| 1. |
- Bengtsson Lindberg, Marie, et al.
(författare)
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Evaluation of Systolic and Diastolic Hypotension in Dementia with Lewy Bodies and Alzheimer’s Disease.
- 2013
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Ingår i: Healthy Aging & Clinical Care in the Elderly. - 1179-0601. ; 5, s. 33-39
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Orthostatic hypotension (OH) can be seen in as many as 30% to 50% of the elderly population as well as in dementia. OH is part of the autonomic dysfunction in dementia with Lewy bodies (DLB) and prevalent in the majority of these patients. It is also suggested to be a negative prognostic factor for survival in DLB. A detailed interpretation of the 10-minute orthostatic blood pressure measurement has shown prolonged orthostasis in DLB compared with other dementias. The type of OH (systolic and diastolic) has not been separately investigated in different dementias. OBJECTIVES: The aims of this study were to analyze the type of orthostatic hypotension, systolic and/or diastolic, in different dementia groups compared with normal controls. PATIENTS AND METHODS: One-hundred fifty-six individuals, 52 with DLB, 50 with Alzheimer’s disease (AD), 54 AD with vascular components (ADvasc), and 62 normal controls, were included. As part of each patient’s routine clinical dementia investigation, systolic and diastolic blood pressure measurements were examined in the supine position, immediately after standing up, and after 1, 3, 5, and 10 minutes of standing. OH was defined as a blood pressure drop of 20 mmHg systolic or 10 mmHg diastolic, and the type of OH—systolic, diastolic or both—was defined. RESULTS: Orthostatic hypotension was severely underdiagnosed before the dementia investigation with only 2% to 4% in the dementia groups, while we found that 69% of DLB, 50% of ADvasc, 38% of AD, and 13% of normal controls had OH. A combination of systolic and diastolic OH was the most common type of OH both in the DLB (67%) and ADvasc (48%) groups, while systolic OH was the most common type in AD (63 %) as well as in normal controls (63%). Mini Mental State Examination scores differed significantly (P < 0.001) between the group with no OH (25.2 ± 4.8) and the group with combined systolic and diastolic OH (22.0 ± 4.8). CONCLUSION: Patients with DLB showed a greater proportion of combined systolic and diastolic hypotension. This might suggest a more complex OH than in patients with AD or elderly controls, possibly exacerbating the clinical picture in DLB. Further investigations of the relevance of these findings and the relation to clinical symptoms are needed.
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| 2. |
- Bengtsson Lindberg, Marie, et al.
(författare)
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Lack of orthostatic symptoms in dementia patients with orthostatic hypotension.
- 2015
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Ingår i: Clinical Autonomic Research. - : Springer Science and Business Media LLC. - 1619-1560 .- 0959-9851. ; 25:2, s. 87-94
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Orthostatic hypotension (OH) is common and increases with age. OH is part of the autonomic dysfunction in dementia with Lewy bodies (DLB). Commonly OH is diagnosed when the patient falls which is a risk factor of premature death. Our objective was to systematically investigate the clinical symptoms associated with measurement of OH in different neurodegenerative dementias and normal controls (NC). Methods: 154 patients [50 DLB, 50 Alzheimer’s disease (AD), 54 AD and vascular components (ADvasc)] were examined with systolic and diastolic blood pressure measurements in supine position, immediately after standing up and after 1, 3, 5 and 10 min of standing. They were compared with 50 NC. Orthostatic symptoms were registered according to a predefined protocol. Results: Twenty-seven percent of all the investigated individuals reported OH symptoms during the measurement while 43% fulfilled the criteria of OH. Sixty-three percent of orthostatic patients did not have any symptoms during the measurement. The prevalence of any orthostatic symptoms during the measurement differed significantly (p<0.001) between the diagnostic groups with 40% in DLB patients, 37% in ADvasc, 28% in AD and 2% in NC. The most frequent symptom was dizziness 13.7%. Conclusions: Classical orthostatic symptoms are absent in the majority of dementia patients with OH. The orthostatic reaction must therefore be routinely measured in this patient group. This is particularly important for patients with DLB where falls as a result of OH are common.
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| 3. |
- Gustavsson, Anders, et al.
(författare)
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Disease progression and costs of care in Alzheimer's disease patients treated with donepezil: a longitudinal naturalistic cohort.
- 2012
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Ingår i: European Journal of Health Economics. - : Springer Science and Business Media LLC. - 1618-7601 .- 1618-7598. ; 13:5, s. 561-568
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND/AIMS: Improved data and methods are needed for modeling disease progression in Alzheimer's disease (AD) for economic evaluation of treatments. The aim is to estimate prediction models for long-term AD progression and subsequently economic outcomes. METHODS: Three-year follow-up data on 435 patients treated with the cholinesterase inhibitor donepezil in clinical practise were analyzed. Regression models were estimated for long-term prediction of decline in cognitive function (ADAS-cog) and activities in daily living (ADL) ability, risk of institutionalization and costs of care. RESULTS: The cognitive deterioration was estimated at between 1.6 and 4 ADAS-cog points per every 6 months, increasing with disease severity. Cognitive function was an important predictor of ADL-ability, which itself was the most important predictor of the risk of institutionalization and costs of care. Combining all models in a cross-validation process generated accurate predictions of costs of care at each 6 months follow-up. CONCLUSION: The proposed methods for representing AD progression and economic outcomes can be used in micro-simulation models for the economic evaluation of new treatments.
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| 4. |
- Larsson, Victoria, et al.
(författare)
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Quality of Life and the Effect of Memantine in Dementia with Lewy Bodies and Parkinson's Disease Dementia.
- 2011
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Ingår i: Dementia and Geriatric Cognitive Disorders. - : S. Karger AG. - 1420-8008 .- 1421-9824. ; 32:4, s. 227-234
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To investigate quality of life (QOL) and the effect of memantine treatment in patients with Lewy body dementias. Methods: A secondary analysis of a randomized controlled study in 70 patients with Parkinson's disease dementia (PDD) or dementia with Lewy bodies (DLB) over 24 weeks using caregiver-rated QOL-Alzheimer's disease (AD) in domains according to the WHO's classification of health. Results: Baseline QOL shows lower ratings for body functions over environmental factors in DLB/PDD. Treatment with memantine significantly improves life as a whole compared to placebo and improves total QOL, body function and structure. Conclusion: This study shows that memantine improves QOL in Lewy body dementias. We also demonstrate important QOL patterns which can be used in clinical practice. Copyright (C) 2011 S. Karger AG, Basel
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| 5. |
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| 6. |
- Minthon, Lennart, et al.
(författare)
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Long-term rivastigmine treatment in a routine clinical setting.
- 2009
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Ingår i: Acta Neurologica Scandinavica. - : Wiley Blackwell. - 0001-6314 .- 1600-0404. ; 119:3, s. 180-185
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The aim of the study was to observe the effects of long-term rivastigmine treatment in patients with mild to moderate Alzheimer's disease (AD) in a routine clinical setting. METHODS: This was a prospective, open-label, observational, multicentre, non-randomized study. Outcome measures included the Mini Mental State Examination (MMSE), the Clinician's Interview-Based Impression of Change (CIBIC) and the Alzheimer's Disease Assessment Scale - cognitive subscale (ADAS-cog). RESULTS: Of 217 patients initiated into rivastigmine treatment, 62% (n = 135) remained on treatment for 24 months. Most patients droped out due to nursing home placement or side effects. Eighty per cent and 67% of completers exhibited a symptomatic attenuation of cognitive decline (< or = 4-point deterioration) as assessed by using the MMSE and ADAS-cog respectively. Forty-four per cent showed an unchanged/improved CIBIC rating. CONCLUSIONS: Over 60% of patients remained on treatment for 2 years in this routine clinical setting. In patients who remained on treatment, rivastigmine appeared to stabilize their condition and prevented or delayed symptomatic decline.
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| 7. |
- Palmqvist, Sebastian, et al.
(författare)
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A Quick Test of cognitive speed is sensitive in detecting early treatment response in Alzheimer's disease
- 2010
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Ingår i: Alzheimer's Research & Therapy. - : Springer Science and Business Media LLC. - 1758-9193. ; 2:5
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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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| 8. |
- Palmqvist, Sebastian, et al.
(författare)
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Comparison of Brief Cognitive Tests and CSF Biomarkers in Predicting Alzheimer's Disease in Mild Cognitive Impairment: Six-Year Follow-Up Study
- 2012
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Ingår i: Plos One. - : Public Library of Science (PLoS). - 1932-6203. ; 7:6
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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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| 9. |
- Wallin, Anders, 1950, et al.
(författare)
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Donepezil in Alzheimer's disease : What to expect after 3 years of treatment in a routine clinical setting
- 2007
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Ingår i: Dementia and Geriatric Cognitive Disorders. - Basel : S. Karger AG. - 1420-8008 .- 1421-9824. ; 23:3, s. 150-160
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Tidskriftsartikel (refereegranskat)abstract
- Background/Aims: Clinical short-term trails have shown positive effects of donepezil treatment in patients with Alzheimer's disease. The outcome of continuous long-term treatment in the routine clinical settings remains to be investigated. Methods: The Swedish Alzheimer Treatment Study (SATS) is a descriptive, prospective, longitudinal, multicentre study. Four hundred and thirty-five outpatients with the clinical diagnosis of Alzheimer's disease, received treatment with donepezil. Patients were assessed with Mini-Mental State Examination (MMSE), Alzheimer's Disease Assessment Scale-cognitive subscale (ADAS-cog), global rating (CIBIC) and Instrumental Activities of Daily Living (IADL) at baseline and every 6 months for a total period of 3 years. Results: The mean MMSE change from baseline was positive for more than 6 months and in subgroups of patients for 12 months. After 3 years of treatment the mean change from baseline in MMSE-score was 3.8 points (95% CI, 3.0-4.7) and the ADAS-cog rise was 8.2 points (95% CI, 6.4-10.1). This is better than expected in untreated historical cohorts, and better than the ADAS-cog rise calculated by the Stern equation (15.6 points, 95% CI, 14.5-16.6). After 3 years with 38% of the patients remaining, 30% of the them were unchanged or improved in the global assessment. Conclusion: Three-year donepezil treatment showed a positive global and cognitive outcome in the routine clinical setting. Copyright © 2007 S. Karger AG.
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| 10. |
- Wallin, Åsa, et al.
(författare)
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Alzheimer's disease - Safety and dropout in long-term galantamine treatment in a routine clinical setting
- 2007
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Ingår i: New Trends in Alzheimer and Parkinson Related Disorders: ADPD 2007. ; , s. 245-249
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- 276 patients with Alzheimer's disease receiving galantamine in the Swedish Alzheimer Treatment Study were investigated for safety and dropout. Completion rates and reasons for dropout were monitored. The occurrence and time of death was investigated. Galantamine was well tolerated and few side effects were observed. The most frequent cause of dropout during the first year was side effects (n=9), the second and third year, because of adding memantine, which was overall the most frequent cause for dropout (28%). The observed death rate in the study population was not higher than in the average Swedish population (matched for age and gender). Completion-rates were high (51%) compared to previous 3-year studies of cholinesterase inhibitor treated patients.
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