Coping with specific stressors in Alzheimer's disease caregiving

Strategies used to cope with specific caregiving stressors were examined in a sample of 170 Alzheimer's disease (AD) caregivers. The most commonly identified stressors were memory deficits, loss of ability to communicate, and gradual decline of a loved one. Wishfulness was related to more depressed affect, regardless of stressor type. Other strategies related to more depressed affect included taking direct action when coping with patient memory deficits and stoicism in response to decline of a loved one. Strategies related to less depressed affect included relaxation in response to memory deficits, acceptance in dealing with communication impairments and decline of a loved one, and seeking social support in coping with decline of a loved one.     

Apolipoprotein E-associated risk for Alzheimer's disease in the African-American population is genotype dependent

As a part of our ongoing study on Alzheimer's disease (AD) in elderly African Americans, we obtained clinical assessment and apolipoprotein E (ApoE) genotype data on 288 individuals (including 60 with AD). The ApoE epsilon4 allele frequency was significantly increased in AD patients compared with controls. The age-adjusted odds ratio (OR) for AD in epsilon4 homozygotes was 4.83 (95% confidence interval [CI], 1.71-13.64) compared with the epsilon3/epsilon3 genotype, but the OR for AD with the epsilon3/epsilon4 genotype did not reach significance (1.20; 95% CI, 0.58-2.45). These findings suggest that the association between ApoE epsilon4 and AD is weaker in African Americans than in whites.     

Cholinesterase inhibitors for Alzheimer's disease

New cholinesterase inhibitors capable of slowing the progression of Alzheimer's disease are being introduced at a rapid pace. In prescribing these drugs and setting realistic expectations for outcome, it is necessary to understand that they affect cholinergic activity in other tissues as well as the brain. They may be most effective when used in combination with other drugs.     

Cholinergic strategies for Alzheimer's disease

Alzheimer's disease is a devastating degenerative disorder of the central nervous system that results in gradual deterioration of cognitive function and severe alteration of personality. Degeneration of neurons in the nucleus basalis Meynert, the origin of the major cholinergic projections to the neocortex, occurs early in the course of the disease, and is correlated with the cognitive decline. This link between cholinergic dysfunction in the basal-cortical system and cognitive deficits has focused scientific efforts on developing tools to elucidate the neurobiological role of the cholinergic system in cognition and to develop therapeutic interventions in the disorder. An important step in understanding the mechanisms underlying cognitive dysfunction has been the development of in vivo rodent models that mimic some of the features of Alzheimer's disease. Acute excitotoxic or immunotoxic lesions of the nucleus basalis in rodents have revealed a role of the basal-cortical system in attention, learning and memory. More recent advances in developing mouse gene technology offer newer models to systematically examine the underlying neuropathological cascade leading to dysfunctions in mnemonic processing. Using in vivo rodent models, several cholinergic enhancement strategies have been tested and proven to be effective in alleviating lesion-induced cognitive deficits, including neuropharmacological approaches (acetylcholinesterase inhibitors), neurotrophic factor administration (nerve growth factor), and transplantation of cholinergic-enriched fetal grafts. Successful results have also been obtained using ex vivo gene transfer to deliver nerve growth factor or acetylcholine to compromised regions of the basal-cortical system. Gene therapy may be of particular interest for clinical applications, because this approach provides a method for topographically restricted and selective delivery of therapeutic genes and their products to afflicted areas of the brain. Advanced techniques in molecular biology (e.g., exogenous regulatable gene transfer) and newly developed tools of modern neuroscience (e.g., neural precursor cells) will be important contributions for deciphering the biological bases of neuronal degeneration and for refining therapeutic strategies for Alzheimer's disease.     

New drugs for Alzheimer's disease

Alzheimer's disease is characterized by degeneration of various structures in the brain, with development of amyloid plaques and neurofibrillary tangles. Deficiencies of acetylcholine and other neurotransmitters also occur. Pharmacologic treatment of the disease generally seeks to correct the histopathology, the biochemical derangements or their effects. The only drugs labeled to date for the treatment of cognitive symptoms in patients with Alzheimer's disease are two cholinesterase inhibitors that prevent the breakdown of acetylcholine in the synapse. Both medications are associated with modest improvements in cognitive function. However, all benefit is lost when these drugs are discontinued; the disease then progresses to the level seen in placebo-treated patients. Tacrine, the first cholinesterase inhibitor to be so labeled, must be taken four times daily and is associated with hepatic toxicity. Donepezil is taken once daily. Side effects of the cholinesterase inhibitors include nausea, vomiting and diarrhea, which tend to subside after the titration period. Other drugs that have shown some promise in the treatment of Alzheimer's disease are vitamin E, estrogen, selegiline and a mixture of ergoloid mesylates. Anti-inflammatory drugs and nicotine are also being studied for their effects as neuroprotectors or neurotransmitter enhancers. The caregivers of patients with Alzheimer's disease may see little effect from these or other investigational agents, but nursing home placement may be delayed.     

Providing dental care for patients diagnosed with Alzheimer's disease

Alzheimer's disease is the most common dementing illness affecting over 4 million Americans. As the population ages, dentists and other health care providers will be faced with the daunting task of managing an increasing number of people with this disease. Currently, there are no definitive medications to treat this disease, although there are a number of recent drugs which may help to alleviate some symptoms. This article reviews the current medical treatment and the dental concerns which face the dentist, patient, and family. Suggestions for dental management are given along with practical recommendations for caregivers.     

Greater relative impairment of object recognition than of visuospatial abilities in Alzheimer's disease.

Histological investigation in Alzheimer's disease (AD) has indicated that the concentration of neurofibrillary tangles in inferotemporal cortex (IT) is greater than that found in posterior parietal cortex (PPC). Researchers hypothesized that the relative degree of impairment of visual function subserved by each of these cortical areas should reflect the disproportionate distribution of neuropathological changes. Eleven AD patients and 16 elderly controls received 8 tests of visual function, 4 of which have been shown previously to be selectively affected by IT lesions and 4 that are selective for PPC lesions. AD patients were significantly impaired on all 8 tests, but multivariate analysis indicated a relatively greater impairment on tests of IT function. The greater impairment of visual function mediated by IT relative to function mediated by PPC is consistent with differential degradation of the respective cortical areas. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Wandering: a significant problem among community-residing individuals with Alzheimer's disease

This study evaluated the frequency, predictors, and effects of wandering in a population-based sample of 193 individuals with Alzheimer's disease (AD). Although wandering occurred in subjects at all levels of cognitive impairment, analysis of variance indicated that for the group as a whole, greater frequency of wandering was associated with significantly more impairment in cognition, day-to-day functioning, and behavior. Caregiver distress also increased significantly with increased frequency of wandering. Logistic regression modeling identified functional impairment and disruptive behavior problems as the strongest independent predictors of wandering occurring within the past week. Cluster analysis revealed four characteristic groups of wanderers that represented a continuum of wandering frequency, each having a unique pattern of other behavioral disturbances. Based on this analysis, we recommend further evaluation and the development of possible treatment strategies that address the individual differences found among AD patients who wander.     

Gene-environment interaction in Alzheimer's disease: a potential role for cholesterol

Alzheimer's disease is probably a complex disease caused by an interaction of multiple environmental and genetic factors. Genetic defects include 'causative' genes which are rare and a 'susceptibility' gene (sigma4 allele of apolipoprotein E) which is more common in cases. Recent research suggests that environmental factors may interact with a genetic predisposition to modify the risk of Alzheimer's disease. An interaction between serum cholesterol levels and sigma4 genotype is proposed. The evidence for this gene-environment interaction is discussed.     

Conceptual priming in perceptual identification for patients with Alzheimer's disease and a patient with right occipital lobectomy.

Two experiments examined explicit recognition memory and perceptual and conceptual contributions to implicit perceptual-identification repetition priming for patients with Alzheimer's disease (AD) and Patient M.S. with right-occipital lobectomy. Participants read words (perceptual encoding) and generated words (conceptual encoding) from a definition and letter cue (e.g., "a vehicle for moving the injured—a"). AD patients demonstrated impaired explicit and intact implicit memory for both perceptually and conceptually encoded words. M.S. demonstrated the opposite pattern: intact explicit and impaired implicit memory in both encoding conditions. The double dissociation between AD and M.S. on implicit and explicit memory tasks is discussed in terms of a putative visual memory mechanism in the right-occipital cortex that interacts with lexical mechanisms to yield perceptual-identification priming after perceptual and conceptual encoding. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Huperzine A (shuangyiping): a promising drug for Alzheimer's disease

Hup A, a novel alkaloid isolated from Chineses herb Huperzia serrata, is a potent and selective inhibitor of AChE, with a rapid absorption and penetration into the brain in experimental animals. The inhibition is reversible with a longer duration of action. Hup A exhibited memory-enhancing activities in a broad range of animal cognitive model. Compared to Phy, Tac, and Gal, Hup A has better therapeutic indices, and peripheral cholinergic side effects are minimal at therapeutic doses. These findings suggest that Hup A is a promising candidate for clinical development as a symptomatic treatment for AD.