Search

Background: The influence of depressive symptoms on awareness of memory disturbances in patients with Alzheimer disease (AD) and metamemory is unknown. Objective: We compared the level of awareness of memory disturbances in AD patients with and without depression using 2 measures: a questionnaire comparing discrepancies in patients/ caregivers' assessments and the patients' predictions of their own performances on a memory task. Methods: AD patients with depression (n = 21) or without depression (n = 21) were asked to complete an assessment of self-reported memory dysfunction (Short Memory Questionnaire; SMQ) and memory task performance prediction (10-words-recall Questionnaire). In addition, the caregivers' evaluations of the memory deficits in the study patients were assessed using the SMQ. Results: We observed a greater discrepancy in the SMQ scores given by the caregivers' and the patients' among AD patients without depression, compared with those with depression. A greater discrepancy was also observed in the ratio score (patient's predicted performance/actual performance) for the 10-words-recall Questionnaire in AD patients without depression than in those with depression. Conclusions: AD patients with depression may estimate their memory ability either more accurately or more negatively than AD patients without depression, as shown using the above 2 methods.

There are various types of underlying damage to tissue and vessels in vascular dementia, including (1) single or multiple infarcts that involve association and limbic cortices, (2) small subcortical infarcts disrupting cortico-subcortical circuits, and (3) white matter lesions. The clinical picture of vascular dementia varies, and the role of functional brain imaging of cerebral blood flow and metabolism would be expected to be different among subtypes of vascular dementia. The role and value of functional brain imaging is limited for cortical infarcts; it is very valuable in assessing the impact on cortical function for small subcortical infarcts; and it is probably useful for evaluating white matter lesions, but this needs to be determined in further studies. At least in research of vascular dementia, functional brain imaging criteria should be included for proper patient selection. Careful studies using functional imaging tools in a well-characterized patient population will be needed.

Parietal cerebral glucose metabolism is reduced before substantial impairments appeared in subjects carrying the apolipoprotein E (APOE) epsilon4 allele, but the effect of the APOE epsilon4 allele on cerebral metabolism in Alzheimer disease (AD) is still undetermined. To investigate the effect of the APOE epsilon4 allele on cerebral metabolism in AD, we examined regional cerebral glucose metabolism in 83 patients with AD by using 18F-fluorodeoxyglucose and positron emission tomography. Cerebral glucose metabolism in the fronto-parieto-temporal association and limbic cortices was significantly decreased in the AD patients compared with 26 age- and sex-matched normal controls. Regional cerebral glucose metabolic rate was not correlated significantly with the number of APOE epsilon4 alleles in any region, which was consistent even after controlling the effects of age, sex, and severity of dementia, and in a subgroup analysis of those aged between 60 and 75. These results supported the view that the APOE epsilon4 allele is not associated with specific deficits in brain metabolism in AD despite evidence of preclinical alterations.