ISSN:0893-0341    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Summary:Complementary medicine is frequently utilized for a variety of chronic health problems. We evaluated its use among patients attending a Canadian dementia clinic. Using a telephone survey, we inquired about the use of alternative therapy, including nutritional supplements, herbal remedies, and chelation therapy, for problems with cognition. Only 9.6% of our patient population used complementary medicine as a treatment for cognitive problems. A further 29% used complementary medicines for general health promotion. While higher use might have been anticipated because of the limited conventional therapies available, we did not find a high prevalence of consumption of alternative medicine for cognitive problems. Knowledge of the use of these therapies is still important and should not be neglected. A nonjudgmental inquiry into all therapies being used (for whatever reason) should be part of the assessment of any patient with suspected dementia.

ISSN:0893-0341    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Summary:This study examined the relation between awareness of memory and functional decline and cognitive function in patients with Alzheimer disease (AD). Twentysix patients with early AD and 16 nondemented elderly controls were studied. Awareness of deficits was determined by using (a) a discrepancy score between subject's and caregiver's ratings on a memory questionnaire, (b) a discrepancy score between subject's and caregiver's ratings on an activities-of-daily-living scale, and (c) a clinical rating of dementia awareness for patients. Whereas self-ratings of memory and activities of daily living were not significantly different between AD patients and controls, these two measures differed significantly when AD patients' ratings were compared with those of their caregivers. Measures of awareness of deficits correlated with one another and were primarily associated with performance on tests of executive and visuospatial functions but not with depression. Early AD is characterized by a failure of self-monitoring. Deficits in self-monitoring have been proposed to occur after damage to the frontal lobes and other cerebral areas. Impaired awareness of memory and functional deficits in AD is related to cognitive impairments, which may involve frontal and right hemisphere connections.

ISSN:0893-0341    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Summary:Gangliosides and major membrane components were determined in caudate nucleus, putamen, and hippocampus of 12 cases with Alzheimer disease (AD) type I, also termed presenile or pure AD, and in age-matched controls. The concentration of gangliosides, a marker for axodendritic arborization, was reduced to 71% in caudate nucleus, 82% in putamen, and 66% in hippocampus of that in the controls. Significant diminution of total dry solids, protein, and phospholipids was also found in caudate nucleus and was most pronounced in hippocampus. The early signs of extrapyramidal features have been emphasized in AD type I. We now provide evidence that the neostriatum is affected in AD type I (the putamen, however, to a lesser extent than the caudate nucleus). The biochemical changes in these nuclei can be significantly related to scores of impairment of motor performance.

ISSN:0893-0341    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Summary:Aggressive behavior is thought to be pervasive among and devastating to demented patients and their caregivers. This study investigated the prevalence of physical aggression in demented inpatients with Alzheimer disease (AD). Additionally, the characteristics and psychiatric symptoms that may be associated with aggression were tested. Forty-seven patients with probable AD were included in this study. Physical aggression was reported in 27 (57.4%) of the patients. These patients were older, had a later onset of dementia, and had a higher prevalence of misidentification, activity disturbances, and day/ night disturbance. The relationship between these factors and physical aggression needs further clarification, which may help provide effective predictors and treatment of the aggressive behavior.

ISSN:0893-0341    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Summary:The frequency and correlates of sexual behavioral changes in Alzheimer disease (AD) were assessed in two studies. In the first study, we reviewed the medical records of 135 consecutive community-living patients who fit the criteria of the National Institute of Neurological and Communicative Disorders and Stroke/ Alzheimer Disease and Related Disorders Association for probable or possible AD, and we asked spouses to complete a questionnaire that included two questions about sexual activity. Indifference to sexual activity was reported by 70% of the spouses, and sexual behavioral modifications were reported by 50%. No correlation was found between sexual changes and the general characteristics of the patients, the severity of the disease, or depressive symptomatology. Sexual changes were correlated to the severity of behavioral and mood disorders, mainly to a reduction of activity and emotional deficit. Seventy-seven of the patients had a second examination after an interval of 18.9 ± 9.9 months. The links between sexual changes and the other variables were similar to those found by the first examination. In the second study, a questionnaire was sent by mail to the spouses of 100 patients. No relationship was found between sexual changes and the severity of cognitive deficits, previous sexual agreement, age, or gender. Sexual changes were considered a factor of maladjustment for the couple by 46% of the spouses.

ISSN:0893-0341    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Summary:Besipirdine hydrochloride (HP 749) is an indole-substituted analog of 4- aminopyridine. Besipirdine enhances both cholinergic and adrenergic neurotransmission in the central nervous system. The present study examined the efficacy and tolerability of two doses of besipirdine (5 and 20 mg b.i.d.) in 275 patients with Alzheimer disease during 3 months of treatment and for 3 months after withdrawal of treatment. Assessment after withdrawal of treatment was used in an effort to distinguish persistent efficacy attributable to a neuroprotective mechanism from reversible symptomatic efficacy. Besipirdine was generally well tolerated. The level of performance on the cognitive subscale of the Alzheimer Disease Assessment Scale (ADAS-Cog) was sustained during 3 months of treatment with besipirdine, whereas some deterioration in the performance of patients treated with placebo was observed over the same period. The small difference between active and placebo treatment groups approached, but did not reach statistical significance in the primary intent-to-treat analysis (p=0.067); analysis of patients who completed all assessments was supportive (p=0.031). Global ratings using the Clinician Interview-Based Impression of Change did not detect a besipirdine treatment benefit, possibly because of an adverse effect on mood and behavior in some patients. A high ratio of adrenergic to cholinergic potency may have resulted in the adverse effects of besipirdine and hence its failure to support the hypothesis that multiple neurotransmitter treatment may be more efficacious than monotherapy. The efficacy apparent on the ADAS-Cog after 3 months of treatment did not persist 3 months after withdrawal of treatment, suggesting that the benefit was symptomatic. This study provides a practical example of the use of treatment withdrawal assessment to distinguish neuroprotective from symptomatic efficacy.

ISSN:0893-0341    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Summary:We reviewed clinical case series published over a 10-year period addressing the cross-sectional frequency, incidence, and diagnostic and prognostic significance of extrapyramidal signs (EPS) in Alzheimer disease (AD). The review was prompted by recent reports of Lewy body (LB) pathology in the brains of many AD patients and the association of LB pathology with clinical parkinsonism in AD. In the clinical case series reviewed, we evaluated several possible determinants of prevalent EPS, including neuroleptic use, EPS assessment technique, and dementia severity. Neuroleptics were a well recognized cause of parkinsonism in these reports, though some failed to document the frequency of neuroleptic use. Assessment methods were also important: Studies using structured clinical research scales to rate EPS reported higher frequencies than studies employing routine neurological examination. The relationship between parkinsonism and dementia severity was complex. Some studies found bradykinesia, facial masking, and parkinsonian postural changes even in mildly demented, neuroleptic-naive AD patients. Rigidity, on the other hand, became increasingly common as dementia progressed. AD patients with EPS showed faster cognitive and functional decline and earlier death than those without EPS, even after consideration of differences in initial dementia severity. In the differential diagnosis of dementia with parkinsonism, LB disease in its various forms, including AD with LB, is the principal diagnostic consideration. Future studies of parkinsonism in AD should employ standardized clinical rating scales and should exclude patients on neuroleptics or analyze their results separately. Investigators should report frequencies for individual parkinsonian signs in addition to the overall prevalence of EPS to facilitate meaningful comparisons across studies.

ISSN:0893-0341    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:0893-0341    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:0893-0341    

出版商:OVID    

年代:1996

数据来源: OVID