-
PloS One 2021While dementia has been associated with specific causes of death, previous studies were relatively small autopsy series or population-based studies lacking autopsy...
BACKGROUND
While dementia has been associated with specific causes of death, previous studies were relatively small autopsy series or population-based studies lacking autopsy confirmation and were restricted to Non-Latinx Whites. Here, we examine the association of dementia with autopsy-verified causes of death in racially-diverse older Brazilians.
METHODS
As part of the Pathology, Alzheimer´s and Related Dementias Study (PARDoS), a community-based study in Brazil, we included 1941 racially-diverse deceased, 65 years or older at death. We conducted a structured interview with legal informants including the Clinical Dementia Rating (CDR) Scale for dementia proximate to death. Causes of death were assessed after full-body autopsy and macroscopic examination of the brain, thoracic and abdominal/pelvic organs. Up to four causes of death were reported for each decedent. Causes of death were classified as circulatory, infectious, cancer and other. Logistic regression was used to determine associations of dementia with cause of death, controlling for age, sex, race, and education.
RESULTS
Dementia was associated with a higher odds of an infectious cause of death (OR = 1.81, 95%CI:1.45-2.25), and with a lower odds of a circulatory disease as cause of death (OR = 0.69, 95%CI:0.54-0.86) and cancer as cause of death (OR = 0.41, 95%CI:0.24-0.71). Dementia was associated with a higher odds of pneumonia (OR = 1.92, 95%CI:1.53-2.40) and pulmonary embolism (OR = 2.31, 95%CI:1.75-3.05) as causes of death and with a lower odds of acute myocardial infarction (OR = 0.42, 95%CI:0.31-0.56) and arterial disease (OR = 0.76, 95%CI:0.61-0.94) as causes of death.
CONCLUSION
Racially-diverse older Brazilians with dementia had a higher odds of an infectious cause of death and a lower odds of cancer and circulatory disease as causes of death than those without dementia.
Topics: Aged; Aged, 80 and over; Autopsy; Brazil; Cause of Death; Dementia; Educational Status; Female; Humans; Male
PubMed: 34910735
DOI: 10.1371/journal.pone.0261036 -
Cellular and Molecular Life Sciences :... Aug 2005The importance of cerebral amyloid deposition in the mechanism of neurodegeneration is still debatable. Classic arguments are usually centered on amyloid beta(Abeta) and... (Review)
Review
The importance of cerebral amyloid deposition in the mechanism of neurodegeneration is still debatable. Classic arguments are usually centered on amyloid beta(Abeta) and its role in the neuronal loss characteristic of Alzheimer's disease, the most common form of human cerebral amyloidosis. Two non-Abeta cerebral amyloidoses, familial British and Danish dementias (FBD and FDD), share many aspects of Alzheimer's disease, including the presence of neurofibrillary tangles, parenchymal preamyloid and amyloid deposits, cerebral amyloid angiopathy and a variety of amyloid-associated proteins and inflammatory components. Both early-onset conditions are linked to specific mutations at or near the stop codon of the chromosome 13 gene BRI2 that cause generation of longer-than-normal protein products. Furin-like processing of these longer precursors releases two de novo-created peptides, ABri and ADan, which deposit as amyloid fibrils in FBD and FDD, respectively. Due to the similar pathology generated by completely unrelated amyloid subunits, FBD and FDD, collectively referred to as chromosome 13 dementias, constitute alternative models for studying the role of amyloid deposition in the mechanism of neuronal cell death.
Topics: Adaptor Proteins, Signal Transducing; Amyloid; Animals; Cerebral Amyloid Angiopathy; Chromosomes, Human, Pair 13; Dementia; Humans; Inflammation; Membrane Glycoproteins; Membrane Proteins; Mice; Mutation; Protein Subunits
PubMed: 15968464
DOI: 10.1007/s00018-005-5092-5 -
International Journal of Geriatric... Apr 2023Alzheimer's disease and related dementias (ADRD) are common among nursing home residents. Yet, conclusive evidence regarding best care practices among this population is... (Review)
Review
BACKGROUND
Alzheimer's disease and related dementias (ADRD) are common among nursing home residents. Yet, conclusive evidence regarding best care practices among this population is lacking. Objectives of this systematic review were to explore features of dementia specialty care units (DSCUs) in long-term care settings and examine benefits for residents, staff, families, and facilities.
METHODS
PubMed, CINAHL, and PsychINFO were searched to identify articles involving DSCUs in long-term care settings published in English with full text available between 01.01.2008 and 06.03.2022. Articles containing empirical data about ADRD special care in long-term care settings were included in the review. Articles focused on clinic-based or out-patient dementia care programs (e.g., adult day care) were excluded. Articles were categorized based on geography (U.S. vs. international) and study design: interventions, descriptive studies, or comparison studies (traditional vs. specialty ADRD care).
RESULTS
Our review included 38 U.S. articles and 54 articles from 15 international countries. In the U.S., 12 intervention, 13 descriptive, and 13 comparison studies met the inclusion criteria. Articles from international countries included 22 intervention, 20 descriptive, and 12 comparison studies. Results were mixed in terms of the efficacy of DSCUs. Promising DSCU features include small-scale settings, dementia-educated staff, and multidisciplinary approaches to care.
CONCLUSION
Overall, our review did not find conclusive evidence regarding the benefits of DSCUs in long-term care settings. No rigorous study designs were found examining 'special' features of DSCUs and associations with outcomes among residents, family, staff, and the facility. Randomized clinical trials are needed to disentangle the 'special' features of DSCUs.
Topics: Humans; Long-Term Care; Dementia; Alzheimer Disease; Ambulatory Care Facilities
PubMed: 36971436
DOI: 10.1002/gps.5907 -
Journal of Alzheimer's Disease : JAD 2022Psychotic phenomena are among the most severe and disruptive symptoms of dementias and appear in 30% to 50% of patients. They are associated with a worse evolution and... (Review)
Review
Psychotic phenomena are among the most severe and disruptive symptoms of dementias and appear in 30% to 50% of patients. They are associated with a worse evolution and great suffering to patients and caregivers. Their current treatments obtain limited results and are not free of adverse effects, which are sometimes serious. It is therefore crucial to develop new treatments that can improve this situation. We review available data that could enlighten the future design of clinical trials with psychosis in dementia as main target. Along with an explanation of its prevalence in the common diseases that cause dementia, we present proposals aimed at improving the definition of symptoms and what should be included and excluded in clinical trials. A review of the available information regarding the neurobiological basis of symptoms, in terms of pathology, neuroimaging, and genomics, is provided as a guide towards new therapeutic targets. The correct evaluation of symptoms is transcendental in any therapeutic trial and these aspects are extensively addressed. Finally, a critical overview of existing pharmacological and non-pharmacological treatments is made, revealing the unmet needs, in terms of efficacy and safety. Our work emphasizes the need for better definition and measurement of psychotic symptoms in dementias in order to highlight their differences with symptoms that appear in non-dementing diseases such as schizophrenia. Advances in neurobiology should illuminate the development of new, more effective and safer molecules for which this review can serve as a roadmap in the design of future clinical trials.
Topics: Caregivers; Dementia; Hallucinations; Humans; Psychotic Disorders; Schizophrenia
PubMed: 35786651
DOI: 10.3233/JAD-215483 -
Dementia and Geriatric Cognitive... 2016Dementia influences a person's experience of social relationships, as described in several studies. In this systematic meta-synthesis of qualitative studies, we aim to... (Review)
Review
BACKGROUND
Dementia influences a person's experience of social relationships, as described in several studies. In this systematic meta-synthesis of qualitative studies, we aim to interpret and synthesize the experiences of persons with dementias and their relations with others.
SUMMARY
Living with dementia changes life, leading to new social roles and different social statuses. Persons with dementia experience being disconnected and dependent on others, feeling like being a burden, and being a person who is treated in paternalistic ways. Family, friends and others with dementia might play significant roles in their ability to maintain a meaningful life. Key Messages: Three categories emerged from the data, change in life, change in relations, and maintenance of meaningful aspects in life; these categories are intertwined and essential in sustaining a lifeline for persons with dementia. The comprehensive meaning of the material is understood as the expression: Living a meaningful life in relational changes.
Topics: Dementia; Emotions; Humans; Interpersonal Relations; Qualitative Research; Role
PubMed: 27866199
DOI: 10.1159/000452404 -
Revista de Neurologia Nov 2012The psychological and behavioural symptoms of dementia (BPSD) [corrected] give rise to personal suffering, are the cause of added deterioration and worsen the economic... (Review)
Review
INTRODUCTION
The psychological and behavioural symptoms of dementia (BPSD) [corrected] give rise to personal suffering, are the cause of added deterioration and worsen the economic and social cost of dementias.
AIM
To offer a systematic approach to the prevention, diagnosis and treatment of BPSD. [corrected].
DEVELOPMENT
The study adopts a global perspective that takes into account biological, psychological and social factors in an attempt to avoid both excessive medicalisation and a purely psychology-based attitude. Satisfying basic needs, treating medical and psychiatric comorbidity, the adaptation of the setting, and the specific pharmacological treatment of dementia, as well as offering patients and their caregivers the counselling and support they need, all contribute to prevent the onset of BPSD. [corrected]. The diagnosis of BPSD [corrected] is based on the patient's medical history and on observation. It is useful to identify a primary or destabilising BPSD [corrected] on which to deploy hypotheses and specific treatments based on modifying the environment, drugs, non-pharmacological therapies and continuous assessment. Any action taken must be integrated within a person-focused care plan aimed at accomplishing the patients' and their caregivers' welfare and quality of life.
CONCLUSIONS
BPSD [corrected] are the result of biological, psychological and social factors. In the present scenario, in which there are no curative treatments in most cases of dementia, a systematic and multidisciplinary approach aimed at preventing and treating BPSD [corrected] is a highly cost-effective therapeutic opportunity in both personal and social terms.
Topics: Dementia; Humans; Mental Disorders
PubMed: 23143961
DOI: No ID Found -
Aging May 2019
Topics: Dementia; Humans; Leukoencephalopathies; Neurodegenerative Diseases; Neuroimaging; White Matter
PubMed: 31102504
DOI: 10.18632/aging.101967 -
AJNR. American Journal of Neuroradiology Mar 2014Most dementias begin insidiously, developing slowly and generally occurring in the elderly age group. The so-called rapidly progressive dementias constitute a different,... (Review)
Review
Most dementias begin insidiously, developing slowly and generally occurring in the elderly age group. The so-called rapidly progressive dementias constitute a different, diverse collection of conditions, many of which are reversible or treatable. For this reason, prompt identification and assessment of acute and subacute forms of dementia are critical to effective treatment. Numerous other entities within this category of presenile rapid-onset dementias are untreatable such as the prion-related diseases. Neuroimaging aids in the diagnosis and evaluation of many of these rapidly progressive dementias, which include myriad conditions ranging from variations of more common neurodegenerative dementias, such as Alzheimer disease, dementia with Lewy bodies, and frontotemporal dementia; infectious-related dementias such as acquired immune deficiency syndrome dementia; autoimmune and malignancy-related conditions; to toxic and metabolic forms of encephalopathy. This first of a 2-part review will specifically address the ability of MR imaging and ancillary neuroimaging strategies to support the diagnostic evaluation of rapidly progressive dementias due to neurodegenerative causes.
Topics: Dementia; Disease Progression; Humans; Neurodegenerative Diseases; Neuroimaging; Time Factors
PubMed: 23436051
DOI: 10.3174/ajnr.A3454 -
Brain : a Journal of Neurology Dec 2021The diversity of cognitive deficits and neuropathological processes associated with dementias has encouraged divergence in pathophysiological explanations of disease.... (Review)
Review
The diversity of cognitive deficits and neuropathological processes associated with dementias has encouraged divergence in pathophysiological explanations of disease. Here, we review an alternative framework that emphasizes convergent critical features of cognitive pathophysiology. Rather than the loss of 'memory centres' or 'language centres', or singular neurotransmitter systems, cognitive deficits are interpreted in terms of aberrant predictive coding in hierarchical neural networks. This builds on advances in normative accounts of brain function, specifically the Bayesian integration of beliefs and sensory evidence in which hierarchical predictions and prediction errors underlie memory, perception, speech and behaviour. We describe how analogous impairments in predictive coding in parallel neurocognitive systems can generate diverse clinical phenomena, including the characteristics of dementias. The review presents evidence from behavioural and neurophysiological studies of perception, language, memory and decision-making. The reformulation of cognitive deficits in terms of predictive coding has several advantages. It brings diverse clinical phenomena into a common framework; it aligns cognitive and movement disorders; and it makes specific predictions on cognitive physiology that support translational and experimental medicine studies. The insights into complex human cognitive disorders from the predictive coding framework may therefore also inform future therapeutic strategies.
Topics: Brain; Cognition; Dementia; Humans
PubMed: 34240109
DOI: 10.1093/brain/awab254 -
Annali Dell'Istituto Superiore Di Sanita 2022The Italian Fund for Alzheimer's and other dementias was approved and signed in December 2021. The Fund is financed with 15 million euros in three years. The main goal...
The Italian Fund for Alzheimer's and other dementias was approved and signed in December 2021. The Fund is financed with 15 million euros in three years. The main goal is to provide new strategies in the field of dementia with a Public Health perspective. The Fund includes eight main activities that will be monitored and supervised by the Italian National Institute of Health: 1) development of a guideline for the assessment, management and support for people with dementia and their families/carers; 2) updating of the Dementia National Plan (DNP); 3) implementation of the documents of the DNP; 4) conducting surveys dedicated to the Italian Dementia Services; 5) promotion of dementia prevention strategies; 6) training strategies for healthcare professionals, families and caregivers; 7) creation of a National Electronic Record for Dementia; 8) evaluation and monitoring of activities promoted by Regions and Autonomous Provinces in the field of dementia, together with the dementia National Permanent Table. These activities are outlined in detail in the present paper.
Topics: Alzheimer Disease; Caregivers; Dementia; Financial Management; Humans; Public Health
PubMed: 36128968
DOI: 10.4415/ANN_22_03_08