A doença de Alzheimer (DA) e a demência vascular (DV), especialmente a sua forma subcortical, são responsáveis pela maioria dos quadros de demência em idosos, nem sempre facilmente diferenciadas do ponto de vista clínico. O objetivo do estudo foi comparar o desempenho de pacientes com DA e com DV em uma bateria breve de testes cognitivos (Mini-exame do estado mental e bateria Neuropsi para confirmar o diagnóstico de demência; CLOX 1 e 2, fluência verbal categoria animal e fonêmica, EXIT 25 e teste de memória tardia da bateria breve de rastreio cognitivo), e verificar seu valor no diagnóstico diferencial entre elas. O desempenho do grupo DV foi inferior ao DA nos testes: CLOX 2, fluência verbal animal e fonêmica. O grupo DA obteve desempenho inferior a DV no subitem evocação do teste de memória tardia. / Alzheimer’s disease (AD) and vascular dementia (VaD), especially its subcortical form, are responsible for the majority of dementia cases in the elderly and are not always easily differentiated from a clinical point of view. The aim of this study was to compare the performance of mild VaD and AD patients in a series of brief cognitive tests (Mini-mental State Examination and Neuropsi battery, in order to confirm the diagnosis of dementia; CLOX 1 and 2, category and letter fluency, a delayed recall test of 10 simple figures and the EXIT 25), and to evaluate the potential use of these tests for the differential diagnosis between them. The performance of the VaD group was significantly impaired, in relation to the AD group, in the tests CLOX 2, category verbal fluency and letter verbal fluency, while the AD patients performed significantly worst in the delayed recall test.

La « fragilité » fait référence à un état de forte vulnérabilité qui résulte d’une réduction des réserves adaptatives de multiples systèmes biologiques et physiologiques sous l’action conjuguée de l’âge, de maladies et du contexte de la vie. Ce syndrome accroit la vulnérabilité de l’individu ainsi que son risque de dépendance, de chutes, d’hospitalisations, d’entrée en institution et de mortalité. La définition la plus utilisée, celle de Fried et collaborateurs, est basée sur la prise en compte d’éléments exclusivement physiques mais la possibilité d’inclure à cette définition d’autres composantes non-physiques, parmi lesquelles la cognition, est actuellement débattue. Cette thèse aborde donc la question d’un point de vue épidémiologique du possible lien entre l’altération des performances cognitives et la fragilité grâce aux données de deux études en population, une cohorte française et une cohorte mexicaine. Les résultats présentés dans cette thèse nous permettent d’affirmer l’existence d’une association entre la fragilité et un déficit cognitif. Qu’il s’agisse de la cohorte de Coyoacan ou des 3 Cités, les deux premières études de cette thèse ont montré une force d’association majorée sur l’incidence d’incapacité, d’hospitalisation ou de décès lorsqu’on considère la fragilité et le déficit cognitif de manière combinée, un résultat plaidant en faveur de l’intégration de la mesure de la cognition dans la définition de la fragilité. Concernant le risque de survenue de démence en revanche, la troisième étude ne montre pas d’effet majoré lorsque ces deux conditions étaient présentes puisque seuls les participants ayant un déficit cognitif étaient à risque de démence, indépendamment de leur statut de fragilité. Enfin, si la fragilité ne constituait pas un risque en soi de démence tous types confondus, la dernière étude de cette thèse a montré une forte association entre l’état de fragilité et le risque de démence vasculaire. Les résultats de cette thèse, ajoutés aux données de la littérature décrivant la présence d’atteintes vasculaires et cérébro-vasculaires dans le syndrome de fragilité, nous ont conduits à formuler l’hypothèse selon laquelle la fragilité pourrait être un état prodromique de démence vasculaire. / “Frailty” is a clinical syndrome characterized by physiological loss of reserves and resilience and represents the summatory action of age, disease and living environment. This geriatric syndrome increases the vulnerability of elderly persons and their risk of disability, falls, hospitalization, institutionalization, and mortality. The definition most widely used, the one proposed by Fried and collaborators, only includes physical elements. Nonetheless, the inclusion of other non-physical components, in particular cognitive function is currently debated. Therefore, the aim of this thesis was the study, from an epidemiological point of view, of the association between cognitive function and frailty using the data of two population-based studies, a French cohort and a Mexican one. The results are in favor of the existence of an association between frailty and cognitive impairment. In the first two studies presented in this thesis, an increased risk of incident disability, hospitalization, and death was found. Therefore, including cognitive function in the phenotype of frailty may be relevant since both processes seem to contribute to the development of negative health-related outcomes. However, regarding the risk of dementia, the results of the third study show that only elderly subjects with cognitive impairment have an increased risk of developing dementia irrespective of their frailty status. Nevertheless, if frailty per se may not be a risk factor of dementia, all types confounded, the last study evidences a strong association between frailty and the incidence of vascular dementia. Such results along with previous studies reporting the existence of vascular and cerebrovascular damage in frail elderly lead us to postulate that frailty could be a prodromal state of vascular dementia.

The purpose of the current study was to explore the relationship between cognitive status and depression in a sample of geriatric patients. Participants included 282 geriatric patients ranging in age from 65 to 96 years who were classified according to diagnosis as: DAT, VaD, MCI, and Norm. All were referred for neurocognitive testing from the Geriatric Assessment Program (GAP) at the University of North Texas Health Science Center (UNTHSC) in Fort Worth, Texas. This study sought to identify factor structures for two versions of the GDS using a geriatric sample of cognitively impaired and intact patients. It then compared these factors to each other to determine whether the GDS-15 is truly a shorter version of the GDS-30. These were then compared to a previously determined factor structure. This study explored whether the four-factors of the GDS-30 are able to differentiate cognitive diagnostic groups. Further, this study sought to identify whether the severity of cognitive decline impacted GDS factor score for each of the cognitively impaired groups. Results revealed a two-factor model of the GDS - 15 and a four-factor model with the GDS - 30. The GDS-15 factors did not differ from the first two factors of the GDS-30. Comparison between the GDS-30 factor structure and that reported by Hall and Davis (in press) revealed no significant differences despite the inclusion of a normal, non-demented group in the current study. Comparisons of subscale scores revealed that DAT patients tended to score lower than the other groups on all but the cognitive impairment subscale. Severity level analyses indicated that as severity of deficits increases, awareness of deficits decreases. This study found that although the GDS-30 is a good screening tool for depression in geriatric patients, it is not particularly useful in differentiating cognitive status group. Also, the GDS-15 was not found to be a good substitute for the GDS-30.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第22336号 / 医博第4577号 / 新制||医||1041(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 高橋 淳, 教授 渡邉 大, 教授 伊佐 正 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Yes / Preliminary evidence suggests that goal-oriented cognitive rehabilitation (CR) may be a clinically effective intervention for people with early-stage Alzheimer's disease, vascular or mixed dementia and their carers. This study aims to establish whether CR is a clinically effective and cost-effective intervention for people with early-stage dementia and their carers. Methods/design: In this multi-centre, single-blind randomised controlled trial, 480 people with early-stage dementia, each with a carer, will be randomised to receive either treatment as usual or cognitive rehabilitation (10 therapy sessions over 3 months, followed by 4 maintenance sessions over 6 months). We will compare the effectiveness of cognitive rehabilitation with that of treatment as usual with regard to improving self-reported and carer-rated goal performance in areas identified as causing concern by people with early-stage dementia; improving quality of life, self-efficacy, mood and cognition of people with early-stage dementia; and reducing stress levels and ameliorating quality of life for carers of participants with early-stage dementia. The incremental cost-effectiveness of goal-oriented cognitive rehabilitation compared to treatment as usual will also be examined. Discussion: If the study confirms the benefits and cost-effectiveness of cognitive rehabilitation, it will be important to examine how the goal-oriented cognitive rehabilitation approach can most effectively be integrated into routine health-care provision. Our aim is to provide training and develop materials to support the implementation of this approach following trial completion. Trial registration: Current Controlled Trials ISRCTN21027481

Yes / A significant proportion of people with dementia live alone, but little is known about their specific needs. To understand the profile of people living alone with mild-to-moderate dementia in the UK and identify any systematic differences associated with living situation. We analyzed cross-sectional data from 1,541 people with mild-to-moderate dementia and 1,277 caregivers participating in the IDEAL cohort at the first wave of assessment. There were 1,256 (81.5%) people with dementia living with others and 285 (18.5%) living alone, of whom 51 (3% of whole sample) reported little or no informal support. There were relatively few differences associated with living situation and odds ratios were generally small. People living alone were older on average, and more likely to be female, than those living with others. Those living alone were more likely to have higher cognitive ability and self-reported functional ability, and more social contact with those from other households. They were also lonelier, expressed less satisfaction with life, and used home care services and equipment more. There were no differences in symptoms, mood, quality of life, or well-being. The findings support the view that it is possible to 'live well' with mild-to-moderate dementia while living alone, given appropriate support, including home care and equipment. Nevertheless, it is important to consider how those living alone may be supported to have a more satisfactory experience, and how health and social care services can best respond to their needs. / ‘Improving the experience of Dementia and Enhancing Active Life: living well with dementia. The IDEAL study’ was funded jointly by the Economic and Social Research Council (ESRC) and the National Institute for Health Research (NIHR) through grant ES/L001853/2. ‘Improving the experience of Dementia and Enhancing Active Life: a longitudinal perspective on living well with dementia. The IDEAL-2 study’ is funded by Alzheimer’s Society, grant number 348, AS-PR2-16-001.

Diabetes is a disease with a deleterious pathology that currently impacts 4.5 million individuals within the United States. This study examined the ability of a specific neuropsychological battery to identify and classify dementia type, investigated the impact of diabetes on cognition and analyzed the ability of the memory measures of the 7 Minute Screen (7MS) and the Rey-Osterrieth Recall to correctly categorize dementia type when not used in combination with a full battery. The battery in addition to exhaustive patient history, medical chart review and pertinent tests were used in initial diagnosis. Results indicated the battery was sufficient in the identification and classification of dementia type. Within the sample, diabetes did not appear to significantly impact overall battery results whereby only two measures were minimally affected by diabetes. Finally, the memory measures of the 7MS and the Rey-Osterrieth Recall were sufficient to predict membership into the Alzheimer's (AD) and vascular dementia (VD) groups with 86.4% accuracy. The classification percentage dropped to 68.3% with addition of the mild cognitive impairment category. The full battery correctly classified AD and VD dementia 87.5% and appeared to be the most robust.

No description available.

Quantitative magnetic resonance imaging (MRI) was used to assess global and regional cerebral volumes in patients with a clinical diagnosis of subcortical vascular dementia (VD) and Alzheimer’s disease (AD). Whole brain volume, cerebrospinal fluid volume, volumes of the temporal, frontal and parietal lobes, the cerebellum and the amygdala-hippocampus complex were determined using a personal computer-based software. Seventeen patients with VD, 22 patients with AD and 13 healthy controls were included. Analysis of covariance using age as covariate demonstrated significant mean differences between controls and dementia groups with respect to all morphological parameters. However, apart from the volume of the cerebellum no significant volumetric differences were found between VD and AD. These results indicate that MRI-based volumetry allows differentiation between AD or VD from normal controls and that measurement of cerebellar volume may be of use to separate vascular and degenerative dementia. However, since the distribution of cerebral atrophy in both dementia groups is very similar, it is suggested that the atrophic changes are not specific to the underlying cause but rather reflect the selective vulnerability of neuronal structures. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Background: Dementia is a common disease today and about 10% of the population in Sweden develop dementia. Dementia is associated with cognitive problems and troublesome symptoms, and is evident in the patient as the disease progresses. Problems: Sleep disorders can be a major problem for people with dementia, their relatives and even the healthcare staff.  As a consequence of sleep disorders negative symptoms like agitation, depression and apathy can be enhanced. This leads to a greater workload for the healthcare staff and more effort emotionally for the relatives. Purpose: The purpose is to describe interventions that improves night sleep in people with dementia. Method: A literature review. The basis consists of 13 articles with both qualitative and quantitative approach. Result: Three categories appeared where night sleep might be promoted through activities, treatments and closeness. In addition to the enhanced night's sleep, the results also showed that improvement in agitation, depression and apathy might be achieved through these interventions. Conclusion: Night sleep in people with dementia can be improved through the interventions reported in the results. The result indicate that in order to perform good care the interventions have to be based on individual conditions. / Bakgrund: Demens är idag en folksjukdom och omkring 10 % av befolkningen i Sverige utvecklar demens. Till demenssjukdomen hör kognitiv problematik samt besvärande symtom och framträder hos den sjuke allt eftersom sjukdomen fortskrider. Problem: Sömnstörningar kan vara ett stort problem för människor med demens, dess anhöriga och även vårdpersonal. Som en konsekvens av sömnstörningar kan negativa symtom såsom agitation, depression och apati förstärkas. Detta leder till större arbetsbörda för vårdpersonalen och mer ansträngning emotionellt för de anhöriga. Syftet: Att beskriva vårdåtgärder som främjar nattsömnen hos människor med demens. Metod: En allmän litteraturöversikt där underlaget består av 13 studier som ligger som grund till resultatet.  Resultatet: Det framkommer tre kategorier där nattsömnen kan främjas genom aktiviteter, behandlingar och närhet hos människor med demenssjukdom. Utöver den främjade nattsömnen visade resultatet även att förbättring på agitationen, depressionen och apatin kan ske med hjälp av åtgärderna. Slutsats: Nattsömnen hos människor med demens kan främjas genom vårdåtgärderna som redovisas i resultatet. Resultatet indikerar dock att åtgärderna måste utföras utifrån individuella förutsättningar för att på bästa sätt kunna utföra en god vård.