| 1. |
- Fäldt, Roger, et al.
(författare)
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Prevalence of thyroid hormone abnormalities in elderly patients with symptoms of organic brain disease.
- 1996
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Ingår i: Aging (Milan, Italy). - 0394-9532. ; 8:5, s. 347-357
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Tidskriftsartikel (refereegranskat)abstract
- Analysis of the serum concentrations of free thyroid hormones (fT3, fT4) and thyrotropin (TSH) in 173 psychogeriatric patients (94 females and 79 males, mean age 79 +/- 8 years) disclosed that the hormone levels were related to sex, psychiatric diagnosis, medication and the presence of nonthyroid illness (NTI). Subnormal concentrations of thyroid hormones and/or TSH were found in 25% of the patients. In addition, fT3 and fT4 concentrations were significantly lower (p < 0.05 and p < 0.001, respectively) in demented males compared with demented females although the levels were within the reference limits. Strongly negative correlations between fT3 and age (p < 0.001), and between fT3 and the sedimentation rate (SR) (p < 0.01) were found in demented but not in non-demented patients. These correlations were most pronounced in (age) or restricted to (SR) demented males. In addition, the correlation between fT3 and Hb was strongly positive (p < 0.001) in demented as well as in nondemented patients, particularly in males. The concentration of fT4 was positively correlated to Hb in demented males (p < 0.001), whereas TSH concentration was positively correlated to Hb in demented females (p < 0.05). The results show that TSH is not sufficient as the sole screening assay for evaluation of possible thyroid dysfunction in psychogeriatric patients. In addition, central (hypothalamic?) hypothyroidism may be present in a substantial amount of psychogeriatric patients, as we found an adequate TSH response to exogenous thyrotropin-releasing hormone (TRH) also in patients with decreased fT3/fT4 and no signs of non thyroid diseases. Furthermore, there was an apparent lack of correlation between thyroid hormone levels and dementia (or subgroups of dementia), even though thyroid hormone abnormalities seemed to be rather common in frontotemporal dementia (38%) and non specified dementia (36%).
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| 2. |
- Passant, Ulla, et al.
(författare)
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Orthostatic hypotension and low blood pressure in organic dementia: a study of prevalence and related clinical characteristics
- 1998
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Ingår i: International Journal of Geriatric Psychiatry. - 1099-1166. ; 12:3, s. 395-403
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To determine the prevalence of orthostatic hypotension (OH), low blood pressure and dizziness, falls and fractures in patients with organic dementia. DESIGN: We prospectively studied 151 patients, assessing the prevalence of OH, hypertension, heart disorders, diabetes mellitus and the use of medication possibly associated with OH. SETTING: The patients were admitted to our psychogeriatric clinic as part of routine clinical investigation of their dementia. PATIENTS: Forty-six patients with Alzheimer's disease (AD), 28 patients with frontotemporal dementia (FTD) and 77 patients with vascular dementia (VaD) were investigated. MAIN OUTCOME MEASURE: Due to the paucity of information about the prevalence of OH in organic dementia, this study is mainly explorative in nature, thus preventing explicit hypothesis formulation. However, clinical impressions indicated a higher prevalence of OH in organic dementia than normally seen in healthy elderly. RESULTS: OH/low blood pressure was present in 39-52% of the patients. The majority reached their maximum systolic decrease within 5 minutes of standing, but in 20-30% the maximum blood pressure drop occurred after 5 minutes or later. In 38%, the systolic blood pressure drop was more than 40 mm Hg. Hypertension and heart disease was found only in AD and VaD, with no difference between those with and without OH/low blood pressure. Falls and fractures were common in orthostatic and hypotensive patients, with an incidence of more than 50% in AD and VaD. CONCLUSIONS: The results support our clinical impressions that OH and low blood pressure is common and an important factor in organic dementia.
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| 3. |
- Warkentin, Siegbert, et al.
(författare)
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Functional imaging of the frontal lobes in organic dementia. Regional cerebral blood flow findings in normals, in patients with frontotemporal dementia and in patients with Alzheimer's disease, performing a word fluency test
- 1997
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Ingår i: Dementia and Geriatric Cognitive Disorders. - : S. Karger AG. - 1420-8008 .- 1421-9824. ; 8:2, s. 105-109
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Tidskriftsartikel (refereegranskat)abstract
- Patterns of functional cortical activation were studied by means of regional cerebral blood flow measurements, performed during rest and during a word fluency task in normal subjects (n = 22), in patients with Alzheimer's disease (n = 17), and in patients with frontotemporal dementia (n = 15). Although all groups showed a significant activation of the Broca's area during word production, the activation of the dorsolateral prefrontal cortex was clearly subnormal in both dementia groups. The frontal dysfunction was not explained by number of words produced, illness duration, or age. Thus, the results demonstrate that the word fluency task is a sensitive measure of frontal lobe function, and its incorporation in imaging studies may facilitate the detection of subtle functional impairment of the frontal lobes in organic dementia.
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| 4. |
- Johanson, Aki, et al.
(författare)
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Brain function in spider phobia
- 1998
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Ingår i: Psychiatry Research. - 1872-7123 .- 0165-1781. ; 84:2-3, s. 101-111
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Tidskriftsartikel (refereegranskat)abstract
- Measurements of regional cerebral blood flow (rCBF) were performed in 16 women suffering from spider phobia. The non-invasive 133Xe inhalation method, giving information about the blood flow of superficial areas, was used. The subjects were studied under three conditions: during resting, when exposed to a videotape showing nature scenery, and finally when watching a video with living spiders. During the rCBF measurements the subjects' behaviour was registered systematically and respiration, blood pressure, Pco2, and heart rate were monitored. Eight subjects who showed and reported severe panic during the spider exposure had marked rCBF decreases in frontal areas, especially in the right hemisphere. The remaining eight subjects displayed a more efficient control of their emotions and became frightened, but not panic-stricken, during the spider exposure. These showed a consistent rCBF increase in the right frontal area compared to neutral stimulation. Thus, results revealed significant functional changes in the frontal cortex in subjects with spider phobia during phobogenic exposure. It seems likely that these frontal changes are related to the experience and control of phobic anxiety.
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| 5. |
- Liu, X, et al.
(författare)
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Synapse density related to cerebral blood flow and symptomatology in frontal lobe degeneration and Alzheimer's disease
- 1999
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Ingår i: Dementia and Geriatric Cognitive Disorders. - : S. Karger AG. - 1420-8008 .- 1421-9824. ; 10:Suppl 1, s. 64-70
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Tidskriftsartikel (refereegranskat)abstract
- In order to evaluate the functional significance of synaptic pathology, synaptic density was quantitated and related to clinical symptomatology and regional cerebral blood flow (rCBF) in 8 patients with frontal lobe degeneration of non-Alzheimer type (FLD) and 19 patients with Alzheimer's disease (AD). Synaptic density was measured in all layers of prefrontal and parietal cortex. The clinical picture of FLD was dominated by a frontal lobe syndrome with changes in personality and behavior, while AD was dominated by temporoparietal symptoms. This parallels the finding of frontal rCBF reductions in FLD patients and temporoparietal reductions in AD patients. Synaptic density was significantly decreased in both FLD and AD, with a regional severity which closely correlated with that of the degeneration, symptomatology and rCBF deficit. The results suggest that synaptic pathology is a likely cause of clinical symptoms and regional metabolic decrement in dementia.
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| 6. |
- Passant, Ulla
(författare)
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Posture and brain function in dementia. A study with special reference to orthostatic hypotension.
- 1996
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Orthostatic hypotension (OH) is believed to be an important cause of cerebral hypoperfusion, leading to chronic fatigue, blurred vision, unsteadiness, dizziness and sometimes syncope. It may also result in episodes of confusion, falls and fractures. The coupling between OH and organic dementia is not clear. Our findings in a large group of patients with Alzheimer's disease, vascular- and frontotemporal dementia has shown a higher prevalence of OH than is seen in healthy elderly people. To examine the blood pressure we used a standardized orthostatic test. The systolic blood pressure drop varied from 20 to about 100 mm Hg. In about 30% of the patients the blood pressure drop did not appear until after 5 minutes or later in the upright position. About 50% of the patients did not report or show any orthostatic symptoms despite marked blood pressure drops. Falls and multiple fractures were significantly higher in the orthostatic patients. The aim of the study was also to investigate whether postural challenge and OH alters the regional cerebral blood flow (rCBF). The results showed significant and consistent lower values in frontal areas during head-up tilt than during supine position. In autopsy verified Alzheimer-cases, additional white matter disease (wmd) was found in about 2/3 of the patients. A highly significant decrease of blood pressure was seen during the progression of dementia in the Alzheimer-patients, especially in those with wmd. The suggested cause of this regional white matter hypoperfusion is the interaction of non-occlusive small vessel sclerosis with recurrent episodes of low blood pressure. Our results also indicate, that in patients with orthostatic symptoms, the cerebral autoregulation seemed more vulnerable than in those without symptoms. Recognition of OH as well as low blood pressure is crucial, and as a risk factor it may not only be treatable but also preventable.
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