ISSN:0893-0341    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Clinicians should be able to provide the patient with Alzheimer disease (AD) and the family with an accurate prediction of what to expect, but the variability in the rate of disease progression precludes this. In several previous studies, specific clinical signs such as muscular rigidity, myoclonus, and hallucinations or delusions were associated with rapid progression to a more severe stage of dementia or death. The “Predictors Study,” a longitudinal study at three independent sites, was designed to develop a predictor model of the natural history of Alzheimer disease. The study was conducted at three study sites, New York, Baltimore, and Boston in a cohort of 224 patients with early probable AD. This article describes the design and implementation of the Predictors Study, and compares features of the study cohort at baseline across sites. Patients were all at the mild stage of disease at entry and were relatively comparable across sites. Extrapyramidal signs and delusions were common, but myoclonus was rarely observed.

ISSN:0893-0341    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

The “Predictors Study” is a prospective cohort study of the natural history of Alzheimer disease (AD), the aim of which is to identify milestones in disease progression and to develop a model to predict disease course in individual patients. The empirical background to this study is based on previous reports that the presence of extrapyramidal signs (EPS), myoclonus, and psychosis in AD may signify greater disease severity at any given stage and a more rapid course of the disease over time. The present analyses were conducted to determine whether these independent “predictor” variables were associated with greater disease severity at baseline within a new cohort of 224 mild AD patients recruited from three different medical centers (in New York, Baltimore, and Boston). Measures of disease severity were provided by the modified Mini-Mental State Examination (mMMSE) and the Blessed Dementia Rating Scale (BDRS), which measures functional capacity. Independent variables were EPS, delusions, and slowing of the posterior dominant EEG rhythm. The frequency of myoclonus and hallucinations was too low to permit adequate statistical assessment of their effects at this time. EPS and EEG slowing were associated with low mMMSE scores, whereas delusions were primarily associated with impaired functional capacity. These effects were independent of the influence of age and disease duration. These results indicate that the effects of these independent variables can be detected at mild stages of AD and that these effects can be generalized across different geographical regions.

ISSN:0893-0341    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

A retrospective study of 376 patients with dementia was performed to determine the rate of syphilis seropositivity. Subjects were seen over a 2.5-year period and received medical, social, psychiatric, neurological, and laboratory evaluations. Mean age was 74 years and 73% were women. Diagnoses included Alzheimer's disease (AD; 29.8%), vascular dementia (VascD; 24.7%), combined AD/VascD (14.3%), and other diagnoses (31.2%). Dementia was moderately advanced with a mean Folstein Mini-Mental State Score of 16. Fluorescent treponemal antibody absorption tests (FA) were performed on 338 of the patients with 10.9% being reactive. Two of nine subjects with reactive FA's had reactive rapid plasma reagin tests.

ISSN:0893-0341    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

We evaluated central, temporal, and cortical atrophy by linear measurements on brain computed tomography (CT) in 17 patients with moderate to severe histologically verified Alzheimer disease (AD) compared with findings in 84 nondemented elderly controls. Measurements were adjusted for age and head size. The AD patients had wider third and lateral ventricles as well as larger temporal horns and Sylvian fissures compared with controls. Cortical atrophy tended also to be more pronounced for AD patients relative to controls. Thus measures of central and temporal atrophy clearly distinguished AD patients from normal aged individuals. In AD patients, the width of the third ventricle was significantly correlated with the choline acetyltransferase (ChAT) activity in the post-mortem frontal cortex (r= 0.65,p= 0.005) and in the temporal cortex (r= 0.59,p= 0.006). CT measures did not correlate significantly with neurofibrillary tangle or senile plaque scores. The result suggests that the width of the third ventricle better reflects the degree of cholinergic deficit than severity of histopathological changes, scores of plaques, and tangles in AD.

ISSN:0893-0341    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

A diagnosis of definite Alzheimer disease (AD) is made when there is a history of progressive dementia combined with the pathologic findings of numerous senile plaques and neurofibrillary tangles in neocortex. Recent studies have shown, however, that there may be significant interrater variability in the quantitation of these histopathologic lesions. In the present two-center study, interrater reliability and test-retest reliability for plaque and tangle counts were examined when histologic staining and sampling were controlled. We report similar levels of reliability for plaque and tangle counts in 35 cases of AD, nine normal elderly controls and six non-AD dementias: Pearson correlations for interrater reliability ranged from 0.68 to 0.88, and from 0.97 to 0.99 for test-retest reliability. Using quantitative cut-points, concordance between laboratories for experimental diagnoses of AD versus non-AD made on the basis of these lesion counts ranged from 84 to 92% (κ scores: 0.69–0.84). The agreement between these experimental diagnoses and the clinicopathologic diagnoses of record ranged from 74 to 86% (κ scores: 0.50–0.71). Thus, under optimal conditions, a moderate to substantial degree of interrater reliability can be attained in the pathologic diagnosis of AD.

ISSN:0893-0341    

出版商:OVID    

年代:1993

数据来源: OVID

ISSN:0893-0341    

出版商:OVID    

年代:1993

数据来源: OVID

ISSN:0893-0341    

出版商:OVID    

年代:1993

数据来源: OVID