Is it Alzheimer's disease or another dementia? Marker may give more accurate diagnosis

ScienceDaily (Nov. 30, 2011) — New research finds a marker used to detect plaque in the brain may help doctors make a more accurate diagnosis between two common types of dementia -- Alzheimer's disease and frontotemporal lobar degeneration (FTLD). The study is published in the November 30, 2011, online issue of Neurology®, the medical journal of the American Academy of Neurology.

"These two types of dementia share similar symptoms, so telling the two apart while a person is living is a real challenge, but important so doctors can determine the best form of treatment," said study author Gil D. Rabinovici, MD, of the University of California San Francisco Memory and Aging Center and a member of the American Academy of Neurology.

For the study, 107 people with early onset Alzheimer's disease or FTLD underwent a brain PET scan using a PIB marker, which detects amyloid or plaque in the brain that is the hallmark of Alzheimer's disease but not related to FTLD. The participants underwent another PET scan using a FDG marker, which detects changes in the brain's metabolism and is currently used to help differentiate between the two types of dementia.

The study found the PIB PET scan performed at least as well as the FDG PET scan in differentiating between Alzheimer's disease and FTLD, but had higher sensitivity and better accuracy and precision with its qualitative readings. The study found PIB had a sensitivity of 89.5 percent compared to 77.5 percent for FDG.

"While widespread use of PIB PET scans isn't available at this time, similar amyloid markers are being developed for clinical use, and these findings support a role for amyloid imaging in correctly diagnosing Alzheimer's disease versus FTLD," said Rabinovici.

The study was conducted at the University of California (UC) San Francisco, UC Berkeley and Lawrence Berkeley National Laboratory, and supported by the National Institute on Aging, the California Department of Health Services, the Alzheimer's Association, John Douglas French Alzheimer's Foundation and the Consortium for Frontotemporal Dementia Research.

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MAKS: Drug-free prevention of dementia decline

ScienceDaily (Nov. 30, 2011) — There are many different causes of dementia and, although its progression can be fast or slow, it is always degenerative. Symptoms of dementia include confusion, loss of memory, and problems with speech and understanding. It can be upsetting for both the affected person and their relatives and carers. New research published in BioMed Central's open access journal BMC Medicine shows that a regime of behavioral and mental exercises was able to halt the progression of dementia.

Researchers led by Prof. Graessel, from Friedrich-Alexander-Universität Erlangen, included in their study patients with dementia from five nursing homes in Bavaria. After random selection, half the patients were included on the year-long MAKS 'intervention' consisting of two hours of group therapy, six days a week. In addition all patients maintained their normal treatment and regular activities provided by the nursing home.

The MAKS system consists of motor stimulation(M), including games such as bowling, croquet, and balancing exercises; cognitive stimulation (K), in the form of individual and group puzzles; and practicing 'daily living' activities (A), including preparing snacks, gardening and crafts. The therapy session began with a ten minute introduction, which the researchers termed a 'spiritual element' (S), where the participants discussed topics like 'happiness', or sang a song or hymn.

After 12 months of therapy the MAKS group maintained their level on the Alzheimer's Disease Assessment Scale (ADAS) and, even more importantly maintained their ability to carry out activities of daily living, while the control group all showed a decrease in cognitive and functional ability.

Prof. Graessel explained, "While we observed a better result for patients with mild to moderate dementia, the result of MAKS therapy on ADAS (cognitive function) was at least as good as treatment with cholinesterase inhibitors. Additionally we found that the effect on the patients' ability to perform daily living tasks (as measured by the Erlanger Test of Daily Living (E-ADL)) was twice as high as achieved by medication. This means that MAKS therapy is able to extend the quality of, and participation in, life for people with dementia within a nursing home environment. We are currently in the process of extending these preliminary results to see if this prevention of dementia decline can be maintained over a longer time period."

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Journal Reference:

Elmar Graessel, Renate Stemmer, Birgit Eichenseer, Sabine Pickel, Carolin Donath, Johannes Kornhuber, Katharina Luttenberger. Non-pharmacological, multicomponent group therapy in patients with degenerative dementia: a 12-month randomised, controlled trial. BMC Medicine, 2011; (in press) [link]

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