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Sökning: WFRF:(Londos Elisabet) > Palmqvist Sebastian

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2.
  • Johansson, C, et al. (författare)
  • Efficacy of memantine in PDD and DLB: an extension study including washout and open-label treatment.
  • 2011
  • Ingår i: International Journal of Geriatric Psychiatry. - : Wiley. - 1099-1166 .- 0885-6230. ; 26, s. 206-213
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVE: This 30-week extension trial was a continuation of the first double-blind randomized controlled trial (RCT) to study memantine in dementia with Lewy bodies (DLB) and Parkinson's disease dementia (PDD). The objective was to evaluate the presence of recurrence of symptoms upon drug withdrawal. Furthermore, the aim was to explore washout dynamics in order to inform clinical practice. METHODS: Patients were enrolled from psychiatric, memory and neurological outpatient clinics in Norway, Sweden and the UK. The trial comprised a 4-week washout period and a 26-week open-label treatment period. Outcome measures were presence of recurrence of symptom upon drug withdrawal, Clinical Global Impression of Change (CGIC) and modified motor Unified Parkinson's Disease Rating Scale (UPDRS). RESULTS: recurrence of symptoms occurred more frequently (p = 0.04) in patients receiving memantine (58%) than in patients receiving placebo (25%). There was a significant global deterioration (p = 0.0003) during washout within the memantine group as measured by CGIC. The patients seemed to recover during the open-label treatment, however these findings were non-significant. CONCLUSIONS: The findings inform clinical practice that any possible memantine-associated benefits might be rapidly lost after drug withdrawal. The magnitude of deterioration suggests a symptomatic rather than a disease-modifying effect of the drug. Open-label results should merely be considered inspiration for future trials. Copyright (c) 2010 John Wiley & Sons, Ltd.
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3.
  • Londos, Elisabet, et al. (författare)
  • Dysphagia in Lewy body dementia - a clinical observational study of swallowing function by videofluoroscopic examination
  • 2013
  • Ingår i: BMC Neurology. - : Springer Science and Business Media LLC. - 1471-2377. ; 13
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Dysphagia, which can result in aspiration pneumonia and death, is a well-known problem in patients with dementia and Parkinson's disease. There are few studies on dysphagia in patients with dementia with Lewy bodies (DLB) and Parkinson's disease dementia (PDD), especially studies objectively documenting the type of swallowing dysfunction. The aim of this study was therefore to investigate the prevalence, and define the actual swallowing dysfunction according to a videofluoroscopic swallowing examination (VFSE) in patients with DLB and PDD. Methods: Eighty-two consecutive patients with DLB or PDD in a clinical follow-up program were asked about symptoms of dysphagia. Those experiencing dysphagia were examined with VFSE. Prevalence and type of swallowing dysfunction was recorded. Results: Twenty-six patients (32%) reported symptoms of dysphagia such as swallowing difficulties or coughing. Twenty-four (92%) of these had a documented swallowing dysfunction on VFSE. Eighty-eight percent suffered from pharyngeal dysfunction. Conclusions: Almost all DLB or PDD patients with subjective signs of dysphagia had pathologic results on VFSE, the majority of pharyngeal type. This type of dysphagia has not been reported in DLB before. The results have clinical implications and highlight the importance of asking for and examining swallowing function to prevent complications such as aspiration.
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4.
  • Nielsen, Henrietta, et al. (författare)
  • Gender-dependent levels of hyaluronic acid in cerebrospinal fluid of patients with neurodegenerative dementia.
  • 2012
  • Ingår i: Current Alzheimer Research. - 1875-5828. ; 9:3, s. 257-266
  • Tidskriftsartikel (refereegranskat)abstract
    • Numerous reports over the years have described neuroinflammatory events and vascular changes in neurodegenerative diseases such as Alzheimers disease (AD) and dementia with Lewy bodies (DLB). Interestingly, recent reports from other research areas suggest that the inflammatory and vascular processes are influenced by gender. These findings are intriguing from the perspective that women show a higher incidence of AD and warrant investigations on how gender influences various processes in neurodegenerative dementia. In the current study we measured the cerebrospinal fluid (CSF) and plasma concentrations of hyaluroinic acid (HA), an adhesionmolecule known to regulate both vascular and inflammatory processes, in AD and DLB patients as well as in healthy elders. Our analysis showed that male AD and DLB patients had almost double the amount of HA compared to female patients whereas no gender differences was observed in the controls. Furthermore, we found that CSF levels of HA in foremost female AD patients correlated with various AD related biomarkers. Correlations between HA levels and markers of inflammation and vascular changes were only detected in female AD patients but in both male and female DLB patients. We conclude that HA may be linked to several pathological events present in AD, as reflected in CSF protein concentrations. The HA profile in CSF, but not in plasma, and associations to other markers appear to be genderdependent which should be taken into account in clinical examinations and future biomarker studies.
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5.
  • Palmqvist, Sebastian, et al. (författare)
  • A Quick Test of cognitive speed is sensitive in detecting early treatment response in Alzheimer's disease
  • 2010
  • Ingår i: Alzheimer's Research & Therapy. - : Springer Science and Business Media LLC. - 1758-9193. ; 2:5
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction There is a great need for quick tests that identify treatment response in Alzheimer's disease (AD) to determine who benefits from the treatment. In this study, A Quick Test of cognitive speed (AQT) was compared with the mini-mental state examination (MMSE) in the evaluation of treatment outcome in AD. Methods 75 patients with mild to moderate AD at a memory clinic were assessed with AQT and the MMSE at a pretreatment visit, at baseline and after 8 weeks of treatment with cholinesterase inhibitors (ChEI) initiated at baseline. Changes in the mean test scores before and after treatment were compared, as well as the number of treatment responders detected by each test, according to a reliable change index (RCI). Results After 8 weeks of treatment, the AQT improvement, expressed as a percentage, was significantly greater than that of the MMSE (P = 0.026). According to the RCI, the cut-offs to define a responder were ≥16 seconds improvement on AQT and ≥3 points on the MMSE after 8 weeks. With these cut-offs, both tests falsely classified ≤5% as responders during the pretreatment period. After 8 weeks of treatment, AQT detected significantly more responders than the MMSE (34% compared with 17%; P = 0.024). After 6 months of treatment, the 8-week AQT responders still showed a significantly better treatment response than the AQT nonresponders (22.3 seconds in mean difference; P < 0.001). Conclusions AQT detects twice as many treatment responders as the MMSE. It seems that AQT can, already after 8 weeks, identify the AD patients who will continue to benefit from ChEI treatment.
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6.
  • Palmqvist, Sebastian, et al. (författare)
  • Comparison of Brief Cognitive Tests and CSF Biomarkers in Predicting Alzheimer's Disease in Mild Cognitive Impairment: Six-Year Follow-Up Study
  • 2012
  • Ingår i: Plos One. - : Public Library of Science (PLoS). - 1932-6203. ; 7:6
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction: Early identification of Alzheimer's disease (AD) is needed both for clinical trials and in clinical practice. In this study, we compared brief cognitive tests and cerebrospinal fluid (CSF) biomarkers in predicting conversion from mild cognitive impairment (MCI) to AD. Methods: At a memory clinic, 133 patients with MCI were followed until development of dementia or until they had been stable over a mean period of 5.9 years (range 3.2-8.8 years). The Mini-Mental State Examination (MMSE), the clock drawing test, total tau, tau phosphorylated at Thr(181) (P-tau) and amyloid-beta(1-42) (A beta(42)) were assessed at baseline. Results: During clinical follow-up, 47% remained cognitively stable and 53% developed dementia, with an incidence of 13.8%/year. In the group that developed dementia the prevalence of AD was 73.2%, vascular dementia 14.1%, dementia with Lewy bodies (DLB) 5.6%, progressive supranuclear palsy (PSP) 4.2%, semantic dementia 1.4% and dementia due to brain tumour 1.4%. When predicting subsequent development of AD among patients with MCI, the cognitive tests classified 81% of the cases correctly (AUC, 0.85; 95% CI, 0.77-0.90) and CSF biomarkers 83% (AUC, 0.89; 95% CI, 0.82-0.94). The combination of cognitive tests and CSF (AUC, 0.93; 95% CI 0.87 to 0.96) was significantly better than the cognitive tests (p = 0.01) and the CSF biomarkers (p = 0.04) alone when predicting AD. Conclusions: The MMSE and the clock drawing test were as accurate as CSF biomarkers in predicting future development of AD in patients with MCI. Combining both instruments provided significantly greater accuracy than cognitive tests or CSF biomarkers alone in predicting AD.
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7.
  • Palmqvist, Sebastian, et al. (författare)
  • Practical suggestions on how to differentiate dementia with Lewy bodies from Alzheimer's disease with common cognitive tests.
  • 2009
  • Ingår i: International Journal of Geriatric Psychiatry. - : Wiley. - 1099-1166 .- 0885-6230. ; 24, s. 1405-1412
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVE: Dementia with Lewy bodies (DLB) is the second most common neurodegenerative dementia, but it is often underdiagnosed and mistaken for Alzheimer's disease (AD) with sometimes lethal consequences. Over 35 studies have established the differences between DLB and AD in neuropsychological tests, but none have provided easy interpretations of common tests suitable for the clinician. The aim of this study was to suggest practical interpretations of the Mini-Mental State Examination (MMSE), clock drawing, and cube-copying to identify DLB and differentiate it from AD. METHODS: Thirty-three DLB patients were matched according to gender, MMSE, and age with 66 AD patients. The median MMSE score was 24. Easy interpretations of the tests, including the MMSE orientation subscore, were sought for. RESULTS: The identified criteria to separate DLB from AD were (1) the MMSE orientation score x 3 >/= the total MMSE score, (2) an impaired clock drawing, and (3) a non-3D cube-copying. If (1) was fulfilled, the sensitivity and specificity were 100 and 57% in patients with MMSE 21-27. If (1) and (2) were fulfilled in patients with MMSE 21-27, the sensitivity and specificity were 93 and 70%. If at least two of the three criteria were fulfilled, the sensitivity was 85%, and the specificity 75% regardless of MMSE score. CONCLUSION: If the orientation score x 3 >/= the total MMSE score together with an impaired clock drawing and possibly a non-3D cube-copying, the patient should be thoroughly investigated according to the DLB consensus criteria. Copyright (c) 2009 John Wiley & Sons, Ltd.
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8.
  • Palmqvist, Sebastian, et al. (författare)
  • The usefulness of cube copying for evaluating treatment of Alzheimer's disease.
  • 2008
  • Ingår i: American Journal of Alzheimers Disease & other Dementias. - : SAGE Publications. - 1938-2731 .- 1533-3175. ; 23:5, s. 439-446
  • Tidskriftsartikel (refereegranskat)abstract
    • Aims: Cube copying measures visuospatial ability, which is often impaired in Alzheimer's disease (AD). Cube copying was examined as an evaluation of cholinesterase inhibitor (ChEI) treatment in AD. Methods: Eighty-five ChEI-treated AD patients were included. Cube drawings made at prebaseline, baseline, 6 months, and 12 months were assessed. Cube drawings from 56 healthy individuals were also examined. Results: The healthy individuals remained stable in cube copying, whereas untreated AD patients deteriorated during a median period of 6 months. When treatment was given, the deterioration was interrupted. After 12 months, Mini-Mental State Examination (MMSE) had deteriorated compared with baseline whereas cube copying was unchanged.Conclusions: The results indicate that cube copying can be used to evaluate ChEI treatment. It might also show a more long-lasting response to treatment than MMSE. Cube copying only measures a narrow cognitive function and can preferably be used with MMSE, which evaluates visuospatial ability poorly.
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