This recently updated book, “Everyday Law for Seniors,” sounds like it might be a worthwhile reading.
Here’s a short article from the New York Times about the book:
newoldage.blogs.nytimes.com/
The New Old Age: Caring and Coping
The Caregiver’s Bookshelf: A Law Guide for Seniors
New York Times
By Paula Span
April 2, 2012, 1:30 pm
Robin
This recent Wall Street Journal article is about the FDA’s approval of the Eli Lilly radiotracer florbetapir, known by the brand name Amyvid. This chemical tracer can now be used in PET scans to detect amyloid protein, which is present if Alzheimer’s and a few other disorders are in the brain. There is no insurance coverage for this type of PET scan because there is currently no treatment available to someone if the diagnosis is Alzheimer’s.
Here’s a link to the article:
online.wsj.com/article/
HEALTH INDUSTRY
Alzheimer Diagnosis Possible With Scan
Wall Street Journal
By Shirley S. Wang
Updated April 9, 2012, 12:24 a.m. ET
On that same webpage is a video of the author talking about the scan.
Here’s a link to a recent article in the Wall Street Journal on long-term care insurance:
online.wsj.com/article/
WEEKEND INVESTOR
Don’t Grow Old Without It
Wall Street Journal
By Kelly Greene
April 6, 2012, 3:02 p.m. ET
The author states upfront:
“Long-term-care insurance: It can make the difference between living out your life the way you want and becoming a burden to your family or a ward of the state. But it is becoming significantly more expensive, more complicated and harder to get with each passing year.”
This letter to the editor is the case report of a 69-year-old man with progressive supranuclear palsy (PSP) “showing tonic flexion of the trunk to the right while standing, compatible with the diagnosis of Pisa syndrome.” Pisa syndrome is a red flag for MSA. But these authors point out that Pisa syndrome can occur in several neurodegenerative disorders, including PSP, though they’ve never read a case of documented Pisa syndrome in PSP.
No one ever used the word but I’d say my father also had “Pisa syndrome” — we called it “leaning” and the direction of the lean changed over time.
The authors of this letter, however, are not sure about the cause of Pisa syndrome in this patient. They think it may be a side effect from Mirapex or Seroquel — both medications thought to cause Pisa syndrome.
One hard-to-understand statement in this letter to the editor is intriguing: “Although the pathophysiology of the akinetic–rigid syndrome of PSP has been based on a multiple neurotransmitter damage, the recent observation of upregulated nigrostriatal postsynaptic 5-HT2A receptors, and a subtle reduction in cortical 5-HT2A receptors, seems to suggest a crucial serotoninergic contribution to the pathophysiology of PSP, based on a presynaptic serotoninergic deficit.”
I wonder if this suggests that an SSRI anti-depressant might be helpful in PSP?
Here’s the citation:
Journal of Clinical Neuroscience. 2012 Apr 2. [Epub ahead of print]
Letter to the Editor
Pisa syndrome in a patient with progressive supranuclear palsy
Solla P, Cannas A, Costantino E, Orofino G, Lavra L, Marrosu F.
Movement Disorders Center, Department of Cardiovascular and Neurological Sciences, Institute of Neurology, University of Cagliari, Monserrato (Cagliari), Italy.
The full article may be available online for a charge.
Robin
This is a short — albeit filled with medical terminology — summary of Dementia with Lewy bodies (DLB). The authors of the review article are Lithuanian geriatricians.
The abstract notes that the differential diagnoses focuses on:
* “other later life dementia syndromes” – an example is Alzheimer’s Disease or vascular dementia
* “other parkinsonian diseases (Parkinson’s disease, progressive supranuclear palsy, corticobasal degeneration)” – within the pool of 100+ families I have helped accomplish brain donation, two families with a clinical diagnosis of DLB ended up with a neuropathology report that said PSP. I have yet to see anyone with CBD on the neuropathology report.
* “primary psychiatric illnesses” – not sure what these would be other than major depression or psychosis (hallucinations and delusions).
The paper mentions one additional disorder that DLB can be confused with:
* Creutzfeldt-Jacob disease. In that same pool of 100+ families, one family had a member with a clinical diagnosis of DLB and a CJD diagnosis upon brain autopsy.
There were a few new things for me in the full paper, including:
1. “Prevalence rates reported in studies by neurologists (0%–2.8%) were different from those reported by other specialists, such as psychiatrists and geriatricians (3.6%–30.5%). It may be due to a different emphasis on clinical phenotypes while diagnosing DLB: psychiatrists pay more attention to psychiatric symptoms and neurologists to neurological ones.”
2. “Timely and accurate diagnosis is very important due to several reasons: 1) neuroleptic sensitivity; 2) effectiveness of the treatment with cholinesterase inhibitors; and 3) some patients may respond to dopaminergic treatment of parkinsonism.”
3. “The loss of consciousness, which is characteristic of DLB, can be explained by temporal slow-wave transients revealed in EEG.”
4. “Currently, there are no evidence-based guidelines available when the treatment with antidementia drugs should be discontinued. The expert group recommends the following procedure: neuropsychological testing should be repeated after 3 to 6 months, and withdrawal of antidementia medication should be considered if the deterioration of cognitive functions is documented. If a significant decrease in the cognitive function is observed after 3-year treatment, antidementia drugs should be discontinued.”
5. “Bonelli with colleagues studied the effect of levodopa in patients with PD, PDD, and DLB and showed that motor improvement was similar in 3 groups studied, although the proportion of patients with an improvement of 10% and more was greater in PD than PDD and DLB.”
6. “A study by Ballard in 1998 reported that severe neuroleptic sensitivity occurred only in DLB (compared with AD) and was seen in 29% of cases, in all cases occurring within 2 weeks’ administration of a new neuroleptic or a dose change.”
I’ve copied the abstract below.
Robin
———————–
Medicina (Kaunas). 2012;45(1):1-8.
Dementia with lewy bodies: the principles of diagnostics, treatment, and management.
Macijauskiene. J, Lesauskaite. V.
Department of Geriatrics, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
Abstract
Dementia with Lewy bodies was first recognized as a separate entity about 30 years ago. The prevalence varies from 0% to 5% in the general population, and this disease accounts for 0% to 30.5% of all dementia cases. Dementia with Lewy bodies is considered the second most common cause of degenerative dementia after Alzheimer’s disease.
The disease is characterized by alpha-synuclein immunoreactive protein deposits in both neurons and glial cells. The protein deposits are especially prominent in dopaminergic neurons, where they can be detected using conventional histological stains, such as hematoxylin and eosin, and are commonly referred to as Lewy bodies.
The diagnosis of dementia with Lewy bodies is based on the presence of dementia as well as 2 of the following 3 core diagnostic features: 1) fluctuating cognition, 2) visual hallucinations, and 3) movement disorder.
Diagnostic tests include laboratory data, structural and functional imaging, and electroencephalography.
Differential diagnosis of dementia with Lewy bodies focuses on other later life dementia syndromes, other parkinsonian diseases (Parkinson’s disease, progressive supranuclear palsy, corticobasal degeneration), and primary psychiatric illnesses.
There is type 1b evidence to support treatment with cholinesterase inhibitors. Glutamatergic and dopaminergic therapies are used as well. Standard neuroleptics are contraindicated, and atypical agents should be used cautiously. Nonpharmacologic measures – therapeutic environment, psychological and social support, physical activity, behavioral management strategies, caregivers’ education and support, and different services – could be suggested.
PubMed ID#: 22481369 (see pubmed.gov for this abstract only)
Some definitions:
cholinesterase inhibitors = Aricept, Exelon, Razadyne
glutamatergic therapies = Namenda
dopaminergic therapies = Sinemet, Selegiline
