May 1999

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IN THIS ISSUE

NON-GENETIC RISK FACTORS FOR DEMENTIA

  • Antihypertensive treatment is associated with fewer cases of dementia in the elderly
  • Operations under general anesthesia are not risk factors for cognitive decline in the elderly
  • Longer-term cognitive impairment is associated with anesthesia in few cases
  • Donepezil improves delirium in dementia
  • Previously thought risk factors for AD are being modified

NEW GENETIC FACTORS IN ALZHEIMER'S DISEASE

  • Normal and aberrant gene function provides insight into AD
  • DLST and APOE genes are related in the very elderly with AD
  • A susceptibility gene for AD may reside near the D12S1045 locus

DEMENTIA IN PARKINSON'S DISEASE

  • CAMCOG may be useful in screening for dementia and cognitive impairment in PD
  • PD patients are at a greater risk of developing dementia than controls
  • Clozapine helps drug-induced psychosis in PD

EDITORIAL
FOREWORD
NON-GENETIC RISK FACTORS FOR DEMENTIA

There is always a strong interest in discovering risk factors for dementia, since this knowledge could lead to etiological hypothesis and preventive approaches in aging populations. The control of systolic hypertension is a good example of how epidemiology of dementia has led to preventive therapy (Forette et al). Fortunately, general anesthesia was not found to be a risk factor for age-associated cognitive decline (Dijkstra et al), although post-operative delirium is well described (Ritchie et al) and may be amenable to treatment by donepezil (Wengel et al). Head injuries are not a specific factor for Alzheimer's disease (Launer et al).

Prevention of dementia in randomised double-blind placebo-
controlled Systolic Hypertension in Europe (Syst-Eur) trial

(LANCET 1998;352:1347-1351)
FRANÇOISE FORETTE,
MARIE-LAURE SEUX,
JAN A. STAESSEN,
LUTGARDE THIJS,
ET AL,
PARIS, FRANCE,
LEUVEN, BELGIUM,
ROTTERDAM, NETHERLANDS,
BUCHAREST, ROMANIA,
VARIOUS OTHER CENTRES

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An operation under general anesthesia as a risk
factor for age-related cognitive decline:
results from a large cross-sectional population study

(J AM GERIATR SOC 1998;46:1258-1265)
JEANETTE B. DIJKSTRA, PHD,
MARTIN P.J. VAN BOXTEL, MD, PHD,
PETER J. HOUX, PHD,
JELLEMER JOLLES, PHD,
MAASTRICHT, THE NETHERLANDS

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Risk factors for dementia: impact of anesthesia
on the cognitive functioning of the elderly

(INTER PSYCHOGERIAT 1997;9[3]:309-326)
KAREN RITCHIE,
CATHERINE POLGE,
GUILHEM DE ROQUEFEUIL,
MICHEL DJAKOVIC,
BERNARD LEDESERT,
MONTPELLIER, FRANCE

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Donepezil improves symptoms of delirium in dementia:
implications for future research

(J GERIATR PSYCHIATRY NEUROL 199811:159-161)
STEVEN P. WENGEL, MD,
WILLIAM H. ROCCAFORTE, MD,
WILLIAM J. BURKE, MD,
OMAHA, NEBRASKA

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Rates and risk factors for dementia and Alzheimer's disease:
results from EURODEM pooled analyses

(NEUROLOGY 1999;52:78-84)
L.J. LAUNER, PHD,
K. ANDERSEN, MD,
M.E. DEWEY, PHD,
L. LETENNEUR, PHD,
ET AL,
ROTTERDAM, THE NETHERLANDS,
BORDEAUX, FRANCE,
FLORENCE, ITALY,
PAMPLONA, SPAIN

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NEW GENETIC FACTORS IN
ALZHEIMER'S DISEASE

EDITORIAL
COMMENT
This complex field has recently been reviewed by Levy-Lahad et al, but already new findings suggest a role for the DLST gene on chromosome 14 (Sheu et al), and for a new gene on chromosome 12 (Zubenko et al). The latter evidence adds to the controversy regarding the importance of mutations on chromosome 12, confirmed (Rogaeva et al, FAX back section) and denied (Wu et al, FAX back section) by excellent laboratories.

Recent advances in the genetics of Alzheimer's disease

(J GERIATR PSYCHIATRY NEUROL 1998;11:42-54)
EPHRAT LEVY-LAHAD, MD,
DEBBY TSUANG, MD, MSC,
THOMAS D. BIRD, MD,
SEATTLE, WA

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odulation by DLST of the genetic risk of
Alzheimer's disease in a very elderly population

(ANN NEUROL 1999;45:48-53)
KWAN-FU REX SHEU, PHD,
ABRAHAM M. BROWN, PHD,
VAHRAM HAROUTUNIAN, PHD,
BRUCE S. KRISTAL, PHD,
ET AL,
MANHASSET, NY,
CLEVELAND, OH,
STOCKHOLM, SWEDEN

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Neurobiological correlates of a putative risk allele
for Alzheimer's disease on chromosome 12q

(NEUROLOGY 1999;52:725-732)
GEORGE S. ZUBENKO, MD, PHD,
HUGH B. HUGHES, III, MS,
J. SCOTT STIFFLER, BS,
PITTSBURGH, PA

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DEMENTIA IN PARKINSON'S DISEASE

EDITORIAL
COMMENT
There is an increased interest in dementia associated with Parkinson's disease (PD). Detection of dementia in persons with PD is facilitated by the CAMCOG (Hobson and Meara). Longitudinal studies have confirmed a relative risk of 1.7 for developing dementia in persons with PD (Marder et al), and first degree relatives of demented PD patients are at higher risk of developing Alzheimer's disease (Marder et al, FAX back section). The dementia associated with PD is often confounded with drug-induced psychosis, which was found to be responsive to low-dose clozapine (The PSG).

The detection of dementia and cognitive impairment in
a community population of elderly people with Parkinson's
disease by use of the camcog neuropsychological test

(AGE AND AGEING 1999;28:39-43)
PETER HOBSON,
JOLYON MEARA,
DENBIGHSHIRE, UK

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The frequency and associated risk factors for
dementia in patients with Parkinson's disease

(ARCH NEUROL 1995;52:695-701)
KAREN MARDER, MD, MPH,
MING-XIN TANG, PHD,
LUCIEN COTE, MD,
YAAKOV STERN, PHD,
RICHARD MAYEUX, MD, MSE,
NEW YORK, NY

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Low-dose clozapine for the treatment of
drug-induced psychosis in Parkinson's disease

(N ENGL J MED 1999;340:757-763)
THE PARKINSON STUDY GROUP,
PAWTUCKET, RI

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