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

摘要:

Summary:This study was undertaken to determine if the progression of dementia of the Alzheimer type (DAT) is accelerated by an intercurrent infection and if management strategy (aggressive or palliative care) would modify this effect. A prospective cohort study compared the progression of DAT in patients in three 25-bed dementia special care units that provide a hospice option for care. There were three groups of patients, as follows: (a) developed a fever and received aggressive care (FAC, n=30), (b) developed a fever and received palliative care (FPC, n=19), and (c) did not develop a fever (NF, n=46). The presence of a fever episode did not have an effect of its own on DAT progression. Over a 3-month period, DAT severity increased in most patients, but more so in FAC patients. Thus aggressive medical treatment of infections did not affect the underlying disease process and was associated with an acceleration of the progression of severity of DAT. Providing palliative care is recommended because it prevents patients from undergoing invasive diagnostic workups and treatments, does not accelerate the progression of DAT, and conserves scarce health care resources

ISSN:0893-0341    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Summary:In the Netherlands, the medical care of demented patients in the last phase of their life is very often the responsibility of the nursing home physician. Against the background of the public debate on euthanasia and related end-of-life decisions, this article discusses the ethical problems encountered in this field of medicine. Special attention is given to the problems of prognosis and the possible contribution of living wills to decision-making on behalf of incompetent demented patients.

ISSN:0893-0341    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Summary:30 scales on the basis of their face validity, their psychometric properties, the frequency of their use, and their promise as assessment instruments. Instruments are described in terms of the population on which they were developed, the symptoms assessed, informant, by whom administered, time to administer, time interval covered, number of items, measurement of frequency and severity, assessment of impact on caregiver, reliability, validity, and scoring. Recommendations are made concerning the best use of each scale. We summarize in table form the sources of information for instruments, characteristics of the instruments by domain, and potential use of instruments for quantification or management of symptoms and for estimation of caregiver burden. There are a number of reliable and valid scales for the assessment of psychiatric symptoms in AD, each with specific assets and liabilities. Knowledge of the specifics of these scales will enable clinicians and researchers to select the best instruments for their particular needs and to design more effective instruments.

ISSN:0893-0341    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Summary:The Dementia Severity Rating Scale (DSRS) is an informant-based, multiple- choice questionnaire that assesses severity from the mildest to the most severe stages in the major functional and cognitive domains affected in Alzheimer disease (AD). The DSRS has good reliability as measured by making repeated observations over short time periods and by comparing caregiver responses to information collected by a physician or an experienced nonphysician research associate. The measure correlates favorably with the Washington University Clinical Dementia Rating scale and with standard cognitive testing measures. The DSRS provides a simple, valid, and sensitive measure of impairment associated with AD. It is ideally suited for multisite collaborative studies and can be implemented with a minimum of staff time and training.

ISSN:0893-0341    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Summary:The spatial patterns of discrete 13-amyloid (Aβ) deposits in brain tissue from patients with Alzheimer disease (AD) were studied using a statistical method based on linear regression, the results being compared with the more conventional variance/mean (V/M) method. Both methods suggested that Aβ deposits occurred in clusters (400 to<12,800 um in diameter) in all but I of the 42 tissues examined. In many tissues, a regular periodicity of the Aβ deposit clusters parallel to the tissue boundary was observed. In 23 of 42 (55%) tissues, the two methods revealed essentially the same spatial patterns of AB deposits; in 15 of 42 (36%), the regression method indicated the presence of clusters at a scale not revealed by the V/M method; and in 4 of 42 (9%), there was no agreement between the two methods. Perceived advantages of the regression method are that there is a greater probability of detecting clustering at multiple scales, the dimension of larger Aβ clusters can be estimated more accurately, and the spacing between the clusters may be estimated. However, both methods may be useful, with the regression method providing greater resolution and the V/M method providing greater simplicity and ease of interpretation. Estimates of the distance between regularly spaced Aβ clusters were in the range 2,200-11,800 um, depending on tissue and cluster size. The regular periodicity of Aβ deposit clusters in many tissues would be consistent with their development in relation to clusters of neurons that give rise to specific neuronal projections.

ISSN:0893-0341    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Summary:The purpose of this study was to determine whether, in Alzheimer disease (AD) patients, abnormalities in energy charge or phospholipid metabolism could be detected during life with quantitative phosphorus magnetic resonance spectroscopy (31P MRS). We performed in vivo31P MRS in 16 patients with a clinical diagnosis of probable AD with mild to moderate dementia severity (mean Blessed Dementia Score=17.5, range=7-37) and in 8 healthy, nondemented, age-matched, control subjects. MR studies were performed on a commercial 1.5 T MR imager using a volume head coil. We acquired brain spectra by sampling a 6-cm-thick axial slice through the cerebrum (a region that includes ~900 ml of brain tissue); we measured B-nucleoside triphosphate (B-NTP), phosphocreatine (PCr), phosphomonoesters (PME), phosphodiesters (PDE), and inorganic phosphate (P,) concentrations, then calculated ratios of these resonances. The B-NTP, PCr, and P, resonances in AD and control subjects were not significantly different. These data indicate that brain energy stores are not depleted in AD. No significant differences were detected in the absolute measurements of PME and PDE between the AD and control groups. However, among the calculated ratios, an increase in the PME/PDE ratio of ~50%, mostly due to a decrease in the PDE signal, was statistically significant (AD PME/PDE mean=0.35, range 0.13-0.71; normal PME/PDE mean=0.22, range 0.16-0.34). We speculate that the difference in PDE reflects changes in the biophysical state of membrane phospholipids in AD.

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