Lending a helping eye: artists in residence at a memory clinic.

An artist-in-residence programme at the Capital Health Memory Clinic in Halifax, Canada, was established 6 years ago. The artists contribute to the clinic's academic mission by helping to describe how Alzheimer's disease treated by cholinesterase inhibitors is providing a better understanding of human cholinergic neurotransmission. The artists also contribute to the clinical programme by helping to establish a therapeutic ambience, and by allowing clinicians to see themselves through their patients' eyes.

Differential effects of lipid-lowering agents on human cholinesterases.

Objectives: Epidemiologic reports indicate that lipid-lowering agents (LLAs) protect against dementia. We hypothesized that LLAs might affect cholinergic systems. The effects of LLAs on the activity of cholinesterases were examined.

Variations in case definition affect prevalence but not outcomes of mild cognitive impairment.

Objective: To examine the prevalence estimates and 5-year outcomes of various case definitions of mild cognitive impairment (MCI).

Methods: The authors examined 1,790 adults 65 years of age or older who completed neuropsychological and clinical assessments in the Canadian Study of Health and Aging, a 5-year, representative, prospective cohort study.

Results: The most commonly used case definition of MCI yielded a population prevalence estimate of 1.

The feasibility of performing resistance exercise with acutely ill hospitalized older adults.

Background: For older adults, hospitalization frequently results in deterioration of mobility and function. Nevertheless, there are little data about how older adults exercise in the hospital and definitive studies are not yet available to determine what type of physical activity will prevent hospital related decline. Strengthening exercise may prevent deconditioning and Pilates exercise, which focuses on proper body mechanics and posture, may promote safety.

The treatment of Alzheimer's disease: success short of cure.

Metaphor has an important role in the discussion of scientific discovery because it enables researchers to talk about things of which their understanding is incomplete. Alzheimer's disease (AD) can be seen as a journey down a path, which becomes steadily less pleasant and ends in a wholly undesirable destination. To further the metaphor, treatments can be seen as attempts to help the patient return to the starting point, to slow the journey, or to stop at some point on the path.

The risk of dementia in relation to statins and other lipid lowering agents.

Recent epidemiological reports suggest that statins, and possibly other lipid lowering agents, might be protective for Alzheimer disease, and for other types of dementia. Importantly, however, epidemiological reports of this type are susceptible to indication bias, i.e.

Responsiveness of goal attainment scaling in a randomized controlled trial of comprehensive geriatric assessment.

Background And Objective: Frail elderly patients have complex problems that require a multidimensional assessment and a range of treatment goals. Goal Attainment Scaling (GAS) measures multiple, individualized goals, but its responsiveness in comparative clinical trials has not been established.

Methods: We assessed the responsiveness of GAS in a randomized, controlled trial of an interdisciplinary Mobile Geriatric Assessment Team (MGAT) in 265 rural frail older adults.

The Consortium to Investigate Vascular Impairment of Cognition: methods and first findings.

Background: The Consortium to Investigate Vascular Impairment of Cognition (CIVIC) is a Canadian, multi-centre, clinic-based prospective cohort study of patients with Vascular Cognitive Impairment (VCI). We report its organization and the impact of diagnostic criteria on the study of VCI.

Methods: Nine memory disability clinics enrolled patients and recorded their usual investigations and care.

Vascular cognitive impairment.

Cerebrovascular disease is the second most common cause of acquired cognitive impairment and dementia and contributes to cognitive decline in the neurodegenerative dementias. The current narrow definitions of vascular dementia should be broadened to recognise the important part cerebrovascular disease plays in several cognitive disorders, including the hereditary vascular dementias, multi-infarct dementia, post-stroke dementia, subcortical ischaemic vascular disease and dementia, mild cognitive impairment, and degenerative dementias (including Alzheimer's disease, frontotemporal dementia, and dementia with Lewy bodies). Here we review the current state of scientific knowledge on the subject of vascular brain burden.

Help available--phenomenological models for research on aging.

In "Help Wanted: Physiologists for Research on Aging," George Martin challenged the scientific community to find better means of tackling aging of the whole organism. Although initiatives such as those proposed by Martin would be most welcome, we propose an additional means by which scientists can take into account the integrative response of the organism and its changes over time. This method consists of systematizing facts that cannot necessarily be explained by considering those facts in isolation.

The accumulation of deficits with age and possible invariants of aging.

This paper extends a method of apprising health status to a broad range of ages from adolescence to old age. The "frailty index" is based on the accumulation of deficits (symptoms, signs, disease classifications) as analyzed in the National Population Health Survey, a representative Canadian population sample (n = 81,859). The accumulation of deficits has both an age-independent (background) component and an age-dependent (exponential) component, akin to the well-known Gompertz-Makeham model for the risk of mortality.

Inhibition of human cholinesterases by drugs used to treat Alzheimer disease.

Current approaches to the treatment of cognitive and behavioral symptoms of Alzheimer disease emphasize the use of cholinesterase inhibitors. The kinetic effects of the cholinesterase inhibitors donepezil, galantamine, metrifonate, physostigmine, rivastigmine, and tetrahydroaminoacridine were examined with respect to their action on the esterase and aryl acylamidase activities of human acetylcholinesterase (AChE) and human butyrylcholinesterase (BuChE). Each of these drugs inhibited both AChE and BuChE, but to different degrees.

Five-year outcomes for dementia defined solely by neuropsychological test performance.

Cognitive impairment that does not meet criteria for dementia is common and progresses to dementia at a high rate. It is not clear how best to define this type of cognitive impairment. We assessed the predictive validity of different case definitions for cognitive impairment and dementia by comparing rates of adverse outcomes for individuals who did not meet dementia criteria but had neuropsychological test results indicating dementia (NPDementia), those who had traditional dementia diagnoses (mild and moderate-severe severity), those who had other cognitive impairment but no dementia (CIND), and those with no cognitive impairment (NCI).

Five-year follow-up of cognitive impairment with no dementia.

Context: The importance of early identification of dementia has prompted numerous investigations of mild cognitive impairment and the preclinical stages of progressive degenerative disorders. To date, there is limited information from large-scale studies regarding outcomes of persons specifically identified with cognitive impairment but no dementia (CIND).

Objectives: To investigate outcomes for persons with no cognitive impairment (NCI) or CIND, focusing on its etiologic subcategories, from the Canadian Study of Health and Aging (CSHA) and to examine the predictive validity of a set of core features thought to be early manifestations of subsequent dementia.

Techniques for knowledge discovery in existing biomedical databases: estimation of individual aging effects in cognition in relation to dementia.

New interest is being expressed in the systematic application of modeling techniques to existing datasets. Under the rubric of Knowledge Discovery in Databases (KDD) large databases are being exploited for commercial and scientific purposes. This article reviews the development and applications of KDD techniques to dementia, using the longitudinal Canadian Study of Health and Aging dataset.

Vascular dementia.

Vascular dementia (VaD) is a term used to describe a particular constellation of cognitive and functional impairment, and is now generally seen as a subset of the larger syndrome of vascular cognitive impairment (VCI). The latter is seen as cognitive impairment in the face of cerebrovascular disease. VCI can be classified clinically by whether patients meet criteria for dementia, and whether the syndrome is distinct or overlaps with primary neurodegenerative diseases, such as Alzheimer's disease.

Prognostic factors for functional independence in older adults with mild dementia: results from the canadian study of health and aging.

We investigated the prevalence of and prognostic factors for functional independence in personal activities of daily living in a population-based sample of 90 seniors with mild dementia from the Canadian Study of Health and Aging. Personal activities of daily living were assessed from the report of proxy respondents at baseline and at the 5-year follow-up (or retrospectively if death had occurred). Sixteen (17.

Patterns of clinically detectable treatment effects with galantamine: a qualitative analysis.

The Clinician's Interview Based Impression of Change, plus carer interview (CIBIC-Plus) is widely used in anti-dementia drug trials. It includes clinicians' notes about patients' behaviour, function, and cognition, and a 7-point clinical global impression of change scale that summarizes patients' changes during treatment. We analyzed the narrative content of clinicians' notes from a randomized, controlled trial of galantamine, an anti-Alzheimer's disease drug, and identified varying degrees of improvement and decline.

APOE genotype, memory test performance, and the risk of Alzheimer's disease in the Canadian Study of Health and Aging.

Objectives: This study examined the relation between two risks for Alzheimer's disease (AD): the apolipoprotein (APOE) epsilon4 allele and poor memory test performance.

Methods: In the Canadian Study of Health and Aging (CSHA), a 5-year longitudinal population-based study that screened and followed over 10,000 participants, 2,914 had an initial clinical assessment and 1,624 had APOE genotype testing. All participants were categorized as having no cognitive impairment, cognitive impairment but no dementia, or dementia at both baseline and follow-up.

The mortality rate as a function of accumulated deficits in a frailty index.

In a representative Canadian population survey (n=66589) the proportion of accumulated deficits in a frailty index showed a linear relationship with mortality in a log-log plot, such that the mortality rate was a power-law function of the frailty index. Represented in this way, the frailty index readily summarizes individual differences in health status. The exponent and amplitude parameters of the power function are gender specific, reflecting that while, on average, women accumulate more deficits than men of the same age, their risk of mortality is lower.

Vascular cognitive impairment and vascular dementia.

The criteria for vascular dementia (VaD) depend on first diagnosing dementia using Alzheimer-type criteria, upon which are superimposed vascular events, usually following a stroke model. This if often inappropriate, however, as memory loss is not always prominent in VaD. Alzheimer-type criteria will not detect these patients, and much brain injury can occur without resulting in classical features of stroke.

Improving clinical descriptions to understand the effects of dementia treatment: consensus recommendations.

Objectives: To recommend how the description of clinically detectable treatment effects might be improved for antidementia drug trials.

Method: Consensus conference, with review of available evidence.

Results: We suggest widespread, systematic, qualitative studies, based on prospective observations such as the clinicians' narrative descriptions of patient's changes used in the Clinician's Interview-Based Impressions of Change (CIBIC-Plus), plus caregiver input.