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

ISSN:0893-0341    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Summary:Evaluation of psychological well-being among persons with an advanced dementia is primarily dependent on verbal and non-verbal cues and behaviors that are observed and interpreted by others. The purpose of the present study was to determine how many components of psychological well-being can be measured. Fifty-seven individuals who were institutionalized for advanced dementia and exhibited agitation or withdrawal were evaluated by direct observations and by interviews with nursing home staff. Engagement was measured by the Lawton Positive Affect scale, visual analog scale, and reported degree of patient's interest in the environment. Mood was measured by a global indicator of mood interpreted from facial expression and two mood items from the Multidimensional Observation Scale for Elderly Subjects. Agitation was measured by a visual analog scale and by the Short Form of the Cohen-Mansfield Agitation Inventory. Correlation analyses and multidimensional scaling provided evidence for three dimensions of psychological well-being: engagement-apathy, happy-sad mood, and calm-agitation. Evaluation of these three dimensions is important for measuring quality of care in long-term care settings and for determining effectiveness of therapeutic interventions.

ISSN:0893-0341    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Summary:The aim of the present study was to determine the longitudinal course of behavioral disturbances and to examine whether these disturbances are stage dependent during the course of Alzheimer disease (AD). One hundred seven community-dwelling patients with probable AD were assessed up to six times annually by using a validated and reliable rating scale, the Troublesome Behavior Scale, for assessing the frequencies of behavioral disturbances. The subjects were divided into three groups according to their baseline global function as assessed by the Clinical Dementia Rating (CDR; 1=mild, 2=moderate, 3=severe). At the end of the 5-year observation period, 31 subjects were still active participants, 52 had died, 20 lived in institutions, and 4 had stopped participating. The patterns of their behavioral disturbance changes depended to a considerable extent on the baseline severity of the illness. The behavioral disturbance frequencies generally peaked at the CDR 2 stage and followed a downward trend thereafter. Considerable individual variations in the disturbance frequencies during the course of the illness were observed. Knowing the behavioral course of AD will enable clinicians to better counse1 families and appraise the results of treatments for behavioral symptoms.

ISSN:0893-0341    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Summary:The aim of the present study was to identify determinants of attrition in a natural history study of a tertiary care sample of patients with Alzheimer disease (AD) and control subjects. A longitudinal study was performed with 978 patients with AD and 466 control subjects age 50 years and older enrolled at 25 sites of the Consortium to Establish a Registry for Alzheimer's Disease between January 1987 and January 1992; subjects were followed annually for up to 78 months. Both descriptive statistics and polytomous logistic regressions were run to identify determinants of attrition. Of the 1,444 subjects enrolled, 10.5% dropped out after initial evaluation, 31.0% provided at least two waves of data, and 58.4% provided complete follow-up. Inadequate involvement by the site, non-white status, and patient's spouse not enrolled in the study were predictive of dropout; cessation of participation because of death (which may have precluded dropout) predicted continuation in the study. Age, level of education, severity of dementia, and rapidity of progression of disease did not predict dropout. Level-of-site commitment was the most significant determinant of continued participation in this natural history study of AD, followed by white race, and the inclusion of both husband and wife where one is a patient and the other a control subject.

ISSN:0893-0341    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Summary:Carriers of the apolipoprotein E (APOE) e4 allele show significantly higher risk of Alzheimer disease (AD). The aim of this present study was to test the hypothesis that a significant interaction exists betweenAPOEgenotype and gender on AD. Interactions of e4 by gender, although indicated in the literature, require further verification. A total of 195 past or current control or AD participants in an ongoing longitudinal study of aging and dementia were genotyped. All subjects were at least 60 years old; demented subjects met clinical or pathologic criteria for late-onset AD. Logistic regression analysis and proportional hazard models were used to evaluate joint effects of APOE and gender. A significant statistical interaction between APOE and gender was shown (p=0.04) in logistic regression analysis. Women carrying one or more APOEe4 allele were more likely to develop AD [odds ratio (OR)=7.8, 95% confidence interval (CI)=3.2-19.1]. For men, the presence of the APOE-e4 allele was not associated with a statistically significant increased risk (OR=1.6, 95% CI=0.5-5.3). The interaction term in the proportional hazards model neared (p=0.07) statistical significance, and a similar but reduced gender effect was shown. The analysis suggests that the presence of one or moreAPOE-e4 allele confers a substantially greater risk of AD to women than to men. These findings in part may account for reports of increased risk of AD faced by women.

ISSN:0893-0341    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Summary:Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a hereditary disease that is characterized by recurrent stroke episodes and focal neurologic deficits progressing to pseudobulbar palsy and dementia. The causative gene is the Notch3 gene on chromosome 19, and 22 missense mutations have been identified in Caucasian patients to date. To perform mutational analysis of the Notch3 gene, we identified its exon-intron boundaries and prepared sets of primers for amplification of each exon. Using these primers, we determined the Notch3 gene in a Japanese family with CADASIL symptoms and found a missense mutation (Argl33Cys) in exon 4. The mutation was heterozygous and cosegregated with the disease. Thus, the Notch3 gene is responsible for CADASIL in patients across different ethnic groups.

ISSN:0893-0341    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Summary:Although diffuse plaques in the neocortex may represent an early stage in the evolution of neuritic plaques, plaques in the striatum and cerebellum retain their predominantly diffuse nature in Alzheimer disease (AD), regardless of disease duration. We had the opportunity to explore the progression of these regional features by using autopsy brain specimens from 15 cognitively normal and five AD subjects, all Catholic sisters enrolled in the Nun Study, a longitudinal study on aging and AD. Neuropathologic changes were assessed in the temporal cortex, striatum, and cerebellum without knowledge of clinical status. We found diffuse plaques in the striatum in six (40%) and cerebellar plaques in none of the brains from the non-demented subjects. Striatal plaques were present in all five and cerebellar plaques in four of the five AD cases. In the 20 cases overall, the presence of striatal plaques generally paralleled the occurrence of neuritic plaques in neocortex and correlated with lower scores on several neuropsychologic tests assessing memory. Our findings suggest that striatal diffuse plaques occur relatively early in the progression of AD pathology and coincide with neocortical pathology and cognitive changes. Thus, it is unlikely that temporal factors alone account for regional differences in progression of AD neuropathology.

ISSN:0893-0341    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Summary:Alexander disease is a leukodystrophy-like neurodegenerative disease that typically presents in infancy or childhood. The disease is essentially a sporadic condition, and there is no known genetic predisposition or metabolic abnormality. The hallmark of the disease is the diffuse accumulation of Rosenthal fibers (RF) throughout the central nervous system. Although an etiological relationship of the RF to disease pathogenesis has been suspected since the initial description of Alexander disease, such a relationship has not been confirmed. We previously identified a number of oxidative posttranslational modifications, including advanced glycation end products and lipid peroxidation adducts, in intimate association with the RF of Alexander disease. Such oxidative protein damage provides a mechanism, through protein cross linking, for insolubility and accumulation of RF. Notably, these findings show a striking parallel with the biochemical features of age-related neurodegenerative diseases such as Alzheimer disease. Therefore, Alexander disease and Alzheimer disease likely share a common pathogenesis, namely oxidative injury as a potential primary process in the etiology and pathogenesis.

ISSN:0893-0341    

出版商:OVID    

年代:1999

数据来源: OVID