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This systematic review of 57 studies examines the accuracy of brief cognitive tests (standalone tests; memory, executive function, and language tests; and brief multidomain batteries) for distingui...

This systematic review of 55 trials with low or medium risk of bias examines the benefits and harms of several prescription drugs and supplements for treatment of clinical Alzheimer-type dementia.

Objectives:The present study explored relationships among personality, Alzheimer’s disease (AD) biomarkers, and dementia by addressing the following questions: (1) Does personality discriminate healthy aging and earliest detectable stage of AD? (2) Does personality predict conversion from healthy aging to early-stage AD? (3) Do AD biomarkers mediate any observed relationships between personality and dementia status/conversion?Methods:Both self- and informant ratings of personality were obtained in a large well-characterized longitudinal sample of cognitively normal older adults (N = 436) and individuals with early-stage dementia (N = 74). Biomarkers included amyloid imaging, hippocampal volume, cerebral spinal fluid (CSF) Aβ42, and CSF tau.Results:Higher neuroticism, lower conscientiousness, along with all four biomarkers strongly discriminated cognitively normal controls from early-stage AD individuals. The direct effects of neuroticism and conscientiousness were only mediated by hippocampal volume. Conscientiousness along with all biomarkers predicted conversion from healthy aging to early-stage AD; however, none of the biomarkers mediated the relationship between conscientiousness and conversion. Conscientiousness predicted conversion as strongly as the biomarkers, with the exception of hippocampal volume.Conclusions:Conscientiousness and to a lesser extent neuroticism serve as important independent behavioral markers for AD risk.

Background Caregiver burden in dementia is an important area of research. Providing care for a relative can be a potent source of chronic stress and can have deleterious consequences for both the physical and emotional health of caregivers. This study aims to evaluate the burden of care in caregivers of patients with Alzheimer-type dementia and compare it with elderly psychosis; and to also study the factors that influence burden of care in Alzheimer’s dementia. Methods Thirty-two caregiver-patient dyads of Alzheimer-type dementia were compared with thirty-two caregiver-patient dyads of psychosis. Cognitive assessment, abilities to perform activities of daily living and severity of dementia was assessed in the patients. Zarit Burden Interview was used to study the caregiver burden in both groups. Results The mean burden score in dementia caregivers was high at 47.7, whereas the mean burden score for elderly psychosis caregivers was lesser at 33.6, and this difference in mean burden scores was found to be statistically significant. Spouses had the highest mean burden scores of 53.48. Caregiver burden in dementia was positively correlated with cognitive impairment and inability to carry out ADLs. Presence of psychological distress in caregivers was also an indicator for greater caregiver burden in dementia. Conclusion The study revealed that dementia carries a greater caregiver burden when compared with elderly patients with psychosis. Innovative interventions are needed to remove burden from caregiving, making it a meaningful practice integral to the Indian society.

The paper presents an overview of new methods for the diagnosis, treatment, and prevention of Alzheimer's disease (AD) according to the proceeding of the Alzheimer's Association International Conference that was held in London on 16 to 20 July 2017. AD is the most common cause of dementia, especially in the elderly. The data of epidemiological and genetic studies and risk factors for AD were considered. Great attention was paid to the relationship of AD to cerebrovascular disorders, the differential diagnosis of AD with dementia in other nosological entities (dementia with Lewy bodies, frontotemporal dementia, cerebrovascular disease). New approaches to managing patients with AD were discussed. Current ideas about therapy for BA, symptomatic and pathogenetic methods for its treatment, combined therapy were outlined.

In this study, the aim was to identify the prevalence of sarcopenia and dynapenia according to disease stage among Alzheimer-type dementia (AD) patients and collect data to suggest precautions related to reducing the disease load.The study was completed with 127 patients separated into stages according to Clinical Dementia Rating Scale (CDR) criteria and 279 healthy volunteers aged 18-39 years and 70-80 years abiding by the exclusion criteria who agreed to participate in the research. Our prospective and cross-sectional study applied the CDR and mini mental test (MMSE) to patients with disorder in more than one cognitive area and possible AD diagnosis according to NINCDS-ADRDA (National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association) diagnostic criteria. The patient and control groups had skeletal muscle mass index (SMMI), muscle strength and physical performance assessed with sarcopenia diagnosis according to European Working Group on Sarcopenia in Older People (EWGSOP) diagnostic criteria.In our study, in parallel with the increase in disease stage of AD patients, the prevalence of sarcopenia (led by severe sarcopenia) and dynapenia was higher compared to a control group of similar age.In chronic, progressive diseases, like AD, identification of changes in parameters, like muscle mass and strength and reductions in physical performance in the early period, is important for identification and to take precautions in the initial stages considering the limitations of the preventive effects of treatment applied after diagnosis of AD.A vizsgálat célja a sarcopenia és a dynapenia prevalenciájának megállapítása a különböző stádiumú Alzheimer-típusú dementiában (AD) szenvedő betegek körében, továbbá adatgyűjtés annak érdekében, hogy javaslatokat tehessünk a betegségteher csökkentése érdekében.A prospektív és keresztmetszeti vizsgálatban 127, különböző stádiumú AD-beteg és 279, a beválasztási kritériumoknak megfelelő, egészséges kontrollszemély vett részt; a stádiumbeosztás a Clinical Dementia Rating Scale/CDR alapján történt, a kontrollszemélyek 18-39 és 70-80 év közöttiek voltak. A beválasztott AD-betegek a NINCDS-ADRDA (National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer’s Disease and Related Disorders Association) diagnosztikai kritériumai alapján nagy valószínűséggel minősültek AD-betegnek, továbbá a mini-mentál teszt (MMSE) szerint több mint egy kognitív területen kórosan teljesítettek. Mértük a betegek és kontrollok vázizomtömeg-indexét (skeletal muscle mass index/SMMI), izomerejét, fizikai teljesítőképességét; a sarcopenia diagnózisát a European Working Group on Sarcopenia in Older People/EWGSOP kritériumai alapján állapítottuk meg.A korban illesztett, egészséges kontrollszemélyekkel összehasonlítva, az AD stádiumának emelkedésével párhuzamosan nőtt a sarcopenia és a dynapenia prevalenciája.A krónikus, progresszív betegségek esetén, amilyen az AD is, fontos a különböző élettani paraméterek - például izomtömeg, izomerő, fizikai teljesítőképesség - romlásának korai stádiumban való azonosítása, és a szekunder prevenció mielőbbi elkezdése.

This study aimed to predict the risk of Alzheimer-type dementia for persons aged over 75 years old without receiving long-term care services using regularly collected claim data. A refined dataset including 48,123 persons was prepared from claim data of health insurance and long-term care insurance in a large city in the metropolitan area in Japan. The utilized features include the age and sex of subjects, 502 diseases based on ICD-10 diagnosis codes, and 107 prescription drugs based on therapeutic classes. The most important challenge in this work was feature selection form a large number of features. We adopted sparse logistic regression models with L0 regularization (SLR-L0) and L1 regularization (SLR-L1) as classification models based on machine learning. These regularizations enable feature selection by estimating sparse solution of non-zero coefficients in the model optimization. Predictions were performed by integrating 100 predictors trained by bootstrap samples. As a result, the area under the ROC curves (AUCs) were 0.663 for SLR-L0 and 0.660 for SLR-L1. These performances were similar, however, the average numbers of selected features were 13 out of a total of 611 for SLR-L0 and 253 for SLR-R1. The results indicate that SLR-L1 tended to include less useful features, whereas SLR-L0 narrowed down influential features. SLR-L0 might be more useful than SLR-L1 for practical use or the discussion of risk factors with medical experts.

The changes that occur with cognitive impairment and Alzheimer's disease could affect psychological aspects unrelated to memory. The purpose of this study is to compare 32 healthy older adults, 31 amnestic mild cognitively impaired (aMCI) adults, and 32 patients diagnosed with Alzheimer's disease (AD), in order to determine whether there are differences in their psychological wellbeing, resilience, and coping strategies. Unifactorial MANOVAS and ANOVAS were performed to analyze the between-group differences. The results reveal that the AD group showed lower levels of resilience and orientation toward problem-solving and greater use of religious strategies. In addition, they had significantly lower wellbeing scores than the other groups. The worsening of the pathology impedes the capacity for adaptation and resilience and the application of strategies oriented toward the problem, and it increases the application of strategies based on magical thinking. Moreover, it also produces a reduction in wellbeing.

In the present study, we hypothesized that lifetime Obsessive-Compulsive (OC) symptomatology would be risk factors for the development of Alzheimer׳s disease (AD). For this aim, first we compared 39 patients with AD and 30 age and gender matched control subjects. We have found that lifetime and current OC symptoms (OCs) and comorbid diagnosis of Obsessive-Compulsive Personality Disorder in AD patients were significantly more prevalent than in control group. AD patients had more likely to have lifetime and current hoarding, and checking obsessions compared to controls. The rate of lifetime and current hoarding, and checking compulsions also appeared to be higher in AD patients in comparison to control subjects. Hoarding and checking obsessions, and compulsions seemed to proceed through the dementia in contrast to other OCs. The mean number of lifetime compulsions seemed to predict the diagnosis of AD. When we compared AD patients with and without OCs, we have found that OC symptomatology prior to AD did not cause an earlier onset of dementia and more severe cognitive impairment. Further longitudinal clinical, genetic and neuroimaging investigations are required to determine if lifetime presence of OCs would predispose to the development of later AD.

Alzheimer type dementia is one of the main health problems, due to the disability and dependence it produces. The implementation of Law 39/2006 attempts to respond to the needs by means of a catalogue of socio-health services and resources to provide support to the patients and their relatives. A study was conducted with 255 caregivers/relatives of people diagnosed with Alzheimer type dementia in order to determine the profile of the beneficiaries of these services, taking into account the caregivers' knowledge, the phase of the illness, and level of dependence. The results show that caregivers with knowledge of the disease and patients who are at a more advanced stage are the ones who use the most resources. Specifically, caregivers with knowledge used the family respite to a greater extent, and predominantly caregivers of patients at a mild phase of the disease enjoyed volunteer services and help at home, whereas caregivers at more advanced phases used the Day Center and economic aid. Lastly, we underline that volunteer service is used by subjects with a lower level of dependence, whereas more dependent people use economic aid the most.

Objectives: Theory of mind (ToM) performance in aging and dementia of the Alzheimer type (DAT) has been a growing interest of researchers and recently theoretical trends in ToM development have led to a focus on determining the cognitive skills involved in ToM performance. The aim of the present review is to answer three main questions: How is ToM assessed in aging and DAT? How does ToM performance evolve in aging and DAT? Do cognitive processesinfluence ToM performance in aging and DAT? Method: A systematic review was conducted to provide a targeted overview of recent studies relating ToM performance with cognitive processes in aging and DAT. Results: Results suggest a decrease in ToM performance more pronounced in complex ToM tasks. Moreover the review points up the strong involvement of executive functions especially inhibition and reasoning skills in ToM task achievement. Conclusion: Current data suggest that the structure of ToM tasks itself could lead to poor performance especially in populations with reduced cognitive abilities. Keywords: Theory of mind; aging; Alzheimer’s dementia; cognitive processes; systematic review

Prospective memory (PM), the memory for future intentions, is an essential component of many day-to-day activities. PM accuracy has consistently been found to decline as a function of age and is further impaired in Alzheimer's disease (AD). In the present study, subjective PM failures, PM accuracy, and cost of carrying a PM were recorded in 42 healthy elderly, 34 younger old, and 45 older old AD participants. It was found that PM deficits across the AD cohort did not change as a function of age. In addition, while PM accuracy was impaired compared to age-matched controls, cost of carrying a PM intention did not differ across the three groups. Evidence that AD participants show a reaction time (RT) cost of PM intention alongside an impaired PM accuracy indicates that the PM intention is held, but is not implemented effectively. The fact that the cost is independent of age and dementia suggests that it may not index working memory (WM) resource. At a practical level, the study suggests that for a comprehensive evaluation of PM competence cost of carrying a PM intention should be measured alongside PM accuracy.

This paper presents a computer-aided diagnosis technique for improving the accuracy of the early diagnosis of the Alzheimer type dementia. The first proposed methodology is based on the selection of those voxels which present a greater difference between Controls and Alzheimer type dementia patients. The mean value of the intensities of the selected voxels is used as features for different classifiers. The proposed methodology reaches an accuracy of 89% in the classification task. A second criterion is chosen to select voxels based on considering those which present not only greater overall difference between both modalities (Controls and Alzheimer) but also present lower dispersion. The classification accuracy using this second condition increases to 94%.

This study aims to know about how is the decision making in Alzheimer Type Dementia (ATD) the target is to see if the tendency at risk appears or not, and the relationship between performance and the cognitive status in each of the areas evaluated by the screening test for dementia cognitive. Ten ATD patients participated in this experiment, compared with ten control subjects. A Card Test (based on the Iowa Gambling Task) was used. Subjects had to choose among different options that implied more or less risk. Furthermore, a screening test was used. The results reflected the fact that subjects with ATD in an initial stage showed a tendency to risk in decision making and they did not develop any election strategy pattern. It seems that the way in which patients make their decisions is related to the cognitive damage and the degree in which Alzheimer affects the different brain areas.

Background: Theory of Mind (ToM) ability allows attribution of mental states to oneself and others. Recent studies suggest that impairment of ToM may be a partial cause of social-communication impairment in adults with right hemisphere disorder, frontal lobe damage, and the frontal variant of frontotemporal dementia. Initial evidence has also been presented for a ToM impairment in individuals with Alzheimer's disease (AD), but extant investigations have inadequately controlled for other cognitive impairments. Aims: The purpose of this study was to determine whether individuals with AD exhibit a ToM impairment that is distinguishable from cognitive and executive function deficits, and to investigate whether memory support affects their ToM performance. Methods & Procedures: Ten participants with mild to moderate AD completed first‐order and second-order false belief tasks with and without memory support, and their performances on ToM testing were compared to those of elderly controls. All ToM test...

We intend to construct an image diagnosis support system for Alzheimer-type Dementia (ATD) that extracts temporal lobe regions and an intracranial region as interest regions from a T2-weighted MR frontal image and uses the cerebral atrophy rates at the regions of interest. In this paper, we specifically discuss extraction of regions of interest. The proposed method consists of three steps. First, we emphasis features of an obscure T2-weighted brain image. Second, we set a first contour that approximates a shape of the temporal lobe region to a triangle and apply Balloon models with the added presser force that push the initial contour outside in order to extract a temporal lobe region. Finally, we extract an intracranial region using extracted temporal lobe regions. Our proposed method can extract regions of interest along individual brain features by only a few interactions with three points. We demonstrate the potential of our method using actual diagnosis images. Moreover, we show a possibility to use of atrophy rate at the regions of interest for diagnosis support of ATD.

Eleven patients with Alzheimer type dementia were investigated by single-photon-emission computed tomography (SPECT) using 99mTc-hexamethylpropylene-aminoxim (HM-PAO). Nine had a typical, symmetrically reduced enrichment in the parieto-temporo-occipital area. In three of these nine patients a similar pattern was recorded additionally in the frontal, in the remaining two in the temporal or parietal region. In a semi-quantitative evaluation radioactivity concentrations in the cerebrum and cerebellum were compared. It demonstrated that there was in relation to the cerebellum a reduced concentration in seven of the eight studied cerebral regions. The relative blood flow of the parieto-temporo-occipital region was most markedly affected and in patients with Alzheimer type dementia was reduced by 25% below that of normal subjects. The results indicate that cerebral SPECT with HM-PAO is a reasonable method of investigation to confirm the diagnosis of "Alzheimer type dementia" and exclude other cerebral disease, especially if pathognomonic findings are to be obtained.

A 76-year-old woman had progressive memory loss for 2 years. Neurologic examination confirmed the memory deficit and also demonstrated ideative-ideomotor apraxia and visuospatial disturbances (Mini-Mental State Examination 17/30). A diagnosis of probable Alzheimer disease dementia (AD) was formulated. She showed us notebooks filled with drawings she had completed as a hobby, covering a period form before the illness (figure 1) to the present (figure 2). These sketches provide an inside into AD-related changes in creativity and visuospatial skills.1 Drawing performance is related to perceptual and executive dysfunctions in the visuospatial domain.

Activities of enzyme markers of subcellular organelles have been measured in brain tissue from subjects with Alzheimer-type dementia (ATD) and Huntington's disease (HD). Significant increases in the activity of the lysosomal enzyme beta-glucuronidase were observed in both ATD temporal cortex and HD putamen. It is suggested that beta-glucuronidase activity may be a useful biochemical indicator of cellular damage in the CNS. A significant reduction in neutral alpha-glucosidase activity was observed in ATD temporal cortex and HD putamen. This change may reflect an alteration in glycoconjugate processing and may relate to the susceptibility of neurones to the degenerative processes of ATD and HD.

It is well known that temporal lobe in MR brain image is in use for estimating the grade of Alzheimer-type dementia. It is difficult to use only region of temporal lobe for estimating the grade of Alzheimer-type dementia. From the standpoint for supporting the medical specialists, this paper proposes a data processing approach on the automatic extraction of the intracranial region from the MR brain image. The method is able to eliminate the cranium region with the laplacian histogram method and the brainstem with the feature points which are related to the observations given by a medical specialist.In order to examine the usefulness of the proposed approach, the percentage of the temporal lobe in the intracranial region was calculated. As a result, the percentage of temporal lobe in the intracranial region on the process of the grade was in agreement with the visual sense standards of temporal lobe atrophy given by the medical specialist. It became clear that intracranial region extracted by the proposed method was good for estimating the grade of Alzheimer-type dementia.

A system for evaluating dementia of the Alzheimer type (DAT) based on magnetic resonance (MR) imaging by means of fuzzy neural networks (FNNs) was investigated. The T1-weighted head MR transverse section images were obtained by a routinely performed examination. Nine slices including the thalamus were analyzed for each subject. Each MR image (MRI) was divided into four parts. The ratio of the brain area to the intracranial area was defined as the atrophy ratio. DAT severity was assessed by the Mini-Mental State (MMS) examination administered to each patient, and the results were used as teaching values for the FNN models. To construct the FNN model with high accuracy, MRI-based input variables were examined. Using atrophy ratios of 9 MRIs based on thalamically fiducial images and the corresponding areal or volumetric data as input variables, highly accurate FNN models were constructed that gave an average error of 1.29 points out of 30 in the MMS scores.

Non-artists with Alzheimer-type dementia created pictures as part of a biweekly (twice per week) activities program. The collages were made by residents at a long-term care facility in the Midwest and were analyzed for compositional complexity and asymmetry over the course of a three-year project. As indicated by a repeated-measures ANOVA, asymmetry did not change significantly with practice, but complexity did. Mean pictorial complexity was lower during later sessions than earlier ones. Mean asymmetry was not influenced by number of sessions (or time) in a generalizable fashion. Implications of the project for understanding the artwork of persons with dementia are discussed.

The occurrence of mania in the geriatric population is rare. Furthermore, there were only six case reports of elderly patients with secondary mania resulting from treatment with cholinesterase inhibitors. In all cases, patients had a prior psychiatric history. We report the case of an elderly patient with no prior history of psychiatric or other organic disorders who experienced first episode mania following treatment with rivastigmine. We discuss the possible mechanism of mania in this patient.

Background: We assessed the relationship between early cognitive dysfunction and morphologic changes in the brain, especially hippocampal atrophy, on MR images in Alzheimer-type dementia (AID) patients to establish a technique for making an early clinical diagnosis of AID. Methods: The subjects of this study were 82 individuals who visited Kawase Neurology Clinic. They consisted of 41 ATD patients and 41 elderly individuals without dementia who visited the clinic for a neurological checkup or because of vertigo or numbness as age-matched controls. As an index for hippocampal atrophy, the hippocampal-intracranial ratio (HIR) was calculated. Discriminant analysis was performed using HIR results and the correct answer rate for recall and calculation items in Mini-Mental State Examination (MMSE). Results: The mean ratio was significantly lower in the ATD patients than in the controls. This supports our previous results. The results of discriminant analysis with Mahalanobis generalized distance in the 41 controls and 22 ATD patients who scored 15 or higher. The sensitivity and specificity of HIR combined with the correct answer rate for recall and calculation items in MMSE were 95.5% and 95.1%, respectively, with an overall accuracy of 95.2%. Conclusion: HIR combined with the correct answer rate for recall and calculation items in MMSE allows for an early diagnosis of ATD.

To examine the possibility of diagnosing Alzheimer-type dementia, we studied this condition using the run length matrix, on head MR images of 29 Alzheimer-type dementia patients (8 men, 21 women, 78.7 +/- 6.7 years) and healthy elderly controls (10 men, 19 women, 72.3 +/- 8.7 years) . The results showed that differences in GLN (gray level nonuniformity) and RLN (run length nonuniformity) were statistically significant. Furthermore, discriminant analysis based on GLN and RLN showed a rate of sensitivity of 69.0%, specificity 86.2%, and correct classification 77.6%. Although this rate of correct classification is inferior to the planimetric and volumetric methods, run length matrix is only one method of texture analysis. The results of this study indicate the possibility of MR imaging-based diagnosis of Alzheimer-type dementia with texture analysis including a run length matrix.

Research suggests that, although everyday action errors increase significantly with dementia progression, accomplishment of the task remains high, even in severe dementia. We used archive observational data charting progressive decline in everyday task performance to explore error-monitoring over a 5-year period in four people with dementia. None of the participants showed effective error-monitoring during their execution of their established tea-making routine: Over 5 years and into more severe stages of dementia, errors increased, but there was no reactive increase from our participants in error-monitoring. Training to error-monitor routine tasks may be an appropriate target for further study.

Light reflex and oculogyration analysing system is proposed in order to diagnose the Alzheimer type dementia (DAT) objectively. 19 patients are studied, which shows that the maximum miosis ratio and miosis velocity are sensitive parameters to evaluate the severity of dementia and the changing time of internal and external rectus eye muscles is the effective index for screening of the dementia. The threshold of the changing time over 0.35 s can discriminate DAT clearly from the normal. Biofeedback trainings of the demented are executed by the objective diagnosing method, which shows improvement in MMSE, ADL score and the eye reflex parameters. The proposed method may become a safe non-pharmacological treatment of the dementia.

Background:Cognitive function in patients with Alzheimer type dementia (ATD) changes over time, and the rate of progression varies according to reports. An aim of the study is to examine the rate of progression in patients with ATD by the onset of the disease. Methods:Forty patients with early onset dementia at the age of 65 or less and 99 patients with late onset dementia at the age of more than 65 years in whom Mini-Mental State Examination (MMSE) scores could be followed up for at least 12 months were enrolled and examined retrospectively for changes in MMSE scores over time. Results:It was demonstrated that the rate of decrease in MMSE scores was significantly higher in Alzheimer disease (AD) than in senile dementia of Alzheimer type (SDAT) and that the decrease in MMSE scores was significantly slower in patients with higher initial scores. Conclusion:ATD patients are likely to be classified into AD or SDAT for evaluation of decreased cognitive function. Initial MMSE score and the subtype according to age at onset are important predictors for the progression of intellectual impairment in ATD patients.

Background: Both patients with schizophrenia and those with dementia show cognitive difficulties, and in many cases of schizophrenia the cognitive disturbance is progressive, as it is in dementia. Event-related potentials have revealed cognitive impairments in patients with schizophrenia and dementia, but most studies of event-related potentials in cases of psychiatric illness or dementia have focused on the single peak latency of the event-related potential components. In the present study, we investigated the cognitive function in elderly patients with schizophrenia and Alzheimer-type dementia (AID) using auditory event-related potentials (P300). Methods: P300 was recorded using the tone discrimination task and peak latencies for N1, P2, N2 and P3 at the Pz electrode site were measured. In addition to analyzing peak latencies of P300, we also analyzed inter-peak latencies (IPL; N1-P2, P2-N2, and N2-P3). Twenty-two elderly residual-type schizophrenics and 36 patients with AID were compared with 39 age-matched healthy volunteers. Results: The mean latencies of P3 and mean IPL of P2-N2 in elderly schizophrenic patients were longer than those of the controls. In ATD the mean latencies of N2 and P3 and the mean IPL of P2-N2 were longer than those of the controls. When the mean latencies of ATD patients were compared with those in patients with schizophrenia, P2, N2, and P3 latencies and N1-P2 and P2-N2 IPL were longer. Conclusion: These findings suggest that a similar impairment of the cognitive process is found in elderly patients with schizophrenia and those with ATD and that the degree of the impairment of patients with ATD is more severe than that of elderly patients with schizophrenia.

Patients with various neuropsychiatric disorders who confused virtual images with real objects have recently been described. When asked to take objects from an investigator's hand while looking in a mirror, these patients reached directly into the mirror for the object's image. To investigate whether the phenomenon occurs in patients with Alzheimer's disease, we studied 127 cases, of whom 67 were suspected of having Alzheimer-type dementia (DAT). The phenomenon in question was not observed in either of two control groups, but whereas 38 (57%) of the DAT patients responded correctly, 17 (25%) of them grasped at the mirror image. Characteristically, none of the eight patients who grasped into the mirror and underwent single photon emission computed tomography analysis showed symmetric activity. We also analyzed the behaviour and verbal utterances of the DAT patients in front of the mirror.

A system for assessing dementia of the Alzheimer type (DAT) from electroencephalogram (EEG) data by means of fuzzy neural networks (FNNs) was investigated. The system consisted of two FNN models, one to discriminate DAT patients from normal subjects and the other to estimate the severity of the DAT patients' symptoms. EEG data were collected using 15 electrodes attached to the scalp. The power spectra were calculated by the fast Fourier transform. For each electrode, the power spectrum was divided into 9 frequency bands and relative power values were calculated. The θ1 (4.0-6.0 Hz), θ2 (6.0-8.0 Hz), and α (8.0-13.0 Hz) band data were used as the network input values. DAT severity was assessed by the Mini-Mental State (MMS) examination administered to each patient and the results were used as the output. The FNN model for DAT patient discrimination correctly distinguished 94% of the DAT patients from normal subjects. The FNN model for severity estimation gave an average error of 2.57 points out of 30 in the MMS scores. The FNNs were found to be useful tools for discrminating DAT patients from normal subjects as well as for estimating quantitatively the severity of DAT symptoms from EEG data.

In a previous article, recent reports by Japanese researchers on non-Alzheimer-type degenerative dementias were reviewed. In the present article, recent Japanese reports on Alzheimer-type dementia (ATD) are reviewed. Alzheimer-type dementia has received great attention and has been studied from various viewpoints in Japan as well as in Europe and the Americas. In Japan, although it was believed that vascular dementia was the most frequent dementia in the elderly, ATD has recently been shown to be the most predominant type of dementia. Such a great number of papers on ATD have been reported in Japan that mainly the clinical, neuropathological, biochemical and molecular biological research papers alone are reviewed here.

The effects of chronic combined treatment with alpha7-nicotinic cholinergic receptor agonist RJR-2403 (1.0 mg/kg intraperitoneally) or alpha7-nicotinic cholinergic receptor antagonist mecamylamine (1.0 mg/kg intraperitoneally) and 17beta-estradiol (0.5 microg per rat intramuscularly) for 10 days on passive avoidance retention were studied in middle-aged (15 months) ovariectomized rats with experimental Alzheimer type dementia. Chronic treatment with RJR-2403 and 17beta-estradiol had a pronounced antiamnestic effect under conditions of Alzheimer type dementia in middle-aged ovariectomized rats.

Die Magnetresonanztomographie (MRT) des Gehirns kommt als strukturelles bildgebendes Verfahren in der Psychiatrie und Neurologie zur breiten Anwendung. Bei der Demenz vom Alzheimer-Typ (AD) tragt die MRT zur Verbesserung der klinischen Diagnosestellung im Rahmen der Mehrebenendiagnostik [1] und zur differentialdiagnostischen Abgrenzung anderer mit einem dementiellen Syndrom einhergehender Erkrankungen bei. Neu entwickelte Verfahren der MRT-gestutzten Volumetrie kortikaler und subkortikaler Strukturen erwiesen sich als nutzlich in der Differenzierung zwischen kognitiv gesunden alteren Probanden und AD-Patienten. Daruber hinaus versprechen sie neue Einsichten in den zeitlichen und strukturellen Verlauf der zerebralen Degeneration. Zusatzlich kann die systematische quantitative Erfassung von Signalveranderungen bei AD-Patienten zur Verbesserung der diagnostischen Genauigkeit beitragen. Es ist die Absicht dieser Arbeit, den Beitrag der MRT zur Diagnostik der AD und zum Verstandnis ihrer Pathogenese darzustellen, aber auch die Grenzen dieser Methodik aufzuzeigen. Dabei werden die Veranderungen des gesunden Alterungsprozesses miteinbezogen, die mit Hilfe der MRT-Bildgebung fasbar sind. Zukunftige Perspektiven liegen insbesondere in der Weiterentwicklung der mikroskopischen MRT, der genauen Differenzierung und Klassifikation von Signalveranderungen der weisen Substanz und im kombinierten Einsatz der MRT mit funktionellen bildgebenden Methoden.

Light reflex and oculogyration analysing system is proposed in order to diagnose the Alzheimer type dementia (DAT) objectively. 19 patients are studied, which shows that the maximum miosis ratio and miosis velocity are sensitive parameters to evaluate the severity of dementia and the changing time of internal and external rectus eye muscles is the effective index for screening of the dementia. The threshold of the changing time over 0.35 second can discriminate DAT clearly from the normal. Biofeedback trainings of the demented are executed by the objective diagnosing method, which shows improvement in MMSE, ADL score and the eye reflex parameters. The proposed method may become a safe non-pharmacological treatment of the dementia.

The concentrations of pancreastatin-like immunoreactivity (PST-LI) of the cerebrospinal fluid (CSF) were measured in the patients with Alzheimer type dementia (ATD) and in age-matched normal subjects. The mean PST-LI concentration in the CSF of ATD patients was significantly lower than that of normal subjects. Gel chromatographic analysis revealed that the main PST-LI peak of ATD's CSF eluted at molecular weight (MW) 13.5 kDa. However, the age-related change of the molecular forms of PST-LI in CSF was observed in normal subjects as following; PST-LI in neonatal CSF showed one peak at MW 13.5 kDa, that of 16-64-year-old showed two peaks at MW 13.5 and 5.4 kDa, however, only one main peak was shown at MW 5.4 kDa in the CSFs of 72-85-year-old. These findings suggest that the production of PST-LI was decreased and the proteolytic cleavage, which should process big PST to PST (1-52) in normal subjects, was altered to that of neonatal type in the CNS of the patients with ATD.

Corsi's block-tapping task was given to 30 normal subjects and 38 Alzheimer-type demented patients following two different procedures. The first is the most widely standardized (scoring criterion: 3 correct reproductions out of 5 sequences), while the second is more lenient since it does not require subjects to replicate a certain performance three times. Demented patients' scores were lower than those of controls in both conditions, and scores on the two tasks were significantly correlated for patients and controls. However, the requirement of replicating the visuospatial memory performances was more detrimental for demented patients than for controls so the two procedures cannot be considered equivalent.

An improved methenamine-silver impregnation method is presented which exhibits sensitivity for amyloid substances comparable to that of anti-beta protein immunostaining. In optimally treated sections, this technique stained both beta-amyloid deposits and neurofibrillary tangles, which are known to have a beta-pleated structure. This simple procedure allows a large number of sections to be stained for routine examination.

We proposed a segmentation method of brain tissues on T2-weighted MR frontal image. In our previous work, we showed an image diagnosis support system for Alzheimer-type Dementia that extracts temporal lobe regions and an intracranial region as regions of interest (ROI) from a T2-weighted MR frontal image and uses the cerebral atrophy rates at the ROI. In this paper, we specifically discuss segmentation of brain tissues which are used for calculation of atrophy rate. We proposed a brain tissue segmentation method using two kinds of unsupervised neural networks: Self-Organizing Maps (SOMs) and Fuzzy Adaptive Resonance Theory (ART). The performance of proposed method was tested in two brain MR images used in daily diagnosis. Proposed method could segment CSF accurately with continuity of brain tissues.

Amyloid deposits (AmD) and neurofibrillary tangles (NFT) were quantitatively examined in methenamine-silver stained hemisphere sections from 98 non-demented elderly individuals and 30 patients with Alzheimer-type dementia (ATD). Of the non-demented cases, 35 (35.7%) had some AmD, and 72 (73.5%) had some NFT, whereas all the ATD cases had both AmD and NFT. AmD-and NFT-positive cases were classified into developmental stages, based on the distribution and incidence of each of these senile changes (AmD: A1, A2, B1, B2, C′ and C; NFT: Ia, Ib, IIa, IIb, III, and IV). When the AmD-positive cases were divided into stages A-B and stages C′-C and the NFT-positive cases into stages I-III and stage IV, all the non-demented individuals were found to belong to NFT stages I-III and all the ATD cases to AmD stages C′-C. This study provides evidence that an approximate dividing line can be drawn between non-demented individuals and ATD patients by using quantitative neuropathological criteria, and that the distinction between the two groups can usually be made on the basis of the difference in the incidence of AmD in the precentral motor area and the incidence of NFT in the temporal isocortex.

I examined the localization of α1-antichymotrypsin (ACT) mRNA and ACT immunoreactivity (ACT-IR) in 12 brains obtained from elderly autopsy cases, including 4 of Alzheimer-type dementia. I investigated the relationship between the ACTmRNA and ACT-IR and the extent of β or tau deposits. In the brains without plaques and tangles, there were no detectable ACTmRNA signals in the gray matter, and those in the white matter were weak. In these brains, ACT-IR was generally weak. The brains with fl-plaques but no tangles showed weak ACT mRNA expression in the astrocytes in both the gray and white matter. They also showed weak ACT-IR in the astrocytes. In the Alzheimer brains with both plaques and tangles, ACTmRNA was expressed intensely in a majority of the astrocytes in the white and gray matter. Some senile plaque-associated astrocytes expressed ACTmRNA. ACT-IR was abundant in the white matter astrocytes. Among protease inhibitors and proteases, only ACT was associated with β-plaques. ACT-IR and ACT mRNA expression in astrocytes was well-correlated with the extent of β and tau deposits. It can be assumed that ACT plays an important role in amyloidogenesis.