The Alzheimer’s Dementia Patients’ Observed Illness Course and Experience in Ghana and Care Lessons to Be Learnt: A Mental Health Professional’s Perspective

Alzheimer’s disease (AD) and associated dementia patient numbers continue to increase globally with associated economic costs to healthcare systems. Of note is the increase in numbers in lower and middle-income countries (LMICs) including Sub-Saharan African (SSA) countries, which already face challenges with their health budgets from communicable and non-communicable diseases. Ghana, an SSA country, faces the problem of healthcare budgetary difficulties and the additional impact of AD as a consequence of increasing population strata of old aged persons (OAPs) due to the demographic transition effect. This article uses examples of known patients’ illness courses to give a perspective on the lived experience of patients with dementia (PWD) in Ghana, living amongst a populace with a culture of stigmatization of PWD, and a relatively fragile public mental health system (PMHS) for those with mental illness, including AD. The lived experience of AD patients is characterised by stigmatisation, discrimination, non-inclusiveness, diminished dignity and human rights abuses in the face of their mental disability, and eventually death. This article is an advocacy article giving voice to the voiceless and all persons suffering from AD and other dementias in Ghana, whilst pleading for a call to action from healthcare professionals and responsible state agencies.

Evaluation of retinal and choroidal changes in patients with Alzheimer’s type dementia using optical coherence tomography angiography

AIM:To evaluate the changes in fundus parameters in patients with Alzheimer’s type dementia(ATD)using optical coherence tomography angiography(OCTA),to record flash electroretinograms(ERG)using the RETeval system and to explore changes in retinal function.METHODS:Twenty-nine patients with ATD and 26 age-matched normal subjects were enrolled.All subjects underwent OCTA scans to analyse the superficial retinal vessel parameters in the macular area,including the vessel length density,the vessel perfusion density and the area of foveal avascular zone(FAZ),as well as the choroidal thickness.The differences between the patients with ATD and the normal control group were compared and explored the relevant factors affecting vessel parameters.We also recorded the flash ERGs using the RETeval system and intended to explore changes in retinal function by analysing the ERG image amplitude in patients with ATD.RESULTS:The vessel parameters[Pvessel length density=0.005 and Pvessel perfusion density=0.006]and average choroid thickness(P<0.001)in the macular area of the ATD group was less than the control group.The FAZ area was statistically significantly enlarged in the ATD group(P<0.001).These parameters were correlated with the Mini-Mental State Examination(MMSE)score and the Montreal Cognitive Assessment(MoCA).CONCLUSION:Patients with ATD exhibit decreases in the parameters associated with fundus.In addition,these indicators significantly correlate with the MMSE score and the MoCA score.OCTA may be an adjunct tool with strong potential to track changes in the diagnosis and monitoring the progression of the disease.

Cerebral amyloid angiopathy vs Alzheimer’s dementia:Diagnostic conundrum

BACKGROUND Diagnosis of a dementia subtype can be complex and often requires comprehensive cognitive assessment and dedicated neuroimaging.Clinicians are prone to cognitive biases when reviewing such images.We present a case of cognitive impairment and demonstrate that initial imaging may have resulted in misleading the diagnosis due to such cognitive biases.CASE SUMMARY A 76-year-old man with no cognitive impairment presented with acute onset word finding difficulty with unremarkable blood tests and neurological examination.Magnetic resonance imaging(MRI)demonstrated multiple foci of periventricular and subcortical microhaemorrhage,consistent with cerebral amyloid angiopathy(CAA).Cognitive assessment of this patient demonstrated marked impairment mainly in verbal fluency and memory.However,processing speed and executive function are most affected in CAA,whereas episodic memory is relatively preserved,unlike in other causes of cognitive impairment,such as Alzheimer’s dementia(AD).This raised the question of an underlying diagnosis of dementia.Repeat MRI with dedicated coronal views demonstrated mesial temporal lobe atrophy which is consistent with AD.CONCLUSION MRI brain can occasionally result in diagnostic overshadowing,and the application of artificial intelligence to medical imaging may overcome such cognitive biases.

Fractal Dimension in Animal Model of Alzheimer’s Dementia

The aim of this study was to qualitatively described effect of the oxidative stress, neurotransmission change and the neurodegeneration in animal model of chronic intoxication by aluminum. Electrocortical brain activity of animal model of stress and neurodegeneration is comparable with Alzheimer’s Dementia (AD). We used adult animals, during 6 weeks intraperitoneally treated with aluminum. Both animals and patients with Alzheimer’s Dementia have increased relative spectral power in delta range. By fractal analysis we described changes in electrocortical activity of aluminum intoxication animals compare to physiological control. We used change in delta range to calculate fractal dimension for the pathophysiological state of disease. We evaluate effect of stress and neurodegeneration, oxidative stress and accumulation of beta amyloid and neurofibrillary tangles as change in fractal dimension (FD). We conclude that change in fractal dimension could be used for prognosis of AD. Results show that decrease in fractal dimension could be used for evaluation of changes in neural activity in occurrence of AD.

Hearing Impairment in Senile Dementia of Alzhaimer's Type

Objectives To evaluate peripheral auditory dysfunction in senile dementia of Alzheimer’s disease (AD) and its relationship with cognitive dysfunction. Methods Pure tone thresholds,word recognition scores (WRS), acoustic immittance and auditory brain-stem responses (ABR) were tested to evaluate the auditory function in 43 AD patients and 50 normal subjects. The test reliability in these subjects was examined before the test results were evaluated for their correlation with the Mini Mental State Examination(MMSE) score. Results There were no statistically significant differences in peripheral auditory functions between the two ears in the tested subjects or between the two groups when the auditometric results of the right ear were compared(P > 0.05). Also, there were no statistically significant differences between the two groups when audiometric test reliability, acoustic impedance and ABR results were compared(P > 0.05). Conclutions The pure tone audiometric threshold and WRS in AD patients are similar to those in comparable non-AD senile subjects. Peripheral auditory dysfunction is not related to cognitive dysfunction.

Cerebral glucose metabolic prediction from amnestic mild cognitive impairment to Alzheimer’s dementia:a meta-analysis

Brain 18F-fluorodeoxyglucose positron emission tomography(FDG-PET)has been utilized to monitor disease conversion from amnestic mild cognitive impairment(aMCI)to Alzheimer’s dementia(AD).However,the conversion patterns of FDG-PET metabolism across studies are not conclusive.We conducted a voxel-wise meta-analysis using Seed-based d Mapping that included 10 baseline voxel-wise FDG-PET comparisons between 93 aMCI converters and 129 aMCI nonconverters from nine longitudinal studies.The most robust and reliable metabolic alterations that predicted conversion from aMCI to AD were localized in the left posterior cingulate cortex(PCC)/precuneus.Furthermore,meta-regression analyses indicated that baseline mean age and severity of cognitive impairment,and follow-up duration were significant moderators for metabolic alterations in aMCI converters.Our study revealed hypometabolism in the left PCC/precuneus as an early feature in the development of AD.This finding has important implications in understanding the neural substrates for AD conversion and could serve as a potential imaging biomarker for early detection of AD as well as for tracking disease progression at the predementia stage.

STUDY OF THE EXTERNAL COUNTERPULSATION (ECP) THERAPY FOR SENILE DEMENTIA OF THE ALZHEIMER'S TYPE (SDAT)

Ten patients with SDAT received the ECP therapy.The examination of Hasegawa’s Dementia Scale(HDS),single photor emission computed tomography (SPECT) brain imaging,and some biochemical parameters in blood and CSF were selected to evaluate the effect of ECP for SDAT.

A transcranial magnetic stimulation study on Alzheimer's diseae and behavioral variant frontotemporal dementia

Objective To investigate the changes in cortical excitability and inhibitory circuits of patients with Alzheimer’s disease(AD)or behavioral variant frontotemporal dementia(bv FTD)using transcranial magnetic stimulation(TMS).Methods Forty-four patients with AD,30 patients with bv FTD and 44 healthy controls were enrolled in the study.The epidemiological data

Comorbidity Burden of Dementia:A Hospital-Based Retrospective Study from 2003 to 2012 in Seven Cities in China

Dementia is increasing dramatically and imposes a huge burden on society. To date, there is a lack of data on the health status of patients with dementia in China. In an attempt to investigate the comorbidity burden of dementia patients in China at the national level, we enrolled 2,938 patients with Alzheimer＇s disease（AD）, vascular dementia（Va D）, or other types of dementia, who were admitted to tertiary hospitals in seven regions of China from January2003 to December 2012. The Charlson Comorbidity Index（CCI） was used to evaluate the comorbidity burden of the patients with dementia. Among these patients, 53.4% had AD, 26.3% had Va D, and 20.3% had other types of dementia. The CCI was 3.0 ± 1.9 for all patients,3.4 ± 1.8 for those with Va D, and 3.0 ± 2.1 for those with AD. The CCI increased with age in all patients, andthe length of hospital stay and daily expenses rose with age and CCI. Males had a higher CCI and a longer stay than females. Moreover, patients admitted in the last 5 years of the study had a higher CCI than those admitted in the first 5 years. We found that the comorbidity burden of patients with dementia is heavy. These findings provide a better understanding of the overall health status of dementia patients, and help to increase the awareness of clinicians and policy-makers to improve medical care for patients.

High-frequency stimulation of anterior nucleus thalamus improves impaired cognitive function induced by intra-hippocampal injection of Aβ1-40 in rats

Background The advent of brain stimulation techniques to treat movement disorders and psychiatric diseases has shown potential to decode the neural mechanism that underlies the cognitive process by modulating the interrupted circuit.Here,the present investigation aimed at evaluating the influence of deep brain stimulation of the anterior nucleus thalamus （ANT-DBS） on memory.Methods Thirty-two rats were randomized into phosphate buffer saline （PBS） group （n=8,rats received PBS injections without implantation of electrodes into the ANT）,Alzheimer＇s dementia （AD） group （n=8,rats received Aβ1-40 injections without implantation of electrodes into the ANT）,ANT sham stimulation group （n=8,rats received Aβ1-40 injections with implantation of electrodes into the ANT but without stimulation） and ANT stimulation group （n=8,rats received Aβ1-40 injections with implantation of electrodes into the ANT and stimulation）.A Morris maze test was used for determining the effect of electrical stimulation on cognitive function in rats.The data were assessed statistically with one-way analysis of variance （ANOVA） followed by Tukey＇s tests for multiple post hoc comparisons.Results The data showed that in the training test,PBS group and AD group managed to learn the hidden-platform faster and faster while AD group needed a significantly longer time to reach the platform than PBS group （P ＜0.05）.Meanwhile,ANT stimulation group demonstrated a significantly shorter time to reach the platform （P ＜0.05） compared to the AD group,while there was no significant difference between the ANT sham stimulation group and the AD group （P ＞0.05）.On the probe test,the AD group spent less time （（10.15±2.34） seconds） in the target quadrant than the PBS group （（28.20±2.75） seconds） （P ＜0.05）.And the times of platform-traversing of the AD group （3.35±1.12） significantly decreased compared with the PBS group （8.69±2.87） （P ＜0.05）.However,the times of platform-traversing and the time spent in the target quadrant of the ANT stimulation group significantly increased compared to the AD group （P ＜0.05）,while times of platformtraversing or the time spent in the target quadrant was not significantly different between the ANT sham stimulation group and the AD group （P ＞0.05）.Conclusion Bilateral high-frequency stimulation of the ANT may be useful as a potential therapeutic modality for cognitive dysfunction in AD.