The September issue of the International Journal of Geriatric Psychiatry looks at national dementia strategies in a number of countries. The authors of a systematic review (open access) of studies looking at communication between people with Alzheimer’s Disease and their caregivers concluded that one technique was particularly effective
‘the use of memory aids combined with specific caregiver training programs’
In the online version of the Journal of Clinical Psychiatry there’s an interesting study on factors associated with good ECT response in older adults (Oudega et al, 2010). This a naturalistic cohort study with a sample size of 81. The authors found that while white matter hyperintensities or global atrophy weren’t associated with differences in response, Medial Temporal Lobe atrophy (MTA) was. On the Montgomery Asberg Depression Scale, MTA was associated with an almost 50% reduction in response compared to those without MTA and this was significant at the 1% level. This is interesting in terms of other research suggesting an association between ECT response and an increase in hippocampal volume (as in this small study) as well as other research suggesting a role for various nerve growth factors. Nevertheless it would be good to see further replication of these findings and it would be particularly interesting to look at what happens to hippocampal volume (if anything) after treatment in a similar sample population.
A small Japanese study showed evidence for factors influencing response to Donepezil including age (inverse), duration of executive dysfunction and time to diagnosis. These are interesting findings but again it would be good to see replication studies with large numbers. In terms of molecular pathology, a recent study from Japan shows evidence of a relationship between insulin resistance and amyloid plaque but not neurofibrillary tangle development. There is other research which has produced different results but there is a write-up of the study over at the Alzheimer’s Forum. After undertaking a systematic review, one group have called for the development of a multidomain rating scale for use in Alzheimer’s Disease and to monitor progress – the paper is open access.
A small Brazilian study looked at the interaction between vascular and other risk factors and cognitive decline in vascular dementia. The researchers found that after controlling for vascular risk factors education was significantly associated with decline. This reinforces previous research suggesting that increasing years of education are a protective factor for dementia although the literature also shows that the relationship is complicated and that education influences the rate at which decline occurs.
The authors of a review article in the Journal of Neurology, Neurosurgery and Psychiatry recommend an increase in referrals for genetic testing in cases of EOAD (Early Onset Alzheimers Disease) and IPD (Inherited Prion Disease) on the basis of case ascertainment from two UK genetic testing centres. Higher (but not lower) T3 levels were associated with decreased performance on memory and visuospatial tasks in a small case control study involving people with Mild Cognitive Impairment and healthy controls. The results for other hormones were non-significant. Briefly white matter hyperintensities in parietal networks were associated with deterioration in executive performance in MCI, diabetes at baseline was associated with a higher prevalence of AD and VaD in this large prospective study, larger temporal lobe volume was suggested to be a protective factor for Alzheimer’s Disease when there is a large Beta-Amyloid load in this PET study and specific variants of the Alzheimer’s Disease associated genes CLU and PICALM were associated with cognitive performance in the ‘oldest old’ in this study.
Mind Hacks has another interesting round-up of Spike Activity here.
Drugs in the Pipeline
There’s another paper from the Journal of Clinical Psychiatry that looks at potential future antidepressants that are in the early stages of research and from the following classes
– Serotonergic drugs
– Triple uptake inhibitors
– Glutamergic drugs
– Neurokinin based interventions
– Neurogenesis based drugs
– Nicotinic agents
In Alzheimer’s Disease research, the Gamma Secretase inhibitors have been problematic as they inhibit not only the desired enzyme but also the functions of the NOTCH protein which has many important biological functions. At the Alzheimer’s Forum, the authors write about recent research published in Nature in which the researchers developed a compound that inhibits Gamma Secretase effectively but not the NOTCH protein functions and it will be interesting to follow subsequent research in this area.
Oudega M et al. White Matter Hyperintensities, Medial Temporal Lobe Atrophy, Cortical Atrophy and Response to Electroconvulsive Therapy in Severely Depressed Elderly Patients. J Clin Psychiatry. 2010. (http://article.psychiatrist.com/dao_1-login.asp?ID=10007043&RSID=27349464415372).
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