ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1985.tb07145.x

出版商:Blackwell Publishing Ltd    

年代:1985

数据来源: WILEY

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1985.tb07146.x

出版商:Blackwell Publishing Ltd    

年代:1985

数据来源: WILEY

摘要:

The role of physicians in the long‐term management of patients with the primary diagnosis of progressive dementia was investigated by surveying the opinions of 57 physicians and 47 family members. Respondents were asked to evaluate the difficulty and helpfulness of various activities physicians perform in the diagnosis, treatment, and management of patients with dementia. Both physicians and families rated the diagnostic services provided by physicians very highly. Although families found physicians' explanations of the diagnosis and prognosis extremely helpful, physicians reported this as an area of difficulty. Physicians and families expressed considerable frustration with the limited medical treatments and interventions for the relief of symptoms associated with dementia. Despite the acknowledged sensitivity of physicians to the social‐psychological consequences of dementia, physicians were found to be least helpful in addressing these issues, either directly or through referral to allied health and social services. This study outlines areas of physician education that need improvement and calls for development of an interdisciplinary network of services for the biopsychosocial management of dementia.J Am Geriatr Soc 33:383,

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1985.tb07147.x

出版商:Blackwell Publishing Ltd    

年代:1985

数据来源: WILEY

摘要:

The use of lumbar puncture (LP) and cerebrospinal fluid (CSF) analysis in the routine, initial evaluation of patients with dementia continues to be questioned. This is especially true in the investigation of infectious causes of dementia. To explore this question further, the authors performed a retrospective analysis of 672 hospitalized patients specifically evaluated for dementia. LP and CSF analysis were performed on 402 patients (60 per cent); routine bacteriologic, acid‐fast, and fungal cultures were also obtained for 333 of these patients. Most patients were white (64 per cent) and male (63 per cent), their mean age being 66 ± 11 years. Four patients were diagnosed as having meningitis—two withCryptococcus neoformans, one with apparentMycobacterium tuberculosis, and one with coagulase‐positiveStaphylococcus aureus.These patients were characterized by a subacute change in mental status, fever or meningismus, and CSF pleocytosis with abnormal CSF chemistries. None of the patients were found to have newly diagnosed neurosyphilis. The authors conclude that LP and CSF analysis should not be part of the routine evaluation of patients with dementia and should be performed only in the presence of such indications as a subacute duration of dementia, fever, and signs of meningeal irritation.J Am Geriatr Soc 33:39

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1985.tb07148.x

出版商:Blackwell Publishing Ltd    

年代:1985

数据来源: WILEY

摘要:

In a retrospective study of 80 patients over 55 years old, the efficacy of lumbar puncture in evaluating elderly demented patients was examined. Despite a cost of $381 per procedure, in addition to cerebrospinal fluid (CSF) evaluation, no diagnosis was made on the basis of the information obtained in any of the patients (53 per cent) who underwent lumbar puncture. The only abnormalities found were 11 cases of nonspecific elevations in CSF protein and one case of abnormal cellularity not related to bacterial infection. An additional 422 cases of dementia from other series were reviewed, and only four patients were found whose diagnosis could have been made by lumbar puncture—one patient had neurosyphilis, and the other three were postencephalitic. In addition, the literature on complications of lumbar puncture was reviewed. There were no serious complications of lumbar puncture in the present study. The authors concluded that although it is low‐risk, lumbar puncture cannot currently be recommended for routine use in the evaluation of elderly demented patients, but should be used in evaluating demented patients under 55 years of age, patients with rapid onset or progression of dementia, patients with syphilis serology in suspected cases of viral encephalitis, and patients with signs and symptoms of fungal meningitis.J Am Geriatr Soc 33:397,

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1985.tb07149.x

出版商:Blackwell Publishing Ltd    

年代:1985

数据来源: WILEY

摘要:

In a prospective, double‐blind study of 84 unselected persons in a dementia clinic, the red blood cell/plasma choline ratios were found to be significantly higher in 47 subjects with clinically defined Alzheimer disease (DAT) than in 37 non‐DAT, nondepressed subjects (3.54 ± 0.48 versus 2.04 ± 0.34,p<0.02). The latter group included intellectually intact subjects as well as patients with other dementias who were comparable to the Alzheimer patients in age, sex, and degree of cognitive impairment. The elevated mean ratio reflected the greater proportion of Alzheimer patients with high red blood cell plasma choline ratios. These elevated ratios appeared to be related to both increases in red cell content and decreases in plasma choline. The authors conclude that the results confirm and extend those previously reported in short series of patients and agree with other evidence that Alzheimer disease has systemic manifestations in nonneural cells, which may be useful in further investigations of the disease's cellular pathophysi

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1985.tb07150.x

出版商:Blackwell Publishing Ltd    

年代:1985

数据来源: WILEY

摘要:

This paper examines the relationship between physical fitness and activity among elderly males in the traditional rural community of Chetbesi, Nepal. It takes advantage of the unique character of the Hindu caste system to implement a quasiexperimental research design that approximates random assignment to high and low activity levels. The members of the Sarki caste have lower heart rates and systolic blood pressure, relative to other castes, at each of three submaximal workloads and during recovery from bicycle ergometer exercise. Direct observation and physiologic monitoring show that the Sarkis engage in more frequent and extended periods of heavy labor. Thus intracohort variation in physical fitness and activity patterns among the Chetbesi elderly is a function of birth into a socially defined group rather than of self‐selection. This pattern of differential fitness may typify the process of aging in many stratified traditional and modernizing societies where socially delimited segments of the population perform the bulk of the hard work. Intrapopulation differences aside, comparison of Sarkis and non‐Sarkis with other samples reveals that both lie within the reported range of variation. The rural, unmechanized, agricultural lifestyle and mountain environment of Chetbesi do not result in exceptional fitness for residents. The Chetbesi data suggest that the popular notion that aging is less debilitating in traditional agrarian societies located in rugged mountain terrains may be a myth. The demonstration of the influence of social forces on physical fitness suggests that future research might concentrate profitably on identifying social structures that produce high levels of physical fitn

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1985.tb07151.x

出版商:Blackwell Publishing Ltd    

年代:1985

数据来源: WILEY

摘要:

Local cerebral blood flow (LCBF) and local tissue:blood partition, coefficient (LΛ) values were measured during CT scanning while patients with different types of Parkinson's syndrome (N= 14) inhaled a contrast mixture of 35–37 per cent stable xenon gas in oxygen. Single‐compartment analysis fitted to infinity was used to calculate LΛ and LCBF values. Results were compared with results from normal age‐matched volunteers (N= 24). Mean hemispheric (p<0.05) and subcortical (p<0.05) gray matter LCBF values were reduced in idiopathic Parkinson's disease (N= 11), compared to values from age‐matched normals. Regionally, LCBF reductions included frontal (p<0.001), parietal cortex (p<0.05), caudate (p<0.05), lentiform nuclei (p<0.001) and thalamus (p<0.05) reductions. LΛ values were normal. Unilateral tremor and/or rigidity correlated directly with reduced LCBF in contralateral lentiform (p<0.01) and caudate (p<0.01) nuclei. In postencephalitic Parkinsonism (N= 1) LCBF reductions were diffuse, with normal LΛ values. In the akinetic form of Parkinsonism (N= 1) associated with lacunar infarcts, LCBF and LΛ reductions were patchy. In Parkinsonism following carbon monoxide poisoning (N= 1), LCBF values of gray and white matter were diffusely reduced and LΛ values were reduced in both pallidal regions. When dementia was present together with Parkinsonism (N= 3), LCBF reductions were more diffuse and severe. Dopaminergic deficiency correlated directly with reduced LCBF values, reflecting the severity of Parkinsonism.J Am Geriatr So

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1985.tb07152.x

出版商:Blackwell Publishing Ltd    

年代:1985

数据来源: WILEY

摘要:

Back‐up of elderly patients in hospital awaiting long‐term placement has become a major problem in some areas of the United States and elsewhere. In 1982, geriatric consultation teams (physician, nurse, and social worker) were introduced into six acute hospitals in Monroe County, New York, to help alleviate the problem through more attention to restoration of patient function and comprehensive discharge planning. Over a six‐month period, 4,328 newly hospitalized patients aged 70 or older were screened, and geriatric consultations were provided for 366 (8.5 per cent) who were judged to be at risk of requiring prolonged hospital stays. During this period, the mean monthly census of elderly patients backed up in hospital declined 21 per cent, a reversal of previous rises that could not be explained by any other identifiable factors. The impact was on length of stay on back‐up status rather than rate of entry to that status. A variety of medical, rehabilitative, and social interventions accounted for this outcome. A number of health care system barriers to expeditious rehabilitation and discharge of hospitalized elderly patients were identified. Geriatric consultation was deemed useful for implementation in acute hospitals in other s

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1985.tb07153.x

出版商:Blackwell Publishing Ltd    

年代:1985

数据来源: WILEY

摘要:

This report examines the psychosocial impact of cancer in 240 men according to age using a recently developed cancer‐specific survey instrument. Overall, younger patients experienced more frequent or severe psychosocial and treatment‐related problems than the older patients, especially in relation to work and chemotherapy. In addition, younger patients experienced more difficulty dealing with the health care setting. The authors conclude that the elderly cancer patient experiences less psychosocial disruption from cancer than do younger individuals.J Am Geriatr Soc 33:429,

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1985.tb07154.x

出版商:Blackwell Publishing Ltd    

年代:1985

数据来源: WILEY