摘要:

The aim of this study was to determine the prevalence of psychiatric symptoms among nondemented individuals with memory changes and whether such symptoms predict progression of functional decline or diagnosis of Alzheimer disease (AD). A semi-structured interview was administered at baseline to controls (n= 32) and to nondemented subjects with memory changes (n= 112) and to each subject's collateral source. The interview assessed the impact of cognition on functional abilities in daily life and a variety of psychiatric symptoms, including symptoms of psychosis, depression, and personality change. Participants were followed annually for 3 years to determine who had progressive functional decline and who progressed to meet clinical criteria for AD. Those diagnosed with AD on follow-up had more symptoms of personality change, such as agitation and passivity, at baseline than those who did not progress to meet clinical criteria for AD. Mild depressive symptoms were also more common among individuals at baseline who subsequently `converted' to AD. Symptoms of personality change were associated with a more rapid increase in functional difficulty over time, whereas depressive symptoms were not. Changes in personality are more common among subjects with memory changes who go on to develop AD. Particular types of personality change, such as agitation and passivity, are related to progression of functional difficulty over time. Depressive symptoms, although common in prodromal AD, are not associated with a more rapid functional decline.

ISSN:0893-0341    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

The Memory and Medical Care Study (MMCS) is a community-based, longitudinal study of elders at risk for dementia. This paper describes the study methods for identifying subjects with dementia or mild cognitive impairment (MCI) and the validation of these methods. The MMCS cohort was established by identifying subjects at risk for dementia in three previous studies of randomly ascertained samples. Neuropsychologic test score criteria were established to identify MMCS subjects with dementia or MCI. These criteria were validated using a fourth community-based sample of at-risk elders in which dementia was identified by a clinical adjudication panel. Of the 498 MMCS subjects, 70% had dementia and 27% had MCI by the MMCS criteria. In the validation sample, the MMCS dementia classification method was in agreement with the clinical adjudication panel for 81% of cases (kappa = 0.62, 95% confidence interval = 0.45–0.78). The methods used in the MMCS are efficient and reasonably valid for establishing a cohort of subjects to investigate how dementia is assessed, diagnosed, and treated in the community.

ISSN:0893-0341    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

To design optimal health services and education programs for Alzheimer disease (AD), it is important to understand cultural differences in perceptions of the disorder. In this study, we investigated differences between African Americans and whites in their beliefs, knowledge, and information sources regarding AD. We distributed a written questionnaire through lay and professional organizations and meetings in the southeastern United States, yielding a sample of 452 adults (61% white, 39% African American; 78% female; mean age 47 years; 33% with family history of AD). The questionnaire assessed the following: (1) illness beliefs, (2) factual knowledge, (3) sources of information, and (4) perceived subjective threat of AD. African Americans and whites were generally similar in their beliefs about common symptoms, prominent risk factors, and the effectiveness of treatments for AD (although whites expressed greater certainty in these beliefs than African Americans). In comparison to whites, African Americans showed less awareness of facts about AD, reported fewer sources of information, and indicated less perceived threat of the disorder. These preliminary findings suggest important distinctions between African Americans and whites in their knowledge about, and conceptualization of, AD. Follow-up studies with more representative samples and more fully validated measures will be necessary to confirm these differences. Health psychologic research suggests that such differences in illness perceptions could shape response to disease burden, assessment and diagnosis, and available health care options.

ISSN:0893-0341    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

This study examined the relationship between driving behaviors and awareness of deficit in patients with Alzheimer's disease (AD). Fifteen mildly impaired AD patients and 15 healthy elderly controls with valid drivers' licenses were administered a series of questionnaires concerning daily functioning and driving performance, and all 30 subjects were evaluated on a standardized road test. Self-report and caregiver/informant responses were compared with determine levels of discrepancy in ratings, while comparisons of AD and healthy elderly controls revealed group differences. Actual driving performance was considered the standard by which to determine accuracy of perceptions. Drivers with AD were rated as significantly worse than healthy elderly drivers on nine of 10 driving behaviors by an independent evaluator. AD patients' self-reports of driving ability were significantly better than the evaluator's ratings on seven of the 10 items, whereas the healthy elderly drivers rated themselves better than did the evaluator on one item. Although caregivers were likely to acknowledge a general concern with their AD patients' driving, they underreported specific driving problems when their ratings were compared with those of an independent evaluator. These findings have implications for the development of caregiver-based modifications of driving behavior.

ISSN:0893-0341    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

The goal of this study was to explore in patients with Alzheimer's disease (AD) the brain correlates of free and cued recall performance using an adaptation of the procedure developed byGrober and Buschke (1987). This procedure, which ensures semantic processing and coordinates encoding and retrieval, has been shown to be very sensitive to an early diagnosis of AD. Statistical parametric mapping (SPM 99) was used to establish clinicometabolic correlations between performance at free and cued verbal recall and resting brain metabolism in 31 patients with AD. Results showed that patient's score on free recall correlated with metabolic activity in right frontal regions (BA 10 and BA 45), suggesting that performance reflected a strategic retrieval attempt. Poor retrieval performance was tentatively attributed to a loss of functional correlation between frontal and medial temporal regions in patients with AD compared with elderly controls. Performance on cued recall was correlated to residual metabolic activity in bilateral parahippocampal regions (BA 36), suggesting that performance reflected retrieval of semantic associations, without recollection in AD. In conclusion, this study demonstrates that the diagnostic sensitivity for Alzheimer's disease of the cued recall performance in the Grober and Buschke procedure (1987) depends on the activity of parahippocampal regions, one of the earliest targets of the disease. Moreover, the results suggest that the poor performance of patients with AD during free and cued recall is related to a decreased connectivity between parahippocampal regions and frontal areas.

ISSN:0893-0341    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

This systematic review seeks to (1) summarize the pharmacologic effects of pentoxifylline on the cerebrovasculature and (2) review critically the studies evaluating pentoxifylline in the treatment of vascular dementia. To retrieve all relevant published and unpublished studies, we performed with no language restrictions computer keyword searches of MEDLINE, EMBASE, and Cochrane Library databases; reviewed bibliographies; and contacted the pharmaceutical manufacturer. We included pertinent articles if they met three quality criteria: randomized, double-blinded, and placebo-controlled study design; objective diagnostic criteria for vascular dementia; and reported original data. The literature search identified a total of 20 articles; however, only four studies met the quality criteria for inclusion in this systematic review. All four studies suggested a trend toward improved cognitive function in patients treated with pentoxifylline. Three of the studies performed a subgroup analysis using a stricter definition for vascular dementia. In these secondary analyses, the studies noted statistically significant differences in cognitive function between placebo and treatment groups. In conclusion, this systematic review suggested a potential therapeutic role for pentoxifylline in vascular dementia. However, few studies met the quality criteria for inclusion in this systematic review, and most of these studies were small and had methodologic limitations.

ISSN:0893-0341    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:0893-0341    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:0893-0341    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:0893-0341    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:0893-0341    

出版商:OVID    

年代:2003

数据来源: OVID