Eylem Sahin Cankurtaran

Assessment of Endothelial Function in Alzheimer's Disease: Is Alzheimer's Disease a Vascular Disease?

OBJECTIVES: To compare endothelial function of people with Alzheimers disease (AD) with that of people without.

Hippocampal atrophy correlates with the severity of cognitive decline

BACKGROUND The aim of this study is to compare the results of magnetic resonance (MR) imaging, particularly the decline in hippocampal volume, of patients with Alzheimers disease (AD) and mild cognitive impairment (MCI) with healthy age-matched controls, to examine the reliability of hippocampal volumetry in the early diagnosis of AD and the correlation of the severity of hippocampal atrophy with the severity of cognitive decline. METHODS Twenty-six AD, 22 MCI and 15 normal cognitive status (NCS) patients were scanned with a 3 Tesla MR scanner. Hippocampus volumes were detected manually by Osiris 4.18. RESULTS Multivariate regression analysis, which was performed to adjust the covariate effects of education, age, gender, hypertension and diabetes mellitus, showed that hippocampal atrophy was correlated with AD and MCI for right hippocampus; AD, MCI and age for left hippocampus independent of other parameters. A second regression analysis revealed that MMSE was correlated with hippocampal volume. CONCLUSIONS Hippocampal volumetry can be used in early diagnosis of cognitive impairment, as well as grading cognitive decline.

Altered Levels of Homocysteine and Serum Natural Antioxidants Links Oxidative Damage to Alzheimer's Disease

Increasing evidence supports the theory that oxidative stress plays an important role in the pathogenesis of Alzheimers disease (AD). Homocysteine (Hcy), uric acid (UA), bilirubin, and albumin are simple laboratory parameters that are related to oxidative stress. In this study we compared serum Hcy and antioxidant levels in patients with AD and normal cognitive function. In this cross-sectional study, 143 AD patients and 1,553 patients with normal cognitive function aged 65 years and over were enrolled. Mean values of UA and albumin levels of AD patients were significantly lower than normal cognitive function subjects (p: 0.003 versus p < 0.001, respectively). Mean value of Hcy levels of AD patients was significantly higher than normal cognitive function subjects (p = 0.031). Multivariate regression analysis revealed that Mini-nutritional assessment short form (OR: 0.905, 95% CI: 0.850-0.965, p = 0.002), hypertension (OR: 1.573, 95% CI: 1.148-2.155, p = 0.005), UA (OR: 0.879, 95% CI: 0.788-0.981, p = 0.021), Hcy (OR: 1.040, 95% CI: 1.022-1.059, p < 0.001), and albumin (OR: 0.505, 95% CI: 0.339-0.753, p < 0.001) were independent variables predicting the occurrence of AD. Our study supports the hypothesis that a decrease in antioxidants and an increase in oxidative damage are linked to AD.

Serum elevated gamma glutamyltransferase levels may be a marker for oxidative stress in Alzheimer's disease.

BACKGROUND Gamma glutamyltransferase (GGT) plays a role in cellular glutathione uptake, which is an important element of antioxidant mechanisms. An increase in serum GGT is thought to be an early and sensitive marker of oxidative stress. Oxidative stress has a role in the pathogenesis of Alzheimers disease (AD). The aim of this study was to investigate the GGT levels in AD. METHOD In this cross-sectional study, 132 patients with AD (mean age: 74.1 +/- 7.4, female 62.9%) and 158 age- and gender-matched normal controls (mean age: 74.5 +/- 6.3, female 67.1%) were evaluated. For cognitive assessment, MMSE and clock drawing tests were performed; DSM-IV and NINCDS-ADRDA criteria were used. Serum GGT, aspartate aminotransferase, alanine aminotransferase and alkaline phosphatase concentrations were determined. RESULTS Median (min-max) GGT levels were 18 (9-70) in AD group and 17 (5-32) in normal controls. Mann-Whitney U test showed that GGT levels were significantly higher in AD patients (p = 0.012). Linear regression analysis revealed AD was an independent correlate of elevated GGT levels. Hypertension, diabetes mellitus, total cholesterol, and low density lipoprotein cholesterol were not associated with GGT levels. CONCLUSION GGT levels were increased significantly in AD patients. To evaluate the role of GGT as a marker of oxidative stress in AD, further studies are needed.

Functional Disability in Alzheimer Disease A Validation Study of the Turkish Version of the Disability Assessment for Dementia Scale

This study aimed to determine the reliability and validity of the Turkish version of Disability Assessment for Dementia (DAD) scale in the Turkish elderly population with Alzheimer disease (AD). The DAD scale was administered to the primary caregivers of 157 patients (age 77.7 ± 6.8 years) with AD. The Turkish version of the DAD scale showed high internal consistency (Cronbach α = .942), excellent test–retest, and interrater reliability (intraclass correlation coefficient [ICC] = 0.996 and ICC = 0.994, respectively). The DAD scale was significantly correlated with activities of daily living (ADL; Modified Older Americans Research Survey ADL) and instrumental activities of daily living (IADL; Lawton and Brody IADL) scales (r = .89, P < .001 and r = .90, P < .001). Disability Assessment for Dementia had a high negative correlation with the Global Deterioration Scale (GDS; r = −.880, P < .001). Post hoc comparisons with Tukey test showed significant differences in the mean DAD scores in different GDS stages. Construct validity was estimated using total score correlation analyses between the standardized Mini-Mental State Examination (MMSE) and the DAD scale. Results revealed high and significant correlation between MMSE score and DAD scale (r = .812, P < .001). The results of multivariate analysis showed that DAD score was not correlated with gender, education, and age. The DAD total score was affected mostly by GDS, MMSE, and duration of the disease. Turkish version of the DAD scale was found to be a reliable and valid instrument to assess functional disability in Turkish elderly patients with AD. This scale assists caregivers and physicians to decide for proper interventions.

Influence of antimuscarinic therapy on cognitive functions and quality of life in geriatric patients treated for overactive bladder

Objectives: Incidences of overactive bladder (OAB) and cognitive dysfunction increase with aging. Treatment of OAB with antimuscarinic agents may result in cognitive decline, especially in patients with Alzheimers disease (AD). The aim of this study is to evaluate the effect of antimuscarinic treatment on cognitive functions, depression, and quality of life (QOL) of patients with OAB. Methods: This non-interventional prospective observational study was conducted in a geriatric medicine outpatient clinic. Overall, 168 OAB patients were enrolled. Patients were followed up in five groups: oxybutynin, darifenacin, tolterodine, trospium, and control groups. Follow-up visits were done at second, third, and sixth months. Comprehensive geriatric assessment, cognitive and mood assessment, QOL scales (IIQ-7, UDI-6) were performed. Results: Mean age of the patients was 73.5 ± 6.1. Of the 168 patients, 92.3% were female, 83.3% benefited from the treatment, and 37.1% discontinued the medication. Discontinuation rate and frequency of side effects were more frequent in the oxybutynin group. Mini Mental State Examination scores did not decline after treatment, even in AD patients. Geriatric Depression Scale scores, Activities of Daily Living scores, and QOL scores significantly improved after treatment. Conclusion: Antimuscarinic agents are effective in OAB treatment. They have a positive impact on daily life activities, depression, and QOL indices. Furthermore, they do not have a negative effect on cognitive function in older adults with or without AD.

Validation of the Turkish Version of the Quick Mild Cognitive Impairment Screen

Background: The objective of this study was to validate the Turkish version of the Quick Mild Cognitive Impairment (Qmci-TR) screen. Methods: In total, 100 patients aged ≥65 years referred to a geriatric outpatient clinic with memory loss were included. The Qmci was compared to the Turkish versions of the standardized Mini-Mental State Examination and the Montreal Cognitive Assessment (MoCA). Results: The Qmci-TR had higher accuracy than the MoCA in discriminating subjective memory complaints (SMCs) from cognitive impairment (mild cognitive impairment [MCI] or dementia), of borderline significance after adjusting for age and education (P = .06). The Qmci-TR also had higher accuracy than the MoCA in differentiating MCI from SMC, which became nonsignificant after adjustment (P = .15). A similar pattern was shown for distinguishing MCI from dementia. Test reliability for the Qmci-TR was strong. Conclusion: The Qmci-TR is a reliable and useful screening tool for discriminating MCI from SMC and dementia in a Turkish population.

The relationship between coping strategies and caregiver burden in caregivers of people with Alzheimer's dementia

and .52 (p < .001), meaning patient’s dementia related factors were more likely to impose heavier burden on caregivers. Number of disease, perceived health status, co-residence, caregiving hours, and contact frequency were identified as factors that increased the burden score significantly. Presence of secondary caregiver and involvement in economic activity lowered caregiver burden scores significantly.Conclusions: The results of this study emphasize the importance of appropriate intervention to support family caregivers that enables caregivers to provide home based care. The cognitive, behavioral, and functional deterioration of patients is highly associated with caregiver burden. Future study is needed to understand the different difficulties in accordance with stage and type of dementia to develop the individualized interventions for family caregivers.

An Iceberg Phenomenon in Dementia: Pain

Background: Pain is one of the most frequent symptoms in older adults. It severely impairs quality of life, increases delirium risk, and may lead to progression of dementia. Assessment of pain performed by taking anamnesis from the patient is not reliable in patients with dementia due to cooperation and communication problems. The aim of this study was to assess pain and its consequences in patients with dementia. Methods: Seventy-five nursing home residents with dementia were enrolled. After comprehensive geriatric assessment, presence of pain was asked to patients, and Pain Assessment in Advanced Dementia (PAINAD), Discomfort Scale for Dementia of the Alzheimer’s Type (DS-DAT), Pain Assessment for the Dementing Elderly (PADE), Wong-Baker Faces Pain Rating Scale, and Numeric Rating Scale tests were performed. Results: Mean age was 81.1 (7.0), and 46.7% (n = 35) were female. Thirty-two percent of the patients were at early stage, 24% at moderate stage, and 44% at severe stage. Although the number of patients declaring pain was lower in moderate and severe stage, scores of PADE, PAINAD, and DS-DAT were significantly higher in severe stage showing the presence of pain (P < .001). Furthermore, scores of PADE, PAINAD, and DS-DAT were negatively correlated with comprehensive geriatric assessment test scores. Conclusion: These results demonstrate that pain is not rare in patients with dementia, but they are not usually capable of expressing it, especially in the severe stage. Therefore, objective pain assessment scales developed for patients with dementia should be routinely used and management of pain should be done regarding the association of pain with other geriatric syndromes.