Fotini Kounti

Effectiveness of nonpharmacological approaches in patients with mild cognitive impairment.

Background: Mild cognitive impairment (MCI) patients are at increased risk of developing dementia. There is a conflict if cognitive interventions can improve cognitive and functional performances in order to delay the development of dementia. Objectives: This study aimed to examine the effectiveness of a holistic cognitive rehabilitation program on patients with MCI. Methods: The participants, 176 MCI patients with Mini-Mental State Examination = 27.89 (1.73), were classified into 2 groups matched for age, gender, education and cognitive abilities: (1) patients (104) on nonpharmacological therapy and (2) patients (72) on no therapy at all. The effectiveness of the interventions was assessed by neuropsychological evaluation performed at baseline and at the end of the interventions. Results: Between-group difference in benefit of the experimental group was demonstrated in abilities of executive function (p = 0.004), verbal memory (p = 0.003), praxis (p ≤ 0.012), daily function (p = 0.001) and general cognitive ability (p ≤ 0.005). The experimental patients improved cognitive and functional performances, while the control patients demonstrated deterioration in daily function (p = 0.004). Conclusions: Our findings indicate that nonpharmacological therapy of the holistic approach can improve MCI patients’ cognitive and functional performances.

Wechsler Memory Scale, Rivermead Behavioral Memory Test, and Everyday Memory Questionnaire in Healthy Adults and Alzheimer Patients

Summary: The Wechsler Memory Scale (WMS) is a laboratory-based memory test that has been criticized for its lack of ecological validity and for not testing long-term memory. A more recent memory test, which aims at testing everyday memory, is the Rivermead Behavioral Memory Test (RBMT); it tests prospective memory and other forms of memory not tapped by WMS. However, even this test does not capture all aspects of everyday memory problems often reported by adults. These problems are the object of the Everyday Memory Questionnaire (EMQ). This study aimed at identifying the relationships between these three memory tests. The differential effect of Alzheimers disease (AD) on the above relationships was also studied. The sample consisted of 233 healthy adults (20 to 75+ years of age) and 39 AD patients (50 to 75 years of age). Confirmatory factor analysis revealed the following latent factors: Verbal Memory, Visual Reconstruction, Orientation, Message (action embedded in spatial context), Visual Recognition, ...

Severe Psychological Stress in Elderly Individuals: A Proposed Model of Neurodegeneration and Its Implications

During clinical practice, degenerative diseases in some patients appear after exposure to a severe psychological stress. Several studies have suggested that the duration of exposure to corticosteroids or stress, the dose of corticosteroids and the vulnerability of the hippocampus, amygdala and prefrontal cortex areas targeted by elevated stress hormones, mediate the damaging effects of elevated corticosteroids. Although understanding what triggers the transition from adaptive plasticity to the maladaptive effects of stress in the elderly is important, one of the great challenges is to determine individual differences in vulnerability to stress-induced events in both animal and human populations, and to devise strategies that may help protecting the brain from permanent damage. This review provides the basis for creating interventions and educational programs during midlife in order to prevent dementia or other neurodegenerative diseases or to halt the progress of neurodegeneration in the early stages.

RHEA,* a Nonpharmacological Cognitive Training Intervention in Patients With Mild Cognitive Impairment: A Pilot Study

Objective: This study aimed to examine the effectiveness of RHEA, a cognitive training through kinetic exercises, on patients with mild cognitive impairment. Subjects and Method: Participants, completing study, were 58 mild cognitive impairment patients with MMSE = 27.69, assigned to 2 groups of 29 each (experimental, 20-weekly RHEA sessions, and no-therapy control), matched for age, gender, education, cholinesterase inhibitors, cognitive abilities. Neuropsychological assessments were performed at baseline and after 5 months. Results: Between groups difference to the benefit of the experimental group were demonstrated in attention (P = .002), language (P = .015), visual-spatial abilities (P = .013), MMSE (P = .047), and daily function (P = .009). Experimental participants improved cognitive and functional performances while control participants remained stable.

Correlations Between the Functional-Cognitive Assessment Scale and the Alzheimer's Disease Assessment Scale When Administered to Patients With Dementia Residing in Long-term Care

The Alzheimer Disease Assessment Scale (ADAS) and the Functional Cognitive Assessment Scale (FUCAS) examine the cognitive performance of patients with dementia. ADAS has been widely used as a clinical instrument, mainly in clinical trials. FUCAS is a useful tool in diagnosing early dementia since it examines executive skills. Moreover, it is sensitive to the subtle changes that occur during the progress of the disease. The aim of this study was to examine the possible correlations between FUCAS and ADAS. The 2 neuropsychological scales were administered to 32 patients with dementia residing in long-term care. They were 12 men and 20 women, 65 to 90 years old, with 4 to 12 years of education. Twenty-four patients were reassessed 3 months after the first assessment, with the same scales. Pearsons correlation showed that the total score of FUCAS correlated significantly with the total score of ADAS: r = 0.80 (P < .01). The t test showed that changes over the 3 months for FUCAS were more significant than ADAS, suggesting that FUCAS is a more sensitive tool.

Capacity to vote in dementia patients and in healthy elderly Greek population

education program. Of those interested, 45% preferred access to an online class, while 35% favored in person sessions. The greatest areas of perceived need were exercise/nutrition programs and clinical trial information. Conclusions: An overwhelming majority of patients live at home with caregivers and are not receiving help from outside sources. This suggests that there is a patient /family commitment to keep cognitively impaired individuals at home. There is need for online and face-to-face caregiver training to optimize safety and function, and to decrease caregiver stress. These findings support the notion that there is a national need to allocate energy and resources to Alzheimer’s care.

What are the symbols of Alzheimer? A permutation entropy based symbolic analysis for the detection of early changes of the electroencephalographic complexity due to mild Alzheimer

Alzheimers disease (AD) is the most common type of dementia, greatly affecting cognitive functioning and independent living of elderly population. The lack of an available drug therapy that could prevent disease progression shifted the research interest towards the early detection of the neurodegeneration symptoms that affect the mature brain and impair the interaction between brain regions, thus partially causing functional disconnection. The notion of electroencephalographic complexity is a valid and reliable method of quantifying the degree of isolation of brain regions due to AD pathology. Recently permutation entropy, which is a methodology of transforming the signal data into symbolic sequences and then computing the frequency distribution of symbolic patterns, gained great attention and was applied in seizure detection and computation of consciousness. The current study aims to investigate whether this complexity marker would be suitable to be applied in dementia research towards the quantification of the degree of cognitive deterioration due to disconnection of brain regions. The promising results indicate that permutation entropy on posterior regions (parieto-occipital areas) abnormally increases during mild dementia and is negatively correlated with the level of cognitive dysfunction, as estimated by the Mini Mental State Examination. Therefore, it may be a fast, accurate and simple tool for screening elderly population prone in Alzheimer.

Effectiveness of pharmacological and non pharmacological therapy in patients with MCI and Mild Alzheimer's disease

cally significant changes in neuropsychological testing. Conclusions: Results suggest that MCI patients and patients at the early stages of dementia benefited more from the intervention program. Although there was no statistically significant improvement in the rest of the groups, patients in the moderate and severe stages of dementia remained stable over a six month period. ADAS-cog); secondary outcome measures: specific cognitive and non-cognitive functions). We determined outcome after intervention at follow-up compared to baseline and to an active control group, which met monthly and received paper-pencil exercises for self-study. Thirty-nine patients (24 amnestic MCI, 15 AD) were randomly assigned to cognitive intervention groups (CIGs: 12 MCI, 8 AD) and control groups (CGs: 12 MCI, 7 AD). Results: Thirty-seven patients completed the study (two drop-outs: lack of compliance, intercurrent illness). For MCI-patients (CIG: 10; CG: 12), we found significantly reduced progression in ADAS-cog comparing baseline vs. follow-up and determining group interactions (treatment vs. control) (p 1⁄4 .03), Trail Making Test B (TMT-B) (p 1⁄4 .04) and Montgomery Asberg Depression Rating Scale (MADRS) (p 1⁄4 .01). For MMSE and Quality of Life-Alzheimer’s Disease (QoL-AD), the progression x group interaction had a p-value of p < .1. For the AD-patients (CIG: 8; CG: 7), the progression x group interaction was significant for TMT-B (p 1⁄4 .03), and showed a tendency towards significance for story recall of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and the MADRS. Conclusions: Our results suggest an improvement in cognition and non-cognitive performance in patients with amnestic MCI after our 6-month stage-specific cognitive intervention compared to baseline and to an active control condition. In contrast, the effects in mild AD showed a trend towards significance on secondary outcomes. These findings in a small sample of subjects encourage the use of the intervention in larger scales studies to confirm the effect in MCI and AD patients and to extend the follow-up period to determine long-term effects of intervention.

Severe Psychological Stress In The Elderly: A Proposed Model Of Neurodegeneration

b-amyloid (Ab)-rich regions of the brain is a distinct feature of Alzheimer’s disease (AD). Compelling evidence shows a strong correlation between accumulation of aggregated neurotoxic b-amyloid peptides and oxidative stress in the brains of patients afflicted with AD. One hypothesis for this correlation involves the direct and harmful interaction of aggregated Ab peptides with cellular proteins responsible for maintaining normal, cellular levels of reactive oxygen species (ROS). Objective: To identify specific, destructive interactions of Ab peptides with cellular antioxidant enzymes and to inhibit these harmful protein-amyloid interactions. Methods: Using cell-free and cellular assays, in addition to fluorescence microscopy, we demonstrate that exposure of human neuroblastoma cells to cytotoxic preparations of aggregated Ab peptides results in significant intracellular co-localization of Ab with catalase-an antioxidant enzyme responsible for catalyzing the degradation of the ROS, hydrogen peroxide (H2O2)-and that these catalase-Ab interactions contribute to an observed increase in cellular levels of H2O2. Furthermore, we evaluate the effects of generating protein-resistive surface coatings on aggregated Ab peptides in cells by using two oligo(ethylene glycol) derivatives of 6-methylbenzothiazole aniline (BTA-EG4 and BTA-EG6) as synthetic molecular probes that exhibit the following characteristics: 1)capability of generating protein-resistive surface coatings on aggregated Ab peptides (to inhibit catalase-amyloid interactions in cells), 2)lack of toxicity, 3)cell permeability, 4)capability of localizing to the same subcellular compartments of cells as Ab, 5)intrinsic fluorescence properties (to visualize the intracellular localization of the molecules), and 6)chemical stability in oxidative environments. We show that these small molecule inhibitors of catalase-amyloid interactions protects the hydrogen peroxide-degrading activity of catalase in an Ab-rich environment, leading to reduction of the co-localization of catalase and Ab in cells, inhibition of Ab-induced increase in cellular levels of H2O2 (Figure 1), and neutralization of the toxicity of Ab peptides. Conclusion: These studies provide evidence for the important role of catalase-amyloid interactions in Ab-induced oxidative stress and propose a novel molecular strategy to inhibit such harmful interactions in AD.