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Alzheimer's disease (AD) is a condition marked by progressive intellectual decline and memory loss, which typically affects individuals over the age of 60. Its origins are unknown but genetic factors are suspected in some cases. There is limited information about the subjective experience of AD although it is often described as a calamity that inevitably destroys the self irrespective of its victims' social circumstances. This dissertation offers an alternative to this nihilistic portrayal that draws on a critical phenomenological framework. It explores the loss of self as an intersubjective phenomenon that is mediated by three contexts: (1) Western representations of the self as autonomous and individualistic; (2) the public description of AD; and (3) the biomedical practices that construct AD as a diagnostic object. / The dissertation examines the experiences of 16 patients and 37 family members who participated in a multi-disciplinary assessment at a dementia clinic. The participants also include 14 clinicians and staff members from the clinic. The findings are derived from a prospective study that includes in-depth, at-home interviews and observations of clinical assessment activities and research-based genetic counseling. The dissertation examines how memory trouble interferes with the intersubjective fabric of everyday life in families as affected participants lose the ability to meaningfully reciprocate on the basis of their individualistic identities. The analysis emphasizes the role of the clinical assessment, diagnosis, and public description in restoring intersubjective order. A salient aspect of this process is the way in which medicalized interpretations of memory trouble facilitate reinterpretation of the eroding self as being animated by pathology. The self is thus rendered meaningful again as it is being indexed to lay descriptions of what people do and say in AD. The analysis also considers how this process extends to participants who came to perceive themselves as victims of AD although they were assessed as not having a dementia disorder. The dissertation finally considers the impact of acquiring genetic knowledge about AD on interpretations of the self. Overall, the research underscores the loss of self in AD as a phenomenological process that is mediated by familial and institutional contexts.

In the present study, the syntactic deficit of Alzheimer's patients was investigated, using an object manipulation task. Four case studies were presented, using data from test batteries devised by Caplan (pers. comm.) and the author. Subjects responded by acting out stimulus sentences presented in aural and written modes, using a set of small figurines. Responses were evaluated following criteria described by Caplan (1986, pers. comm.). Data from the four subjects were compared with each other, and with data obtained from a similar battery administered to aphasic patients. An impairment in the ability to interpret certain syntactic structures was found for all subjects, indicating that Alzheimer's patients do suffer from a syntactic comprehension deficit in the early stages of the disease. Several syntactic structures which caused errors in the responses of the Alzheimer's subjects, also caused errors for the aphasic patients, suggesting that the parsing model underlying the design of the stimuli, described by Caplan (in press) is a valid description of normal language function. Results of the present investigation are examined in relation to a model of syntactic comprehension suggested by Caplan (in press). Contradictions to hypotheses proposed are noted. The limitations and diagnostic use of the object manipulation test, are discussed. / Medicine, Faculty of / Audiology and Speech Sciences, School of / Graduate

The purpose of this study was to determine if distinct subgroups of patients with Senile Dementia of the Alzheimer Type (SDAT) could be identified using seven scales of the Cognitive Behavior Rating Scale (CBRS). Ward's method of cluster analysis was used to group 104 patients with a probable diagnosis of SDAT into subtypes.The following three clusters were identified: (a) Moderately Impaired, (b) Severely Impaired, and (c) Emotionally Intact which displayed differences in symptom severity. Clusters could be partially defined by the amount of time they had been diagnosed with the disease. Differences in the cluster's configuration of scores had little/no descriptive utility. Subsequent discrimination analyses indicated that patient demographics were not as useful as the CBRS in classification of patients.This study provided evidence for the CBRS's ability to differentially portray SDAT patients' profiles. Results provide partial support for a stage model of SDAT. Implications of existing subgroups in SDAT are discussed as they pertain to patient management issues. / Department of Counseling Psychology and Guidance Services

Background: There has been a rise in dementia awareness, with policy changes leading to increased diagnosis rates. However, the stigma of dementia is likely to cause challenges in diagnostic communication. This is complicated by the effect of dementia on cognitive functioning. The aims of this study were to (1) identify how diagnoses of dementia are communicated, (2) identify how people with dementia respond to the diagnosis, and (3) explore doctors’ perspectives on dementia diagnosis delivery. Methodology: A systematic literature review was conducted. Twenty doctors from 9 memory clinics across 4 NHS trusts participated. Eighty-one dementia diagnosis feedback meetings were video-recorded. Conversation analysis was used to identify patterns in diagnosis delivery. Four focus groups with the participating doctors were analysed using thematic analysis (inter-rater reliability 0.89). Findings: The literature review highlighted the dilemma of communicating both sensitively and honestly with people with dementia, as well as challenges stemming from cognitive impairment. This was also evident in diagnostic communication. Prior to diagnosis doctors elicited patient orientation to the meeting purpose (“do you know why you’re here?) and perspective into symptoms (“how is your memory?”). The majority of patients displayed some confusion as to the meeting purpose and offered non-medicalised explanations for their symptoms. Doctors attempted to address this through repeated explication of test results and statements of the clinic purpose. Dementia was always explicitly named. Diagnoses were often delivered indirectly (“that is dementia”), a practice to manage patient resistance and negative responses. However, over 40% were delivered directly (“you have dementia”), especially when patients were more cognitively impaired. Doctors pursued non-minimal responses to diagnosis, apparently to obtain perspective before progressing to treatment. However, resistance was not always addressed and prognosis was often avoided. Doctors highlighted pressure to make diagnoses and an aim to emphasise “living well” rather than discussing prognosis. Conclusion: The findings of this study highlighted the delicate balance between minimising likely resistance and distress and maximising understanding in the context of cognitive impairment. Instilling hope is evidently a priority for doctors. The diagnosis meeting is just one part of the journey of the person with dementia, and sufficient pre- and post-diagnosis support is integral.

Alzheimer's disease has become one of the most common diseases jeopardizing the health of the human being. The main pathological feature of AD is the accumulation of Aβ in the brain to form senile plaques. Therefore, it is of great significance to develop new and efficient drugs targeting at amyloid-β for the detection, diagnosis and therapeutics for Alzheimer's disease. Xanthohumol (Xn) naturally presents in hops (Humulus lupulus L). Studies have shown that it has anti-lipoperoxidative, anti-inflammatory, anti-proliferative activities, antiangiogenic and antioxidant effects, which further illustrates its potential therapeutic for AD. However, the bio-incompatibility and blood-brain barrier impermeability of Xanthohumol hindered it in vivo efficacy potential for treating Alzheimer's disease. Thus, we designed and prepared a series of Xanthohumol derivatives, namely, Xn-n, (n = 1-9) and its chalcone derivatives C-n, (n = 1-10) to enhance the desirable physical, biological and pharmacological properties, especially the blood-brain barrier permeability for intervention of AD. As an effective technique for in vivo visualization, Near-infrared fluorescence imaging based on organic small molecule probes has a promising application in the diagnosis of Alzheimer's disease. However, most of the reported imaging probes can only visualize Aβ-plaques but do not have therapeutic potential such as neuroprotection against Aβ induced toxicity. Herein, we designed and synthesized a series of oligomeric Aβ targeted near infrared (NIR) fluorescent probes for the diagnosis and therapeutics of Alzheimer's disease, namely DBAN-SLM, DBAN-SLOH, DBAN-OSLM which showed remarkably effective inhibitory effect on Aβ aggregation, significant neuroprotection effect against the Aβ-induced toxicities, and suppression on Aβ-induced ROS generation. indicating its great promise as a useful theragnostic agent for the early diagnosis and therapy of AD. Dual-modal imaging is an important approach to overcome the limitations of single imaging technology in the diagnosis of AD disease. Therefore, based on the dual-modal, we designed and synthesized the NIR/MR dual-modal detection and theragnostic probes namely Dyad-1, Dyad-2, Dyad-3 and NP@SiO2@F-SLOH. More surprising is that the two NIR/MR dual-modal probes show excellent biological properties, including the ability to inhibit Aβ aggregation to a certain extent, neuroprotective effects on cytotoxicity caused by different forms of Aβ species, blood-brain barrier (BBB) permeability, and high stability. All of these newly designed and synthesized molecules were characterized with 1H NMR, 13C NMR, and HRMS and found to show good agreement with the desired structures. The photophysical properties and biological properties of these novel designed and synthesized fluorescent probe such as UV-vis absorption, fluorescence emission, dissociation constant determined by fluorescence titration, cytotoxicity assay, neuroprotection, and inhibition of Aβ aggregation were investigated

published_or_final_version / abstract / Electrical and Electronic Engineering / Doctoral / Doctor of Philosophy

The purpose of the present study was to compare 42 community-dwelling spouse and child Alzheimer's Disease caregivers with 38 community-dwelling potential caregivers on salience of illness symptoms, and accuracy of judging symptoms of illnesses.

This study examined differences in scoring patterns among those diagnosed with Alzheimer's dementia and vascular dementia on the clock-drawing test. Archival clock drawing data was retrieved on 279 patients presenting at a county hospital-based memory clinic. Analysis of drawings was based on frequency of qualitative errors, as well as an overall quantitative score. Mean comparisons found those patients with Alzheimer's dementia to perform worse on both quantitative and qualitative scoring measures. However, Pearson's chi-squared test revealed a significantly higher rate of spacing errors among subjects with vascular dementia. Such lends support to my hypothesis that impaired executive functioning in vascular dementia patients would lead to poor qualitative performance. Logistic regression found significant predictive ability for the qualitative criteria in diagnosis (χ2 = 25.49, p < .001), particularly the rate of omission (z = 8.96, p = .003) and addition errors (z = 7.58, p = .006). Such findings hold important implications for the use of qualitative criteria in cognitive screening assessments.

Two skills necessary for the execution of proficient calculation, retrieving arithmetic facts from memory and accessing number magnitude information, were studied in a group of patients diagnosed with Alzheimer's disease (AD), mild cognitive impairment (MCI), and healthy controls to try to elucidate the locus of impairment in AD-related calculation deficits. This was achieved through the use of an arithmetic production task and a number-matching task as measures of explicit and implicit retrieval of arithmetic facts, and a numerical Stroop task that assesses automatic access to number magnitude representation. AD patients, but not MCI patients, showed high response latencies and a high number of errors when performing multiplications in the production task, and reduced automatic retrieval of arithmetic task in the number-matching task. All participants showed the classic problem-size effect often reported in the mathematical cognition literature. Performance on the numerical Stroop task suggests that access to number magnitude information is relatively resistant to cognitive impairment. ... Results for the AD group are consistent with a pattern of preserved and impaired cognitive processes that might mediate the reported calculation deficits in AD. / by Marâia Beatriz Jurado Noboa. / Thesis (Ph.D.)--Florida Atlantic University, 2013. / Includes bibliography. / Mode of access: World Wide Web. / System requirements: Adobe Reader.