摘要:

The prevalence and correlates of behavior problems were assessed among 614 residents with dementia living in 70 special care units (SCUs) throughout the country. We assessed behavior problems at admission, using a comprehensive measure of behavior problems, the Memory and Behavior Problems Checklist–Nursing Home version. Overall, behavior problems were quite prevalent, with some problems reported for >90% of the sample. Emotional distress was a frequent area of concern, second only to memory-related problems. Although the overall number of behavior problems was not associated with cognitive impairment, age, or gender, item analyses revealed relationships between these variables and individual behavior problems. The applicability of these findings to the care of the SCU resident is discussed.

ISSN:0893-0341    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Acetyl-L-carnitine (ALCAR) is a drug currently under investigation for Alzheimer disease (AD) therapy. ALCAR seems to exert a number of central nervous system (CNS)–related effects, even though a clear pharmacological action that could explain clinical results in AD has not been identified yet. The aim of this study was to determine cerebrospinal fluid (CSF) and plasma biological correlates of ALCAR effects in AD after a short-term, high-dose, intravenous, open treatment. Results show that ALCAR CSF levels achieved under treatment were significantly higher than the ones at baseline, reflecting a good penetration through the blood–brain barrier and thus a direct CNS challenge. ALCAR treatment produced no apparent change on CSF classic neurotransmitters and their metabolite levels (homovanillic acid, 5-hydroxyindoleacetic acid, MHPG, dopamine, choline). Among CSF peptides, while corticotropin-releasing hormone and adrenocorticotropic hormone remained unchanged, β-endorphins significantly decreased after treatment; plasma cortisol levels matched this reduction. Since both CSF β-endorphins and plasma cortisol decreased, one possible explanation is that ALCAR reduced the AD-dependent hypothalamic–pituitary–adrenocortical (HPA) axis hyperactivity. At present, no clear explanation can be proposed for the specific mechanism of this action.

ISSN:0893-0341    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

The aim of this controlled study was to evaluate the effects of a long-term program of formal didactic group therapy [class reality orientation therapy (ROT)] in Alzheimer disease. The study was conducted in the day hospital of an Alzheimer Dementia Research and Care Unit (Brescia, Italy), a multidisciplinary care center providing diagnostic evaluation and treatment for elderly patients with cognitive impairment. The criteria for the inclusion of patients in the study were mild to moderate cognitive impairment [Mini Mental Status Examination (MMSE) between 11 and 24/30] and absence of major aphasia, blindness, and overt behavioral disturbances such as wandering or agitation. Sixteen patients constituted the experimental group and 12 the control group. The last cognitive, functional, and affective evaluation in the experimental and control group was performed 8.2 and 8.5 months after baseline assessment, respectively. The experimental group had repeated cycles of 1-month ROT classes, and 5–7 weeks was allowed between each cycle. Differential change for MMSE score between the two groups was significant. In the experimental group, there was mild improvement in MMSE score (0.68 point) at the last assessment, whereas the control group declined (-2.58 points). This treatment effect on MMSE score (3.27 points) was controlled for potential confounders in a multiple regression analysis. Adjusted treatment effect, including age, education, baseline MMSE, disease duration, disease severity, number of diseases other than Alzheimer, and time elapsing from baseline to last assessment, was very slightly lower: 3.12. In the experimental group, treatment effect was evaluated by comparing ROT cycle changes and resting period changes. A clearly significant treatment effect was found for MMSE and verbal fluency.

ISSN:0893-0341    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Our experience with studies investigating central nervous system active compounds in Alzheimer disease (AD) patients suggest that conducting a “bridging study,” in which patients from the target population are included in Phase I, could expedite the drug development process in AD. With one acetylcholinesterase (AChE) inhibitor compound (velnacrine), we found that AD patients tolerated considerably lower dosages than young normals and healthy elderly subjects, whereas our findings were exactly the opposite with another AChE inhibitor (eptastigmine). In studies of a muscarinic agonist (CI-979), AD patients were able to tolerate dosages higher than those that were well tolerated in young normals. A possible explanation for differences in drug effect and tolerance in the target population may be the pathologic changes in both the brain and the peripheral nervous system that are associated with AD.

ISSN:0893-0341    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

One hundred consecutive outpatients with dementia were prospectively studied to investigate the diagnoses of dementing diseases and to correlate these diagnoses with socioeconomic status and with education. Alzheimer disease was the most common cause of dementia (54%), followed by vascular dementia (20%). Eight patients presented with potentially reversible causes of dementia. These frequencies are similar to those reported by case register studies from Western Europe and the United States. We did not find differences in the frequencies of the dementing diseases according to socioeconomic status or education. Alzheimer disease was the most common cause of dementia in all socioeconomic classes. Potentially reversible dementias, vascular dementias, and other secondary dementias were not more frequent in the lower socioeconomic strata. There was a trend to a higher frequency of vascular dementia among patients with less education, but this was not statistically significant.

ISSN:0893-0341    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

The NINCDS-ADRDA criteria for the clinical diagnosis of probable Alzheimer disease (AD) state that “gait disturbances at the onset or very early in the course of the illness make the diagnosis of Alzheimer disease uncertain or unlikely,‘’ yet there have been few studies documenting the validity of the statement. We therefore reviewed all cases of pure autopsy-proven AD in the Ramsey Brain Bank to determine how frequently an abnormal gait was noted at time of presentation. Any reported gait disturbance was considered an abnormal gait. Only cases for which medical records were available documenting the patient's presentation for dementia were included. Cases were excluded if any other pathology was present that may have contributed to the patient's dementia or to a gait disorder, if neuroleptic medication had been used, or if there was a preexisting gait disorder. Clinical dementia severity at time of presentation was graded as mild, moderate, or severe perDSM-IIIRcriteria. Of the 95 cases that met study criteria, none of the 36 patients with mild dementia were reported to have had an abnormal gait. Sixteen percent of the patients with moderate and 32% with severe dementia had gait abnormalities reported. This study confirms the statement regarding gait in the NINCDS-ADRDA criteria.

ISSN:0893-0341    

出版商:OVID    

年代:1995

数据来源: OVID

ISSN:0893-0341    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Allelic frequencies of apolipoprotein &epsis;4 were compared in 13 dizygotic twin pairs and 13 sibling pairs in which at least one member has Alzheimer disease (AD). Among discordant pairs of twins and siblings, frequencies were significantly greater in affected than intact partners. There was no significant difference in allelic frequencies between twins with a positive family history and twins with a negative family history. The &epsis;4 allele was more common in the sibling sample selected for family aggregation of AD than the twin sample. Several lines of evidence indicate that while the &epsis;4 allele appears to be one risk factor for AD, other etiological factors must be considered as well.

ISSN:0893-0341    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

The prevalence of the symptoms at disease onset reported by close informants, in an unselected group of demented elderly, is presented in this study. Of the 174 dementia cases, 98 were Alzheimer disease (AD), 41 were vascular dementia (VaD), and 35 were other dementias. In 42% of AD subjects, single memory deficit was the earliest problem, while in 56% of VaD cases, the tendency was to present two or more disturbances in the early stages. Slightly younger mean age at onset was reported in VaD than in AD cases. Our results support the hypothesis that the debut of the dementia is variable with any combination of symptoms. However, when memory problems start, assessment is needed. Among the neurological findings in the clinical examination, extrapyramidal signs were present in 25% of all dementia cases and in 20% of AD cases. A higher frequency of extrapyramidal signs was present in more severe cases, confirming previous reports of the unfavorable prognostic value of these signs.

ISSN:0893-0341    

出版商:OVID    

年代:1995

数据来源: OVID

ISSN:0893-0341    

出版商:OVID    

年代:1995

数据来源: OVID