bluuebunny/crossref_metadata_2025 huggingface dataset:
Olanzapine as a possible treatment for anxiety due to vascular dementia: An open study
Authors: Moretti Rita , Torre Paola , Antonello Rodolfo M. , Cattaruzza Tatiana , Cazzato Giuseppe , Bava Antonio
Published: May 2006

Disabilities caused by behavioral problems can be potentially devastating in cognitively impaired patients. These behavioral symptoms can be a major cause of stress, anxiety, and concern for caregivers. While psychotropic drugs are frequently used to control these symptoms, they can be accompanied by significant side effects, which include sedation, disinhibition, depression, falls, incontinence, parkinsonism, and akathisias. Agitation is a major problem in older patients with dementia. Agitation and aggression have always been difficult behaviors to manage, and when it is severe, agitation can be a behavioral emergency that requires urgent and immediate intervention.

This six-month study included a group of 94 outpatients (48 men and 46 women) who had a diagnosis of subcortical vascular dementia (VaD). To be eligible for the study, patients needed a score of at least 3 for agitation/ aggression on the Neuropsychiatric Inventory (NPI), suggesting at least moderate frequency and/or severity, and 0 for delusions and hallucinations. Patients were divided into two homogenous groups. Group A received olanzapine (2.5-5 mg/day) and Group B received bromazepam (0.25 percent, 15 drops, three times per day). Patients in both groups were allowed to continue any previous therapy. Patients receiving olanzapine at an average dose of 3.21 ± 1.02 mg/day showed statistically significant improvement on the anxiety rating compared with those receiving bromazepam. Our patients had a host of medical conditions and received numerous concomitant medications. Given the potential complications associated with these therapeutic agents, these patients tolerated olanzapine quite well. It appeared that adverse events, particularly somnolence, postural instability, and postural hypotension, were mild and transient. Moreover, no anticholinerigic effect was registered. These findings suggest that olanzapine could be a safe and effective treatment for anxiety in cognitively impaired patients.
Ganstigmine and donepezil improve neurodegeneration in AD11 antinerve growth factor transgenic mice
Authors: Capsoni Simona , Giannotta Sabina , Stebel Marco , Garcia Addys Ancheta , de Rosa Roberta , Villetti Gino , Imbimbo Bruno Pietro , Pietra Claudio , Cattaneo Antonino
Published: May 2006

Ganstigmine (CHF2819) is an acetylcholinesterase inhibitor that increases acetylcholine in rat hippocampus and ameliorates scopolamine-induced amnesia. In this article, we examined whether and how ganstigmine might prevent or rescue the neurodegenerative phenotype in AD11 antinerve growth factor (anti-NGF) mice, a transgenic model for Alzheimer's disease. The effects of ganstigmine were compared with those obtained after administration of donepezil. Results demonstrate that intraperitoneal and oral administration of ganstigmine and donepezil can reverse the cholinergic and behavioral deficit in AD11 mice but not the amyloid and phosphotau accumulation, uncovering different mechanisms leading to neurodegeneration in AD11 mice.
Documenting pathways to dementia care: Relative validity of questionnaire, interview, and medical record formats
Authors: Drebing Charles , Movitz Rachel , Lyon Paula , Harden Tamara , McCarty Ellen , Herz Lawrence
Published: May 2006

One of the shortcomings of the pathways-to-care literature is the lack of empirical support for the validity of the data collection methods. This study uses three common formats to collect retrospective pathways-to-care data for adults who have been diagnosed with possible or probable Alzheimer's disease (AD) and compares indicators to evaluate their relative validity. Forty family caregivers of adults diagnosed with possible or probable AD were recruited from the caregiver registry of the Boston University Alzheimer's Disease Core Center (BU ADCC). In each of three formats (questionnaire, structured interview, and medical record review), data were collected regarding four key events in the pathway to dementia care: first appearance of symptoms, first verbalized recognition of symptoms, first effort to seek professional help, and first diagnosis by a professional. In addition to the dates of these events, researchers attempted to determine: the first verbalized concern about the symptoms, who first sought professional help, what professional was first approached, and what professional made the first diagnosis. In a consensus meeting, data collected in all three formats were reviewed, and a consensus on the most likely answers to all questions was recorded and compared to data collected in each format. The results suggest that the three formats are not equivalent in terms of concurrent validity. While substantial agreement is found among data collection methods, the validity of the structured interview format and the medical record review is most consistently supported by the data in this study. Questionnaire data resulted in underestimates of delays and correlated poorly with other data sources, including the consensus judgment.
Clinicopathological concordance of dementia diagnoses by community versus tertiary care clinicians
Authors: Mok W. , Chow T. W. , Zheng L. , Mack W. J. , Miller C.
Published: May 2006

Subjects enrolled in the Autopsy Program at the University of Southern California Alzheimer's Disease Research Center may receive clinical diagnoses from primary care providers in the community or from specialists in neurology. We reviewed the autopsy concordance rates for 463 subjects for diagnoses made by both groups of clinicians. Seventy-seven percent of the sample met neuropathological criteria for Alzheimer's disease (AD). The overall diagnostic accuracy for this sample was 81 percent. Neurologists assessed 200 of the subjects (43 percent). The diagnostic accuracy for any clinical diagnosis among the non-neurologists was 84 percent, and 78 percent (p = 0.07) among neurologists. For AD, non-neurologists had a diagnostic concordance rate of 91 percent and neurologists 87 percent. Where neuropathological AD was missed, non-neurologists had failed to detect any cognitive impairment; neurologists had diagnosed Parkinson's disease (PD) and amyotrophic lateral sclerosis (ALS). Erroneous clinical diagnoses of AD missed dementia with Lewy bodies (DLB) or AD concurrent with Parkinson's disease (PD). Our findings identify specific foci for improving clinical diagnosis of dementia among all physicians managing dementia.
Working with organization to implement dementia awareness training for public contact staff
Authors: Shanley Chris , Quirke Sharon , Shaw Lynn , Sammut Anne
Published: May 2006

People with dementia living in the community interact with a range of people who provide services to the public. Within these interactions, there may be communication problems associated with symptoms of the person's dementia. Problems include memory loss, difficulty communicating clearly, inability to grasp complex ideas, and problems handling money. This article describes a project that set out to promote training in dementia awareness for public contact staff with the expectation that it would help them better cater to people living with dementia. We worked with a police service, members of a city council, and staff of community pharmacies. This report provides suggestions about appropriate learning outcomes and program content and recommends steps to help others set up similar education programs.
Stress in the caregivers of Alzheimer's patients: An experimental investigation in ltaly
Authors: Aguglia E. , Onor M. L. , Trevisiol M. , Negro C. , Saina M. , Maso E.
Published: May 2006

In Italy, the family constitutes the major caregiving response to the needs of the elderly who are no longer self-sufficient. These caregivers are often wives or daughters who have chosen to keep the patient at home with them. On average, three-quarters of the caregiver's day is devoted to the patient, a proportion that tends to increase linearly as the disease progresses.

The primary aim of our study was to describe a group of Italian caregivers of patients with a diagnosis of dementia to assess their levels of stress. We then correlated these caregivers with a number of sociodemographic variables and the patients' degree of cognitive impairment and independence in daily life activities. The study was conducted on a sample group of 236 caregivers of patients with a diagnosis of Alzheimer's disease (AD) according to the DSM-IV criteria. Each caregiver took part in a sociodemographic interview and filled in two questionnaires: the Caregiver Burden Inventory (CBI), to quantify the caregiving workload and the Brief Symptom Inventory (BSI), to assess the level of anxiety and depression.

Patients were administered the Mini-Mental State Examination (MMSE) to evaluate their level of cognitive impairment and the Instrumental Activities of Daily Living (IADL) and Activities of Daily Living (ADL) tests to quantify their level of independence. The analysis of the results shows that the average Italian caregiver of an AD patient is a woman, approximately 60 years old. The majority of caregivers are spouses, followed by children. In general, these caregivers work at home, are housewives or retired, and are personally involved in caring for the patients.

The greater the level of a patient's cognitive impairment and the less independent they are, the greater amount of care and supervision they require, leaving less free time for the caregiver; this leads to higher levels of anxiety related to caregiving. Toward the final stages of the disease, patient care tasks take up nearly all of the caregiver's free time, leaving them only about two hours per week for themselves or their friends.

In conclusion, the management of dementia patients places a particular burden on the caregiver and involves several economic and social costs. The burden becomes heavier as the disease progresses, since the increase of cognitive disorders and the resulting reduction of independence in daily life, together with the onset of behavioral symptoms, heighten the caregiver's distress, anxiety, and depression. Establishing a network of community services able to alleviate the burden on families is therefore a priority.

Parallels can be drawn between the stresses documented for American caregivers and their Italian counterparts.
Cost effects of a specialized care center for people with Alzheimer's disease
Authors: Bloom Bernard S. , Chhatre Sumedha , Jayadevappa Ravi
Published: May 2006

A retrospective cohort control study of three populations, 65 years of age or older, at the same institution estimated the incremental cost of Alzheimer's disease (AD). The AD population of the ambulatory Alzheimer's Disease Center (ADC) (n = 640) was matched by age, gender, ethnicity, and address to one with AD from the general internal medicine practice (AD-GM) (n = 419) and to a control group without AD (n = 5331) from the same general medicine practice. Medicare costs of all care for all diagnoses were obtained for 1998 and 1999. Mean per person annual Medicare costs were $19,418 for ADC, $18,753 for AD-GM, and $12,085 for the control group. Incremental cost for ADC population was $7,333 and $6,668 for AD-GM population compared with the control group. Incremental cost was $665 (9.1 percent) higher for ADC than AD-GM. Higher non-AD hospitalizations and length of stay (LOS) by AD populations were the main cost drivers.
Discussions about cognitive impairment in first medical visits: Older patients' perceptions and preferences
Authors: Adelman Ronald D. , Greene Michele G. , Friedmann Erika
Published: May 2006

Primary care physicians are the first medical contact for most patients with early-stage dementia. However, little is known about older patients' desire for discussions about cognitive problems or the frequency of discussions about cognitive status during primary care visits. To investigate this question, older patients and accompanying individuals were interviewed separately following the first visit with a primary care physician in an outpatient geriatric medical practice. Patients indicated that memory was discussed in 62 percent of visits. When memory was not discussed, almost one-third of patients stated that they would have wanted to discuss it. Physicians were more likely than patients to initiate discussions about memory. Patient factors, including age, gender, the presence of an accompanying individual, number of diagnoses, and the patient's statement that cognitive function was a main goal of the visit, were examined as predictors of the likelihood of discussion of memory during the first visit. Patients who identified discussing cognitive function as a goal of the visit were more likely to have a discussion about memory than those who did not.
Evaluating the effect of therapeutic gardens
Authors: Heath Yuko
Published: May 2006

Sometimes the visitors to therapeutic gardens do not necessarily experience the garden the way the designers intended. A postoccupancy evaluation (POE) can reveal discrepancies between the designer's intentions and use of the environment by the actual visitors. A POE is a user-oriented assessment that elicits the opinions of the visitors to a building, facility, or environment. This paper describes a POE of therapeutic gardens at a multilevel care facility for the aged. The population included patients at various stages of Alzheimer's disease progression.
Genetic aspects of Alzheimer's disease, Pick's disease, and other dementias
Authors: Nee Linda E. , Tierney Michael C. , Lippa Carol F.
Published: May 2006

Although genetic testing is available for some degenerative diseases, in most types of dementia, both genetic and environmental factors are involved. Overall, dementing diseases can be either sporadic or inherited, and in general, the earlier the onset, the more likely a disease is to be inherited. Before genetic testing is performed, the ethical issues, such as the effect the tests might have on asymptomatic children, should be considered. The ethical use of DNA samples in research is another genetic testing issue to be considered.
Why do many NMDA antagonists fail, while others are safe and effective at blocking excitotoxicity associated with dementia and acute injury?
Authors: Albensi Benedict C. , Igoechi Chiazor , Janigro Damir , Ilkanich Erin
Published: May 2006

Similar to drug development programs for stroke and traumatic brain injury, programs developed for Alzheimer's disease (AD) have not been very effective in treating dementia. Recently, researchers have explored modulating excitatory synaptic neurotransmission via the N-methyl-D-aspartate receptor (NMDAR) to treat AD. However, many investigators doubt that NMDA antagonists are safe and effective for treating persons with AD because they have failed in stroke and trauma programs. This article explores the role of NMDA-mediated excitotoxicity in AD, reviews how the NMDAR functions, highlights the side effects and alternate signaling pathways that are initiated from NMDAR activation, provides examples of NMDA antagonists that do not exhibit the typical side effects, and discusses why some NMDA antagonist compounds are effective and safe in limiting cascades of excitotoxicity in dementia or acute brain injury.
Statin use and hippocampal volumes in elderly subjects at risk for Alzheimer's disease: A pilot observational study
Authors: Doraiswamy P. Murali , Steffens David C. , Mcquoid Douglas R.
Published: May 2006

Statins are investigational therapies for preventing or treating Alzheimer's disease (AD) and mild cognitive impairment (MCI). Hippocampal atrophy is a characteristic feature of MCI and AD.

This study analyzed cross-sectional data from 246 nondemented elderly subjects to test the effect of lipid lowering agent (LLA) therapy on cognition and brain magnetic resonance imaging (MRI) measures of white matter lesions and hippocampal volume. The study also compared rates of hippocampal volume change over two and four years in a smaller subset.

At baseline, LLA users were younger, better educated, more likely to be male, and had higher cognitive scores. Cognitive performance also varied by age and gender, and MRI measures varied by age. After adjusting for these differences, the effect of LLA use on baseline cognition, baseline hippocampal volume, and baseline white matter lesion scores was not significant. The effect of LLA use on hippocampal volume loss at two-year and four-year follow-ups was also not significant.

This study is the first to examine statin effects on brain atrophy measured by MRI. In this cohort, statin use was not associated with rate of change of hippocampal volume. While the study was limited by a relatively small number of statin users, the findings seem consistent with three prior randomized trials that found no cognitive benefits for statins in nondemented subjects. Prospective studies in both nondemented and AD subjects may provide more conclusive answers.
Variation in cost of informal caregiving and formal-service use for people with Alzheimer's desease
Authors: Harrow Brooke S. , Mahoney Diane F. , Mendelsohn Aaron B. , Ory Marcia G. , Coon David W. , Belle Steven H. , Nichols Linda O.
Published: May 2006

This study used a geographically diverse sample to estimate the total cost of informal care and formal services for community-residing Alzheimer's disease (AD) care recipients. Baseline data were used for 1200 family caregivers from the Resources for Enhancing Alzheimer's Caregiver Health (REACH) study, a multisite intervention trial. The replacement-wage-rate approach estimated informal cost. Formal services were assigned a cost based on secondary sources. Annual cost per care recipient amounted to $23,436 for informal care and $8,064 for formal services. Variation in informal cost was almost entirely due to instrumental activities of daily living (IADLs) assistance. Cross-site differences in cost persisted after controlling for caregiver and care-recipient characteristics. Geographic variation may suggest regional preferences or ethnic/cultural values. Further study is needed to determine whether this reflects differences in access or availability or how including a control group for care recipients with nondementia diagnoses might have affected these findings.
Dangerous wandering: Elopements of older adults with dementia from long-term care facilities
Authors: Aud Myra A.
Published: May 2006

Wandering is a commonly observed behavior among older adults with Alzheimer's disease (AD) and other types of dementia. When wandering around becomes wandering away, older adults with dementia are at high risk of injury. This exploratory, qualitative study described the circumstances, environmental risks, and injuries sustained in 62 elopements from long-term care facilities by elderly residents with dementia. Content analysis of the reports of the elopements identified patterns that included: 1) a lack of effective precautions to prevent elopement when residents had indicated an intent to elope, had repeatedly attempted to elope, or had a history of elopement; 2) a lack of awareness by the staff of resident location; and 3) ineffective use of alarm devices intended to alert staff to elopement attempts.
Relationship between subjective memory complaints, objective memory performance, and depression among older adults
Authors: Zandi Taher
Published: May 2006

A growing number of studies have investigated the relationship between the elderly subjective memory complaint and their actual memory performance. If memory complaints can be used as indicators of actual memory deficits, these complaints could be an invaluable test for early detection and management of dementia disorders. This study examined the relationships between the elderly subjective memory complaint and their objective memory performance while taking into account several factors such as health and depression. The individuals with subjective memory deficits scored higher on the depression scale in comparison to the individuals without subjective memory problems. However, the alert elderly subjective complaints should be taken seriously while evaluating for dementia.
Integrated treatment approach improves cognitive function in demented and clinically depressed patients
Authors: Bragin Valentin , Chemodanova Marina , Dzhafarova Narmina , Bragin Ilya , Czerniawski Jennifer L. , Aliev Gjumrakch
Published: May 2006

The purpose of this study was to evaluate the efficacy of an integrative treatment approach on cognitive performance. The study sample comprised 35 medically ill patients (20 male, 15 female) with an average age of 71.05, who were diagnosed with mild dementia and depression. These patients were evaluated at baseline and at six, 12, and 24 months of treatment, which included antidepressants (sertraline, citalopram, or venlafaxine XR, alone or in combination with bupropion XR), cholinesterase inhibitors (donepezil, rivastigmine or galantamine), as well as vitamins and supplements (multivitamins, vitamin E, alpha-lipoic acid, omega-3 and coenzyme Q-10). Patients were encouraged to modify their diet and lifestyle and perform mild physical exercises. Results show that the integrative treatment not only protracted cognitive decline for 24 months but even improved cognition, especially memory and frontal lobe functions.
Assessment of active music participation as an indication of subsequent music making engagement for persons with midstage dementia
Authors: Clair Alicia Ann , Mathews R. Mark , Kosloski Karl
Published: May 2006

Persons with midstage dementia and in special care (N = 45) were assessed in groups by a music therapy practitioner to determine the level of engagement in a 15-minute protocol that included a five-minute segment for each of three music activity types—rhythm playing, exercising with music, and singing. Activity staff with little to no formal music training who were employed by the facility were taught to use the protocol to conduct eight subsequent activity sessions for small groups from which activity engagement data were collected for each subject. Results indicated the protocol was accessible and successful for indigenous activity staff, initial assessments were strong predictors of subsequent engagement, and participation levels were stable over time and across each of the three activities.
Evaluating hospital care for individuals with Alzheimer's disease using inpatient quality indicators
Authors: Laditka James N. , Laditka Sarah B. , Cornman Carol B.
Published: May 2006

The purpose of this study was to determine whether persons with Alzheimer's disease (AD) were at greater risk for in-hospital mortality than non-AD patients as a result of poor quality of care. The study focused on six common medical conditions that result in hospital mortality. Using 1995 to 2000 data from New York state (n = 7,021,065), analysts compared mortality risk for individuals with and without AD. Among men, adjusted odds of death were greater for those with AD for gastrointestinal (GI) hemorrhage (+52 percent), congestive heart failure (CHF) (+42 percent), hip fracture (+35 percent), and acute myocardial infarction (AMI) (+30 percent) (all p < .0001). Among women, AD did not affect risks for most conditions. The results of the study show that men with AD are at higher risk of hospital mortality for common medical conditions, which may indicate poor quality of care. Their risk of hospital death was greater than that of men without AD for AMI, CHF, hip fracture, and GI hemorrhage. Their risk was also greater than that of women with AD for CHF, pneumonia, hip fracture, and GI hemorrhage. With the exception of pneumonia, this risk difference notably exceeded the analogous difference between women and men without AD. Hospital staff should be alerted to greater mortality risk for men with AD, as this risk may indicate lower quality of care.
Knowledge of personal information and caregiver awareness in Alzheimer's disease
Authors: Ala Thomas A. , Popovich Ann M. , Berck Lilla G.
Published: May 2006

We assessed the ability of 73 patients with Alzheimer's disease (AD) to recall important personal information like their names, their caregivers' names, their addresses, and their telephone numbers. We also assessed their caregivers' awareness of their abilities. There was an association between the abilities of the patients and their Mini-Mental Status Examination (MMSE) scores, with the patients with the lowest MMSE scores making the most errors. Five to 10 percent of the mildest patients were unable to state their addresses and telephone numbers correctly. The caregivers of the patients with intermediate MMSE scores made the most errors in their predictions, with up to 50 percent being incorrect and up to 37 percent overestimating their patients' abilities. We concluded that AD patients lose their ability to provide personal information as their illness progresses. Caregivers of patients with MMSE ranging from 10 to 25 are the most likely to be unaware of their patients' impairment. These findings highlight safety concerns in AD.
Focused supervision of high-risk fall dementai patients: A simple method to reduce fall incidence and severity
Authors: Detweiler Mark B. , Kim Kye Y. , Taylor Brenda Y.
Published: May 2006

Dementia units in nursing homes have a disproportionately high number of demographic risk factors for falls. Many residents have a previous history of falls, the inability to call for assistance, and the inability to remember safety instructions. For interdisciplinary falls review committees, this population may be the most difficult to manage. The Virginia Veterans Care Center (VVCC) Dementia Unit Interdisciplinary Fall Team instituted a novel practice for reducing the number and severity of falls among the highest risk group of dementia patients. Certified nursing assistants (CNAs) were assigned to high-risk residents for focused supervision. The patients received consistent supervision by selected CNAs during the day and evening shifts.

Eight residents identified as high risk who continued to have falls despite multiple interventions were selected for the study. A comparison of four months of intervention with the four months prior to the intervention revealed a significant (p = 0.024) fall reduction during the intervention months. Individually, seven of the eight participants had reduced falls during the intervention period. A 5-point scale for fall severity demonstrated an overall reduction in fall severity during that period. Individually, five of the eight patients had a decreased fall severity, and one had no change. Two patients experienced an increase in fall severity due to ongoing medical problems. While the small number of patients in the study limits the power of the results, this novel intervention of using designated CNAs to supervise high-risk fall residents with dementia may prove helpful for staff in other nursing facilities.
Cholesterol and apolipoprotein E in Alzheimer's disease
Authors: Reiss Allison B.
Published: May 2006

Alzheimer's disease (AD) is the most common cause of dementia in North America and Europe. The incidence of the disease rises dramatically with age. AD is a complex multifactorial disorder that involves numerous susceptibility genes, but the exact pathogenesis and biochemical basis of AD is not well understood. Cholesterol is receiving a great deal of attention as a potentially crucial factor in the etiology of AD. Almost all cholesterol in the brain is synthesized in the brain. Cholesterol exits the brain through the blood-brain barrier (BBB) in the form of apolipoprotein E (ApoE) or by first being converted to a more polar compound, 24(S)-hydroxycholesterol, which is elevated in individuals with AD. The key event leading to AD appears to be the formation and aggregation in the brain of amyloid β (Aβ) peptide, a proteolytically derived product of amyloid precursor protein (APP). Cholesterol has been demonstrated to modulate processing of APP to Aβ. High levels of cholesterol are associated with increased risk of AD. Patients taking cholesterol-lowering statins have a lower prevalence of AD. ApoE, which transports cholesterol throughout the brain, exhibits an isoform-specific association with AD such that the E4 isoform, by unknown mechanisms, shifts the onset curve toward an earlier age.
Undercoding of Alzheimer's disease and related dementias in hospitalized elderly patients in Italy
Authors: Greco Antonio , Cascavilla Leandro , Paris Francesco , Errico Massimo , Orsitto Giuseppe , D'Alessandro Vito , Placentino Giuliana , Franceschi Marilisa , Seripa Davide , Vendemiale Gian Luigi , Pilotto Alberto
Published: May 2006

The prevalence of Alzheimer's disease (AD) and AD-related dementias (ADRD) in acute ward— hospitalized elderly patients is not well known, owing principally to misclassification and undercoding of AD and ADRD on hospital discharge abstract forms (DAFs). The aims of this study were to evaluate the prevalence of AD and ADRD, as evaluated by the DAF, in elderly patients hospitalized in acute wards, and to compare clinical severity, length of stay, comorbidity, and number of diagnostic procedures in patients with AD versus ADRD to explain the different reimbursement costs of DRG12 (AD) versus DRG429 (ADRD).

From the inpatient DAF database of the Casa Sollievo della Sofferenza Hospital, the DAFs of patients aged 65 years or over discharged from January 1, 2001, to March 31, 2003, with principal or secondary diagnoses of AD (ICD9-CM code 331) or ADRD (ICD9-CM codes from 290.0 to 290.43) were extracted and grouped by APR-grouper version 12. Age, gender, length of stay, principal and secondary diagnoses and procedures, and APR-DRG severity index (SI) and mortality risk (MR) were evaluated in these patients.

Senile dementia was reported in 294 patients (0.58 percent, N = 50,253). In 123 patients (41.8 percent) dementia was the principal diagnosis, whereas in 171 patients (58.2 percent) dementia was reported on the DAF as a secondary diagnosis. Of the 123 patients with a principal diagnosis of dementia, 35 patients were included in the DRG-12 (AD) and 88 patients were included in the DRG-429 (ADRD). No differences were found in mean age, length of stay, comorbidity, or number of diagnostic procedures, as well as in the APR-DRG SI and APR-DRG MR between AD and ADRD patients. Conversely, reimbursement amounts were established as 4,033 for DRG-12 (AD) and 2,952 for DRG-429 (ADRD).

AD and ADRD are undercoded in elderly hospitalized patients. The limits of the ICD9-CM classification system and the influence of reimbursement amounts may influence the coding reports by physicians.
Observed well-being among individuals with dementia: Memories in the Making©, an art program, versus other structured activity
Authors: Kinney Jennifer M. , Rentz Clarissa A.
Published: May 2006

This manuscript analyzes the use of the Greater Cincinnati Chapter Well-Being Observation Tool© in observing seven domains of well-being among individuals with dementia. We observed the well-being of 12 individuals while they engaged in Memories in the Making©, an art program for persons in the early and middle stages of the disease that encourages self-expression through the visual arts. This was then compared to the observed well-being in the same individuals during participation in more traditional adult day center activities, such as current events and crafts. Results indicated that the individuals demonstrated significantly more interest, sustained attention, pleasure, self-esteem, and normalcy during participation in Memories in the Making; additionally, there were no differences in negative affect or sadness between the two types of activities. Directions for future research are also discussed.
Effects of galantamine on working memory and global functioning in patients with mild cognitive impairment: A double-blind placebo-controlled study
Authors: Koontz Jennifer , Baskys Andrius
Published: May 2006

Mild cognitive impairment (MCI) causes memory impairment and executive function deficits in those with the condition. There is also some evidence that MCI patients are impaired in their daily functioning. Cholinesterase inhibitors have been widely used for patients with Alzheimer's disease (AD), with evidence of improving cognitive function. There is currently no established treatment for MCI, and cholinesterase inhibitors are beginning to be studied in these patients. Galantamine is a cholinesterase inhibitor that also has nicotinic receptor-modulating properties that has been successful in improving AD patients. This study examined the effects of galantamine in patients with MCI in areas of memory, executive functioning, and global functioning. There was a significant improvement in scores on the Functional Activities Questionnaire, which is a measure of global functioning. There were also improvements in the galantamine group on two of six measures in the Cambridge Automated Neuropsychiatric Test Assessment Battery and in immediate free recall on the California Verbal Learning Test.
Ask the consumer: An innovative approach to dementia-related adult day service evaluation
Authors: Carroll Andrea M. , Vetor Karen , Holmes Sara , Supiano Katherine P.
Published: May 2006

Historically, family caregivers have been considered the “consumers” when evaluating respite programs for persons with dementia offered by adult day service (ADS) centers. The purpose of this article is to describe a unique evaluation of ADS conducted directly with persons with dementia. Seventeen persons who regularly attended the Silver Club, an ADS program associated with the University of Michigan Turner Geriatric Clin ic, were interviewed by an independent, trained interviewer using a single group, one-time, cross-sectional administration of a consumer satisfaction survey. Fifteen persons were able to complete the interview successfully. The implication of this evaluation is that when specially designed procedures are used, persons with dementia are capable of contributing usable data to consumer satisfaction surveys. Including the voice of this vulnerable population improves the quality of an agency's overall evaluation process and supports the basic philosophy of ADS to preserve the self-worth, independence, and dignity of cognitively impaired individuals.
α-Synuclein aggregation in pathological aging and Alzheimer's disease: The impact of ß-amyloid plaque level
Authors: Lippa Sara M. , Lippa Carol F. , Mori Hiroshi
Published: May 2006

In central nervous system diseases, abnormal aggregation of one protein is often associated with aggregation of other proteins. To begin to assess whether ß-amyloid (Aß) is associated with α-synuclein (AS) aggregation [secondary Lewy body (LB) formation], we used immunohistochemical techniques to compare the amygdala of 11 subjects with pathological aging and 18 with Alzheimer's disease. Overall, Aß-40 plaque level was greater in cases with secondary AS aggregates. Aß42 plaque level was not associated with AS aggregation. Aß-40 plaque levels cannot be ruled out as a factor involved in secondary LB formation.
Prevalence and clinical correlates of neuropsychiatric symptoms in dementia
Authors: Steffens David C. , Maytan Margaret , Helms Michael J. , Plassman Brenda L.
Published: May 2006

The purpose of this research was to assess the frequency and severity of neuropsychiatric and behavioral symptoms and to examine the association between preexisting medical conditions and specific neuropsychiatric symptoms in demented individuals. We studied 211 demented subjects (87.7 percent male) who were participants in epidemiological studies of dementia. Using the Neuropsychiatric Inventory (NPI), we assessed the frequency and severity of neuropsychiatric symptoms. We collected medical history information during a structured telephone interview. Our analyses focused on determining prevalence of neuropsychiatric symptoms by dementia diagnosis and severity. We also examined the association of history of head injury, alcohol abuse, and stroke with development of neuropsychiatric symptoms.

We found that neuropsychiatric symptoms were common, with approximately three-fourths of the subjects exhibiting at least one symptom during the preceding month. Apathy (39.3 percent), agitation (31.8 percent), and aberrant motor behavior (31.1 percent) were the most frequent symptoms. Frequency and severity of symptoms were similar for the all-dementia and

Alzheimer's disease–only groups. neuropsychiatric symptoms varied by severity of dementia, but generally not in a consistent ordinal pattern. History of alcohol abuse, head injury, or stroke was associated with presence of specific neuropsychiatric symptoms in dementia.

While psychiatric symptoms are common in dementia, they also vary by type and severity of dementia. The finding that certain medical conditions may increase risk for specific types of neuropsychiatric symptoms expands our knowledge of the natural history of dementia and should improve management of dementia in medically ill patients. Our results may also shed light on mechanisms that underlie neuropsychiatric symptoms.
Computerized cognitive testing battery identifies mild cognitive impairment and mild dementia even in the presence of depressive symptoms
Authors: Doniger Glen M. , Dwolatzky Tzvi , Zucker David M. , Chertkow Howard , Crystal Howard , Schweiger Avraham , Simon Ely S.
Published: May 2006

Cognitive and depressive symptoms co-occur, complicating detection of mild cognitive impairment (MCI) and early dementia. In this study, discriminant validity of a novel computerized cognitive battery for MCI detection was evaluated after covariation for depressive symptom severity. In addition to the computerized battery, participants at two sites received the 30-item self-administered Geriatric Depression Scale (GDS; n = 72); those at two other centers received the observer-administered Cornell Scale for Depression in Dementia (CSDD; n = 88). In both cohorts, a Global Cognitive Score and memory, executive function, visual spatial, and verbal index scores discriminated among cognitively healthy, MCI, and mild dementia groups after covariation for GDS or CSDD, respectively (p < 0.05). Thus, the computerized battery for detection of mild impairment is robust to comorbid depressive symptoms, supporting its clinical utility in identifying neurodegenerative disease even in elderly with depression.
The corpus callosum in Pick's disease, Alzheimer's disease, and amyotrophic lateral sclerosis: Gliosis implies possible clinical consequence
Authors: Murray Cynelle , Viehman Alex , Lippa Carol F.
Published: May 2006

Lesions of the corpus callosum have the potential to interfere with a neurologically impaired individual's ability to function in day-to-day activities, since the corpus callosum is important for a number of higher-order activities that involve information transfer between the left and right hemispheres. Even in normal individuals, callosal lesions may lead to apraxia, agraphia, and even an alien hand syndrome whereby the person is unable to control the actions of a hand. It is easy to envisage that callosal damage could compound cognitive symptoms in individuals with dementia. However, despite the common presence of apraxia in dementia, physicians and other healthcare providers rarely focus on callosal function in dementia patients. The current manuscript compares pathological data from a variety of patients with dementia with age-matched control subjects showing callosal gliosis in neurodegenerative diseases including Alzheimer's disease (AD), frontotemporal dementia (FTD), and amyotrophic lateral sclerosis. We conclude that callosal gliosis is not uncommon, particularly in patients with AD and FTD. Given the severity of this pathology in some cases, we cannot exclude the possibility that it is clinically relevant. Clinical implications are discussed, and it is recommended that further studies be done to determine whether there is a relevant clinical correlate.
A Unique Waterskiing Injury Leading to a Necrotizing Foot Infection in an Insulin-Dependent Diabetic
Authors: Mozer Mark A. , Mozer Cheryl H. , Kujath Scott W.
Published: May 2006

Reports of waterskiing-related injuries are limited in the medical literature. The authors report a case of a unique waterskiing injury that progressed into a necrotizing foot infection in a well-controlled insulin-dependent diabetic. This case shows that with aggressive therapy, including hyperbaric oxygen treatments and use of a wound vacuum-assisted closure system, limbs can be saved.
Management of a Difficult-to-Heal Chronic Wound Infected With Methycillin-Resistant Staphylococcus aureus in a Patient With Psoriasis Following a Complex Knee Surgery
Authors: Bhattacharyya Mayukh , Bradley Helen
Published: May 2006

This report presents the difficulties encountered in managing a wound colonized with methycillin-resistant Staphylococcus aureus (MRSA) following a complex knee surgery in an elderly female patient with generalized psoriasis. The patient’s chronic wound was successfully treated with nanocrystalline silver-releasing dressings (Acticoat™). The patient did not develop a deep-seated infection, nor was removal of the implant needed. However, the wound infection persisted for 6 months. At 3 years follow-up, the patient has satisfactory skin over the implant on the knee.
A Study of the Prevalence and Risk Factors of Foot Problems in a Population of Diabetic Patients in Cameroon
Authors: Ndip E. A. Agbor , Tchakonte Baudouin , Mbanya Jean-Claude
Published: May 2006

Foot problems are common in diabetic patients and are one of the most expensive chronic complications to treat. The authors sought to determine the prevalence and risk factors of the diabetic foot in a clinic population. In this cross-sectional study of 300 diabetic patients, the authors reviewed records, carried out an interview, and performed a meticulous foot examination with assessment of neuropathy (monofilaments and tuning fork) and ischemia (pulses). Foot lesions were classified according to Wagner grades. The prevalence of foot lesions was 13.0% (inpatients 25.6% and outpatients 11.1%). Diabetic neuropathy assessed using monofilaments was found in 81 patients (27.3%) (monofilaments). The prevalence of ischemia was 21.3% and deformity was 17.3%, whereas 37 patients (12.3%) had a previous history of foot lesions. Foot examination was done in 14.3% of patients, and 47% had a risky nail-trimming habit, whereas 22% wore ill-fitting shoes. The prevalence of diabetic foot lesions is high, and known risk factors are significantly present, especially poor foot care.
A Role for Vacuum-Assisted Closure in Lower Limb Trauma: A Proposed Algorithm
Authors: Hardwicke Joseph , Paterson Peter
Published: May 2006

The British Association of Plastic Surgeons and British Orthopaedic Association estimate that 70% of Gustilo 3b tibial fractures require flap coverage. Prior to the introduction of vacuum-assisted closure (V.A.C.®) in the late 1990s, options were limited for the treatment of such injuries in selected individuals with medical comorbidity or complex wounds. VAC has now become an important part of our algorithm for soft tissue reconstruction with excellent results, but its role has not yet been defined in common management pathways. The authors present 3 cases, all different in their mechanism of injury, type of injury, and subsequent management, but all had a successful outcome with VAC.
Donor-derived mesenchymal stem cells are immunogenic in an allogeneic host and stimulate donor graft rejection in a nonmyeloablative setting
Authors: Nauta Alma J. , Westerhuis Geert , Kruisselbrink Alwine B. , Lurvink Ellie G. A. , Willemze Roel , Fibbe Willem E.
Published: May 2006

Mesenchymal stem cells (MSCs) are multipotent progenitor cells that have emerged as a promising tool for clinical application. Further clinical interest has been raised by the observation that MSCs are immunoprivileged and, more important, display immunosuppressive capacities. These properties may be of therapeutic value in allogeneic transplantation to prevent graft rejection and to prevent and treat graft-versus-host disease. In the present study, we examined the in vivo immunomodulatory properties of MSCs in murine models of allogeneic bone marrow (BM) transplantation. Sublethally irradiated recipients received allogeneic BM with or without host or donor MSCs. The addition of host MSCs significantly enhanced the long-term engraftment associated with tolerance to host and donor antigens. However, the infusion of donor MSCs was associated with significantly increased rejection of allogeneic donor BM cells. Moreover, we showed that the injection of merely allogeneic donor MSCs in naive mice was sufficient to induce a memory T-cell response. Although the observed engraftment-promoting effects of host MSCs in vivo support the therapeutic potential of MSCs, our results also indicate that allogeneic MSCs are not intrinsically immunoprivileged and that under appropriate conditions, allogeneic MSCs induce a memory T-cell response resulting in rejection of an allogeneic stem cell graft.
Asthma is associated with acute chest syndrome and pain in children with sickle cell anemia
Authors: Boyd Jessica H. , Macklin Eric A. , Strunk Robert C. , DeBaun Michael R.
Published: May 2006

Pain and acute chest syndrome (ACS) episodes are 2 of the most common causes of hospitalization in children with sickle cell anemia (SCA). However, very few potentially modifiable risk factors for either condition have been identified. In this prospective infant cohort study, we tested the hypothesis that asthma is associated with an increased incidence rate of pain and ACS episodes. An infant cohort was composed of 291 African American children with hemoglobin SS enrolled in the Cooperative Study for Sickle Cell Disease before age 6 months and followed beyond age 5 years. Asthma was defined by a physician diagnosis, an acute asthma event, or use of prescription asthma medications. The incidence rates of ACS and painful episodes were compared for children with and without asthma. A clinical diagnosis of asthma was made in 17% of the cohort. Asthma was associated with more frequent ACS episodes (0.39 vs 0.20 events per patient year, P < .001) and painful episodes (1.39 vs 0.47 events per patient year, P < .001). In conclusion, in children with SCA, asthma is associated with an increased incidence of sickle cell disease–related morbidity, including ACS and painful episodes.
Mantle cell lymphoma cells express predominantly cyclin D1a isoform and are highly sensitive to selective inhibition of CDK4 kinase activity
Authors: Marzec Michal , Kasprzycka Monika , Lai Raymond , Gladden Andrew B. , Wlodarski Pawel , Tomczak Ewa , Nowell Peter , DePrimo Samuel E. , Sadis Seth , Eck Stephen , Schuster Stephen J. , Diehl J. Alan , Wasik Mariusz A.
Published: May 2006

The prognosis for patients with mantle cell lymphoma (MCL) is poor, and at present there is no truly effective therapy. Gene translocation-mediated constitutive expression of cyclin D1 seems to play the key role in the pathogenesis of MCL. Here we report that although 3 of 4 MCL cell lines expressed the recently identified, highly oncogenic cyclin D1b isoform, as well as the canonical cyclin D1a, 8 MCL patient samples expressed only the cyclin D1a protein despite expressing detectable cyclin D1b mRNA. Cell lines and tissue samples displayed constitutive activation of the cyclin D1 signaling cascade, as evidenced by strong expression of CDK4, Rb phosphorylation, and cyclin D1/CDK4 coassociation. All MCL cell lines and tissues examined displayed nondetectable to diminished expression of the cyclin D1 inhibitor p16. Novel small molecule CDK4/CDK6 inhibitor PD0332991 profoundly suppressed—at low nanomolar concentrations—Rb phosphorylation, proliferation, and cell cycle progression at the G0/G1 phase of MCL cells. These findings provide evidence that MCL should be very sensitive to targeted therapy aimed at functional inhibition of the cyclin D1/CDK4 complex.