Health promotion intervention for people with early-stage dementia: A quasi-experimental study

Introduction: With the limited advancements in medical treatment, there is a growing need for supporting people with early‐stage dementia adjust to their diagnosis and improve their quality of life. This study aimed to investigate the effects of a 12‐week health promotion course for people with early‐stage dementia. Methods: Quasi‐experimental, single group, pretest‐posttest design. A total of 108 persons with dementia participated in this study, and for each participant, a carer was interviewed. The 12‐week health promotion intervention consisted of 2‐hr sessions at weekly intervals. Outcome measures were cognition, measured by Mini‐Mental State Examination, personal, and instrumental activities of daily living (P‐ADL and I‐ADL), measured by Lawton and Brody's Physical Self‐Maintenance Scale and Instrumental Activities of Daily Living Scale, self‐rated health, measured by the European Quality of life Visual Analogue Scale, depressive symptoms, measured by the Cornell Scale for Depression in Dementia, and neuropsychiatric symptoms, measured by The Neuropsychiatric Inventory. Assessments were conducted at baseline and at follow‐up 1–2 months postintervention. Results: The results demonstrate a small but statistically significant improvement in depressive symptoms (p = .015) and in self‐rated health (p = .031). The results also demonstrated a small statistically significant decline in the participants’ I‐ADL (p = .007). The participants’ cognitive function, P‐ADL, and neuropsychiatric symptoms were stable during the 4‐month follow‐up. Conclusion: This study demonstrates promising results with regard to the benefit of attending a 12‐week health promotion intervention in promoting health and well‐being in people with early‐stage dementia. With the majority of participants with early‐stage dementia living at home without any healthcare services in a vulnerable stage of the condition, this study makes an important contribution to highlighting the need for, and benefit of, educational approaches for this population.publishedVersio

Frequency and Course of Mild Cognitive Impairment in a Multiethnic Community

Objective To examine incidence rates and antecedents of mild cognitive impairment (MCI) and Alzheimer's disease (AD) among diverse elders without dementia at the initial visit, and to examine the characteristics of elders with MCI who reverted to normal on follow-up examination. Methods A total of 2,364 Caribbean Hispanic, black, or non-Hispanic white subjects, aged 65 or older, who were free of dementia at initial evaluation were followed up every 18 to 24 months. Incidence rate of MCI and AD was determined by examination of neurological, medical, psychiatric, and neuropsychological function. Results Over 10,517 person-years, 21% of normal elderly subjects progressed to MCI (annual incidence rate, 5.1%; 95% confidence interval, 4.6–5.6%). Of those with MCI initially, 21.8% were subsequently diagnosed with AD (annual incidence rate, 5.4%; 95% confidence interval, 4.7–6.3%), 47% remained unchanged, and 31% reverted to normal. Those with MCI were 2.8 times more likely to experience development of AD than normal elderly subjects. MCI with impairment in memory and at least one other cognitive domain was associated with greatest risk for progression to AD and was also least likely to revert to normal at follow-up. Consistent diagnosis of MCI or incident probable or possible AD was 60% sensitive and 94% specific for the pathological diagnosis of AD. Interpretation Impaired memory and language were useful predictors of transition to AD. Reversion to normal from MCI was frequent, but those with impairment in more than one cognitive domain were more likely to progress or remain impaired than those with single-domain impairment. Clinical diagnosis of MCI does not always predict AD neuropathology. Ann Neurol 200

Novel CSF biomarkers to discriminate FTLD and its pathological subtypes

Objective: Frontotemporal lobar degeneration (FTLD) is the second most prevalent dementia in young patients and is characterized by the presence of two main protein aggregates in the brain, tau (FTLD-Tau) or TDP43 (FTLD-TDP), which likely require distinct pharmacological therapy. However, specific diagnosis of FTLD and its subtypes remains challenging due to largely overlapping clinical phenotypes. Here, we aimed to assess the clinical performance of novel cerebrospinal fluid (CSF) biomarkers for discrimination of FTLD and its pathological subtypes. Methods: YKL40, FABP4, MFG-E8, and the activities of catalase and specific lysosomal enzymes were analyzed in patients with FTLD-TDP (n\ua0=\ua030), FTLD-Tau (n\ua0=\ua020), AD (n\ua0=\ua030), DLB (n\ua0=\ua029), and nondemented controls (n\ua0=\ua029) obtained from two different centers. Models were validated in an independent CSF cohort (n\ua0=\ua0188). Results: YKL40 and catalase activity were increased in FTLD-TDP cases compared to controls. YKL40 levels were also higher in FTLD-TDP compared to FTLD-Tau. We identified biomarker models able to discriminate FTLD from nondemented controls (MFG-E8, tTau, and A\u3b242; 78% sensitivity and 83% specificity) and non-FTLD dementia (YKL40, pTau, p/tTau ratio, and age; 90% sensitivity, 78% specificity), which were validated in an independent cohort. In addition, we identified a biomarker model differentiating FTLD-TDP from FTLD-Tau (YKL40, MFGE-8, \u3b2HexA together with \u3b2HexA/tHex and p/tTau ratios and age) with 80% sensitivity and 82% specificity. Interpretation: This study identifies CSF protein signatures distinguishing FTLD and the two main pathological subtypes with optimal accuracy (specificity/sensitivity\ua0>\ua080%). Validation of these models may allow appropriate selection of cases for clinical trials targeting the accumulation of Tau or TDP43, thereby increasing their efficiency and facilitating the development of successful therapies