Angela Lunde

Diagnosis and management of dementia with Lewy bodies Fourth consensus report of the DLB Consortium

The Dementia with Lewy Bodies (DLB) Consortium has refined its recommendations about the clinical and pathologic diagnosis of DLB, updating the previous report, which has been in widespread use for the last decade. The revised DLB consensus criteria now distinguish clearly between clinical features and diagnostic biomarkers, and give guidance about optimal methods to establish and interpret these. Substantial new information has been incorporated about previously reported aspects of DLB, with increased diagnostic weighting given to REM sleep behavior disorder and 123iodine-metaiodobenzylguanidine (MIBG) myocardial scintigraphy. The diagnostic role of other neuroimaging, electrophysiologic, and laboratory investigations is also described. Minor modifications to pathologic methods and criteria are recommended to take account of Alzheimer disease neuropathologic change, to add previously omitted Lewy-related pathology categories, and to include assessments for substantia nigra neuronal loss. Recommendations about clinical management are largely based upon expert opinion since randomized controlled trials in DLB are few. Substantial progress has been made since the previous report in the detection and recognition of DLB as a common and important clinical disorder. During that period it has been incorporated into DSM-5, as major neurocognitive disorder with Lewy bodies. There remains a pressing need to understand the underlying neurobiology and pathophysiology of DLB, to develop and deliver clinical trials with both symptomatic and disease-modifying agents, and to help patients and carers worldwide to inform themselves about the disease, its prognosis, best available treatments, ongoing research, and how to get adequate support.

Telehealth home monitoring of solitary persons with mild dementia.

Medication safety is a special concern for the 30% to 40% of dementia patients who live alone at the time of diagnosis, and it plays an important part in relocation decisions. Televideo monitoring could improve medication self-administration accuracy and improve mood for persons with mild dementia who live alone or spend a significant amount of their day alone. The authors used 2-way interactive video technology to monitor medication compliance of 8 persons with mild dementia. They conducted more than 4000 contacts with these persons and found adequate technical outcome in 82% of calls. End medication compliance was 81% in the video-monitored group compared to 66% in the controls (P < .05). Comparison of compliance from initial to end ratings revealed that video-monitored participants’ compliance remained stable while unmonitored patients’ compliance fell 12 percentage points, consistent with expectations for dementia. This difference was also significant. Quantitative and qualitative outcome data from this project are presented.

The Memory Club: Providing Support to Persons with Early-Stage Dementia and Their Care Partners

There is a growing emphasis on delivering services for persons with early-stage dementia (ie, ‘‘persons with memory loss,’’ or PWMLs) and their family members (care partners). The goal of this evaluation was to determine whether participation in the Memory Club, a 10- to 13-session joint support group, would result in decreased distress, enhanced preparation for care, and improved feelings of confidence managing the challenges of early-stage dementia. The single group, pre-/post-test evaluation included 63 PWMLs and 61 care partners who participated in three Memory Club sites in Minnesota. Paired T-test results found that care partners reported significant (P < .05) increases in preparation activities, feelings of preparation, and confidence in managing memory loss. The results suggest that the Memory Club can fill an important gap in early-stage dementia care by offering care partners the opportunity to plan, prepare, and increase coping skills in the face of early dementia progression.

Priority of Treatment Outcomes for Caregivers and Patients with Mild Cognitive Impairment: Preliminary Analyses

IntroductionThe patient-centered movement advocates for greater attention to the outcomes that matter most to patients and their families. In neurodegenerative disease, determination of patient and caregiver priorities has received scant attention in part because dementia patients are deemed unreliable reporters. However, people with mild cognitive impairment (MCI) likely retain capacity to report their preferences.MethodsIn two separate MCI cohorts, we conducted preliminary analyses of patient and caregiver priorities among seven patient and five caregiver outcomes of the HABIT® Healthy Action to Benefit Independence & Thinking program (Mayo Clinic, Rochester, MN, USA).ResultsVia interview and paper-and-pencil reporting both patient and caregiver respondents’ ranked patient and caregiver quality of life and patient self-efficacy as highest priorities, ranking them ahead of patient and caregiver mood, patient functional status, patient distressing behaviors and caregiver burden. Patients and caregivers tended to value the outcomes for their loved ones higher than their own outcomes.ConclusionCaregivers appeared to be reasonable, but not perfect, proxies for patient reports. Additional research with larger cohorts and a more comprehensive range of outcomes is needed.

Computer versus Compensatory Calendar Training in Individuals with Mild Cognitive Impairment: Functional Impact in a Pilot Study

This pilot study examined the functional impact of computerized versus compensatory calendar training in cognitive rehabilitation participants with mild cognitive impairment (MCI). Fifty-seven participants with amnestic MCI completed randomly assigned calendar or computer training. A standard care control group was used for comparison. Measures of adherence, memory-based activities of daily living (mADLs), and self-efficacy were completed. The calendar training group demonstrated significant improvement in mADLs compared to controls, while the computer training group did not. Calendar training may be more effective in improving mADLs than computerized intervention. However, this study highlights how behavioral trials with fewer than 30–50 participants per arm are likely underpowered, resulting in seemingly null findings.

Early Diagnosis of Alzheimer’s Disease, Caregiving, and Family Dynamics

With the aging of society, Alzheimer’s disease (AD) poses a potential public health crisis. This potential crisis has spurred research on making an early diagnosis of AD. Progress has been made in identifying AD risk factors, including those involving genetics. This progress has led to hope that prevention models might work in AD as they have in cancer and heart disease. These trends offer exciting new directions in AD research. However, the potential impact of these trends on AD caregivers has received little consideration. The goal of this chapter is to explore the potential impact of early diagnosis, advances in genetics, and prevention models on AD caregivers. An examination of what is currently known in these areas will be followed by discussion of the research, education, practice, and policy needs these trends have created. Finally, we will speculate about future directions in AD caregiving that may result from early diagnosis and prevention efforts.

THE LEWY BODY DEMENTIA ASSOCIATION RESEARCH CENTERS OF EXCELLENCE PROGRAM: TOWARD OPTIMIZING CLINICAL CARE AND CLINICAL TRIAL INFRASTRUCTURE

Age of Conversion to DLB 77.6 68.2 75.3 68.2 78.3 67.8 81.2 67.7 Years between Baseline and DLBConversion 3.1 62.2 1.3 60.4 3.1 60.9 7.3 6 1.7 Education 15.8 63.7 16.1 63.4 15.8 63.8 15.2 64.0 Sex 71.2% Male 75.3% Male 65.1% Male 76.7% Male Age of Cognitive Decline 71.7 68.8 70.2 69.0 72.1 68.2 74.0 69.8 Age of Behavioral Decline 71.2 6 10.4 64.5 62.6 66.5 6 8.9 80.3 6 8.4 Age of Motor Function Decline 72.1 68.9 66.3 62.9 67.8 67.0 79.4 67.9

P4-187: Compensating for memory loss in amnestic mild cognitive impairment

2) Have you been able to utilize the information provided in your day-today living? 3) Would you call the Memory Disorder Clinic for additional information? 4) Are you interested in additional programs at the clinic?. The scoring system we used was 5 strongly agree through 1 strongly disagree with the above statements. During this period 528 received the full evaluation and counseling. We mailed 80 surveys and received 60 responses. Results: On question one through 4 the mean (STD deviation) scores were 4.0( /-0.89), 3.7( /-1.0), 4.0( /-1.1 and 4.1 ( /-1.0.). We made 353 referrals for respite, 97 referrals for adult day care, 292 referrals to support groups, 102 referrals to assisted living facilities, 74 referrals to skilled nursing facilities and 96 referrals for other related social services. Conclusions: From this survey it is clear that physician and geriatric counseling sessions are highly valued by the caregiver. The families receive important information and referrals. Third party payers such as Medicare should reimburse for this service.