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Journal of General Internal Medicine Aug 2022The emotional stress of caring for someone with Alzheimer's disease and related dementias is high and results in adverse effects on caregivers and the persons living...
BACKGROUND
The emotional stress of caring for someone with Alzheimer's disease and related dementias is high and results in adverse effects on caregivers and the persons living with disease. In preliminary work, caregiver reports of regularly feeling "completely overwhelmed" were associated with lack of measurable clinical benefit from a comprehensive dementia care program.
OBJECTIVE
To examine the sociodemographic and clinical characteristics of all caregivers who felt overwhelmed at entry into a comprehensive dementia care program, the trajectory of this symptom over 1 year, and its predictive value for 1-year caregiver outcomes.
DESIGN
Longitudinal cohort study SETTING: Academic health center PARTICIPANTS: Caregivers of patients enrolled in a comprehensive dementia care program EXPOSURES: Caregiver report of feeling "completely overwhelmed" at baseline MAIN MEASURES: Caregiver report of feeling "completely overwhelmed" at baseline and 1 year, and validated scales of caregiver strain, distress, depressive symptoms, burden, mortality, and long-term nursing home placement KEY RESULTS: Compared to caregivers who were not overwhelmed, overwhelmed caregivers had more distress from behavioral symptoms of the person living with dementia, worse depression scores, and higher composite dementia burden scores at baseline. They also had worse depressive symptoms, strain, and composite burden scores at 1 year, after adjustment for baseline scores. Having an overwhelmed caregiver did not predict long-term nursing home placement or mortality among persons with dementia.
CONCLUSIONS
A single question about whether a caregiver is overwhelmed might indicate caregivers who have considerable current and future symptom burden and who may benefit from increased support and resources.
Topics: Alzheimer Disease; Caregivers; Dementia; Humans; Nursing Homes; Vital Signs
PubMed: 34389938
DOI: 10.1007/s11606-021-07054-3 -
Journal of Integrative Neuroscience Apr 2022Worldwide, more than 50 million people live with dementia, and due to the rapidly aging population, dementia cases are expected to increase at least five times in 2050.... (Review)
Review
Worldwide, more than 50 million people live with dementia, and due to the rapidly aging population, dementia cases are expected to increase at least five times in 2050. 30%-40% of dementia cases are diagnosed as non-Alzheimer's dementia. Common subtypes of non-Alzheimer's dementia are known as vascular, Lewy body, and frontotemporal dementia. Despite advances in modern medicine, the mechanism of dementia is still not fully understood. The term "omics" is a general term and is used to comprehensively characterize molecules by functional and biological similarities, focusing on the basic biological processes of a living organism and these techniques have enabled us to examine the unknown areas of biology, such as the genome, transcriptome, proteome, microbiome, and metabolome. This review highlights the progress that has been made in omics research while noting the gaps in our knowledge.
Topics: Aged; Aging; Alzheimer Disease; Dementia; Humans; Learning
PubMed: 35633157
DOI: 10.31083/j.jin2103076 -
Neurobiology of Disease Nov 2023Dementia with Lewy bodies and Parkinson's disease dementia are common neurodegenerative diseases that share similar neuropathological profiles and spectra of clinical... (Review)
Review
Dementia with Lewy bodies and Parkinson's disease dementia are common neurodegenerative diseases that share similar neuropathological profiles and spectra of clinical symptoms but are primarily differentiated by the order in which symptoms manifest. The question of whether a distinct molecular pathological profile could distinguish these disorders is yet to be answered. However, in recent years, studies have begun to investigate genomic, epigenomic, transcriptomic and proteomic differences that may differentiate these disorders, providing novel insights in to disease etiology. In this review, we present an overview of the clinical and pathological hallmarks of Lewy body dementias before summarizing relevant research into genetic, epigenetic, transcriptional and protein signatures in these diseases, with a particular interest in those resolving "omic" level changes. We conclude by suggesting future research directions to address current gaps and questions present within the field.
Topics: Humans; Lewy Body Disease; Dementia; Parkinson Disease; Proteomics; Lewy Bodies
PubMed: 37918758
DOI: 10.1016/j.nbd.2023.106337 -
The Psychiatric Clinics of North America Jun 2015Young-onset dementias frequently present with prominent behavioral features and constitute a diagnostic challenge. Most cases are secondary to neurodegenerative... (Review)
Review
Young-onset dementias frequently present with prominent behavioral features and constitute a diagnostic challenge. Most cases are secondary to neurodegenerative conditions, including the behavioral variant of frontotemporal dementia, which has overlapping symptoms with many primary psychiatric disorders. This article reviews the differential diagnosis and neuropsychiatric assessment of young-onset dementia, which includes detailed history taking, family history, mental status examination, office-based cognitive tests, and a focused neurologic examination. The clinical examination serves to establish the presence of a dementia and the specific clinical syndrome. Biomarkers can be subsequently integrated in a probabilistic model to determine the most likely neuropathological process.
Topics: Age of Onset; Alzheimer Disease; Behavioral Symptoms; Dementia; Diagnosis, Differential; Diagnostic and Statistical Manual of Mental Disorders; Humans; Intelligence Tests; Mental Competency; Middle Aged; Neuroimaging; Neuropsychological Tests
PubMed: 25998114
DOI: 10.1016/j.psc.2015.01.002 -
BMJ (Clinical Research Ed.) Oct 2023
Topics: Humans; Charities; Dementia
PubMed: 37821121
DOI: 10.1136/bmj.p2356 -
Advances in Experimental Medicine and... 2021Filamentous inclusions of tau protein are found in cases of inherited and sporadic frontotemporal dementias (FTDs). Mutations in MAPT, the tau gene, cause approximately...
Filamentous inclusions of tau protein are found in cases of inherited and sporadic frontotemporal dementias (FTDs). Mutations in MAPT, the tau gene, cause approximately 5% of cases of FTD. They proved that dysfunction of tau protein is sufficient to cause neurodegeneration and dementia. Clinically and pathologically, cases with MAPT mutations can resemble sporadic diseases, such as Pick's disease, globular glial tauopathy, progressive supranuclear palsy and corticobasal degeneration. The structures of tau filaments from Pick's disease and corticobasal degeneration, determined by electron cryo-microscopy, revealed the presence of specific tau folds in each disease, with no inter-individual variation. The same was true of chronic traumatic encephalopathy.
Topics: Alzheimer Disease; Frontotemporal Dementia; Humans; Pick Disease of the Brain; Tauopathies; tau Proteins
PubMed: 33433876
DOI: 10.1007/978-3-030-51140-1_12 -
International Psychogeriatrics Oct 2015Dementia raises many ethical issues. The present review, taking note of the fact that the stages of dementia raise distinct ethical issues, focuses on three issues... (Review)
Review
Dementia raises many ethical issues. The present review, taking note of the fact that the stages of dementia raise distinct ethical issues, focuses on three issues associated with stages of dementia's progression: (1) how the emergence of preclinical and asymptomatic but at-risk categories for dementia creates complex questions about preventive measures, risk disclosure, and protection from stigma and discrimination; (2) how despite efforts at dementia prevention, important research continues to investigate ways to alleviate clinical dementia's symptoms, and requires additional human subjects protections to ethically enroll persons with dementia; and (3) how in spite of research and prevention efforts, persons continue to need to live with dementia. This review highlights two major themes. First is how expanding the boundaries of dementias such as Alzheimer's to include asymptomatic but at-risk persons generate new ethical questions. One promising way to address these questions is to take an integrated approach to dementia ethics, which can include incorporating ethics-related data collection into the design of a dementia research study itself. Second is the interdisciplinary nature of ethical questions related to dementia, from health policy questions about insurance coverage for long-term care to political questions about voting, driving, and other civic rights and privileges to economic questions about balancing an employer's right to a safe and productive workforce with an employee's rights to avoid discrimination on the basis of their dementia risk. The review highlights these themes and emerging ethical issues in dementia.
Topics: Dementia; Disclosure; Ethics, Research; Human Rights; Humans; Patient Care; Social Discrimination; Social Stigma
PubMed: 26061118
DOI: 10.1017/S1041610215000848 -
Neuropsychology Review Mar 2015As the population steadily ages, dementia, in all its forms, remains a great societal challenge. Yet, our knowledge of their etiology remains rather limited. To this... (Review)
Review
As the population steadily ages, dementia, in all its forms, remains a great societal challenge. Yet, our knowledge of their etiology remains rather limited. To this end, genetic studies can give us insight into the underlying mechanisms that lead to the development of dementia, potentially facilitating treatments in the future. In this review we cover the most recent genetic risk factors associated with the onset of the four most common dementia types today, including Alzheimer's disease (AD), Vascular Dementia (VaD), Frontotemporal Lobar Degeneration (FTLD) and Lewy Body Dementia (LBD). Moreover, we discuss the overlap in major underlying pathologies of dementia derived from their genetic associations. While all four dementia types appear to involve genes associated with tau-pathology and neuroinflammation only LBD, AD and VaD appear to involve amyloid genes while LBD and FTLD share alpha synuclein genes. Together these findings suggest that some of the dementias may exist along a spectrum and demonstrates the necessity to conduct large-scale studies pinpointing the etiology of the dementias and potential gene and environment interactions that may influence their development.
Topics: Aging; Dementia; Genetic Variation; Genetics; Humans; Sex Characteristics
PubMed: 25567624
DOI: 10.1007/s11065-014-9276-3 -
Aging Jan 2023
Topics: Humans; Alzheimer Disease; Dementia
PubMed: 36602534
DOI: 10.18632/aging.204478 -
Maturitas Oct 2014Over the last few years, advances in neuroimaging have generated biomarkers, which increase diagnostic certainty, provide valuable information about prognosis, and... (Review)
Review
Over the last few years, advances in neuroimaging have generated biomarkers, which increase diagnostic certainty, provide valuable information about prognosis, and suggest a particular pathology underlying the clinical dementia syndrome. We aim to review the evidence for use of already established imaging modalities, along with selected techniques that have a great potential to guide clinical decisions in the future. We discuss structural, functional and molecular imaging, focusing on the most common dementias: Alzheimer's disease, fronto-temporal dementia, dementia with Lewy bodies and vascular dementia. Finally, we stress the importance of conducting research using representative cohorts and in a naturalistic set up, in order to build a strong evidence base for translating imaging methods for a National Health Service. If we assess a broad range of patients referred to memory clinic with a variety of imaging modalities, we will make a step towards accumulating robust evidence and ultimately closing the gap between the dramatic advances in neurosciences and meaningful clinical applications for the maximum benefit of our patients.
Topics: Alzheimer Disease; Brain; Dementia; Dementia, Vascular; Frontotemporal Dementia; Functional Neuroimaging; Humans; Lewy Body Disease; Magnetic Resonance Imaging; Neuroimaging; Positron-Emission Tomography; Tomography, Emission-Computed, Single-Photon
PubMed: 24685291
DOI: 10.1016/j.maturitas.2014.02.016