| 1. |
- Alafuzoff, I, et al.
(författare)
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Histopathological criteria for progressive dementia disorders : clinical-pathological correlation and classification by multivariate data analysis.
- 1987
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Ingår i: Acta Neuropathologica. - 0001-6322 .- 1432-0533. ; 74:3, s. 209-25
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Tidskriftsartikel (refereegranskat)abstract
- Autopsied brains from 55 patients with dementia between 59-95 years of age (mean age 77.9 +/- 8.1 years) and 19 non-demented individuals between 46-91 years of age (mean age 74.3 +/- 10.5 years) were examined to establish histopathological criteria for normal ageing, primary degenerative [Alzheimer's disease (AD)/senile dementia of Alzheimer type (SDAT)] and vascular (multi-infarct) dementia (MID) disorders. Senile/neuritic plaques, neurofibrillary tangles, microscopic infarcts and perivascular serum protein deposits were quantified in the frontal lobe (Brodmann area 10) and in the hippocampus. The demented patients were classified according to the DSM-III criteria into AD/SDAT and MID. Operationally defined histopathological criteria for dementias, based on the degree/amount of the histopathological changes seen in aged non-demented patients, were postulated. The demented patients were clearly separable into three histopathological types, namely AD/SDAT, MID and AD-MID, the dementia type where both the degenerative and the vascular changes are coexistent in greater extent than are seen in the non-demented individuals. Using general clinical, gross neuroanatomical and histopathological data three separate dementia classes, namely AD/SDAT, MID and AD-MID, were visualized in two-dimensional space by multivariate data analysis. This analysis revealed that the pathology in the AD-MID patients was not merely a linear combination of the pathology in AD/SDAT and MID, indicating that AD-MID might represent a dementia type of its own. The clinical diagnosis for AD/SDAT and MID was certain in only half of the AD/SDAT and one third of the MID cases when evaluated histopathologically and by multivariate data analysis. AD/SDAT, MID and AD-MID were histopathologically diagnosed in 49%, 24% and 27%, respectively, of all the dementia cases studied. Opposite correlation between the number of tangles, plaques and the patient age in non-demented and AD/SDAT cases were observed, indicating that the pathogenesis of tangles and plaques in the two groups of patients might be different and that AD/SDAT might not be a form of an exaggerated ageing process.
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| 2. |
- Aström, S, et al.
(författare)
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Attitudes of health care personnel toward demented patients.
- 1987
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Ingår i: Comprehensive gerontology. Section B, Behavioural, social, and applied sciences. - 0902-008X. ; 1:3, s. 94-9
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Tidskriftsartikel (refereegranskat)abstract
- Health care personnel (n = 724) working in psychogeriatric care, somatic and psychiatric long-term care, somatic and psychiatric general care and in homes for the aged, were interviewed by means of questionnaires evaluating attitudes and intentions regarding work with demented patients and education in their care. The overall attitude towards demented patients was positive. The largest numbers of personnel with positive attitudes were found in psychogeriatric care and somatic long-term care and the lowest in general medical and psychiatric care. The figure for positive attitudes in relation to education showed a similar figure for all categories. Given a free choice only 4% of the respondents had the intention of working solely with demented patients. A majority of the respondents reported that their knowledge of the care of demented patients came from clinical work. There is a strong need for further education.
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| 3. |
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| 4. |
- Hardy, J, et al.
(författare)
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Transmitter deficits in Alzheimer's disease.
- 1985
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Ingår i: Neurochemistry International. - 0197-0186 .- 1872-9754. ; 7:4, s. 545-63
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Tidskriftsartikel (refereegranskat)abstract
- The pattern of neurotransmitter pathway losses in Alzheimer's disease are reviewed. Deficits of the cholinergic pathway from the nucleus basalis, the noradrenergic pathway from the locus coeruleus and the serotoninergic pathway from the raphe nuclei are established. Cortical somatostatin interneurons are affected and dopaminergic neurons may be affected although these may be late or secondary phenomena in the disease process. Other neuronal systems, particularly in the hippocampus and temporal cortex, are also damaged. However, the disease is not one of generalised neuronal atrophy since some neurons are selectively spared. The established pathway-specific losses are discussed in relation to the clinical symptomatology and the pathology of the disorder. The biochemical and histological findings are compared with similar measurements made on tissues from other dementing disorders in an attempt to trace features common to dementias. Finally, as an addendum, a hypothesis is briefly outlined which attempts to explain the common features of the affected neurons and the pathogenesis of the disorder.
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| 5. |
- Sandman, Per-Olof, 1950-
(författare)
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Aspects of institutional care of patients with dementia
- 1986
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of the present study was to investigate all long-term institutions in the county of Västerbotten, Northern Sweden, to give a detailed description of the institutionalized population with respect to motor functions, vision, hearing, speech, ADL-functions, prevalence of psychiatric symptoms and behavioral disturbances, staff work load, use of psychoactive drugs and prevalence of dementia. Another aim was to select some specific 'problem areas' in the nursing care of demented patients for further descriptive and interventional studies. For this reason, morning care procedure (hygiene, dressing), meal behavior (eating, communication), nutrition, constipation and relocation between institutions were selected.The results of the study have been reported in six papers summarized below:I.The study has shown that the proportion of demented patients is increasing in longterm institutions in Sweden. Furthermore, demented patients were shown to be more impaired in all rated functioning abilities and exhibited more psychiatric symptoms and behavioral symptoms. A high proportion of the demented probands were also prescribed psychoactive drugs, i.e. neuroleptics.II. Five patients with Alzheimer-type dementia were monitored during morning care. A 12-step classification system was developed to be used as a guide to understand and determine abilities essential for performance of morning care for demented patients. The quantitative assessment showed that none of the patients were able to manage morning care independently, but there was a wide variation in their highest level of performance.III. Five patients with Alzheimer-type dementia were observed (video taped) during their meals in a changed meal milieu and with new meal routines. When the patients ate without staff participation, the two least demented patients became 'caregivers'. When two mental nurses joined the group, first in civil clothes and then in white uniforms, the patients dropped their roles as helpers. The patients were able to compose complete meals in 0-79 per cent of the meals. The conversation during the meals could be characterized as incomplete, with short sentences and a lot of breaks. Sixty-three per cent of all utterances were about food and eating and almost all conversation concerned the present time.IV. Thirty-three psychogeriatric patients, with severe constipation were given a high- bran bread instead of their accustomed laxatives. During the high-bran treatment period, the number of bowel evacuations and the volume of faeces increased. The total laxative consumption decreased by 93 per cent.V. Nutritional status and dietary intake were studied in a sample of severely demented, institutionalized patients. Energy and /or protein malnutrition was found in 50 per cent of the patients. The mean energy intake was 2059 kcal. Malnourished patients had had four times as many infectious periods during their hospital stay as patients without malnutrition. Thirty-nine of 44 patients lost weight during their hospital stay.VI. Thirty-three psychogeriatric patients were followed for 36 weeks after relocation from a mental hospital to two newly built nursing homes. An intensive pre-relocation program was performed. No negative effects of the relocation were found. On the contrary, the relocated group improved their ADL-functions after the transfer.Based upon the above cited studies, a model for nursing care of demented patients is presented.
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| 6. |
- Sandman, Per-Olof, 1950-, et al.
(författare)
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Long-term care of the elderly : A descriptive study of 3600 institutionalized patients in the county of Västerbotten, Sweden
- 1988
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Ingår i: Comprehensive gerontology. Section A, Clinical and laboratory sciences. - 0902-0071. ; 2:3, s. 120-32
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Tidskriftsartikel (refereegranskat)abstract
- Probands (n = 3607) living in long-term care institutions in the county of Västerbotten were assessed to estimate whether the prevalence of dementia in different types of institutions had changed since a similar survey was made 7 years before. The probands' motoric functions, vision, hearing, speech, prevalence of behavioral disturbances and psychiatric symptoms, work load and use of psychoactive drugs were also investigated with special emphasis on the differences between the demented and the non-demented. About 40% were demented. This proportion of demented patients had increased in somatic long-stay clinics, nursing homes and homes for the aged since 1975. Further, the mean age of the probands and their length of stay had increased in these institutions. Demented probands were more impaired with regard to motor functions, speech, vision, hearing, ADL-functions, behavioral and psychiatric symptoms, and they also imposed a higher work load on the staff than the non-demented. Demented probands were also prescribed psychoactive drugs, i.e. neuroleptics but not minor tranquilizers or antidepressants, more often than the non-demented in accordance with the increased prevalence of behavioral disturbances and psychiatric symptoms.
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| 7. |
- Sandman, Per-Olof, 1950-, et al.
(författare)
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Morning care of patients with Alzheimer-type dementia : A theoretical model based on direct observations
- 1986
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Ingår i: Journal of Advanced Nursing. - : John Wiley & Sons. - 0309-2402 .- 1365-2648. ; 11:4, s. 369-378
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Tidskriftsartikel (refereegranskat)abstract
- Five hospitalized patients in different stages of Alzheimer-type dementia were monitored by unstructured, direct observations during morning care. Orem's model of nursing as a compensation for the patient's lack of self-care capabilities was used as a frame of reference for an analysis of the behaviours of patients and nurses during morning care. A 12-step classification system was developed to be used as a guide to understand and determine abilities essential for performance of morning care for demented patients. The quantitative assessment showed that none of the patients was able to manage morning care independently, but there was a wide variation in their highest level of performance.
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| 8. |
- Sandman, Per-Olof, 1950-, et al.
(författare)
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Nutritional status and dietary intake in institutionalised patients with Alzheimer's disease and multifarct dementia
- 1987
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Ingår i: Journal of The American Geriatrics Society. - 0002-8614 .- 1532-5415. ; 35, s. 31-38
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Tidskriftsartikel (refereegranskat)abstract
- Nutritional status, dietary intake, weight change, and mortality were studied in a sample of severely demented, institutionalized patients. Dietary intake was registered during five days in two periods, five weeks apart. A weighing method was used. Nutritional status was assessed by anthropometric measurements (weight for height index, triceps skinfold thickness, arm muscle circumference) and determination of circulating proteins (albumin, transferrin, and prealbumin). Energy and/or protein malnutrition was found in 50% of the patients. The mean dietary intake was sufficient according to energy (2059 kcal/day), proteins, vitamins, and minerals. A comparison of patients with or without malnutrition showed no differences in dietary intake, diagnoses, age, length of hospital stay, or duration of illness. However, malnourished patients had had four times as many infectious periods treated by antibiotics as patients with no malnutrition. Thirty-nine of 44 patients lost weight during their hospital stay. There was no correlation between loss of weight, length of hospital stay, or duration of illness.
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| 9. |
- Sandman, Per-Olof, 1950-, et al.
(författare)
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Verbal communication and behaviour during meals in five institutionalized patients with Alzheimer-type dementia
- 1988
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Ingår i: Journal of Advanced Nursing. - : John Wiley & Sons. - 0309-2402 .- 1365-2648. ; 13:5, s. 571-578
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Tidskriftsartikel (refereegranskat)abstract
- Five institutionalized patients with Alzheimer-type dementia were observed (video-recorded) during meals. The aim was to assess their meal behaviour and social interaction. The results showed that when the patients ate without the participation of staff, the two least demented patients became 'caregivers' in the group and helped the three most demented patients to eat. When two mental nurses joined the group, the patients dropped their roles as helpers. The conversation in the group could be characterized as incomplete, with short sentences and a lot of breaks. Sixty-three per cent of all comprehensible utterances concerned food and eating and almost all conversation concerned the present.
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| 10. |
- Wester, P, et al.
(författare)
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Monoamine metabolite concentrations and cholinesterase activities in cerebrospinal fluid of progressive dementia patients : relation to clinical parameters.
- 1988
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Ingår i: Acta Neurologica Scandinavica. - 0001-6314 .- 1600-0404. ; 77:1, s. 12-21
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Tidskriftsartikel (refereegranskat)abstract
- Forty-five well clinically characterized patients with progressive dementia were investigated for lumbar cerebrospinal fluid (CSF) monoamine metabolites and cholinesterase activities. Monoamine concentrations were determined by reverse phase liquid chromatography with electrochemical detection and the cholinergic enzymes were measured photometrically. Firstly, all clinical and CSF parameters were studied in statistical cluster analyses to detect groups of variables which demonstrated a high correlation with respect to each other. The CSF transmitter markers were then used in multiple regression models to explain the variance of clinical variables as chosen from the cluster analyses. The degree of dementia, as assessed by global deterioration score (GDS) and activity in daily life (ADL) status, as well as the Alzheimer-related symptoms dyspraxia and dysphasia, were associated with low AChE activities in CSF. A presumed subgroup of dementia patients clinically characterized by asymmetry of neurological signs, increased unilateral tonus, stepwise progression, and high Hachinski score, showed low HVA concentrations in CSF. These data suggest a coupling of clinical/neurological parameters to different CSF transmitter profils and, thus, that CSF biochemical parameters are of use as antemortem markers in dementia conditions.
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