摘要:

Behavioral problems are thought to be pervasive and devastating to patients with dementia of the Alzheimer's type and their families. Despite this, little empirical data are available concerning the nature of such impairments, their rate of occurrence or their relationship to the disease process. This study investigated 127 patients with a primary diagnosis of dementia of the Alzheimer's type. Two methods of behavioral assessment were employed: a standardized dementia rating scale and a checklist of behavioral problems. Results indicated a) the overall number of problems significantly increased with increased cognitive impairment, b) the types of problems reported varied with cognitive severity, and c) behavioral problems were not significantly associated with patient's age, gender, duration, or age at onset of dementia. These findings are discussed as they relate to the phenomenology of dementia of the Alzheimer's type and to suggestions for interventions at different stages of the disease process. Problems found associated with level of impairment such as wandering, agitation, incontinence, and poor personal hygiene are thought to be characteristic of the disease and therefore predictable. Problems found not associated with level of impairment such as hallucinations, irrational suspicions, falls, and restlessness are likely to be idiosyncratic. The former should probably be incorporated into education and intervention programs; the latter addressed as needed on an individual basis.

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1988.tb03426.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

The authors used a semistructured interview administered to primary family caregivers to assess the prevalence and nature of psychiatric pathology in 175 well‐diagnosed community‐residing Alzheimer's disease patients. Symptoms that are indicative of depression in the cognitively intact were virtually ubiquitous in this demented population. A variety of psychotic features were also regularly reported. The implications of these findings for the recognition and treatment of reversible psychiatric impairment are discus

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1988.tb03427.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

In order to standardize and quantify diagnostic information derived from medical histories and case reports given by demented patients, their families or care‐providers, a questionnaire has been developed containing 94 questions. The output is categorized by computer into graphic clinical scales which correlate and weigh information relating to seven of the most common causes of dementia. The present investigation assesses the validity of predictive diagnostic classifications derived from the clinical scales tested on admission by correlating them later with final diagnoses determined independently by thorough clinical evaluation including standard diagnostic tests, computed tomography and nuclear magnetic resonance scans. Results of 101 healthy, neurologically normal, age‐matched volunteers and 140 patients representative of the more common forms of dementia indicate that correct diagnostic identification was: 75% for dementia secondary to Parkinson's disease, 100% for Huntington's disease, 90.2% for Alzheimer's disease, 82.4% for multi‐infarct dementia, 90.0% for posttraumatic dementia, 77.8% for normal‐pressure hydrocephalus and 85.7% for Wernicke‐Korsakoff dementia. Correct diagnostic assignment was highly significant (P<.0005). The screening questionnaire may prove to be a useful and standard diagnostic tool for clinicians and investigators concerned with epidemiology, prevention and treatment of

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1988.tb03428.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

To determine the prevalence of unrecognized brain dysfunction accompanying chronic severe cardiac disease, we examined 20 clinically stable consecutive admissions to a cardiac rehabilitation service who were free of known stroke or dementia. Age range was 47 to 85 years (mean ± SEM, 72.5 ± 2.1 years), the male: female ratio was 10:10. Multiple cognitive deficits including significant memory impairment and disorientation were present in eight patients (40%), and seven of these eight patients were unable to administer their own medications reliably. An additional six patients (30%) showed milder impairments. One patient was found to be normal after neurological examination, four showed evidence of a single brain lesion, and 15 of 20 (75%) had multiple neurological abnormalities suggesting multifocal brain disease. The mechanism of cognitive deficits in cardiac patients is unclear, and it may be related to multiple infarcts, or acute or chronic hypoxic damage secondary to arrhythmias, cardiac failure, or small vessel disease of the brain. The term “circulatory dementia” is proposed to describe patients with vascular disease and non‐Alzheimer type dementia. Patients with cardiac disease should undergo cognitive screening, as early identification of patients at risk of progressive intellectual loss may allow early use of preventive

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1988.tb03429.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

Fit elderly score higher on tests of fluid intelligence than aged‐matched sedentary controls. Elderly patients who have taken part in exercise programs have shown improvement in mental function. We compared the effects of 45 minutes of exercise on memory, mood, and cognitive function in elderly subjects to a control intervention using a randomized control study design. Neuropsychological tests employed where the color slide test, digit symbol test, digit span test, logical memory test, word fluency test, and the Mini‐Mental State Examination. We measured mood using a mood test and geriatric depression scale. Each subject was tested before, and immediately after, control and exercise sessions. Fifteen elderly subjects [ten men and five women; mean age, 66 years, (range, 60 to 85 years)] completed the study. There was a greater improvement in six of the eight scores of cognitive function following exercise, compared to control. These differences were significantly greater following exercise for the logical memory test score (P ≤ 0.02) and Mini‐Mental State Examination (P ≤ 0.025) compared with the control int

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1988.tb03430.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

Labor and supply costs associated with the care of urinary incontinent patients in three nursing homes were measured. First, normal nursing home changing patterns and their associated costs were measured. Second, the costs were documented when patients were checked by research staff and changed on an hourly basis as needed. Nursing home staff changed patients significantly less frequently than patient voiding as detected by the hourly checking system. Thus, cost of incontinence during the hourly checking condition ($3.35) per 12‐hour patient‐day was significantly higher than the cost normally incurred in nursing homes ($1.52) per 12‐hour patient‐day. The cost of an incontinence rehabilitation program, which significantly reduced incontinence episodes, was contrasted to the cost of incontinence as measured under both of the previous conditions. The rehabilitation program produced significant labor and supply savings only when compared with the hourly checking and changing system. Maintaining patients in a more continent condition costs significantly more than the direct incontinence cost normally incurred by the nursing home. Quality of life and other second‐order benefits must be considered if continence rehabilitation is to be judged cost

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1988.tb03431.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

In order to determine if a bladder‐relaxant drug could enhance the effectiveness of a toileting program for incontinence among functionally impaired nursing home patients, 15 patients with detrusor hyperreflexia were enrolled in a 6‐week trial during which they were put on a habit training protocol alone for 2 weeks, habit training (HT) and a placebo for 2 weeks, and then HT and oxybutynin for 2 weeks (2.5 mg three times daily for 1 week, then 5 mg three times daily for 1 week). Bacteriuria, which was present without other symptoms in 11 of the 13 patients who completed the trial, was treated before HT began. Eradication of the bacteriuria resulted in a small, statistically significant increase in cystometric bladder capacity (44 mL; 95% confidence interval 16 to 72 mL), but the detrusor hyperreflexia and frequent episodes of incontinence persisted. HT alone reduced the mean percentage of every‐two‐hour checks which were wet from 43% to 32% (95% confidence interval of the difference −1% to −21%; P = .04 by a paired t test); addition of placebo and active drug did not result in any further reduction. Cystometric bladder capacity had not changed significantly by the end of the trial (measured while patients were still on active drug), and there was no consistent relationship between changes in bladder capacity and changes in wet checks. Although our sample size is small, the data are consistent with other studies in similar populations. The relatively practical and inexpensive interventions we employed in this study will need to be modified or intensified in order to substantially reduce the frequency of incontinence among functionally disabled nursing ho

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1988.tb03432.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

Although there has been increasing attention to the ethical and legal issues involved in the patient's right to have treatment or hospitalization withheld, there have been few empirical evaluations of programs designed to accomplish that end. Over a 7‐year period, a medical group cared for 110 patients in a skilled nursing facility. After assessing the patients' wishes and the opinions of the personal physicians and nurses, care plans were made specifying whether each one was to receive maximum, intermediate, or comfort care. The hospitalization rate was found to be 79% lower for the patients receiving comfort care. Multiple admissions were unusual. Those patients made no use of outpatient consultants or major diagnostic procedures and had only 14% as many roentgenograms as the patients receiving maximum care. Whereas acute medical and surgical problems and related physician visits were more frequent for the comfort care groups, specific treatment of those problems was withheld far more often. Mortality was twice as great among the comfort care patients, and nearly all of these deaths occurred in the nursing home. It was concluded that the patient's decision to avoid active management can be honored by specific patient plans carefully communicated to all physicians sharing responsibility for that person's car

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1988.tb03433.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

With aging, there are changes in both libido and erectile function. Although the majority of aged men remain interested in sex, less than 15% report continued sexual intercourse. The cause of this “libido‐potency gap” is due primarily to erectile failure.Penile erection is dependent upon a complex interaction of the autonomic nervous system, cardiovascular system, and local neurotransmitters such as acetylcholine and vasoactive intestinal polypeptide. Sexual stimulation causes augmented blood flow into the corpora cavernosa, and restricted outflow, resulting in penile rigidity. With aging, there is a decline in gonadal steroids, nerve conduction velocity, and vascular compliance, any of which could interfere with normal erections. When disease is superimposed on the normal changes of aging, erectile function is further impaired.Evaluation of an elderly male with impotence may consist of a detailed drug history and trial of alternate therapy, as in the case of adverse drug reactions. More often, evaluation entails hormonal assays, penile vascular assessment, neurologic assessment, and an evaluation of nocturnal erectile function. Based on the results of these assessments, appropriate treatment alternatives can be chosen. With the availability of multiple treatment options, patients and physicians can now choose from a range of noninvasive or invasive alternatives depending upon the etiology, associated disorders, and preference of the pa

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1988.tb03434.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

This paper examines the moral and professional issues present in cases involving continued treatment of fatally ill patients in order to benefit a third party. It is argued that such treatment can be justified in some cases from a moral point of view. Practical considerations make such cases difficult to identify at times. It is also argued on the other hand that professional concerns should rule out the permissibility of continuing such treatment. Thus, even though it may be morally permissible at times to continue treatment, it is not good medical practice to do so.

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1988.tb03435.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY