| 1. |
- Warkentin, Siegbert, et al.
(författare)
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rCBF pathology in Alzheimer's disease is associated with slow processing speed
- 2008
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Ingår i: Neuropsychologia. - : Elsevier BV. - 1873-3514 .- 0028-3932. ; 46:5, s. 1193-1200
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Tidskriftsartikel (refereegranskat)abstract
- Decreased information processing speed (mental slowing) is a known sequelae of many brain disorders, and can be assessed by continuous naming tasks. Functional imaging studies have shown that pause and articulation times in continuous speech are normally associated with different brain regions, but knowledge about such association in dementia is lacking. We therefore tested the hypothesis that perfusion deficits in Alzheimer's disease (AD) are not only associated with slower processing, but also with these speech measures. Using regional cerebral blood flow (rCBF) measurements during the performance of a continuous colour and form-naming task, we found that naming speed was substantially slower in AD patients than in controls. This slower naming was exclusively determined by an increase in mean pause time, and only to a limited extent by articulation time. The increased pause time was uniquely associated with temporo-parietal rCBF reductions of the patients, while articulation was not. By contrast, the rCBF of healthy elderly control subjects was consistently accompanied by substantially shorter articulation and pause times, although the naming measures were not statistically associated with rCBF. These findings suggest that pause time (in contrast to articulation time) may serve as a sensitive measure in the assessment of information processing speed deficits in dementia, by virtue of its close association with brain pathology. (C) 2007 Elsevier Ltd. All rights reserved.
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| 2. |
- Sundvall, Pär-Daniel, et al.
(författare)
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Evaluation of dipstick analysis among elderly residents to detect bacteriuria: a cross-sectional study in 32 nursing homes.
- 2009
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Ingår i: BMC geriatrics. - : Springer Science and Business Media LLC. - 1471-2318. ; 9
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Few studies have evaluated dipstick urinalysis for elderly and practically none present confidence intervals. Furthermore, most previous studies combine all bacteria species in a "positive culture". Thus, their evaluation may be inappropriate due to Yule-Simpson's paradox. The aim of this study was to evaluate diagnostic accuracy of dipstick urinalysis for the elderly in nursing homes. METHODS: In this cross-sectional study voided urine specimens were collected from 651 elderly individuals in nursing homes. Dipstick urinalysis for nitrite, leukocyte esterase and urine culture were performed. Sensitivity, specificity, positive and negative predictive values with 95% confidence intervals were calculated. Visual readings were compared to readings with a urine chemistry analyzer. RESULTS: 207/651 (32%) of urine cultures showed growth of a potentially pathogenic bacterium. Combining the two dipsticks improved test characteristics slightly compared to using only one of the dipsticks. When both dipsticks are negative, presence of potentially pathogenic bacteria can be ruled out with a negative predictive value of 88 (84-92)%. Visual and analyzer readings had acceptable agreement. CONCLUSION: When investigating for bacteriuria in elderly people at nursing homes we suggest nitrite and leukocyte esterase dipstick be combined. There are no clinically relevant differences between visual and analyzer dipstick readings. When dipstick urinalysis for nitrite and leukocyte esterase are both negative it is unlikely that the urine culture will show growth of potentially pathogenic bacteria and in a patient with an uncomplicated illness further testing is unnecessary.
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| 3. |
- Passant, Ulla, et al.
(författare)
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Psychiatric Symptoms and Their Psychosocial Consequences in Frontotemporal Dementia.
- 2005
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Ingår i: Alzheimer Disease and Associated Disorders. - 0893-0341. ; 19 Suppl 1, s. 15-18
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Tidskriftsartikel (refereegranskat)abstract
- Based on a retrospective study of 19 neuropathologically verified cases with frontotemporal dementia (FTD), neuropsychiatric symptoms related to behavioral disturbances and their psychosocial consequences were studied. The results indicate that frontotemporal dementia is often misdiagnosed early in the clinical course. Behavioural features with impaired social interactions, impaired personal regulation, and loss of insight were seen in all patients. The psychosocial consequences reported in this paper challenge future research in frontotemporal dementia.
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| 4. |
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| 5. |
- Buchhave, Peder, et al.
(författare)
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Cube copying test in combination with rCBF or CSF A beta(42) predicts development of Alzheimer's disease
- 2008
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Ingår i: Dementia and Geriatric Cognitive Disorders. - : S. Karger AG. - 1420-8008 .- 1421-9824. ; 25:6, s. 544-552
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Tidskriftsartikel (refereegranskat)abstract
- <i>Background/Aim: </i>The aim was to identify subjects with incipient Alzheimer’s disease (AD) among patients with mild cognitive impairment (MCI) using brief cognitive tests. <i>Methods: </i>A total of 147 MCI patients were followed for 4–6 years and the incidence of AD was 11.6%/year. At baseline, the cube copying test, clock drawing test, MMSE and measurements of regional cerebral blood flow (rCBF) and cerebrospinal fluid (CSF) β-amyloid<sub>1–42</sub> (Aβ<sub>42</sub>) were performed. <i>Results: </i>The cube copying test, but not the clock drawing test, could predict AD among MCI patients with an area under the receiver operating characteristic curve of 0.64 (p < 0.01). The relative risk for future AD was increased in MCI subjects with impaired cube copying test (sex- and age-adjusted hazard ratio = 1.8, p < 0.05) and the incidence of AD was 18.2% in this subgroup. Combining the cube copying test with either rCBF or CSF Aβ<sub>42</sub> had additive effects on the risk assessment for future development of AD. MCI patients achieving high scores on both MMSE and cube copying test had a very low risk of developing AD (incidence of AD = 1.6%). <i>Conclusion: </i>In conclusion, combinations of the cube copying test with MMSE, rCBF and CSF Aβ<sub>42</sub> measurements can identify subgroups of MCI subjects with either substantially reduced or increased risk for future development of AD.
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| 6. |
- Englund, Hillevi, et al.
(författare)
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Increase in beta-amyloid levels in cerebrospinal fluid of children with down syndrome
- 2007
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Ingår i: Dementia and Geriatric Cognitive Disorders. - : S. Karger AG. - 1420-8008 .- 1421-9824. ; 24:5, s. 369-374
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Tidskriftsartikel (refereegranskat)abstract
- <i>Background:</i> Individuals with Down syndrome (DS) invariably develop Alzheimer’s disease (AD) during their life span. It is therefore of importance to study young DS patients when trying to elucidate early events in AD pathogenesis. <i>Aim:</i> To investigate how levels of different amyloid-β (Aβ) peptides, as well as tau and phosphorylated tau, in cerebrospinal fluid (CSF) from children with DS change over time. The first CSF sample was taken at 8 months and the following two samples at 20–40 and 54 months of age. <i>Results:</i> Individual levels of the Aβ peptides, as well as total Aβ levels in CSF increased over time when measured with Western blot. Tau in CSF decreased whereas there was no change in levels of phosphorylated tau over time. <i>Conclusion:</i> The increasing levels of Aβ in CSF during early childhood of DS patients observed in this study are probably due to the trisomy of the Aβ precursor APP, which leads to an overproduction of Aβ. Despite the increased CSF concentrations of Aβ, there were no signs of an AD-indicating tau pattern in CSF, since the levels of total tau decreased and phosphorylated tau remained unchanged. This observation further strengthens the theory of Aβ pathology preceding tau pathology in AD.
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| 7. |
- Freund-Levi, Yvonne, 1956-, et al.
(författare)
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Effects of omega-3 fatty acids on inflammatory markers in cerebrospinal fluid and plasma in Alzheimer's disease : the OmegAD study
- 2009
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Ingår i: Dementia and Geriatric Cognitive Disorders. - : S. Karger. - 1420-8008 .- 1421-9824. ; 27:5, s. 481-490
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: omega-3 fatty acids (omega-3 FAs) found in dietary fish or fish oils are anti-inflammatory agents that may influence Alzheimer's disease (AD).OBJECTIVE: To study the effects of dietary omega-3 FA supplementation on inflammatory markers in cerebrospinal fluid (CSF) and plasma from patients with mild to moderate AD.METHODS: Thirty-five patients (70.3 +/- 8.2 years) were randomized to a daily intake of 2.3 g omega-3 FAs or placebo for 6 months. The inflammatory markers interleukin (IL)-6, tumour necrosis factor-alpha and soluble interleukin-1 receptor type II (sIL-1RII) were analysed in CSF and plasma at baseline and at 6 months. The AD markers tau-protein, hyperphosphorylated tau-protein and beta-amyloid (Abeta(1-42)) were assessed in CSF. High-sensitivity C-reactive protein was assessed in plasma. A possible relation to the APOE genotype was investigated.RESULTS: There was no significant treatment effect of omega-3 FAs on inflammatory and AD biomarkers in CSF or on inflammatory markers in plasma, nor was there any relation with APOE. A significant correlation was observed at baseline between sIL-1RII and Abeta(1-42) levels in CSF.CONCLUSIONS: Treatment of AD patients with omega-3 FAs for 6 months did not influence inflammatory or biomarkers in CSF or plasma. The correlation between sIL-1RII and Abeta(1-42) may reflect the reciprocal interactions between IL-1 and Abeta peptides.
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| 8. |
- Hansson, Oskar, et al.
(författare)
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Prediction of Alzheimer's disease using the CSF A beta 42/A beta 40 ratio in patients with mild cognitive impairment
- 2007
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Ingår i: DEMENTIA AND GERIATRIC COGNITIVE DISORDERS. - : S. Karger AG. - 1420-8008 .- 1421-9824. ; 23:5, s. 316-320
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Tidskriftsartikel (refereegranskat)abstract
- Evidence supports an important role for β-amyloid (Aβ) in the pathogenesis of Alzheimer’s disease (AD). Here, we investigate baseline levels of the 40- and 42-amino-acid-long Aβ peptides (Aβ40 and Aβ42) in cerebrospinal fluid (CSF) from a cohort of patients with mild cognitive impairment (MCI, n = 137) in relation to the final diagnosis after 4–6 years of follow-up time. CSF Aβ42 concentration at baseline and the Aβ42/Aβ40 ratio were significantly decreased in the MCI patients who developed AD as compared to cognitively stable MCI patients and MCI patients who developed other forms of dementia (p < 0.001). The baseline levels of Aβ40 were similar in all MCI groups but correlated with change in Mini Mental State Examination scores in converters to AD. The Aβ42/Aβ40 ratio was superior to Aβ42 concentration with regard to identifying incipient AD in MCI (p < 0.05). In conclusion, the data provide further support for the view that amyloid precursor protein metabolism is disturbed in early sporadic AD and points to the usefulness of the Aβ42/Aβ40 ratio as a predictive biomarker for AD.
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| 9. |
- Höglund, Kina, 1976, et al.
(författare)
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The effect of simvastatin treatment on the amyloid precursor protein and brain cholesterol metabolism in patients with Alzheimer's disease
- 2005
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Ingår i: Dementia and Geriatric Cognitive Disorders. - : S. Karger AG. - 1420-8008 .- 1421-9824. ; 19:5-6, s. 256-265
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Tidskriftsartikel (refereegranskat)abstract
- During the last years, several clinical studies have been published trying to elucidate the effect of statin treatment on amyloid precursor protein (APP) processing and metabolism of brain cholesterol in Alzheimer’s disease (AD) in humans. We present an open biochemical study where 19 patients with AD have been treated with simvastatin (20 mg/day) for 12 months. The aim was to further investigate the effect of simvastatin treatment on cerebrospinal fluid (CSF) biomarkers of APP processing, AD biomarkers as total tau and tau phosphorylated at threonine 181, brain cholesterol metabolism as well as on cognitive decline in patients with AD. Despite biochemical data suggesting that treatment with 20 mg/day of simvastatin for 12 months does affect the brain cholesterol metabolism, we did not find any change in CSF or plasma levels of β-amyloid (Aβ)<sub>1–42</sub>. However, by analysis of APP isoforms, we found that statin treatment may favor the nonamyloidogenic pathway of APP processing. The relevance and mechanism between statin treatment and AD has to be further elucidated by using statins of different lipophility in different dosages over a longer period of time.
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| 10. |
- Johansson, Annica, 1969, et al.
(författare)
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Genetic association of CDC2 with cerebrospinal fluid tau in Alzheimer's disease
- 2005
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Ingår i: Dementia and Geriatric Cognitive Disorders. - : S. Karger AG. - 1420-8008 .- 1421-9824. ; 20:6, s. 367-374
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Tidskriftsartikel (refereegranskat)abstract
- We have recently reported that a polymorphism in the cell division cycle <i>(CDC2) </i>gene, designated Ex6 + 7I/D, is associated with Alzheimer’s disease (AD). The <i>CDC2</i> gene is located on chromosome 10q21.1 close to the marker D10S1225 linked to AD. Active cdc2 accumulates in neurons containing neurofibrillary tangles (NFT), a process that can precede the formation of NFT. Therefore, <i>CDC2 </i>is a promising candidate susceptibility gene for AD. We investigated the possible effects of the <i>CDC2</i> polymorphism on cerebrospinal fluid (CSF) biomarkers in AD patients. <i>CDC2</i> genotypes were evaluated in relation to CSF protein levels of total tau, phospho-tau and β-amyloid<sub>(1–42)</sub> in AD patients and control individuals, and in relation to the amount of senile plaques and NFT in the frontal cortex and in the hippocampus in patients with autopsy-proven AD and controls. The <i>CDC2</i> Ex6 + 7I allele was associated with a gene dose-dependent increase of CSF total tau levels (F<sub>2, 626</sub> = 7.0, p = 0.001) and the homozygous <i>CDC2</i> Ex6 + 7II genotype was significantly more frequent among AD patients compared to controls (p = 0.006, OR = 1.57, 95% CI 1.13–2.17). Our results provide further evidence for an involvement of cdc2 in the pathogenesis of AD.
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| 11. |
- Lind, Karin, 1952, et al.
(författare)
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Increased saliva cortisol awakening response in patients with mild cognitive impairment
- 2007
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Ingår i: Dementia and Geriatric Cognitive Disorders. - : S. Karger AG. - 1420-8008 .- 1421-9824. ; 24:5, s. 389-395
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Tidskriftsartikel (refereegranskat)abstract
- <i>Background:</i> It is unknown whether HPA-axis dysfunction is present in patients with mild cognitive impairment (MCI). The aim of the present study was to investigate whether cortisol levels are elevated among patients with MCI and/or whether the individuals have adequate feedback control of their HPA axis. <i>Material and Methods:</i> 27 patients with MCI and 15 healthy controls were included in the study. Saliva samplings were performed 5 times a day before intake of 0.5 mg dexamethasone, and 5 times a day after intake of dexamethasone, respectively. <i>Results:</i> Significantly higher cortisol levels were found 15 min after awakening among patients with MCI in comparison with the controls, both before and after dexamethasone administration (p < 0.05). Also, the ratio between cortisol at awakening time and 15 min after awakening was lower in the patient group after dexamethasone administration (p < 0.05). There were no significant differences in basal cortisol levels before or after dexamethasone between groups. <i>Conclusion:</i> The results indicate that there is an HPA-axis disturbance, with normal basal cortisol levels and increased awakening response among patients with MCI. The dissociation between basal values and the awakening response may be of pathophysiological importance for the cognitive impairment.
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| 12. |
- Lindén, Thomas, 1962
(författare)
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Demens efter stroke.
- 2007
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Ingår i: E-publikation Vårdalinstitutets hemsida "Tematiska rum" 2007.
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 13. |
- Magnil, Maria, 1952, et al.
(författare)
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Prevalence of depressive symptoms and associated factors in elderly primary care patients: a descriptive study
- 2008
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Ingår i: Primary Care Companion to The Journal of Clinical Psychiatry. - 1523-5998. ; 104:6, s. 462-468
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Tidskriftsartikel (refereegranskat)abstract
- ACKGROUND: Depressive symptoms are common in older adults. A majority will be seen in primary care. The aim was to study the prevalence of and to explore factors associated with depressive symptoms in elderly primary care patients. METHOD: In consecutive patients aged 60 years and older attending a Swedish primary care center between February and December of 2003, depressive symptoms were identified as >/= 13 points on the Montgomery-Asberg Depression Rating Scale-Self-Rated version (MADRS-S). Somatic symptoms measured according to PRIME-MD, age, socioeconomic status, gender, somatic diagnoses, and medication were analyzed in relation to presence of depressive symptoms. RESULTS: Forty-six of 302 patients (15%) rated themselves in the depressed range. There were no differences between depressed and nondepressed patients concerning socioeconomic status, other illnesses, or medication except for use of sedatives/hypnotics being more common (OR = 2.7, 95% CI = 1.3 to 5.6) in depressed patients. Patients in the group scoring >/= 13 on the MADRS-S were more likely to have become widowed during the last year (OR = 6.0, 95% CI = 1.7 to 20.8) or to have indicated significant life events (OR = 4.3, 95% CI = 2.0 to 9.0), but were less likely to report having leisure time activities (OR = 0.2, 95% CI = 0.08 to 0.41) or perception of good health (OR = 0.1, 95% CI = 0.05 to 0.3). Patients being treated for depression did not have increased depression scores (OR = 1.4, 95% CI = 0.66 to 3.1). CONCLUSION: In a group of unselected primary care elderly patients, the prevalence of depressive symptoms was high. Use of sedatives/hypnotics was remarkably common in patients with depressive symptoms. Patients with ongoing treatment of depression did not have increased depression scores, indicating the good prognosis for treated depression in the elderly.
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| 14. |
- Nilsson, Christer, et al.
(författare)
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Transitorisk global amnesi - godartat tillstånd som även kan drabba unga
- 2005
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Ingår i: Läkartidningen. - 0023-7205. ; 102:24, s. 7-1905
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Tidskriftsartikel (refereegranskat)abstract
- Transient global amnesia (TGA) occurs mostly in middle-aged and elderly individuals, and is generally believed to be very rare in individuals less than 40 years of age. We present three cases of TGA in young persons (16-22 years). They all had a medical history and presented symptoms fulfilling the criteria for TGA. Physical examinations and investigations were all normal. All three presented their symptoms while playing football. Reviewing the literature the suggested causes are partly different for TGA in old and young people, respectively. The present report confirms that TGA may also occur in younger individuals. We propose that single TGA is a benign condition also in younger persons and that the investigation should be similar to that of TGA in older age groups.
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| 15. |
- Nägga, Katarina, 1962-, et al.
(författare)
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Evaluation of factors of importance for clinical dementia diagnosis
- 2005
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Ingår i: Dementia and Geriatric Cognitive Disorders. - : S. Karger AG. - 1420-8008 .- 1421-9824. ; 19:5-6, s. 289-298
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Tidskriftsartikel (refereegranskat)abstract
- Diagnosing clinical dementia is based on an assessment of different variables, such as the patient’s medical history, known risk factors, and biochemical features. Partial least squares discriminant analysis was used to evaluate variables of importance for diagnosing dementia in a clinical dementia population. Polymorphism for genotypes of glutathione S-transferase (GST) and sulfotransferase 1A1, hypothetically of importance in dementia disorders, was also included in the analysis. The study population consisted of 73 patients with Alzheimer’s disease (AD), 14 with mixed dementia, 75 patients with vascular dementia, and 28 control cases. We found that several of the variables, such as the presence of ApoE4 allele, high cerebrospinal fluid levels of total tau protein, low levels of β-amyloid<sub>(1–42)</sub>, and a low score on the Mini-Mental State Examination, facilitated a discrimination between the diagnoses compared with the controls. The different diagnoses overlapped. There were indications that genotypes of GSTs contributed to a subgrouping within AD.
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| 16. |
- 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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| 17. |
- de Frias, Cindy M., et al.
(författare)
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Cholesterol and triglycerides moderate the effect of apolipoprotein E on memory functioning in older adults.
- 2007
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Ingår i: Journal of Gerontology: Psychological Sciences. - Washington : The gerontological society of America. - 1079-5014 .- 1758-5368. ; 62B:2, s. P112-P118
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Tidskriftsartikel (refereegranskat)abstract
- We used data from the Betula Study to examine associations between total cholesterol, triglycerides, and apolipoprotein E on 10-year changes in cognitive performance. Tests assessing episodic memory (recall and recognition), semantic memory (knowledge and fluency), and visuospatial ability (block design) were administered to 524 nondemented adults (initial age of 55-80 years); multilevel modeling was applied to the data. Higher triglyceride levels were associated with a decline in verbal knowledge. Lipid levels moderated the influence of apolipoprotein E on episodic memory, such that among epsilon 4 allele carriers, decline in recognition was noted for individuals with higher cholesterol levels. Cholesterol and triglyceride levels are pharmacologically modifiable risk factors that account for variation In normal cognitive aging.
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| 18. |
- Andin, Ulla, et al.
(författare)
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A Clinico-Pathological Study of Heart and Brain Lesions in Vascular Dementia.
- 2005
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Ingår i: Dementia and Geriatric Cognitive Disorders. - : S. Karger AG. - 1420-8008 .- 1421-9824. ; 19:4, s. 222-228
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Tidskriftsartikel (refereegranskat)abstract
- All vascular dementia (VaD) cases, neuropathologically verified in a longitudinal prospective dementia project, were classified according to the vascular brain lesion type and related to the dementia type and cardiovascular pathology. From 1976 to 1995, there were 175 VaD cases, 49 of which were pure, without Alzheimer pathology and only one type of cerebrovascular lesion. Furthermore, it was found that 6 cases suffered hypoxic hypoperfusive disease, while 7 were found to have large vessel disease and 36 small vessel disease. In addition to Alzheimer pathology, more than one type of vascular brain pathology was found in the remaining 126 cases. In these cases, diagnosed in accordance with the predominant type of VaD, hypoxic-hypoperfusive lesions were found in 55, large vessel lesions in 50 and small vessel lesions in 110 cases. It should be stressed that 87% of all cases with hypoxic hypoperfusive lesions also had Alzheimer pathology. Cardiovascular and aortic pathologies were more prevalent in small vessel dementia than in the other VaD groups. Clinically diagnosed arterial hypertension was significantly associated with small vessel dementia, but not with hypoxic-hypoperfusive dementia. Cardiovascular symptoms varied considerably in frequency between different dementia groups. VaD is a heterogeneous group regarding lesions caused by different pathophysiological mechanisms and with different combinations of brain pathologies. It is therefore necessary to identify the various types of vascular brain lesions for a correlation with clinical symptoms and for diagnostic purposes in the search for risk factors and therapeutic strategies.
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| 19. |
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| 20. |
- Gräsbeck, Anne, et al.
(författare)
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Dementia in First-Degree Relatives of Patients with Frontotemporal Dementia. A Family History Study.
- 2005
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Ingår i: Dementia and Geriatric Cognitive Disorders. - : S. Karger AG. - 1420-8008 .- 1421-9824. ; 19:2-3, s. 145-153
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Tidskriftsartikel (refereegranskat)abstract
- Several studies have found a clustering of dementia in relatives of patients with frontotemporal dementia (FTD). This study analysed the familial aggregation of FTD specifically as well as the occurrence of dementia in general in first-degree relatives of patients with FTD. A family history study was carried out on 478 first-degree relatives of 74 index patients suffering from FTD. Cases of organic dementia and of FTD were diagnosed according to internationally accepted diagnostic criteria. Age- and sex-specific incidences of organic dementia and of FTD were calculated as was the proportion of FTD in relation to organic dementia in general; comparisons with clinical and population studies were made. There was a tenfold increase in the incidence of FTD in the first-degree relatives of FTD patients compared with the incidence of FTD in a population study. The proportion of FTD in relation to all types of organic dementia was much higher in relatives of FTD patients compared to the corresponding proportions in clinical and population-based studies. There was a small, non-significant difference between the present family history study and the population studies as regards the incidence of organic dementia. The findings suggest that hereditary and/or shared environmental factors are strongly involved in the aetiology of FTD. There were no indications of familial clustering of organic dementia in general in relatives of FTD patients.
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| 21. |
- Karlsson, Staffan, et al.
(författare)
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Older people receiving public long-term care in relation to consumption of medical health care and informal care
- 2008
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Ingår i: The Open Geriatric Medicine Journal. - Bussum : Bentham Open. - 1874-8279. ; 1, s. 1-9
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Tidskriftsartikel (refereegranskat)abstract
- The aim of the study was to investigate medical health care and informal care consumption among older people receiving public long-term care, and factors associated with medical health care consumption. 1958 persons aged 65 years and over were included. Data were collected from two registers, including demography, functional ability and received long-term, informal and medical health care. 35% of those at home were admitted to hospital and 76% had contact with outpatient care by physician compared to 26% and 87% respectively of those in special accommodation. Living in special accommodation was associated with more contacts with primary health care and fewer contacts with specialist care other than psychiatric care. Informal care was associated with more contacts with primary health care, specialist care, admissions to and days in hospital. More elderly people being cared for at home may mean more hospital and outpatient care consumption.
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| 22. |
- Törner, Anna, et al.
(författare)
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Renal function in community-dwelling frail elderly : comparison between measured and predicted glomerular filtration rate in the elderly and proposal for a new cystatin C-based prediction equation
- 2008
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Ingår i: Aging Clinical and Experimental Research. - Milano : Editrice Kurtis. - 1594-0667 .- 1720-8319. ; 20:3, s. 216-225
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND AIMS: There is a great need to evaluate renal function regularly in elderly people. This study aimed at analyzing renal function in stable, community-dwelling elderly people of 75 years and over, to compare measured and predicted glomerular filtration rates (GFR) and to develop an accurate prediction equation for this age group. METHODS: Forty-five ambulatory elderly people in stable health in ordinary living were randomly selected into four age-classes, aged 75-95. Demographic data, personal activities of daily living, continuous drug prescriptions, body composition, blood pressure and blood chemistry were analysed. GFR was measured as Iohexol clearance based on three time-points 3, 4 and 7 hours after Iohexol injection. RESULTS: Mean GFR was well preserved in all four age-classes. The GFR range was 18-83 mL/min and declined with age. The Cockcroft-Gault prediction equation systematically underestimated measured GFR. A new 'GFRA' prediction equation is presented, based on the inverse of serum cystatin C and independent of gender, body surface area, body weight, lean body mass or serum creatinine. The proposed equation underestimated measured GFR with a mean of only 0.1 mL/min, had better precision compared with the Cockcroft-Gault equation, and was evaluated by the method of cross-validation. CONCLUSIONS: GFR exhibits extensive heterogeneity in frail, community-dwelling elderly people. The proposed GFRA was clearly more precise than the Cockcroft-Gault prediction equation in the study group. However, it needs to be validated in a larger population of elderly subjects, including more individuals in stable health with substantially reduced renal function in whom GFR is measured by a reference method with adequate sampling time.
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| 23. |
- Alstad, Torgny, 1955, et al.
(författare)
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Patterns of carbohydrate intake--a study of typology, associations and changes over time in an elderly Swedish population.
- 2006
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Ingår i: The journal of nutrition, health & aging. - 1279-7707. ; 10:5, s. 401-7
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Patterns may explain part of the dietary variation between subjects. OBJECTIVE: To create a typology of carbohydrate intake among the elderly and to analyse whether it seems valuable or not. DESIGN: Factor and cluster-analyses of dietary interviews from two elderly cohorts of free-living elderly people in Göteborg, Sweden. SUBJECTS AND METHODS: Three hundred and thirty seven women and three hundred and twenty three men aged 70-79 was studied cross-sectionally and longitudinally. The altogether 917 dietary interviews were based on the dietary history method. Cluster analysis, based on factor scores, was used to create the typology. RESULTS: Seven clusters were identified: 1) Small eaters (high relative intake of starch and a low energy intake), 2) Lean and green eaters (high intake of dietary fibre), 3) Fruit eaters (high intake of monosaccharides), 4) Sweet tooth eaters (high intake of sucrose), 5) Gourmands (high absolute intake of starch, dietary fibre and energy), 6) Milk drinkers (high intake of lactose) and 7) Fat eaters (high intake of fat and low intake of carbohydrates). The different patterns were associated with different food consumption, different intake of micronutrients and different social and physiological factors. There were also changes over time of the proportion of subject within the clusters. CONCLUSIONS: The typology found by using cluster analysis, seems to be valid and was related to all analysed dimensions. Therefore, the methods may be valuable for describing and analysing the dietary intake among elderly.
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| 24. |
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| 25. |
- Andin, Ulla
(författare)
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Vascular dementia - classification and clinical correlates
- 2007
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- During the period (1976-1995) a total of 175 consecutive patients (m 88/f 87) with neuropathologically verified vascular dementia (VaD) were examined. 22 patients with pure Alzheimer's Disease (AD) were also studied. All patients were diagnosed and followed at the Department of Psychogeriatrics (Lund University Hospital). The neuropathological examination revealed VaD, sometimes with additional contribution of Alzheimer pathology. The cases were classified as Large Vessel Dementia (LVD), Small Vessel Dementia (SVD) and Hypoperfusive Hypoxic-ischemic Dementia (HHD). The mean age at death was 80 years (range 54-100) and almost identical in the three groups.The results show that VaD is neuropathologically heterogeneous, characterized by one, two or all three types of vascular pathology. The majority of cases (126/175), showed more than one type of brain pathology (vascular or in combination with Alzheimer pathology). There was a large coexistence with Alzheimer pathology (65% of the total 175 cases). 49 cases were pure, with only one type of vascular pathology. SVD was the largest pure group (21% of the total 175 cases). Post mortem verified heart pathology, was twice as common in SVD as in LVD and HHD.Cardio-cerebrovascular features (arrhythmia, congestive heart failure, cardiac infarction, hypertension, orthostatic hypotension and TIA/stroke) were more common in LVD and SVD, than in HHD. The coexistence of Alzheimer pathology did not change these results.Dizziness and unsteadiness or falls were reported in 102 of the 175 VaD patients. Dizziness correlated with hypertension and orthostatic hypotension while unsteadiness correlated only with hypertension. Falls correlated strongly to the use of neuroleptics and hypnotics.Hallucinations/delusions and delirium were reported in many patients and most common in the groups with pure LVD, pure SVD and especially in the SVD with combined Alzheimer pathology.Cardio-cerebrovascular features were more common in patients with AD combined with white matter pathology than those with pure AD. This study illustrates the neuropathological and clinical heterogeneity in VaD. This is of great importance for the understanding, treatment and care of the individual suffering from VaD.
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| 26. |
- Appelros, Peter, et al.
(författare)
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Changes in mini mental state examination score after stroke : lacunar infarction predicts cognitive decline
- 2006
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Ingår i: European Journal of Neurology. - : Wiley. - 1351-5101 .- 1468-1331. ; 13:5, s. 491-495
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Tidskriftsartikel (refereegranskat)abstract
- Stroke and cognitive impairment are inter-related. The purpose of this study was to show the natural evolution of cognitive performance during the first year after a stroke, and to show which factors that predict cognitive decline. Subjects were patients with a first-ever stroke who were treated in a stroke unit. A total of 160 patients were included. At baseline patients were evaluated with regard to stroke type, stroke severity, pre-stroke dementia and other risk factors. Mini Mental State Examinations (MMSE) were performed after 1 week and after 1 year. Patients had a median increase of 1 point (range -8 to +9) on the MMSE. Thirty-two pre cent of the patients deteriorated, 13% were unchanged, and 55% improved. Lacunar infarction (LI) and left-sided stroke were associated with a failure to exhibit improvement. Patients with LI had an average decline of 1.7 points, whilst patients with other stroke types had an average increase of 1.8 points. Most stroke survivors improve cognitively during the first year after the event. The outcome for LI patients is worse, which suggests that LI may serve as a marker for concomitant processes that cause cognitive decline.
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| 27. |
- Appelros, Peter
(författare)
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Heart failure and stroke
- 2006
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Ingår i: Stroke. - 0039-2499 .- 1524-4628. ; 37:7, s. 1637-1637
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Tidskriftsartikel (refereegranskat)
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| 28. |
- Appelros, Peter, et al.
(författare)
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Living setting and utilisation of ADL assistance one year after a stroke with special reference to gender differences
- 2006
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Ingår i: Disability and Rehabilitation. - : Informa UK Limited. - 0963-8288 .- 1464-5165. ; 15:28(1), s. 43-49
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To examine living setting and need for ADL assistance before and one year after a first-ever stroke with special focus on gender differences. METHODS: One-year survivors from a population-based stroke study (n = 377) were studied with regard to place of living, need for ADL assistance and who provided the help. Stroke severity, cognitive impairment, post-stroke depression as well as risk factors were evaluated. RESULTS: Before the stroke 48 patients (13%) lived in special housing (service flats or nursing homes), and one year after the stroke, 50 of the survivors (20%) lived in such accommodations. Before the stroke, 80 (21%) of the patients needed help with their personal ADL, while 90 (36%) needed help after one year. The increased need was fulfilled by relatives. Female spouses more often helped their male counterparts, and they tended to accept a heavier burden. Age, living alone, stroke severity, cognitive impairment, pre-stroke ADL dependency and depression were predictors for special housing. CONCLUSIONS: In a time when more and more stroke survivors are cared for at home, it is important to pay attention to the situation of the caregivers. Female caregivers seem to be in an especially exposed position by accepting a heavier burden.
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| 29. |
- Appelros, Peter
(författare)
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Prevalence and predictors of pain and fatigue after stroke : a population-based study
- 2006
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Ingår i: International Journal of Rehabilitation Research. - 0342-5282 .- 1473-5660. ; 29:4, s. 329-333
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Tidskriftsartikel (refereegranskat)abstract
- Pain and fatigue are two often overlooked symptoms after stroke. Their prevalence and determinants are not well understood. In this study patients with first-ever stroke (n=377) were examined at baseline and after 1 year. General characteristics of the patients, as well as stroke type, stroke severity and risk factors were registered at baseline. After 1 year survivors (n=253) were examined with respect to residual impairment, disability, cognition and depression. They were asked whether they had experienced pain and/or fatigue which had started after the stroke, and which the patient felt to be stroke related. Twenty-eight patients (11%) had stroke-associated pain and 135 (53%) had stroke-associated fatigue. Pain was associated with depression and different manifestations of stroke severity, especially degree of paresis at baseline. Fatigue was more associated with physical disability. In univariate analysis, fatigue was also associated with sleep disturbances. In conclusion, it is important to be aware of the occurrence of pain and fatigue after stroke, because these symptoms are common, they impair quality of life and they are potentially treatable. Post-stroke depression may coexist with pain and fatigue. The detection of one symptom should lead to consideration of the others. Follow-up and individual assessment of stroke patients is crucial.
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| 30. |
- Björkman Björkelund, Karin, et al.
(författare)
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The Organic Brain Syndrome (OBS) scale: a systematic review.
- 2006
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Ingår i: International Journal of Geriatric Psychiatry. - : Wiley. - 1099-1166 .- 0885-6230. ; 21:3, s. 210-222
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Forskningsöversikt (refereegranskat)abstract
- Background/Objective The Organic Brain Syndrome (OBS) Scale was developed to determine elderly patients' disturbances of awareness and orientation as to time, place and own identity, and assessment of various emotional and behavioural symptoms appearing in delirium, dementia and other organic mental diseases. The aim of the study was to examine the OBS Scale, using the eight criteria and guidelines formulated by the Scientific Advisory Committee of the Medical Outcomes Trust (SAC), and to investigate its relevance and suitability for use in various clinical settings. Method Systematic search and analysis of papers (30) on the OBS Scale were carried out using the criteria suggested by the SAC. Results: The OBS Scale in many aspects satisfies the requirements suggested by the SAC: conceptual and measurement model, reliability, validity, responsiveness, interpretability, respondent and administrative burden, alternative forms of administration, and cultural and language adaptations, but there is a need for additional evaluation, especially with regard to different forms of reliability, and the translation and adaptation to other languages. Conclusions The OBS Scale is a sensitive scale which is clinically useful for the description and long-term follow-up of patients showing symptoms of acute confusional state and dementia. Although the OBS Scale has been used in several clinical studies there is need for further evaluation. Copyright (c) 2006 John Wiley & Sons, Ltd.
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| 31. |
- Boström, Fredrik, et al.
(författare)
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CSF Mg and Ca as diagnostic markers for dementia with Lewy bodies.
- 2008
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Ingår i: Neurobiology of aging. - : Elsevier BV. - 1558-1497 .- 0197-4580. ; 30:8, s. 1265-1271
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Tidskriftsartikel (refereegranskat)abstract
- Accumulating evidence implicates a role for altered metal homeostasis in the pathogenesis of neurodegenerative disorders such as Alzheimer's disease (AD). However, few investigations have addressed this issue in dementia with Lewy bodies (DLB). The aim of the present study was to investigate metal concentrations in cerebrospinal fluid (CSF) and plasma from patients with DLB and other neurodegenerative disorders. To that end, CSF and plasma samples were collected from 29 patients with DLB, 174 patients with AD, 90 patients with AD with minor vascular components, and 51 healthy volunteers. Total concentrations of Mg, Ca, Mn, Fe, Cu, Zn, Rb, Sr, and Cs were determined using mass spectrometry. Patients with DLB had elevated Ca and Mg levels in CSF and Mg levels in plasma as compared to all other groups (p<0.001). Furthermore, a combination of CSF-Mg and CSF-Ca could distinguish DLB from AD with a sensitivity of 93% and a specificity of 85%. Cu levels in both CSF and plasma tended to be higher in DLB compared to the other groups, but these trends failed to reach significance after correction for multiple comparisons. Mn, Fe, Zn, Rb, and Sr concentration in CSF or plasma were similar in all groups. The observed elevations of CSF-Mg, CSF-Ca and CSF-Cu may contribute to or be associated with the neurodegenerative process in DLB. Furthermore, determination of CSF-Mg and CSF-Ca concentration may be a valuable tool in distinguishing DLB from AD.
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| 32. |
- Edvardsson, David, et al.
(författare)
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Associations between the working characteristics of nursing staff and the prevalence of behavioral symptoms in people with dementia in residential care
- 2008
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Ingår i: International psychogeriatrics. - New York : Cambridge University Press. - 1041-6102 .- 1741-203X. ; 20:4, s. 764-776
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Clinical experience suggests that the work characteristics of staff in residential care may influence the well-being of residents with dementia. However, few studies have explored those anecdotal experiences. The aim of this study was to investigate associations between work characteristics of nursing staff and prevalence of behavioral symptoms among people with dementia in residential care settings.METHODS: The self-report job strain assessment scale was used to measure staff perceptions of their working environment, and the Multi Dimensional Dementia Assessment Scale to measure the occurrence of behavioral symptoms among residents in 40 residential care units for people with dementia.RESULTS: The findings show that in settings where staff reported high job strain, the prevalence of behavioral symptoms was significantly higher compared to settings where staff reported low job strain. Furthermore, settings characterized by staff having a more positive caring climate had significantly less prevalence of escape, restless and wandering behaviors compared to settings having a less positive caring climate. There was no statistically significant association between staff members' self-reported knowledge in caring for people with dementia and prevalence of behavioral symptoms.CONCLUSIONS: This study provides evidence for the oft-cited clinical experience that the well-being of nursing staff is associated with the well-being of people with dementia in residential care settings.
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| 33. |
- Elgh, Eva, et al.
(författare)
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Cognitive function in early Parkinson's disease : a population-based study
- 2009
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Ingår i: European Journal of Neurology. - : John Wiley & Sons. - 1351-5101 .- 1468-1331. ; 16:12, s. 1278-1284
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND PURPOSE: The study aims to describe the frequency, pattern and determinants of cognitive function in patients with newly diagnosed Parkinson's disease (PD); to compare patients with impaired cognition to patients with intact cognition; and to compare to matched healthy controls.METHODS: Patients were identified in a longitudinal population based study of idiopathic non-drug induced parkinsonism. Eighty-eight newly diagnosed patients with PD and no dementia were included during a four year period. The patients and 30 age- and sex-matched healthy control subjects underwent a comprehensive neuropsychological assessment.RESULTS: Patients performed significantly worse than healthy controls in a majority of neuropsychological tests. Test results in attention, psychomotor function, episodic memory (free recall), executive function and category fluency were significantly lower in the patient group. Comparison with normative data revealed that 30% of the patients had deficits in > or =1 cognitive domain (episodic memory, executive function and verbal function). Seventy per cent of the patients had normal performance. Unified Parkinson's Disease Rating Scale (UPDRS) III sub scores; speech, facial expression, rigidity and bradykinesia were significantly higher, and disease duration shorter amongst the cognitively impaired than amongst the cognitively intact patients. Tremor showed no difference. Education level was an independent predictor of dysfunction in patients with > or =2 cognitive domains affected.CONCLUSION: Cognitive dysfunction is common in untreated patients in early PD, affecting attention, psychomotor function, episodic memory, executive function and category fluency. Education level was an independent predictor of severe cognitive dysfunction.
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| 34. |
- Freund-Levi, Yvonne, 1956-, et al.
(författare)
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Omega-3 supplementation in mild to moderate Alzheimer's disease : effects on neuropsychiatric symptoms
- 2008
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Ingår i: International Journal of Geriatric Psychiatry. - : Wiley. - 0885-6230 .- 1099-1166. ; 23:2, s. 161-169
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Tidskriftsartikel (refereegranskat)abstract
- Background: Epidemiological and animal studies have suggested that dietary fish or fish oil rich in omega-3 fatty acids (ω3), docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), may have effects in psychiatric and behavioral symptoms in Alzheimer's disease (AD). An association with APOEω4 carriers and neuropsychiatric symptoms in AD has also been suggested. Objective: To determine effects of dietary ω3 supplementation to AD patients with mild to moderate disease on psychiatric and behavioral symptoms, daily functions and a possible relation to APOEgenotype. Methods: Randomized, double-blind, placebo-controlled clinical trial where 204 AD patients (74 ± 9 years) with acetylcholine esterase inhibitor treatment and a MMSE >15 points were randomized to daily intake of 1.7 g DHA and 0.6 g EPA (ω3 group) or placebo for 6 months. Then, all received the ω3 supplementation for 6 more months. Neuropsychiatric symptoms were measured with Neuropsychiatric Inventory (NPI) and Montgomery Åsberg Depression Scale (MADRS). Caregivers burden and activities of daily living (Disability Assessment for Dementia, DAD) were also assessed. Results: One hundred and seventy-four patients fulfilled the trial. 72% were APOEω4 carriers. No significant overall treatment effects on neuropsychiatric symptoms, on activities of daily living or on caregiver's burden were found. However, significant positive treatment effects on the scores in the NPI agitation domain in APOEω4 carriers (p = 0.006) and in MADRS scores in non-APOEω4 carriers (p = 0.005) were found. Conclusions: Supplementation with ω3 in patients with mild to moderate AD did not result in marked effects on neuropsychiatric symptoms except for possible positive effects on depressive symptoms (assessed by MADRS) in non-APOEω4 carriers and agitation symptoms (assessed by NPI) in APOEω4 carriers. ClinicalTrials.gov identifier: NCT00211159.
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| 35. |
- Haglund, Mattias, et al.
(författare)
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Cerebral amyloid angiopathy and cortical microinfarcts as putative substrates of vascular dementia.
- 2006
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Ingår i: International Journal of Geriatric Psychiatry. - : Wiley. - 1099-1166 .- 0885-6230. ; 21:7, s. 681-687
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose Vascular dementia (VaD) has occasionally been associated with cerebral amyloid angiopathy (CAA), but the prevalence and significance of this counterintuitive relationship are poorly known. Therefore, we investigated the presence and characteristics of CAA in brains of VaD cases. Methods We examined temporal and parietal regions of the cerebral cortex of 26 consecutive VaD cases from the Lund Longitudinal Dementia Study. We carried out immunohistochemistry and routine stainings, determined Apolipoprotein E (ApoE) genotypes, and obtained clinical characteristics on the studied group for retrospective analysis. Results CAA was marked in eight out of 26 cases, and correlated strongly with the presence of cortical microinfarcts, both in the temporal lobe and in the parietal lobe. Based on comparisons with eight age-matched VaD cases without CAA, the clinical records suggested that VaD cases with CAA as a group exhibited less pronounced neurological symptoms. A clear contribution of the ApoE genotype could not be identified. Conclusions Based on a combination of the clinical and pathological data, we suggest that microinfarcts in the cerebral cortex associated with severe CAA may be the primary pathological substrate in a significant proportion of VaD cases. Future studies should be undertaken to confirm or dismiss the hypothesis that these cases exhibit a different symptom profile than VaD cases without CAA. Copyright (c) 2006 John Wiley & Sons, Ltd.
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| 36. |
- Hassing, Linda, 1967, et al.
(författare)
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Overweight in midlife and risk of dementia: a 40-year follow-up study
- 2009
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Ingår i: International Journal of Obesity. - : Springer. ; 33:8, s. 893-898
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Tidskriftsartikel (refereegranskat)abstract
- Objective: This study examines whether overweight in midlife increases dementia risk later in life. Methods: In 1963 body mass index was assessed in 1152 participants of The Swedish Twin Registry, at the age of 45–65 years. These participants were later screened for dementia in a prospective study with up to 40 years follow-up. A total of 312 participants were diagnosed with dementia. Results: Logistic regression analyses adjusted for demographic factors, smoking and alcohol habits, indicated that men and women categorized as overweight in their midlife had an elevated risk of dementia (OR=1.59; 95% CI: 1.21–2.07, P=0.002), Alzheimer's disease (OR=1.71; 95% CI: 1.24–2.35, P=0.003), and vascular dementia (OR=1.55; 95% CI: 0.98–2.47, P=0.059). Further adjustments for diabetes and vascular diseases did not substantially affect the associations, except for vascular dementia (OR=1.36; 95% CI: 0.82–2.56, P=0.116), reflecting the significance of diabetes and vascular diseases in the etiology of vascular dementia. There was no significant interaction between overweight and APOE alt epsilon4 status, indicating that having both risk factors does not have a multiplicative effect with regard to dementia risk. Conclusions: This study gives further support to the notion that overweight in midlife increases later risk of dementia. The risk is increased for both Alzheimer's disease and vascular dementia, and follows the same pattern for men and women. Keywords: BMI, alzheimer's disease, vascular dementia, dementia, overweight, obesity
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| 37. |
- Horstmann, Vibeke, et al.
(författare)
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Occurrence of Depression in Families with Frontotemporal Dementia: A Family History Study.
- 2009
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Ingår i: Neuroepidemiology. - : S. Karger AG. - 1423-0208 .- 0251-5350. ; 33:2, s. 124-130
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Tidskriftsartikel (refereegranskat)abstract
- Background: There are clinical similarities between frontotemporal dementia (FTD) and depression. The aim is to study co-aggregation of depression in families with FTD, indicating the existence of common aetiological factors. Methods: The study included 74 index patients with FTD and their 540 first-degree relatives above the age of 15 years. Occurrence of depression was studied at 3 different levels. Results: The incidence of depression in first-degree relatives of FTD patients was not higher than that of a general population. Occurrence of depression was not higher in families where parents had FTD compared to families with parents having no indications of FTD. Individuals with FTD had not suffered from depression to a greater extent than those without FTD. Conclusions: The hypothesis of a common aetiological factor of FTD and depression was not supported.
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| 38. |
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| 39. |
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| 40. |
- Landqvist, Maria, et al.
(författare)
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Frontotemporal demens heterogen sjukdomsgrupp.
- 2009
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Ingår i: Läkartidningen. - 0023-7205. ; 106:20, s. 1381-1385
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Tidskriftsartikel (refereegranskat)abstract
- Frontotemporal lobar degeneration (FTLD) or frontotemporal dementia (FTD) is a clinically and neuropathologically heterogeneous group of primary degenerative dementia diseases. The clinical representation consists of progressive psychiatric and/or neurological symtoms such as behavioural changes, language or motor dysfunction. FTD is usually divided into the following subgroups: Behavioural variant FTD (FTD-bv), semantic dementia (SD), progressive non-fluent aphasia (PNFA) and FTD with motor neuron disease (FTD-MND). Progressive supranuclear palsy (PSP) and corticobasal degeneration (CBD) show both clinical and neuropathological similarities to FTD, and therefore are often considered being part of the FTD complex. Knowledge about the great diversity in phenotype of FTD facilitates early refererral and diagnosis of patients, which is necessary for adequate support and treatment.
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| 41. |
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| 42. |
- Lövdén, Martin, et al.
(författare)
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Studying Individual Aging in an Interindividual Context : Typical Paths of Age-Related, Dementia-Related, and Mortality-Related Cognitive Development in Old Age
- 2005
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Ingår i: Psychology and Aging. - Washington : American Psychological Association (APA). - 0882-7974 .- 1939-1498. ; 20:2, s. 303-316
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Tidskriftsartikel (refereegranskat)abstract
- This study has 2 objectives: (a) to explore typical paths of cognitive development associated with aging, terminal decline, and dementia and (b) to promote and illustrate an individual-oriented approach to the study of cognitive aging based on longitudinal panel data from a population-based sample (N = 500; age range-sub(T1)= 60-80, where T refers to time) tested at 3 occasions 5 years apart. Results document interindividual differences in multivariate patterns of change. Although cognitive changes generally covary, the present study indicates that subgroups of individuals develop along different paths characterized by selective changes in subsets of cognitive functions. Typical progression of dementia followed a developmental cascade from low declarative memory, via low functioning across all observed cognitive measures, to dementia diagnosis, and finally, death.
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| 43. |
- Nilsson, Anna-Karin, et al.
(författare)
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C-reactive protein: vascular risk marker in elderly patients with mental illness.
- 2008
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Ingår i: Dementia and Geriatric Cognitive Disorders. - : S. Karger AG. - 1420-8008 .- 1421-9824. ; 26:3, s. 251-256
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: There is increasing evidence that vascular disease contributes to cognitive impairment and dementia. Clarification of the role of vascular risk factors in dementia is important because most are modifiable, in contrast to other risk factors such as age and genetics. METHODS: In 428 patients with mental illness we have investigated the relation of vascular disease to diagnoses, and a biochemical parameter, C-reactive protein (CRP), which is associated with inflammation and vascular disease. RESULTS: Patients with vascular disease showed higher CRP levels than patients without vascular disease. Furthermore, patients with Alzheimer's disease showed lower CRP levels than patients with vascular dementia, mild cognitive impairment or depression. There is no obvious reason for this finding, since it could not be attributed to drug treatment. CONCLUSION: The findings indicate that the control of conventional vascular risk factors and therapy could be guided by the level of CRP.
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| 44. |
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| 45. |
- Nilsson, Karin, et al.
(författare)
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Association between plasma homocysteine levels and mortality in elderly patients with mental illness.
- 2009
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Ingår i: Dementia and Geriatric Cognitive Disorders. - : S. Karger AG. - 1420-8008 .- 1421-9824. ; 27:6, s. 579-583
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND/METHOD: Total plasma homocysteine (tHcy) concentration is elevated in elderly patients with mental illness. Plasma tHcy is known to be associated with cardiovascular disease, renal impairment and negative lifestyle factors, and has been shown to predict mortality in human subjects. Epidemiological data on this topic in elderly patients with mental illness are missing. We therefore investigated the association between plasma tHcy levels and mortality in these patients. RESULTS: The group of deceased patients showed higher age, higher plasma tHcy, lower renal function and lower serum folate than patients who were still alive. Only age, plasma tHcy and the presence of vascular disease significantly influenced mortality. CONCLUSION: The association between plasma tHcy level and mortality risk was probably explained in part by the two plasma tHcy determinants age and presence of vascular disease. The determination of plasma tHcy in elderly patients with mental illness may help to identify patients in need of more intensive treatment.
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| 46. |
- Nilsson, Karin, et al.
(författare)
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Elevated plasma homocysteine concentration in elderly patients with mental illness is mainly related to the presence of vascular disease and not the diagnosis
- 2007
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Ingår i: Dementia and Geriatric Cognitive Disorders. - : S. Karger AG. - 1420-8008 .- 1421-9824. ; 24:3, s. 162-168
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Tidskriftsartikel (refereegranskat)abstract
- Background: Plasma total homocysteine (tHcy) is often elevated in patients with mental illness. Since patients with mental illness and vascular disease exhibit a higher plasma tHcy concentration than patients without vascular disease, it is possible that elevated plasma tHcy in mental illness is mainly due to concomitant vascular disease. Methods: We have investigated plasma tHcy, cobalamin/folate status, renal function and the presence of vascular disease in patients with vascular dementia (VaD, n = 501), Alzheimer's disease ( AD, n = 300), depression ( n = 259) and in healthy subjects ( n = 144) stratified according to age ( below and above 75 years). Results: Plasma tHcy concentration showed the highest increase in patients with VaD compared to patients with AD or depression. After the exclusion of patients with cobalamin/ folate deficiencies and increased serum creatinine, patients with AD or depression above 75 years with vascular disease showed a similar elevation of plasma tHcy concentration as patients with VaD. Furthermore, patients with AD and depression without vascular disease showed a similar plasma tHcy concentration to healthy subjects. Conclusion: The findings imply that elevated plasma tHcy concentration in elderly patients with mental illness is mainly associated with the presence of vascular disease and is not related to the specific psychogeriatric diagnosis.
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| 47. |
- Nilsson, Karin, et al.
(författare)
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Homocysteine, cystatin C and N-terminal-pro brain natriuretic Peptide. Vascular risk markers in elderly patients with mental illness.
- 2008
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Ingår i: Dementia and Geriatric Cognitive Disorders. - : S. Karger AG. - 1420-8008 .- 1421-9824. ; 25:1, s. 88-96
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: There is increasing evidence that vascular disease contributes to cognitive impairment and dementia. Clarification of the role of vascular risk factors in dementia is important because most are modifiable, in contrast to other risk factors such as age and genetics. METHODS: In 451 patients with mental illness we have investigated three biochemical markers related to vascular disease, total plasma homocysteine (tHcy), cystatin C, and N-terminal-pro brain natriuretic peptide (NT-proBNP), and their association with vascular disease, diagnoses, and brain imaging findings (CT). RESULTS: Plasma tHcy, serum cystatin C, and serum NT-proBNP showed significantly increased frequencies of elevated levels in patients with vascular disease, in patients with a pathological CT finding indicating cerebrovascular disease, and in patients above 75 years of age. CONCLUSION: It is possible that the control of conventional vascular risk factors and therapy could be guided by the level of plasma tHcy, serum cystatin C, and serum NT-proBNP. Patients with an elevation of any of these three parameters could be selected for a lower target level of risk factors such as blood pressure, hyperlipidemia etc. than conventional target levels.
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| 48. |
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| 49. |
- Nilsson, Karin, et al.
(författare)
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Plasma Homocysteine and Vascular Disease in Psychogeriatric Patients.
- 2006
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Ingår i: Dementia and Geriatric Cognitive Disorders. - : S. Karger AG. - 1420-8008 .- 1421-9824. ; 21:3, s. 148-154
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Tidskriftsartikel (refereegranskat)abstract
- <i>Background:</i> There is a high frequency (40–50%) of elevated plasma total homocysteine (tHcy) concentrations in elderly patients with mental disorders, and patients with a history of vascular disease exhibit significantly higher plasma tHcy concentration than patients without vascular disease. <i>Method:</i> The main objective of the present study was to further investigate the association between plasma tHcy concentration and vascular disease in psychogeriatric patients. We have therefore investigated 304 psychogeriatric patients and determined plasma tHcy and its most important determinants (folate and cobalamin status and renal function), and the natriuretic peptide N-terminal-pro brain natriuretic peptide (NT-proBNP). The patients were classified into several groups of vascular disease according to the findings of brain imaging and presence of a history/symptoms indicating manifest occlusive arteriosclerotic vascular disease. <i>Results:</i> Plasma tHcy concentration is associated with the presence of vascular disease in psychogeriatric patients. The presence of vascular disease is also associated with higher age, higher serum NT-proBNP, renal impairment and lower serum folate concentration than in patients without vascular disease. The significant association between plasma tHcy concentration and vascular disease remained after correction for age and for cystatin C differences between the groups of patients without and with vascular disease. In the present population with only 16% of the patients showing elevated plasma tHcy, renal function was a more important determinant for plasma tHcy concentration than folate status. <i>Conclusion:</i> Plasma tHcy concentration is associated with vascular disease. In the present population of psychogeriatric patients renal function is associated with vascular disease and elevated plasma tHcy concentration. Thus, the association between plasma tHcy concentration and vascular disease might partially be explained by impairment of renal function.
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| 50. |
- Nilsson, Karin, et al.
(författare)
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Plasma Homocysteine, Cobalamin/Folate Status, and Vascular Disease in a Large Population of Psychogeriatric Patients.
- 2006
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Ingår i: Dementia and Geriatric Cognitive Disorders. - : S. Karger AG. - 1420-8008 .- 1421-9824. ; 22:4, s. 358-366
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Tidskriftsartikel (refereegranskat)abstract
- <i>Background:</i> Cobalamin/folate deficiency and vascular disease are prevalent in elderly subjects and may lead to mental symptoms, but may even more often influence the severity of other organic and non-organic mental diseases. In the present study, we have evaluated cobalamin–folate status and the presence of vascular disease in 1,982 psychogeriatric patients investigated and diagnosed in a psychogeriatric clinic. The objective of the present study is to obtain information on the role of cobalamin/folate status and vascular disease in different diagnoses of psychogeriatric patients and their association with plasma homocysteine (tHcy). <i>Methods:</i> We have measured serum cobalamin, blood/serum folate, serum creatinine, plasma tHcy and evaluated the presence of vascular disease in 1,982 well-defined psychogeriatric patients. <i>Results and Conclusions:</i> The present study indicates that cobalamin/folate deficiencies do not play an important role in cognitive dysfunction in psychogeriatric patients, since only about 7% of the study population had metabolic cobalamin/folate deficiencies. Furthermore, cobalamin/folate deficiencies were rare in younger patients (below 70 years of age). We were also able to confirm our previous finding that there was no association between dementia of Alzheimer type (AD) and plasma tHcy level or metabolic cobalamin/folate deficiencies. Furthermore, we observed a low proportion of vascular disease in patients with AD, which does not give support for an association between well-defined AD and the presence of vascular disease. The presence of vascular disease was higher and of similar degree in patients with mild cognitive impairment and depression, which indicates an association between these diagnoses and the presence of vascular disease. The present study also shows that at plasma tHcy levels below 14 µmol/l, the likelihood of cobalamin/folate deficiency is small and further investigation of cobalamin/folate status could be omitted.
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