| 1. |
- McCaddon, Andrew, et al.
(author)
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Transcobalamin polymorphism and serum holo-transcobalamin in relation to Alzheimer's disease
- 2004
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In: Dementia and Geriatric Cognitive Disorders. - : S. Karger AG. - 1420-8008 .- 1421-9824. ; 17:3, s. 215-221
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Journal article (peer-reviewed)abstract
- Isoforms of the vitamin B<sub>12</sub> carrier protein transcobalamin (TC) might influence its cellular availability and contribute to the association between disrupted single-carbon metabolism and Alzheimer’s disease (AD). We therefore investigated the relationships between the TC 776C>G (Pro259Arg) genetic polymorphism, total serum cobalamin and holo-TC levels, and disease onset in 70 patients with clinically diagnosed AD and 74 healthy elderly controls. TC 776C>G polymorphism was also determined for 94 histopathologically confirmed AD patients and 107 controls. Serum holo-TC levels were significantly higher in TC 776C homozygotes (p = 0.04). Kaplan-Meier survival functions differed between homozygous genotypes (Cox’s F-Test F(42, 46) = 2.1; p = 0.008) and between 776C homozygotes and heterozygotes (Cox’s F test F(46, 108) = 1.7; p = 0.02). Proportionately fewer TC 776C homozygotes appear to develop AD at any given age, but this will require confirmation in a longitudinal study.
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| 2. |
- Wallin, Åsa, et al.
(author)
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Five-year outcome of cholinergic treatment of Alzheimer's disease: Early response predicts prolonged time until nursing home placement, but does not alter life expectancy
- 2004
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In: Dementia and Geriatric Cognitive Disorders. - : S. Karger AG. - 1420-8008 .- 1421-9824. ; 18:2, s. 197-206
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Journal article (peer-reviewed)abstract
- Fifty consecutive outpatients with Alzheimer’s disease (AD) received treatment with the cholinesterase inhibitor tacrine in an open longitudinal study. Assessments using Mini-Mental State Examination, Alzheimer’s Disease Assessment Scale – cognitive subscale, and a global rating were made at baseline and at 6, 12, 24, 36, 48 and 60 months. Three outcome groups were characterized: responders, unchanged and deteriorated. Additional outcome measures were time until nursing home placement, and mortality rate. At 6 months –75%, at 12 months –42%, at 24 months –20%, and after that 10% of the patients still on medication had improved or remained stable. The mortality rate did not differ between the outcome groups. Response to tacrine treatment at 6 or 12 months was found to predict a prolonged time until nursing home placement. No predictors for a positive treatment response could be identified at baseline.
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| 3. |
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| 4. |
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| 6. |
- Risberg, Jarl, et al.
(author)
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A new tomographic technique for absolute measurements of white and gray matter blood flow
- 2004
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In: Proceedings of the 8th Nordic Meeting in Neuropsychology, Turku, Finland, August 26–29, 2004, 85.
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Conference paper (peer-reviewed)abstract
- Objective. Most methods for measurements of the regional cerebral blood flow are unable to provide absolute blood flow values. Until now interest has been focused on measurement of the gray matter blood flow, while the white matter blood flow has been rather neglected. The aim of the present project was to develop and evaluate an improved method for reliable tomographic measurements of absolute white and gray matter blood flow Method. The new tomographic method (modified Xe-SPECT) is based on an extension of the period of 133Xe inhalation from one to eight minutes followed by 22 instead of four minutes of breathing of ambient air. This gives a markedly enhanced signal from the white matter and better basis for correct quantification of the blood flow. The arrival and clearance of the tracer are recorded by a three head gamma camera system that provides flow maps with a spatial resolution of about one cm. Results The new method has been evaluated in 33 healthy younger and older (around 70 years) subjects as well as in a group of elderly patients with organic dementia. Our preliminary findings indicate that new and clinically valuable information is obtained by the improved Xe-SPECT method.
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| 7. |
- Risberg, Jarl, et al.
(author)
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A new tomographic technique for absolute measurements of white and gray matter blood flow
- 2003
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In: Journal of the International Neuropsychological Society. - 1355-6177. ; 9, s. 323-323
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Conference paper (peer-reviewed)abstract
- The integrity of the white matter is as important as that of the gray matter and white matter pathology has commonly been reported in elderly subjects and in patients with organic dementia. The aim of the present study is to develop and evaluate an improved method for reliable tomographic measurements of absolute white and gray matter blood flow. The new tomographic method (modified Xe-SPECT) is based on an extension of the period of 133Xe inhalation from one to eight minutes followed by 22 instead of four minutes of breathing of ambient air. This gives a markedly enhanced signal from the white matter and better basis for correct quantification pf the blood flow. The arrival and clearance of the tracer are recorded by a three head gamma camera system that provides flow maps with a spatial resolution of about one cm. The new method has been evaluated in healthy younger and older (around 70 years) subjects as well as in a group of elderly patients with organic dementia. Our preliminary findings indicate that new and clinically valuable information is obtained by the improved Xe-SPECT method
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| 8. |
- Sjöbeck, Martin, et al.
(author)
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Alzheimer's disease and the cerebellum: a morphologic study on neuronal and glial changes
- 2001
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In: Dementia and Geriatric Cognitive Disorders. - : S. Karger AG. - 1420-8008 .- 1421-9824. ; 12:3, s. 211-218
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Journal article (peer-reviewed)abstract
- Structural manifestations of Alzheimer's disease (AD) including neuronal loss were investigated in 12 cases of AD and in 10 healthy age-matched controls, with focus on the cerebellum. Linear Purkinje cell (PC) density was measured in the vermis and cerebellar hemispheres. Neurons were also counted in the inferior olivary nucleus. In vermis of the AD cases, the mean PC number was significantly lower (p = 0.019) than in the controls. The neurons in the inferior olive were similarly fewer, though not significantly (p = 0.13). Molecular layer gliosis and atrophy in the vermis was clearly severer in AD than in the controls. Features typical of cerebral Alzheimer encephalopathy (plaques, tangles and microvacuolization) were inconspicious. The structural cerebellar changes in the AD cases were thus neuronal loss, atrophy and gliosis, judged to represent the disease process, and with a main involvement in the vermis. This may be reflected in some of the symptoms and signs seen in AD, signs that are generally overlooked or judged to be of noncerebellar origin.
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| 9. |
- Andersson, Edith, et al.
(author)
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Acute confusional state in elderly orthopaedic patients: factors of importance for detection in nursing care
- 2001
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In: International Journal of Geriatric Psychiatry. - 1099-1166. ; 16:1, s. 7-17
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Journal article (peer-reviewed)abstract
- OBJECTIVES: The aims of this study were to identify factors of significance in the development of acute confusional state (ACS) and the differences between patients who developed ACS and those who did not. METHOD AND RESULTS: Assessment, observations and interviews with 505 patients admitted to an orthopaedic clinic revealed that 51 patients developed ACS during their in-hospital stay. Patients admitted for hip fracture had a higher incidence of ACS (20.2%) than patients admitted for elective surgery for coxarthros or gonarthros (3.6%). The highest hazard ratio for ACS was several other physical diseases 15.94 (CI: 4.60-55.31 and p-value <0.00001) and the lowest was age 1.10 (CI: 1.04-1.15 and p-value <0.0002). The ACS lasted from 1 to 9 days, and patients had one (N=42), two (N=8) or three episodes (N=1) of confusion during their stay on the ward. More patients who developed ACS before surgery had two or more confusional episodes and emergency patients developed ACS more rapidly. The ACS lasted longer in patients with a higher score on the OBS scale at admittance and with rapid development of ACS. CONCLUSIONS: Acuteness in the situation seems an important risk indication for ACS in the elderly. Awareness of factors associated with the development of ACS makes it possible to more systematically identify those at risk, for instance by systematic assessment in the first interview with the patient on admission to hospital.
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| 10. |
- Bauer, Betty, et al.
(author)
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Right temporal lobe activation when listening to emotionally significant music
- 2004
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In: Applied Neuropsychology. - : Informa UK Limited. - 0908-4282 .- 1532-4826. ; 11:3, s. 161-166
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Journal article (peer-reviewed)abstract
- The cerebral activation when normal elderly participants (6 women, 6 men, M age = 70 years) listened to self-selected emotionally significant music was investigated. Musical memories and preferences were discussed in an interview, and a piece of music with great emotional significance to the participant was selected and later played during measurement of the regional cerebral blood flow (rCBF). Measurements were made during silence, individually selected emotional music, and standard neutral music. The right temporal lobe showed a significant (p < .01) increase in rCBF when the emotional music was compared to silence. A temporal lobe asymmetry (right > left) during emotional music was also significant (p < .01). A decrease in the left prefrontal areas reached significance (p < .05) when standard music was compared to silence. For the emotional music, the right prefrontal area showed a decrease (p < .05). Emotional music thus activates right temporal and deactivates prefrontal regions in the right hemisphere.
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| 11. |
- Bergman, Birgitta, 1941
(author)
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On vision in old age. A longitudinal study of subjects 70 to 97 years old
- 2003
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Doctoral thesis (other academic/artistic)abstract
- Aims. The main purpose of this study was to investigate different aspects of vision and visual function in old people, like change in vision and visual ability, to study the natural course of eye diseases, assess needs of visual intervention, investigate risk factors for ocular disorders late in life, and also to investigate coexistence between visual and hearing impairments. Materials and Methods. Within the framework of the Gerontological and Geriatric Population Studies, the H70 Study , launched 1971 in Göteborg, Sweden, a cohort comprising 958 subjects at the start of the study was eye-examined longitudinally at ages 70, 82, 88, 95, and 97 years. At ages 95 and 97, cross-sectional groups were added to extend the sample. Audiological and laboratory data were analysed in connection with the ophthalmological examinations.Results. At age 70, best-corrected normal vision (VA ³0.8) was found in 86%, at age 82 in 48%, at age 88 in 24%, and at age 95 in 8% of subjects. At age 97, severe visual impairment (VA £0.1) was found in every third subject. The deterioration rate (i.e., logMAR change per year) was faster in the highest age interval. At age 82, the visual ability score correlated with distance VA (r = 0.62). In subjects with no pathological findings, median VA was 0.9 at age 82 and 0.8 at age 88. Geographic atrophy was more common than exudative late ARM. At 97 years 30% had undergone cataract surgery. The benefit of regular eye examinations, improvement of glasses, and early cataract surgery was assessed. At age 70, blood folate levels, and physical activity earlier, correlated positively, and body mass index (BMI) correlated negatively, to VA ³0.8 at ages 82 and 88. Higher BMI at 70 correlated to cataract disease at age 88, and smoking at age 70 correlated to early ARM at age 82. Mild impairments of vision and hearing increased from 2% at age 70 to 22% at age 82.Conclusions. In old age, gradual deterioration of vision is encountered. Regular eye screening, with improvement of glasses, and/or cost-effective cataract surgery, should be performed early to increase the time of improved vision. Lifestyle variables may prospectively correlate to future eye health and vision. Combined visual and hearing impairment can result in pronounced problems in everyday activities.
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| 12. |
- Elfgren, Christina, et al.
(author)
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Subjective experience of memory deficits related to clinical and neuroimaging findings.
- 2003
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In: Dementia and Geriatric Cognitive Disorders. - : S. Karger AG. - 1420-8008 .- 1421-9824. ; 16:2, s. 84-92
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Journal article (peer-reviewed)abstract
- The aim of this study was to evaluate cognitive impairment, psychiatric symptoms and cerebral blood flow (CBF) patterns in middle-aged (35–64 years) and younger old patients (65–74 years) with subjective experience of memory deficits. The study group was heterogeneous with patients fulfilling criteria for dementia, as well as patients with mild cognitive impairment (MCI) and with non-verified cognitive impairment (non-MCI). Seventy per cent of the non-MCI patients reported long-lasting experiences of psychosocial stress tentatively causing the memory problems. The MCI patients were subdivided into two groups: MCI type 1 included patients with isolated memory impairment, while MCI type 2 included patients with memory impairment together with slight verbal and/or visuospatial impairments. CBF measurements comparing the two MCI groups with the non-MCI group were performed. The MCI type 2 showed reduced CBF in the left anterior medial temporal lobe as well as in parts of the posterior cingulate gyrus. The CBF pattern in MCI type 2 concurs with the pathophysiological process of Alzheimer’s disease. The results indicate that it is important to make a subdivision of MCI patients regarding the presence of isolated memory impairments or memory impairments together with other slight cognitive deficits.
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| 13. |
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| 14. |
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| 15. |
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| 16. |
- Gustafson, Lars, et al.
(author)
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Frontotemporal dementia – Differentiation from Alzheimer's disease
- 2004
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In: Psychogeriatria Polska. - 1732-2642. ; 1:4, s. 279-292
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Research review (peer-reviewed)abstract
- Organic dementia is dominated by primary degenerative disorders such as Alzheimer’s disease (AD) and frontotemporal dementia (FTD). FTD is a distinct clinical syndrome with behavioural, personality, emotional and language disturbances preceding the cognitive decline. This clinical presentation is distinctly different from that of AD which is characterized by early cognitive changes, such as memory impairment, aphasia and apraxia, and a relatively preserved personality and behaviour. The differences between these two conditions reflect the predominant topographic distribution of brain pathology. The differences in clinical profiles and treatment strategies will be highlighted. In both disorders loss of functional ability, development of behavioural disturbances and dependency impose heavy demands on family and other caregivers. This presentation will concentrate on early recognition and diagnosis, using systematic clinical evaluation, neuropsychological testing and different brain imaging methods. This is important for a successful development of therapeutic strategies for both cognitive and behavioural symptoms in FTD and AD.
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| 17. |
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| 18. |
- Hultberg, Björn, et al.
(author)
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Markers for the functional availability of cobalamin/folate and their association with neuropsychiatric symptoms in the elderly
- 2001
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In: International Journal of Geriatric Psychiatry. - : Wiley. - 1099-1166 .- 0885-6230. ; 16:9, s. 873-878
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Journal article (peer-reviewed)abstract
- Cobalamin/folate deficiency is common in elderly subjects and may lead to psychiatric symptoms, but even more often it increases the severity of other organic and non-organic mental diseases. This paper reviews the literature relevant for markers of cobalamin/folate status and their relation to neuropsychiatric symptoms in the elderly. Plasma homocysteine, a marker of cobalamin/folate status, is frequently increased in psychogeriatric patients. Among markers of cobalamin/folate status, plasma homocysteine shows the best association with neuropsychiatric dysfunction.
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| 19. |
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| 20. |
- Ingvarsson, T, et al.
(author)
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Assessment of primary hip osteoarthritis: comparison of radiographic methods using colon radiographs : comparison of radiographic methods using colon radiographs
- 2000
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In: Annals of the Rheumatic Diseases. - : BMJ. - 1468-2060 .- 0003-4967. ; 59:8, s. 650-653
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Journal article (peer-reviewed)abstract
- OBJECTIVE: To compare the reliability of quantitative measurement of minimum hip joint space with a qualitative global assessment of radiological features for estimating the prevalence of primary osteoarthritis (OA) of the hip in colon radiographs.METHODS: All colon radiographs from patients aged 35 or older, taken at three different radiographic departments in Iceland during the years 1990-96, were examined. A total of 3002 hips in 638 men and 863 women were analysed. Intraobserver and interobserver reliability was assessed by measuring 147 randomly selected radiographs (294 hips) twice by the same observer, and 87 and 98 randomly selected radiographs (174 and 196 hips) by two additional independent observers. Minimum hip joint space was measured with a millimetre ruler, and global assessment of radiological features by a published atlas.RESULTS: With a minimum joint space of 2.5 mm or less as definition for OA, 212 hips were defined as having OA. When the global Kellgren and Lawrence assessment with grade 2 (definite narrowing in the presence of definite osteophytes) or higher as definition for OA was used, 202 hips showed OA. However, only 166 hips were diagnosed as OA with both systems. With 2.0 or 3.0 mm minimum joint space as cut off point, the difference between the two methods increased. Both intrarater and interrater reliability was significantly higher with joint space measurement than with global assessment.CONCLUSIONS: Overall prevalence of radiological OA was similar with the two methods. However, the quantitative measurement of minimum hip joint space had a better within-observer and between-observer reliability than qualitative global assessment of radiographic features of hip OA. It is thus suggested that minimum joint space measurement is a preferable method in epidemiological studies of radiological hip OA.
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| 21. |
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| 22. |
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| 23. |
- Londos, Elisabet, et al.
(author)
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Clinical Lewy body dementia and the impact of vascular components
- 2000
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In: International Journal of Geriatric Psychiatry. - 1099-1166. ; 15:1, s. 40-49
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Journal article (peer-reviewed)abstract
- OBJECTIVE: To study the prevalence of patients fulfilling the clinical consensus criteria for dementia with Lewy bodies (DLB) in a dementia population followed up with postmortem examination. To compare the clinical and neuropathological findings in the clinical Lewy body dementia (LBD) group with findings in a clinically defined group with Alzheimer's disease (AD). DESIGN: Medical records from 200 patients were studied retrospectively. Clinical consensus criteria for DLB and clinical criteria for other dementias were applied. SETTING: The majority of the cases were examined and cared for in psychogeriatric and psychiatric departments. PATIENTS: The patients, who died between 1985 and 1994, were part of a longitudinal dementia project. Each case was neuropathologically examined. Main outcome measures Prevalence of clinical signs and neuropathology was compared between the clinical groups. RESULTS: Forty-eight (24%) patients fulfilled the clinical criteria for DLB while 45 (22%) fulfilled the clinical criteria for Alzheimer's disease. The clinical LBD group had a higher Hachinski score compared to the clinical AD group. They also showed a tendency towards a 'frontal profile' with disinhibition, confusion, personality change and vocally disruptive behaviour. More than 80% of the AD and LBD groups respectively exhibited Alzheimer pathology. The LBD group had frontal white matter pathology and degeneration of the substantia nigra more often than the clinical AD group. Both LBD and AD groups showed a progressive and marked increase in severity of dementia and decrease in ADL capacity according to an evaluation based on the Berger scale and Katz index. The condition of the LBD group was significantly worse earlier in dementia. CONCLUSION: The results of this study indicate that patients fulfilling the clinical criteria for DLB also exhibit clinical features of possible vascular origin and a frontal profile. Subcortical vascular pathology, nigral degeneration and AD pathology in this group could partly explain the clinical features used to define DLB.
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| 24. |
- Londos, Elisabet, et al.
(author)
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Neuropathological correlates to clinically defined dementia with Lewy bodies
- 2001
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In: International Journal of Geriatric Psychiatry. - : Wiley. - 1099-1166 .- 0885-6230. ; 16:7, s. 667-679
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Journal article (peer-reviewed)abstract
- OBJECTIVES: To analyse the neuropathological changes behind clinically defined dementia with Lewy bodies (clinDLB) compared with clinically diagnosed Alzheimer's disease (clinAD). METHODS: The prevalence of neuropathological findings in 48 clinDLB and 45 clinAD cases was compared. Sixteen clinDLB and 10 clinAD cases were reassessed with alpha-synuclein staining for Lewy bodies (LB). RESULTS: Alzheimer pathology was found in 81% of the clinDLB and 93% of the clinAD cases. The clinDLB group had a higher prevalence of frontal white matter pathology, mostly of ischemic type, and a more severe degeneration of the substantia nigra compared with the clinAD group. In hematoxylin-eosin staining, LBs were identified in seven (15%) of the clinDLB and in four (9%) of the clinAD group. In alpha-synuclein staining, 38% of the clinDLB and 40% of the clinAD cases exhibited LBs. The cases without LBs, in the clinDLB group, had AD pathology in combination with frontal white matter disease. Vascular pathology of significant degree was prevalent in more than 40% of all the cases with verified LBs regardless of clinical diagnosis. CONCLUSION: Consecutive dementia cases, fulfilling the clinical consensus criteria for DLB, may exhibit combinations of neuropathological changes which in themselves can explain the clinical picture of DLB even when LBs are absent.
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| 25. |
- Nilsson, Karin, et al.
(author)
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Improvement of cognitive functions after cobalamin/folate supplementation in elderly patients with dementia and elevated plasma homocysteine
- 2001
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In: International Journal of Geriatric Psychiatry. - : Wiley. - 1099-1166 .- 0885-6230. ; 16:6, s. 609-614
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Journal article (peer-reviewed)abstract
- OBJECTIVES: To investigate the effect of cobalamin/folate supplementation on cognitive function in elderly patients with dementia. METHOD: The cobalamin/folate status of the patients was evaluated by measuring plasma homocysteine, serum methylmalonic acid, serum cobalamin and blood folate. Thirty-three patients were studied and repeatedly assessed with the Mini-Mental State Examination (MMSE) and 'A short cognitive performance test for assessing memory and attention' (SKT) during vitamin substitution. RESULTS: Patients with mild-moderate dementia and elevated plasma homocysteine levels improved clinically with increased test scores after vitamin substitution, while severely demented patients and patients with normal plasma homocysteine levels did not improve clinically. CONCLUSIONS: Plasma homocysteine may be the best marker for detecting treatable cobalamin/folate deficiency in patients with dementia.
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| 26. |
- Nilsson, K, et al.
(author)
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Lack of association between plasma homocysteine and inflammation in psychogeriatric patients
- 2002
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In: Dementia and Geriatric Cognitive Disorders. - 1420-8008. ; 14:3, s. 151-155
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Journal article (peer-reviewed)abstract
- Background/Objectives: In previous studies we observed a high incidence of elevated plasma homocysteine (tHcy) concentrations in psychogeriatric patients. Plasma tHcy is increased in folate deficiency. Folates are sensitive to oxidative stress. Oxidative stress, caused by inflammatory processes, could represent an endogenous reason for folate deficiency, even when the dietary intake of the vitamin is within the recommended range. It has been suggested that oxidative stress rather than insufficient folate intake causes hyperhomocysteinemia in different forms of psychogeriatric diseases. In the present study we investigated the association between plasma tHcy and C-reactive protein (CRP), a sensitive marker for inflammation, in psychogeriatric patients. Methods: Plasma tHcy, its main determinants, and CRP were measured in plasma and serum of 132 psychogeriatric patients (53 males and 79 females, mean age 75 12 years). Results. In the psychogeriatric patients, plasma tHcy was elevated and blood folate and serum creatinine were lower than in control subjects, whereas serum CRP concentrations did not differ significantly. We also subdivided the psychogeriatric patients into different diagnosis groups, yet there were no differences in serum CRP concentrations in these groups compared with age-matched control groups. There was a significant correlation between plasma tHcy and serum CRP (rho = 0.19, p < 0.05). A stepwise multiple regression analysis including serum CRP, age, blood folate, serum cobalamin, serum methylmalonic acid and serum creatinine showed that only blood folate (p < 0.001), age (p < 0.001), serum creatinine (p < 0.001), serum cobalamin (p < 0.001), and serum methylmalonic acid (p < 0.001) independently predicted plasma tHcy concentration. Thus CRP concentration was not an independent predictor of plasma tHcy. Conclusion: The present study did not show any association between inflammatory status and plasma tHcy concentration in psychogeriatric patients.
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| 27. |
- Nilsson, Karin, et al.
(author)
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Optimal use of markers for cobalamin and folate status in a psychogeriatric population.
- 2002
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In: International Journal of Geriatric Psychiatry. - : Wiley. - 1099-1166 .- 0885-6230. ; 17:10, s. 919-925
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Journal article (peer-reviewed)abstract
- BACKGROUND: Cobalamin/folate deficiency is common in elderly subjects and may lead to psychiatric symptoms, but even more often it increases the severity of other organic and non-organic mental diseases. It is therefore of importance to evaluate the optimal use of different markers of cobalamin/folate status in a psychogeriatric population. METHODS: We measured serum cobalamin, blood folate, plasma homocysteine (tHcy) and serum methylmalonic acid (MMA) in 475 well-defined psychogeriatric patients. RESULTS: The findings in the present study showed that many (41%) of the patients with normal levels of serum MMA (<0.41 &mgr;mol/l) had pathological values of at least one of the other markers for cobalamin/folate status, whereas only 17% of patients with normal plasma tHcy (<19.9 &mgr;mol/l) had pathological levels of other markers. If patients with decreased levels of serum cobalamin and/or blood folate were also excluded from these patients, only nine patients with slightly elevated levels of serum MMA remained. In the present study different upper reference limits were also tested for both serum MMA and plasma tHcy. However, the use of these limits did not cause any diagnostic improvement in the evaluation of cobalamin-folate status. Plasma tHcy was increased in almost all diagnosis groups of the psychogeriatric patients, whereas serum MMA was increased in only some groups. The distribution of the two common polymorphisms of the methylenetetrahydrofolate reductase gene (C677T and A1298C) was similar in patients with elevated and normal plasma tHcy. CONCLUSIONS: The findings in the present study suggest the use of plasma tHcy, serum cobalamin and blood folate to evaluate cobalamin-folate status in psychogeriatric patients and to omit the use of serum MMA. Copyright 2002 John Wiley & Sons, Ltd.
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| 28. |
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| 29. |
- Nilsson, Karin, et al.
(author)
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Relation between plasma homocysteine and Alzheimer's disease.
- 2002
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In: Dementia and Geriatric Cognitive Disorders. - : S. Karger AG. - 1420-8008 .- 1421-9824. ; 14:1, s. 41467-41467
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Journal article (peer-reviewed)abstract
- OBJECTIVE: Several studies have shown that plasma total homocysteine (tHcy) concentration is elevated in Alzheimer's disease (AD). However, it is not clear whether elevated plasma tHcy is a primary cause or a consequence of AD. METHOD: To elucidate this question, we have analysed plasma homocysteine and its determinants in patients with early (EOAD)- and late-onset AD (LOAD) and compared the findings with those in vascular dementia (VaD) and age- and sex-matched control subjects. RESULTS: One of the main findings in the present study is that in EOAD there is no change in the levels of either plasma tHcy or its determinants compared with an age- and sex-matched control group. The fact that plasma tHcy concentration is normal in EOAD thus indicates that elevated plasma tHcy is not the primary cause of the disease. Another main finding is that patients with mixed dementia (AD and VaD) and patients with VaD showed significantly increased plasma tHcy concentration compared with controls and that plasma tHCy concentration in patients with LOAD and a history of additional cardiovascular disease was elevated compared both with AD patients without such a history and with the controls. Thus, there is an association between elevated plasma tHcy and vascular disease. A third main finding is that patients with AD who were followed up for several years showed a clinical deterioration of dementia and an elevation of plasma tHcy concentration. This finding likewise supports the notion that elevated plasma tHcy is not the primary cause of the disease. CONCLUSIONS: The findings suggest that elevated plasma tHcy is not the primary cause of the disease. Furthermore, the findings indicate that elevated plasma tHcy might be a reflection of concomitant vascular disease in AD patients.
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| 30. |
- Nilsson, Karin, et al.
(author)
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Role of impaired renal function as a cause of elevated plasma homocysteine concentration in psychogeriatric patients.
- 2002
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In: Scandinavian Journal of Clinical & Laboratory Investigation. - : Informa UK Limited. - 1502-7686 .- 0036-5513. ; 62:5, s. 9-385
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Journal article (peer-reviewed)abstract
- In previous studies a high frequency of elevated plasma tHcy concentrations has been observed in psychogeriatric patients (40-50%), but the main cause of these increased concentrations could not be established with certainty. Impaired renal function could partly contribute to elevated plasma tHcy concentrations in psychogeriatric patients. Therefore, in the present study, cystatin C was used as a sensitive marker for glomerular filtration. A linear regression analysis including age, blood folate, serum cobalamin, serum cystatin C and serum creatinine showed that only serum creatinine (p<0.001) and blood folate (p<0.001) independently predicted plasma tHcy concentration. However, about 44% of the patients with elevated plasma tHcy concentrations had signs of reduced glomerular filtration rate, as judged by increased serum cystatin C, whereas only about 13% of the patients with normal concentrations of plasma tHcy had signs of reduced glomerular filtration rate. This finding indicates that renal impairment may to some extent contribute to the elevated plasma tHcy concentration, even though serum cystatin C did not independently predict plasma tHcy concentration.
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| 31. |
- Nilsson, Karin, et al.
(author)
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Treatment of cobalamin deficiency in dementia, evaluated clinically and with cerebral blood flow measurements
- 2000
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In: Aging. - 0394-9532. ; 12:3, s. 199-207
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Journal article (peer-reviewed)abstract
- We investigated the relation between cobalamin deficiency, clinical changes and brain function in dementia patients. On admittance to the clinic, 24 patients had cobalamin deficiency, and dementia with additional symptoms of delirium. During cobalamin supplementation, the patients underwent repeated regional cerebral blood flow (rCBF) studies, psychiatric evaluations, and in some cases assessment with MMSE and the Organic Brain Syndrome scale. Fifteen patients who showed mild to moderate dementia improved clinically, and also showed a concomitant increase in their general CBF after treatment. In contrast, 9 patients who were severely demented showed no obvious clinical improvement, and no general blood flow change, although some regional flow increases were seen in sensory motor areas. We conclude that symptoms which probably indicated superimposed delirium such as clouding of consciousness, disorientation and clinical fluctuation, responded to the vitamin B12 supplementation, while the underlying dementia condition remained basically unchanged. The clinical improvement was also mirrored in general and focal rCBF changes.
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| 32. |
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| 33. |
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| 34. |
- Philpot, M, et al.
(author)
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Barriers to the use of electroconvulsive therapy in the elderly: a European survey
- 2002
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In: European Psychiatry. - 1778-3585. ; 17:1, s. 41-45
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Journal article (peer-reviewed)abstract
- A postal survey was carried out to determine the clinical and legal guidelines governing the use of electroconvulsive therapy (ECT) in the countries of the wider Europe. Respondents from 23 of the 33 countries returned completed questionnaires. Considerable variation was found in the availability of ECT, the frequency of its use and associated legal procedures. However, there was a broad consensus with regard to the clinical indications. Access to the treatment was most frequently limited by financial or other resource constraints, political or legal restrictions. (C) 2002 Editions scientifiques et medicales Elsevier SAS.
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| 35. |
- Risberg, Jarl, et al.
(author)
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99mTC-HMPAO-SPECT related to clinical findings in patients with subjective experience of memory deficit
- 2004
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In: Proceedings of the 8th Nordic Meeting in Neuropsychology.
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Conference paper (peer-reviewed)abstract
- Objective. The aim was to evaluate cognitive impairments, psychiatric symptoms and cerebral blood flow (CBF) patterns in middle-aged and younger old patients with subjective experience of memory deficits. Methods. The CBF was measured by 99m-Tc-HMPAO-SPECT. The study group was heterogeneous with patients fulfilling criteria for dementia (n=13) and patients with mild cognitive impairment (MCI; n= 24) as well as with not verified cognitive impairment (Non-MCI; n=17). The MCI patients were subdivided into two groups. The MCI type 1 group (n=14) had isolated memory impairments while the MCI type 2 group (n=10) had memory impairments together with slight verbal and/or visuospatial disturbances. Results. The MCI type 1 group showed lower blood flow in the left middle/inferior gyrus and in parts of the left inferior parietal lobe compared to the Non-MCI group. The MCI type 2 group showed reductions in the left anterior medial temporal lobe as well as in parts of the posterior cingulate gyrus. The Non-MCI patients reported high incidence (70%) of long-lasting psychosocial stress. Conclusions. The combination of clinical and CBF data provides diagnostically meaningful information about regional brain dysfunction in patients with memory deficits.
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| 36. |
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| 37. |
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| 38. |
- Vestberg, Susanna, et al.
(author)
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Early signs of incipient dementia?
- 2001
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In: International Psychogeriatrics. - 1741-203X. ; 13:Suppl. 2, s. 215-215
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Conference paper (other academic/artistic)
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| 39. |
- Wadman, Maria, et al.
(author)
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Survival after operations for ischaemic bowel disease
- 2000
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In: European Journal of Surgery. - : Oxford University Press (OUP). - 1102-4151. ; 166:11, s. 872-877
-
Journal article (peer-reviewed)abstract
- Objective: To find out what factors influence the outcome of operations for ischaemic bowel disease. Design: Retrospective study. Setting: University hospital, Sweden. Main outcome measures: Morbidity and mortality. Subjects: 74 patients, mean age 75 years (range 40-98), operated on for acute bowel ischaemia between 1987 and 1996. Results: A total of 75 emergency operations were done, including 42 bowel-resections, one percutaneous transluminal angioplasty, and one thrombectomy. Thirty-one patients had exploration alone because of extensive gangrene. These explorations were performed in 11 of 14 (79%) patients aged >84 years; 18 of 40 (45%) patients aged 71-84 years and 2 of 21 (9%) patients aged <71 years, (p < 0.001). Of the 14 patients over 84 years old only one survived more than 30 days, compared with 12 of 40 (30%) aged 71-84 years, and 17 of 21 (81%) younger than 71 years (p < 0.001). Operation within 6 hours of admission resulted in significantly better survival compared with operations done after more than 6 hours delay (p = 0.04). Conclusions: Advanced age was a strong risk factor for death after operation for ischaemic bowel disease, and there was a higher incidence of unresectable gangrene. Delay in surgical intervention was associated with increasing mortality.
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| 40. |
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| 41. |
- Akner, Gunnar
(author)
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Arbetsmetod
- 2003
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In: Evidensbaserad äldrevård. - Stockholm : Statens beredning för medicinsk utvärdering (SBU). - 9187890836 ; , s. 45-50
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Book chapter (other academic/artistic)
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| 42. |
- Akner, Gunnar
(author)
-
Background
- 2003
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In: Geriatric care and treatment. - Stockholm : Statens beredning för medicinsk utvärdering (SBU). ; , s. 23-42
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Book chapter (other academic/artistic)
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| 43. |
- Akner, Gunnar
(author)
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Bakgrund
- 2003
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In: Evidensbaserad äldrevård. - Stockholm : Statens beredning för medicinsk utvärdering (SBU). - 9187890836 ; , s. 25-44
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Book chapter (other academic/artistic)
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| 44. |
- Akner, Gunnar, 1953-, et al.
(author)
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Drug treatment
- 2003. - 1
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In: Geriatric care and treatment. - Stockholm : Statens beredning för medicinsk utvärdering (SBU). ; , s. 233-256
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Book chapter (other academic/artistic)
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| 45. |
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| 46. |
- Akner, Gunnar, 1953-
(author)
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Geriatric medicine in Sweden : a study of the organisation, staffing and care production in 2000-2001
- 2004
-
In: Age and Ageing. - : Oxford University Press (OUP). - 0002-0729 .- 1468-2834. ; 33:4, s. 338-341
-
Journal article (peer-reviewed)abstract
- OBJECTIVE: the organisation of long-term medicine and geriatric medicine has undergone many changes during the last 15 years. The aim of this study is to gain an overall perspective of the present organisation of geriatric medicine in Sweden.DESIGN: questionnaire survey.METHODS: The Swedish Society for Geriatric Medicine and Gerontology, in collaboration with the Federation of County Councils and the Swedish Association of Local Authorities, sent out a survey to people in all county councils in Sweden. The subject of the survey was the speciality of geriatric medicine in the Swedish healthcare system, with regard to healthcare organisation, staffing and care production in 2000/2001.RESULTS: there were 52 separate geriatric units, 41 independent 'clinics' and 11 'sections' within other departments. There were a total of 3,101 geriatric inpatient beds. On average, there was one geriatric bed for every 799 individuals within the local population aged 65 years and over, with a 10-fold variation between counties. Four counties had no geriatric provision. The 'geriatric clinics' were mainly located in university towns and averaged 85 beds per clinic, again with a 10-fold variation. There were 604 established positions for doctors within geriatrics, of which 63% were at geriatric clinics. On average, the clinics had 16 positions each (of which 75% were filled with geriatric specialists) with 7 beds per doctor. The corresponding averages for nurses and paramedics could not be summarised due to organisational differences between the county councils. In general, there were very few nurses with specialist training in geriatric medicine.CONCLUSIONS: the field of geriatric medicine in Sweden is very heterogeneous regarding terminology, designations, structure, staffing and care production. There is no overall structural plan for the role of geriatric medicine in Swedish healthcare, with the desired close connection between content and dimensioning of geriatric specialist training and the practical organisation of the activities. The county councils designate geriatric medicine so differently that it is hardly possible to compare different geriatric facilities today. Considering how many patients at hospitals today are elderly and suffer from multiple illnesses, it is a major quality issue to ensure that these patients have access to geriatric specialists.
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| 47. |
- Akner, Gunnar, 1953-, et al.
(author)
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Läkemedelsbehandling
- 2003. - 1
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In: Evidensbaserad äldrevård. - Stockholm : SBU. - 9187890836 ; , s. 233-256
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Book chapter (other academic/artistic)
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| 48. |
- Akner, Gunnar, 1953-
(author)
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Malnutrition
- 2003. - 1
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In: Geriatric care and treatment. - Stockholm : Statens beredning för medicinsk utvärdering (SBU). ; , s. 257-264
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Book chapter (other academic/artistic)
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| 49. |
- Akner, Gunnar
(author)
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Methods
- 2003
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In: Geriatric care and treatment. - Stockholm : Statens beredning för medicinsk utvärdering (SBU). ; , s. 43-48
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Book chapter (other academic/artistic)
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| 50. |
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