Nicotinicα4β2acetylcholine receptors and cognitive function in Parkinson's disease
R. LorenzSamuel SamnickUlrich DillmannMarkus SchillerM.F. OngKlaus FaßbenderAndreas K. BuckJörg Spiegel
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Background Idiopathic Parkinson's disease (IPD) is characterized by the clinical motor symptoms of hypokinesia, rigidity, and tremor. Apart from these motor symptoms, cognitive deficits often occur in IPD. The positive effect of cholinesterase inhibitors on cognitive deficits in IPD and findings of earlier molecular imaging studies suggest that the cholinergic system plays an important role in the origin of cognitive decline in IPD. Methods Twenty-five non-demented patients with IPD underwent a 5-[123I]iodo-3-[2(S)-2-azetidinylmethoxy]pyridine (5-I-A-85380) SPECT to visualize α4β2 nicotinic acetylcholine receptors (nAchR) and cognitive testing with the CERAD (Consortium to Establish a Registry for Alzheimer's Disease) battery to identify domains of cognitive dysfunction. Results In the CERAD, the IPD patients exhibited deficits in non-verbal memory, attention, psychomotor velocity, visuoconstructive ability, and executive functions. After Bonferroni correction for multiple comparisons, we found significant correlations between performance of the CERAD subtests Boston Naming Test (a specific test for visual perception and for detection of word-finding difficulties) and Word List Intrusions (a specific test for learning capacity and memory for language information) vs binding of α4β2 nAchR in cortical (the right superior parietal lobule) and subcortical areas (the left thalamus, the left posterior subcortical region, and the right posterior subcortical region). Conclusions These significant correlations between the results of the CERAD subtests and the cerebral α4β2 nAchR density, as assessed by 5-I-A-85380 SPECT, indicate that cerebral cholinergic pathways are relevant to cognitive processing in IPD.Alzheimer's disease is the most common form of dementia, representing 60-80% of cases, and ageing is the primary risk factor for the development of Alzheimer's disease. The objective of this study was to examine the chance of developing dementia (i.e. mild cognitive impairment (MCI), Alzheimer's disease) among geriatric people in Bangladesh.This study included 390 adult citizens of Bangladesh (age range: 60-70 years). The Takeda Three Colors Combination (TTCC) test was used to detect the prevalence of MCI and mild dementia among the subjects, and then the Clinical Dementia Rating was used to determine the level of dementia.The subjects who were aged 60-65 years included 154 with MCI, 76 with mild dementia, 1 with moderate dementia, 4 with severe dementia, and 29 without dementia. The subjects who were aged 66-70 years included 75 with MCI, 36 with mild dementia, 0 with moderate dementia, 2 with severe dementia, and 13 without dementia. The sensitivity of the TTCC was 75% and 58% for the mild dementia and MCI groups, respectively, and the specificity was 52%. The odds ratio of incorrect responses to the TTCC was 3.42 (95% confidence interval: 1.63-7.21) for subjects with mild dementia compared those without dementia. However, the TTCC outcomes revealed no significant differences between the MCI and non-dementia groups. The results showed no significant associations between cognitive decline/developing dementia and social status/occupation.The outcomes of this study indicated that most of the subjects had MCI or mild dementia and were farmers aged 60-65 years.
Clinical Dementia Rating
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Background: The knowledge and awareness of dementia among the public have been poorly estimated by the regional center for dementia.
Methods: To assess the feasibility of dementia care facilities and the attitudes of community members toward dementia care facilities, we conducted semi-structured interviews with patients and caregivers who utilize regional centers for dementia. The questionnaires consisted of an assessment of the understanding of dementia, the items and amount requested for facility use and satisfaction with dementia care facilities.
Results: A total of 151 residents completed this questionnaire form. The rate of interest in
dementia was very high, 48.3% of total responses; however, the knowledge and familiarity
with dementia were very low in comparison to the rate of interest (36.4%, 37.1%, respectively).
Most of the responders suggested that more precise and easily understandable information should be provided by the regional center for dementia.
Conclusion: The public need for dementia care facilities is very high, despite their minimal understanding of dementia. Therefore, it is crucial for the public to receive urgent preventive education. and a conversion of knowledge regarding dementia.
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We performed a retrospective study of 145 consecutive patients referred on suspicion of dementia. We were particularly interested in the occurrence of reversible dementia. Dementia was defined with reference to the ICD-10 criteria.All patients underwent a clinical neurological examination, a battery of blood tests, and a CT scan of the brain.Dementia was found in 63% and in only 4% was it potentially reversible: Three patients had subnormal cobalamin and one patient had normal pressure hydrocephalus. However, treatment did not influence the state of dementia. Hence, patients with reversible dementia were not identified in this study. In the group without dementia one patient had a meningoma. Mental depression was the most common "second" diagnosis in both groups.The number of patients with potential dementia was surprisingly small. We conclude that most patients with reversible dementia are detected by their general practitioner and that the majority of patients suspected of dementia can be diagnosed by the general practitioner, especially if access to CT scans is further liberalised.
Normal pressure hydrocephalus
Depression
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Background: Diabetes mellitus (DM) increases the risk of dementia in the elderly.However, its underlying mechanisms, its connection with Alzheimer disease and vascular cognitive impairment, and effects of therapy remain unclear.Objective: To test the hypothesis that DM promotes specific neuropathologic processes that contribute to dementia and that these processes may be suppressed by antidiabetic therapy.Design: A comprehensive neuropathologic assessment of all cases from a community-based study of incident dementia (Adult Changes in Thought Study) that underwent autopsies (n=259) and had information on DM status (n=196).Biochemical analysis was conducted on a subset of these cases with rapidly frozen brain tissue (n=57).Participants: Autopsy cases were divided into 4 groups: no DM/no dementia (DM-/dementia-), DM/no dementia (DMϩ/dementia-), no DM/dementia (DM-/ dementiaϩ), and DM/dementia (DMϩ/dementiaϩ).Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) diagnosis of dementia was assigned through a consensus of experts following biennial cognitive and physi-cal evaluations.Diabetes was diagnosed based on information obtained from participants' extensive medical records.Results: In cases without dementia (n = 125), neuropathologic and biochemical end points did not differ significantly by DM status.However, we observed 2 patterns of injury in patients with dementia (n=71) by their DM status.Individuals without DM but with dementia (DM-/dementiaϩ) had a greater amyloid- peptide load and increased levels of F 2 -isoprostanes in the cerebral cortex, while DMϩ/dementiaϩ patients had more microvascular infarcts and an increased cortical IL-6 (interleukin 6) concentration.The number of microvascular infarcts was greater in deep cerebral structures in patients with dementia whose diabetes was treated, whereas amyloid plaque load tended to be greater for untreated diabetic patients with dementia.Conclusions: These novel characterizations of 2 different patterns of cerebral injury in patients with dementia depending on DM status may have etiologic and therapeutic implications.
Vascular dementia
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People aged 90 and older are the fastest growing age group in most parts of the world. Since the prevalence of dementia has been shown to increase exponentially after the age of 65, there is an acceptance that the oldest old population has a high burden of dementia; however, there is a lack of consensus on how best to diagnose dementia in this population. This review summarizes the various approaches to diagnosing dementia and the prevalence and incidence rates of dementia that have been reported. We also summarize the literature on cognitive and functional performance and biomarkers for dementia and discuss the limitations to interpretation of these data. Finally, we make recommendations for both researchers and clinicians who intend to diagnose dementia in the oldest old population.
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Ten to 33 percent of the patients who present for evaluation of dementia are found to have a potentially reversible cause of dementia such as a metabolic, structural, or psychiatric condition. Another group of patients who present with symptoms or complaints of impaired thinking are erroneously diagnosed as suffering from dementia. The author reviews the criteria for diagnosis of dementia, the laboratory and other tests advisable for use in evaluating the presence of dementia or guiding the treatment of irreversible dementia, and some factors that may lead to the misdiagnosis of dementia. He emphasizes that a thorough medical, psychiatric, and psychosocial evaluation of all patients presenting with cognitive impairments is essential.
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The nationally-recognized Susquehanna
Chorale will delight audiences of all
ages with a diverse mix of classic and
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aim to make the audience feel,
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performance - and all this while
working at an extremely high
musical level.AÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂA¢AÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂA Experience choral
singing that will take you to new
heights!
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Cardiometabolic morbidities and dementia are increasingly common as people age. In this chapter, we summarize the epidemiological literature concerning: (1) mixed dementia due to cerebrovascular and neurodegenerative lesions as the most common form of dementia in older people; (2) the relation of cardiovascular disease with cognitive decline and dementia and the underlying pathophysiological mechanisms; and (3) cardiovascular comorbidities in dementia and impact on dementia care and prognosis. Atherosclerotic and arteriosclerotic disorders resulting from long-term exposures to cardiovascular risk factors, together with neurodegeneration in brain ageing, contribute to accelerated cognitive decline and dementia. The heart-brain connection in ageing has implications for dementia interventions. Furthermore, cardiovascular comorbidities in dementia contribute to poor outcomes, create complex challenges for dementia care, and substantially increase social care costs of dementia. Thus, early recognition and management of cardiovascular comorbidities in dementia may help health and social care providers maximize the well-being of people with dementia.
Cognitive Decline
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