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Advanced Dementia

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https://www.readbyqxmd.com/read/29040344/dilemmas-for-guardians-of-advanced-dementia-patients-regarding-tube-feeding
#1
Efrat Gil, Maayan Agmon, Ayal Hirsch, Miriam Ziv, Anna Zisberg
Background: advanced dementia is an incurable illness, its last stage marked by inability to eat. Tube feeding was deemed a helpful solution at this stage, but in recent years its inefficiency has been proved, and it is no longer practiced in many countries around the world. In Israel, however, the procedure is still accepted. In the gastroenterology department at the Bnai Zion Medical Center, a serious interaction is ongoing with patients' legal guardians, where detailed information is given about the inefficiency of the tube procedure...
October 13, 2017: Age and Ageing
https://www.readbyqxmd.com/read/29034646/index-of-theta-alpha-ratio-of-the-quantitative-electroencephalogram-in-alzheimer-s-disease-a-case-control-study
#2
Golshan Fahimi, Seyed Mahmoud Tabatabaei, Elnaz Fahimi, Hamid Rajebi
Alzheimer's disease (AD) is a devastating neurodegenerative disorder in human beings associated with cognitive, behavioral and motor impairments. The main symptom of AD is dementia, which causes difficulties in carrying out daily practices. Brain waves are altered in people with AD. Relative indices of brain waves can be beneficial in the diagnosis of AD. In this case-control study, 50 patients with AD and 50 matched healthy individuals were enrolled in case and control groups respectively. With recording and analyzing of brain waves with the utilization of quantitative electroencephalogram (QEEG), index of theta/alpha ratio was assessed in both groups...
August 2017: Acta Medica Iranica
https://www.readbyqxmd.com/read/29031901/als-and-ftd-insights-into-the-disease-mechanisms-and-therapeutic-targets
#3
Rajka M Liscic
Amyotrophic lateral sclerosis (ALS) and frontotemporal lobar degeneration (FTLD) are neurodegenerative disorders, related by signs of deteriorating motor and cognitive functions, and short survival. The causes are still largely unknown and no effective treatment currently exists. It has been shown that FTLD may coexist with ALS. The overlap between ALS and frontotemporal dementia (FTD), the clinical syndrome associated with FTLD, occurs at clinical, genetic, and pathological levels. The hallmark proteins of the pathognomonic inclusions are SOD-1, TDP-43 or FUS, rarely the disease is caused by mutations in the respective genes...
October 11, 2017: European Journal of Pharmacology
https://www.readbyqxmd.com/read/29025435/withania-somnifera-as-a-potential-candidate-to-ameliorate-high%C3%A2-fat-diet-induced-anxiety-and-neuroinflammation
#4
Taranjeet Kaur, Gurcharan Kaur
BACKGROUND: The epidemic of obesity has reached alarming levels in both developing and developed nations. Excessive calorie intake and sedentary lifestyle due to technological advancements are the main causal factors for overweight and obesity among the human population. Obesity has been associated with a number of co-morbidities such as hypertension, type 2 diabetes mellitus, cardiovascular diseases, and neurodegeneration and dementia. The progression of neurological disorders in obese subjects has been mainly attributed to neuroinflammation...
October 12, 2017: Journal of Neuroinflammation
https://www.readbyqxmd.com/read/29023452/functional-imaging-of-cognition-in-an-old-old-population-a-case-for-portable-functional-near-infrared-spectroscopy
#5
Theodore J Huppert, Helmet Karim, Chia-Cheng Lin, Bader A Alqahtani, Susan L Greenspan, Patrick J Sparto
In this study, functional near-infrared spectroscopy (fNIRS) was used to record brain activation during cognitive testing in older individuals (88±6yo; N = 19) living in residential care communities. This population, which is often associated with loss of personal independence due to physical or cognitive decline associated with aging, is also often under-represented in neuroscience research because of a limited means to participate in studies which often take place in large urban or university centers. In this study, we demonstrate the feasibility and initial results using a portable 8-source by 4-detector fNIRS system to measure brain activity from participants within residential care community centers...
2017: PloS One
https://www.readbyqxmd.com/read/29017626/case-series-of-mild-behavioral-impairment-toward-an-understanding-of-the-early-stages-of-neurodegenerative-diseases-affecting-behavior-and-cognition
#6
Alicja Cieslak, Eric E Smith, John Lysack, Zahinoor Ismail
Mild behavioral impairment (MBI) is characterized by later life acquired, sustained, and impactful neuropsychiatric symptoms (NPS) of any severity that cannot be better accounted for by other formal medical and psychiatric nosology. MBI is an "at risk" state for incident cognitive decline and dementia, and for some, MBI is the index manifestation of neurodegeneration, observed in advance of cognitive impairment. Initially described in Frontotemporal Dementia (FTD), MBI evolved to describe a preclinical stage of all cause dementia, and has been operationalized in the International Society to Advance Alzheimer's Research and Treatment-Alzheimer's Association (ISTAART-AA) proposed research diagnostic criteria...
October 11, 2017: International Psychogeriatrics
https://www.readbyqxmd.com/read/28994390/clearance-of-beta-amyloid-is-facilitated-by-apolipoprotein-e-and-circulating-high-density-lipoproteins-in-bioengineered-human-vessels
#7
Jerome Robert, Emily B Button, Brian Yuen, Megan Gilmour, Kevin Kang, Arvin Bahrabadi, Sophie Stukas, Wenchen Zhao, Iva Kulic, Cheryl L Wellington
Amyloid plaques, consisting of deposited beta-amyloid (Aβ), are a neuropathological hallmark of Alzheimer's Disease (AD). Cerebral vessels play a major role in AD, as Aβ is cleared from the brain by pathways involving the cerebrovasculature, most AD patients have cerebrovascular amyloid (cerebral amyloid angiopathy (CAA), and cardiovascular risk factors increase dementia risk. Here we present a notable advance in vascular tissue engineering by generating the first functional 3-dimensioinal model of CAA in bioengineered human vessels...
October 10, 2017: ELife
https://www.readbyqxmd.com/read/28991666/educational-attainment-and-motor-burden-in-advanced-parkinson-s-disease-the-emerging-role-of-education-in-motor-reserve
#8
Josefine Blume, Eva Rothenfusser, Jürgen Schlaier, Ulrich Bogdahn, Max Lange
OBJECTIVE: To explore the relationship of motor burden and educational attainment in patients with advanced stage PD. MATERIALS AND METHODS: We included 102 consecutive patients who underwent a complete evaluation for DBS surgery, including detailed neuropsychological testing and UPDRSIII in a standardized Levodopa challenge. Years of education (YoE) were calculated as the highest grade attained in secondary school plus years for post-secondary training. RESULTS: The OFF medication UPDRS-III score was associated with YoE (p=0...
October 15, 2017: Journal of the Neurological Sciences
https://www.readbyqxmd.com/read/28990351/human-capabilities-in-advanced-dementia-nussbaum-s-approach
#9
Catharina Melander, Stefan Sävenstedt, Britt-Marie Wälivaara, Malin Olsson
AIMS AND OBJECTIVES: To explore how Martha Nussbaum's approach to human capabilities can apply to dignity in the lives of people with advanced dementia living in nursing homes. BACKGROUND: Challenges experienced when supporting people with advanced dementia who express problematic behaviours include understanding their needs and ensuring a dignified life for them. DESIGN AND METHODS: Data were gathered using an ethnographic approach based on participatory observation...
October 9, 2017: International Journal of Older People Nursing
https://www.readbyqxmd.com/read/28988561/discussing-advance-care-planning-insights-from-older-people-living-in-nursing-homes-and-from-family-members
#10
Francesca Ingravallo, Veronica Mignani, Elena Mariani, Giovanni Ottoboni, Marie Christine Melon, Rabih Chattat
BACKGROUND: Evidence concerning when and in which manner older people living in nursing homes (NHs) would prefer to discuss advance care planning (ACP) is still scarce. This study explored the attitudes of NH residents and family members toward ACP and their opinions as to the right time to broach the subject, the manner in which it should be approached, and the content of ACP. METHODS: This was a qualitative study using face-to-face interviews with 30 residents (age range 66-94), and 10 family members from 4 Italian NHs...
October 9, 2017: International Psychogeriatrics
https://www.readbyqxmd.com/read/28985257/potentially-inappropriate-medication-among-people-with-dementia-in-eight-european-countries
#11
Anna Renom-Guiteras, Petra A Thürmann, Ramón Miralles, Renate Klaaßen-Mielke, Ulrich Thiem, Astrid Stephan, Michel H C Bleijlevens, David Jolley, Helena Leino-Kilpi, Ingalill Rahm Hallberg, Kai Saks, Maria Soto-Martin, Adelaida Zabalegui, Gabriele Meyer
Objectives: to evaluate the frequency of potentially inappropriate medication (PIM) prescription among older people with dementia (PwD) from eight countries participating in the European study 'RightTimePlaceCare', and to evaluate factors and adverse outcomes associated with PIM prescription. Methods: survey of 2,004 PwD including a baseline assessment and follow-up after 3 months. Interviewers gathered data on age, sex, prescription of medication, cognitive status, functional status, comorbidity, setting and admission to hospital, fall-related injuries and mortality in the time between baseline and follow-up...
September 1, 2017: Age and Ageing
https://www.readbyqxmd.com/read/28982489/palliative-care-in-neurology
#12
REVIEW
Maisha T Robinson, Robert G Holloway
Palliative medicine is a specialty that focuses on improving the quality of life for patients with serious or advanced medical conditions, and it is appropriate at any stage of disease, including at the time of diagnosis. Neurologic conditions tend to have high symptom burdens, variable disease courses, and poor prognoses that affect not only patients but also their families and caregivers. Patients with a variety of neurologic conditions such as Parkinson disease, dementia, amyotrophic lateral sclerosis, brain tumors, stroke, and acute neurologic illnesses have substantial unmet needs that can be addressed through a combination of primary and specialty palliative care...
October 2017: Mayo Clinic Proceedings
https://www.readbyqxmd.com/read/28981694/protecting-me-from-my-directive-ensuring-appropriate-safeguards-for-advance-directives-in-dementia
#13
Cressida Auckland
With one in six people over 80 now suffering from dementia, advance directives provide an important means of empowerment. Upholding directives in the context of dementia, however, raises extra challenges, given the potential for the directive to conflict with an assessment of what is in the person's current best interests. Given the profound harm that tying a person with dementia to their previous wishes can do, it is essential that we have sufficient safeguards in place to ensure that we only uphold such directives where we can be sure they are truly autonomous and are intended to apply to the situation at hand-safeguards which are at present, severely lacking...
August 16, 2017: Medical Law Review
https://www.readbyqxmd.com/read/28975616/percutaneous-feeding-tubes-in-individuals-with-advanced-dementia-are-physicians-choosing-wisely
#14
Marzena Gieniusz, Liron Sinvani, Andrzej Kozikowski, Vidhi Patel, Christian Nouryan, Myia S Williams, Nina Kohn, Renee Pekmezaris, Gisele Wolf-Klein
OBJECTIVES: To evaluate physician knowledge and perceptions about the American Board of Internal Medicine/American Geriatrics Society (ABIM/AGS) Choosing Wisely recommendations regarding percutaneous endoscopic gastrostomy (PEG) in individuals with advanced dementia. DESIGN: Multicenter, mixed-mode, anonymous questionnaire. SETTING: Three tertiary and four community hospitals in New York. PARTICIPANTS: Internal medicine physicians (N = 168)...
October 4, 2017: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/28969014/do-cancer-patients-with-dementia-receive-less-aggressive-treatment-in-end-of-life-care-a-nationwide-population-based-cohort-study
#15
Huei-Kai Huang, Jyh-Gang Hsieh, Chia-Jung Hsieh, Ying-Wei Wang
Dementia is a progressive, incurable disease that can deprive patients of the ability to make decisions. This study determines whether dementia influences the medical care that a cancer patient receives at the end of life. We conducted a nationwide population-based cohort study on patients aged ≥20 with newly diagnosed cancer during 2000-2012. After matching to reduce confounders, there were 7,111 patients with and 28,444 without dementia. The adjusted odd ratios (OR) for medical interventions, including intensive care, palliative care, invasive procedures, and advanced diagnostic testing, were calculated for the final month and three months of life by a multiple logistic regression model...
September 8, 2017: Oncotarget
https://www.readbyqxmd.com/read/28966021/impaired-cardiac-function-and-cognitive-brain-aging
#16
REVIEW
Isabelle F van der Velpen, Clyde W Yancy, Farzaneh A Sorond, Behnam Sabayan
It is well established that patients with heart failure are at a greater risk for dementia. Recent evidence suggests that the heart-brain link goes beyond advanced heart failure, and even suboptimal cardiac function is associated with brain structural and functional changes leading to cognitive impairment. In this review, we address several pathophysiological mechanisms underlying this association, including hemodynamic stress and cerebral hypoperfusion, neuroinflammation, cardiac arrhythmias, and hypercoagulation...
July 20, 2017: Canadian Journal of Cardiology
https://www.readbyqxmd.com/read/28965503/assessing-bpsd-with-the-support-of-the-npi-nh-a-discourse-analysis-of-clinical-reasoning
#17
Catharina Melander, Stefan Sävenstedt, Malin Olsson, Britt-Marie Wälivaara
BACKGROUND: The ability of nursing staff to assess and evaluate behavioral and psychological symptoms of dementia (BPSD) to determine when intervention is needed is essential. In order to assist with the assessment process, the current use of the Neuropsychiatric Inventory Nursing Home version (NPI-NH) is internationally accepted. Even though the NPI-NH is thoroughly validated and has several advantages, there are also various challenges when implementing this system in practice. Thus, the aim of this study was to explore clinical reasoning employed by assistant nurses when utilizing the NPI-NH as a tool to assess frequency and severity of BPSD in individuals with advanced dementia...
October 2, 2017: International Psychogeriatrics
https://www.readbyqxmd.com/read/28965295/comprehensive-and-methodical-diagnostic-and-management-approaches-to-rapidly-progressive-dementia
#18
REVIEW
Supriya Mahajan, Brian S Appleby
Purpose of review The sudden emergence of a change in cognitive abilities or behavior is an important symptom that warrants medical evaluation and may represent the early stages of a rapidly progressive dementia (RPD). To correctly ascertain the cause of RPD in a given patient, the clinician must be methodical and knowledgeable about the range of potential causes and must move forward with supportive treatment, and in some cases empiric treatment, based on clinical features alone. Recent findings Significant advances in prion disease biomarkers, the molecular features of rapidly progressive Alzheimer's disease, and new detection of autoimmune limbic encephalitis disease entities have caused a shift in the diagnostic and treatment framework of RPD...
September 30, 2017: Current Treatment Options in Neurology
https://www.readbyqxmd.com/read/28963060/dna-versus-rna-oxidation-in-parkinson-s-disease-which-is-more-important
#19
K Gmitterová, J Gawinecka, U Heinemann, P Valkovič, I Zerr
BACKROUND: 8-hydroxy-2 deoxyguanosine (8-OHdG) and the 8-hydroxyguanosine (8-OHG) are the most widely used biomarkers of nucleoside oxidation affecting DNA and RNA and are considered reliable markers of oxidative stress. Increased levels of these markers are found in the various biological fluids of patients with neurodegenerative disorders. OBJECTIVE: The primary aim of our study was to assess the differences of investigated markers between patient groups and subsequently study the influence of clinical factors that might modify the levels of investigated markers during the disease progression...
September 27, 2017: Neuroscience Letters
https://www.readbyqxmd.com/read/28962505/inoperable-patients-with-acute-type-a-dissection-are-they-candidates-for-endovascular-repair
#20
Eric E Roselli, Saad M Hasan, Jay J Idrees, Muhammad Aftab, Matthew J Eagleton, Venu Menon, Lars G Svensson
OBJECTIVES: The objectives are to (i) report characteristics and outcomes of patients with inoperable acute type A aortic dissection, (ii) describe proximal aortic morphology and (iii) identify potential for endovascular treatment of the entry tear. METHODS: Fifty-three (7.7%) of 686 patients with acute type A dissection between 2005 and 2015 were deemed inoperable. Chart review and active follow-up were performed for clinical characteristics and outcomes. Specific attention was directed at determining the reasons for inoperability...
October 1, 2017: Interactive Cardiovascular and Thoracic Surgery
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