bluuebunny/crossref_metadata_2025 huggingface dataset:
Kartagener's syndrome presenting in old age
Authors: Ohara G. , Satoh H. , Ohtsuka S. , Yanai H. , Homma T. , Ohtsuka M.
Published: June 2007

It is considered that Kartagener's syndrome is caused by ciliary dysfunction. This syndrome is characterized by the clinical triad of bronchiectasis, sinusitis, and dextrocardia. We describe an elderly patient with Kartagener's syndrome who reached advanced age. We suppose that it may be possible for patients with Kartagener's syndrome to live a full span with optimal therapy for respiratory tract infection and control progression of this disease. Chronic Respiratory Disease 2007; 4: 75—76
REVIEW SERIES: Chronic cough: Behaviour modification therapies for chronic cough
Authors: Vertigan A.E. , Theodoros D.G. , Gibson P.G. , Winkworth A.L.
Published: June 2007

Chronic cough (CC) can be refractory to medical treatment and newer strategies are required for these patients. Behaviour modification therapies are a potential approach for management of cough that does not respond to medical management. Behaviour modification therapy for CC involves an individually tailored programme teaching individuals to increase control over cough symptoms and includes education, specific strategies to suppress the cough, vocal hygiene training and psychoeducational counselling. Several case series have described speech pathology treatment for CC and a recent randomized control trial has demonstrated a significant improvement in symptoms. Possible mechanisms for this improvement include reduced cough reflex sensitivity, increased voluntary control of the cough and reduced stimulation of cough receptors. Respiratory retraining used by physiotherapists may also have potential for use in CC. The validity of psychological therapeutic approaches to CC rests on concepts of CC as a disorder with a psychogenic component, and the ability of cognitive therapies to modify the cough pathway. This work outlines current literature into behavioural management of CC and suggests new directions for practice and research in adults with this condition. Chronic Respiratory Disease 2007; 4: 89—97
Pictures of a Bygone Era
Authors: Battema Doug
Published: June 2007

This article seeks to raise questions about historiographical practice, challenge the reliance on apparently stable discourses of nation and race within contemporary historiography, and expand understanding of the potential and multiple sites of influence in which television operated during its early years as a popular medium. Drawing on principles articulated by Foucault and de Certeau about the production and generation of knowledge, the article critiques previous historical examinations of Amos ‘n’ Andy for overlooking salient features of the television program's cultural and industrial context, as well as its syndication run from the mid-1950s to the mid-1960s. Using information about the syndication of Amos ‘n’ Andy gleaned principally from entertainment and advertising trade journals, the article points out how a more thorough understanding of the local, regional, and international context and of industrial practices may prove essential for recognizing possibilities about the patterns and circulation of cultural beliefs and historiographical norms.
Confirmation Delay for Vacancies on the Circuit Courts of Appeals
Authors: Nixon David C. , Goss David L.
Published: June 2007

Supreme Court confirmation is an exhaustively studied phenomenon, but lower court confirmation is less well understood, in part because lower court nominees are very rarely rejected, and the Senate fails even to hold a recorded vote for most appointees. However, the length of time it takes to fill a judicial vacancy serves as alternate evidence of conflict between the president and the Senate. We present an empirical assessment of appellate vacancy conflict, based on a continuous time-proportional hazard model of vacancy duration. Our results demonstrate that female and minority candidates are confirmed only after unusually long vacancies, and this has nothing to do with the qualifications of the nominees. Our results also demonstrate that institutional and partisan conflict between the Senate and the White House drive the confirmation process for the federal appeals courts, but delay tactics employed by the Senate are only partially strategic.
Predictors of misconceptions of Alzheimer's disease among community dwelling elderly
Authors: Edwards Anne B. , Cherry Ralph L. , Peterson Janet
Published: June 2007

Although discussion of Alzheimer's disease (AD) is increasing in the popular media, knowledge about AD has not been extensively examined. This study analyzes factors associated with knowledge about AD in an elderly sample. Data from a mail survey was sent to a random sample (N=527) of subjects aged 60 and older in the Northwest Indiana metropolitan area. We performed a multiple regression analysis to determine the effect of demographic characteristics, knowledge about services for the elderly, and health information scanning on knowledge about AD. Results indicate that misconceptions of AD are widespread among the elderly population. Race and general knowledge about services for the elderly is associated with specific misconceptions of AD. In addition, a higher education level is associated with fewer misconceptions of AD, while health information scanning is not. These findings suggest that there is a need for accurate information about both AD and community services for older people. Results of these analyses indicate the importance of addressing race and education level when disseminating information about services and AD.
Ethnoculturally-sensitive practice and Alzheimer's disease
Authors: Kane Michael N.
Published: June 2007

Alzheimer's disease (AD) does not respect the boundaries of ethnicity or culture. Diverse ethnocultural groups adapt to the stresses of AD in their own unique fashion. As the attitudes, values, help-seeking and coping behaviors vary from one individual to another, so also does variation exist among the diverse ethnocultural groups. This paper will review current literature regarding several ethnocultural groups, as well as common attitudes, values, helpseeking and coping behaviors. Skills, values, and knowledge for the ethnoculturally-sensitive practitioner are discussed. Finally, case examples are cited.
Alzheimer memory training: Students replicate learning successes
Authors: Arkin Sharon M.
Published: June 2007

Eleven subjects with Alzheimer's disease took a 30-item biographical baseline quiz. Seven experimentals received 10 weekly sessions of a tape-recorded narrative plus quiz exercise, created and administered by university undergraduates. Controls had equivalent student contact, but no memory training. The exercise contained all items missed on the baseline quiz, plus additional items. Experimentals learned or relearned seven - 13 personal facts, as determined by a post-test administered one distraction-filled hour after the 10th training session. Experimentals' improvement in performance from the first to the last session was highly significant and experimentals did significantly better than controls on a readministration of the baseline test.
Predictors of empathy in dementia care staff
Authors: Gilson Aaron M. , Moyer Delores M.
Published: June 2007

Past research suggests that empathy levels between people vary as a function of individual characteristics. Although empathy has been studied in such health care professionals as physicians and nurses, there has been little evaluation of empathy in staff caring for patients with Alzheimer's disease (AD) and other senile dementia disorders. This study examines the relationship between levels of empathy and the demographic and personality characteristics of a sample of dementia care staff in Wisconsin. Results suggest that empathy is related to diverse caregiver characteristics and is associated more frequently with personality rather than demographic variables. Empathy levels also were found to be different between male and female caregivers, which is consistent with past studies. Recommendations are made for future research with this population of health care professionals. Clinical implications are discussed.
Frontotemporal dementia with ubiquitinated inclusions: A case study of the regional distribution of hippocampal pathology
Authors: Mehring Bess , Lin Judy C.Y. , Wilson Dahlia , Lippa Carol F.
Published: June 2007

In motor neuron disease (MND) cases associated with dementia, neurons often contain ubiquitin-positive, taunegative cytoplasmic inclusions that are numerous in the granule cell neurons of the hippocampal complex. Dot or threadlike ubiquitinated neurites are also observed in the surrounding neuropil and in other frontotemporal regions. Cases of frontotemporal dementia (FTD) with identical appearing ubiquitinated deposits have been described in FTD cases lacking signs of MND. The underlying pathobiology of these cases remains obscure. We describe a case from a familial FTD kindred and use immunohistochemistry to evaluate the hippocampal ubiquitin-positive cytoplasmic granule cell inclusions in relationship to the threads and dots that surround them. Ubiquitin-positive threads were more numerous in the overlying molecular layer of the dentate gyrus (DG) compared with the underlying polymorphic layer, suggesting that threads are formed primarily in the dendrites of the affected granule cells. In contrast, dot-like inclusions were uniformly distributed. Using antibodies to synapticterminal specific proteins, we observed loss of perforant pathway synapses in the outer molecular layer of the DG. The numbers of thread-and dot-like inclusions were no greater in the region of synaptic loss than in the layer that lacked detectable synaptic loss. Similarly, ubiquitinated aggregates were more numerous in rostral sections, and they tended to cluster, whereas synapse loss was uniform. These findings expand upon previous data by suggesting that formation of these ubiquitinated aggregates relate to an inherent susceptibility in the granule cell neuron, rather than solely to a deafferentation effect. This study contributes to our understanding of what might be a common pathological process underlying FTD and MND cases with ubiquitinated inclusions.
Community-based services help people in the early stages of Alzheimer's disease and other cognitive impairments
Authors: Noyes Lin E. , Daley Peggy , French Kelly
Published: June 2007

The increasing number of people being diagnosed with early Alzheimer's disease (AD) is calling attention to the need for additional community-based services. Programs are needed specifically for this population to address the unmet needs of people with the diagnosis who still have insight into their situation. Using a community-based, holistic approach, Family Respite Center's Early Intervention Program provides an array of services to people in the early stages of an Alzheimer's type illness through the use of support programs, cognitive therapies and education. The benefits received from participating in such a program have been positive, as measured by group member feedback. Once overcoming the psychosocial, awareness and provider-support barriers often associated with participation in similar groups, the family and diagnosed person can both benefit.
Correlation of rCBF (SPECT), CSF tau, and congnitive function in patients with dementia of the Alzheimer's type, other types of dementia, and congrol subjects
Authors: Tsolaki M. , Sakka V. , Gerasimou G. , Dimacopoulos N. , Chatzizisi O. , Fountoulakis K. N. , Kyriazis G. , Papanastasiou J. , Kazis A.
Published: June 2007

Background. The diagnosis of Alzheimer's disease (AD) during life remains difficult and a definite diagnosis of AD relies on histopathological confirmation at post-mortem or by cerebral biopsy. It is well known that levels of tau proteins are consistently and significantly increased in the cerebrospinal fluid (CSF) of Alzheimer's patients versus levels in normal controls. However, the sole use of this biochemical marker as a test for AD is hampered by mediocre specificity, since tau concentrations may also be elevated in certain other neurological disorders (OND). Studies of the regional cerebral blood flow (rCBF) are widely performed because of their convenience and usefulness in a variety of neurological disorders. Most studies have reported high diagnostic accuracy for brain perfusion single-photon emission tomography (SPECT) in Alzheimer's disease.

Methods. In order to improve specificity, in this study, correlation of 99mTc-HMPAO SPECT scanning and CSF tau protein levels was made in 117 patients with AD, 67 patients with OND (26 of which had other dementias), and 23 age-matched controls. Means and standard deviations of tau protein levels were 297, 42 ± 221, 12 in AD patients and 78,07 ± 98, 51 in patients with OND (p = 0.0006). No correlation was noted between CSF tau protein levels and age, duration of the disease, and neuropsychological scores of mini-mental state examination (MMSE), Cambridge Cognitive Examination (CAMCOG), and Functional Rating Scale for Symptoms of Dementia (FRSSD).

Findings. There was a bilateral parietal and temporal hypoperfusion in patients with AD in SPECT in comparison to normal subjects (p < 0.05) and there was a statistical correlation between this hypoperfusion and neuropsychological tests, such as MMSE and CAMCOG (p < 0.01). There was no correlation between tau protein levels and hypoperfusion in SPECT.

Interpretation. Conclusively, the correlation between elevated levels of tau proteins and hypoperfusion in SPECT in AD patients therefore cannot improve the specificity of tests in AD and this means that the determination of CSF tau proteins levels is not a specific diagnostic test for AD.
A reflective study of Alzheimer's caregivers
Authors: Juozapavicius Kevin Petronela , Weber Joseph A.
Published: June 2007

Symbolic interaction posits that to truly understand a situation, it must be considered from both an observer's perspective and the perspective of the actor involved in the situation. In this study, the actors involved are former Alzheimer's caregivers (N = 20) and the situations examined are reflections of the caregiving experience. An in-depth interview was used to explore caregiver issues. The results show that former Alzheimer's caregivers remember their experiences vividly and can recount many stories regarding their successes, regrets, coping strategies, and barriers faced. Participants also shared how they coped with the death of their loved one, the major issues they had immediately following the death, and issues with which they are still dealing. From the information shared by former caregivers, an Alzheimer's Caregiver Transition Model (ACT-M) was developed to help explain the process individuals go through as they transition out of the caregiver's role.
Comparing the well-being of post-caregivers and noncaregivers
Authors: Rubio Doris McGartland , Berg-Weger Marla , Tebb Susan S. , Parnell Lisa A.
Published: June 2007

Researchers who study family caregiving have begun to recognize the need to broaden the realm of inquiry to include the exploration of the positive aspects of caregiving as well as conceptualizing caregiving on a continuum from the pre-caregiving phase through the post-caregiving phase. Additionally, researchers are urged to use control groups in research. This study complements the current trends by examining the positive aspects of caregiving among former caregivers. Specifically, the well-being of post-caregivers is compared to that of noncaregivers. Bivariate analyses examine the factors that are significantly different between former caregivers and noncaregivers. Results show that former caregivers have higher wellbeing than noncaregivers. In the multivariate model, only one subscale of well-being (basic needs) is different between the two groups. Implications of this research are discussed.
Bingo vs. physical intervention in stimulating short-term cognition in Alzheimer's disease patients
Authors: Sobel Benjamin P.
Published: June 2007

Past research has shown that pharmacological measures can enhance cognitive and functional capacities for patients with Alzheimer's disease, but may result in unacceptable side effects. Investigations using nonpharmacological treatments are limited. This study evaluates the therapeutic effect of the game of Bingo as cognitive stimulation, versus daily physical activity, on short-term memory, concentration, word retrieval, and word recognition. Informed consent was obtained from the designated representatives of 50 subjects from six community adult day care centers on Long Island. The results show that cognitive stimulation enhanced performance on the Boston Naming Test and a Word List Recognition Task; physical intervention, however, did not reach statistical significance. Thus, a simple cognitive activity such as Bingo can be of great value to the daily management of Alzheimer's patients.
Insight in Alzheimer's patients: Results of a longitudinal study using three assessment methods
Authors: Arkin Sharon , Mahendra Nidhi
Published: June 2007

Three direct measures of dementia insight were administered to 20 participants in a longitudinal Alzheimer's disease (AD) rehabilitation research project 1 and to subsets of these participants that completed one (N = 19), two (N = 12), and three (N = 6) years of program participation. The measures were: (1) responses to a discourse prompt question about AD (ADPQ); (2) endorsements of seven items on the Geriatric Depression Scale 2 (GDS) about the effects of dementia (separate analyses were done for two of the seven items that related specifically to memory and thinking); and (3) a sentence-completion exercise. Responses to measures 1 and 2 and the subset of 2 were quantified, tracked over time, and subjected to correlational analyses with age, Mini-Mental State Exam 3 (MMSE) score, and depression, as measured by total GDS score, and with each other.

Major findings: There were no decreases in insight from baseline to year 1, 2, or 3, as measured by free responses to the AD prompt question. There was a significant decline in insight from baseline to year one on the GDS measure, but no change from year 1 to year 2 and a return to baseline level at year 3. There was no correlation between insight and baseline age, between insight and MMSE score at any time point, between MMSE score and depression, as measured by total GDS score, or between MMSE score and depression score, except for the year 3 completers, where depression score was negatively correlated with MMSE score at year 3 only. GDS insight and ADPQ scores were not correlated. Several participants that showed no insight on the quantified measures did so on the sentence completions.
Interaction between apolipoprotein-E and angiotensin-converting enzyme genotype in Alzheimer's disease
Authors: Isbir Turgay , Agaçhan Bedia , Yilmaz Hülya , Aydin Makbule , Kara Ihsan , Eker Deniz , Eker Engin
Published: June 2007

Both apolipoprotein-E (apo-E) 4 allele and angiotensinconverting enzyme (ACE) deletion (D) polymorphism have been associated with a high risk for coronary heart disease. Increased frequency of the 4 allele has also been reported in patients with late-onset of familial and sporadic Alzheimer's disease (AD). The primary aim of this study is to examine the possible relationship between the ACE gene polymorphism and AD. The second aim of this study is to explore the relation of the ACE and apo-E genotypes with AD. Polymerase chain reaction (PCR), restriction fragment length polymorphism (RFLP), and agarose gel electrophoresis techniques were used to determine the apo-E and ACE genotypes.

The frequencies of ACE D and ACE insertion (I) allele among AD patients and controls were 55.7 percent versus 44.2 percent and 51.7 versus 48.2 percent, respectively. Apo-E allele frequencies in the AD group for 2, 3 and 4 were, 1.7 percent, 96.5 percent, and 1.7 percent, respectively. The apo-E allele frequencies of healthy groups for 2, 3 and 4 were 1 percent, 56 percent, and 1.7 percent, respectively.

In conclusion ACE D and apo 4 allele were found to be more frequent in patients with Alzheimer's disease than in the control group.
Statewide survey to compare services provided for residents with dementia in special care units and non-special-care units
Authors: Gerdner Linda A. , Beck Cornelia K.
Published: June 2007

To protect the consumer, consistency is needed in what one can expect when a long-term care facility (LTCF) advertises having an Alzheimer's special care unit (SCU). Arkansas recently passed disclosure legislation, which has led to the development of criteria for licensure of SCUs. This study compared the extent to which Arkansas LTCFs, with and without SCUs, met these criteria. We conducted a statewide survey of 238 LTCFs prior to the enforcement of these regulations and will conduct the same survey following their enforcement. Of the 147 (62 percent) facilities responding, 24 (16 percent) had a SCU. None of the LTCFs with SCUs met all the state criteria. The number and quality of services provided in SCUs and non-SCUs were similar.
Correlates of personal concerns about developing Alzheimer's disease among middle-aged persons
Authors: Cutler Stephen J. , Hodgson Lynne G.
Published: June 2007

We examine correlates of personal concerns about developing Alzheimer's disease (AD) among (1) adult children, 40 to 60 years of age, who have a living pare n t with a diagnosis of probable AD (N = 108), and (2) a matched comparison group of persons with no parental history of AD (N = 150). Using stepwise regression, predictors measuring subjective perceptions of memory functioning, overall family history of AD, knowledge of AD, and sociodemographic characteristics were entered into models for the total sample and each of the subsamples. The results indicate that worries about memory functioning play a consistent role in personal concerns about developing AD across both groups, but that additional pathways to personal concerns differ among individuals having and not having a parent with AD.
Developing More Flexible Approaches to Respite for People Living with Dementia and Their Carers
Authors: Shanley Chris
Published: June 2007

A vital aspect of the care of people living with dementia is the provision of respite services, which allow family caregivers a break from the caring role. The flexibility of such services has consistently been identified as a major factor in whether families make use of them. This study of dementia respite services explores the notion of flexibility and then presents a comprehensive checklist that respite service providers can use to assess the flexibility of their service. It then provides brief descriptions of a number of creative respite programs that are examples of flexible service provision.
Frontotemporal Dementia-like Phenotypes Associated With Presenilin-1 Mutations
Authors: Mendez Mario F. , McMurtray Aaron
Published: June 2007

Frontal behavioral changes may be the presenting features of single-photon emission tomography (presenilin-1 [PS-1]) mutations, the most common cause of familial Alzheimer's disease (AD). The authors describe a PS-1 (M233L) mutation with the features of frontotemporal dementia (FTD) and review the literature. PS-1 mutations may produce FTD-like phenotypes with the neuropathology of AD. Some PS-1 mutations have additional Pick's bodies, a neuropathological marker of FTD, and a report of a PS-1 (G183V) mutation found Pick's bodies without amyloid plaques. The patient and the literature suggest that PS-1 mutations result in an overlapping continuum of the clinical and neuropathological features of AD and FTD. In PS-1 mutations, the expression of AD or FTD may depend on the degree of loss of function of the PS-1 gene and the resultant τ pathophysiology.
Information and Service Needs of Persons With Alzheimer's Disease and Their Family Caregivers Living in Rural Communities
Authors: Edelman Perry , Kuhn Daniel , Fulton Bradley R. , Kyrouac Gregory A.
Published: June 2007

This study aimed to identify the information and service needs of persons with Alzheimer's disease (AD) and their family caregivers living in rural communities and to assess differences and similarities in each partner's perspective. In an outpatient clinic setting, a self-report survey was completed by 100 caregivers, while a similar survey was used to interview 100 persons with mild to moderate AD. The survey assessed respondents' interest in information or services related to 22 topics about AD and various aspects of coping with the disease. Although more caregivers than persons with AD reported interest in each topic, 8 of the top 10 topics endorsed by each group of respondents were the same. However, analysis of responses by dyads revealed substantial disagreement in terms of each partner's interest in information and services. Patient and family education, as well as referrals for services, must take into account each partner's unique perspective and needs.
Do Interventions Bringing Current Self-care Practices Into Greater Correspondence With Those Performed Premorbidly Benefit the Person With Dementia? A Pilot Study
Authors: Cohen-Mansfield Jiska , Jensen Barbara
Published: June 2007

This article assessed whether bringing current self-care practices into greater correspondence with those performed before the onset of dementia benefits the dementia patient. Participants were 20 nursing home residents with dementia, their spouses, and nursing assistants. Past and current self-care routines were determined by proxy responses of spouses and nursing assistants, respectively, using the Self-maintenance Habits and Preferences in Elderly questionnaire. Interventions were proposed based on current practices that were inconsistent with those practiced in the past and that had been important to residents. Residents showed engagement with the interventions, as these resulted in significantly more positive than negative or neutral responses. There was no effect on agitation. Incorporating prior preferences into care routines can contribute to the quality of life of dementia patients.
Evaluation of a Telephone-Based Support Group Intervention for Female Caregivers of Community-Dwelling Individuals With Dementia
Authors: Winter Laraine , Gitlin Laura N.
Published: June 2007

Family caregivers, the “second victims” or hidden patients in dementia care, are at risk for social isolation, stress, depression, and mortality. Telephone-based support (telesupport groups) represents a practical, low-burden, low-cost source of emotional support. The present study evaluated the feasibility and effectiveness of professionally led telephone-based support groups for female family caregivers of community-dwelling dementia patients. Recruited through various community sources, 103 female caregivers were randomized to the telesupport group treatment or a control condition. Effects on caregiver burden, depression, and personal gains were evaluated at 6 months, the main end point. Older care-givers (≥65) in telesupport reported lower depression than control group caregivers did.
Mealtime Experiences of Families With Dementia
Authors: Keller Heather H. , Edward H. Gayle , Cook Carly
Published: June 2007

Twenty-three family caregivers participated in interviews to provide their perspectives on mealtimes when caring for someone with dementia (probable Alzheimer’s disease, n = 14; senile dementia, n = 2; mixed dementia, n = 2; frontal temporal lobe dementia, n = 3; and Parkinson-related dementia, n = 1). Qualitative analyses described eating conduct changes and strategies to make mealtimes manageable. They also identified that mealtimes provided a social connection for families, although simplification of meals was required. Additionally, pleasure from food consumed was important, although tension existed around providing nutritious meals. Sometimes, caregivers compromised or “gave in”; at other times they needed to “step in” to promote a successful meal. The many changes noted around meals signaled the changing status of their family member. This study provides important insight into the challenges and benefits of mealtimes for those living with dementia in the community.
Family Physicians’ Recommendations for the Treatment of Alzheimer’s Disease
Authors: Werner Perla
Published: June 2007

The aim of this study was to examine family physicians’ recommendations for various pharmacological and nonpharmacological treatments for Alzheimer’s disease (AD) and its correlates. A phone survey was conducted with 395 family physicians using an experimental vignette methodology, varying in the severity of the disease. Information regarding participants’ recommendations about 10 interventions for the person described in the vignette was elicited. Sociodemographic and professional correlates were examined. Engagement in social activities and participation in support groups were the interventions most recommended by the physicians. Isolation and physical restraints were the least recommended. Recommendations about AD treatments were associated with the severity of the disease and the extent to which the person described in the vignette was perceived as dangerous. Physicians’ recommendations were very similar to those of the lay public, a fact that might contribute to the efficiency of the treatment plan.
Depressive Symptoms Associated With Hereditary Alzheimer’s Disease: A Case Description
Authors: Contreras Mònica Yicette Sànchez , Vargas Paula Alejandra Osorio , Ramos Lucero Rengifo , Velandia Rafael Alarcòn
Published: June 2007

The authors describe a family group studied by the Centro de Biologìa Molecular y Biotecnologìa, and the Clìnica de la Memoria, las Demencias y el Envejecimiento (Universidad Tecnològica de Pereira, Colombia), and evaluate the association of depressive symptoms with Alzheimer’s disease (AD). This family presented a hereditary pattern for AD characterized by an early onset of dementia symptoms, a long preclinical depressive course, and, once the first symptoms of dementia appeared, a rapid progression to severe cognitive function impairment. The authors found a high prevalence of depressive symptoms in this family and propose that the symptoms could be an important risk factor for developing AD in the presence of other risk factors such as the APOE E4 allele.
The Genetics of Alzheimer’s Disease
Authors: Chai Chen K.
Published: June 2007

The genetics of Alzheimer’s disease is produced by 3 essentially interactive gene groups: (1) APP and presenilin 1 and 2; (2) APOE E2, E3, and E4; (3) genes on chromosomes 9, 10, 12, etc. If any gene in (1) mutates, beta amyloid (Aβ) increases sharply beyond what the genes of (3) can remove, with early-onset Alzheimer’s disease the result. With retention of Aβ by E4 in (2), Alzheimer’s disease might result even though (1) and (3) are normal. If any gene in (3) mutates, the level of Aβ will rise, but because many genes are involved in Aβ removal, late-onset Alzheimer’s disease would be detected only eventually.
Effectiveness of Support Groups for People With Mild to Moderate Alzheimer’s Disease: An Evaluative Survey
Authors: Snyder Lisa , Jenkins Cecily , Joosten Liesbeth
Published: June 2007

Support groups can provide a forum for socialization and learning for people with mild to moderate Alzheimer’s disease. The aim of this study was to evaluate the effectiveness of these groups based on participant feedback. A survey questionnaire was administered to 70 support group participants with Alzheimer’s disease from 8 well-established groups across the United States. Participants reported on the educational value, positive socialization, and improved ability to cope with symptoms and to accept the diagnosis as a result of participating in a support group. These reported outcomes suggest the importance of creating more sensitive measures to better evaluate the effectiveness of support groups and other educational or social support programs for persons with dementia.
Cognitive and Psychopathologic Response to Rivastigmine in Dementia With Lewy Bodies Compared to Alzheimer’s Disease: A Case Control Study
Authors: Rozzini Luca , Chilovi Barbara Vicini , Bertoletti Erik , Conti Marta , Delrio Ilenia , Trabucchi Marco , Padovani Alessandro
Published: June 2007

Cholinesterase inhibitors (ChEIs) are effective in improving cognition and behavior in patients affected by Alzheimer’s disease (AD) as well as by Lewy bodies dementia (DLB). The authors compared the effect of rivastigmine in the treatment of cognitive impairment and behavioral and psychological symptoms of dementia (BPSD) in 30 AD and in 30 DLB patients. At baseline, DLB compared to AD patients showed a greater number of extrapyramidal symptoms ( P < .005) and were similar regarding cognitive symptoms and BPSD. After treatment, both groups showed a comparable cognitive and psycho-behavioral improvement. A significant difference between AD and DLB patients was found for hallucinations ( P < .002). Rivastigmine produces comparable cognitive benefits in patients with DLB and AD and also a significant improvement of behavioral disorders. These findings support the view that ChEIs should be considered a first-line treatment of the cognitive and psycho-behavioral symptoms of both AD and DLB.
Issues in the clinical diagnosis of Alzheimer's disease
Authors: Davidoff Donald A.
Published: June 2007

A review of the issues surrounding the diagnosis of Alzheimer's disease (AD) is presented in this paper. Discussed are complications in diagnosis resulting from inconsistent agreement about what's considered “normal” impairment in the elderly. Also discussed are diagnostic complications resulting from factors other than dementia that produce AD-like symptoms and deficits (depression, psychosocial issues). A definition of AD is presented, along with an explanation of the course of data and is a rived at through the exclusion of other possibilities. Clinical indicators of whether a patient possibly has AD, probably has it, or definitely has it, are also discussed.
Alzheimer's disease: clinical, neuropathologic, neuropsychologic, and brain metabolic findings
Authors: Cutler Neal R. , Narang Prem K.
Published: June 2007

Approximately four million individuals over 65 years ofage sufferfrom some form of dementia. A majority of these people sufferfrom an Alzheimer's-type dementia. Brain alterations associated with this disease process include neurofibrillary tangles and senile plaques and reductions in concentrations of chemical messengers. Alzheimer's-type dementia is typified by a slow decline in intellect andpersonality. It is usually diagnosed after other possibilities have been excluded, and can be correctly diagnosed only upon autopsy. Over 12 of these chemical messenger systems have been examined in Alzheimer's disease. Brain tissue of autopsied Alzheimer's patients has revealed reductions in chemical messenger systems such as the cholinergic, noradrenergic, dopaminergic, serotoninergic, and recently, somatostatin and corticotropin. Treatment strategies based on the deficits of these chemical systems has been unremarkable to date. The only treatment that has yielded positive results thus far has been with a drug of the cholinergic system, physostigmine. However, side effects limit its use. A new brain scanning methodology called Positron Emission Tomography has revealed brain metabolic deficits in the parietal and temporal lobes of the brain in patients with mild to moderate Alzheimer's disease. Patients with severe Alzheimer's disease have brain metabolic deficits throughout their brain. Effective study ofAlzheimer's disease must encompass clinicalandpost-mortem studies that include brain chemical evaluations in addition to PET scanning. A combined approach willyield a better understanding of what Alzheimer's-type dementia is, how it progresses, and how it might better be treated.
Etiologic theories of Alzheimer's disease
Authors: Schweber Miriam
Published: June 2007

A variety of theories about the cause or origin of Alzheimer's disease (AD) have been proposed. Some of these theories are based on a particular research finding, such as abnormal protein formation or aluminum accumulation. Others are based on possible imbalances in brain function (calcium disruption, for example), and some are based on analogies to other diseases such as infectious disorders. Still other theories are based on general systemic conditions such as immune function and nutrition, and some are simply based on speculation. Evidence has been found for separate classifications or subgroups of AD that could imply separate causes. There have also been various genetic explanations for the familial category of AD.

This review summarizes the various theories suggested for AD with the reason sfor their proposal, the evidence for or against them, and their current status. Appraisals have been carnied out from the perspective that identification of the primary cause of AD could be crucial to the discovery of effective treatment strategies.
Validating the accuracy and quality of data in the New York State Alzheimer's Disease and Other Dementias Registry
Authors: Gerber Todd , Henry Mary Ellen , Bunn Geraldine , Johnson Christine , White June , Sayetta Rona
Published: June 2007

Validity can be measured by the amount of bias in registry data which consists of anything that changes the ability to correctly measure the risk of disease in the population. Three issues are explored which may effect the validity of the data: selection of patients; information or measurement errors; and confounding.

New York State has practiced various measures to control for and prevent bias in the data collected for the Alzheimer's Disease and Other Dementias Registry. In addition to preventing bias through registry design and quality control, possible sources of confounding are identified which may be controlled during statistical analysis.

Besides preventing and controlling bias, it is necessary to continuously measure and evaluate the validity of the data which has already been collected. An important outcome of this examination is the conclusion that an evaluation of diagnostic practices and validity of diagnoses reported to the registry must not be conducted.
State surveillance of dementing illnesses: perspective and workshop recommendations
Authors: Helmick Charles G. , Henry Mary Ellen , Aubert Ronald E. , Gerber Todd M. , Sayetta Rona Beth
Published: June 2007

Dementias are a large and growing health problem as measured by prevalence and economic/social burden. Prior efforts in the prevention and treatment of dementia have focused on clinical and basic science research, but growing public awareness and support have spurred new public health approaches to the problem. Measuring the problem more carefully through disease surveillance is the first step in any public health approach. However, chronic diseases such as demenia present more difficult surveillance problems than acute diseases because the diagnoses are usually less clearcut and access to affected patients is less centralized. The February Dementia Registry Workshop of seven states represents one of the first attempts of states to coordinate their approaches to these problems. Recommendations of the workshop include a national consensus conference on operational definitions of dementias, autopsy validation of these and other diagnostic criteria, better Medical Subject Heading (MeSH) categories at the National Library of Medicine, and revised death certificates that better reflect data important to the diagnoses of Alzheimer's disease. This workshop helped begin to address important issues of standardizing and coordinating state efforts to deal with dementias that are national in scope and, as such, serves as a model for efforts to deal with other chronic diseases.
Combining medical and dementia day care units: Problems and solutions
Authors: Chodosh H. Louis , Adelman Ruth , Caruso Dana , Martin Freda , Muro Elisabeth Scotti
Published: June 2007

The effect of the establishment of a day dementia unit within an existing medical day care program for the elderly was evaluated. The psychosocial effect of the new unit on the day care clients, their families and the staff was considerable. Strategies were devised to deal with the problems which arose regarding the interpersonal relationships, programming and administration. In retrospect, it appeared that with appropriate planning and flexibility, a combined day program of elderly with medical problems and those with dementia could operate successfully, with certain advantages. 2, 3

The growing number of elderly with dementia and their increasing longevity 1,2,3 has created a significant burden on care-giving families and nursing facilities. It is estimated that less than 4000 of the more than one million non-institutionalized demented persons in this country are served by day care centers.4 Individuals with dementia constitute only 20 percent of the clientele of most day care programs for the elderly. Therefore, it is evident that the needs of the majority of demented persons and their families are not being met. Day care programs specifically for the demented are being developed to assist families in the management of the demented at home.

In a previous paper, the authors expressed the view that from a psychosocial standpoint the advantages of a mixed program of frail elderly and those with dementia outweighed the disadvantages.6 In this review of a day care program that included some dementia clients, it was noted that although some were able to remain in the program for extended periods of time, others had to be discharged because of advancing dementia and inability to participate in social or activity programs.

In April 1987 the Daughters of Miriam Center for the Aged established an Alzheimer's Disease and Related Disorders (ADRD) Unit integrated with the existing medical day care program. The addition of this dementia-specific unit to an existing medical day care program made it possible to retain clients with more severe dementia in a day program. The two units, operating side-by-side, provided opportunities for mainstreaming, whereby the dementia clients could join the well-aged for some activities. Equally important, this concept of two units also appeared to have advantages in regard to financing, administration, staffing and transportation.

As the ADRD unit enlarged, the staff noted distinct changes in the attitude and behavior of the day care clients despite preparation for this expansion. Administrative, logistical and programming problems arose as well, requiring frequent modification of the management and operational plans of both programs. The purpose of this review is to document these observations from administrative, medical, nursing, psychosocial and programmatic standpoints and to propose recommendations which can facilitate the addition of a dementia unit to an existing day care program.
Non-amnestic dementias: special considerations for clinicians and caregivers
Authors: Weintraub Sandra , Kapust Lissa Robins
Published: June 2007

Memory disorders are only one aspect of degenerative dementia. When the dementia instead is characterized by prominent impairments of judgment, insight, reasoning and social graces, this provides a challenge not only for differential diagnosis, but also for management. Two case studies illustrate the special issues facing a multidisciplinary team of clinicians and the caregivers who are involved with patients with non-amnestic dementias. The unique situation of the patient with presenile dementia is considered and broader questions of public policy are raised.
Respite care for Alzheimer's families: Research findings and their relevance to providers
Authors: Lawton M. Powell , Brody Elaine , Saperstein Avalie
Published: June 2007

A research project to evaluate a respite care program for caregivers of patients with Alzheimer's disease and related conditions provided information relevant to service providers of respite care. Providers must under-stand the psychological needs of caregivers that enter into their willingness to use respite care. Caregiving equity, caregiving modeling, the moral imperative of caregiving, caregiving as a challenge, caregiving as role continuity, and resignation to caregiving are themes that may be accountedfor in designing and marketing respite care. People use formal respite as a supplement to the caregiving relief provided byfamily members. Although respite care was highly valued by most who used it, persistent problems involve the cost of care as well as the reluctance of many to entrust their impaired relative and their home to a relative stranger. Training and selectivity in recruitment of respite workers are essentialfor consumer acceptance.
The use of visual imagery as a mnemonic device for healthy elderly and Alzheimer's disease patients
Authors: Byrd Mark
Published: June 2007

Two experiments were conducted to determine the efficacy of visual inagery as a memory aid for Alzheimer's disease patients. The first experiment showed Alzheimer's disease patients to have equally poor memory for both visual as well as verbal material. Verbal cues presented to aid both learning and retrieval efforts proved to have some beneficial effects on the memory of the Alzheimer's disease patients. The second experiment showed that, when provided with both a visual prompt that is similar to the to-be-remembered material, as well as a verbal cue to direct learning and retrievalprocesses, Alzheimer's patients' recognition and memory approached that of healthy older adults. It was suggested that contextual cues to guide and restrict processing during both learning and retrieval efforts may be used to improve the memory of healthy older adults as well as patients with Alzheimer's disease.
Children and memory loss
Authors: Hall Geri Richards , Buckwalter Kathleen C. , Crowe JoEllen
Published: June 2007

Alzheimer's disease and related disorders are often described as having significant effects on all family members. Yet, while there is much research and programming devoted to caregivers, spouses and adult children, the effects of the disease process on young children in the family are often overlooked. The program described in this article was apilotprogram designed to assist children with a better comprehension of dementing illness and to promote parent/child communication about this topic.
Technological innovations for individuals with Alzheimer's disease
Authors: Fernie Geoff , Femnie Bonnie
Published: June 2007

Principles of good design for products and environments that enhance the dignity and avoid stigmatizing individuals with Alzheiner's disease are illustrated. The importance of ergonomic design is stressed with the objective of encouraging the development ofproducts that are welcomed by everyone because of their simplicity and ease of use. Prioritiesfor research and technological development are suggested, including means of quantifying activity and behaviour, the design of reminder devices, guidelines for control interface design and investigations of the suitability of intelligent environments.