ISSN:0893-0341    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Summary:We studied the validity of a complete (S-IQCODE) and a shortened (SS-IQCODE) Spanish version of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) for the diagnosis of dementia in a clinical setting. Fifty-three consecutive outpatients were assessed with an ezxtensive workup and followed up for 6 months in a specialized clinic for the diagnosis and management of dementia. Thirty eight (71%) were finally diagnosed as demented. The Mini-Mental State Examination (MMSE) had a slightly greater diagnostic power than did the S-IQCODE and the SS-IQCODE (sensitivity 89% vs. 84% and 79%; specificity 80% vs. 73% for both; positive predictive value 92% vs. 89% and 88%; negative predictive value 75% vs. 65% and 58%), but without statistical significance. Both the S-IQCODE and SS-IQCODE were independent of previous education of the patients. The best diagnostic results were obtained when the cognitive scores of the patient in the MMSE and the report of the relative in the S-IQCODE were simultaneously considered. We conclude that the IQCODE, in a complete as well as in a shortened form, is a good diagnostic instrument in the clinical setting that can enhance the validity of other cognitive tests.

ISSN:0893-0341    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Summary:We retrospectively assessed the data from 24 patients with dementia of the Alzheimer type (DAT) who underwent comprehensive neuropsychological evaluations in order to determine whether there is a relationship between neuropsychological heterogeneity and educational level. Postmortem neuropathological examination results were made available for seven cases, confirming the diagnosis of DAT. Thirteen patients had ≤8 years of schooling (less educated subgroup), and the other 11 had ≥8 years (higher educated subgroup). There were no significant differences between the two subgroups regarding age and duration of symptoms. Performance within each subgroup was compared with that of a specific set of education-matched elderly controls. In the less educated subgroup, 10 patients evidenced a homogeneous pattern of cognitive impairment, with all cognitive areas being similarly affected. Conversely, 10 higher educated patients had at least one cognitive area relatively preserved in comparison with the others, characterizing a heterogeneous pattern of impairment. These data suggest that a high level of education may lead to a greater capacity to compensate for neuronal damage and determines specific patterns of cognitive impairment in DAT.

ISSN:0893-0341    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Summary:Advanced age and dementia are well-known risk factors for delirium, and most studies of delirium have concentrated on hospitalized populations. We reviewed the records of 199 community-dwelling Alzheimer disease (AD) patients and identified 43 (22%) who had had episodes of delirium during their dementing illness. These patients were matched for age, gender, and disease duration to AD patients without previous episodes of delirium. Variables examined included causes of delirium, Mini-Mental State Examination scores, Clinical Dementia Rating scores, Blessed Activities of Daily Living (ADL) scores, years of education, neuropsychological performance, and incidence of behavioral symptoms on the Brief Psychiatric Rating Scale. In six of 198 (3%) patients delirium was an initial symptom of AD. Conditions associated with onset of delirium were urinary tract infections, stressful events, surgery, medical illnesses, and medications. No significant differences were found between groups on neuropsychological testing. Patients with previous episodes of delirium had worse ADL scores and higher disease-course incidences of hallucinations and paranoid delusions, mostly occurring during the delirious episode. We conclude that delirium is common in AD, but it is an unusual initial symptom and it occurs in diverse clinical settings. Measures of behavioral symptoms and ADLs are more likely to reflect the impact of delirium on clinical status than measures of cognition or stage of dementia.

ISSN:0893-0341    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Summary:There is evidence to support the role of a number of environmental factors in Alzheimer disease (AD). This study examines the role of chemical and physical exposures in the occupational environment. The sample included 170 patients with AD and 170 medical-practice-based controls, matched for age and sex, who were assessed for histories of occupational exposures to a range of chemical and physical agents, including hydrocarbon solvents, lead, mercury, organophosphates, aluminum, asbestos and other silicates, vibration, and physical underactivity. Occupational histories were obtained from informants for both patients and controls. Exposure was assessed by a panel of occupational hygienists, blinded to the case or control status of each subject, using the occupational histories and the Job-Exposure Matrix of the U.S. National Institute for Occupational Safety and Health. No statistically significant associations were found between any of the exposures and the occurrence of AD, either in the overall study group or in patients with a family history of AD. The findings suggest the absence of any occupational cause for AD.

ISSN:0893-0341    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Summary:The number of older drivers in Sweden will be rapidly increasing during the next decades. A possible relationship exists between the increased relative crash risk of older drivers and the prevalence of age-related diseases such as dementia. However, a clear-cut policy for evaluating driving competence in demented persons is still lacking. In recognition of this fact, the Swedish National Road Administration invited a group of researchers to formulate a consensus on the issue of driving and dementia. This consensus document is aimed at providing primary care physicians with practical advice concerning the assessment of cognitive status in relation to driving. Suggestions are based on a review of existing research and discuss the use of general and driving-specific sources of information available to the physician. Consensus was reached on the statement that a diagnosis of moderate to severe dementia precludes driving and that certain individuals with mild dementia should be considered for a specialized assessment of their driving competence.

ISSN:0893-0341    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Summary:This exploratory study describes the frequency, demographic features, and clinical manifestations of Alzheimer disease (AD) in a sample of demented black outpatients evaluated at the Emory University Alzheimer's Disease Center. The study reviews prospectively collected research data from 88 demented black outpatients who completed a standardized diagnostic evaluation. Forty-seven percent of these patients met NINCDS-ADRDA criteria for probable AD, and 29% met NINCDS-ADRDA criteria for possible AD. The majority of the probable AD patients were women, and many were suffering from comorbid medical illnesses. In the probable AD patients, there was an association between higher levels of education and a higher frequency of affective symptoms, and an association between longer duration of cognitive symptoms and the presence of parkinsonism. Possible AD was also common in this sample of demented black outpatients and was often encountered mixed with vascular dementia.

ISSN:0893-0341    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Summary:The main objectives were to study relationships between the design of group living (GL) units and psychiatric symptoms in demented patients before, 6 months after, and 1 year after admission to GL units. The study population comprised 105 demented elderly (83 ± 6 years), 37% with dementia of Alzheimer's type and 58% with vascular dementia. The patients were relocated by the municipal care planning team after clinical examination. An observational scale (the Organic Brain Syndrome scale) was used to assess confusional symptoms and disorientation. The physical environment was assessed by an architect using the Therapeutic Environment Screening Scale, which evaluates general design, space, lighting, noise, communication area, floor plan, and related factors. Less than 15% of the patients had no signs of dyspraxia, hallucinosis, dysphasia, or depression at admission, whereas 66% or more reported lack of vitality, aggressiveness, or restlessness. Fourteen out of 18 units had a corridor-like design (group A), one unit an L-shaped design (group B), and the others a square or H-shaped design (group C). Patients living in the B unit had less disorientation than the others at the 6-month follow-up. After 1 year, the patients in the A units had more dyspraxia, lack of vitality, and disorientation of identity. The communication areas in the units were negatively associated with “disorientation for recent memory” and “lack of vitality,” adjusted for type of dementia (r= −0.13 to −0.16). The size of the activity area, indoor public rooms in square meters, was not correlated to confusional reactions and disorientation. In conclusion, a GL unit design that facilitates perception without reducing the communication area is to be preferred.

ISSN:0893-0341    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Summary:A small feasibility study was performed in Italy to evaluate whether the special care unit (SCU) model could minimize behavioral disturbances in demented patients. In a nursing home an area was selected to provide an appropriate environment for individuals with dementia. The physical environment was adapted, and the staff was trained to meet the needs of demented patients. Sixteen residents were transferred from traditional wards to the SCU. Functional status, cognitive performance, behavioral symptoms, and use of psychotropic drugs or physical restraints were assessed before and 6 months after admission to the SCU. Our findings show that transferring demented persons from traditional nursing home wards to an SCU significantly lessens behavioral problems but does not improve functional abilities or cognitive status after a short period of follow-up. Changes in caring strategies (in particular the use of physical restraints) seem to be important in reducing behavioral problems. The regional government of Lombardia (8.5 million inhabitants) decided to open small (20-bed) SCUs in 60 nursing homes (corresponding to 3.5% of the total nursing home beds in our region) and to reserve these units for demented a high level of behavioral disturbances.

ISSN:0893-0341    

出版商:OVID    

年代:1997

数据来源: OVID

ISSN:0893-0341    

出版商:OVID    

年代:1997

数据来源: OVID