Modeling Alzheimer Disease Through Functional Independence and Participation.

INTRODUCTION: The relationship between cognitive and functional impairment in Alzheimer Disease (AD) at the earliest stages of the disease is not well characterized. This study aimed at investigating such relationships along AD evolution by means of the Disability Assessment for Dementia (DAD). METHODS: Consecutive pairs of AD outpatients and their primary informal caregivers were enrolled. Patients were evaluated by means of the Mini Mental State Examination and neuropsychological tests. A clinician completed the Clinical Dementia Rating Scale to stage dementia severity and interviewed the caregivers to complete the Neuropsychiatric Inventory to assess behavioral disturbances and the DAD to evaluate patients' functional competence. RESULTS: A total of 158 dyads were enrolled; the Mini Mental State Examination score was used to stratify patients into 4 groups (>24; 20 to 23.9; 10 to 19.9; <10) that were compared. The statistical analysis revealed that all the cognitive domains were positively related to functional independence, but only logical and executive functions seemed to predict autonomy. An intergroup comparison did not show significant differences in the DAD subscales measuring initiation, planning and organization, and performance. The role of education emerged, confirming the relevance of cognitive reserve. DISCUSSION: As the field moves toward earlier intervention in preclinical AD, the detection of early functional changes may drive the definition of trials on prevention or intervention for dementia.

Memantine in Alzheimer's disease: experience in an Alzheimer's disease assessment unit.

BACKGROUND AND AIMS: Memantine is an uncompetitive N-methyl-D-aspartate receptor antagonist. Clinical and observational studies have demonstrated its efficacy on both cognitive and behavioral symptoms of moderate-to-severe Alzheimer's disease (AD) and described its good safety and tolerability profile. We report here our experience with memantine in patients with AD during a two-year follow-up. METHODS: From June 2005 to May 2010, memantine was given to 201 outpatients with moderate-to-severe AD: 93 patients were concomitantly receiving treatment with acetyl cholinesterase inhibitors (AChEIs) (Group 1) and the other 108 were prescribed memantine as monotherapy (Group 2). All patients were administered the following scales: Mini Mental State Examination, Activities of Daily Living, Instrumental Activities of Daily Living, Neuropsychiatric Inventory. We report the results of followup assessments conducted at six months and 1, 2 and 3 years. RESULTS: Sixteen patients (8%) stopped treatment within the first month because of side-effects. In each group, about 20% of subjects showed no deterioration at six months and 1 year, and this proportion decreased only slightly at 2 years. Higher NPI scores at baseline and psychotropic drug use emerged as factors significantly related to reduced response to treatment (p<0.01). CONCLUSIONS: Results confirmed the short-term effect of memantine, both in monotherapy and in combination with AchEIs in moderate-to-severe AD. This efficacy, albeit slight, was found to persist in the longer term.

Differences between physician and caregiver evaluations in Alzheimer's disease.

In Alzheimer's disease (AD) differences are often reported between caregivers' and physicians' aims and evaluations. The aim of this study was to investigate the presence of discrepancies between the evaluations of caregivers and physicians. Two hundred and eighteen caregivers of outpatients diagnosed with mild-to-moderate AD, referred to our Alzheimer's Disease Assessment Unit, entered the study. Caregiver burden was investigated using the Caregiver Burden Inventory (CBI) and the Neuropsychiatric Inventory Caregiver Distress Scale (NPIDS). Caregivers were also administered a four-point scale to assess quantitatively whether their expectations in relation to the efficacy of the pharmacological treatment had been satisfied and a scale exploring clinical global impression of change. Caregivers whose expectations had not been satisfied had significantly higher CBI and NPIDS scores and a lower level of education; moreover, caregivers tended to overestimate the degree of cognitive decline during the course of the disease. These results underline the importance of correct and constant communication with AD patients and their families.