Alzheimer Disease: Cunningham C

Yu F, Rose KM, Burgener SC, Cunningham C, Buettner LL, Beattie E, Bossen AL, Buckwalter KC, Fick DM, Fitzsimmons S, Kolanowski A, Janet K, Specht P, Richeson NE, Testad I, McKenzie SE. · University of Minnesota School of Nursing, Minneapolis, MN 55455, USA. · J Gerontol Nurs. · Pubmed #19326826 No free full text.

Abstract: The purpose of this article is to critically review and synthesize the literature on the effects of nonpharmacological cognitive training on dementia symptoms in early-stage Alzheimer's disease (AD) and related dementia. Electronic databases MEDLINE (PubMed), CINAHL, PsycInfo, and the Cochrane Library were searched using the keywords cognition, reality orientation, Alzheimer's disease, psychosocial factors, cognitive therapy, brain plasticity, enriched environments, and memory training. The findings support that cognitive training improves cognition, activities of daily living, and decision making. Interventions are more effective if they are structured and focus on specific known losses related to the AD pathological process and a person's residual ability, or are combined with cognitive-enhancing medications. Nursing implications are also discussed.

Eustace A, Bruce I, Coen R, Cunningham C, Walsh C, Walsh JB, Coakley D, Lawlor BA. · Mercer's Institute for Research in Ageing, St James's Hospital, Dublin 8, Ireland. · Int J Geriatr Psychiatry. · Pubmed #17136712 No free full text.

Abstract: OBJECTIVE: To determine the frequency of unrecognised dementia in a group of community dwelling elderly, and to identify factors associated with dementia recognition by informants. SAMPLE SELECTION: People over 65 years with an AGECAT case or subcase organic diagnosis or an MMSE < or = 23 were identified from a database of community dwelling elderly. A psychiatrist to confirm the diagnosis of dementia according to ICD-10 criteria interviewed these individuals. STUDY PARTICIPANTS: Sixty-two community dwelling elderly meeting ICD-10 criteria for dementia whom had reliable informants. METHODS: Prior to the start of the interview the informant was questioned about whether they felt the patient had memory difficulties and if so whether they had a medical evaluation for their memory problems. A psychiatrist then interviewed the patient and informant to establish whether that patient met ICD-10 criteria for dementia. Basic sociodemographic details were collected and the following assessments were carried out: the Blessed Dementia Rating Scale, the Clinical Dementia Rating Scale, the Behave-AD and the Baumgarten Behavioural Disturbance Scale. ANALYSIS: Univariate and step-wise forward logistic regression analysis were used to examine the factors associated with recognition of memory difficulties. RESULTS: Twenty-nine percent of family informants of people with dementia failed to recognise a problem with their relatives'memory. Where memory difficulties were recognised only 39% of this group received a medical evaluation. Using univariate analysis recognition of memory difficulties by family informants was associated higher levels of behaviour disturbance ( p = or < 0.0011), greater functional impairment ( p = 0.0039), with increasing cognitive impairment ( p = 0.013). Using a logistic regression model, to test the independence of these variables, increasing behavioural disturbance (p = 0.0001) was associated with recognition of dementia by family informants. CONCLUSIONS: Recognition of memory problems by family members is associated with increasing behavioural disturbance. Even with recognition of dementia, families often fail to seek medical attention. Education of the lay public on the early signs and symptoms of dementia must be a key first step in improving recognition of dementia in the community dwelling elderly.

Holmes C, El-Okl M, Williams AL, Cunningham C, Wilcockson D, Perry VH. · School of Medicine and Biological Sciences, University of Southampton, Southampton, UK. · J Neurol Neurosurg Psychiatry. · Pubmed #12754353 links to  free full text

Abstract: Activated microglia, the resident macrophages of the brain, are a feature of Alzheimer's disease. Animal models suggest that when activated microglia are further activated by a subsequent systemic infection this results in significantly raised levels of interleukin 1beta within the CNS, which may in turn potentiate neurodegeneration. This prospective pilot study in Alzheimer's disease subjects showed that cognitive function can be impaired for at least two months after the resolution of a systemic infection and that cognitive impairment is preceded by raised serum levels of interleukin 1beta. These relations were not confounded by the presence of any subsequent systemic infection or by baseline cognitive scores. Further research is needed to determine whether recurrent systemic infections drive cognitive decline in Alzheimer's disease subjects through a cytokine mediated pathway.

Eustace A, Kidd N, Greene E, Fallon C, Bhrain SN, Cunningham C, Coen R, Walsh JB, Coakley D, Lawlor BA. · Mercer's Institute for Research in Ageing, St. James's Hospital, Dublin 8, Ireland. · Int J Geriatr Psychiatry. · Pubmed #11571764 No free full text.

Abstract: OBJECTIVES: To determine the clinical, functional and neuropsychological correlates of verbal aggression in Alzheimer's disease in a group of consecutive first attendees to a memory clinic. METHODS: 150 people were evaluated and diagnosed as suffering with probable Alzheimer's disease. These people were tested using the Behave-AD for the presence of verbal aggression, delusions, depression and agitation. They were also assessed with cognitive, functional and neuropsychological scales. RESULTS: Twenty-eight per cent of this group of Alzheimer patients had exhibited some verbal aggression in the preceding month. Male gender (p = 0.022), the presence of paranoid and delusional ideation (p = 0.003) and agitation (p = 0.042) were significantly associated with verbal aggression in a stepwise backward logistic regression analysis. CONCLUSION: The presence of verbal aggression should prompt the clinician to search for delusional ideation, which may respond to pharmacotherapy.

Denihan A, Wilson G, Cunningham C, Coakley D, Lawlor BA. · Mercers Institute for Research in Ageing, St James' Hospital, Dublin 8, Ireland. · Int J Geriatr Psychiatry. · Pubmed #10767729 No free full text.

Abstract: OBJECTIVE: Measurement of medial temporal lobe atrophy (MTL) by computerised tomography (CT) may be a useful adjunct to the diagnosis of AD. The aim of this study was to assess the sensitivity, specificity, predictive values and diagnostic accuracy of CT measurement of MTL thickness for patients with probable AD, compared with a 'diseased' control group, and to correlate the measure with neuropsychological test scores. DESIGN: Cross-sectional. METHODS: One hundred subjects were prospectively recruited: 60 with probable AD (mean age 73.7 years, mean Mini-Mental State Examination [MMSE] 19.6), 17 with probable vascular dementia (VaD) (mean age 77.9 years, mean MMSE 20.9), 14 with depression (mean age 73.2 years, mean MMSE 25.7) and nine with paraphrenia (mean age 74 years, mean MMSE 25.4). Axial and temporal lobe-oriented CT brain was performed and the minimum MTL thickness was measured electronically. RESULTS: The mean minimum MTL thickness was significantly smaller in AD subjects compared to VaD (p<0.0001) and psychiatric subjects (p<0.0001). For the clinical diagnosis of probable AD, the sensitivity of the measure was 0.75, specificity 0.9, and diagnostic accuracy 0.81. For the mildest cases of AD (CDR 0.5), the sensitivity of the measure was 0.61, specificity 0.91, and diagnostic accuracy 0.81. No significant correlations with neuropsychological test scores were found. CONCLUSIONS: Temporal lobe-oriented CT imaging is a non-invasive test with good discrimination for AD. Potential uses of this technique include as an aid to diagnosis and possibly as a means of monitoring disease progression.