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Subjective cognitive decline (SCD) designates a self-reported cognitive decline despite preserved cognitive abilities. This study aims to explore, in older adults with SCD, the association between intensity of self-reported cognitive complaint and psychological factors including Young's early maladaptive schemas (EMSs) (i.e. enduring cognitive structures giving rise to beliefs about oneself and the world), as well as depression and anxiety.
Seventy-six subjects (69.22 years ± 6.1) with intact cognitive functioning were recruited through an advertisement offering free participation in an intervention on SCD. After undergoing a neuropsychological examination (including global cognition (MMSE) and episodic memory (FCSRT)) and a semi-structured interview to assess depressive symptoms (MADRS), they completed a set of online self-reported questionnaires on SCD (McNair questionnaire), Young's EMSs (YSQ-short form), depression (HADS-D), and anxiety (HADS-A and trait-STAI-Y).
The McNair score did not correlate with the neuropsychological scores. Instead, it was highly (r > 0.400; p < 0.005) correlated with trait anxiety and three EMSs belonging to the “Impaired autonomy and performance” domain: Dependence/incompetence, Failure to achieve and Vulnerability to harm or illness. Our final regression model comprising depression, anxiety, and these three EMSs as predictors (while controlling for age, gender, and objective cognition) accounted for 38.5% of the observed variance in SCD intensity.
The level of cognitive complaint is significantly associated with Young's EMSs in the category of “Impaired autonomy and performance”. We assume that SCD may primarily be driven by profound long-term inner beliefs about oneself that do not specifically refer to self-perceived memory abilities.
Young Onset Dementia (YOD), defined by first symptoms of cognitive or behavioral decline occurring before the age of 65 years, is relatively rare compared to dementia of later onset, but it is associated with diagnostic difficulty and heavy burden on affected individuals and their informal carers. Existing health and social care structures rarely meet the needs of YOD patients. Internet-based interventions are a novel format of delivering health-related education, counseling, and support to this vulnerable yet underserved group.
The RHAPSODY (Research to Assess Policies and Strategies for Dementia in the Young) project is a European initiative to improve care for people with YOD by providing an internet-based information and skill-building program for family carers. The e-learning program focuses on managing problem behaviors, dealing with role change, obtaining support, and looking after oneself. It will be evaluated in a pilot study in three countries using a randomized unblinded design with a wait-list control group. Participants will be informal carers of people with dementia in Alzheimer's disease or behavioral-variant Frontotemporal degeneration with an onset before the age of 65 years. The primary outcome will be caregiving self-efficacy after 6 weeks of program use. As secondary outcomes, caregivers’ stress and burden, carer health-related quality of life, caring-related knowledge, patient problem behaviors, and user satisfaction will be assessed. Program utilization will be monitored and a health-economic evaluation will also be performed.
The RHAPSODY project will add to the evidence on the potential and limitations of a conveniently accessible, user-friendly, and comprehensive internet-based intervention as an alternative for traditional forms of counseling and support in healthcare, aiming to optimize care and support for people with YOD and their informal caregivers.
Positron emission tomography (PET) imaging of brain amyloid beta is now
clinically available in several countries including the United States and
the United Kingdom, but not Canada. It has become an established technique
in the field of neuroimaging of aging and dementia, with data incorporated
in the new consensus guidelines for the diagnosis of Alzheimer disease and
predementia Alzheimer’s disease–related conditions. At this point, there are
three US Food and Drug Administration– and European Union–approved tracers.
Guided by appropriate use criteria developed in 2013 by the Alzheimer’s
Association and the Society of Nuclear Medicine and Molecular Imaging, the
utility of amyloid imaging in medical practice is now supported by a growing
body of research. In this paper, we aimed to provide an update on the 2012
Canadian consensus guidelines to dementia care practitioners on proper use
of amyloid imaging. We also wished to generate momentum for the industry to
submit a new drug proposal to Health Canada. A group of local, national, and
international dementia experts and imaging specialists met to discuss
scenarios in which amyloid PET could be used appropriately. Peer-reviewed
and published literature between January 2004 and May 2015 was searched.
Technical and regulatory considerations pertaining to Canada were
considered. The results of a survey of current practices in Canadian
dementia centers were considered. A set of specific clinical and research
guidelines was agreed on that defines the types of patients and clinical
circumstances in which amyloid PET could be used in Canada. Future research
directions were also outlined, notably the importance of studies that would
assess the pharmaco-economics of amyloid imaging.
Although non-drug interventions are widely used in patients with Alzheimer's disease, few large scale randomized trials involving a long-term intervention and several cognitive-oriented approaches have been carried out. ETNA3 trial compares the effect of cognitive training, reminiscence therapy, and an individualized cognitive rehabilitation program in Alzheimer's disease to usual care.
This is a multicenter (40 French clinical sites) randomized, parallel-group trial, with a two-year follow-up comparing groups receiving standardized programs of cognitive training (group sessions), reminiscence therapy (group sessions), individualized cognitive rehabilitation program (individual sessions), and usual care (reference group). Six hundred fifty-three outpatients with Alzheimer's disease were recruited. The primary efficacy outcome was the rate of survival without moderately severe to severe dementia at two years. Secondary outcomes were cognitive impairment, functional disability, behavioral disturbance, apathy, quality of life, depression, caregiver's burden, and resource utilization.
No impact on the primary efficacy measure was evidenced. For the two group interventions (i.e. cognitive training and reminiscence), none of the secondary outcomes differed from usual care. The larger effect was seen with individualized cognitive rehabilitation in which significantly lower functional disability and a six-month delay in institutionalization at two years were evidenced.
These findings challenge current management practices of Alzheimer's patients. While cognitive-oriented group therapies have gained popularity, this trial does not show improvement for the patients. The individualized cognitive rehabilitation intervention provided clinically significant results. Individual interventions should be considered to delay institutionalization in Alzheimer's disease.
The aim of this study was to explore the cerebral correlates of functional deficits that occur in behavioral variant frontotemporal dementia (bvFTD). A specific neuropsychological battery, the Social cognition & Emotional Assessment (SEA; Funkiewiez et al., 2012), was used to assess impaired social and emotional functions in 20 bvFTD patients who also underwent structural MRI scanning. The SEA subscores of theory of mind, reversal-learning tests, facial emotion identification, and apathy evaluation were entered as covariates in a voxel-based morphometry analysis. The results revealed that the gray matter volume in the rostral part of the medial prefrontal cortex [mPFC, Brodmann area (BA) 10] was associated with scores on the theory of mind subtest, while gray matter volume within the orbitofrontal (OFC) and ventral mPFC (BA 11 and 47) was related to the scores observed in the reversal-learning subtest. Gray matter volume within BA 9 in the mPFC was correlated with scores on the emotion recognition subtest, and the severity of apathetic symptoms in the Apathy scale covaried with gray matter volume in the lateral PFC (BA 44/45). Among these regions, the mPFC and OFC cortices have been shown to be atrophied in the early stages of bvFTD. In addition, SEA and its abbreviated version (mini-SEA) have been demonstrated to be sensitive to early impairments in bvFTD (Bertoux et al., 2012). Taken together, these results suggest a differential involvement of orbital and medial prefrontal subregions in SEA subscores and support the use of the SEA to evaluate the integrity of these regions in the early stages of bvFTD. (JINS, 2012, 18, 972–985)
Alzheimer's disease (AD) has traditionally been defined as a type of dementia, a concept reinforced by the publication of the National Institute of Neurological and Communicative Disorders and Stroke–Alzheimer's Disease and Related Disorders (NINCDS–ADRDA) criteria in 1984 (Isaac et al., 2011). Three major tenets of these criteria were that (i) the clinical diagnosis of AD cannot be made with certainty and requires post-mortem confirmation; (ii) for that reason, the clinical diagnosis of AD can only be “probable”; and (iii) the diagnosis can be made only when the disease is advanced and reaches the threshold of dementia.
This chapter talks about a 70-year-old woman who consulted for a severe cognitive complaint encompassing numerous domains. MRI showed no focal atrophy especially of the hippocampal regions. The initial diagnostic impression was a subjective cognitive complaint with an attention disorder of probable psychogenic origin. Subjective cognitive complaint (SCC) is frequent in normal aging with a prevalence of 50% after 55 years of age. Episodic memory is the capacity to recall personal events that can be identified in time or in space. Memory disorders in everyday life can result from attention disorders, retrieval difficulties as well as genuine memory deficit due to Alzheimer's disease. The best way to disentangle the diagnostic problem is to assess memory by objective tests that may control for attention and that can facilitate the retrieval. This is the case of the Free and Cued Selected Recall Test (FCSRT).
Our knowledge of how the brain functions has markedly improved in recent years, but this improvement has largely been constrained to simpler levels of processing such as those involved in sensory or motor systems. In contrast, the neural bases of higher functions such as consciousness, will, long-term planning, complex problem- solving, etc., are still under investigation, although everyone agrees that the frontal lobes (FL) play an important role in such processes. The importance of understanding these neural bases of higher functions becomes even more evident in the study of aging, since a decrease of frontal lobe perfusion is reported during aging, and because this age-related frontal lobe dysfunction has been proposed to explain part of the cognitive disorders (attention disorders, decreased mental flexibility and abstraction) and behavioral changes (mainly apathy or indifference) associated with aging.
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