Radoslaw Magierski

The influence of vascular risk factors on the survival rate of patients with dementia with Lewy bodies and Alzheimer disease.

BACKGROUND AND PURPOSE The aim of this study was to determine whether dementia with Lewy bodies (DLB) progres-ses more rapidly than Alzheimer disease (AD) and to compare survival after dementia onset and mortality in both dementia groups. MATERIAL AND METHODS A medical records analysis of AD (n = 183) and DLB (n = 51) patients was performed to determine age at onset of symptoms, the date of first presentation to the psychiatric services, dementia severity at diagnosis (MMSE score), and mean disease duration before diagnosis. Categorical data regarding vascular risk factors were collected. Projected decline rate (MMSE/year), survival rate after the diagnosis of dementia, mean survival time after diagnosis and mortality rate were calculated and compared between DLB and AD groups. RESULTS The comparison of clinical and demographic parameters revealed no significant differences between groups, apart from a more pronounced decline rate in the DLB group. Diabetes, and to a lesser extent hypertension, influenced survival in AD, but not in DLB subjects. Overall, however, the difference in mortality rates and survival time between DLB and AD subjects cannot be attributed to the presence of any vascular risk factor analysed. DLB, independently of the presence of vascular risk factors, seems to be a more aggressive disorder than AD, when mortality and survival time are taken into account. CONCLUSIONS More rapid progression of cognitive decline and shorter duration of dementia were found in DLB in this naturalistic study. The findings may have important implications for the management and treatment of DLB and should be confirmed in prospective studies.

Body mass index and mild cognitive impairment-to-dementia progression in 24 months: a prospective study.

Background/Objectives:Mild cognitive impairment (MCI), often considered as an early stage of dementia, is heterogeneous, and not all subjects with MCI progress into clinically diagnosed dementia. Low body weight (and body mass index, BMI) as well as losing weight while in MCI stadium have been proposed as possible risk factors of MCI-to-dementia conversion.Subjects/Methods:A prospective, 2-year observation of 102 MCI subjects has been conducted. Data on MCI subtype, somatic and neuropsychiatric co-morbidity and demographic characteristics (including age, gender and education), were collected. In addition, baseline and yearly BMI were calculated.Results:Data of 83 out of the originally included 102 subjects were available after 2 years; 27 of those (32.5%) progressed to dementia. In univariate analysis, multiple-deficit MCI subtype (as compared with pure amnestic), higher age, the presence of diabetes and apathy, and lower baseline BMI (and losing weight on 2-year follow-up) were associated with conversion to dementia. Variables retained in the multivariate backward stepwise logistic regression model for conversion after 24 months of observation included lower baseline BMI (odds ratio, OR (95% cofidence interval, CI): 0.6 (0.4–0.9)), weight loss on 2-year follow-up (OR (95% CI): 1.3 (1.1–1.5)), male gender (OR (95% CI): 0.1 (0.01–0.9)) and presence of apathy (OR (95% CI): 70.7 (5.6–699)). Apathetic subjects had lower BMI and higher weight loss after controlling for potential confounders (age, gender, years of education and baseline ADAS-cog (Alzheimers Disease Assessment Scale-cognitive subscale) score).Conclusion:MCI subjects presenting with apathy, low initial BMI and losing weight on follow-up have a significantly greater risk of developing dementia. Nutritional and behavioural assessment should be considered as additional tools in evaluating the risk of dementia among MCI subjects.

Serotonergic drugs for the treatment of neuropsychiatric symptoms in dementia

ABSTRACT Behavioral and psychological symptoms of dementia (known also as neuropsychiatric symptoms) are essential features of Alzheimer’s disease and related dementias. The near universal presence of neuropsychiatric symptoms in dementia (up to 90% of cases) has brought significant attention of clinicians and experts to the field. Non-pharmacological and pharmacological interventions are recommended for various types of neuropsychiatric symptoms. However, most pharmacological interventions for the treatment of behavioral and psychological symptoms of dementia are used off-label in many countries. Cognitive decline and neuropsychiatric symptoms can be linked to alterations in multiple neurotransmitter systems, so modification of abnormalities in specific systems may improve clinical status of patients with neuropsychiatric symptoms. Use of serotonergic compounds (novel particles acting on specific receptors and widely acting drugs) in the treatment of neuropsychiatric symptoms is reviewed.

Evaluation of the influence of metabolic processes and body composition on cognitive functions: Nutrition and Dementia Project (NutrDem Project)

The global increase in the prevalence of dementia and its associated comorbidities and consequences has stimulated intensive research focused on better understanding of the basic mechanisms and the possibilities to prevent and/or treat cognitive decline or dementia. The etiology of cognitive decline and dementia is very complex and is based upon the interplay of genetic and environmental factors. A growing body of epidemiological evidence has suggested that metabolic syndrome and its components may be important in the development of cognitive decline. Furthermore, an abnormal body mass index in middle age has been considered as a predictor for the development of dementia. The Nutrition and Dementia Project (NutrDem Project) was started at the Department of Old Age Psychiatry and Psychotic Disorders with close cooperation with Department of Medical Psychology. The aim of this study is to determine the effect of dietary patterns, nutritional status, body composition (with evaluation of visceral fat) and basic regulatory mechanisms of metabolism in elderly patients on cognitive functions and the risk of cognitive impairment (mild cognitive impairment and/or dementia).

Apathy but not other affective symptoms is predicting conversion to dementia in mild cognitive impairment

measure ANOVA revealed significant main effects of personality (F(4, 592) 1⁄4 297.76, p < .001) and time (F(2, 296) 1⁄4 3.25, p < .05), and significant interactions of time and personality (F(8, 1184)1⁄4 2.41, p1⁄4 .01), and of personality and diagnosis (F(4, 592) 1⁄4 5.48, p < .001) as well as of personality and sex (F(4, 592)1⁄4 5.08, p< .001), but there was no significant interaction between personality, diagnosis and sex. MCI subjects scored significant higher on neuroticism and lower on openness. Conclusions: The results support the hypothesis that MCI subjects differ in their personality traits relative to healthy controls. Premorbid high neuroticism is a possible risk factor for developing MCI.

Magnetic Resonance Spectroscopy in the Diagnosis of Dementia with Lewy Bodies

Dementia with Lewy bodies (DLB) is considered to be the second most frequent primary degenerative dementing illness after Alzheimers disease (AD). DLB, together with Parkinsons disease (PD), Parkinsons disease with dementia (PDD) belong to α-synucleinopathies—a group of neurodegenerative diseases associated with pathological accumulation of the α-synuclein protein. Dementia due to PD and DLB shares clinical symptoms and neuropsychological profiles. Moreover, the core features and additional clinical signs and symptoms for these two very similar diseases are largely the same. Neuroimaging seems to be a promising method in differential diagnosis of dementia studies. The development of imaging methods or other objective measures to supplement clinical criteria for DLB is needed and a method which would accurately facilitate diagnosis of DLB prior to death is still being searched. Proton magnetic resonance spectroscopy (1H-MRS) provides a noninvasive method of assessing an in vivo biochemistry of brain tissue. This review summarizes the main results obtained from the application of neuroimaging techniques in DLB cases focusing on 1H-MRS.

P3-156: The Polish adaptation of the Montreal cognitive assessment and preliminary results of its clinical utility in the screening for cognitive impairment

Background: The Mini-Mental State Examination (MMSE) is a standard tool used for screening purposes but it often fails to detect early cognitive decline. The Montreal Cognitive Assessment (MoCA) is a brief cognitive screening tool with high sensitivity and specificity for detecting mild cognitive impairment (MCI). Aim of this study was to adapt the Polish version of The Montreal Cognitive Assessment test and to evaluate and compare the usefulness of the MoCA test vs MMSE in the early detection of cognitive decline in MCI. Methods: The scale was adapted through translation and back translation to guarantee the semantic equivalence. Afterwards, it was tested on a group of 70 subjects (n 30 meeting criteria DSM IV for Alzheimer’s disease, AD; 20 meeting Petersen’s criteria for MCI; 20 cognitively intact controls) in the University-based Alzheimer’s Outpatients Clinic. All subject underwent general medical, neurological, psychiatric and neuropsychological investigation. The applied testing battery included MMSE, Clinical Dementia Rating (CDR), short version (15-items) of the Geriatric Depression Scale (GDS), Apathy subscale from the Neuropsychiatric Inventory (NPI). Results: Only patients with a mild severity of AD (CDR 1) were included. Both MCI and AD groups exhibited impaired performance on MoCA compared to controls. Patients with AD showed significantly greater deficits on MoCA than on MMSE. In the tested population the MoCA test was superior to MMSE in discriminating AD patients from MCI and control populations. Conclusions: The Polish version of MoCA seems appropriate for the differentiation of healthy and deteriorated cognitive performance in a population of Polish patients.

Neutrophil-lymphocyte ratio is increased in elderly patients with first episode depression, but not in recurrent depression

Association between inflammation and depression, especially in elderly patients, leads to conclusions about their shared influence on risk of cardiovascular disease and death. It might be found useful to predict those issues by monitoring inflammatory parameters, such as neutrophil/lymphocyte ratio (NLR). The aim of this study was to determine the NLR in elderly patients with unipolar depression compared with non-depressed elderly patients. NLR was measured in 684 Caucasian subjects (depressed: n = 465, non-depressed: n = 219), aged ≥ 60 (depressed: mean age 74.8 ± 7.8 years, non-depressed: mean age: 71.1 ± 5.7 years). There were two subgroups within depressed patients: first episode depression (n = 138, 29.6%) and recurrent depression (n = 328, 70.3%). NLR was calculated as ratio between absolute neutrophil count to absolute lymphocyte count. NLR was significantly higher in unmedicated patients with depression compared with healthy control (2.10 ± 2.13 vs. 2.01 ± 0.75, p = 0.004). It was higher in first episode depression compared with recurrent depression (2.11 ± 1.76 vs 1.64 ± 1.04, p < 0.05). There was a positive correlation with severity of symptoms. We found non-specific effect of treatment with antidepressants or antipsychotics on lower NLR. Increased NLR in patients with first episode of depression compared to recurrent depression and healthy control may have important clinical consequences. Severity of symptoms are positively correlated with NLR, which may indicate that with increasing severity of depression, the risk of cardiovascular events is also rising, which leads to higher mortality. In elderly patients with depression even a small reduction of such risk may translate into better prognosis and improve quality of live. The difference between first episode and recurrent depression in terms of inflammatory biomarkers requires further studies.

Nutrition and dementia project (NutrDem project)

circuitry was assessed using BOLD fMRI two weeks earlier among 7 of the individuals with MCI and 6 age-, gender-, and educationmatched healthy controls. Results:We found that high level mental fatigability disrupted the normal U shape of HF-HRV reactivity to cognitive stress in individuals with MCI. Furthermore, the stronger connectivity of intra-network of central executive network and the inter-network between central executive network and basal ganglia network (especially between the bilateral middle prefrontal cortex and left putamen) within the frontal basal ganglia circuitry (Figure 1) were related to lower mental fatigability and stronger HF-HRV reactivity in both MCI and healthy control (Figure 2). Conclusions: These results indicate that mental fatigability may contribute to abnormal cardiovascular reactivity to acute stress in MCI, and frontal basal ganglia circuitry may support such a link.

The polish version of the montreal cognitive assessment (MoCA) is superior to the mini-mental state examination in the early detection of mild cognitive impairment

Animal Naming (4) 4.00 6 0.00 3.74 60.59 0.006* Attention (3) 2.88 6 0.32 2.71 6 0.60 0.11 Total Score (30) Illiterate Participants 26.29 6 1.60 21.33 63.76 <0.001* Literate Participants 26.61 6 1.95 22.95 6 2.06 <0.001* p-value Within Cognitive Group 0.681 0.093 Time Used (Minutes) Illiterate Participants 16.42 6 3.15 20.90 6 5.65 0.058 Literate Participants 14.61 6 3.39 17.38 65.70 0.052 p-value Within Cognitive Group 0.197 0.051