Are Alzheimer Patients Healthier?

Wolf‐Klein, Gisele; Silverstone, Felix A.; Brod, Meryl S.; Levy, Arnold P.; Foley, Conn J.; Termotto, Val; Breuer, Joseph

doi:10.1111/j.1532-5415.1988.tb01804.x

Cited by 137 publications

(113 citation statements)

References 10 publications

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“…In addition it supports the personal experience of the authors reported elsewhere [21]. This finding is somewhat surprising considering DAT sufferers may be healthier than other age controlled elderly [31] and by definition only suffer initially from a loss in cognitive domains [12]. A possible explanation is that moderate DAT patients who showed shorter step length, lower gait speed, lower stepping frequency, greater step-to-step variability, and greater sway path [32].…”

Section: Discussionsupporting

confidence: 71%

Behavioral profile of possible Alzheimer's disease patients in Virginia search and rescue incidents

Koester¹,

Stooksbury²

1995

Wilderness & Environmental Medicine

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We performed a retrospective study of the behavior of lost Dementia of Alzheimer's Type (DAT) patients who became the subjects of organized Search and Rescue efforts. We compared the DAT patients behavior to the behavior of elderly lost victims that possessed normal cognitive abilities. Data for both populations was from the Virginia Department of Emergency Services lost subject database. We found that normal elderly individuals on average traveled a greater straight line distance (2.56 km) from the Point Last Seen (PLS) than DAT patients (0.88 km). The median straight line distance from the PLS was the same for both populations (0.8 km). The mortality rate for DAT patients was 19 percent. Mortality was caused by hypothermia, dehydration, and drowning. No fatalities were found among DAT patients when they were located within 24 hours. A mortality rate of 46 percent was found for patients requiring more than 24 hours to locate. This 24 hour survivability window suggests that lost DAT patients require an immediate and aggressive search response.Keywords: Wandering, Alzheimer's Disease, Lost person behavior, missing person, Behavioral profile IntroductionOur goals are to create a preliminary behavioral profile of lost Dementia of Alzheimer's Type (DAT) patients, determine factors that impact survivability, and to create a database. Incident commanders in missing person searches rely on lost person behavior profiles and statistics for the initial deployment of resources, development of objectives, and predicting survivability. The major textbooks and field guides currently used by incident commanders combine both Alzheimer's with Elderly subjects or fail to give any numbers [1,2]. Unfortunately, search subjects suffering from Alzheimer's disease are grouped with elderly subjects or undocumented.Current estimates of Alzheimer's Disease are four million based upon an estimated 10.3% of the population over the age of 65 suffers from probable Alzheimer's disease [3]. An estimated 12-14 million Americans will be affected by the year 2040 [4]. The increase is believed to be due to an increase in awareness of the disease and an increase in the age of the U.S. population [5]. Regional demographics also will affect the percentage of Alzheimer's cases found in each state. Indeed there appears to be a higher prevalence in rural areas [6] and among those with less education [7,8]. It is this particular subset of DAT patients that often results in search and rescue incidents.Alzheimer's disease (AD) is a disease of exclusion since only after the patients' death can it be diagnosed positively. However, DAT [9] or probable AD is characterized well and can be documented with behavioral tests [10,11,12]. Wandering significantly increases with further deterioration of the DAT patient. Among mild cases of DAT, 18% of the patients wander, while in severe cases, wandering increases to 50% [13]. Other studies have made estimates of the prevalence of wanderers ranging from twelve to thirty-nine percent [14,15]. Another study reported twe...

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Section: Discussionsupporting

confidence: 71%

Behavioral profile of possible Alzheimer's disease patients in Virginia search and rescue incidents

Koester¹,

Stooksbury²

1995

Wilderness & Environmental Medicine

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“…Some studies suggest that the prevalence of Alzheimer disease is increased in type 2 diabetes (58 -60), whereas in others, it has been reported as decreased (61)(62)(63)(64)(65)(66) or comparable (48,49,(67)(68)(69)(70)(71). A confounding factor in these studies (including the current one) is that Alzheimer disease is often accompanied by a decreased BMI presumed to be a result of decreased food intake.…”

Section: Discussionmentioning

confidence: 44%

Increased Risk of Type 2 Diabetes in Alzheimer Disease

et al. 2004

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Alzheimer disease and type 2 diabetes are characterized by increased prevalence with aging, a genetic predisposition, and comparable pathological features in the islet and brain (amyloid derived from amyloid ␤ protein in the brain in Alzheimer disease and islet amyloid derived from islet amyloid polypeptide in the pancreas in type 2 diabetes). Evidence is growing to link precursors of amyloid deposition in the brain and pancreas with the pathogenesis of Alzheimer disease and type 2 diabetes, respectively. Given these similarities, we questioned whether there may be a common underlying mechanism predisposing to islet and cerebral amyloid. To address this, we first examined the prevalence of type 2 diabetes in a community-based controlled study, the Mayo Clinic Alzheimer Disease Patient Registry (ADPR), which follows patients with Alzheimer disease versus control subjects without Alzheimer disease. In addition to this clinical study, we performed a pathological study of autopsy cases from this same community to determine whether there is an increased prevalence of islet amyloid in patients with Alzheimer disease and increased prevalence of cerebral amyloid in patients with type 2 diabetes. Patients who were enrolled in the ADPR (Alzheimer disease n ‫؍‬ 100, non-Alzheimer disease control subjects n ‫؍‬ 138) were classified according to fasting glucose concentration (FPG) as nondiabetic (FPG <110 mg/dl), impaired fasting glucose (IFG, FPG 110 -125 mg/dl), and type 2 diabetes (FPG >126 mg/dl). The mean slope of FPG over 10 years in each case was also compared between Alzheimer disease and non-Alzheimer disease control subjects. Pancreas and brain were examined from autopsy specimens obtained from 105 humans (first, 28 cases of Alzheimer disease disease vs. 21 non-Alzheimer disease control subjects and, second, 35 subjects with type 2 diabetes vs. 21 non-type 2 diabetes control subjects) for the presence of islet and brain amyloid. Both type 2 diabetes (35% vs. 18%; P < 0.05) and IFG (46% vs. 24%; P < 0.01) were more prevalent in Alzheimer disease versus non-Alzheimer disease control subjects, so 81% of cases of Alzheimer disease had either type 2 diabetes or IFG. The slope of increase of FPG with age over 10 years was also greater in Alzheimer disease than non-Alzheimer disease control subjects (P < 0.01). Islet amyloid was more frequent (P < 0.05) and extensive (P < 0.05) in patients with Alzheimer disease than in non-Alzheimer disease control subjects. However, diffuse and neuritic plaques were not more common in type 2 diabetes than in control subjects. In cases of type 2 diabetes when they were present, the duration of type 2 diabetes correlated with the density of diffuse (P < 0.001) and neuritic plaques (P < 0.01). In this community cohort from southeast Minnesota, type 2 diabetes and IFG are more common in patients with Alzheimer disease than in control subjects, as is the pathological hallmark of type 2 diabetes, islet amyloid. However, there was no increase in brain plaque formation in cases of type 2 diabet...

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“…One reason for our findings could be related to the types of dementias and the comorbidities associated with them. As an example, patients with vascular dementia had the highest comorbidity scores, related to conditions associated with cardiovascular risk: hypertension, hyperlipidemia, stroke, peripheral vascular disease and others [36][37][38][39] Table 5: Unadjusted and adjusted cox proportional hazard ratios for in-hospital Dementia mortality by nis year and age group: african americans, hispanics vs. whites*.…”

Section: Discussionmentioning

confidence: 99%

Age and Race Specific Trends and Mortality for Dementia Hospitalization in the US

Sherzai¹,

Sherzai²

2016

J Neurol Neurophysiol

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Objective: To explore ethnoracial and gender specific mortality associated with dementia hospitalizations from 1997 to 2008, using a nationally representative database.Design: Cross-sectional.Participants: 354,949,163 from the Nationwide Inpatient Sample (NIS) database using appropriate ICD-9 and procedure codes. Measurements:Descriptive, univariate and multivariable analysis (Linear, Cox) adjusting for comorbidity, hospital factors and socio-demographics were used.Results: Mortality was higher for dementia hospitalizations for all age groups (35-64 years and ≥ 65 years) vs. non-dementia hospitalizations (2.7% vs. 1.5% and 5.5% vs. 4.5%). For individuals aged 35-64 years, dementia hospitalizations were more common among males vs. females (53.8% vs. 46.2%). Crude in-hospital mortality was higher among Whites and males for all age groups and overall mortality declined from 1999 to 2008. Adjusted relative risk of mortality was higher among men as compared to women of all age groups (RR 2.87, 95% CI 2.82-2.92) and also higher among Hispanics and African Americans as compared to Whites (African Americans: RR 2.35, 95% CI 2.21-2.51; Hispanics: RR 2.15, 95% CI 2.06-2.23). Conclusion:African Americans, Hispanics and men bear a disproportionate burden from dementia in the hospital setting. Interventions to improve care outcomes in these populations are important.

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Are Alzheimer Patients Healthier?

Cited by 137 publications

References 10 publications

Behavioral profile of possible Alzheimer's disease patients in Virginia search and rescue incidents

Behavioral profile of possible Alzheimer's disease patients in Virginia search and rescue incidents

Increased Risk of Type 2 Diabetes in Alzheimer Disease

Age and Race Specific Trends and Mortality for Dementia Hospitalization in the US

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