Recognizing dementia in the clinic: whom to suspect, whom to test.

Dementia-particularly that due to Alzheimer's disease-affects millions of Americans, costs society billions of dollars, and takes an incalculable toll on human lives. Despite these staggering statistics, dementia is still frequently unrecognized in clinical settings. While several rationales are employed to justify this failure to diagnose dementia, there are as many important reasons to diagnose the syndrome. Unrecognized dementia puts patients at risk for numerous complications, including medication errors, fragmented health care, and delirium. Unrecognized dementia can lead patients to financial disaster; accidents on the road, in the home, and at work; and unnecessary interpersonal conflicts and alienation from family and friends. Patients are robbed of their chance to plan for healthier and happier futures and to perhaps contribute meaningfully to our understanding of these dreadful diseases. Recognizing progressive dementia should be a priority for all health care providers dealing with the elderly.

Triazolam in Alzheimer's disease: pilot study on sleep and memory effects.

We examined the effects on sleep and memory of a nighttime dose of triazolam, 0.125 mg, in seven subjects with Alzheimer's disease (AD) who were reported by caregivers to be frequently up at night. Subjects were admitted to an intermediate care hospital ward for the 8-day ABA design protocol (placebo baseline-drug-placebo washout). Drug or placebo was given each evening at 2100 h. Sleep was assessed with a wrist-worn activity monitor. Memory was evaluated using a computerized delayed-matching-to-sample (DMTS) task administered at 0800 and 2130 h. Triazolam had no significant effects on total sleep time at night, latency to sleep onset, number of arousals, or time asleep during the day. DMTS performance was significantly worse at night compared to morning during baseline, but there were no significant drug effects. Our results suggest the standard geriatric dose of triazolam, 0.125 mg, may not be an effective hypnotic in AD patients with disrupted sleep, but neither does it substantially worsen the recent memory deficits of AD.

Nicotine patches in Alzheimer's disease: pilot study on learning, memory, and safety.

In view of the cholinergic deficits present in patients with Alzheimer's disease (AD), a widely investigated treatment strategy for the cognitive deficits in AD is cholinergic stimulation. Although nicotinic cholinergic receptor binding has been demonstrated to be deficient in the AD brain, the predominant theoretical and therapeutic focus to date has been on muscarinic cholinergic receptors and systems. The purpose of the present study was to evaluate the effects of sustained nicotine administration on behavior, cognition, and physiology. A double-blind placebo-controlled trial was conducted in which six patients with probable AD were exposed to 7, 8, and 7 days of placebo, nicotine, and washout, respectively. Daily sessions evaluating learning, memory, and behavior were conducted. Global cognitive functioning, rest and activity levels, cardiac activity, and blood levels were also measured. Findings included improved learning during the nicotine condition, which persisted throughout washout. Memory, behavior, and global cognition were not significantly affected. Sustained administration of nicotine appeared to be safe, although sleep showed a significant decrease.

Multicomponent intervention for agitated behavior in a person with Alzheimer's disease.

We evaluated a multicomponent intervention for agitated behavior in a man with probable Alzheimer's disease. Hypotheses about variables controlling his agitated behavior guided intervention design. Based on staff interviews, direct observations, and brief experimental probes, intervention components were chosen to increase rate of reinforcement and decrease aversive aspects of his job. Intervention reduced agitated behavior without disrupting his work rate.