Alzheimer Disease: Scherder E

Scherder E, Eggermont L, Sergeant J, Boersma F. · Institute of Human Movement Sciences, Rijksuniversiteit Groningen, , The Netherlands. · Rev Neurosci. · Pubmed #17593877 No free full text.

Abstract: Epidemiological studies show a positive relationship between physical activity and cognition in patients with Alzheimer's disease (AD). A relatively small number of intervention studies have examined the effects of physical activity, such as walking, on cognition in AD patients. The results of these studies, reviewed here, include both positive and negative findings. The finding that physical activity does not improve cognition in all AD patients could be explained by two factors that have received little attention thus far: executive dysfunction and gait disturbances. These two factors are part of a cascade of events, initiated by cerebrovascular disease in AD. This cascade of events is addressed in detail. Finally, (non)pharmacological interventions to improve executive dysfunctions and gait disturbances in patients with AD are discussed.

Eggermont L, Swaab D, Luiten P, Scherder E. · Department of Clinical Neuropsychology, Vrije Universiteit, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands. · Neurosci Biobehav Rev. · Pubmed #16359729 No free full text.

Abstract: Regional hypoperfusion, associated with a reduction in cerebral metabolism, is a hallmark of Alzheimer's disease (AD) and contributes to cognitive decline. Cerebral perfusion and hence cognition can be enhanced by exercise. The present review describes first how the effects of exercise on cerebral perfusion in AD are mediated by nitric oxide (NO) and tissue-type plasminogen activator, the release of which is regulated by NO. A conclusion of clinical relevance is that exercise may not be beneficial for the cognitive functioning of all people with dementia if cardiovascular risk factors are present. The extent to which cardiovascular risk factors play a role in the selection of older people with dementia in clinical studies will be addressed in the second part of the review in which the effects of exercise on cognition are presented. Only eight relevant studies were found in the literature, emphasizing the paucity of studies in this field. Positive effects of exercise on cognition were reported in seven studies, including two that excluded and two that included patients with cardiovascular risk factors. These findings suggest that cardiovascular risk factors do not necessarily undo the beneficial effects of exercise on cognition in cognitively impaired people. Further research is called for, in view of the limitations of the clinical studies reviewed here.

Scherder E, Knol D, van Tol MJ, van Someren E, Deijen JB, Swaab D, Scheltens P. · Institute of Human Movement Sciences, University of Groningen, Groningen, The Netherlands. · Dement Geriatr Cogn Disord. · Pubmed #16912480 No free full text.

Abstract: OBJECTIVE: In a previous study, low-frequency (0.5 Hz) cranial electrostimulation (CES) neither improved the rest-activity rhythm nor reduced the level of salivary cortisol in patients with probable Alzheimer's disease (AD). To investigate whether the frequency of CES was responsible for these negative findings, we set out to examine the effects of high-frequency CES on the rest-activity rhythm and salivary cortisol of patients with probable AD. We hypothesized that a decreased level of cortisol would parallel a positive effect of high-frequency CES on nocturnal restlessness in AD patients. METHODS: Twenty AD patients were randomly assigned to an experimental group (n = 10) and a control group (n = 10). The experimental group was treated with high-frequency CES, the control group received sham stimulation, for 30 min a day, during 6 weeks. The rest-activity rhythm was assessed by actigraphy. Level of cortisol was measured by means of salivette tubes. RESULTS: The rest-activity rhythm and the level of salivary cortisol did not react positively to high-frequency CES. In contrast, both groups showed an increase in the level of cortisol after the 6-week treatment period. CONCLUSIONS: High-frequency CES appeared to be ineffective in AD patients.

Scherder E, Knol D, van Someren E, Deijen JB, Binnekade R, Tilders F, Sergeant J. · Department of Clinical Neuropsychology, Vrije Universiteit, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands. · Neurorehabil Neural Repair. · Pubmed #12814055 No free full text.

Abstract: OBJECTIVE: In previous studies, cranial electrostimulation (CES) had positive effects on sleep in depressed patients and in patients with vascular dementia. The present study examined the effects of low-frequency CES on the rest-activity rhythm and cortisol levels of patients with probable Alzheimer's disease (AD). METHOD: It was hypothesised that a decreased level of cortisol would parallel a positive effect of low-frequency CES on nocturnal restlessness. Sixteen AD patients were randomly assigned to an experimental group (n = 8) or a control group (n = 8). The experimental group was treated with CES, whereas the control group received sham stimulation, for 30 minutes a day, during 6 weeks. The rest-activity rhythm was assessed by actigraphy. Cortisol was measured repeatedly in the saliva throughout the day by means of salivette tubes. RESULTS: Low-frequency CES did not improve the rest-activity rhythm in AD patients. Moreover, both groups showed an increase instead of a decrease in the level of cortisol. CONCLUSIONS: These preliminary results suggest that low-frequency CES has no positive effect on the rest-activity rhythm in AD patients. An alternative research design with high-frequency CES in AD is discussed.

Achterberg WP, Scherder E, Pot AM, Ribbe MW. · EMGO-Institute and Department of Nursing Home Medicine, VU University Medical Center Amsterdam, The Netherlands. · Eur J Pain. · Pubmed #17157543 No free full text.

Abstract: Cardiovascular risk factors (CRF) such as hypertension and diabetes mellitus favour the development of both vascular dementia (VaD) and Alzheimer's disease (AD). The resulting deafferentation may increase the experience of pain in VaD and in AD. The goal of the present study was to examine the relationship between CRF and pain in a sample of 107 cognitively impaired nursing home patients who had also a chronic pain condition. The prevalence of pain in patients with hypertension or diabetes mellitus was higher (25/41=61% of them had pain) than those without diabetes or hypertension (of whom 24/66=36.4% had pain, p=0.017). In a multivariate logistic regression model (adjusted for gender, age and depression) the presence of diabetes or hypertension was a risk indicator for pain: odds ratio: 3.48, p=0.005, 95% CI: 1.45-8.38. This finding supports the hypothesis that as a result of CRF, disruptions of cortico-cortico and cortico-subcortical pathways occur, and consequently, enhances pain in this group of patients.

Scherder E, van Manen F. · Clinical Neuropsychology, Vrije Universiteit, Amsterdam, The Netherlands. · J Adv Nurs. · Pubmed #16164476 No free full text.

Abstract: AIM: This paper reports on a study examining the level of agreement between the pain perceptions of nursing assistants, older people without dementia and patients with Alzheimer's dementia. It was hypothesized that nursing assistants would overestimate the pain experience of patients with Alzheimer's dementia. BACKGROUND: There is now increasing evidence that, in contrast to other subtypes of dementia, patients with Alzheimer's disease might experience a decrease in pain. It is unfortunate that these latest insights into the complex relationship between subtypes of dementia and pain are not always included in education programmes for nursing assistants. METHOD: Twenty patients with Alzheimer's disease and 17 older people with arthrosis and/or osteoporosis but no dementia and their personal nursing assistants participated in the study. Pain experience was assessed using the Coloured Analogue Scale for the assessment of Pain Intensity and Pain Affect, the Faces Pain Scale, and the Checklist of Non-verbal Pain Indicators. The data were collected in 2002-2003. RESULTS: Before and after walking, the absolute difference in pain evaluation between nursing assistants and older people without dementia was statistically significantly less than the difference in pain evaluation between nursing assistants and patients with Alzheimer's disease on the Coloured Analogue Scale for Pain Intensity (P = 0.007 and P = 0.04, respectively) and on the Coloured Analogue Scale for Pain Affect (P = 0.009 and P = 0.01, respectively). CONCLUSION: Nursing assistants may overestimate the extent of suffering from pain of patients with Alzheimer's disease. They might be very well able to estimate this pain, provided they were educated about new insights into the influence of the various subtypes of dementia on pain.

Scherder E, Bouma A, Slaets J, Ooms M, Ribbe M, Blok A, Sergeant J. · Department of Clinical Neuropsychology, Vrije Universiteit, De Boelelaan 1109, NL-1081 HV Amsterdam, The Netherlands. · Dement Geriatr Cogn Disord. · Pubmed #11598312 No free full text.

Abstract: In previous studies, patients with probable Alzheimer's disease (AD) have indicated that they experienced less pain intensity and affect from their painful conditions than nondemented elderly persons. However, in those studies, pain assessment occurred only once. Therefore, it may be possible that pain which had occurred, for example, a day earlier, could have been forgotten. Therefore, in the present study, AD patients' pain was assessed daily, i.e. once a day and even three times a day, during a longer period. The results parallel those of earlier studies, i.e. compared to elderly persons without dementia, AD patients appear to perceive less pain intensity and pain affect. These findings support the hypothesis that AD is characterized by an alteration in pain experience.

Scherder E, Bouma A, Borkent M, Rahman O. · Department of Clinical Psychology, Vrije Universiteit, Amsterdam, The Netherlands. · Psychiatry. · Pubmed #10612117 No free full text.

Abstract: Pain assessment for patients with Alzheimer's disease (AD) is generally aimed at quantifying pain, i.e., the intensity and locations of pain. Based on the extensive neuropathology in limbic brain areas with this disorder, we hypothesized that, compared to control patients, AD patients would report an additional loss of qualitative aspects of pain, i.e., pain affect. This hypothesis was tested by administering specific parts of three pain questionnaires and comparing the use of analgesics in 19 AD patients with that of 18 elderly patients without dementia who were matched for the presence of painful conditions. Results reveal that AD patients, compared to controls, experience less intense pain and less pain affect. In contrast, the number of AD patients using analgesics did not differ from the number of controls. These findings suggest that pain assessment for patients with AD should be focused on both quantitative and qualitative aspects of pain.