bluuebunny/crossref_metadata_2025_split huggingface dataset:
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.
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.
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.
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.
Exterior space for patients with Alzheimer's disease and related disorders
Authors: Randall Priscilla , Burkhardt Sandra S. J. , Kutcher Joan 
Published: June 2007

This paper examines program considerations for the design of exterior space for Alzheimer's disease patients. It is directed to planners and administrators, architects and landscape architects involved in the initial planning stages of an Alzheimer's disease facility (or nursing home) building project. The focus of the study is the Alzheimer's disease patient who is no longer able to attend to the activities of daily living (middle dementia), and therefore resides in a day care facility, a special unit, or a nursing home. This paper outlines design schemes based on cognitive and behavioral symptoms of the disease. For example, sundowning (patient agitation and hallucination in late afternoon) is a common Alzheimer's diseases symptom. In order to ameliorate sundowning, the designer needs to provide not only familiarity and comfort, but also a way to minimize shadows that could be misinterpreted as frightening spectres. The exterior space should be located on the southeast side of the building in order to ensure only a monolithic building shadow cast into the garden by the afternoon sun. For this purpose, and a number of others discussed in the paper, siting is an important consideration in this design program. Considerations of agitation, frailty, loss of short-term memory, and reduced sensory perception suggest and control all elements of the design. The study presents concepts and suggestions for creating outdoor activity and garden space for Alzheimer's disease patients. The outlined concepts may also be usefully employed in an already established facility. Creating exterior space that is safe and pleasant for Alzheimer's disease patients, as well as acceptable to adninistrators and visitors, is both a challenge and an attainable goal.
Decision making and dementia
Authors: Zarit Steven H. , Goodman Caryn R. 
Published: June 2007

One of the most complex problems facing families and practitioners is making decisions for the person with dementia. Families and other care providers are often faced with difficult decisions and they must weigh several potentially conflicting factors, including: • The patient's best interest, • What the patient previously indicated his or her preferences were, and • The potential of risk or harm to the patient or to others. Examination of the process of decision making, including when to take over decision making and what principles to use in reaching a decision, can help prepare families and practitioners for some of the dilemmas they may encounter.
Adapting day care center settings for persons with Alzheimer's disease: Environmental design training for staff
Authors: Cohen Evelyn , Lyman Karen , Pynoos Jon 
Published: June 2007

Until recently there has been limited awareness of the interaction between the adult day care environment and the functioning of participants and staff. Emphasis is often put on the program rather than on the setting in which it takes place. Even when environmental knowledge exists, there is often a lack of input by staff and adaptations may be made to poor physical conditions that can contribute to staff stress as well as reduced participant functioning. This paper describes the development of training materials for an educational workshop. Thirty Alzheimer day care staff were participants. The purpose was to increase information concerning the impact of the physical environment on Alzheimer care, and to train “trainers” in this area. In developing training materials, evaluations of adult day care settings were made which included observer ratings, interviews with staff, and 35mm. slides of 12 Alzheimer day care facilities. A variety of materials were developed including a slide show and a script that represented three major areas of environmental design: * Environmental cues to promote recall and wayfinding; * Safety and accessibility; and * Surveillance and wandering. Findings within the adult day care centers evaluated are described. Pre- and post-test results are reported, indicating that awareness of the Participants was heightened in identifying and modifying design features in adult day care settings. Practical contributions to the literature include materials on the planning of facilities for dementia care and training tools for staff.
What people know about Alzheimer's disease: A study of public knowledge
Authors: Steckenrider Janie S. 
Published: June 2007

Given the frequent attention and focus on Alzheimer's disease by the mass media over the recent decades, it is assumed that the American public is fairly well-informed and knowledgeable about the disease. However, what the public actually knows about Alzheimer's disease and the characteristics of those persons most informed have generally remained a mystery as only afew aspects of disease awareness have been sporadically measured. Thus, this study explicitly explores the level of overall public knowledge about Alzheimer's disease measured through survey research based on a nationally representative sample of 1498 persons age 45 and over. The Alzheimer's Disease Awareness Test (ADAT) was developed and utilized with 17 items dealing with disease etiology, symptoms, and misconceptions. While almost everyone (91 percent) has heard of AD, there are wide gaps in disease knowledge among a significant portion of the public. Two tiers of knowledge arefound to exist indicating the different types of information known: The Easy/General Knowledge Tier is comprised of eight items tapping disease aspects that are less technical in nature, require little conceptual sophistication and tend to be facts widely disseminated by the mass media; and The Hard/Specific Knowledge Tier is comprised of nine items requiring more complex understanding and deal with more scientific disease aspects. Most persons score moderately high on the Easy/General Index while few do well on the Hard/Specific Index. Correlates of a high level of knowledge on both tiers are education, age, knowing someone with AD as well as the closeness and relationship of the effected person, and having parents who are living
Taxonomy of evening and nighttime behavior patterns of persons with Alzheimer's disease
Authors: Crosby Leanna J. , Wyles Christina L. , Verran Joyce A. , Tynan Concetta M. 
Published: June 2007

Among the many symptoms associated with Alzheimer's disease, disrupted nighttime sleep has been identified as one of the most troublesome. Frequently disrupted sleep, as well as nighttime wandering, determines whether or not the person is able to remain within his/her home or must be institutionalized. The first step toward altering disrupted sleep is to gain an understanding of the associated behavior patterns. The purposes of this research were to: • Describe - based on family care provider reports, the evening and nighttime behavior patterns of persons diagnosed with Alzheimer's disease; and • Develop a taxonomy that characterized the identified patterns. Data were collected using a guided interview format. Eleven care providers were interviewed at length and asked to respond to open-ended questions. Themes and categories were identified including two major, four minor and 10 sub-categories. In addition, precipitating events that triggered, intensified or accelerated the behavior patterns were identified. These data will be used to develop an instrument designed to quantify the behaviors associated with sleep disruption. This will allow for evaluation of care provider burden as well as the effect of interventions designed to enhance the sleep/rest of persons with Alzheimer's disease.
Alzheimer's disease and dementing disorders: Practices and experiences of rural physicians
Authors: Glasser Michael 
Published: June 2007

This paper presents information on rural primary care physicians' diagnoses, the procedures used, treatment recommendations, as well as reported advantages and disadvantages ofpracticing in a rural setting and managing patients with Alzheimer's disease and dementing disorders. A total of 102 primary care physicians in rural Illinois counties were interviewed (response rate = 72.3 percent). There was considerable variability in physicians' responses to the causes of dementia syndrome and the procedures used in making a diagnosis. When questioned in an open-ended format about possible causes of dementing disorders, physicians mostfrequently mentioned Alzheimer's disease (80 percent), multi-infarct dementia (56percent), and drug toxicity (53 percent). “Non-specific” causes were also mentioned, including arteriosclerosis (36 percent), organic brain syndrome (27 percent), and old age (25 percent). Laboratory tests and CT scans were most often used in the diagnostic process. Less than 10 percent of the physicians used more formal, cognitive screening tests like the Mini-Mental State Exam. Less than one-half of the physicians had previously recommended nursing home placement in the management of their dementia patients. Physician age, practice type (solo/group) and specialty (internal/family medicine) were associated with some of the physicians' responses regarding dementia causes and procedures used in diagnosis. The rural setting was viewed as inadequate with regard to laboratory facilities and supportpersonnel as well as problematic in requiring long distance travel for consultation. On the other hand, the rural community provided an advantage over the urban in opportunities for support and cooperation forfamilies andfriends to assist in managing the care ofdementia disorder patients. Alzheimer's disease and other dementias present the problem of uncertainty at many levels including medical, patient outcome, and family management issues. In the rural setting, the physician often represents the entire health professions community. It is imperative that rural physicians be prepared to both diagnose and, in turn, manage the complex and difficultsituation created by dementia syndrome.
The impact of infection on agitation: Three case studies in the nursing home
Authors: Cohen-Mansfield Jiska , Werner Perla , Marx Marcia S. 
Published: June 2007

Agitation is a major problem in the demented elderly, and may be related to pain and discomfort. The aim of this article is to investigate the relationship between agitation and infection in three highly agitated cognitively impaired nursing home residents. Agitation was assessed using the Agitation Behavior Mapping Instrument (ABMI), a nonobtrusive assessment tool used for direct observation and recording ofagitated behaviors. Information concerning antibiotic drug use was extractedfrom the participants'charts. A relationship was inferred between the presence of an infection (as suggested by antibiotic medication use) and higher levels of agitation. Elucidating the possible antecedents of the agitated behaviors is the first step in the management of these disruptive behaviors.
Caregivers and the nutritionalneeds of the patient with Alzheimer's disease: A pilot study
Authors: Ryan Cass , Kline Mya , Hamrick Dale , Edwards Kristen 
Published: June 2007

A pilot study was conducted at a day care center for those affected with Alzheimer's disease (AD). The day care center is affiliated with a statewide Department of Mental Health. The purpose of the study was to determine the adequacy of caregivers' knowledge of nutrition in general and of the nutritional needs of the AD affected person, specifically. Also studied was the caregivers'perceived amount of burden and the caregivers' levels of depression. It was found that the caregivers' knowledge of nutrition was below average overall, despite the fact that many were educated beyond high school. A high level of caregiver perceived burden was also discovered. Depression, however did not seem to be a factor with these caregivers. While this was only a pilot study (n=12), one can begin to see the importance of assisting caregivers with nutrition education. The better prepared caregivers are to take care of their elderly, the longer it is before nursing home placement becomes a consideration. Health care workers are in an excellent position to assume this teaching role.