Autonomic dysfunction in patients with dementia of the Alzheimer type

Abnormalities of the noradrenergic system have been documented in the central nervous system of patients with dementia of the Alzheimer's type (DAT). To evaluate the autonomic sympathetic system in DAT, we measured lying and standing blood pressure (BP), pulse, and plasma epinephrine (E) and norepinephrine (NE) in 60 DAT patients (mean age +/- SD = 65 +/- 8 years), and 20 normal elderly controls. DAT patients had normal baseline findings (BP, pulse, NE, and E). Upon standing, plasma NE and E significantly increased in both DAT patients and controls, without group differences. However, the systolic BP response to standing was reduced in DAT patients compared with the normal controls (repeated measures ANOVA, p < 0.01). This impaired response of the systolic BP on standing was particularly evident in DAT patients with symptoms of depression. Severely impaired DAT patients did not differ in E, NE, BP, pulse, or in orthostatic changes from mild-to-moderately impaired patients. These results suggest that the sympathetic response to the stress of standing is functionally impaired in DAT. This deficit was especially evident when DAT was accompanied by depression, consistent with prior studies in non-demented depressed patients.     

Repetition priming with nonverbal stimuli in patients with dementia of the Alzheimer type.

Perceptual repetition priming was examined in patients with dementia of the Alzheimer type (DAT) and normal control (NC) participants using a task involving the discrimination of geometric designs that had either a continuous ("closed") or discontinuous ('open") perimeter. With the open stimuli, the groups displayed significant and equivalent levels of priming after immediate repetition of the stimuli, whereas only the NC group primed significantly over a delay of three intervening items. Neither group demonstrated significant priming with the closed stimuli. Results indicate that under some conditions DAT patients can exhibit normal repetition priming with stimuli that do not have pre-existing representations but that (due possibly to a deficiency in the level of steady-state cortical activation) this priming dissipates more rapidly in DAT patients than in NC participants. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Crystallized and fluid intelligence in elderly patients with mild dementia of the Alzheimer type

OBJECTIVE: To describe a systematic procedure for adapting, or 'tailoring' the World Health Organisation's 'global guidelines for the management of HIV/AIDS in adults and children' for use in two developing countries: Malawi and Barbados. DESIGN: In order for these guidelines to achieve reproducibility, clinical flexibility, and clinical applicability, a systematic procedure is needed to tailor the guidelines to the local practice conditions of specific settings. METHODS: A group of local experts in each country used a nominal group process to modify the global program on AIDS (GPA) guidelines for local use. Semantic analysis techniques, known as clinical algorithm nosology (CAN), were used to compare the two modified guidelines with the global ones to determine the extent and type of differences between sets of guidelines. RESULTS: Standard, locally-tailored algorithm map guidelines (AMG) were developed within 4 months. CAN semantic analysis showed that guideline structure was maintained; 572/858 (66.6%) decision nodes were found to be the same in the GPA/Malawi, GPA/Barbados and Malawi/Barbados comparisons. However, different guideline versions managed patients quite differently, as evidenced by clinical algorithm patient abstraction (CAPA) scores of between 0 and 8.46 (0 = different; 8 = similar; 10 = identical). Analysis of the 197 specific differences found in these abstractions showed that 83% were in approaches to diagnosis and therapy, while the remaining 17% related to disease prevalence. CONCLUSIONS: Standard techniques involving consensus used to develop clinical guidelines can also be employed to tailor these guidelines to local settings. Semantic analysis shows that the tailoring preserves structure but may involve significant modification to the processes of clinical care that could in turn affect care outcomes.     

Serial position effects in dementia of the Alzheimer type

We evaluated the usefulness of an automated hematology analyzer (SE-9000) for the identification and counting of peripheral blood stem cells (PBSCs). The samples tested were from 14 patients with hematological malignancies. Peripheral blood samples were collected from the subjects before and after a course of chemotherapy. From the leukapheresis sample, CD34+ cells, assumed to be hematopoietic stem cells, were obtained with an immunomagnetic cell separator. The CD34+ cells obtained accumulated in the gate corresponding to low recurrent frequencies of the automated hematology analyzer. This gate shows results of the 'immature information' (IMI) channel. Software for detection of only the cells that accumulated in this gate was therefore developed. With this trial program, the regression coefficient between the percentage of leukocytes from the blood samples that were CD34+ and the percentage of such leukocytes that appeared on the IMI channel was 0.79. With this analyzer, the number of PBSC could be counted in about 80 s. The identification and counting of cells picked up by the IMI channel should be clinically useful for the monitoring of changes in PBSC after chemotherapy for mobilization.     

Preserved cognitive skills in dementia of the Alzheimer type

OBJECTIVE: To describe preserved cognitive skills in patients with dementia. DESIGN: Case series. SETTING: Community clinic. PATIENTS: Five patients who met National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association criteria for probable Alzheimer's disease and were claimed to retain a cognitive skill. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Standard neuropsychological tests and individualized measures of patient's skilled behaviors. For patients who remained skilled at games, performance was compared with that of normal controls in direct competition. For the patient-trombonist, raters compared premorbid and postmorbid recordings of his play. RESULTS: One patient continued to play the trombone in a Dixieland band, although he could not name well-known numbers that he played. Another continued to solve adult jigsaw puzzles. A third patient retained skill at canasta, the fourth at dominoes. The fifth patient remained a skillful contract bridge player, although he could not name the suits or articulate simple bidding rules. Four patients had impaired performance on standard anterograde and remote memory and naming tests but performed normally on pursuit rotor and letter fluency tests. Mini-Mental State Examination scores for these patients ranged from 10 to 22. One patient refused neuropsychological testing but displayed his skill. CONCLUSIONS: Together with previous studies of preserved piano playing or painting skills, our findings indicate that a broad range of complex cognitive abilities may be preserved in patients with dementia of the Alzheimer type who cannot perform simpler actions.     

Focal cognitive deficits in dementia of the Alzheimer type.

It is widely accepted that the natural history of Alzheimer type-dementia is accurately described by a relatively fixed, invariant sequence of stages of behavioral, cognitive, and neurological symptoms. This stage-wise deterioration model is examined and found wanting. The evidence shows that there is no generalization about the inevitable ordering of symptoms that has not been contradicted by reports in the literature. Two alternatives to the stage-wise model are discussed, both of which reject the notion of a homogeneous disintegration of function and take as a goal the delimitation of a set of symptom domains that define and differentiate patients. Of these 2 alternatives, the subgroups model and the multiple components model, the latter seems to accord best with the available data. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Bender-Gestalt Test performance in senile dementia of the Alzheimer type.

Bender-Gestalt Test performances of 144 persons with very mild, mild, or moderate senile dementia of the Alzheimer type (SDAT) and 96 healthy older adults ranging in age from 63 to 95 yrs were compared. Total scores and error types according to the modified Hutt-Briskin scoring system are reported. The Bender-Gestalt Test does not appear to be useful in differentiating very mild or mild SDAT from normal aging. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A longitudinal study of the course of Alzheimer type dementia

OBJECTIVE: We carried out a prospective longitudinal study of 41 patients diagnosed as probably having a mild form of Alzheimer's disease according to the data of an investigation of prevalence done in 1991 in the municipality of Habana Vieja. MATERIAL AND METHODS: The research covered two phases, with an interval of one year between them. During both phases the patients were interviewed by the same neurology resident in a door-to-door survey using the Mini-Mental State, Hughes scale (CDR) and Blessed scale, to evaluate higher mental functions. We determined the progress of the disease over the course of two years (1991-1992 and 1992-1993) and the frequency and degree of deterioration of cognitive functions during a period of one year. RESULTS AND CONCLUSIONS: There was evidence of progressive worsening of the illness in 46.4% of the patients. In 34.2% this was to a moderate form and in 12.2% to a severe form. There was no progression in 46.3%. In this group 17.0% continued with a diagnosis of doubtful dementia and 29.3% as having slight dementia. The other 7.3% of the total number of patients (n = 41) were reclassified as normal. Cognitive functions almost always showed a tendency to deteriorate over time, but in a small percentage of patients they did not deteriorate and some even improved. The cognitive functions which deteriorated most were those of orientation, language and copying, with an average deterioration of 28% and 24% respectively with regard to their initial values.     

Preclinical cognitive markers of dementia of the Alzheimer type.

56 nondemented elderly normal control (NC) Ss were studied at 3 consecutive annual administrations of the California Verbal Learning Test (CVLT). NC Ss with a positive family history for progressive dementia performed significantly worse than individuals with a negative family history for progressive dementia on several quantitative and qualitative indices of the CVLT and were more likely to undergo changes in diagnostic status over time (i.e., develop dementia of the Alzheimer type [DAT]). Stepwise discriminant function analyses of critical CVLT indices of the NC Ss and of 25 patients with mild DAT classified 5 NC Ss as DAT patients 1–2 yrs prior to their eventual changes in diagnostic status. Results suggest that specific memory deficits may serve as preclinical cognitive markers for DAT, especially in individuals with risk factors for DAT such as a positive family history. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

APOE-epsilon 4 in patients with Alzheimer disease and vascular dementia

This study reports seven cases of epulis excised by the CO2 laser without anesthesia. The laser was used in a continuous wave mode at power setting of 2-4 W. All lesions were excised completely, and no patients felt pain during laser irradiation. The operation was successful without using surgical packs, and there was no postoperative discomfort. There has been no evidence of recurrence after operation.     

Speed of scanning in primary memory in persons with dementia of the Alzheimer type.

The nature of the search of primary memory by persons with a presumptive diagnosis of mild Alzheimer's disease (dementia of the Alzheimer type [DAT]) was compared with that of normal elderly and young persons using the S. Sternberg (1966) paradigm. DAT Ss evidenced a substantial deficit in the speed of scanning in primary memory and a deficit in at least one other stage of processing. These findings are consistent with the hypothesis that the decline in memory performance evidenced by persons with DAT may be attributable to an increase in the time requirements of mnemonic processing. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Amygdala-hippocampal atrophy and memory performance in dementia of Alzheimer type

The aim of the present study was to examine the involvement of brain structures, especially the amygdala-hippocampal complex, in dementia of Alzheimer type (DAT), and to assess the relation of amygdala-hippocampal atrophy with memory dysfunction. 14 patients with DAT and 10 healthy age-matched controls were examined with different neuropsychologic tests including the UCLA-Auditory Verbal Learning Test. MRI was performed with a conventional 1.5-tesla scanner. Atrophy was found in many brain structures of demented subjects in comparison with healthy age-matched controls. The volumes of amygdala-hippocampal complexes and of the temporal lobes of demented subjects were more reduced than the total brain volume and other structures. Memory dysfunction was highly correlated with atrophy of the amygdala-hippocampal complexes and of the temporal lobes. Consequently, DAT seems to affect the amygdala-hippocampal complex and their related function (i.e. memory) more than other cerebral structures, but cerebral degeneration in DAT is not restricted to these structures.     

Reading in dementia of the Alzheimer type: A preserved ability?

Assessed 45 patients with a probable diagnosis of dementia of the Alzheimer type (DAT), varying from minimal to moderate levels of dementia, on 3 tasks of reading aloud: (1) an extensive list of regular and exception words across a range of word frequencies, (2) the National Adult Reading Test (NART), and (3) a test of nonword reading. On the first test, the patients showed substantial effects of regularity, word frequency, and disease severity. Reading of less common words with atypical spelling-sound correspondences was significantly impaired in the moderately demented subgroup of patients and significantly correlated with measures of semantic memory for the patient group as a whole. This impaired exception word reading was attributed to the breakdown in semantic memory that occurs as the DAT disease process advances. A significant drop in performance on both the NART and nonword reading also accompanied increasing disease severity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Identity negative priming in older adults and individuals with dementia of the Alzheimer type.

This study addressed the question of whether dementia of the Alzheimer type (DAT) produces a breakdown in aspects of the inhibitory component underlying selective attention. Two measures of identity negative priming and 2 measures of distractor interference were obtained. In Experiment 1, participants were presented with overlapping picture stimuli, and in Experiment 2, participants were presented with overlapping written word stimuli. The results of both experiments produced reliable and similar size negative priming in young and old adults, but there was no evidence of negative priming in the individuals with DAT. In contrast, the naming latencies of all 3 groups showed a reliable and similar size distractor interference effect. These results suggest that although the inhibitory component underlying selective attention is impaired in individuals with DAT, the ability to differentiate a target from a distractor may be preserved under certain task conditions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Abnormal amino acid metabolism in patients with early stage Alzheimer dementia

Plasma levels of several amino acids were studied in 14 patients with early stage probable Alzheimer's disease (AD) and 17 age-matched controls. In the AD patients a possible relationship between amino acid levels and behavioural symptomatology was also investigated. We found significantly reduced levels of tryptophan and methionine in plasma samples from the AD patients compared to the control subjects. Moreover, plasma tyrosine/large neutral amino acids (LNAA) ratio and the ratio of plasma taurine and the product of the plasma levels of methionine and serine (TSM-ratio) were significantly increased in the AD patients in comparison with the controls. However, no difference was found in plasma tryptophan/LNAA ratio and in homocysteine levels between both groups. Concerning the behavioural symptomatology no significant correlation was found between the Reisberg Behave AD scale and plasma amino acid levels or ratios. The reported findings suggest that abnormal amino acid metabolism is present in the early stages of AD. We hypothesize that this abnormality could play a role in the pathogenesis of behavioural changes occurring in later stages of AD.     

Cross-form priming in normal aging and in mild dementia of the Alzheimer type

Twenty patients at early stages of Alzheimer's disease (AD), 20 elderly control subjects and 20 young subjects completed a cross-form priming task, followed by a free recall task. Results show that patients with mild AD display priming effects, and that these priming effects are strictly comparable to those obtained by elderly and young control subjects. Moreover, while the patients' performances are normal in the implicit part of the task, they are massively impaired in the explicit free recall task. These results don't support the hypothesis of a dissociation of performances between identification tasks and generation tasks in Alzheimer's disease, and show that conceptual priming can be observed at early stages of the disease, despite semantic memory impairments.     

Deficits in reading performance in very mild dementia of the Alzheimer type.

Reading of irregular words using the American version of the National Adult Reading Test ([AMNART] E. Grober & M. Sliwinski; see record 1992-16981-001) was examined in 101 healthy older adults and compared with 50 people with very mild and 62 people with mild dementia of the Alzheimer type. Significant deficits were observed in both the very mild and mild dementia groups. Performance on this reading test was substantially correlated with other measures of semantic memory, which are also affected early in the course of the disease. Use of this test as an indicator of premorbid intelligence in people with dementia of the Alzheimer type does not appear wise. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Musical structural determinants of emotional judgments in dementia of the Alzheimer type.

People with dementia of the Alzheimer type (DAT) may well be emotionally soothed by listening to music. However, very few systematic studies have been conducted to support the anecdotal evidence. DAT does damage certain cerebral structures that subsume emotional processing, and some studies have demonstrated deficits affecting emotional judgments of facial expression and prosody in DAT. Accordingly, this study addressed the question of whether DAT might leave musical emotional judgment intact. Twelve early DAT participants and 12 healthy elderly participants took part in this study. Emotional judgments were examined in relation to mode and tempo, two important structural properties that contribute to the happy-sad distinction in music. Their respective contributions were assessed in four different experimental conditions. The DAT participants' responses were similar to those of healthy elderly participants, showing spared ability to employ tempo and mode as cues for emotional interpretation. The DAT participants' performance was not correlated with their global cognitive functioning. These results constitute a preliminary empirical demonstration that, in early DAT, musical emotional judgments appear to be based on normal structural analysis of musical input. (PsycINFO Database Record (c) 2010 APA, all rights reserved)