Small Vessel Cerebrovascular Pathology Identified by Magnetic Resonance Imaging Is Prevalent in Alzheimer's Disease and Mild Cognitive Impairment: A Potential Target for Intervention.

Background: There is evidence that Alzheimer's disease (AD) has significant cerebrovascular etiopathogenesis. Understanding potentially modifiable risk factors for vascular disease can help design long-term intervention strategies for controlling or preventing cognitive dysfunction attributable to cerebrovascular disease.

Objective: To evaluate the presence and severity of markers of cerebrovascular pathology, its relationship to diagnostic categories of dementia, including AD, and association with the metabolic biomarker homocysteine.

The relationship between plasma amyloid-β peptides and the medial temporal lobe in the homebound elderly.

Background: The ratio of high amyloid-β peptide40 (Aβ40) and low Aβ42 in plasma predicts the risk of Alzheimer's disease (AD) and is associated with episodic recall in depression. We thus examined the relationship between plasma Aβ levels and brain volumes.

Methods: Homebound elders (N = 352) who had undergone brain MRI were used.

Depression and glycemic intake in the homebound elderly.

Background: Depression is associated with an increase in the incidence of type 2 diabetes, but the mechanism is unclear. We aimed to study the relationship between depression and glycemic intake in the elderly, and examine whether antidepressant use modified this relationship.

Design, Setting And Participants: We evaluated 976 homebound elders in a cross-sectional study.

Functional expressions of the aging brain.

In the conventional view, aging of the brain is associated with atrophy vascular abnormalities and loss of volume in hippocampus and amygdala. Cognitively, aging is associated with slowing of processing and memory loss. However, many studies of aging do not examine the cases to exclude demented people.

Plasma Amyloid-β Peptides and Homocysteine in Depression in the Homebound Elderly.

Objectives: Both plasma amyloid-β peptide 40 (Aβ40) and homocysteine (tHcy) are linked to vascular disease, which is related to depression in the elderly. We sought to study whether the relationship between tHcy and plasma Aβ40 differs in those with and without depression.

Study Design And Methods: In a cross-sectional study of 1058 homebound elders, vascular depression was defined as a score ≥ 16 on the Center for Epidemiological Studies Depression scale (CES-D) along with self-reported cardiovascular disease (CVD).

Depression and plasma amyloid beta peptides in the elderly with and without the apolipoprotein E4 allele.

Depression associated with low plasma amyloid-beta peptide 42 (Abeta42) leading to a high ratio of Abeta40/Abeta42, a biomarker of Alzheimer disease (AD), may represent a unique depression subtype. The relationship between low plasma Abeta42 in depression and the major risk factor of AD, apolipoprotein E4 (ApoE4), is unknown. With the goal of clarifying this relationship, we analyzed 1060 homebound elders with ApoE characterization and depression status in a cross-sectional study.

Diffusion tensor imaging, white matter lesions, the corpus callosum, and gait in the elderly.

Background And Purpose: Gait impairment is common in the elderly, especially those with stroke and white matter hyperintensities on conventional brain MRI. Diffusion tensor imaging (DTI) is more sensitive to white matter damage than conventional MRI. The relationship between DTI measures and gait has not been previously evaluated.

Validity of estimated dietary eicosapentaenoic acid and docosahexaenoic acid intakes determined by interviewer-administered food frequency questionnaire among older adults with mild-to-moderate cognitive impairment or dementia.

Epidemiologic research is increasingly being focused on elderly persons, many of whom exhibit mild-to-moderate cognitive impairment. This presents a challenge for collection and interpretation of self-reported dietary data. There are few reports on the impact of cognitive function and dementia on the validity of self-reported dietary intakes.

Vitamin D is associated with cognitive function in elders receiving home health services.

Background: The objective of this study was to examine the association between 25-hydroxyvitamin D, 25(OH)D, and cognitive function.

Methods: A cross-sectional investigation of 25(OH)D and cognition was completed in 377 black and 703 non-black (mainly Caucasian) elders (65-99 years) participating in the nutrition and memory in elders study. Participants underwent a comprehensive neuropsychological battery, and 25(OH)D concentrations were obtained.

Albuminuria, cognitive functioning, and white matter hyperintensities in homebound elders.

Background: Albuminuria, a kidney marker of microvascular disease, may herald microvascular disease elsewhere, including in the brain.

Study Design: Cross sectional.

Setting & Participants: Boston, MA, elders receiving home health services to maintain independent living who consented to brain magnetic resonance imaging.

Amyloid-associated depression: a prodromal depression of Alzheimer disease?

Context: A high ratio of plasma amyloid-beta peptide 40 (Abeta(40)) to Abeta(42), determined by both high Abeta(40) and low Abeta(42) levels, increases the risk of Alzheimer disease. In a previous study, we reported that depression is also associated with low plasma Abeta(42) levels in the elderly population.

Objective: To characterize plasma Abeta(40):Abeta(42) ratio and cognitive function in elderly individuals with and without depression.

Depression, antidepressants, and plasma amyloid beta (Beta) peptides in those elderly who do not have cardiovascular disease.

Background: Low plasma amyloid-beta peptide 42 (Abeta42) is associated with depressive symptoms independently of cardiovascular disease (CVD) in the elderly. It is critical to investigate whether antidepressants modify this relationship.

Methods: We evaluated 324 elders without CVD in a cross-sectional study.

The homocysteine hypothesis of depression.

High levels of homocysteine are associated with cerebrovascular disease, monoamine neurotransmitters, and depression of mood. A plausible hypothesis for these associations is that high homocysteine levels cause cerebral vascular disease and neurotransmitter deficiency, which cause depression of mood. The homocysteine depression hypothesis, if true, would mandate inclusions of imaging studies for cerebrovascular disease and measures of homocysteine, folate, and B12 and B6 vitamins in the clinical evaluation of older depressed patients.

Improving dementia assessment by reducing sample heterogeneity.

Outcome assessment for clinical dementia trials could be enhanced by using the Mini-mental State Examination (MMSE) and the Hopkins Verbal Learning Test (HVLT), in addition to imaging and genetic screening. The statistical power of trials could be increased if heterogeneity of the sample were reduced by the administration of a risk factor inventory which could be used for subject selection or selection of drug responders.

Depression is associated with low plasma Abeta42 independently of cardiovascular disease in the homebound elderly.

Background: Depression often precedes the onset of Alzheimer's disease (AD) before the appearance of cognitive symptoms. Plasma Amyloid-beta peptide 42 (Abeta42) declines before and soon after the onset of AD, yet the relationship between plasma Abeta42 and depression is unclear.

Methods: We used 515 homebound elders aged 60 and older in a population-based, cross-sectional study to investigate associations between plasma Abeta levels and depression with and without cardiovascular co-morbidities.

The Nutrition, Aging, and Memory in Elders (NAME) study: design and methods for a study of micronutrients and cognitive function in a homebound elderly population.

Background: Micronutrient status can affect cognitive function in the elderly; however, there is much to learn about the precise effects. Understanding mediating factors by which micronutrient status affects cognitive function would contribute to elders' quality of life and their ability to remain in the home.

Objectives: The Nutrition, Aging, and Memory in Elders (NAME) Study is designed to advance the current level of knowledge by investigating potential mediating factors by which micronutrient status contributes to cognitive impairment and central nervous system abnormalities in the elderly.

Executive dysfunction in homebound older people with diabetes mellitus.

Objectives: To describe patterns of cognitive deficits and activities of daily living (ADLs) in older people with diabetes mellitus.

Design: Cross-sectional, population-based study.

Setting: Three homecare agency areas in Boston, Massachusetts.

Insulin, insulin-degrading enzyme and amyloid-beta peptide in Alzheimer's disease: review and hypothesis.

Clinical and epidemiological studies have found that type 2 diabetes, and hyperinsulinaemia, increased the risk of developing Alzheimer's disease (AD) in the elderly. The link between hyperinsulinaemia and AD may be insulin-degrading enzyme (IDE). This enzyme degrades both insulin and amylin, peptides related to the pathology of type 2 diabetes, along with amyloid-beta peptide (Abeta), a short peptide found in excess in the AD brain.

Homocysteine and B vitamins relate to brain volume and white-matter changes in geriatric patients with psychiatric disorders.

Objective: There is a growing literature on the relationship between low serum B-vitamins, elevated homocysteine, and cognitive impairment; however, few studies have examined radiological markers of associated neuropathology in geropsychiatry inpatients. The authors examined the relationship of homocysteine, folate, and vitamin B12 with magnetic resonance imaging (MRI) markers of neuropathology.

Methods: In this archival study, authors reviewed the MRIs and medical records of 34 inpatients in a geriatric psychiatry unit.

New phenomenon of abnormal auditory perception associated with emotional and head trauma: pathological confirmation by SPECT scan.

We report the case of an immigrant who suffered from death threats and head trauma while a prisoner of war in Kuwait. Two months later, he began to hear conversations that had taken place previously. These perceptions occurred spontaneously or were induced by the patient's effortful concentration.

Psychiatric perspectives on headache and facial pain.

For a subset of headache patients, an understanding of psychological antecedents and interpersonal difficulties is an important part of the headache evaluation. This subset includes patients with chronic headache, frequent headache, treatment-refractory headache, analgesic misuse problems, and serious compliance issues. Inadequate coping with stress is central to the persistence of headache in many such patients.