Now is the Time to Improve Cognitive Screening and Assessment for Clinical and Research Advancement.

Wang et al. analyze Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment accuracy as screening tests for detecting dementia associated with Alzheimer's disease (AD). Such tests are at the center of controversy regarding recognition and treatment of AD.

Genetic Risk of Alzheimer's Disease: Three Wishes Now That the Genie is Out of the Bottle.

The availability and increasing popularity of direct-to-consumer genetic testing for the presence of an APOE4 allelle led the Alzheimer's Foundation of America Medical, Scientific and Memory Screening Advisory Board to identify three critical areas for attention: 1) ensure consumer understanding of test results; 2) address and limit potential negative consequences of acquiring this information; and 3) support linking results with positive health behaviors, including potential clinical trial participation. Improving access to appropriate sources of genetic counseling as part of the testing process is critical and requires action from clinicians and the genetic testing industry. Standardizing information and resources across the industry should start now, with the input of consumers and experts in genetic risk and health information disclosure.

Undertreatment of patients with Alzheimer's disease in an elderly United States population.

Background: The aim of this study was to assess the undertreatment of elderly mild to moderate Alzheimer's disease (AD) patients in the United States utilizing baseline data from a community-based trial that has established comparability to national survey samples on demographic characteristics.

Methods: Baseline data were used from an open-label, 12-week, postapproval study of compliance with galantamine, an AChEI and nicotinic receptor modulator, and vitamin E. A total of 2,114 patients from 406 community-based US practices in which physicians had previously treated patients with acetylcholinesterase inhibitors (AChEIs) were included in the study.

Morning or evening activity improves neuropsychological performance and subjective sleep quality in older adults.

Study Objectives: Sleep disturbances and decline in neuropsychological performance are common in older adults. Reduced social and physical activity is likely a contributing factor for these age-related changes in sleep and cognition. We previously demonstrated that a program of structured social and physical activity, with 2 daily activity sessions, 1 in the morning and 1 in the evening for a relatively short period of 2 weeks, improved sleep and neuropsychological performance in community-dwelling older adults.

Effects of rivastigmine on behavioral and psychological symptoms of dementia in Alzheimer's disease.

Background: The presence of certain behavioral and psychological symptoms (eg, paranoia, hallucinations, aggression, activity disturbances) in Alzheimer's disease (AD) may predict faster cognitive and functional decline; therefore, such symptoms represent an important treatment target. Behavioral and psychological symptoms of dementia (BPSD) may be caused at least in part by cholinergic deficits. Regulatory studies of rivastigmine in AD were not designed to evaluate effects on BPSD, but further investigation of rivastigmine in AD was prompted by later studies demonstrating behavioral benefits in other types of dementia.

Behavioral and psychologic symptoms of dementia.

Although tremendous strides with regard to identification and treatment of BPSD have been made over the last several decades, much work remains. Presently, BPSD research opportunities are at their greatest. The increasing worldwide social and economic impact of BPSD, however, requires that researchers, clinicians, and scientists develop a global network focused on collaboration and innovation.

A randomized, placebo-controlled study of the efficacy and safety of sertraline in the treatment of the behavioral manifestations of Alzheimer's disease in outpatients treated with donepezil.

Objective: To examine the safety and efficacy of sertraline augmentation therapy in the treatment of behavioral manifestations of Alzheimer's disease (AD) in outpatients treated with donepezil.

Methods And Materials: Patients with probable or possible AD, and a Neuropsychiatric Inventory (NPI) total score >5 (with a severity score > or =2 in at least one domain), were treated with donepezil (5-10 mg) for 8 weeks, then randomly assigned to 12 weeks of double-blind augmentation therapy with either sertraline (50-200 mg) or placebo. Primary efficacy measures were the 12-item Neuropsychiatric Inventory (NPI) and the Clinical Global Impression Improvement (CGI-I) and Severity (CGI-S) scales.

Dementia patients in primary care. Care managers offer a solution to providing ongoing care.

The structure of our healthcare system does not take into consideration the many psychological and social needs of older patients. For a patient like Mr. G, who has mild-to-moderate dementia, a critical aspect of primary medical care is determining the patient's non-medical needs.

Cognitive screening in the primary care setting. The role of physicians at the first point of entry.

There are many reasons why it is important to conduct the cognitive assessment and arrive at a preliminary diagnosis within the primary care setting. In addition to starting the patient on anti-cholinesterase medications, the physician must discuss with the family (and often the patient) issues related to financial matters and self-care. Alzheimer's patients who live alone may be targets for financial and personal exploitation, and are at risk for self-neglect.

Behavioral and psychological symptoms of dementia. Assisting the caregiver and managing the patient.

Behavioral and psychological symptoms of dementia cause many problems for patients and caregivers. Fortunately, physician intervention and pharmacologic and nonpharmacologic approaches to managing the patient provide hope for successful treatment. New antipsychotic agents and pharmacologic treatments are in development and may provide greater benefits to patients and their caregivers.

A Retrospective Chart Review of Antidepressant Use, Effectiveness, and Adverse Effects in Adults Age 70 and Older.

The authors assessed the use, side effects, and outcomes of various antidepressants, including selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs), in adults 70 years of age and older by means of a retrospective study of outpatient records. Of these patients (N = 70), 26% improved or recovered. Patients were more likely to improve or recover if they took the antidepressant for at least 3 months.