. The severity of parkinsonian features at initiation of therapy had little bearing on the ultimate response. Positive results were...

Does Tolerance Develop to Levodopa

Followed the same predictable course of progression independent of the duration of levodopa therapy. This was confirmed after 12 years of follow-up of the first group (119,120). The authors concluded that levodopa works at all stages of PD, does not result in tolerance over time but does not stop progression of disease. In other words, changes in disability of PD are related to the duration of disease and not the duration of therapy or tolerance to levodopa. Aside from progression of disease, another cause of the apparent loss of efficacy relates to narrowing of the therapeutic window, resulting in increased sensitivity to adverse effects such as dyskinesia and hallucinations (64,65). The worsening of disease also comes from the onset and progression of symptoms not attributable to dopamine systems, such as postural instability, freezing, and dementia (65,121).

Memory Animal Studies

The midline diencephalon is another brain area important for memory, although less is known about which specific structures in this region contribute to memory function. Findings from work in animals, including the development of an animal model of alcoholic Korsakoff's syndrome in the rat (Mair et al., 1992), have been consistent with the anatomical findings from human amnesia in showing the importance of damage within the medial thalamus, especially damage in the internal medullary lamina, for producing memory loss. Lesions in the internal medullary lamina would be expected to disconnect or damage several thalamic nuclei, including intralaminar nuclei, the mediodorsal nucleus, and the anterior nucleus (Aggleton and Mishkin 1983 Mair et al. 1991 Zola-Morgan and Squire 1985). However, the separate contributions to memory of the mediodorsal nucleus, the anterior nucleus, and the intralaminar nuclei remain to be explored systematically with well-circumscribed lesions in animals.

Baby Boomers and Nutritional Supplements

Informed, prosperous, and health-conscious, the baby boomers are known as a generation that plans to fight vigorously against the encroachments of age. During the 1990s, as the boomers began reaching their fifties, they increasingly turned to supplements to ward off osteoporosis, memory loss, and a host of other ailments. With increased demand, the vitamins, minerals, and herbs they sought migrated from health food stores to mass merchandisers. Between 1997 and 2002 the supplement industry experienced a 34 percent jump in sales, to more than 19 billion annually.

Levodopa And Homocysteine

An evolving concern with levodopa therapy relates to its association with elevated homocysteine (HC) levels. Since the late 1990s, several studies have indicated that levodopa dose correlates with elevation of HC. Postuma and Lang (131) reviewed this literature, and the relevance of the increase of HC to PD and patient health remains unclear. The concern relates to data suggesting that elevated HC levels increase the risk of stroke, coronary artery disease, and dementia (132-134). HC is metabolized from dietary methionine through two intermediates SAM (s-adenosylmethionine) and SAH (s-adenosylhomocysteine). HC is metabolized back to methionine via methylene tetrahydrofolate reductase (MTHFR) or to cysteine via other mechanisms. These enzymatic reactions occur in the presence of folate and vitamins B12 and B6. Hence, deficiency of any of these could lead to elevated HC. This is true for the presence of the C677T MTHFR polymorphism, which decreases metabolism of HC. In PD, it is the...