摘要:

In the oldest age group of dementia, patients dying after age 80, 38 cases were studied clinically and neuropathologically. In comparison with dementia cases dying at younger ages the disease panorama dififered in important respects. In the older age group frontal lobe dementia of non-Alzheimer type was entirely absent but trauma was much more common as were also cerebrovascular diseases. Dementia of the Alzheimer type was in many cases milder than in younger age groups and a mild, subclinical Alzheimer encephalopathy often complicated the cerebrovascular disorders. In this context, it may be of interest that some of the patients died from diseases not directly connected with the dementing disorder such as heart failure, Cancer and pulmonary embolism, suggesting that the dementing disorders did not necessarily repre-sent an end stage. Contrary to our previous opinion Alzheimer disease in these aged patients was of a very long duration, in many cases lasting 7-13 years. Labile blood pressure and orthostatism presented further prominent Problems. The mild Alzheimer changes, in 1 case precluding a distinct diagnosis, may be taken as a harbinger of the vague changes found in 3 centenanans, 2 of whom had dementia. They suffered from changes of an Alzheimer encephalopathy of a subclinical severity, mild frontal white matter degeneration and a loss of frontal cortical neurons, changes that would be difficult to diagnose in life and which may be the cause of the real dementia of the senium.

ISSN:1420-8008    

DOI:10.1159/000107006

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

The possible relationship between growth hormone (GH) responses to the dopamine (DA) agonist apomorphine (APO; 0.24 mg i.v.) and CSF concentrations of the monoamine metabolites was investigated in 15 patients with dementia of the Alzheimer type (DAT). A significant negative correlation was found between the CSF concentrations of homovanillic acid (HVA) and the maximum APO-stimulated serum GH levels. Assuming that CSF HVA reflects central DA release and the GH response to APO reflects postsynaptic DA D2 receptor function, this finding suggests that low DA release is associated with upregulation of DA D2 in DAT.

ISSN:1420-8008    

DOI:10.1159/000107007

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

One source of variance in familial aggregation studies in Alzheimer''s disease (AD) is proband diagnosis. In this study, the morbid risk of primary progressive dementia (PPD) was assessed in first degree relatives of 32 patients with clinically diagnosed AD (mean onset = 59.9 ± 7.2 years) whose diagnoses were confirmed at autopsy. The Alzheimer''s Disease Risk Questionnaire and the Dementia Questionnaire were administered to multiple family informants by trained raters blind to the probands'' clinical and neuropathologic diagnoses. Morbid risk for PPD was analyzed using the Kaplan-Meier life-table method. The estimated cumulative risk of PPD in first degree relatives (n = 159; age ≧: 45) was estimated to be 48.8 ± 11.3% by age 86. The risk estimate for affected siblings (n = 96; age ≧ 45) reached 54.9 ± 20.7 % by age 78. These figures are consistent with those calculated for most cohorts of relatives of clinically selected AD probands lacking autopsy confirmation of diagnosis. Although based on a relatively small sample, this series is the first morbid risk analysis to employ clinically diagnosed probands with neuropathologic confirmation

ISSN:1420-8008    

DOI:10.1159/000107008

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

The syndrome of circulating anticoagulants in patients without evidence of systemic lupus erythematosus (SLE) has lately become a focus of interest. The clinical features, neuroimaging findings and clinical course of 12 such patients, who presented with neurological symptoms, were analyzed. None of the patients fulfilled the American Rheumatism Association (ARA) criteria of SLE. During a follow-up period of up to 5 years, 9 patients (75%) deteriorated mentally. In 5, cerebrovascular lesions were observed clinically and/or neuroradiologically. Four patients showed slowly progressive mental decline without focal deficits on clinical examination or on CT and MR studies of the brain, except for a small cortical infarct in one case. All patients had radiological evidence of cortical atrophy. Thus, dementia may be a prominent feature among patients with the lupus anticoagulant. Possible underlying mechanisms, such as multi-infarct state, as well as an autoimmune process affecting specifically CNS structures, are discussed.

ISSN:1420-8008    

DOI:10.1159/000107009

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

The overall prevalence of dementia in 1,410 Japanese leprosy patients 65 years or over continuously treated with dapsone or closely related drugs was 2.9%. This compares with 4.83% of 621 cases treated intermittently and 6.25 % of 1,761 cases untreated for at least 5 years. Multiple logistic regression analysis showed a highly significant increase of dementia with age (p = 0.0001) and, after age adjustment, a significant reduction of dementia in drug-treated compared with drug-free patients (p = 0.017). Such treatment had no significant effect on the prevalence of strokes. These data suggest that dapsone and closely related drugs may have potential use as antidementia agents.

ISSN:1420-8008    

DOI:10.1159/000107010

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

The number of individuals over age 100 years in the United States will increase from 25,000 in 1986 to more than 108,000 by the year 2000. Despite this expected growth there is almost no information about their intellectual function. This is unfortunate since the study of centenarians offers valuable insight into the effects of aging upon the central nervous system. It may also clarify whether Alzheimer''s disease represents premature aging. To better understand their mental state, I evaluated 20 centenarians (17 women and 3 men) with a mean age of 101.75 years. The group completed on average 6.6 years of education and each had 4 illnesses and took 3.5 prescribed drugs. Eighty percent were in nursing homes, mostly due to inadequate social supports. Caregivers had thought that the majority were not demented. During evaluation, 75% had impaired vision while half had disturbed hearing. The speed of thought and body movement were slowed significantly. Centenarians had poor awareness of their environment, in general (p = 0.0019) and had impaired judgement (p = 0.006). Additionally, only 3 individuals had a history and examination to suggest Alzheimer''s disease. Unfortunately, the Folstein Mini-Mental State Exam (MMSE) and the Washington University Clinical Dementia Rating (CDR) were often difficult to score. Mean scores for the MMSE of 7.5 (1 standard deviation, 7.134) and the CDR of 2.08 (1.07) suggested dementia. These observations suggest that impaired intellectual function may be common in this group but there are several limitations on evaluating and interpreting such data.

ISSN:1420-8008    

DOI:10.1159/000107011

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

This paper examines the clinical presentation of, the biochemical abnormalities associated with, and the treatment of depressive disorders in late life. A comparison of geriatric depression (late-onset, first-episode depression) will be made to depression as it presents in childhood and middle age. Childhood onset depression is now accepted as a valid diagnostic/clinical entity. However, there is no conclusive evidence to date that pharmacologic intervention is effective in the treatment of childhood onset depressive disorder. On the other hand, major depression occurring in middle age has been shown to be quite responsive to pharmacologic interventions. Although the precise mechanism of pharmacologic intervention is unknown, certain biochemical abnormalities have been associated with middle-age onset of depression. We will discuss the similarities and differences of depression in the elderly to depression in both middle age and childhood. It is often difficult to diagnose a depressive disorder within the geriatric population. In addition to a primary depression, elderly individuals are susceptible to other syndromes which may present in a fashion similar to depression. These include depressive reactions associated with dementia and demoralization in the elderly. In addition, depression, especially in the elderly, may masquerade as other clinical entities. Following the discussion of the diagnostic difficulties associated with depression in the elderly, we will discuss potential treatment modalities for late-onset, first-episode depression. This will include an examination of common antidepressant treatments, such as tricyclic antidepressants and monoamine oxidase inhibitors, as well as other less frequently used and experimental treatment modalities.

ISSN:1420-8008    

DOI:10.1159/000107012

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

Efforts continue toward the goal of uncovering a dominant pathogenetic and therapeutic model for Alzheimer type dementia. This article critically reviews the evolution and current status of unitary transmitter concepts, the prototype of which is the cholinergic model proposed by Deutsch and others, from early animal studies to ongoing drug trials. We conclude that evidence is sufficient to dismiss such models as a means of directing treatment and further resources. A survey of novel approaches to Alzheimer type dementia, many of which transcend unitary thought, reveals a more promising direction for further research.

ISSN:1420-8008    

DOI:10.1159/000107013

出版商:S. Karger AG    

年代:1992

数据来源: Karger

摘要:

An at risk offspring of an individual with familial Alzheimer''s disease showed a white matter lesion on magnetic resonance imaging. This finding might appear in some individuals with Alzheimer''s disease before its clinical onset.

ISSN:1420-8008    

DOI:10.1159/000107014

出版商:S. Karger AG    

年代:1992

数据来源: Karger