摘要:

Twenty-four subjects with Alzheimer disease underwent cognitive and functional assessment. Functional assessment by caregivers consisted of a 25-item bipolar analog scale measuring activities of daily living and social behaviors divided into four functional domains: memory, attention/executive abilities, everyday skills, and self-care. Cognitive assessment consisted of standardized neuropsychological tests designed to evaluate five cognitive domains: episodic memory, attention/executive function, semantic memory, visuospatial function, and auditory–verbal short-term (working) memory. Functional assessment correlated well with overall severity as measured by Mini Mental State Examination (r= −0.733). Analysis of individual cognitive and functional domains revealed no significant correlation between episodic memory and functional performance. By contrast, functional ability correlated strongly with the cognitive domains of visuospatial function and semantic memory, being significantly greater than the correlation of functional ability with any other cognitive domain. These results were supported by multiple regression analyses that showed visuospatial function to be the sole cognitive predictor of functional abilities. These findings have implications for the evaluation of drug therapies in Alzheimer disease, in particular the effect of current cholinergic therapies on activities of daily living.

ISSN:0893-0341    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Multiple studies of individuals with Alzheimer disease have substantiated significant levels of informant-rated change in several domains and facets of the Neuroticism-Extraversion-Openness Personality Inventory, including increases in Neuroticism and decreases in Extraversion and Conscientiousness relative to premorbid personality traits. Decline in Openness was cited in some reports, and replicable changes were identified in several facets. Current and premorbid personality of 50 patients with Alzheimer disease were rated by informants using the Neuroticism-Extraversion-Openness Personality Inventory. Multiple regression analysis was used to assess possible relationships of levels of reported change with covariates, including premorbid rating, education, duration of dementia, age, gender, and Mini-Mental State Examination score. Premorbid rating was the only significant predictor of reported change for Neuroticism, Extraversion, Conscientiousness, and the facets Anxiety (N1), Assertiveness (E3), and Activity (E4). Rated change in Depression was also found to be related to duration of dementia, change in Vulnerability was influenced by gender, and reported change in both Openness and Ideas showed a relationship to level of education.

ISSN:0893-0341    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Research involving persons with cognitive impairments presents ethical and practical challenges, including how to obtain valid informed consent. We asked the directors of the 29 U.S. research centers funded by the National Institute on Aging as “Alzheimer Disease Centers” to provide us with policies or guidelines used in their centers or associated institutions with regard to research involving cognitively impaired subjects. Twenty-four of the 29 centers (83%) responded. Five institutions (21%) had authored their own institutional policies, seven (29%) used guidelines issued by the Department of Health and Human Service's Office for Protection from Research Risks, and 12 (50%) had no policy or guidelines. The five institutional policies addressed a variety of issues, including obtaining consent from cognitively impaired subjects or their authorized representatives, subjects' assent to research participation, and guidance concerning determination of subjects' intellectual capacity. A well-written policy on the protection of cognitively impaired research subjects is one way a research institution demonstrates that it gives serious attention to the rights and welfare of these vulnerable persons. We recommend that all institutions conducting such research author written policies articulating appropriate safeguards for these vulnerable subjects. To promote the protection of cognitively impaired subjects, federal agencies and other funding groups may want to consider requiring written institutional policies as one condition of receiving funds to conduct such research.

ISSN:0893-0341    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

The Professional Environmental Assessment Procedure (PEAP) was developed as a global quality-assessment measure for use by trained professionals in special care units for older people in dementia units of nursing homes. The PEAP consists of nine ratings whose relationship to another assessment device, the Therapeutic Environment Screening Schedule (TESS), is reported. Although designed to be multidimensional, the PEAP as tested in 43 special care units seems to reflect primarily a single evaluative dimension. It correlates highly with the TESS and may be used either separately or in combination with the TESS.

ISSN:0893-0341    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

A randomized, double-blind, placebo-controlled, parallel-group study was undertaken to evaluate the safety and tolerability of a once-daily oral administration of metrifonate in patients with probable mild to moderate Alzheimer disease. Metrifonate was given as a loading dose of 125–225 mg based on weight (2.5 mg/kg) for 2 weeks, followed by a maintenance dose of 50–90 mg based on weight (1.0 mg/kg) for 4 weeks. Twenty-nine patients received metrifonate, and 10 patients received placebo. Metrifonate produced a mean erythrocyte acetylcholinesterase inhibition at the end of treatment of 86.3%. The proportion of patients who experienced at least one adverse event was comparable between the metrifonate (76%) and placebo (80%) groups. Selected adverse events in disfavor of metrifonate (defined as those for which the incidence in the metrifonate and placebo groups differed by at least 10%) were diarrhea, nausea, leg cramps, and accidental injury. Adverse events were predominantly mild in intensity and transient. No severe adverse events were experienced by any patient. The most notable hemodynamic change observed during metrifonate treatment was a clinically insignificant mean decrease in the heart rate (by electrocardiogram) of approximately 9 beats/min, compared with an approximate 3-beats/min decrease for the placebo group. No muscle weakness was observed in this study. No clinically relevant laboratory abnormalities, such as liver toxicity, or changes in exercise tolerance or pulmonary function tests were found with metrifonate treatment. This metrifonate dose provided a high level of acetylcholinesterase inhibition, which was associated in these patients with a favorable safety and tolerability profile. Indeed, the magnitude of the peripheral acetylcholinesterase inhibition is the highest tolerable inhibition level yet observed.

ISSN:0893-0341    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

To compare brain perfusion between corticobasal degeneration (CBD) and progressive supranuclear palsy (PSP), we investigated regional cerebral blood flow (rCBF) semiquantitatively with single-photon emission computed tomography and [123I]iodoamphetamine in six patients with CBD and five with PSP. Compared with 12 age-matched control subjects, the average of the left and right rCBF values for the CBD patients was significantly reduced in the inferior prefrontal, anterior cingulate, medial premotor, sensorimotor, posterior parietal, and superior temporal cortices as well as in the basal ganglia and thalamus, whereas only the medial premotor cortex was significantly hypoperfused in the PSP patients. Compared with the PSP patients, the CBD patients showed significantly decreased rCBF in the inferior prefrontal, sensorimotor, and posterior parietal cortices, but not in the subcortical regions. Compared with the controls, interhemispheric differences of rCBF were significant in the inferior prefrontal, sensorimotor, and posterior parietal cortices of the CBD patients but in only the medial prefrontal cortex of the PSP patients. These results indicate that rCBF reductions are more extensive and asymmetric in CBD than in PSP, although the two diseases share medial frontal involvement.

ISSN:0893-0341    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

An immunoblotting method using prefrontal cortical and hippocampal membranes from control and Alzheimer disease postmortem brains was employed to detect three subtypes of G&agr;oprotein. In the membranes from control subjects, the density of G&agr;o1in hippocampus and cortex was the highest, whereas the density of G&agr;o2was the lowest and that of G&agr;o3was intermediate. In the Alzheimer disease membranes from hippocampus, the density of total G&agr;oand all three subtype forms was not changed significantly when compared with control values. There were statistically significant alterations in G&agr;oin cortical membranes from Alzheimer disease when compared with controls. The density of G&agr;o1was decreased by approximately 85%, density of G&agr;o3was decreased by approximately 95%, and total G&agr;odensity was decreased by approximately 84% of control value. However, G&agr;o2density was decreased by approximately 44% but was found not to be statistically different from controls.

ISSN:0893-0341    

出版商:OVID    

年代:2000

数据来源: OVID

ISSN:0893-0341    

出版商:OVID    

年代:2000

数据来源: OVID