Abnormalities of saccadic eye movements in dementia due to Alzheimer's disease and mild cognitive impairment.

Background: There is increasing evidence that people in the early stages of Alzheimer's disease (AD) have subtle impairments in cognitive inhibition that can be detected by using relatively simple eye-tracking paradigms, but these subtle impairments are often missed by traditional cognitive assessments. People with mild cognitive impairment (MCI) are at an increased likelihood of dementia due to AD. No study has yet investigated and contrasted the MCI subtypes in relation to eye movement performance. Methods: In this work we explore whether eye-tracking impairments can distinguish between patients with the amnesic and the non-amnesic variants of MCI. Participants were 68 people with dementia due to AD, 42 had a diagnosis of aMCI, and 47 had a diagnosis of naMCI, and 92 age-matched cognitively healthy controls. Results: The findings revealed that eye-tracking can distinguish between the two forms of MCI. Conclusions: The work provides further support for eye-tracking as a useful diagnostic biomarker in the assessment of dementia.

Correction to: The Edinburgh Consensus: preparing for the advent of disease-modifying therapies for Alzheimer's disease.

Since the publication of this article [1], it has come to the attention of the authors that information for one of the authors was not included in the competing interests section. Craig Richie has declared potential competing interests with the following companies; Janssen, Eisai, Pfizer, Eli Lilly, Roche Diagnostics, Boeringher Ingleheim, Novartis, AC Immune, Ixico, Aridhia, Amgen, Berry Consultants, Lundbeck, Sanofi, Quintiles (IQVIA) and Takeda. The full competing interests section for this article can be found below.

The Edinburgh Consensus: preparing for the advent of disease-modifying therapies for Alzheimer's disease.

CONTEXT: This commentary discusses the implications of disease-modifying treatments for Alzheimer's disease which seem likely to appear in the next few years and results from a meeting of British experts in neurodegenerative diseases in Edinburgh. The availability of such treatments would help change public and professional attitudes and accelerate engagement with the prodromal and preclinical populations who might benefit from them. However, this would require an updated understanding of Alzheimer's disease, namely the important distinction between Alzheimer's disease and Alzheimer's dementia. CONSENSUS: Since treatments are likely to be most effective in the early stages, identification of clinically relevant brain changes (for example, amyloid burden using imaging or cerebrospinal fluid biomarkers) will be crucial. While current biomarkers could be useful in identifying eligibility for new therapies, trial data are not available to aid decisions about stopping or continuing treatment in clinical practice. Therefore, effective monitoring of safety and effectiveness when these treatments are introduced into clinical practice will be necessary to inform wide-scale use. Equity of access is key but there is a tension between universal access for everyone with a diagnosis of Alzheimer's disease and specifying an eligible population most likely to respond. We propose the resources necessary for an optimal care pathway as well as the necessary education and training for primary and secondary care. CONCLUSION: The majority of current services in the UK and elsewhere would not be able to accommodate the specialist investigations required to select patients and prescribe these therapies. Therefore, a stepped approach would be necessary: from innovating sentinel clinical-academic centres that already have capacity to deliver the necessary phase IV trials, through early adoption in a hub and spoke model, to nationwide adoption for true equity of access. The optimism generated by recent and anticipated developments in the understanding and treatment of Alzheimer's disease presents a great opportunity to innovate and adapt our services to incorporate the next exciting development in the field of dementia.

Experiences of apathy in people with Parkinson's disease: a qualitative exploration.

PURPOSE: Research has suggested that people with Parkinson's disease (PD) can experience apathy. This study explored the lived experiences of apathy in people with PD. METHOD: Seven participants with Parkinson's disease who were also described as having apathy were interviewed and the data analysed using interpretative phenomenological analysis. RESULTS: The findings were understood within three overlapping themes: (1) "The apathy creeps into jobs that I used to be able to do and no longer can do": Reduced motivation in response to the consequences of impairment; (2) "I hate at the end of the day if I've achieved nothing": The (un)acceptability of apathy; (3) "They say 'come on you lazy b*gger, get something done'": The social context of apathy. CONCLUSIONS: These themes are compared to wider research on apathy, PD and chronic illness. This study offers a view that, for some, apathy may be experienced as a number of behavioural choices influenced by increasing impairment and enacted in a social context. It presents an alternative conceptualisation from one describing apathy as the sole result of an endogenous disease process. As such, a number of therapeutic options are discussed but with the caveat that "apathy" need not always be the focus for intervention. Implications for Rehabilitation Apathy is a term used to denote a decrease in motivation and, although widely used, lacks conceptual clarity. Therefore the personal meaning of the behaviour for the individual within the context of their illness must be considered on assessment. Apathy is a societal as well as personal issue and the therapist also needs to assess the meaning and implications of the behaviour in the individual's social context. Practitioners need to be aware that apathy need not always be a focus for intervention. Discussion around the meaning of the behaviour may be all which is needed. Where individuals do wish to change their behaviours, a number of behavioural and psychological approaches are available. "Third wave" psychological therapies such as compassion- and acceptance-based approaches seem useful although none currently have any evidence base specifically with people with Parkinson's disease.