BACKGROUND: While not definitive, many studies demonstrate a link between type 2 diabetes mellitus (DM) and a higher risk of all-cause dementia and Alzheimer’s disease (AD). This study aims to compare the risk of developing all-cause dementia or AD in subjects with a history of controlled versus uncontrolled DM. METHODS: Framingham Heart Study (FHS) Offspring Cohort participants that were without dementia and at least 45 years old when they attended the 7th biennial examination (n = 2978 persons) were included in this prospective community-based cohort study. Subjects were designated a history of controlled DM if they had a positive history of DM and fasting blood glucose (FBG) less than 140 mg/dL. Subjects were designated a history of uncontrolled DM if they had a positive history of DM and FBG greater than or equal to 140 mg/dL. All-cause dementia was determined through criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). AD was determined through criteria from the National Institute of Neurological and Communicative Diseases and Stroke/Alzheimer's Disease and Related Disorders Association (NINCDS/ADRDA). Models were adjusted for age, self-reported sex, education and cardiovascular risk factors. RESULTS: At baseline, 333 participants (11.2%) were positive for ‘current diabetes.’ In the 20-year follow-up period, 12.2% of uncontrolled DM subjects, 11.2% of controlled DM subjects, and 6.4% of normal control (NC) subjects developed all-cause dementia. Relative risk for all-cause dementia with controlled DM was 1.62 (95% confidence interval, 0.900 - 2.93). Relative risk for all-cause dementia with uncontrolled DM was 1.72 (95% confidence interval, 1.02 - 2.89). 11% of uncontrolled DM subjects, 7.9% of controlled DM subjects, and 4.7% of NC subjects eventually acquired AD. The relative risk for AD with controlled DM was 1.76 (95% confidence interval, 0.890 – 3.47). Relative risk for AD with uncontrolled DM was 2.15 (95% confidence interval, 1.22 - 3.80). CONCLUSION: In the FHS Offspring Cohort, subjects with uncontrolled DM were at higher risk of developing all-cause dementia and AD compared to controlled DM and NC participants. The controlled DM status was not found to be a risk factor for all-cause dementia or AD.

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AIDS Dementia Complex (ADC) is a common neurological complication of HIV/AIDS. ADC is characterized by cognitive, behavioral, and motor impairments including slowed thinking, decreased concentration, forgetfulness, apathy, irritability, anxiety, clumsiness, leg weakness, and altered handwriting. Symptoms progress into pronounced verbal and motor slowing, extensive thought disturbances, profound disorientation, hostility, ataxia, incontinence, and eventually a near vegetative state. Presently, no cure is available for ADC. However, treatment with the antiretroviral drug, zidovudine (AZT), has been shown to slow the progression of ADC and improve functioning. Other promising pharmacological treatments under investigation include newer antiretroviral drugs, combination use of protease inhibitors and zidovudine, calcium channel blocking agents, receptor antagonists for excitatory neurotransmitters, and antagonists of cytokines and inflammatory agents. Psychosocial interventions for managing patients in the early stages of ADC focus on preserving independence, promoting self-esteem, and assisting patients to compensate for cognitive changes. During the later stages of ADC, interventions deal with adapting patients' environments to ensure safety and maintain structure, routine, and simplicity. Prompt intervention is essential to improving the quality and length of these patients' lives.

Thesis advisor: Sara Moorman / Studies show that family caregivers are at high risk for morbidity and mortality due to high strain and low efficacy. Dementia caregivers experience a particular type of strain because of the long term nature of the disease. Caregiver studies and intervention programs aim to lower strain and improve perceived efficacy, but they do not often look at these outcomes over time and how they may change throughout the prognosis. This thesis aims to analyze caregiver outcomes in relation to the duration of caregiving, individual characteristics, and type of diagnosis. By using linear regressions and hierarchical linear modeling, I find that caregiver outcomes do not change over time for the average caregiver but vary significantly among individuals. This emphasizes that caregiver strain and efficacy are not solely guided by caregiving tasks. Understanding relationships, perception of one's role, and the ability to adapt to changes are crucial to effective and sustained caregiving. / Thesis (BA) — Boston College, 2019. / Submitted to: Boston College. College of Arts and Sciences. / Discipline: Departmental Honors. / Discipline: Sociology.

Thesis advisor: Daniel Daly / Thesis advisor: James Keenan / Thesis (STL) — Boston College, 2023. / Submitted to: Boston College. School of Theology and Ministry. / Discipline: Sacred Theology.

Yes / Dementia is a serious, progressive, and often debilitating illness with no known cure, having a severe adverse effect on memory, behaviour, reasoning, and communication. A comprehensive review of current refereed research material in the use of games in this area is scarce and suffers from being orientated towards commercially available games or derivatives such as “Dr. Kawashima’s brain training.” There is much lesser concern for bespoke research grade alternatives. This review will attempt to assess the current state of the art in research orientated games for dementia, importantly identifying systems capable of prediction before the onset of the disease. It can be ascertained from the literature reviewed that there are clearly a large number of interactive computer game based mechanisms used for dementia. However, these are each highly intrusive in terms of affecting normal living and the patient is aware of being tested; furthermore their long-term or real benefits are unknown as is their effect over conventional tests. It is important to predict cognitive impairment at a stage early enough to maximise benefit from treatment and therapeutic intervention. Considering the availability, use, and increasing power of modern mobile smartphones, it is logically plausible to explore this platform for dementia healthcare.

No / The objective of this study was to investigate whether the presence of depressive symptoms influences the clinical expression of Alzheimer's pathology. We have analysed the relationships between the severity of Alzheimer's pathology and cognitive decline in two patient groups defined by the presence or absence of depressive symptoms. The study included 89 subjects who participated in a longitudinal research programme prior to death, underwent post-mortem examination and were found to have only Alzheimer-type pathology in their brains, ranging in severity from the entorhinal to neocortical stages. Our results indicate that depressive symptoms did not influence cognition in the early (entorhinal) stages of Alzheimer's disease (AD; where cognition was good regardless of whether or not there was evidence for depressive symptoms) or in the late (neocortical) stages (where cognition was poor regardless of whether or not there was evidence for depression). However, in the intermediate (limbic) stages, patients with depressive symptoms had significantly worse cognitive performance (mean CAMCOG of 32) than those who did not (mean CAMCOG of 73). We conclude that depressive symptoms may contribute to the cognitive decline of AD patients in that pathology, that would be otherwise silent, becomes clinically apparent. Therefore, a multiple diagnosis of early AD and depression should be more widely considered in elderly persons presenting with mild cognitive decline and depression. Treating the depressive symptoms would benefit the patient, but the cognitive improvement may not indicate that AD is absent.

Yes / It might be argued that visual methods are particularly appropriate in research involving participants whose ability to express themselves verbally (eg by means of formal interviews) is compromised for some reason. One such group of participants is people with dementia, a condition often characterised by fluctuations in memory, concentration, comprehension and speech. Whilst increased research into the subjective experience of people with dementia is vital, this can often be hampered by the difficulties of ascertaining participants¿ capacity to give informed consent. Ideally, also, research should go beyond non-malfeasance, and offer real benefits to those involved. People with dementia are all too often subjected to social exclusion and narrative dispossession (Baldwin 2006), so research practice should reverse these trends as far as possible.

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