Stop Memory Loss Naturally

Super Memory Formula

After the harsh reality that the doctor had to face his son ending his life, he suffered a major irreversible memory loss disease. This caused him to fall into depression and depend on the drugs from the pharma which was devasting for his mental and physical health and on so many other levels. After countless hours of research and experimentation, he realized that the root of all problems of memory loss was an enzyme that eats away the memory cells when the person gets older. This makes the person forget their loved ones, family and friends as if they have never met them. In some cases, they even forget about their past experiences, if they had children, how they came to the place they are in right now and who they are in the first place. This was exactly what the doctor had in his future if he did not make a decision. But he did and met with great people who helped him find the cure. This was a groundbreaking study that no one wanted to believe or endorse because it would go against the large pharma industry. However, the information is in there to protect yourself and your loved ones from such a devastating experience. You only need to follow the link and you will be guided to get the information downloaded to your device and follow the all-natural ways to get rid of memory loss. Read more here...

Super Memory Formula Summary


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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...

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

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 reinforced...

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,...

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...

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.

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...

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...

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.

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...

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...

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...


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).

Aging Memory and the Brain

Memory is not a unitary function but instead encompasses a variety of dissociable processes mediated by distinct brain systems. Explicit or declarative memory refers to the conscious recollection of facts and events, and is known to critically depend on a system of anatomically related structures that includes the HIPPOCAMPUS and adjacent cortical regions in the medial temporal lobe. This domain of function contrasts with a broad class of memory processes involving the tuning or biasing of behavior as a result of experience. A distinguishing feature of these implicit or nondeclarative forms of memory is that they do not rely on conscious access to information about the episodes that produced learning. Thus, implicit memory proceeds normally independent of the medial temporal lobe structures damaged in amnesia. Although many important issues remain to be resolved concerning the organization of multiple memory systems in the brain, this background of information has enabled substantial...

Peter Rapp References

Flood. (1987). Neuron numbers and dendritic extent in normal aging and Alzheimer's disease. Neurobiology of Aging 8(6) 521-545. Peters, A., D. L. Rosene, M. B. Moss, T. L. Kemper, C. R. Abraham, J. Tigges, and M. S. Albert. (1996). Neurobiological bases of age-related cognitive decline in the rhesus monkey. Journal of Neuropathology and Experimental Neurology 55 861-874.

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 the American Health...

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.

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.

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.

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).

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).

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...

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.

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...

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 other groups...

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.

Progressive Supranuclear Palsy

PSP is an atypical parkinsonian disorder associated with progressive axial rigidity, vertical gaze palsy, dysarthria and dysphagia first described by Steele-Richard-son-Olszewski (35). Frontal lobe syndrome and subcortical dementia are present in some cases. In contrast to PD, gross examination of the brain often has distinctive features. Most cases have varying degrees of frontal atrophy that may involve the precentral gyrus. The midbrain, especially the midbrain tectum, and to a lesser extent the pons, shows atrophy. The third ventricle and aqueduct of Sylvius may be dilated. The substantia nigra shows loss of pigment, whereas the locus ceruleus is often better preserved. The subthalamic nucleus is smaller than expected and may have a gray discoloration. The superior cerebellar peduncle and the hilus of the cere-bellar dentate nucleus are usually atrophic and have a gray color due to myelinated fiber loss (36). Microscopic findings include neuronal loss, gliosis and NFTs affecting...

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).

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

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

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...

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.

Clinical Vignettes

A 79-year-old African American woman has dementia. Her son has heard about the genetic basis for Alzheimer disease and is worried about his risk of developing the disease. Looking over her chart you see that she was high functioning 10 years prior and then first suddenly became rather mildly cognitively impaired about 7 years ago. She continued at that level until 5 years ago when she developed significant memory problems and needed some part-time help at home. Two years ago she again got worse and required assisted living. What do you tell her son about his risks of Alzheimer disease His risk is the same as the normal population. The patient's history with a stepwise decline is suggestive of vascular dementia, not AD.

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...

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.

Violence and Serotonin

Each parent passes to his or her offspring either a short or a long version of this gene. The short version encodes less efficient transporters. People who inherit one (or two) of these short forms suffer from anxiety. The aggressiveness of some patients with Alzheimer's disease may also be related to these mutations.

Are Older People Less Likely To Misplace Things

Even if a difference between older and younger people had been found, it could be that the difference was not caused by age per se, but by disease. In a sample of older people, there will tend to be a few who have a physical illness that burdens them, or who are suffering from some form of dementia. These conditions are more common among older people. If a few unwell people in the older group are more likely to lose things, then that will raise the average figure for the group. However, the resulting difference between the older and younger groups would not be caused by a direct effect of age on memory.

Cognitive Dysfunction

Cognitive dysfunction, sometimes called fibro-fog, is common and highly distressing in FM. Cognitive changes include difficulty with short-term recall, speed of thought processing, verbal fluency, and multitasking under distraction. There is evidence that these deficits are consistent with healthy persons who are at least twenty years older than the person with FM. There is no evidence that fibro-fog will progress into dementia, Alzheimer's, or Parkinson's disease. Nonetheless, cognitive declines do interfere with the ability to remain gainfully employed at a level consistent with education. Loss of full-time employment often means significant income reduction that is often followed by a lack of health insurance.

Special Syndromes Associated with Alcoholism

Sharp, P., Gemmell, H., Cherryman, G., Besson, J., Crawford, J. and Smith, F., Application of iodine-123-labeled isopropylamphetamine imaging to the study of dementia. J. Nucl. Med. 27 761-768, 1986. Hunter, R., McLuskie, R., Wyper, D., Patterson, J., Christie, J. E., Brooks, D. N., McCulloch, J., Fink, G. and Goodwin, G. M., The pattern of function-related regional cerebral blood flow investigated by single photon emission tomography with 99mTc-HMPAO in patients with presenile Alzheimer's disease and Korsakoff's psychosis. Psychol. Med. 19 847-855, 1989. Pappata, S., Chabriat, H., Levasseur, M., Legault-Demare, F. and Baron, J. C., Marchiafava-Bignami disease with dementia severe cerebral metabolic depression revealed by PET. J. Neural. Transm. Park. Dis. Dement. Sect. 8 131-137, 1994. Case Report

Huntingtons Disease

Huntington's disease (HD) is a fully penetrant genetic neurodegenerative disorder that is inherited as an autosomal dominant mutation of the HD gene (136). Affected individuals begin to exhibit symptoms in the third to fifth decade of life with some cases of juvenile (under 20 years old) and late onset (over 65 years old) (137,138). Clinical manifestations of the disease include progressive chorea, emotional disturbances, and dementia. Neuropathological features of HD include an extensive loss of neurons and astrogliosis in the striatum, primarily the caudate nucleus. Histologically, intracellular inclusions consisting of ubiquitinated polyglutamine aggregates have been found in neurons of the striatum and other less affected areas such as neocortex.

Neurological Evidence On Concepts

A second noteworthy finding is the way in which knowledge about superordinate concepts seems to be less susceptible to damage than more subordinate information (Warrington, 1975). Warrington (1975 see also Coughlan & Warrington, 1978) studied a patient, EM, also with a dementing illness, using a forced-choice decision task that is, the patient was given a question like Is cabbage an animal, a plant, or an inanimate object or Is cabbage green, brown, or grey and had to choose one of the alternatives. It was discovered that EM was only wrong in 2 of cases on the former type of question but was wrong 28 of the time on the latter type of question. The point being that more subordinate attribute information about the cabbage concept was lost, even though the superordinate classification of a cabbage as a plant was retained (although see Rapp & Caramazza, 1989, for a challenge to this finding). Similar evidence has been found by Martin and Fedio (1983) in the naming errors made by...

Methodology of the Study

While the subjective 'perceived quality of life' is arguably the most important from the clients' perspective, at the same time it poses the greatest challenge to meaningful assessment of persons with severe dementia. In CareKeys a specific aim was to incorporate the 'voice' of people with dementia into the assessment of crQoL. As noted in Chapter 2, the key approaches adopted in Care Keys were self-reports and proxy accounts. Chapters 2 and 3 provide detailed accounts of the approach and methodology adopted in the Care Keys survey. This section provides a brief overview of aspects of methods as they are specifically related to people with dementia.

Acute Administration

F., Yokoi, F., Stephane, M., Rice, K. C., Matecka, D., Clough, D. J., Dannals, R. F. and Rothman, R. B., GBR12909 attenuates amphetamine-induced striatal dopamine release as measured by (11)C raclopride continuous infusion PET scans. Synapse 33 268-273, 1999. Nonhuman Primate

Chronic Administration

L., Garada, B., Johnson, K. A., Mendelson, J. H., Hallgring, E., Teoh, S. K., Worth, J. and Navia, B., A comparison of brain perfusion SPECT in cocaine abuse and AIDS dementia complex. J. Nucl. Med. 33 1312-1315, 1992. Volkow, N. D., Wang, G. J., Fowler, J. S., Logan, J., Gatley, S. J., Hitzemann, R., Chen, A. D., Dewey, S. L. and Pappas, N., Decreased striatal dopaminergic responsiveness in detoxified cocaine-dependent subjects. Nature 386 830-833, 1997.

Third Party Informants

Point scales to measure aspects such as appearance of sadness, discomfort, vocalising discontent, irritability and enjoyment of contact and activities. A sum score of responses indicates relative well-being in a range 11-65, with lower scores representing higher QoL. The Cornell Scale for Depression in Dementia (Alexopoulos, Abrams, Young, & Shamoian, 1988) is answered by the relative or care person who knows the client well. Three-point scales are used to measure items such as mood, behavioural disturbance, physical signs, cyclic functions and ideational disturbance. A sum score indicates overall depression with scores also for the different sub-components. An evaluation of the quality of care provided to the client was also elicited using the Relative's Information questionnaire of Care Keys (RELinfo), adapted from the client satisfaction questions in the CLINT.

Considering a Patient for a Surgical Procedure

By the time of referral to a surgical program, most patients will have late stage disease, possibly with cognitive or active psychiatric symptoms. Patients with moderate or significant cognitive decline may have less benefit from surgery and may further decompensate postoperatively (24,32). It should be recognized by the patient, family, and carers that their benefit risk ratio is lower than in a cognitively intact patient. Centers should obtain formal neuropsychometric testing prior to surgery and utilize these results in considering surgical candidacy. Psychiatric symptoms (hypomania, depression, suicide, or impulse control disorders) can be aggravated or induced by functional neurosurgery (33). Patients referred for surgical consideration are usually referred in the knowledge that they have an absence of dementia or active psychiatric symptoms, and yet a recent review revealed that the presence of depression (60 ), anxiety (40 ), and psychosis (35 ) with 23 of the 40 patients...

As the Twig Is Bent the Tree Will Grow

Wind has the strength to shape trees. Besides Alzheimer's, one of the biggest concerns among individuals is acquiring the bent forward position, like grandma developed when she aged. To improve posture and back strength, we use the Ball Exercise (see Figure 5). I have had patients tell me that they literally grew two inches using this exercise.

Pharmacological Management of Undernutrition

Dronabinol (delta-9-tetrahydrocannabinol), the active ingredient of Cannabis sativa, is another FDA-approved orexigenic agent for use in patients with Acquired Immune Deficiency Syndrome (AIDS). Dronabinol is also an effective orexigenic and antiemetic in patients receiving cancer chemotherapy. Additional evidence indicates that dronabinol induces weight gain in persons with dementia, although research has yet to determine whether weight gain in such patients is due to increased energy intake or reduced agitation with improved behavior and consequently decreased energy expenditure. Side effects of dronabinol in older adults include delirium, euphoria, and increased somnolence. The latter two qualities may favor the use of dronabinol as an orexigenic agent in palliative care.

Psychiatric Disorders

Severe cognitive deficits (memory loss) are a frequent complication of chronic Alcoholism. Low brain levels of serotonin may be a factor in this type of memory loss. Fluvoxamine, a serotonin-uptake inhibitor, improved episodic memory in patients with alcohol amnestic disorder. This might greatly facilitate success in cognitively oriented treatments for alcoholism.

Ferrari L Cravello M Bonacina F Salmoiraghi and F Magri

Abstract Dementia is a relatively well-defined condition characterized by a progressive decline of cognitive and performances, as a consequence of degenerative and or vascular brain changes. In this chapter, we examine particularly the evidence for a link between dementia and HPA activity on the basis of the data in the literature as well as of our personal findings. Likewise to other age-related diseases, dementia is a clinical condition characterized by increasing prevalence and incidence, due to both the improved diagnostic tools and the significant increase of life expectancy. Indeed, due to its increased prevalence with age, especially till 80-85 years, senile dementia may be defined as an age-related disease, but it seems not to be caused by the aging process itself, being not an inevitable feature of aging (Ritchie and Kildea, 1995). Among the different types of dementia, the most common is certainly Alzheimer's disease (AD), amounting for 50-80 of all causes (Lobo et al,...

Bioassays For Activity

All major pharmaceutical companies employ highly specific bioassay systems to test partially or completely purified compounds for anticancer, antiviral (e.g., anti-AIDS virus), anti-heart disease, anti-Alzheimer's disease, and antineuro-logical disease activities. Most of these bioassay systems involve enzyme-linked reaction systems that are specific to the particular disease syndrome being tested. The assays utilize 80-well plates, dose-response assays for the compound of interest, and robotics to carry out all chemical additions (enzymes, substrates, and different concentrations of the compound being tested). The system at Parke-Davis Warner-Lambert Pharmaceutical Research Laboratories in Ann Arbor, MI utilizes three robots to do these tasks. It operates 24 h d, 7 d week and requires very little human input except to set up the initial programs and to collect the final data. If a compound proves to be active, and is not a false positive , it is considered to be a positive hit ....

Patient Selection For Pallidal And Subthalamic Deep Brain Stimulation

Patients older than 75 years are generally not considered candidates as they may have difficulty in tolerating the procedure and the programming. Patients should have been tried on combinations of different antiparkinsonian medications and evaluated by a movement disorder specialist, if possible, before being recommended for surgery. Patients with disabling medication resistant tremor or an inability to tolerate antiparkinsonian medications may also be candidates for STN or GPi DBS. There should be no evidence of dementia or significant cognitive, psychiatric or behavioral abnormalities as these can worsen after surgery. To rule these out, patients should undergo detailed neuropsychological testing. There should be no significant abnormalities on neuroimaging and no other medical conditions that might increase surgical risk. Finally, the patient should have an adequate support network and be able to attend multiple visits to the surgical site for programming.

The Cholinergic System in AD

The classic pathological hallmarks of AD are the formation of neurofibrillary tangles and amyloid-containing neuritic plaques. These changes can occur without clinical dementia, and they are not good independent predictors of the severity of dementia. Although cell loss in AD eventually becomes widespread and involves multiple neurotransmitter populations, cholinergic cell death in particular correlates with the clinical disease and degree of synaptic loss (14). The basal forebrain nuclei are the most prominently affected. These include the nucleus basalis of Meynert (NBM), the medial septal nuclei, and the vertical limb of the diagonal band. The connections of these nuclei with the cortex are widespread (Fig. 1). Evidence of the importance of the cholinergic system in AD is supported by the observation that cholinergic antagonists can reproduce or exacerbate the symptoms of the disease, while cholinergic agonists improve the symptoms of AD (15). Clinical and experimental lesions in...

Aetiology of mental fatigue

Interleukin-1 (IL-1) crosses the blood-brain barrier, with the highest rate of entry occurring in the hypothalamus (Dantzer et al. 1992). The hypothalamus has rich connections with the brainstem, frontal cortex, and limbic system. IL-1 and its receptors are found in many areas of the brain. IL-1 messenger RNA is found in abundance in the hippocampus (Dantzer et al. 1992), a critical structure for memory processes. IL-1P depresses the influx of calcium into hippocampus neurons, which may explain the preponderance of memory impairment in patients with IL-1-associated toxicity (Plata-Salaman and Ffrench-Mullen 1992). TNF is also neurotoxic, and is associated with demyelination in the brain (Ellison and Merchant 1991). TNF and IL-1 are synergisti-cally toxic (Waage and Espevik 1988) and are associated with the development of multiple sclerosis plaques and gliosis (Wollman et al. 1992). Patients with Alzheimer's disease have elevated levels of IL-6 (Huberman et al. 1995). We have found...

Goals for Stem Cell Transplantation

Finally, and most importantly, transplantation of these cells would have to result in the substantial improvement or reversal of the symptoms of PD. Loss of dopaminergic neurons is associated with bradykinesia, rigidity, postural instability, and tremor. These symptoms might be expected to improve with stem cell transplantation. However, additional nondopaminergic symptoms such as dementia, autonomic dysfunction, depression, and sleep disturbance would likely remain. Furthermore, stem cell therapies should not produce disabling dopamine-associated side effects, such as troubling dyskinesia. As with any invasive or complex therapy, serious consideration will have to be given to cost relative to changes in patient quality of life. Despite these substantial challenges, several different stem cell types have been considered and studied.

Acute Alcohol Withdrawal

ALZHEIMER'S DEMENTIA Although promising overall, a 2001 Cochrane review stated that it is still not possible to draw any conclusions about the effectiveness of thiamine supplementation in AD (Rodriguez-Martin et al 2001). In practice, it is often used as part of a broad-spectrum approach with other B-group vitamins in age-related cognitive decline however, further research is required to determine whether this method produces more consistent results.

Dopamine Synthesis Gene Therapy

Or dopamine, thereby avoiding side effects of systemic drug delivery. To this end, several groups have designed therapies that deliver, via a viral carrier, genes in the dopamine biosynthetic pathway. The first reports in the early 1990s relied on the implantation of exogenously modified fibroblasts. These cells were harvested, amplified, and then genetically modified to produce enzymes such as tyrosine hydroxylase. Reimplantation resulted in an increase in striatal dopamine levels in rodent models (83-85). Studies have been extended to primate models as well. An early study demonstrated the feasibility of transfecting tyrosine hydroxylase and AADC to produce dopamine in the primate striatum but showed no significant behavioral changes (93). Later, Matsumura et al. demonstrated that AAV transmission of tyrosine hydroxylase, AADC, and GTP-CHI in primates produced substantial improvements in manual dexterity tasks and resulted in increased striatal dopamine levels relative to the...

Agents To Improve Cognitive Function

Chronic heavy drinking can lead to impairment of most cognitive functions, including abstract thinking, problem solving, concept shifting, psychomotor performance, and memory. The two most common diseases of cognitive impairment in alcoholism are alcoholic amnestic disorder (Wernicke-Korsakoff syndrome) and alcoholic dementia. Alcoholic amnestic disorder is associated with prolonged and heavy use of alcohol and is characterized by severe memory problems. Though the exact cause is unknown, this disease is thought to be preventable by proper diet, including vitamins, particularly the B vitamin thiamine. The other impairment, alcoholic dementia, has a gradual onset and thus displays various degrees of cognitive impairment, including difficulties in short-term and long-term memory, abstract thinking, intellectual abilities, judgment, and other higher cortical functions. Most studies indicate that alcoholics with impaired cognitive function will have poorer treatment outcome. This, of...

Late Life Depression and Mania

Among the elderly when compared to younger adults. There are few studies on the prevalence of mania in the elderly. Retrospective studies generally have found that the number of new cases of mania and the prevalence of mania in the population decrease, although there is evidence to contradict this belief 2 . The diagnosis of mania in the elderly is confounded by the overlap of manic symptoms with other syndromes that occur in the elderly, as dementia, confusional states, and delirium. Pure mania as a part of a bipolar disorder is rather rare. This may be the result of premature death of patients with bipolar disorders due to suicide or cardiovascular disease. It may, however, also reflect age-related differences in symptom presentation of both depression and mania in the elderly. In the elderly it is obvious that the ageing process and neurodegenerative disorders are important risk factors for syndromes of depression and mania. In patients with Alzheimer's dementia (AD) 25 also fulfil...

Face Validity of MAssTD

Special attention from the users was received by the MAssT-D, the variant of the MAssT tool specifically for clients with dementia or other cognitive impairment. In general, users welcomed the move to include this client group, given their increasing numbers within the care system and the lack of appropriate instruments to include their perspectives. Doubts were expressed concerning the interview with the client's relatives for MAssT-D with a version of CLINT (RELINFO) adapted for this purpose to include especially scales on the perceived quality of care. For various reasons in the relative's history with the client, they might not always be an independent and trustworthy source of information on the client. To summarise the users' opinions, the MAssT-D with the inclusion of QUALID measuring client's quality of life as observed by carers was seen as having the potential not only to monitor and improve the well-being of people with dementia, but also to educate care staff and to draw...

Strategic Evaluation and Monitoring of Care Processes

Care documentation systems (when in place) are mainly used to monitor care itself, not for the evaluation of care. The MAssT module provides a tool for the professional carer by supporting care planning, monitoring and evaluation at regular intervals. Target efficiency and costs can easily be related to a set of quality criteria or to the documented compliance with care standards. A consistent profile of quality dimensions makes it possible to evaluate the comprehensiveness of care and care outcomes. This can be done for the individual client and for relevant groups of clients, for example all clients of a given carer, or all clients with diagnosed dementia. In particular, the aggregated information can be used in staff meetings or team sessions where the intention is to improve practice. The smilies illustrate the results and help in forming a more comprehensive picture of the performance and identifying problems. The standard elements of MAssT give also structures for the...

When do I look for a nursing home

No one wants to go to a convalescent or nursing home, and no one wants to send his or her partner or parent to one. But there comes a time when it is impossible to lift and turn a PD patient, impossible to bathe or clean up after him or her, impossible to get a good night's sleep to prepare to do it all over again for another day, and even more impossible to care for him or her if the patient has developed dementia. Everyone has heard the horror stories about nursing home care, but living at home without proper care is a horror story, too. In a convalescent home, there are strong people to help bathe the patient, hot food and help to feed the patient, people to get the patient up out of bed and clean up behind him her, and even social activities. And the care is given 24 hours a day, 7 days a week. So the decision to place a parent or partner in a nursing home must be seen as an opportunity to provide better care for the patient, to make his or her life a bit more comfortable.

The American Dietetic Association ADA

A new category of foods, functional foods, has recently appeared. This category includes a large number of herbal-enriched products that make a variety of structure function claims. Examples include cereal fortified with ginkgo biloba, which is marketed as reducing symptoms of dementia and juice fortified with echinacea, marketed for boosting the immune system.

Chronic Disease Prevention

Importantly, vitamin E's potential role in preventing or ameliorating chronic diseases associated with oxidative stress leads us to ask whether vitamin E supplements might be beneficial. For many vitamins, when 'excess' amounts are consumed, they are excreted and provide no added benefits. Antioxidant nutrients may, however, be different. Heart disease and stroke, cancer, chronic inflammation, impaired immune function, Alzheimer's disease - a case can be made for the role of oxygen free radicals in the etiology of all of these disorders, and even in aging itself. Do antioxidant nutrients counteract the effects of free radicals and thereby ameliorate these disorders And, if so, do large antioxidant supplements have beneficial effects beyond 'required' amounts The 2000 Food and Nutrition Board and Institute of Medicine DRI Report on Vitamin C, Vitamin E, Selenium, and Carotenoids stated that there was insufficient proof to warrant advocating supplementation with antioxidants. But, they...

Diseases Epidemiological Evidence

Among the most common neurologic diseases are neurodegenerative disorders such as Alzheimer's and Parkinson's disease, which may be caused by oxida-tive stress and mitochondrial dysfunction leading to progressive neural death. An increasing number of studies show that antioxidants (vitamin E and polyphenols) can block neuronal death in vitro. In a 2-year, double-blind, placebo-controlled, randomised trial of patients with moderately severe impairment from Alzheimer's disease, treatment with 1340 mg day-1 a-TE significantly slowed the progression of the disease. Clinical treatment of Alzheimer's patients with large doses of vitamin E (670 mg a-TE twice daily) is one of the key therapeutic guidelines of the American Academy of Neurology. In a multicentre, double-blind trial, vitamin E (1340 mg a-TE day-1) was not beneficial in slowing functional decline or ameliorating the clinical features of Parkinson's disease. Administration of vitamin E significantly relieved symptoms in patients...

Micronutrients And Aids

There is abundant evidence that micronutrient deficiencies can deeply affect immunity micronutrient deficiencies are widely seen in HIV, even in asymptomatic patients. Direct relationships have been found between deficiencies of specific nutrients, such as vitamins A andB12, and a decline in CD4 counts 22-24 , Deficiencies in vitamin A influence vertical transmission ofHIV 26-29 and may affect progression to AIDS (vitamin A, B12, zinc). Correction of deficiencies has been shown to affect symptoms and disease manifestation (AIDS dementia complex andB12 diarrhea, weight loss, and zinc), and certain micronutrients have demonstrated a direct anti-viral effect in vitro (vitamin E and zinc). Some studies suggest that micronutrient deficiencies probably have few direct effects on the functioning of immune cells. The main effect appears to be a reduction in cell mass that may indirectly affect immune cell function 42 , Although the results published appear contradictory, some of these

Folate adequacy and gene variants

A lack of active folate metabolites during the lirst weeks of pregnancy greatly increases the risk of neural tube malformations and other birth defects. Low folate intake in conjunction with variant genes of folate metabolism is most often the underlying cause. High folate intake (0.4 4mg'day) greatly reduces the risk associated w nh several, if not all. predisposing variants. It is essential that such high intakes start before conception. Increased concentration of the toxic metabolite homocysteine in people with low folate status is also associated w ith increased risk of cardiovascular disease, cancer, and cognitive decline.

Communicatoin In Old Age As

Communication and interaction within dementia care triads. Developing a theory for relationship-centred care. Dementia, 4, 185-205. Pieper, R. (1997). Technology and the social triangle of home care Ethical issues in the application of technology to dementia care. In S. Bj rneby & A. van Berlo (Eds.), Ethical issues in the use of technology for dementia care. Knegsel AKONTES Publishing. Wilkinson, H., Kerr, D., & Cunningham, C. (2005). Equipping staff to support people with an intellectual disability and dementia in care home settings. Dementia, 4(3), 387-400.

Programed and Genetic Theories

However, the genetics of longevity have not been as revealing in mammalian studies. In mouse systems genes involved with immune response have been implicated in longevity, as has the 'longevity gene p66shc, which is involved in signal transduc-tion pathways that regulate the cellular response to oxidative stress. In humans, a number of mitochon-drial DNA polymorphisms are associated with longevity. Linkage analysis in humans systems has associated certain genes on chromosome 4 with exceptional longevity. Further support for human longevity genes may be provided by the observation that siblings and parents of centenarians live longer. The major histocompatibility complex (MHC), the master genetic control of the immune system, may also be one of the gene systems controlling aging, since a number of genetic defects that cause immunodeficiency shorten the life span of humans. Certain MHC phenotypes have also been associated with malignancy, autoimmune disease, Alzheimer's disease, and...

Who is Abraham Lieberman

My medical training is as follows I'm a 1963 graduate of the New York University School of Medicine Board Certified in neurology and psychiatry and a Fellow of the American Academy of Neurology, the American Neurological Association, and the Movement Disorder Society. I trained in neurology at Bellevue Hospital, one of the largest and busiest hospitals in America, between 1964-1967. During the Vietnam War, I was a neurologist at the United States Air Force Hospital in Tachikawa, Japan, 1967-1969. From 1970 to 1989, I was, successively, an instructor, then an assistant professor, then an associate professor, and then a full professor of neurology at NYU. I was principal or co-principal investigator of more than 200 grants and studies of such diverse topics as Alzheimer disease, brain tumors, coma, epilepsy, migraine headaches, nerve and muscle disease, Parkinson disease, and stroke. Most of the studies involved inventing ways of evaluating these diseases. The studies were complemented...

Intracerebral Drug Infusion Glial Cell Line Derived Neurotrophic Factor

A series of trials were also underway to evaluate the effects of intrastriatal microinfusion of GDNF. A phase I safety study published by Gill et al. reported that microinfusion in five parkinsonian patients produced no significant adverse effects and improved UPDRS scores by 48 . Furthermore, positron emission tomography (PET) scanning demonstrated increased striatal dopamine uptake (40). Notable side effects also included anorexia, with significant weight loss, and Lhermitte's phenomenon. The results of this study were sufficient to begin a phase II study with a

Robert J Ferguson Raine Riggs Tim Ahles and Andrew J Saykin

Interest in the neuropsychological impact of cancer treatment dates back to the early 1980s when Silberfarb and colleagues observed measurable cognitive decline among patients undergoing cancer treatment.3 However, many of these early studies had methodological shortcomings such as comparing chemotherapy recipients' Overall these data support the hypothesis that a certain subset of cancer patients experience cognitive decline secondary to treatment with systemic chemotherapy. The functional domains affected generally appear to be verbal memory and psy-chomotor processing speed. However, the bulk of data show two distinct trends. First, not all cancer patients are equally affected. Ahles and Saykin, et al. found 24 50 of chemotherapy recipients had lower neuropsychological performance as compared to only 5-23 of survivors treated with local treatments in various neuropsychological performance domains. The result that not all chemotherapy recipients are found to have cognitive problems...

Mayo sleep questionnaire

Boeve et al. also assessed the validity of the MSQ by comparing the responses of patients' bed partners with the findings (REM sleep without atonia) on PSG. The study subjects were 176 individuals (150 males median age 71 years (range 39-90)) with the following clinical diagnoses normal (n 8), mild cognitive impairment (n 44), Alzheimer's disease (n 23), dementia with Lewy bodies (n 74), and other dementia and or parkinsonian syndromes (n 27). Sensitivity and specificity for question 1 on the MSQ for PSG-proven RBD were 98 and 74 , respectively. They concluded that the MSQ has adequate sensitivity and specificity for the diagnosis of RBD among aged subjects with cognitive impairment and or parkinsonism (Boeve et al, 2011).

Differential diagnosis of REM sleep behavior disorder

The differential diagnosis of recurrent dream enactment behavior includes NREM parasomnia, nocturnal panic attacks, nocturnal seizures, nightmares, nocturnal wandering associated with dementia, and OSAS (Boeve, 2010a). A complaint of nocturnal disruptive behaviors is the major clinical feature of several other conditions, such as primary and secondary disorders of arousal, dreaming, and panic disorders (Table 3).

Neurovirulence of murine oncornaviruses

Two neurologic diseases of humans are known to be caused by retroviruses human immunodeficiency virus (HlV)-associated dementia, and tropical spastic paraparesis caused by HTLV-1. Evidence of the involvement of retroviruses in other diseases of the nervous system is loose at best. The most recent example is the suggested link between the expression of an endogenous virus belonging to the HERV-W family (Komurian-Pradel et al., 1999) and multiple sclerosis (Perron et al., 1997). Viral RNA was identified by RT-PCR in culture supernatants of Our thinking about the function of microglial cells is currently in a state of flux. While it is clear that these cells are the scavengers of the brain and also can act, under certain special situations, as antigen-presenting cells (reviewed in Kreutzberg 1996 ), it now appears that they may play a critical role in the maintenance of immune privilege in the CNS (Bauer et al., 1999 Ford et al., 1996). These newly discovered functions are beginning to...

Paraneoplastic Syndromes

Uncut Men Black

Limbic Encephalopathy Limbic encephalopathy is characterized by profound loss of short-term memory, seizures, and behavior changes, including dementia, which often antedate the diagnosis of cancer. It is associated with inflammatory infiltrates in the hippocampal and medial temporal lobe regions of the brain and may be reversible with successful treatment of the cancer. 50 of patients have Hu-Ab (type 1 antineuronal nuclear antibody) and a few have CV2-Ab or amphiphysin-Ab.

Pathogenic Autoantibodies

39 patients), with a minority of sera positive for U1 RNP or Scl -70. The neurologic manifestations based on retrospective chart review were sensorimotor polyneuropathy, small fiber neuropathy, ataxia, sensory neuronopathy, and progressive dementia with seizure disorder, a profile very similar to that described in neurologic SS.

Considerations for the Application of Ex Vivo Gene Therapy to AD

Rodent and primate studies in cholinergic denervation indicate that NGF is important in rescuing cells from axotomy-induced cell death as well as potentially augmenting cholinergic function. Therefore, to evaluate the effectiveness of NGF as a therapy for AD, patients to be treated would ideally be in the early stages of the disease, so that the rate of disease progression can be assessed. Outcomes should be assessed with careful preoperative and postoperative monitoring with standard psychological batteries, AD and other dementia rating scales, and magnetic resonance imaging (MRI) of the brain.

Sleepdisordered breathing disorders in neurological diseases

Generation of respiratory movements (neuromuscular disorders). Vascular damage to the respiratory center may lead to central respiratory disturbances. Neurodegenerative disease can damage the respiratory center (Cormican, 2004), as well as demyelinating lesions (Auer, 1996) located within the respiratory center. Damage of the axons projecting from respiratory center to spinal cord a-motoneurons (cervical spine trauma, demyelinating plaques in multiple sclerosis) can cause respiratory disorders. Damage to the a-motor neurons of the spinal cord (amyotrophic lateral sclerosis, post-polio syndrome) leads to respiratory failure (Aboussouan, 2005). Similarly, peripheral nerve conduction abnormalities (Guillian-Barre syndrome and congenital polyneuropathy) may lead to hypoventilation and respiratory failure. Disorders of the neuromuscular transmission (myasthenia gravis, botulinum toxin poisoning) and primary muscle disorders (myopathies, muscular dystrophy) can cause respiratory disorders....

Gas6 and Other Vitamin KRequiring Gla Proteins

A Gla protein that is associated with the central nervous system, rather than with liver or bone, was discovered in 1993. In tissue culture models it had the properties of a growth arrest-specific (GAS) cell-signalling gene product. It acts as a ligand for a number of receptor protein kinases it potentiates the growth of vascular smooth muscle cells, Schwann cells, and the neurons that synthesize gonadotropin-releasing hormones and it can prevent apoptotic cell death. Knockout mice in which three Gas6 receptors are mutated had major neurological and spermatogenic abnormalities. There is interest in potential roles for Gas6 in Alzheimer's disease and Parkinson's disease. Clearly, these properties and emerging roles have helped to confirm the growing suspicion that vitamin K-dependent Gla proteins possess key functions beyond blood clotting and even bone remodelling. Gas6 has a MW of 75,000 with 11 or 12 Gla residues, and its structure is partly homologous with protein S.

The Effects Of Alcohol On Bodily Systems

The main adverse consequences of chronic alcohol consumption with respect to the nervous system are the following brain damage (manifested by dementia and alcohol amnestic syndrome) complications of the withdrawal syndrome (seizures, HALLUCINATIONS) and peripheral neuropathy. Chronic alcohol consumption results in tolerance, followed by an increased long-term consumption that likely leads to tissue damage. PHYSICAL DEPENDENCE may also develop (i.e., a withdrawal syndrome occurs on sudden cessation of drinking). The brain damage, when severe, is usually classified as one of two main disorders. The first is a type of global (general) dementia. It is estimated that 20 percent of admissions to state mental hospitals suffer from alcohol-induced dementia (Freund & Ballinger, 1988). The second is an alcohol-induced amnestic (memory-loss) syndrome, more commonly known as Wernicke-Korsakoff syndrome. This is related to thiamine (Vitamin B1) deficiency. The Wernicke component refers to the...

Shellfish poisoning 243

Symptoms While everyone is susceptible to shellfish poisoning, elderly people appear to be predisposed to the severe neurological effects of amnesic shellfish poisoning. Within 24 hours of eating contaminated shellfish, the symptoms begin vomiting and diarrhea, abdominal pain, and a host of neurological problems, including confusion, memory loss, disorientation, seizure, and coma.

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