ISSN:0893-0341    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

There has been increasing recognition of the ethical dilemmas that arise in the delivery of health care services and in planning and executing scientific research. Alzheimer disease (AD) and related dementias pose a particular challenge for families, care providers, and researchers because of the nature of the illness. Naturally, those at potential risk of developing the disease are eager for scientists to develop valid predictive tests for the disease. Alzheimer organizations have developed worldwide in response to the growing awareness and knowledge of the effects of dementia on individuals and their families. These organizations have played a role in advocating for research, increasing general awareness of the nature of the disease, and lobbying for more services for persons with dementia and their families. These organizations have also realized the increasing concern about the many ethical issues that arise in caring for those with AD and researching causes and cures. This paper describes a unique process one national Alzheimer society used to develop an Ethics Task Force to provide guidelines on ethical issues.

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:

We studied the utility of a “vignette method” to assess mental competency for decision making on medical treatment and research participation. A vignette is a description of an imaginary situation in which the subject is asked to decide on a proposed treatment or on participation in research. His or her understanding of the situation and the quality of the reasoning underlying that choice are tested by a short series of questions. Subjects were participants in the Amsterdam Study of the Elderly (AMSTEL), a population-based study on cognitive decline and dementia. The sample consisted of elderly people (70–90 years), who were cognitively intact (n= 176) or had a dementia syndrome (n= 64; mostly Alzheimer disease). Dementia was diagnosed using the Cambridge Examination for Mental Disorders of the Elderly (CAMDEX) schedule. Two vignettes were used as competency assessment instruments. The answers to the vignette questions were summed to form a competency score. The reliability (internal consistency) of this score was 0.82 for both vignettes combined. After dichotomization into competent/incompetent (cutoff at the fifth centile of the control group), the agreement between the vignette method and a physician's judgment of competency was poor (k = 0.36) in the demented group. There was no agreement whatsoever when subjects with “minimal dementia” (n= 14) were left out of this analysis (k = 0.04). As expected, mean competency scores declined with increasing dementia severity. A multiple regression analysis showed that mental competency as measured by the vignette method was determined mainly by recent memory, expressive language, and abstract thinking. In the control group the competency score was only slightly related to education (r= 0.12) and verbal intelligence (r= 0.27). We conclude that the vignette method is a reliable and valid method for the assessment of mental competency in elderly people with cognitive decline. The vignette method is preferred over a physician's judgment, especially in patients with early dementia.

ISSN:0893-0341    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Two patients meeting the criteria for probable Alzheimer disease (AD) who were participating in a phase 3 clinical program with eptastigmine, a cholinesterase inhibitor, committed suicide. The first patient committed suicide by a self-inflicted gunshot wound to the head. The second patient committed suicide by jumping from a 19th story window. These two patients shared several clinical features with those found in the literature: being at the early stages of the disease, having a high level education, with preserved insight, having access to firearms, and being aware of not responding to pharmacological treatment.

ISSN:0893-0341    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Some of the views of the Royal Dutch Medical Association on end-of-life decisions in cases of people suffering from Alzheimer disease and related disorders are presented. The focus of the present report is on the views of the commission regarding active life termination of demented patients with or without an actual and explicit request from the patient. Some comments on these views are made, particularly regarding the notion of “loss of human dignity”(ontluistering)with respect to dementia.

ISSN:0893-0341    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Frontotemporal dementia (FTD) is the second cause of degenerative dementia. Behavioral changes occur before the cognitive decline and remain the major feature. A poor perception of emotion could account for some behavioral symptoms. The aim of this study was to assess the perception of emotion in patients with FTD and to compare it with that of patients with Alzheimer disease (AD). Fifty subjects performed the tests: 20 patients with probable AD, 18 patients with FTD, and 12 matched controls. The two patient groups did not differ in age, sex, severity of dementia, duration of the disease, and language tests. Subjects had to recognize and point out the name of one of seven basic emotions (anger, disgust, happiness, fear, sadness, surprise, and contempt) on a set of 28 faces presented on slides. The three groups were equally able to distinguish a face displaying affect from one not displaying affect. Naming of emotion was worse in patients with FTD than in patients with AD (correct answers 46% vs. 62%;p= 0.0006) who did not differ significantly from controls (72%). Anger, sadness, and disgust were less recognized in FTD than in AD patients who did not differ from controls, whereas fear and contempt were poorly recognized in both groups of patients compared with controls. These findings argue for different neural substrates underlying the recognition of various basic emotions. Behavioral disorders in FTD may be partly due to an impaired interpretation of the emotional environment.

ISSN:0893-0341    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

We have reported that physostigmine, a reversible cholinesterase inhibitor, enhances verbal memory in patients with Alzheimer disease (AD). To elucidate the mechanism of cognition enhancement, plasma hormones were measured during high-dose acute and low-dose chronic steady-state intravenous infusions of physostigmine in nine subjects with AD. High-dose hormone responses were measured during and for 24 h after the infusion of physostigmine 1–1.5 mg over 45–60 min. Chronic responses were measured during continuous intravenous infusions of physostigmine at doses (0.5–25 mg/day) that escalated over 2 weeks, and then during 1 week infusion of the dose that optimized cognition (2–12 mg/day) or placebo administered in a randomized, double-blind, crossover design. A replicable improvement in verbal memory was found in five subjects. High-dose physostigmine infusion that produced noxious side effects resulted in significant elevation above baseline in plasma levels of adrenocorticotrophic hormone (ACTH) (p= 0.0001), cortisol (p= 0.0001), and β-endorphin (p= 0.0001). Chronic physostigmine administration, in the absence of adverse effects, produced no significant elevation in ACTH (p= 0.08), cortisol (p= 0.70), or β-endorphin (p= 0.82). These results indicate that high-dose physostigmine activates the hypothalamic-pituitary-adrenal (HPA) axis, likely representing a “stress response.” In contrast, cognition-enhancing doses do not produce a peripheral corticosteroid response. Thus, physostigmine-induced memory improvement is independent of the activation of the HPA axis.

ISSN:0893-0341    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

This study aimed to characterize the features of outdoor areas for persons with dementia, and to clarify the relationship between design features, use, and satisfaction with these areas. A national survey of long-term care facilities with outdoor areas investigated the characteristics and features of these areas, and how those related to their perceived impact on their users. Most respondents rated outdoor spaces as very useful, and as having a great benefit for users. The perceived benefit was related to the presence of more design features, such as the presence of gazebos and to the number of activities offered in the area. Despite these positive findings, respondents stated the areas were not used as much as possible and indicated several problems, mostly related to the safety of the residents. The results of this survey can assist facilities in better designing or improving their outdoor areas to increase use and satisfaction.

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