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Alzheimeŕs disease (AD) represents the most prevalent neurodegenerative disorder that causes cognitive decline in old age. In its early stages, AD is associated with microstructural abnormalities in white matter (WM). In the current study, multiple indices of diffusion tensor imaging (DTI) and brain volumetric measurements were employed to comprehensively investigate the landscape of AD pathology. The sample comprised 58 individuals including cognitively normal subjects (controls), amnestic mild cognitive impairment (MCI) and AD patients. Relative to controls, both MCI and AD subjects showed widespread changes of anisotropic fraction (FA) in the corpus callosum, cingulate and uncinate fasciculus. Mean diffusivity and radial changes were also observed in AD patients in comparison with controls. After controlling for the gray matter atrophy the number of regions of significantly lower FA in AD patients relative to controls was decreased; nonetheless, unique areas of microstructural damage remained, e.g., the corpus callosum and uncinate fasciculus. Despite sample size limitations, the current results suggest that a combination of secondary and primary degeneration occurrs in MCI and AD, although the secondary degeneration appears to have a more critical role during the stages of disease involving dementia.
Behavioral and psychological syndromes such as depression and psychosis often occur along with cognitive (esp. executive) deficits in vascular cognitive disorder (VCD) in the elderly. We present the case of an 85-year-old woman with deficits in executive functions as well as a persistent and clearly circumscribed paranoid hallucinatory syndrome (most probably due to VCD) which could not be adequately treated with antipsychotic medication. The patient also suffered from severe depression (independent of psychotic symptoms). Both psychosis and depression were successfully managed in a home treatment based on Flexible Assertive Community Treatment (FACT). Interestingly, a thematic association between the delusional contents and early childhood traumata could be reconstructed, and late-onset trauma-related symptoms could be successfully treated with cognitive-behavioral therapy (CBT) as well. In sum, behavioral management of psychotic syndromes is possible in the absence of adequate pharmacological treatment options, and multiprofessional and person-centered home treatment may be successful in the elderly, even in severe and complex disorders.