Background: Recently, the concept of motoric cognitive risk (MCR) syndrome was proposed, where slow gait is considered a risk factor for conversion to dementia. Aim: To retrospectively investigate the characteristics of MCR among a population aged 75+ years, focusing on the aspects of epidemiology and neurobehavioral characteristics. Method: The participants were 590 residents aged 75+ years living in Kurihara who underwent MRI and neurobehavioral assessments including walking velocity. The prevalence of MCR and conversion to dementia (AD8 Dementia Screening Interview cutoff 2/8), together with the neurobehavioral characteristics of the MCR group, were analyzed. Results: The prevalence was 11.1%, and the conversion ratio in the MCR group was higher than that in the non-MCR group (OR = 1.38). The MCR group had lower scores on the executive function test as well as gait velocity. Conclusions: The MCR syndrome increases the rate of conversion to dementia, and both slow gait and lower scores in executive tests, which are ‘frontal-based' functions, are predictive of higher rates of conversion to dementia.
Introduction: To assess cognitive impairment, self-awareness is an important issue. The Ascertain Dementia 8 questionnaire (AD8) is a brief observation checklist for detecting mild cognitive impairment (MCI) and dementia. After analyzing the reliability and validity of a self-reported Japanese version of the AD8 (AD8-J), we compared self- and informant-reported versions of the AD8-J. Methods: A total of 93 community residents aged 75 years or older living in Wakuya, Northern Japan, agreed to participate in this study; 35 were rated as Clinical Dementia Rating (CDR) 0 (healthy), 46 as CDR 0.5 (defined herein as MCI), and 12 as CDR 1 or above (dementia, confirmed by the DSM-IV). We examined the reliability and validity using a receiver operating characteristic (ROC) curve. We analyzed the differences between self-reported and informant-reported AD8-J using a repeated measures ANOVA. Results: The self-reported AD8-J showed a satisfactory reliability (i.e., Cronbach coefficient, α = 0.71; Guttman split half method coefficient = 0.60). For CDR 0 vs. CDR 0.5 or above, the area under the ROC curve was 0.74 and the cutoff score was 1/2, with a sensitivity of 70.7% and a specificity of 65.7%. Analysis of the subscores of AD8 suggested that, from the early stage of dementia, the subjects showed a subjective decline in memory and interest in hobbies/activities, as well as problems with judgment. Conclusion: It is suggested that the self-reported AD8-J was effective in detecting MCI and dementia. We could use it for detecting MCI and dementia, including in those living alone, in the primary health checkup.
Background/Aim: The purpose of this study was to investigate the estimated prevalence of dementia and the relationship between cognitive impairment and fear of falling in patients with hip fractures. Methods: Analysis 1 included 100 patients with hip fractures. Analysis 2 included a subgroup of subjects with ≥75 years of functional independence: 46 patients with hip fractures and 46 control subjects without hip fractures, and presence or absence of dementia. We used an informant-rated questionnaire including the AD8 for screening for dementia, the Barthel Index for assessing activities of daily living, and the Short Falls Efficacy Scale-International (FES-I) for assessing fear of falling. Results: The estimated prevalence of dementia was 66% in patients with hip fractures. There were significant fracture and dementia effects, with significant covariate effects of age and gender on the Short FES-I scores. Conclusion: Our results suggested that more than two-thirds of patients with hip fractures had dementia. Fear of falling may reflect not only physical functions but also cognitive impairments.
It is noteworthy that television news is difficult to understand, even for healthy older adults. We found that MCI subjects had particular difficulties due to the disaster and suggest that risk cognition could be evaluated using visually presented materials.
We previously examined cerebral blood flow (CBF) with single-photon emission computed tomography (SPECT) in Alzheimer’s disease (AD) with reference to drug treatment (donepezil) and psychosocial intervention.Objective:The aim is to provide “brain-based” evidence for psychosocial interventions using SPECT.Methods:The participants were 27 consecutive outpatients with AD who received the drug and psychosocial intervention, and SPECT three times (baseline, pre-/post-intervention) at 6 month-intervals. The significance level of changes in CBF (Z score) and the extent of significantly changed areas, calculated with the eZIS system, were used as monitoring parameters. The participants were classified into three groups: improve (post-intervention CBF increased), worsening (progressive decline), and no change.Results:Six, 8, and 13 patients were classified as improve, worsening, and no change, respectively. All subjects in the improve group showed improvement in cognitive test scores for the MMSE and/or the CGI scores associated with the brain area with a CBF increase (right parietal lobe), suggesting appropriate psychosocial intervention (visuospatial intervention).Conclusion:These results suggest that monitoring of CBF with the eZIS system may be clinically applicable for monitoring of drug treatment and psychosocial intervention in AD patients.
life (QOL) of patients likely among AD patients [4]. Beyond delayed progression and increased QOL, the ultimate outcome of drug treatment should be measured in terms of lifetime expectancy.For such a long-term effect, we previously demonstrated a positive effect of DNP administration and a Special Nursing Home (SNH) replacement on lifetime expectancy after the onset of AD (without DLB) [5]. This may be due to the decreased mortality rate caused by reduction of concomitant diseases such as pneumonia. In the SNH, they can receive sophisticated psychosocial interventions. For AD patients, the similar lifetime expectancies in patients taking DNP at home and those not taking DNP in the SNH indicated a positive health economic effect of the drug; however, the effect for DLB is unclear. Herein, using the same database (1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012) with additional database (2013)(2014)(2015)(2016)(2017), we re-analyzed the effects of DNP administration and/or SNH replacement on lifetime expectancy in DLB.
IntroductionLifetime expectancy for patients with dementia, especially Alzheimer disease (AD) directly influences medical and care service needs and is a common question posed by families and patients. Brodaty et al.[1] compared mortality and survival in dementia with estimated lifetime expectancies in the general population. Survival after diagnosis of dementia varies considerably and depends on numerous factors and complex interactions among these factors. Relative loss of life expectancy decreases with age at diagnosis and also depends on gender, dementia subtype, and severity stage. A definitive meta-analysis of survival in dementia is precluded by deficiencies in primary studies.Following AD and vascular dementia (VaD), dementia with Lewy Bodies (DLB) has been reported to be the third main cause of dementia [2]. At present, there are no curative drugs for AD or DLB; however, symptomatic drugs, such as cholinesterase inhibitors (ChEIs), e.g. 1 donepezil (DNP), may delay progression (not biological but symptomatic) of the disease. We previously reported that the visual hallucinations manifested by DLB patients were also improved by DNP [3]. This effect combined with psychosocial interventions such as reality orientation and/or reminiscence approach may increase the quality of
AbstractObjective: Cholinesterase inhibitors (ChEIs) can delay the progression of Alzheimer disease (AD). We previously demonstrated a positive effect of donepezil (DNP) administration and a Special Nursing Home (SNH) replacement on lifetime expectancy after the onset of AD. Recently DNP has been indicated for use in the treatment of dementia with Lewy Bodies (DLB); however, the effect on lifetime expectancy remains unclear. Herein, we analyzed the effects of DNP on DLB.Methods: All outpatients at the Tajiri Clinic with available medical records and death certificates from 1999-2012 were included in this retrospective analysis. The entry criteria were a diagnosis of dementia based on DSM-I...
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