Abstract Background: Home care is an important care setting for those with Alzheimer’s disease (AD). It provides support that allows individuals with AD to remain at home and may delay the transition to long-term care homes. Many clients with AD receive medications that are used for managing the symptoms of AD: cholinesterase inhibitors (ChEIs) and memantine. Ontario’s provincial drug benefit plan (ODB) provides subsidies for some of these medications based on specific clinical criteria. These AD medications are costly and can have significant side effects, so it is important to understand how they are being used in practice. Objectives: The objectives of this study were to report the proportion taking AD medications and which types were taken, show the change in receipt of AD medications over time, and show the covariates that were independently associated with receiving AD medications. Methods: Analysis of secondary data was performed on the provincial home care dataset. All home care clients receiving long-term home care services were assessed using the RAI-Home Care (RAI-HC), which is a comprehensive and standardized assessment. One assessment from each individual over the age of 65 who was assessed between January 2004 and September 2008 was used, for a final sample size of 321,013. Results: Overall, 65% of clients with a diagnosis of AD were receiving an AD medication. Logistic regression analysis among those diagnosed with AD showed that increased physical impairment and clinical complexity were associated with decreased odds of receiving AD medication. Contraindicating diagnoses such as congestive heart failure, lack of medical oversight and needing to make economic tradeoffs were also associated with decreased odds of receiving AD medication. Conclusions: The multivariate model showed trends of rational prescribing, such as clients with contraindicating diagnoses or very high clinical complexity having decreased odds of receiving AD medications. At the same time, evidence of structural barriers to receiving the medications was shown. There is debate about the cost-effectiveness of these medications. The provincial government could consider expanding ODB guidelines to include all AD medications for those with all levels of cognitive impairment, but further analyses involving longitudinal outcomes available in this dataset should be performed to ensure it would be in the public interest.

Background: Dementia is a disease known to cause chronic deterioration of intellectual functions severe enough to interfere with the ability to perform activities of daily living. Alzheimer’s disease (AD) is the most frequent cause of dementia and is expected to have a substantial impact on the health care system as the Canadian population ages. Current therapies are ineffective at halting disease progression; thus, investigations examining risk factors for AD have become a popular avenue of research. A relationship between cerebrovascular disease and the risk of AD has been established, but the underlying mechanisms on how these morbidities are related remain unclear. The apolipoprotein E gene (ApoE) influences the development of AD with the apolipoprotein E-e4 allele (ApoE-e4) conferring increased risk. The underlying mechanism by which the ApoE-e4 allele influences AD is unclear. Since the ApoE-e4 allele is related to both AD and stroke, the impact of cerebral infarcts on AD may vary by ApoE-e4 allele status. Objective: The objective of this study was to assess if ApoE-e4 allele status modified the relationship between cerebral infarcts and AD. Methods: Secondary data from the Nun Study, a longitudinal clinico-pathologic study of aging representing 678 female participants 75+ years were used for this investigation. AD was diagnosed using criteria for clinical dementia and AD pathology. Dementia was diagnosed using standard criteria, including the Consortium to Establish a Registry for Alzheimer’s Disease battery of neuropsychological tests and performances on activities of daily living. AD pathology was diagnosed using a modified version of the National Institute on Aging and Reagan Institute criteria. Infarcts were identified during gross neuropathologic assessment at autopsy. Logistic regression was used to assess the relationship between AD and the presence, location, and size of cerebral infarcts. Regression models were then stratified by ApoE-e4 allele status to determine if this variable was a significant effect modifier. The relationship of ApoE-e4 allele status with AD, as well as presence of cerebral infarcts, was also explored. All regression models were adjusted for age at death, educational level, and, when appropriate, ApoE-e4 allele status. A sensitivity analysis using different definitions for the outcome AD was performed and showed that varying criteria for AD pathology did not change study results; however, the use of clinical dementia (regardless of pathology) as an outcome did produce significantly different results. Thus, the research questions were repeated using clinical dementia as an outcome. Results: The presence of cerebral infarcts was not significantly associated with AD; this relationship did not change when location and size of infarcts were examined. ApoE-e4 was significantly associated with an increased risk of AD. ApoE-e4 was not associated with presence of cerebral infarcts. ApoE-e4 did not modify the relationship between presence of cerebral infarcts and AD. When the outcome clinical dementia was investigated, presence of cerebral infarcts significantly increased the risk of dementia. This relationship remained when location and size of infarcts were analyzed. ApoE-e4 allele status slightly modified the relationship between presence of cerebral infarcts and dementia. Conclusions: The findings from this study suggest that individuals with severe AD pathology are unlikely to be affected by cerebral infarcts. Future studies should focus on examining levels of severity of AD pathology in relation to cerebral infarcts. Cerebral infarcts appear to have an impact on dementia and this relationship was found to slightly vary by ApoE-e4 status. Future studies are recommended to examine how ApoE interacts with a variety of age-related risk factors to increase the risk of AD.

Aβ oligomer-induced neurotoxicity has become an important area of therapeutic development in treating Alzheimer’s disease. Platelet-derived growth factor (PDGF) has been shown to be able to protect neurons against several neuronal insults such as ischemia and HIV1 toxin induced cytotoxicity. These neuroprotective effects correlate well with our previous results that demonstrate the neuroprotective effects of PDGF-BB, one of the PDGF receptor ligand subtypes, against NR2B containing NMDA receptor induced excitotoxicity, a possible underlying cause of Aβ oligomer induced synaptic dysfunction and neuronal death. This project examines the neuroprotective effect of PDGF-BB against Aβ1-42 oligomer induced cytotoxicity in both SH-SY5Y cells and primary hippocampal neurons. Cell viability was monitored by MTT assay and the affected signaling pathways were examined using pharmacological methods and Western blotting. The results demonstrated that Aβ1-42 oligomer elicited a dose-dependent toxicity with a sign of saturation at higher dosages, PDGF-BB failed to protect neurons against Aβ1-42 oligomer induced cytotoxicity. In contrast, Aβ1-42 oligomers strongly inhibit PDGF-BB induced mitogenesis in both SH-SY5Y cells and primary neurons. Further investigation using Western blotting to measure PDGF receptor expression and phosphorylation in SH-SY5Y cells showed that Aβ1-42 oligomer can inhibit PDGF-BB induced phosphorylation of PDGF β-receptor on Tyr1021, a site that is crucial for PLCγ mediated mitogenesis. These findings not only explained the poor neuroprotective effect elicited by PDGF-BB against Aβ1-42 oligomers, but also led to a novel hypothesis that Aβ1-42 oligomer may interfere with neurotrophic factor induced neuronal survival, either selectively or perhaps globally. Further exploration on this hypothesis will be able to shed light on this potentially novel mechanism of pathogenesis in Alzheimer’s disease.

Beta-amyloid (Aâ) remains to be the focus of research interest of the pathogenesis of Alzheimers disease (AD). Aâ is subject to oligomerization and its polymers are cytotoxic. Advanced aggregation leads to formation of senile plaques. Depositions of Aâ surrounding the cerebral vasculature, i.e. cerebral amyloid angiopathy (CAA), occur in most AD patients. The occurrence of Aâ aggregation in AD brains is not due to over-expression of amyloid precursor protein in most cases of AD. Factors influencing Aâ polymerization are yet to be established.<p> Aldehydes are highly reactive. They can cause protein crosslinkage. It is interesting to study whether endogenous aldehydes may be involved in Aâ polymerization process. In order to investigate the potential interaction of endogenous aldehydes with Aâ and their effects on its aggregation, various techniques including thioflavin T fluometry, dynamic light scattering, circular dichroism and atomic force microscopy were employed to assess Aâ aggregation at different stages. Formaldehyde, methylglyoxal, malondialdehyde and 4-hydroxyl-nonenal were found to enhance Aâ â-sheets formation, oligomerization and fibrillogenesis in vitro. The sizes of the oligomers are increased after interaction with the aldehydes. Lysine residues of Aâ were identified to be the primary site of interaction with aldehydes by forming Schiff bases, which may subsequently lead to intra- and inter-molecular crosslinkage. Aldehydes can also crosslink Aâ with other proteins such as apolipoprotein E and á2-macroglobulin (á2M), to form large complexes. Results suggest that aldehydes substantially increase the rate of Aâ oligomerization at each stage of fibrillogenesis.<p> The native and formaldehyde-modified Aâ oligomers were isolated by size exclusion chromatography and their cytotoxic effects towards SH-SY5Y neuroblastoma cells were assessed using MTT, LDH and caspase-3 activity assays. The aldehyde-modified oligomers are slightly but significantly more cytotoxic compared to the native oligomers. Since aldehydes significantly increase the production of Aâ oligomers, an increase in aldehydes would enhance the total cytotoxicity, suggesting that aldehydes may potentially exacerbate neurovascular damage and neurodegeneration caused by Aâ.<p> Low-density lipoprotein receptor related protein-1 (LRP-1) plays a crucial role in Aâ clearance via the cerebral vasculature. Semicarbazide-sensitive amine oxidase (SSAO) and LRP-1 are both richly expressed on the vascular smooth muscle cells (VSMCs). We demonstrated that SSAO-mediated deamination affects LRP-1 function using isolated VSMCs. Formaldehyde at low concentrations decreases LRP-1-mediated uptake of á2M, a substrate of LRP-1 and a carrier for Aâ. Methylamine, an SSAO substrate that is converted to formaldehyde, also inactivates LRP-1 function, but not in the presence of an SSAO inhibitor. Increased SSAO-mediated deamination can potentially impair Aâ clearance via LRP-1.<p> In conclusion, aldehydes derived from oxidative stress and SSAO-mediated deamination induce Aâ aggregation, enhance Aâ cytotoxicity and impair Aâ clearance. The exclusive localization of SSAO on the cerebral vasculature may be responsible for the perivascular deposition of Aâ, i.e. CAA, which is associated both with vascular dementia and with AD. Vascular surface SSAO may be a novel pharmacological target for the treatment of AD.

Bakgrund: I Sverige finns det cirka 160 000 personer som är drabbade av någon form av demenssjukdom och av dessa lider ca 60 % av Alzheimers sjukdom. Cirka en halv miljon svenskar beräknas vara anhöriga till någon som drabbats av Alzheimers sjukdom. Alzheimers kallas ibland för de anhörigas sjukdom, eftersom livssituationen förändras både för den drabbade och för de anhöriga. Syfte: Att beskriva anhörigas upplevelser av att vårda personer med Alzheimers sjukdom. Metod: Studien utfördes som en allmän litteraturstudie. Resultat: I resultatet framkom att de anhöriga upplevde många känslor under sjukdomsförloppet, som till exempel oro inför framtiden och en stor sorg över sjukdomsbeskedet. Många unga anhörigas situationer upplevdes som särskilt svåra då de fortfarande var beroende av sina föräldrar. Slutsats: Som sjuksköterska är det av stor vikt att se till både den sjukes och de anhörigas situation för att i god tid kunna ge familjen det stöd och den information som de kan behöva för att orka fortsätta leva som en familj tills sjukdomens slutstadie. / Background: In Sweden there are about 160 000 people who are suffering from some form of dementia and of those suffering around 60% of them has Alzheimer's disease. Approximately half a million Swedes are expected to be relatives of someone affected by Alzheimer's disease. Alzheimer's is sometimes called the relatives' disease, because it is a life-changing situation both for the victim and the family. Purpose: To describe relatives' experiences of caring for people with Alzheimer's disease. Method: The study was carried out as a general literature study. Results: The results showed that many emotions were felt by the relatives during the course of the disease, such as concern for the future and a great sadness at the diagnosis. Many young families’ situations perceived as especially difficult when they were still in need of their parents. Conclusion: As a nurse it is vital to see both the patients and the relatives’ situation in good time to give the family the support and information they might need to be able to continue to live as a family until the terminal stage.

<p>Cellular damage due to oxidative stress is implicated in a wide variety of conditions including degenerative diseases like Alzheimer's and Parkinson's Diseases. One source of oxidative stress is the interaction of redox-active metals such as copper and iron with hydrogen peroxide to produce hydroxyl radicals. Preventing metal-induced oxidative stress by metal chelation is one potential approach to treat some of these diseases, but there remain significant challenges in designing chelators that target damaging metals while not disturbing healthy metal ion distribution.</p><p>To overcome this challenge, prochelators that are responsive to conditions of oxidative stress have been introduced. By designing ligands that only bind metal ions in the presence of oxidants, damaging metals can be bound and removed while not perturbing the metals necessary for cell function. Masking the phenol of a chelator with a boronic ester creates a prochelator that has little to no affinity for metal ions until exposure to H₂O₂ converts the prochelator to the chelator, which is then available to bind metal ions. Described here is the development of boronate-based prochelators that react with H₂O₂ to produce chelating agents of variable denticity, ranging from 2 to 6.</p><p>Quinoline boronic acid pinanediol ester, or QBP, is a new bidentate prochelator introduced here that reacts with H₂O₂ with a rate of 0.22 M<super>-1</super>s<super>-1</super> to produce 8-hydroxyquinoline, a known metal-binding agent. Results in Chapter 2 show that QBP can be activated in vitro under conditions that mimic early Alzheimer's Disease pathology where copper, amyloid beta peptide, and ascorbic acid exacerbate formation of reactive oxygen species. QBP does not bind metal ions, nor does it disaggregate metal-promoted amyloid beta peptide aggregates. However, the released 8-hydroxyquinoline sequesters copper from amyloid beta and both diminishes further formation of reactive oxygen species and inhibits further aggregation of amyloid-beta.</p><p>The syntheses and crystal structures of hexadentate prochelators are described in Chapter 3, along with their rates of oxidation in response to hydrogen peroxide exposure and their ability to protect against hydroxyl radicals formed in vitro by iron (or copper), ascorbic acid, and hydrogen peroxide. The hexadentate chelators are based on a tripodal architecture in which three phenol moieties are linked via nitrogens on three alkyl arms to a central nitrogen to provide an N₃O₃ donor set for metal complexation. Of three prochelator/chelator pairs prepared, the pair (trenBsalam/trensalam) with amine linkages was deemed most suitable for potential biological studies. The prochelator trenBsalam oxidizes at a rate of 0.72 M<super>-1</super>s<super>-1</super> to produce the chelator trensalam in the presence of hydrogen peroxide. The transition metal coordination chemistry and metal ion affinities of trensalam were further studied in Chapter 4 by x-ray crystallography, UV/Vis spectroscopy and cyclic voltammetry.</p><p>The response of a series of bidentate prochelators to various oxidants, including hydrogen peroxide, superoxide, peroxynitrite and hypochlorite, was evaluated by UV/Vis spectroscopy in Chapter 5. Varying the diol that is appended to the boronic ester results in hydrogen peroxide oxidation rates ranging from 0.018 to 1.27 M<super>-1</super>s<super>-1</super>. Lastly, the stability of different boronic acid and diol combinations was probed by spectroscopic techniques and indicate that boronic esters formed with pinanediol form the most stable prochelators under physiological conditions.</p> / Dissertation

Alzheimer¡¦s disease (AD) is a neurodegenerative disorder characterized by progressive deterioration of cognitive functions and the presence of intracellular neurofibrillary tangles (NFT) and extraneuronal senile plaques (SP). The major component of NFT is the hyperphosphorylated microtubules-associated protein tau. SP is consistent of extracellular deposition of £]-amyloid (A£]), mainly A£]1-42 peptide (A£]42). Given the need of tools for early and accurate diagnosis and prediction of disease progression and monitoring the efficacy of therapeutic agents for AD, development of cerebrospinal fluid (CSF) biomarkers have become a rapidly growing research field. In our study, patients with AD (n=28), non-AD dementia (n=16), other neurological disorder (OND, n=14) and healthy controls (HC, n=21) were included. Our results revealed that AD patients have significant higher CSF total tau (t-tau) and lower A£]42 levels than HC and OND groups. There is no significant difference of both CSF t-tau and A£]42 levels between AD and non-AD dementia groups. These results suggest that both CSF t-tau and A£]42 are good biomarkers for distinguishing AD from non-dementia control subjects but demonstrate less discriminating power in differentiating AD from non-AD dementia. Moreover, our results show only CSF t-tau level but not A£]42 has an inverse correlation with the score of short-term memory patients with AD (spearman: r = -0.444; p=0.018). These data indicate the higher CSF t-tau level is associated with much NFT pathology and more severe impairment of short-term memory in AD patients. In the study of the moleacular mechanism of tau¡¦s hyperphosphorylation by glycogen synthase kinase 3b (GSK3b), we show that the T231 is the primary phosphorylation site for GSK3b and the tau227-237 (AVVRTPPKSPS) derived from tau containing T231P232 motif is identified as the GSK3b binding site with high affinity of a Kd value 0.82 ¡Ó 0.16 mM. Our results suggest that direct binding and phosphorylation of T231P232 motif by GSK3b induces conformational change of tau and consequentially alters the inhibitory activity of its N-terminus that allows the sequential phosphorylation of C-terminus of tau by GSK3b. Furthermore, hyperphosphorylation reduces tau¡¦s ability to promote tubulin assembly and to form bundles in N18 cells. T231A mutant completely abolishes tau phosphorylation by GSK3b and retains the ability to promote tubulin polymerization and bundle formation. Taken together, these results suggest that phosphorylation of T231 by GSK3b may play an important role in tau¡¦s hyperphosphorylation and functional regulation.

Thesis (Ph. D.)--University of Hong Kong, 2001. / Includes bibliographical references (leaves 150-191).

Thesis (Ph.D.)--University of Central Florida, 2008. / Adviser: Sic L. Chan. Includes bibliographical references (p. 74-84).

Besides age, inheritance of the apoE-E4 allele is the main risk factor for late-onset AD. To determine the role of apoE in amyloid deposition, we studied mice expressing both mutant human amyloid [beta]-protein precursor (APP) and presenilin 1 (PS1) that were either normal or knocked-out for apoE. By 7 months, amorphous A[beta] deposition developed equally in both lines, indicating that A[beta] alone is sufficient for deposition to occur. In contrast, filamentous amyloid deposition was catalyzed at least 3000 fold by apoE. Electron micrographs further illustrate the filamentous nature of these plaques. These results and other, behavioral, data indicate that the primary function of apoE in AD is to promote the polymerization of A[beta] into mature, neurotoxic, amyloid. ApoE is also synthesized in the liver and is crucial in cholesterol metabolism, for mice lacking apoE exhibit hypercholesterolemia. We investigated neuropathology in mice using an uncommon technique, parabiosis, to determine whether apoE in the peripheral circulation influences brain amyloid formation. This surgical procedure allows exchange of proteins via peripheral circulation. We show that plasma apoE is found in parabiosed PS/APP/apoE-KO mice, rescuing their hypercholesterolemia. Unexpectedly, amyloid deposition is reduced in parabiosed PS/APP/apoE-KO mice compared to PS/APP controls. ApoE in the periphery seems to slightly reduce amyloid burden, by likely promoting efflux of A[beta];from the brain. These findings reinforce that the mechanisms whereby apoE affects A[beta] metabolism are complex, and the modulation of peripheral apoE metabolism is not likely to impact AD neuropathology. Since cognitive stimulation is associated with lower risk of AD, we sought to investigate the preventative potential of environmental enrichment (EE) using our mouse model.