ISSN:0893-0341    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

SummaryDuring the past 10 years, there has been a rapidly growing number of pharmaceutical industry-sponsored drug trials for treatment of Alzheimer disease (AD) and other neurodegenerative diseases. As public awareness and concerns about AD have grown, so has interest in developing drug therapies for retarding symptom progression, delaying onset, and ultimately curing the disease. Ethical debate on the use of placebo control trials in AD research has come of age in the United States with the availability of treatments approved by the Food and Drug Administration. The experts and the public agree that more effective therapies are necessary, and new therapeutic options are being developed as rapidly as possible. The arguments on each side of the debate are provocative and important but do not provide unequivocal justification for either the abandonment or the maintenance of placebo-controlled trials in all AD research. Clinical trials differ with respect to scientific and practical goals, and these factors inherently affect the ethical priorities of each study. We present these contrasting points of view to delineate some of the issues rather than to make specific recommendations other than to urge that all clinical trials in AD should be designed with careful consideration of the ethical issues surrounding the use of placebo controls. As new and more effective treatments emerge, the ethical framework for placebo use in AD studies will require frequent re-examination. To make wise choices, patients, caregivers, physicians, and ethicists (among others) must have a voice in this continuing discussion

ISSN:0893-0341    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0893-0341    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

SummaryLittle is known about the person behind the eponymous dementia, Alois Alzheimer. We wished to study his life and contributions to the field of neuroscience. All cited articles about Alzheimer by his contemporaries and selected correspondence by him was translated from German. Additional personal information was obtained from his granddaughter. Alois Alzheimer made seminal contributions to the field of neuroscience, not only through his own research but also through the numerous scientists and physicians whom he taught. His contributions made a lasting impact not only in the area of Alzheimer disease but also other aspects of brain disease. In addition, he emerges as a complex person who coped successfully with numerous personal and career-related dilemmas that remain relevant in the academic environment today

ISSN:0893-0341    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

SummaryResults of recent investigations suggest that Alzheimer disease (AD) has a more deleterious effect on language in women than in men. This intriguing finding motivated an analysis of the language performance of probable AD patients, equally divided as to gender, on a variety of language comprehension and production tests. Cross-sectional data were available for 63 probable AD subjects and longitudinal data were available for 26. In addition to analysis of covariance used with the cross-sectional data, effect sizes were calculated. The longitudinal data were analyzed with repeated-measures analyses of covariance. The sum of scores on the orientation items of the Mini-Mental State Examination was used as the covariate in both analyses. No significant differences between the performance scores of male and female subjects were obtained for either the cross-sectional or longitudinal data. All effect sizes of gender were relatively small, with female patients outperforming males on most language tests. Results are discussed in the context of previous findings and comparison of the effect sizes among studies

ISSN:0893-0341    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

SummaryThere are multiple assessment techniques to help clinicians diagnose, stage, and measure the rate of progression in Alzheimer disease (AD). We analyzed retrospectively the relationship between scores on commonly used scales and tests (Mini-Mental State, the Blessed Information-Memory-Concentration Test, the Alzheimer's Disease Assessment Scale—cognitive portion, the Activities of Daily Living Scale, and the Global Deterioration Scale) of 100 successive admissions to a memory clinic. Patients were included in the study if they were diagnosed subsequently with probable AD and if all five measures were administered in the same day. Regression analysis yielded 20 linear equations that allowed for conversion between test scores on any two instruments. With the exception of the Activities of Daily Living Scale (intercorrelation range with the other four instruments, r=0.56-0.66), intercorrelations were generally high (r=0.81-0.87). The results of this study should provide a clinically useful tool for converting test scores on five commonly used dementia screening/rating instruments

ISSN:0893-0341    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

SummaryThirty-five patients with Alzheimer disease (AD), including 19 who were still driving, were evaluated for level of awareness and driving status. There was no significant correlation between driving status and Mini-Mental State Examination (MMSE) scores. Only the attention subscore of the awareness questionnaire yielded a statistically significant difference between drivers and nondrivers. Follow-up of the patients who were still driving was conducted 12-18 months later. All but 4 patients had stopped driving. Caregivers responded to a questionnaire assessing the patient's driving behaviors since the onset of AD. There was no correlation between MMSE and driving status. In 7 of 10 cases, caregivers or patients made the decision that the patient should stop driving. However, caregivers reported long periods between the caregiver's perception that the patient should stop driving and actual cessation (0.5^8 months). Results suggest that AD patients do restrict several areas of their driving voluntarily and that a failure to do so may be associated with an awareness deficit. In particular, a deficit of awareness for attention was significantly associated with an absence of restricted driving behaviors such as avoiding unfamiliar routes. Awareness of a deficit that is related to driving performance may be critical to restricted driving behavior, and this change in behavior may enable the patient to prolong his or her status as a driver

ISSN:0893-0341    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

SummaryWe sought to identify the most reliable magnetic resonance (MR) measures for the diagnosis and staging of Alzheimer disease (AD) in a clinical setting and to estimate, for different degrees of dementia, the rate of change of cerebral atrophy in certain regions of interest (ROIs). Forty-two probable AD patients and eight normal controls underwent MR brain scans, neurological examinations, and neuropsychological testing. We computed each subject's corpus callosum width, ventricular size, right and left temporal lobe areas, interuncal distance, and assessed the degree of cortical atrophy. We also estimated the rate of change for Information-Memory-Concentration Test scores and for temporal lobe areas and corpus callosum width. Measures of temporal lobe area and subjective evaluation of temporal lobe atrophy both served to distinguish controls from mild AD cases (p<0.05), whereas only the latter differentiated moderate from severe patients (p<0.05). The rate of change for temporal lobe areas remained constant over different AD stages, whereas those for corpus callosum width and for cognitive impairment were greater for severe cases (p<0.05). Our findings imply that measurements of temporal lobe area and ratings of temporoparietal atrophy can be useful in the diagnosis and staging of AD and suggest that atrophy progressed at different rates in selected ROIs for various stages of AD severity

ISSN:0893-0341    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

SummaryThe association between occupational exposure to electromagnetic fields (EMF) and Alzheimer disease (AD) was examined. Subjects were identified from a large health maintenance organization in Seattle, Washington, and matched by age, sex, and proxy type. A complete occupational history was obtained from proxies and controls. Following the interview, two industrial hygienists (IHs) rated exposures to EMF for each job blinded to case-control status. Exposures to EMF were rated as probable intermittent exposure or probable exposure for extended periods to levels above threshold. Conditional logistic regression was used to calculate the risk of AD given EMF exposure stratified by IH. The odds ratios for ever having been exposed to EMF were 0.74 [95% confidence interval (CI) 0.29-1.92] and 0.95 (95% CI 0.27-2.43) for each IH, adjusting for age and education. No dose-response effect was noted. Agreement between the two IHs for ever having been exposed to EMF was good (K=0.57, p<0.0001). This study was unable to support an association between EMF and AD

ISSN:0893-0341    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

SummaryFrom April 1996 to January 1997, 74 Alzheimer disease (AD) patients and their caregivers were recruited for participation in a comprehensive assessment at the Veterans General Hospital-Taipei, a 2,198-bed tertiary care teaching hospital in Taipei, Taiwan. Diagnosis of AD was made according to criteria of the Diagnostic and Statistical Manual of Mental Disorders-III-R (DSM-III-R). All AD patients were tested with the Chinese version of Cognitive Abilities Screening Instrument (CASI). Their primary caregivers rated the patients using the Revised Memory and Behavior Problems Checklist (RMBPC), the short version of Geriatric Depression Scale (GDS-S), and obtained information about coping strategies using the Carer's Stress scale. The three subscale scores for memory-related problems, depression, and disruptive behavior were obtained from the RMBPC. Scores for three subscales for management of situations, meaning, and distress were obtained from the coping strategies' assessment. Depression was defined as a GDS-S score s» 5. Among the 74 AD patients, 38 were men and 36 women. Their ages ranged from 47 to 90 years, with a mean age of 12.2 years (SD, 9.0). The CASI scores ranged from 1 to 88 (mean, 45.2; SD, 22.9). Thirty-three caregivers were men and 41 were women. Their age ranged from 20 to 85 years, with a mean age of 53.5 years (SD, 16.9). Twenty-six of the 74 caregivers (35.1%) were classified as depressed. The GDS-S scores of caregivers were correlated positively with the frequency of the use of a management of distress coping strategy and the frequency of the patients' disruptive behavior and were correlated negatively with the educational years of the caregivers

ISSN:0893-0341    

出版商:OVID    

年代:1999

数据来源: OVID