There is a need for nonpharmacological approaches to behavior problems in those with Alzheimer’s disease and other types of dementia. Bharwani et al (in Individualized Behavior Management Program for Alzheimer’s/Dementia Residents Using Behavior-Based Ergonomic Therapies) developed a comprehensive nonpharmacological intervention for Alzheimer’s disease, the behavior-based ergonomics therapy, which consists of multiple interventions. Their low-cost, 24/7 program used learning, personality, behavioral profiles, and cognitive function to develop individualized therapies. This pilot study was encouraging since those using the individualized therapy had reduced falls and agitation. This type of strategy may be useful in the management of a wide range of behavior problems in patients with dementia.
Yokoi et al (Conditions Associated With Wandering in People With Dementia From the Viewpoint of Self-Awareness: 5 Case Reports) note that conditions associated with wandering in participants with dementia include purposeless activity, purposeful actions, irritation, and depression. The words and actions of 5 people admitted to long-term health care facilities, who wandered were observed, using their self-awareness model (consisting of “theory of mind,” “self-evaluation,” and “self-consciousness”). This article provides insight into the spectrum of circumstances associated with wandering.
The behavior problems in Parkinson’s syndromes often include apathy. Rita Moretti et al note that apathy is a common disturbance in Parkinson’s disease, possibly due to dysfunction of the nigrostriatal pathway. They examined the prevalence and clinical correlates of apathy in a representative community-based sample of patients with akinetic-rigid parkinsonism and tremor-dominant Parkinson’s disease. They found more apathy in the akinetic-rigid group. Apathy was related to frontal impairment but not to motor impairment or depression. It is notable that, in general, patients with the rigid form of parkinsonism are less likely to have classical Parkinson’s disease. This group may also have more frontal lobe dysfunction.
Health care providers are concerned about medication side effects in the elderly individuals. Isik et al examines the side effects caused by donepezil, rivastigmine, and galantamine on cardiac rhythm and postural blood pressure changes in elderly patients with Alzheimer’s disease. There were no changes relative to the baseline in any of the electrocardiograph (ECG) parameters or arterial blood pressure with any of the administered cholinesterase inhibitors. Isik et al conclude these agents seem safe when used in elderly patients with dementia. Building on the theme of safety of interventions, Osmonov et al evaluate the safety of pacemaker implantation in patients with Alzheimer’s disease by review of charts. They studied symptomatic bradyarrhythmia, in cases where a permanent pacemaker was implanted. Twenty patients had a diagnosis of Alzheimer’s disease. All 3 experienced a complication, and reoperation was needed. They concluded that pacemaker implantation may be riskier in patients with Alzheimer’s disease.
In A Clinical Approach to Early-Onset Inheritable Dementia, Rogers and Lippa note that early-onset dementia is not uncommon and is more commonly genetic than late-onset disease. They review clinical features of early-onset Alzheimer disease, frontotemporal dementia, Kuf disease, and Niemann-Pick disease type C as well as the basics of etiology, pathophysiology, and interventions. A discussion of the diagnosis and workup for early-onset inherited forms of dementia is included.
Burgos et al (How Statins Could be Evaluated Successfully in Clinical Trials for Alzheimer’s Disease?) note that there may be a relationship between alterations in cholesterol homeostasis and Alzheimer’s disease. Epidemiological studies have pointed an association between statin treatment and a decrease in the risk of Alzheimer’s disease. However, clinical trials using lipid-lowering agents have been disappointing, and some feel these medications may even worsen dementia symptoms. This is a complex topic, and further research is needed to understand the issue.
Cedervall et al (Declining Physical Capacity, But Maintained Aerobic Activity in Early Alzheimer’s Disease) examine the longitudinal influences on physical capacity and habitual aerobic activity level in the early stages of Alzheimer’s disease. The Alzheimer’s disease group showed a lower physical capacity than controls at baseline but comparable levels of aerobic activity. During the follow-up period, physical capacity declined in the Alzheimer’s disease group but aerobic activity levels were nearly stable.
In Predicting Current Memory With the Modified Telephone Interview for Cognitive Status, Duff et al use the modified Telephone Interview for Cognitive Status for categorizing mental status of older adults. Observed and predicted memory composites were comparable for 2 of their 6 equations, indicating that these equations adequately predict observed memory scores. The predicted memory composite based on the total score was also most highly correlated with the observed memory composite. These results further validate this scale, and they suggest that this is an efficient tool for screening cognitive functioning in later life.