Wandering Dementia—A Syndrome with Forensic Implications

Byard, Roger W.; Langlois, Neil E. I.

doi:10.1111/1556-4029.13885

Cited by 18 publications

(16 citation statements)

References 29 publications

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“…Individuals become lost, putting them at risk of significant injury and death. 9 Eventually, the neuronal damage of Alzheimer's disease extends to parts of the brain that enable basic bodily functions such as walking and swallowing. Individuals become bed-bound and require aroundthe-clock care.…”

Section: Overviewmentioning

confidence: 99%

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2022 Alzheimer's disease facts and figures

2022

Alzheimer's & Dementia

1,571

664

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This article describes the public health impact of Alzheimer's disease (AD), including incidence and prevalence, mortality and morbidity, use and costs of care, and the overall impact on family caregivers, the dementia workforce and society. The Special Report discusses consumers' and primary care physicians' perspectives on awareness, diagnosis and treatment of mild cognitive impairment (MCI), including MCI due to Alzheimer's disease. An estimated 6.5 million Americans age 65 and older are living with Alzheimer's dementia today. This number could grow to 13.8 million by 2060 barring the development of medical breakthroughs to prevent, slow or cure AD. Official death certificates recorded 121,499 deaths from AD in 2019, the latest year for which data are available. Alzheimer's disease was officially listed as the sixth-leading cause of death in the United States in 2019 and the seventh-leading cause of death in 2020 and 2021, when COVID-19 entered the ranks of the top ten causes of death. Alzheimer's remains the fifth-leading cause of death among Americans age 65 and older. Between 2000 and 2019, deaths from stroke, heart disease and HIV decreased, whereas reported deaths from AD increased more than 145%. More than 11 million family members and other unpaid caregivers provided an estimated 16 billion hours of care to people with Alzheimer's or other dementias in 2021. These figures reflect a decline in the number of caregivers compared with a decade earlier, as well as an increase in the amount of care provided by each remaining caregiver. Unpaid dementia caregiving was valued at $271.6 billion in 2021. Its costs, however, extend to family caregivers' increased risk for emotional distress and negative mental and physical health outcomes -costs that have been aggravated by COVID-19. Members of the dementia care workforce have also been affected by COVID-19. As essential care workers, some have opted to change jobs to protect their own health and the health of their families. However, this occurs at a time when more members of the dementia care workforce are needed. Average per-person Medicare payments for services to beneficiaries age 65 and older with AD or other dementias are almost three times as great as payments for beneficiaries without these conditions, and Medicaid payments are more than 22 times as great. Total payments in 2022 for health care, long-term care and hospice services for people age 65 and older with dementia are estimated to be $321 billion. A recent survey commissioned by the Alzheimer's Association revealed several barriers to consumers' understanding of MCI. The survey showed low awareness of MCI among Americans, a reluctance among Americans to see their doctor after noticing MCI symptoms, and persistent challenges for primary care physicians in diagnosing MCI. Survey results indicate the need to improve MCI 700

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Section: Overviewmentioning

confidence: 99%

“…Wandering refers to individuals walking away from a particular location and being unable to retrace their steps. Individuals become lost, putting them at risk of significant injury and death 9 …”

Section: Overviewmentioning

confidence: 99%

2022 Alzheimer's disease facts and figures

2022

Alzheimer's & Dementia

1,571

664

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“…Many reports have documented the pathologic changes observed in human affected by hypothermia due to cold exposure, and "classic" morphologic findings supporting a diagnosis of hypothermia have been established [1][2][3][4][5][6][7]. However, as other etiologies of hypothermia include drug abuse, dementia, malnutrition, and infectious disease, only a few studies have specifically examined pathologic findings after cold exposure [8,9], especially from a biochemical perspective, such as the presence and levels of ketone bodies [10][11][12][13]. Furthermore, only a few reports have estimated hormone levels as part of the pathophysiologic findings of cold exposure [14][15][16].…”

Section: Introductionmentioning

confidence: 99%

Cortisol levels after cold exposure are independent of adrenocorticotropic hormone stimulation

Shida¹,

Ikeda²,

Tani³

et al. 2020

PLoS ONE

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We previously showed that postmortem serum levels of adrenocorticotropic hormone (ACTH) were significantly higher in cases of hypothermia (cold exposure) than other causes of death. This study examined how the human hypothalamic-pituitary-adrenal axis, and specifically cortisol, responds to hypothermia. Human samples: Autopsies on 205 subjects (147 men and 58 women; age 15-98 years, median 60 years) were performed within 3 days of death. Cause of death was classified as either hypothermia (cold exposure, n = 14) or noncold exposure (controls; n = 191). Cortisol levels were determined in blood samples obtained from the left and right cardiac chambers and common iliac veins using a chemiluminescent enzyme immunoassay. Adrenal gland tissues samples were stained for cortisol using a rabbit anti-human polyclonal antibody. Cell culture: AtT20, a mouse ACTH secretory cell line, and Y-1, a corticosterone secretory cell line derived from a mouse adrenal tumor, were analyzed in mono-and co-culture, and times courses of ACTH (in AtT20) and corticosterone (in Y-1) secretion were assessed after low temperature exposure mimicking hypothermia and compared with data for samples collected postmortem for other cases of death. However, no correlation between ACTH concentration and cortisol levels was observed in hypothermia cases. Immunohistologic analyses of samples from hypothermia cases showed that cortisol staining was localized primarily to the nucleus rather than the cytoplasm of cells in the zona fasciculata of the adrenal gland. During both mono-culture and coculture, AtT20 cells secreted high levels of ACTH after 10-15 minutes of cold exposure, whereas corticosterone secretion by Y-1 cells increased slowly during the first 15-20 minutes of cold exposure. Similar to autopsy results, no correlation was detected between ACTH levels and corticosterone secretion, either in mono-culture or co-culture experiments. These results suggested that ACTH-independent cortisol secretion may function as a stress response during cold exposure.

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“…Dementia is a term that is used for a range of diseases that cause cognitive impairment, most often in the elderly, resulting in difficulty in performing everyday activities [ 1 ]. According to the World Health Organization, dementia is estimated to affect nearly 78 million people by 2030 and more than 150 million by 2050 [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Non-Pharmacological Interventions for Wandering/Aberrant Motor Behaviour in Patients with Dementia

et al. 2022

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Background: Aberrant motor behaviour or wandering refers to aimless movement without a specific purpose. Wandering is common in patients with dementia and leads to early institutionalization and caregivers’ burden. Non-pharmacological interventions should be also considered as a first-line solution for the wandering because current pharmacological treatment has serious side-effects. Methods: A cross-over randomised controlled trial (RCT) with 60 participants of all stages and different types of dementia was conducted in Greece. The sample was randomly assigned in 6 different groups of 10 participants each. Every intervention lasted for 5 days, and there were 2 days as a wash-out period. There was no drop-out rate. The measurements used were the Mini Mental State Examination (MMSE), Addenbrooke’s Cognitive Examination Revised (ACE-R), Geriatric Depression Scale (GDS), Functional Rating Scale for Symptoms in Dementia (FRSSD), and Neuropsychiatric Inventory (NPI). The interventions that were evaluated were reminiscence therapy (RT), music therapy (MT), and physical exercise (PE). Results: NPI scores were reduced in the group receiving PE (p = 0.006). When MT (p = 0.018) follows PE, wandering symptoms are reduced further. RT should follow MT in order to reduce wandering more (p = 0.034). The same combination was effective for the caregivers’ burden as well; PE (p = 0.004), MT (p = 0.036), RT (p = 0.039). Conclusions: An effective combination that can reduce wandering symptoms in all stages and types of dementia was found: The best order was PH-MT-RT. The same combination in the same order reduced caregivers’ burden.

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Wandering Dementia—A Syndrome with Forensic Implications

Cited by 18 publications

References 29 publications

2022 Alzheimer's disease facts and figures

2022 Alzheimer's disease facts and figures

Cortisol levels after cold exposure are independent of adrenocorticotropic hormone stimulation

Non-Pharmacological Interventions for Wandering/Aberrant Motor Behaviour in Patients with Dementia

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