Nayuta Namioka

Elevated inflammatory markers in diabetes‐related dementia

the questionnaire, of which 132 (63.5%) are aged less that 65 years and 76 (36.5%) where aged 65 years or older. No significant differences were found between age groups, level of education, family history of dementia and immigration status. Both sexes performed poorly on question 1 (females 24%; males 22%, χ = 0.95, P = 0.759). However, in question 2, both sexes recognized symptoms of dementia (females 64%; males 75%, χ = 2.27, P = 0.132). Albeit in question 3, men were more informed on dementia prognosis (females 32%; males 50%, χ = 5.62, P = 0.017). Our survey shows that males and females recognize symptoms of dementia, but continue to exhibit the misconception that dementia is a natural process of aging, which is consistent with those found in prior research. Also worrisome is that women seem to know less about the prognosis of dementia than men. This could be related to Asian–American females creating stronger social support; that they are more likely than men to serve as caregivers to those with dementia. Prior studies have shown, even without education as a confounding factor, these caregivers combine a folk and biomedical model to describing dementia. With consistently misinformed female caregivers continuing their role every generation, differences in sex impressions of dementia could develop due to how information is disseminated to the next generation of caregivers. As such, properly informed females are the bridge to early disease recognition and seeking treatment. If Asian–American females do not understand that dementia decreases lifespan, this could delay early medical intervention. The study’s limitations include the participant group consisting mainly of females and research only consisting of three questions. Despite these limitations, the present study alludes to the gaps in knowledge needing to be filled in the Asian–American community. With this community already underutilizing mental healthcare, dementia management in this population is grim without prompt intervention. To this end, clinical efforts should be made to further dementia knowledge among Asian– Americans, especially for women, as they are the forerunners to preventing delays in care. Building on this foundation might finally help improve dementia management within the fastest growing minority group.

Oxidative stress and inflammation are associated with physical frailty in patients with Alzheimer's disease

Dementia is closely connected with frailty, and these two conditions are common in older adults. However, the biological mechanism that causes frailty in patients with Alzheimers disease (AD) is not fully understood. We determined whether oxidative stress and inflammatory mechanisms could be associated with physical frailty in patients with AD.

Guidelines for the Clinical Diagnosis of Diabetes Mellitus-Related Dementia.

ties in the context of poor glycemic control. Diabetic striatopathy is a well-recognized but rare cause of hemiballism-hemichorea, associated with contralateral basal ganglia hyperdensity on CT and hyperintensity on T1weighted MRI. The cause of clinical and imaging abnormalities is unclear. Several mechanisms attributed to hyperglycemia have been proposed: transient ischemic injury with microhemorrhage resulting in hyperviscosity caused by hyperosmotic state, calcium deposition, gemistocytosis, altered GABAergic and dopaminergic neurotransmission, paramagnetic mineral deposition including zinc-containing metallothionein expressed in swollen astrocytes, and autoimmunity-mediated inflammation. This was the first case, to the authors’ knowledge, of contemporary occurrence of hyperglycemia-related hemichorea and stroke. Two possible diagnostic hypothesis were taken into account: the first considered stroke to have played a central role in diabetes mellitus decompensation, which, in a context of cerebral frailty due to stroke, led to the development of hyperglycemia-related hemiballismhemichorea; the second considered hyperglycemia as the trigger of stroke through an ischemic injury due to hyperviscosity. The available anamnestic data did not help identify which of the two disorders first appeared. The proximity of the stroke lesion to the altered basal ganglia, both in the right middle cerebral artery area, is interesting; although this strengthens the hypothesis of the ischemic mechanism for imaging abnormalities associated to hyperglycemia, it seems in accord with the second hypothesis. It could also be related to the first hypothesis, if the abnormal basal ganglia is considered to enter the ischemic penumbra of the documented stroke. Moreover, a participating direct role of the documented ischemic stroke to the abnormal movements cannot be excluded given the existence also of vascular hemichorea-hemiballism typically associated with lesions of the basal ganglia and, as in this case, of the adjacent white matter. Difficulties in optimal glycemic control probably contributed to the persistence for several months of basal ganglia abnormalities accompanied by recurrence of hemichorea, both finally disappearing 24 months later when diabetes mellitus compensation was also evident. Hyperglycemia-related hemiballism-hemichorea and the occurrence of four ischemic strokes during a 24-month period are rare in clinical practice. This man’s case raises doubts also about the possible predictive role of hyperglycemiarelated hemiballism-hemichorea for recurrence of stroke.

Diabetes-related dementia is associated with dynapenia, but not with sarcopenia

injury in Korea. Seoul: Korea Health Promotion Foundation, 2009. 3 FinnN. Fall-related injuries amongst elderly in Sweden: still an emerging risk? DISSERTATION Karlstad University Studies 2014; 20: 1–79. 4 Stevens JA, Mahoney JE, Ehrenreich H. Circumstances and outcomes of falls among high risk community-dwelling older adults. Injury Epidemiology 2014; 1: 1–9. 5 Cho H, Shin H, Baek M. A study on the establishment and revitalization measures of international safe community – based on samcheok in Gangwon-do. J Korean Soc Disaster 2013; 9: 339–346. 6 Sun ML, Kim SC, Jung HS et al. Injury data comparison between national and local emergency centers in Korea. J Koran Soc Emerg Med 2012; 23: 181–188. 7 Park SS, Choi SE. Analysis on relationship between the accident and injury occurrence and the absence appearance of adults in South Korea. Technol Health Care 2014; 22: 369–377. 8 Kang CH, Kang HA, Park JH. Students injuries and injury surveillance system in cheonan. J Korean Soc Sch Health 2009; 22: 157–167. 9 Lee HW, Park JH, Kang SH et al.A study on self-sufficiency for hospital injury inpatients in Korea. Korea Acad Industr Coop Soc 2011; 12: 5779–5788.

Correlation between clinical symptoms and striatal DAT uptake in patients with DLB

ObjectiveIt is widely known that there is low striatal 123I-FP-CIT dopamine transporter-single photon emission tomography (DAT-SPECT) uptake in patients with dementia with Lewy bodies (DLB). We assessed the correlation between symptom and regional low DAT uptake in the striatum.MethodsPatients with Alzheimer’s disease (AD) (n = 95) and patients with DLB (n = 133) who underwent DAT-SPECT were enrolled. We examined the correlation between symptoms [cognitive function decline, fluctuations, visual hallucinations, parkinsonism, and REM sleep behavior disorder (RBD)] and regional striatal DAT uptake in the patients with DLB.ResultsWhen comparing the DLB patients with or without fluctuations, visual hallucinations, or RBD, there were no significant differences in DAT uptake in any regions of the striatum. DLB patients with parkinsonism had significantly lower DAT uptake in entire striatum, entire putamen, and anterior putamen compared to DLB patients without parkinsonism. Moreover, there was weak but significant correlation between severity of parkinsonism and DAT uptake in entire regions of the striatum in patients with DLB. There was no significant correlation between cognitive function and DAT uptake in any regions of the striatum in patients with DLB.ConclusionsIn patients with DLB, only parkinsonism is associated with a reduction in striatal DAT uptake.

Comparison of diagnostic utility of semi-quantitative analysis for DAT-SPECT for distinguishing DLB from AD

PURPOSE It is widely known that there is low striatal 123I-FP-CIT dopamine transporter single photon emission computed tomography (DAT-SPECT) uptake in patients with dementia with Lewy bodies (DLB). However, a consistent quantitative evaluation method for DAT-SPECT has not yet been established. There are two semi-quantitative software packages for DAT-SPECT available in Japan, namely, DaTView and DaTQUANT. The aim of this study was to identify which of these is superior for distinguishing DLB from AD. Moreover, we aimed to identify which region of the striatum is more suitable for distinguishing DLB from AD. METHODS Patients with Alzheimers disease (AD) (n=95) and patients with DLB (n=133) who underwent DAT-SPECT were enrolled. DaTView and DaTQUANT were used as semi-quantitative analysis tools for DAT-SPECT. RESULTS There were significant correlations in DAT uptake between DaTView and entire regions by DaTQUANT. There was no significant difference in diagnostic accuracy between DaTView and DaTQUANT except in the posterior putamen by DaTQUANT. CONCLUSIONS For distinguishing DLB from AD, both of DaTView and DaTQUANT software are useful. Moreover, assessing the DAT uptake in entire striatum by DaTView might be sufficient for distinguishing DLB from AD.

Frailty in diabetes-related dementia

In older adults, delirium is a frequent cause for hospitalization and is a length misleading condition. Aseptic meningitis might be related to specific leukemia CNS involvement, usually in end-stage treated disease. We showed that aseptic meningitis might reveal AML with no blast cells in blood samples. Therefore, a bone marrow examination should be considered in unexplained aseptic meningitis.

Circulating Levels of Advanced Glycation End Products in Diabetes Mellitus–Related Dementia

but remains underappreciated in the community. Because HCNs spend much time with patients in their homes, they can uniquely identify readmission factors. HCNs identified worsening symptoms, poor home environments, challenging patient priorities, and inappropriate self-management strategies that PCPs did not identify. The lack of relationships between PCPs and HCNs prevents community providers from addressing these concerns collaboratively. These results support the need for explicit agreement on roles and responsibilities and coordination among all providers caring for a patient, concepts that accountable care organizations and patient-centered medical homes espouse. Recently introduced care transitions and care coordination payments by the Centers for Medicare and Medicaid Services may provide incentives to improve communication and coordination among outpatient providers. Because readmissions represent a marker of poor care, improving the delivery of outpatient care may strengthen overall care. This study highlights a fragmented system of community providers and calls for new community provider–focused initiatives to improve the care of this vulnerable population.

Comprehensive geriatric assessment in elderly patients with dementia

We have recently developed and validated a screening test for comprehensive geriatric assessment (CGA) named “Dr. SUPERMAN”. We compared the results obtained by the CGA of patients with Alzheimers disease (AD), vascular dementia (VaD) and dementia with Lewy bodies (DLB), and determined the relationship between functional deficits and clinical characteristics in each type of dementia.

Frailty and sarcopenia in subjects with Alzheimer's disease with or without cerebrovascular disease

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