We present the case of a 39-year-old patient with frontotemporal dementia. This case depicts the complexities in the process leading to the diagnosis, treatment, and placement of young patients presenting with severe psychiatric symptoms as the first signs of an underlying neurological disease. Obstacles in the health care system and residential placement process that hinder the optimal and timely care of such difficult cases are discussed. Practical solutions are offered that center upon better awareness and education and the provision of additional resources. These interventions are likely to provide a positive return on investment for the medical system and could be used as strong levers for new health policies relevant to younger patients with neurological illness.

As life expectancy continues to increase, Alzheimer’s disease (AD) has become much more prevalent and as yet there is no cure. This has given rise to the situation Tithonus faced in Greek mythology of living longer but not staying young. In this article, the authors explore this phenomenon while reviewing some notable people and AD.

We explored the association of Alzheimer’s disease (AD) Assessment Scale (ADAS-Cog) item scores with AD severity using cross-sectional and longitudinal data from the same study. Post hoc analyses were performed using placebo data from a 12-month trial of patients with mild-to-moderate AD (N = 281 randomized, N = 209 completed). Baseline distributions of ADAS-Cog item scores by Mini-Mental State Examination (MMSE) score and Clinical Dementia Rating (CDR) sum of boxes score (measures of dementia severity) were estimated using local and nonparametric regressions. Mixed-effect models were used to characterize ADAS-Cog item score changes over time by dementia severity (MMSE: mild = 21-26, moderate = 14-20; global CDR: mild = 0.5-1, moderate = 2). In the cross-sectional analysis of baseline ADAS-Cog item scores, orientation was the most sensitive item to differentiate patients across levels of cognitive impairment. Several items showed a ceiling effect, particularly in milder AD. In the longitudinal analysis of change scores over 12 months, orientation was the only item with noticeable decline (8%-10%) in mild AD. Most items showed modest declines (5%-20%) in moderate AD.

Primary Progressive Aphasia (PPA) is a neurodegenerative disorder initially presenting with progressive language imapirment. This article provides a clinically oriented review of PPA. Different clinical presentations and imaging findings of 3 subtypes, agrammatic, semantic and logopenic, are presented. Underlying neuropathology, medical and social management aspects of these patients are reviewed.

Objective: There are no Food and Drug Administration (FDA)-approved medications indicated for the treatment of frontotemporal dementia (FTD). We sought to determine the most commonly used drugs used to treat behavioral variant FTD (bvFTD) in specialized dementia clinics. Methods: Medication and demographic data from the Alzheimer’s Disease Research Centers of California (ARCC) and a multicenter FTD natural history study (NHS) data set were compared in bvFTD and Alzheimer’s disease (AD), and effects of demographic variables were assessed using logistic regression. Results: Overall, the percentage of patients taking one or more FDA-approved AD or psychiatric medications was similar in bvFTD and AD; however, after controlling for demographic variables, acetylcholinesterase inhibitor (AChI) use was less common in bvFTD, whereas memantine use remained similar in the 2 groups. Conclusions: Despite lack of evidence for efficacy, the use of AChIs and memantine is common in bvFTD. Clinical trials should be pursued to determine the optimal therapeutic interventions for bvFTD.

Background/rationale: Various interventions are available to manage verbal agitation (VA), but our understanding regarding their acceptability is limited. The purpose of this study is to compare the acceptability of 3 interventions from the point of view of elderly individuals: direct interaction (DI), differential reinforcement of incompatible behaviors (DRI), and risperidone (RIS). Methods: Participants (N = 69) evaluated the acceptability of each treatment according to the description of a fictional person who demonstrated aggressive or nonaggressive VA. Results: There is an interaction between the type of intervention and the severity of VA. For nonaggressive VA, DI is the most acceptable intervention followed by DRI and RIS. For aggressive VA, DI and DRI are more acceptable than RIS, but there is not a significant difference between them. The acceptability of each intervention is not associated with the participants’ characteristics. Conclusion: The results of this study highlight the acceptability of DI for managing VA.

Disease-specific assessments are not currently available for patients with Parkinson’s disease dementia (PDD). This study evaluated the criterion-related validity and test—retest reliability of the Alzheimer’s Disease Assessment scale cognitive subscale (ADAS-cog) in terms of sensitivity for differentiation between mild and moderate severity impairment in PDD. Six other dementia rating scales and cognitive tests were also examined. A total of 113 patients with PDD or Alzheimer disease were recruited into this 4-week, multicenter study, segregated into 2 severity groups based on Mini-Mental State Examination (MMSE) score. Mean ADAS-cog scores showed a statistically significant separation between mild and moderate severity patients in both dementias (P < .001). For the ADAS-cog, test—retest Spearman correlation coefficients were significant for each dementia type and severity. This study demonstrated the criterion-related validity and test—retest reliability for ADAS-cog in patients with PDD and strong correlations with MMSE. This supports the validity of previous results obtained with these measures in studies of patients with PDD.

Cognitive impairment and seizures are common in our aging population. Anticonvulsant treatment is problematic due to sedation, cognitive slowing, and behavioral changes. Levetiracetam has favorable pharmacokinetics, good efficacy in elderly individuals, a favorable side effect profile, and lacks major drug interactions. We conducted a prospective, uncontrolled, phase 4, open label, 12-week study of levetiracetam to better profile its efficacy, safety, and impact on cognitive/behavioral status in 24 cognitively impaired, elderly individuals. In total, 69% were seizure free for the duration of the study; the remaining participants had satisfactory seizure control. Fatigue was the most common side effect (5 participants). Significant overall improvements were observed for the Folstein’s Mini-Mental State Examination and the Alzheimer’s Disease Assessment Scale—Cognitive. No significant changes were seen in behavioral or functional measures. Levetiracetam is an effective antiepileptic drug in elderly individuals with cognitive impairment. At 3 months, participants who remained on levetiracetam showed excellent cognitive tolerability.

Following a 48-week, double-blind, randomized, placebo-controlled trial of donepezil in 821 patients with amnestic mild cognitive impairment (aMCI), safety and tolerability of donepezil (10 mg) were further evaluated in a 28-week extension study. Of 499 participants who completed the double-blind phase, 145 enrolled in the open-label study. Adverse events (AEs) were recorded throughout. Overall, 57.4% of participants in the donepezil/donepezil group and 62.3% in the placebo/donepezil group experienced an AE, with the most frequent treatment-emergent AEs being diarrhea, muscle spasms, insomnia, and nausea. Most were mild to moderate in severity and were more common in the first several weeks after treatment initiation. More participants in the placebo/donepezil group (22.1%) discontinued donepezil due to an AE compared with the donepezil/donepezil group (10.3%). These findings support the safety of donepezil in patients with aMCI. When compared with other studies, however, the data suggest that patients with Alzheimer’s tolerate donepezil better than patients with MCI.

Objective: The purpose was to describe (a) individuals’ reasons for participating in cognitive screening and (b) reasons to pursue testing after screening across 4 ethnic groups: African American, Afro-Caribbean, European American, and Hispanic American. Methods: Prior to memory screening, 119 adults were interviewed regarding their thoughts about memory screening and follow-up testing. Interviews were coded and differences between ethnic groups were compared. Results: More African Americans and European Americans were concerned about their memory. More Hispanic Americans planned to seek professional help if needed. Hispanic Americans were most optimistic about treatment. Conclusions: Future research is needed to better understand cultural factors that influence older adults’ willingness to be screened for cognitive impairment and to pursue follow-up testing when recommended.

Wandering is a complex behavior, and defining wandering has been challenging. The current study used the integrated circuit (IC) tag monitoring system to describe the distance moved per day and the spatial movements of patients with dementia. The study was conducted in a 60-bed semiacute dementia care unit in a general hospital in Japan over a 3-month period in 2006. The distance moved per day, the numbers of pacing and lapping movements, and the proportions of the distance moved that was paced or lapped were tabulated in 23 patients diagnosed with dementia. The distance moved per day and the numbers of pacing and lapping movements varied greatly within and among study participants. The median distance moved per day was inversely correlated with participants’ age and Mini-Mental State Examination (MMSE) scores (adjusted r2 = .34, P = .01). Consecutive lapping and pacing movements were rare patients with in Alzheimer’s disease (AD), while 2 patients with frontotemporal dementia paced or lapped repeatedly.