Early psychosocial intervention does not delay institutionalization in persons with mild Alzheimer disease and has impact on neither disease progression nor caregivers' well-being: ALSOVA 3-year follow-up.

OBJECTIVES: Early diagnosis, initiation of Alzheimer's disease (AD) therapy and programs that support care of persons with AD at home are recommended. The objective of this study was to assess the effect of early psychosocial intervention on delaying the institutionalization of persons with AD. We also assessed the influence of intervention on AD progression, behavioral symptoms, and health-related quality of life (HRQoL) in persons with AD and caregivers. METHODS: Kuopio ALSOVA study, a prospective, randomized intervention study with a 3-year follow-up, was carried out at memory clinics. Home-dwelling persons with very mild or mild AD (n = 236) and AD-targeted therapy and their family caregivers (n = 236) were randomized to the intervention or control group (1:2). Psychosocial intervention including education, counseling, and social support was given during the first 2 years (16 days). The primary outcome was the cumulative risk (controlled for death) of institutionalization over 36 months. Secondary outcomes were adjusted mean changes from baseline in disease severity, cognition, daily activities, behavior, and HRQoL for persons with AD; and change in psychological distress, depression, and HRQoL for caregivers. RESULTS: No differences were found in nursing home placement after the 36-month follow-up between intervention and control groups. No beneficial effects of the intervention were found on the secondary outcomes. CONCLUSIONS: The psychosocial intervention did not delay nursing home placement in persons with AD and had no effect on patient well-being, disease progression, or AD-related symptoms or caregiver well-being. Instead of automatically providing psychosocial intervention courses, individualized support programs may be more effective.

Progression of Alzheimer's disease during a three-year follow-up using the CERAD-NB total score: Kuopio ALSOVA study.

BACKGROUND: We studied the suitability of The Consortium to Establish a Registry for Alzheimer's Disease Neuropsychological Battery (CERAD-NB) total score for monitoring Alzheimer's disease (AD) progression in early-diagnosed medicated patients. We also investigated possible differences in progression between patients with very mild or mild baseline AD. METHODS: In this three-year follow-up of 115 ALSOVA study patients with clinical dementia ratings (CDR) of very mild (0.5) or mild (1) AD, we analyzed total CERAD-NB, Mini-Mental State Examination (MMSE), Neuropsychiatric Inventory (NPI), The Alzheimer's Disease Cooperative Study-Activities of Daily Living Inventory, and Clinical Dementia Rating Sum of Boxes scores. Correlations were identified with efficacy parameters. RESULTS: Over three years, total CERAD-NB declined significantly in both groups. Annual change rates of total CERAD-NB were also significant. Total CERAD-NB revealed annual differences in cognition between study groups, while MMSE did not. Total CERAD-NB correlated well with other cognitive and global measures, but not with NPI. For almost two years, the CDR-0.5 group maintained a higher activities of daily living than the CDR-1 group exhibited at baseline. Furthermore, the CDR-0.5 group showed milder neuropsychiatric symptoms at the end of follow-up than the CDR-1 group showed at baseline. CONCLUSIONS: The CERAD total score is a suitable and sensitive follow-up tool in longitudinal AD trials. Cognition progression rates did not significantly differ between study groups; however, patients with very mild AD at baseline had milder neuropsychiatric symptoms after long-term follow-up. This emphasizes the importance of early diagnosis and assessment of neuropsychiatric symptoms at the diagnostic visit and during follow-up.

Cognitive and Neuropsychiatric Symptom Differences in Early Stages of Alzheimer's Disease: Kuopio ALSOVA Study.

BACKGROUND/AIM: Alzheimer's disease (AD) causes impairment in memory and other cognitive functions as well as neuropsychiatric symptoms and limitations in the activities of daily living (ADL). The aim of this study was to examine whether demographic variables, dementia severity, ADL and neuropsychiatric symptoms are associated with cognition in very mild or mild AD. METHODS: We analyzed the baseline data of 236 patients with very mild or mild AD participating in a prospective AD follow-up study (ALSOVA). The Consortium to Establish a Registry for Alzheimer's Disease neuropsychological battery total score was used in the evaluation of the global cognitive performance. RESULTS: Cognition was associated with dementia severity and ADL but not with neuropsychiatric symptoms. ADL functions were associated with both cognitive performance and neuropsychiatric symptoms. CONCLUSION: Even patients with very mild or mild AD may exhibit neuropsychiatric symptoms not related to cognitive impairment. The results of this study emphasize the importance of taking a multidimensional approach to the diagnostic and prognostic evaluation of AD patients already in the early stages of the disease.

Neuropsychiatric symptoms and quality of life in patients with very mild and mild Alzheimer's disease.

BACKGROUND: Neuropsychiatric symptoms (NPS) are common manifestations of Alzheimer' s disease (AD). OBJECTIVE: To examine the prevalence and significance of NPS in very mild and mild AD patients with emphasis on their influence on the well-being of the patients and their caregivers. METHODS: The participants were 240 patient-caregiver dyads who participated in a prospective, controlled rehabilitation study (ALSOVA). Three Quality of Life (QoL) instruments were used; generic 15D, disease-specific QoL-AD and Visual Analog Scale (VAS). The disease-specific QoL-AD was both self-rated and caregiver rated. Other scales used were Mini-Mental State Examination (MMSE), Clinical Dementia Rating (CDR), ADCS-ADL, Neuropsychiatric Inventory (NPI) and Beck Depression Inventory (BDI). RESULTS: NPS were present in 76.5% of patients with very mild AD (CDR 0.5) and in 84.9% of patients with mild to moderate AD (CDR 1). The most frequent symptoms were apathy, depression, irritability, and agitation. The strongest predictor of self-reported QoL-AD scores was depressive symptoms whereas functional decline and presence of NPS predicted poor caregiver ratings of patients' QoL. However, caregiver depression also influenced significantly their ratings. CONCLUSION: NPS are common even in the early stages of AD. NPS were significantly associated with caregiver assessment of the patient's QoL but not with patients' self-assessed QoL. Depression decreases QoL, but may remain unrecognized in AD patients, emphasizing the need for careful and structured assessment of NPS before deciding on the appropriate treatment.

Seasonal variation in thoracic vessel calcifications: evidence from a chest computed tomography study.

BACKGROUND: Cardiovascular disease incidence and mortality exhibit a winter peak and a summer trough, a fact that could have radiological manifestations. PURPOSE: To identify possible seasonal trends in the occurrence of thoracic vessel calcifications. MATERIAL AND METHODS: 505 male construction workers (aged 39-80 years) were each imaged once with chest spiral computed tomography (CT) during a 2-year period. Based on visual assessment of calcified plaques (0=no, 1=slight, 2=moderate, 3=extensive calcification), sum scores of atherosclerosis in coronary arteries, in the thoracic aorta, in the pre-cervical artery bases, and overall were constructed. The scores were regressed on the annual rank number of the CT day. RESULTS: By using the cubic regression model, seasonal variation in calcified plaques in coronary arteries (P=0.003), in pre-cervical artery origins (P=0.015), and in the overall sum score (P=0.004) was observed. The peak occurred in January-February and the nadir in August. Depending on the model, about 2-3% of the variation in atherosclerotic calcifications could be explained by the season of imaging. CONCLUSION: The observed seasonal trend in calcifications parallels with mortality reports. Seasonal variations should be considered in atherosclerosis treatment studies. Confirmatory studies using modern imaging technology are needed in different countries and geographical locations, preferably with repeat imaging of the same individuals.

Relación entre las calcificaciones ateroscleróticas en el tórax detectadas mediante tomografía computarizada y la función pulmonar / Relation Between Atherosclerotic Calcifications Detected in Chest Computed Tomography and Lung Function

IntroducciónVarios hallazgos epidemiológicos recientes indican que hay una conexión entre la aterosclerosis y algunas funciones pulmonares. Examinamos en más detalle la relación entre la aterosclerosis calcificada de tórax, según se visualiza en la tomografía computarizada (TAC), y varios parámetros de función pulmonar.Pacientes y métodosEn obreros de la construcción masculinos a quienes inicialmente se realizó una TAC para la detección precoz de cáncer de pulmón ocupacional, se efectuó también una clasificación visual de la aterosclerosis en la zona torácica (aorta, origen de arterias del cayado aórtico, arterias coronarias y válvulas cardíacas). Se evaluó la relación entre las puntuaciones de la calcificación aterosclerótica y los parámetros de función pulmonar —capacidad pulmonar total (TLC), volumen espiratorio forzado en el primer segundo (FEV1%), capacidad vital forzada (FVC%), flujo espiratorio máximo cuando queda un 50% de la FVC por espirar y capacidades de difusión total y específica (todos ellos expresados como porcentajes del valor predicho), así como el cociente FEV1/FVC&%#x02014; con un modelo lineal general ajustado para tabaquismo, años de exposición al asbesto e índice de masa corporal (n=432).ResultadosTodos los parámetros de la función pulmonar, salvo la TLC, mostraron asociaciones negativas y significativas con la calcificación de la aorta y de sus ramas. La TLC sólo mostró tal asociación con la aterosclerosis en la aorta ascendente.ConclusionesLa aterosclerosis aórtica parece estar relacionada con una función pulmonar deficiente. Esto puede deberse al deterioro de la circulación bronquial, pero también pueden intervenir otros mecanismos. Una función pulmonar más deficiente de lo esperado según las condiciones pulmonares puede indicar aterosclerosis aórtica(AU)

Background and objectivesA few recent epidemiological findings indicate a link between atherosclerosis and some lung functions. We studied further the relation between calcified chest atherosclerosis as seen in computed tomography (CT) and several lung functional parameters.Patients and methodsMale construction workers originally screened for occupational lung cancer with CT had their chest atherosclerosis (aorta, the origins of its cervical branches, the coronary arteries and heart valves) visually classified. The relation between the atherosclerotic calcification scores and lung function (total lung capacity [TLC], forced expiratory volume in one second [FEV1%], forced vital capacity [FVC%], maximal expiratory flow when 50% of FVC remains to be exhaled, total and specific diffusing capacities; all above expressed as percent of predicted value, and the FEV1/FVC% ratio) were studied with the general linear model adjusted for smoking, exposure years for asbestos, and body mass index (n=432).ResultsAll lung functions except TLC showed significant negative associations with calcifications in aorta and in its branches. TLC showed such association only with atherosclerosis in the ascending aorta.ConclusionsAortic atherosclerosis seems to be related with poor lung function. This may be due to deteriorated bronchial circulation, but other mechanisms can also be involved. Lung function poorer than would be expected due to pulmonary reasons may indicate aortic atherosclerosis(AU)

[Relation between atherosclerotic calcifications detected in chest computed tomography and lung function]. / Relación entre las calcificaciones ateroscleróticas en el tórax detectadas mediante tomografía computarizada y la función pulmonar.

BACKGROUND AND OBJECTIVES: A few recent epidemiological findings indicate a link between atherosclerosis and some lung functions. We studied further the relation between calcified chest atherosclerosis as seen in computed tomography (CT) and several lung functional parameters. PATIENTS AND METHODS: Male construction workers originally screened for occupational lung cancer with CT had their chest atherosclerosis (aorta, the origins of its cervical branches, the coronary arteries and heart valves) visually classified. The relation between the atherosclerotic calcification scores and lung function (total lung capacity [TLC], forced expiratory volume in one second [FEV1%], forced vital capacity [FVC%], maximal expiratory flow when 50% of FVC remains to be exhaled, total and specific diffusing capacities; all above expressed as percent of predicted value, and the FEV1/FVC% ratio) were studied with the general linear model adjusted for smoking, exposure years for asbestos, and body mass index (n=432). RESULTS: All lung functions except TLC showed significant negative associations with calcifications in aorta and in its branches. TLC showed such association only with atherosclerosis in the ascending aorta. CONCLUSIONS: Aortic atherosclerosis seems to be related with poor lung function. This may be due to deteriorated bronchial circulation, but other mechanisms can also be involved. Lung function poorer than would be expected due to pulmonary reasons may indicate aortic atherosclerosis.

Atherosclerotic and pleural calcifications are related among asbestos-exposed workers.

METHODS: We studied the relationship between calcified chest atherosclerosis and pleural plaques among 505 construction workers with computed tomography. The extent and thickness of pleural plaques and the score of visceral pleural thickening were estimated, as was calcification of both pleural disease and chest atherosclerosis. RESULTS: Adjusted for age, BMI, smoking, and asbestos exposure, pleural calcification was associated with calcification in coronary arteries (P<0.001) and in the aorta (P<0.001). CONCLUSION: These associations may be due to susceptibility factors common to both conditions. Calcification in pleural plaques may be a hint of atherosclerosis at least among asbestos-exposed people.