Babak Tousi

Don't forget non-Alzheimer dementias.

Dementia is commonly encountered in the elderly, with prevalence increasing with age. Although Alzheimer disease is the most recognized form of dementia, other types have distinct clinical features and are often overlooked. Proper identification aids patients, caregivers, and physicians in planning and management. An accurate diagnosis is important, as the causes of dementia can differ in their course and treatment.

Utility of Montreal Cognitive Assessment in Differentiating Dementia With Lewy Bodies From Alzheimer’s Dementia

Alzheimer’s disease (AD) and dementia with Lewy bodies (DLB) are the 2 most common neurodegenerative dementias. Identification of patients with DLB is necessary to guide appropriate clinical management and medication trials. Patients with DLB are reported to perform poorly on tasks of visuospatial and executive function, compared to patients with AD who perform poorly on memory tasks. Using the Montreal Cognitive Assessment, we found that patients with DLB (n = 73) had statistically significant lower performance in clock drawing (visuospatial and executive function) and higher performance in delayed recall (memory) subscores compared to patients with AD (n = 57). This score pattern should raise suspicion for a DLB diagnosis at initial evaluation of patients with dementia.

Falls Related to Accidental Deactivation of Deep Brain Stimulators in Patients With Parkinson's Disease Living in Long Term Care Facilities

This case series highlights three patients with Parkinsons disease residing at nursing home facilities whose deep brain stimulators were accidentally deactivated for varying lengths of time, which was associated with an increase in falls. In all three cases, neither the patients nor the caregivers were aware of the random deactivations/reactivations. We propose a specific care plan for these patients that includes further education of caregivers regarding deep brain stimulators and regular checks of the review device, especially when there is concern about a patients mobility or balance that is out of character.

Diagnosis and Management of Cognitive and Behavioral Changes in Dementia With Lewy Bodies.

Opinion statementProper diagnosis of dementia with Lewy bodies (DLB) in clinical practice remains suboptimal as many cases are misdiagnosed, usually as Alzheimer disease (AD) or Parkinson’s disease (PD) and, in rare cases, psychosis. Therefore, it is important for patients with dementia to be thoroughly evaluated by a specialist who is familiar with current diagnostic tests and treatment options. New diagnostic criteria from the Dementia with Lewy Bodies Consortium have been developed to increase diagnostic sensitivity for DLB (Diagnosis and management of dementia with Lewy bodies: fourth consensus report of the DLB Consortium; McKeith et al.; Neurology, 89(1): 88–100). REM sleep behavior disorder (RBD) has been studied more thoroughly in correlation with DLB and is now considered a core feature. D2 receptor blocking antipsychotics, which can cause severe antipsychotic sensitivity, are now rarely prescribed for treatment. Therefore, severe antipsychotic sensitivity, which was a suggestive criterion for DLB diagnosis, is now listed as a supportive feature. Reduced DAT uptake in basal ganglia demonstrated by SPECT or PET imaging has high specificity (90%) for distinguishing DLB from AD. Reduced uptake on metaiodobenzylguanidine myocardial scintigraphy correlates with reduced postganglionic sympathetic cardiac innervation in Lewy body diseases, which can increase specificity for discriminating probable DLB from probable AD in milder cases of dementia. However, the latter is more commonly used in Japan and is not used in the USA. The evidence supporting the benefit of other therapeutic modalities is limited in DLB due to lack of extensive studies. There are no FDA-approved medications for the treatment of DLB, although some effective drugs have been used off label to treat various symptoms.

COLOR VISION IMPAIRMENT IN DEMENTIA WITH LEWY BODIES: A NOVEL AND HIGHLY SPECIFIC DISTINGUISHING FEATURE FROM ALZHEIMER DEMENTIA

monitor progress in the global public health response to dementia. Member States took part to a formal consultation on the proposed structure of the GDO. Detailed feedback was given throughout 2016 by hundreds of national and international representatives and focal points. The relevance of the proposed indicators, and the feasibility and potential limitations of the data collection sources and systems envisaged for each of them were enquired about to identify existing data sources at the country level, and their potential use. Results:The GDO has been successfully finalized by WHO andWHOCC, and it will align with theWHOGlobal Action Plan on the Public Health Response to Dementia currently in preparation, as the key moniotring and knowledge echange platform to support evidence-based dementia service planning and strengthening of policies in health and social care systems for dementia. Conclusions: In the coming years comparable data at a country-level will become available through WHO to monitor dementia progress, favor knowledge translation and exchange, and the creating of country profiles on dementia readiness and progress.

5HT6 Antagonists in the Treatment of Alzheimer’s Dementia: Current Progress

Alzheimer’s disease is an important condition with a considerable and unmet disease burden in large need of continued research and more treatment options. The 5HT6 antagonists are a new class of medications to be offered. Because they are pro-cholinergic, these medications are to be used as adjuncts to acetylcholinesterase inhibitors (such as donepezil), further increasing acetylcholine in the central nervous system (CNS). Early trials of the 5HT6 antagonists showed improvements in cognition and activities of daily living when used as adjuncts to current therapies for Alzheimer’s dementia. However, recent phase III trials have failed to show a statistically significant improvement in cognitive function. This article will provide a comprehensive review of 5HT6 antagonists in drug development, including some that have been recently discontinued. We will discuss both the successes and failures of this drug class and provide rationale for their continued research and development.

Color Vision Impairment Differentiates Alzheimer Dementia From Dementia With Lewy Bodies

Objective: Dementia with Lewy bodies (DLB) is frequently misdiagnosed for Alzheimer dementia (AD), especially in its earlier stages. We characterized color vision impairment (CVI) in patients with DLB versus patients with AD to determine its usefulness in improving accuracy of early diagnosis. Methods: We retrospectively reviewed charts of patients with AD, DLB, and patients with mild cognitive impairment suspected to be in the prodromal phase of DLB (pro-DLB) or prodromal phase of AD (pro-AD). All patients underwent an online 15-hue color vision arrangement test. Results: Fifty-two patients were included in this study with a median age of 77 years, of which 44% were female. No significant differences in gender, age, or Montreal Cognitive Assessment existed among patients with AD (n = 15), pro-AD (n = 5), pro-DLB (n = 8), and DLB (n = 24). Of the 52 patients, 4 (2 AD, 1 DLB, and 1 pro-AD) had CVI history from a young age and were excluded from final analyses. New-onset CVI prevalence differed significantly based on diagnosis: patients with pro-AD (20%), patients with AD (15%), patients with pro-DLB (38%), and patients with DLB (78%, P < .001). In a stepwise multivariate logistic regression analysis to determine factors associated with CVI, “diagnosis type” as a binary variable (DLB or pro-DLB vs AD or pro-AD) was the only variable retained in the model (odds ratio = 9.8 [95% CI: 2.3-42.1], P < .001). Conclusions: Color vision impairment in patients with DLB showed a prevalence similar to the core features of DLB (∼80%) and can be supportive to a diagnosis of DLB versus AD. Pending prospective confirmation of our findings, simple online color vision testing could be incorporated into multivariate diagnostic tools to possibly improve accuracy of early diagnosis of DLB.

ALZ i-Connect A Novel Audiovisual Care Consultation for Caregivers

Currently, there is not enough time or staff in the physician’s office to provide education about Alzheimer’s disease for newly diagnosed patients and their family members. The Alzheimer’s Association Cleveland Area Chapter has implemented a novel approach for individuals to connect to helpful information about Alzheimer’s disease and related dementias while at the physician’s office. This project is being piloted at two memory assessment clinics of The Cleveland Clinic as a way to give assessment center staff the opportunity to connect families right away with the free support services available at the Association.

Alzi-connect: A novel audiovisual communication system to connect caregivers to Alzheimer's association chapters

Project Description:Alzheimer’s Association (AA) has the mission to provide and enhance care and support for all affected. At the current practice settings, there is not enough time or staff to provide education, especially for recently diagnosed ones and their family at physician’s office. The Alzheimer’s Association Cleveland Area Chapter has implemented a novel approach for individuals to connect to helpful information about memory loss and the Chapter’s free services at the physician’s office. ALZ i-connect allows users to visually connect with AA staff via Skype for an initial conversation addressing the many questions and concerns they have about memory and thinking disorders, especially soon after receiving a diagnosis in a private setting. This project is being piloted at two memory assessment clinics of Cleveland Clinic as a way to enable assessment center staff the opportunity to connect families right away with the free support services available at the Association. The Association provides a TV with camera to the site location, which is then connected to the internet service available at that location. Site staff receives a brief in-service by AA on how to use the equipment and easily connect their patients to the service. Assessment Center staff offer the opportunity for an individual to speak to someone at the Association “in-person” through ALZiconnect and makes the click to initiate the call after the clinic visit. Results: Here, we present the 1st year survey results. 59 Surveys were sent to assess the experience of caregiver with this novel approach of communicating with Alzheimer’s Association. The results reflect the responds from returned surveys. 81% of responders reported feeling comfortable during the skype session. 90% found that the presented information was clear and helpful. 81% reported this audiovisual call was beneficial. 72% thought that the ALZiconnect call was an efficient way of communicating and gathering information from the association, while only 18% would have preferred a different means of communication with the association. Conclusions:ALZiconnect seems to be an innovative efficient and beneficial approach to connect the caregivers to AA. That can be a complementary approach to the currently available helplines and to reach remote centers.