| 1601. |
- Patra, Kalicharan, et al.
(författare)
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Plasma Apolipoprotein E Monomer and Dimer Profile and Relevance to Alzheimer's Disease
- 2019
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Ingår i: Journal of Alzheimer's Disease. - 1387-2877 .- 1875-8908. ; 71:4, s. 1217-1231
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Tidskriftsartikel (refereegranskat)abstract
- The APOE epsilon 4 gene variant is the strongest genetic risk factor for Alzheimer's disease (AD), whereas APOE epsilon 3 conventionally is considered as 'risk neutral' although APOE epsilon 3-carriers also develop AD. Previous studies have shown that the apolipoprotein E3 (apoE3) isoform occurs as monomers, homodimers and heterodimers with apolipoprotein A-II in human body fluids and brain tissue, but the relevance of a plasma apoE3 monomer/dimer profile to AD is unknown. Here we assessed the distribution of monomers, homodimers and heterodimers in plasma from control subjects and patients with mild cognitive impairment (MCI) and AD with either a homozygous APOE epsilon 3 (n = 31 control subjects, and n = 14 MCI versus n = 5 AD patients) or APOE epsilon 4 genotype (n = 1 control subject, n = 21 MCI and n = 7 AD patients). Total plasma apoE levels were lower in APOE epsilon 4-carriers and overall correlated significantly to CSF A beta(42), p(Thr181)-tau and t-tau levels. Apolipoprotein E dimers were only observed in the APOE epsilon 3-carriers and associated with total plasma apoE levels, negatively correlated to apoE monomers, but were unrelated to plasma homocysteine levels. Importantly, the APOE epsilon 3-carrying AD patients versus controls exhibited a significant decrease in apoE homodimers (17.8 +/- 9.6% versus 26.7 +/- 6.3%, p = 0.025) paralleled by an increase in apoE monomers (67.8 +/- 18.3% versus 48.5 +/- 11.2%, p = 0.008). In the controls, apoE monomers and heterodimers were significantly associated with plasma triglycerides; the apoE heterodimers were also associated with levels of high-density lipoprotein cholesterol. The physiological relevance of apoE dimer formation needs to be further investigated, though the distribution of apoE in monomers and dimers appears to be of relevance to AD in APOE epsilon 3 subjects.
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| 1602. |
- Persson, M., et al.
(författare)
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Validation of a dietary record routine in geriatric patients using doubly labelled water
- 2000
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Ingår i: European Journal of Clinical Nutrition. - : Springer Science and Business Media LLC. - 0954-3007 .- 1476-5640. ; 54:10, s. 789-796
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To validate a 7-day estimated dietary record routine with standardized portion sizes and household measuring in a clinical setting with the doubly labelled water (DLW) method as the reference method. Design: Energy expenditure was measured with deuterium (2H) and oxygen-18 (18O), and water loss was estimated by 2H dilution as part of the DLW measurements. Energy and water intake was measured with a 7 day dietary record. Setting: Five nursing home wards in Sweden. Subjects: Thirty-one geriatric patients with a mean age of 86y. Inclusion criteria were stable body weight, defined as a maximum change of ± 4% during the last 4 months of ± 2% during the last 2 months and without any acute illness. Results: The mean daily energy intake was 7.2 MJ (1727 kcal) and the mean daily energy expenditure was 6.7 MJ (1595 kcal). The mean daily water intake was 1787 ml and mean daily water loss assessed by labelled water was 1774 ml. Using the dietary record routine, the staff overestimated the patients' energy intake by 8% and water intake from food and beverages by < 1% compared to DLW. Conclusion: The 7 day dietary record routine based on standardized portion sizes and household measuring seems to be a valid method for assessing the intake of energy and fluids by geriatric patients.
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| 1603. |
- Petrazzuoli, Ferdinando
(författare)
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Dementia management in European primary care
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Around 50 million people worldwide have dementia and the prevalence is expected to increase to 152 million by 2050. According to the WHO, dementia is a priority health policy issue. The role of primary care physicians (PCPs) for timely dementia management can be cost-effective, yet PCP involvement in the management of patients with presumed or diagnosed dementia vary across Europe.Aim: Exploring dementia identification and management in European primary care. Methods: Paper I is a key informant survey across 25 countries based on self-administered questionnaires from 445 PCPs. Paper II is an adaptation into Italian of the cognitive test - A Quick Test of cognitive speed (AQT). Paper III is an explorative analysis inspired by grounded theory examining dementia case reports from 106 key informant PCPs (same study as paper I). Paper IV examined if brief cognitive tests used in primary care could identify mild cognitive impairment (MCI) in 466 primary care patients referred to a memory clinic due to cognitive complaints. The examined tests were the Mini-Mental State Examination (MMSE), the Clock Drawing Test and AQT.Results: In paper I we found that in some countries, PCPs were allowed to establish a diagnosis of dementia and start specific drug treatment reimbursed by health insurance. In most countries only neurologists, geriatricians, and psychiatrists were allowed to diagnose and treat dementia. A positive association found between the right to prescribe dementia drugs and pursuing dementia diagnostic work-up (OR 3.4; 95% CI 2.3–5.2) implied that dementia diagnostic activities were higher for PCPs who were entitled to prescribe dementia drugs. In paper II Italian reference norms for AQT were successfully established. In paper III we analysed 155 dementia case stories (81 women, 74 men, median age 80 years) from 106 PCPs from 23 countries. In 89 of 155 cases (57%) memantine or acetylcholinesterase inhibitors were prescribed; appropriate according to guidelines in 60% and questionable/inappropriate in 40%, showing a broadening of guideline indications. Unburdening dementia, especially by drugs, was a core pattern of dementia management by many physicians. In paper IV we showed that no single or combination of tests had sufficient accuracy to identify patients with MCI and differentiate them from those with only subjective and benign symptoms. Conclusions: Differing regulations about who does what in dementia management affected PCP’s activities in dementia investigations and assessment. The cognitive test AQT has now been adapted to Italian speakers. Real world dementia drug treatment was characterised by a broadening of guideline indications in order to unburden dementia patients and family members. Since the currently used tests in primary care lack accuracy for identifying MCI better cognitive tests are needed.
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| 1604. |
- Pettersson, Beatrice, et al.
(författare)
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'Maintaining balance in life'—exploring older adults' long-term engagement in self-managed digital fall prevention exercise
- 2023
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Ingår i: European Review of Aging and Physical Activity. - : BioMed Central (BMC). - 1813-7253 .- 1861-6909. ; 20:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Accidental falls are one of the greatest threats to older adults’ health and well-being. The risk of falling can be significantly reduced with strength and balance interventions. However, there needs to be further knowledge into how older adults can be supported to achieve a maintained exercise behaviour. Therefore, the aim of this study was to explore factors that enabled older adults to maintain their exercise during a 1-year self-managed digital fall prevention exercise intervention.Methods: This study used a grounded theory methodology. Semi-structured individual interviews were conducted by phone or conference call. Eighteen community-dwelling older adults aged 70 years or more participated. The participants had a self-reported exercise dose of 60 min or more per week during the last three months of participation in a 12-months intervention of self-managed digital fall prevention exercise, the Safe Step randomized controlled trial. Open, axial, and selective coding, along with constant comparative analysis, was used to analyze the data.Results: The analysis resulted in a theoretical model. We found that the fall prevention exercise habits of adults were developed through three stages: Acting against threats to one’s own identity, Coordinating strategies to establish a routine, and Forming habits through cues and evaluation. The main category of Maintaining balance in life encases the participants transition through the three stages and reflects balance in both physical aspects and in between activities in daily life. The process of maintaining balance in life and desire to do so were mediated both by intrinsic person-dependent factors and the Safe Step application acting as an external mediator.Conclusion: This study identified three stages of how older adults developed self-managed fall prevention exercise habits, supported by a digital application. The generated theoretical model can inform future interventions aiming to support long-term engagement in digitally supported and self-managed fall prevention interventions.
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| 1605. |
- Philpot, M, et al.
(författare)
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Barriers to the use of electroconvulsive therapy in the elderly: a European survey
- 2002
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Ingår i: European Psychiatry. - 1778-3585. ; 17:1, s. 41-45
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Tidskriftsartikel (refereegranskat)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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| 1606. |
- Pohl, Petra, et al.
(författare)
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Community-dwelling older people with an injurious fall are likely to sustain new injurious falls within 5 years : a prospective long-term follow-up study
- 2014
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Ingår i: BMC Geriatrics. - : BioMed Central. - 1471-2318 .- 1471-2318. ; 14:1, s. 120-
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Fall-related injuries in older people are a leading cause of morbidity and mortality. Self-reported fall events in the last year is often used to estimate fall risk in older people. However, it remains to be investigated if the fall frequency and the consequences of the falls have an impact on the risk for subsequent injurious falls in the long term. The objective of this study was to investigate if a history of one single non-injurious fall, at least two non-injurious falls, or at least one injurious fall within 12 months increases the risk of sustaining future injurious falls.METHODS: Community-dwelling individuals 75-93 years of age (n = 230) were initially followed prospectively with monthly calendars reporting falls over a period of 12 months. The participants were classified into four groups based on the number and type of falls (0, 1, ≥2 non-injurious falls, and ≥1 injurious fall severe enough to cause a visit to a hospital emergency department). The participants were then followed for several years (mean time 5.0 years ±1.1) regarding injurious falls requiring a visit to the emergency department. The Andersen-Gill method of Cox regression for multiple events was used to estimate the risk of injurious falls.RESULTS: During the long-term follow-up period, thirty per cent of the participants suffered from at least one injurious fall. Those with a self-reported history of at least one injurious fall during the initial 12 months follow-up period showed a significantly higher risk for sustaining subsequent injurious falls in the long term (hazard ratio 2.78; 95% CI, 1.40-5.50) compared to those with no falls. No other group showed an increased risk.CONCLUSIONS: In community-dwelling people over 75 years of age, a history of at least one self-reported injurious fall severe enough to cause a visit to the emergency department within a period of 12 months implies an increased risk of sustaining future injurious falls. Our results support the recommendations to offer a multifactorial fall-risk assessment coupled with adequate interventions to community-dwelling people over 75 years who present to the ED due to an injurious fall.
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| 1607. |
- Polistena, Andrea, et al.
(författare)
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Surgical treatment of secondary hyperparathyroidism in elderly patients : an institutional experience
- 2017
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Ingår i: Aging clinical and experimental research. - : Springer Science and Business Media LLC. - 1594-0667 .- 1720-8319. ; 29:suppl. 1, s. 23-28
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Tidskriftsartikel (refereegranskat)abstract
- Background: Secondary hyperparathyroidism in elderly fragile patients presents clinical difficulties due to severity of symptoms and related comorbidity. The optimal surgical approach for this group of patients is still debated. Aim: The aim of the study was to define the optimal technique of parathyroidectomy in elderly patients with secondary hyperparathyroidism. Methods: Retrospective analysis in a series of 253 patients including 35 elderly individuals at a single institution was carried out. Postoperative parathyroid hormone decrease, surgical complications and symptoms control were analyzed for all patients in relation to the types of parathyroidectomy performed. Results: In elderly patients, total parathyroidectomy was the most used approach. Subtotal parathyroidectomy was mostly reserved for younger patients suitable for kidney transplantation. No elderly patients treated with total parathyroidectomy were autotransplanted. No significant difference in surgical complications was observed between younger and elderly patients and considering the different procedures. Adequate symptom control after surgery was achieved in almost 90% of patients. A limited rate of recurrence requiring repeat surgery was observed only after subtotal parathyroidectomy. Discussion: Considering the features of all types of parathyroidectomy, very low recurrence rate, contained postoperative hypocalcemia and limited complications following total parathyroidectomy, might represent specific advantages for elderly patients. Conclusions: Total parathyroidectomy without parathyroid transplantation is safe for elderly patients with secondary hyperparathyroidism and a good alternative to the well-established total parathyroidectomy with autografting.
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| 1608. |
- Povoroznyuk, V., et al.
(författare)
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FRAX-Based Intervention Thresholds for Osteoporosis Treatment in Ukraine
- 2021
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Ingår i: Journal of Osteoporosis. - : Hindawi Limited. - 2090-8059 .- 2042-0064. ; 2021
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Tidskriftsartikel (refereegranskat)abstract
- Objectives. Osteoporosis, in addition to its consequent fracture burden, is a common and costly condition. FRAX(R) is a well-established, validated, web-based tool which calculates the 10-year probability of fragility fractures. A FRAX model for Ukraine has been available since 2016 but its output has not yet been translated into intervention thresholds for the treatment of osteoporosis in Ukraine; we aimed to address this unmet need in this analysis. Methods. In a referral population sample of 3790 Ukrainian women, 10-year probabilities of major osteoporotic fracture (MOF) and hip fracture separately were calculated using the Ukrainian FRAX model, with and without femoral neck bone mineral density (BMD). We used a similar approach to that first proposed by the UK National Osteoporosis Guideline Group, whereby treatment is indicated if the probability equals or exceeds that of a woman of the same age with a prior fracture. Results. The MOF intervention threshold in females (the age-specific 10-year fracture probability) increased with age from 5.5% at the age of 40 years to 11% at the age of 75 years where it plateaued and then decreased slightly at age 90 (10%). Lower and upper thresholds were also defined to determine the need for BMD, if not already measured; the approach targets BMD measurements to those at or near the intervention threshold. The proportion of the referral populations eligible for treatment, based on prior fracture or similar or greater probability, ranged from 44% to 69% depending on age. The prevalence of the previous fracture rose with age, as did the proportion eligible for treatment. In contrast, the requirement for BMD testing decreased with age. Conclusions. The present study describes the development and application of FRAX-based assessment guidelines in Ukraine. The thresholds can be used in the presence or absence of access to BMD and optimize the use of BMD where access is restricted.
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| 1609. |
- Praetorius, Marcus, 1982, et al.
(författare)
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Substantial effects of APOE ε4 on memory decline in very old age: Longitudinal findings from a population-based sample
- 2013
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Ingår i: Neurobiology of Aging. - : Elsevier BV. - 0197-4580. ; 34:12, s. 2734-2739
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Tidskriftsartikel (refereegranskat)abstract
- We examined associations between the apolipoprotein E (APOE) epsilon 4 allele and levels of performance and rates of change in cognition in late life taking incident dementia into account. The sample consisted of 482 nondemented individuals, aged 80 years and older at baseline, drawn from the OCTO twin study. A battery of 10 cognitive tests was administered at 5 occasions with measurements intervals of 2 years. We fitted hierarchical linear models with time specified as time to death and controlled for baseline age, sex, education, stroke, cardiovascular disease, hypertension, diabetes, and incident dementia. The epsilon 4 allele was significantly associated with lower levels of performance or steeper rate of decline in all 7 memory tests. Largest effect sizes were found in tests of delayed recall and recognition memory. The effects of the APOE epsilon 4 allele were, however, reduced to a nonsignificant level in all tests except 1 after accounting for incident dementia. The findings support the notion that the APOE epsilon 4 allele is associated with substantial memory decline in very old age, but as expected, the effect is largely related to incident dementia. (C) 2013 Elsevier Inc. All rights reserved.
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| 1610. |
- Puschmann, Andreas, et al.
(författare)
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Diagnosis and Treatment of Common Forms of Tremor
- 2011
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Ingår i: Seminars in Neurology. - : Georg Thieme Verlag KG. - 0271-8235 .- 1098-9021. ; 31:1, s. 65-77
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Tidskriftsartikel (refereegranskat)abstract
- Tremor is the most common movement disorder presenting to an outpatient neurology practice and is defined as a rhythmical, involuntary oscillatory movement of a body part. The authors review the clinical examination, classification, and diagnosis of tremor. The pathophysiology of the more common forms of tremor is outlined, and treatment options are discussed. Essential tremor is characterized primarily by postural and action tremors, may be a neurodegenerative disorder with pathologic changes in the cerebellum, and can be treated with a wide range of pharmacologic and nonpharmacologic methods. Tremor at rest is typical for Parkinson's disease, but may arise independently of a dopaminergic deficit. Enhanced physiologic tremor, intention tremor, and dystonic tremor are discussed. Further differential diagnoses described in this review include drug- or toxin-induced tremor, neuropathic tremor, psychogenic tremor, orthostatic tremor, palatal tremor, tremor in Wilson's disease, and tremor secondary to cerebral lesions, such as Holmes' tremor ( midbrain tremor). An individualized approach to treatment of tremor patients is important, taking into account the degree of disability, including social embarrassment, which the tremor causes in the patient's life.
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