| 21. |
- Edlund, A, et al.
(författare)
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Clinical profile of delirium in patients treated for femoral neck fractures
- 1999
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Ingår i: Dementia and Geriatric Cognitive Disorders. - : S. Karger AG. - 1420-8008 .- 1421-9824. ; 10:5, s. 325-329
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Tidskriftsartikel (refereegranskat)abstract
- The incidence of delirium, its predisposing factors, clinical profile, associated symptoms and consequences were investigated in 54 consecutive patients, 19 men and 35 women, mean age 77.1 years, admitted to an 'ortho-geriatric unit' with femoral neck fractures. The incidence of postoperative delirium was 15/54 (27.8%) and a logistic regression model found that dementia and a prolonged waiting time for the operation increased the risk of postoperative delirium. Delirium during the night was most common but in 5 patients the delirium was worst in the morning. Patients with delirium suffered more anxiety, depressed mood, emotionalism, delusions and hallucinations. A larger proportion of patients with delirium could not return to their previous dwelling, and a larger proportion of delirious patients were either dead, wheelchair-bound or bedridden at the 6-month follow-up (p < 0.005). The conclusion is that delirium is common and has a serious impact on the outcome after hip fracture surgery.
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| 22. |
- Elmståhl, Sölve, et al.
(författare)
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A 3-year follow-up of stroke patients : Relationships between activities of daily living and personality characteristics
- 1996
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Ingår i: Archives of Gerontology and Geriatrics. - : Elsevier BV. - 0167-4943. ; 22:3, s. 233-244
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Tidskriftsartikel (refereegranskat)abstract
- The importance of some personality characteristics for improvement of activities of daily life (ADL) was studied in sixty-six stroke patients, initially admitted to geriatric rehabilitation (n = 37) or the department of medicine (n = 29), 3 years after stroke. Outcome measurements were activities of daily life and motor and mental functions assessed using the Activity Index (AI) by Hamrin and Wohlin. Neuroticism and extroversion were measured with the Eysenck Personality Inventory Scale. Preferred coping strategies were assessed from interviews on how the patients handle difficult events. Major improvements of ADL and motor functions were seen the first year after stroke. There was no major differences between patients admitted, either to geriatric rehabilitation or traditional medical wards regarding the outcome measurements except for better eating ability in the former group 3 years later. Subjects living alone showed deteriorated ADL functions after 3 years. Extrovert personality and active coping strategy predicted improved ADL functions. Multiple regression analyses with AI as the dependent variable proved active coping to predict functional outcome. In conclusion; increased knowledge about personality characteristics can improve possibilities for a more individual rehabilitation program.
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| 23. |
- Elmståhl, Sölve, et al.
(författare)
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Behavioral disturbances and pharmacological treatment of patients with dementia in family caregiving : A 2-year follow-up
- 1998
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Ingår i: International Psychogeriatrics. - 1041-6102. ; 10:3, s. 239-252
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Tidskriftsartikel (refereegranskat)abstract
- Behavioral disturbances are common in dementia. Polypharmacy due to progression of disease and fluctuation of symptoms among patients might increase risk of overtreatment and/or undertreatment. Drug prescription habits were studied in relationship to symptoms of dementia after relocation of patients to group-living care units (GC). Seventy-six demented patients (mean age 81 years) were assessed before, 12 months after, and 24 months after relocation to GC. Vascular dementia was found in 47%, Alzheimer's dementia in 46%, and other dementias in 7%. Medications, regular or as required, were recorded from medication lists. Repeated observations of symptoms like depressive mood and lack of vitality were made with validated scales. Eighty percent of the patients were prescribed drugs; 40% were given neuroleptics and 9% were given antidepressants. During the 2-year follow-up, polypharmacy increased; patients with five drugs or more increased from 15% to 35%; usage of neuroleptics or sedatives, as required, increased from 8% to 25%, p < .01. Depressive mood was noted in 86% after 2 years and 74% showed aggressiveness and anxiety, but only 12% of the patients with depressive symptoms were on antidepressants. Analgesics were prescribed to 26% of patients. In conclusion, a high proportion of patients with dementia had depressive mood and undertreatment of depressive disorder might be suspected. Polypharmacy increased during the 2-year follow-up; this finding calls for careful monitoring of adverse drug reactions, because of the deteriorating cognitive function of these patients.
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| 24. |
- Elmståhl, Sölve, et al.
(författare)
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Caregiver's burden of patients 3 years after stroke assessed by a novel caregiver burden scale
- 1996
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Ingår i: Archives of Physical Medicine and Rehabilitation. - 0003-9993 .- 1532-821X. ; 77:2, s. 177-182
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To assess burden of caregivers to stroke patients three year after a primary stroke and to test validity and reliability of a novel caregiver burden scale (CB scale). Design: A longitudinal community-based 3- year follow-up study of 35 consecutive primary stroke patients initially admitted to an Acute Medical Unit (mean age 82yr). The validity of the CB scale was studied in 150 patients (mean age 77yr):83 demented outpatients assessed for need of group living and 67 outpatients with stroke from a general geriatric day-care unit. Reliability was studied in another 23 outpatients (mean age 72yr) with stroke from the same unit. Methods: A 22- item CB scale for different types of caregiver burden and scales for neuroticism and extroversion (Eysenck Personality Inventory) and quality of life (11-item scale). Activities of daily life were assessed by a 6-item scale, initially and 3 years later. Outcome Measure: Reliability and validity of the CB scale. Improvements of activities of daily life of stroke patients. Results: Factor analyses of the CB scale gave five indices-general strain, isolation, disappointment, emotional involvement, and environment-having good kappa values, .89 to 1.00 and Cronbach's alpha, .70 to .87, except for environment. A higher burden was related to a closer relationship but not to the living situation. The highest caregiver burden was found among patients showing the greatest improvements of ADL, when divided into tertiles. The patient's degree of extroversion and quality of life were negatively correlated to caregiver burden, -.46 (p < .05) and .59 (p < .01). Conclusions: The CB scale proved to be a valid and reliable instrument to assess caregiver burden. To improve the caregiver situation, individual patient personality characteristics, like extroversion, feeling of quality of life, and progression of the disease, must be considered.
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| 25. |
- Elmståhl, Sölve, et al.
(författare)
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Family caregiving in dementia : Prediction of caregiver burden 12 months after relocation to group-living care
- 1998
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Ingår i: International Psychogeriatrics. - 1041-6102. ; 10:2, s. 127-146
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Tidskriftsartikel (refereegranskat)abstract
- The strain of caregiving associated with the care of demented persons living at home often continues after relocation, and group-living-care units (GL), designed for a small number of subjects, have been developed. The aim was to prospectively describe caregiver burden in relationship to symptoms of patients with dementia after relocation to GL. Sixty-four caregivers and 64 demented patients were assessed before, 6 months after, and 12 months after relocation. Thirty-six caregivers were children, 7 were spouses, and 21 were others. Validated scales were used for caregiver burden and dementia symptoms. Total burden of caregivers decreased after 12 months, but the degree of isolation was unchanged and feeling of disappointment increased significantly. The burden was not related to changes of activities of daily life or disorientation. Patients' lack of vitality at relocation independently predicted caregiver's burden 1 year later. Hallucinations and changes of symptoms during the first year were associated with less caregiver burden, probably due to greater detachment of the relationship. The caregiver burden remains 1 year after relocation and any support to the caregiver should consider patients' symptoms, especially lack of vitality.
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| 26. |
- Elmståhl, Sölve, et al.
(författare)
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Postural hypotension and EEG variables predict cognitive decline : Results from a 5-Year follow-up of healthy elderly women
- 1997
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Ingår i: Dementia and Geriatric Cognitive Disorders. - : S. Karger AG. - 1420-8008 .- 1421-9824. ; 8:3, s. 180-187
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Tidskriftsartikel (refereegranskat)abstract
- Quantified electroencephalographic activity (EEG) has been used to study normal ageing and dementia. Few studies have described longitudinal changes in the very old. A cognitive decline has been described in subjects with white-matter lesions and hypertension but the association with hypotension is unclear. Our aim was to study the predictive value of quantified EEG for the development of cognitive decline and associations with postural hypotension. Participants: Thirty-three healthy women aged 75–95 years, with no signs of cerebrovascular disease, dementia or acute illness at baseline examination took part in a longitudinal 5-year follow-up study. The women were recruited from a random selection using the Municipal Registry. Quantified EEG was assessed twice and recorded on a Siemens-Elema connected to a Biological Banker. The medical and neuropsychological examination was conducted twice. Dementia was classified according to DSM criteria. The assessment included Mini-Mental Scale Examination (MMSE), spatial and vocabulary tests. Blood pressure was measured in supine position and an orthostatic test was performed with continuous ECG recording. Seven women (cases) developed cognitive decline at the 5-year follow-up, defined as newly developed MMSE < 27 and dementia symptoms. Low beta activity at baseline predicted development of cognitive decline. The women who remained healthy at follow-up showed an increase of alpha and theta activity. The cases had a higher orthostatic blood pressure fall during tilting at baseline (16 mm Hg) than the controls (1 mm Hg, p < 0.01). The orthostatic reaction was correlated with increased levels of theta and alpha activity at follow-up (r = −0.47 to −0.52; p < 0.01). Low beta activity predicts for cognitive decline in the elderly and an orthostatic blood pressure reaction is a risk factor for cognitive decline.
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| 27. |
- Hallengren, Bengt, et al.
(författare)
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No increase in fracture incidence in patients treated for thyrotoxicosis in Malmo during 1970-74. A 20-year population-based follow-up
- 1999
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Ingår i: Journal of Internal Medicine. - : Wiley. - 0954-6820 .- 1365-2796. ; 246:2, s. 139-144
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Tidskriftsartikel (refereegranskat)abstract
- Objectives. To study whether there is an increased fracture incidence following thyrotoxicosis. Design. A case-control study. Setting. Malmo University Hospital, Malmo, Sweden. Subjects: All patients (n = 333) from the population of Malmo who were treated for thyrotoxicosis for the first time during the 5-year period 1970-74. A total of 618 controls were selected from the local municipality registry in Malmo. For each case the aim was to randomly select two age- and gender-specific controls, alive in 1993 and born the same year and month as the case. Main outcome measures. Fracture incidence. Results. Comparing survivors, there were no differences in the percentage of individuals with fractures (all, fragility, non-fragility) between the patients and the controls. Comparing all individuals and including all fractures, the percentage of individuals with fractures in the entire female patient group (24.6%) was lower (P < 0.05) than in female controls (33.1%). There was a similar but non-significant pattern between male patients and controls. The mean number of all fractures was lower in male patients than in controls (P < 0.05), but no significant difference was noted between female patients and controls. For fragility fractures, there were no significant differences in the percentage of individuals with fractures or in the mean number of fractures between female or male patients and controls. Conclusion. In conclusion we found no increased incidence of fragility fractures in patients with previous thyrotoxicosis as compared with controls. Our results do not support the suggestion that screening for osteoporosis should be performed in patients with previous thyrotoxicosis.
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| 28. |
- Lexell, Jan
(författare)
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Human aging, muscle mass, and fiber type composition
- 1995
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Ingår i: Journals of Gerontology. Series A: Biological Sciences & Medical Sciences. - 1758-535X .- 1079-5006. ; 50, s. 11-16
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Tidskriftsartikel (refereegranskat)abstract
- To assess the age-related loss of muscle mass and to determine the mechanisms behind this aging atrophy, the muscle structure and fiber type composition have been estimated, using invasive and noninvasive techniques. Limb muscles from older men and women are 25-35% smaller and have significantly more fat and connective tissue than limb muscles from younger individuals. Comparisons of muscle biopsies from younger and older individuals reveal that type 2 (fast-twitch) fibers are smaller in the old, while the size of type 1 (slow-twitch) fibers is much less affected. Studies of whole muscle cross sections also show a significantly smaller number of muscle fibers, a significantly lower relative type 2 fiber area, and a significant increase in fiber type grouping with increasing age. These results indicate a gradual decrease in size/volume with advancing age, accompanied by a replacement by fat and connective tissue. This aging atrophy seems to be due to a reduction in both number and size of muscle fibers, mainly of type 2, and is to some extent caused by a slowly progressive neurogenic process.
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| 29. |
- Nilsson, Evalill, et al.
(författare)
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Preparation of artificial ceroid/lipofuscin by UV-oxidation of subcellular particles
- 1997
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Ingår i: Mechanisms of Ageing and Development. - : Elsevier. - 0047-6374 .- 1872-6216. ; 99:1, s. 61-78
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Tidskriftsartikel (refereegranskat)abstract
- Recent studies have consistently shown that, during oxidative damage, glycation, and other oxygen stress-related reactions, various biomolecules are converted into ceroid- and lipofuscin-like fluorescent pigments. In this study, artificial ceroid/lipofuscin was produced by exposing rat liver fractions to UV-light overnight. Thiobarbituric acid reactive substances (TBARS) were formed in increasing amounts during the early stages of the process, but decreased as the material was later converted into a polymeric structure with few remaining peroxides. In the transmission electron microscope the artificial pigment showed lamellar structures and was osmiophilic. By energy-dispersive X-ray analysis the material was found to contain Ca and Fe in the same way as natural ceroid/lipofuscin. Moreover, it exhibited ceroid/lipofuscin-like, greenish-yellowish autofluorescence when assayed by microfluorometry, with a fluorescence maximum consistently found at 430 nm when excited at 350 nm. Identical fluorescence maxima were found for each fraction of rat liver that was used as the origin of the pigments, i.e. nuclei, mitochondria, lysosomes and microsomes. Extracts with either chloroform-methanol, or sodium dodecylsulphate, showed identical complex fluorescence. When the pigments were extracted by chloroform-methanol, five fluorescent bands were obtained after thin-layer chromatographic separation. Fibroblasts were found to endocytose the material, a process that converted them into lipofuscin-loaded cells of an aged phenotype as observed by light and electron microscopy. Similar fluorescence emission spectra were obtained from cells grown at 40% O2, in order to stimulate endogenous lipofuscin-formation, and from cells exposed to artificial ceroid/lipofuscin. The described technique for creating artificial ceroid/lipofuscin is relatively easy to perform and should provide a useful new tool to study the possible influences of ceroid/lipofuscin on lysosomal and cellular functions.
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| 30. |
- Nägga, Katarina, 1962-, et al.
(författare)
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Associated physical disease in a demented population
- 1998
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Ingår i: Aging (Milan, Italy). - : Springer Science and Business Media LLC. - 0394-9532. ; 10:6, s. 440-4
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Tidskriftsartikel (refereegranskat)abstract
- Clinical experience indicates that physical diseases are probably underdiagnosed in patients suffering from dementia. We investigated the prevalence of physical diseases in patients with different types of dementia by means of a retrospective patient record survey including 236 inpatients and outpatients referred for dementia evaluation to the Dementia Investigation Unit, University Hospital in Linköping during 1994. Forty-four patients had dementia of the Alzheimer type, 78 had vascular dementia, 28 had dementia due to multiple etiologies, 42 were not demented, and 44 patients could not be classified by the DSM IV criteria. The physical diseases were registered as separate diagnoses comprising all newly-diagnosed physical diseases and previously known diseases that had exacerbated and contributed to the medical contact. Sixty-four percent of the patients had previously unknown physical diseases and/or exacerbation of previously known diseases. The most common physical conditions were cobalamin deficiency and infectious diseases, which occurred in 27% and 24% of the patients, respectively. There was no difference in the number or kinds of diagnoses between the diagnostic groups. Associated physical diseases were underdiagnosed in patients referred for dementia evaluation. We suggest that thorough medical investigation and adequate treatment are of importance in the management of dementia.
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