| 1. |
- Bixo, Marie, 1957-
(författare)
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Ovarian steroids in rat and human brain : effects of different endocrine states
- 1987
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Ovarian steroid hormones are known to produce several different effects in the brain. In addition to their role in gonadotropin release, ovulation and sexual behaviour they also seem to affect mood and emotions, as shown in women with the premenstrual tension syndrome. Some steroids have the ability to affect brain excitability. Estradiol decreases the electroshock threshold while progesterone acts as an anti-convulsant and anaesthetic in both animals and humans. Several earlier studies have shown a specific uptake of several steroids in the animal brain but only a few recent studies have established the presence of steroids in the human brain.In the present studies, the dissections of rat and human brains were carried out macroscopically and areas that are considered to be related to steroid effects were chosen. Steroid concentrations were measured by radioimmunoassay after extraction and separation with celite chromatography. The accuracy and specificity of these methods were estimated.In the animal studies, immature female rats were treated with Pregnant Mare's Serum Gonadotropin (PMSG) to induce simultaneous ovulations. Concentrations of estradiol and progesterone were measured in seven brain areas pre- and postovulatory. The highest concentration of estradiol, pre- and postovulatory, was found in the hypothalamus and differences between the two cycle phases were detected in most brain areas. The preovulatory concentrations of progesterone were low and the highest postovulatory concentration was found in the cerebral cortex.In one study, the rats were injected with pharmacological doses of progesterone to induce "anaesthesia". High uptake of progesterone was found and a regional variation in the formation of 5<*-pregnane-3,20-dione in the brain with the highest ratio in the medulla oblongata.Concentrations of progesterone, 5a-pregnane-3*20-dione, estradiol and testosterone were determined in 17 brain areas of fertile compared to postmenopausal women. All steroids displayed regional differences in brain concentrations. Higher concentrations of estradiol and progesterone were found in the fertile compared to the postmenopausal women.In summary, these studies show that the concentrations of ovarian steroids in the brain are different at different endocrine states in both rats and humans and that there are regional differences in brain steroid distribution.
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| 2. |
- Sandman, Per-Olof, 1950-
(författare)
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Aspects of institutional care of patients with dementia
- 1986
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of the present study was to investigate all long-term institutions in the county of Västerbotten, Northern Sweden, to give a detailed description of the institutionalized population with respect to motor functions, vision, hearing, speech, ADL-functions, prevalence of psychiatric symptoms and behavioral disturbances, staff work load, use of psychoactive drugs and prevalence of dementia. Another aim was to select some specific 'problem areas' in the nursing care of demented patients for further descriptive and interventional studies. For this reason, morning care procedure (hygiene, dressing), meal behavior (eating, communication), nutrition, constipation and relocation between institutions were selected.The results of the study have been reported in six papers summarized below:I.The study has shown that the proportion of demented patients is increasing in longterm institutions in Sweden. Furthermore, demented patients were shown to be more impaired in all rated functioning abilities and exhibited more psychiatric symptoms and behavioral symptoms. A high proportion of the demented probands were also prescribed psychoactive drugs, i.e. neuroleptics.II. Five patients with Alzheimer-type dementia were monitored during morning care. A 12-step classification system was developed to be used as a guide to understand and determine abilities essential for performance of morning care for demented patients. The quantitative assessment showed that none of the patients were able to manage morning care independently, but there was a wide variation in their highest level of performance.III. Five patients with Alzheimer-type dementia were observed (video taped) during their meals in a changed meal milieu and with new meal routines. When the patients ate without staff participation, the two least demented patients became 'caregivers'. When two mental nurses joined the group, first in civil clothes and then in white uniforms, the patients dropped their roles as helpers. The patients were able to compose complete meals in 0-79 per cent of the meals. The conversation during the meals could be characterized as incomplete, with short sentences and a lot of breaks. Sixty-three per cent of all utterances were about food and eating and almost all conversation concerned the present time.IV. Thirty-three psychogeriatric patients, with severe constipation were given a high- bran bread instead of their accustomed laxatives. During the high-bran treatment period, the number of bowel evacuations and the volume of faeces increased. The total laxative consumption decreased by 93 per cent.V. Nutritional status and dietary intake were studied in a sample of severely demented, institutionalized patients. Energy and /or protein malnutrition was found in 50 per cent of the patients. The mean energy intake was 2059 kcal. Malnourished patients had had four times as many infectious periods during their hospital stay as patients without malnutrition. Thirty-nine of 44 patients lost weight during their hospital stay.VI. Thirty-three psychogeriatric patients were followed for 36 weeks after relocation from a mental hospital to two newly built nursing homes. An intensive pre-relocation program was performed. No negative effects of the relocation were found. On the contrary, the relocated group improved their ADL-functions after the transfer.Based upon the above cited studies, a model for nursing care of demented patients is presented.
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| 3. |
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| 4. |
- Sandman, Per-Olof, 1950-, et al.
(författare)
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Long-term care of the elderly : A descriptive study of 3600 institutionalized patients in the county of Västerbotten, Sweden
- 1988
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Ingår i: Comprehensive gerontology. Section A, Clinical and laboratory sciences. - 0902-0071. ; 2:3, s. 120-32
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Tidskriftsartikel (refereegranskat)abstract
- Probands (n = 3607) living in long-term care institutions in the county of Västerbotten were assessed to estimate whether the prevalence of dementia in different types of institutions had changed since a similar survey was made 7 years before. The probands' motoric functions, vision, hearing, speech, prevalence of behavioral disturbances and psychiatric symptoms, work load and use of psychoactive drugs were also investigated with special emphasis on the differences between the demented and the non-demented. About 40% were demented. This proportion of demented patients had increased in somatic long-stay clinics, nursing homes and homes for the aged since 1975. Further, the mean age of the probands and their length of stay had increased in these institutions. Demented probands were more impaired with regard to motor functions, speech, vision, hearing, ADL-functions, behavioral and psychiatric symptoms, and they also imposed a higher work load on the staff than the non-demented. Demented probands were also prescribed psychoactive drugs, i.e. neuroleptics but not minor tranquilizers or antidepressants, more often than the non-demented in accordance with the increased prevalence of behavioral disturbances and psychiatric symptoms.
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| 5. |
- Sandman, Per-Olof, 1950-, et al.
(författare)
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Morning care of patients with Alzheimer-type dementia : A theoretical model based on direct observations
- 1986
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Ingår i: Journal of Advanced Nursing. - : John Wiley & Sons. - 0309-2402 .- 1365-2648. ; 11:4, s. 369-378
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Tidskriftsartikel (refereegranskat)abstract
- Five hospitalized patients in different stages of Alzheimer-type dementia were monitored by unstructured, direct observations during morning care. Orem's model of nursing as a compensation for the patient's lack of self-care capabilities was used as a frame of reference for an analysis of the behaviours of patients and nurses during morning care. A 12-step classification system was developed to be used as a guide to understand and determine abilities essential for performance of morning care for demented patients. The quantitative assessment showed that none of the patients was able to manage morning care independently, but there was a wide variation in their highest level of performance.
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| 6. |
- Sandman, Per-Olof, 1950-, et al.
(författare)
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Nutritional status and dietary intake in institutionalised patients with Alzheimer's disease and multifarct dementia
- 1987
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Ingår i: Journal of The American Geriatrics Society. - 0002-8614 .- 1532-5415. ; 35, s. 31-38
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Tidskriftsartikel (refereegranskat)abstract
- Nutritional status, dietary intake, weight change, and mortality were studied in a sample of severely demented, institutionalized patients. Dietary intake was registered during five days in two periods, five weeks apart. A weighing method was used. Nutritional status was assessed by anthropometric measurements (weight for height index, triceps skinfold thickness, arm muscle circumference) and determination of circulating proteins (albumin, transferrin, and prealbumin). Energy and/or protein malnutrition was found in 50% of the patients. The mean dietary intake was sufficient according to energy (2059 kcal/day), proteins, vitamins, and minerals. A comparison of patients with or without malnutrition showed no differences in dietary intake, diagnoses, age, length of hospital stay, or duration of illness. However, malnourished patients had had four times as many infectious periods treated by antibiotics as patients with no malnutrition. Thirty-nine of 44 patients lost weight during their hospital stay. There was no correlation between loss of weight, length of hospital stay, or duration of illness.
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| 7. |
- Alafuzoff, Irina, 1952-
(författare)
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Histopathological and immunocytochemical studies in age-associated dementias : the importance of rigorous histopathological criteria for classification of progressive dementia disorders
- 1985
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Dementia is an age-associated organic brain disorder, recognizable by the essential features of psychological or behavioral abnormality associated with permanent dysfunction of the brain interfering with social and occupational functioning.There are two clinical and three histopathological forms of dementia 1) primary degenerative dementia, (PDD), or Alzheimer's dementia/Senile dementia of Alzheimers type (AD/SDAT) which is associated with clinical features of uniform progression and insidious onset of symptoms and histopathologically i- dentified by the occurrence of neurofibrillary tangles (NFT) and senile/neuritic plaques (SP/NP) in various cortical and subcor- tical regions; 2) vascular dementia, or multi-infarct dementia (MID), which is associated with clinical features of stepwise progress and patchy distribution of deficits, and histopathologically identified by the occurrence of multiple large and/or small haemorrhagic and/or ischaemic infarcts in various cortical and subcortical regions and 3) intermediate form of dementia or "mixed” ("combined") dementia (AD-MID), which is histopatho- logically associated with the coexistance of symptoms and lesions observed in AD/SDAT and MID, and clinically referred to the MID group. The DSM-III criteria separate the demented into two groups, AD/SDAT and MID, while there are no unique clinical criteria for the AD-MID patients. The clinical diagnosis of dementia according to the DSM-III criteria was shown to be insufficient . Histopathological diagnostic criteria were postulated by us for 1) pathological changes developing in mentallyunimpaired ageing, 2) AD/ SPAT, 3) MID and 4) AD-MID.These histopathological classes could be separated, by means of multivariate data analysis. The pathology in AD-MID was shown not to be merely a linear combination of the AD/SDATand MID pathology.Intrathecal synthesis of Ig, oligoclonal bands or other abnormal proteins in the CSF could not be demonstrated in aged non-demen- ted and demented patients.The blood-cerebrospinal barrier (B-CSF-B) or blood-brain barrier (BBB) function alters with age and this alteration was shown to be more pronounced in MID and AD-MID patients. In MID and AD-MID patients the BBB alteration involves primarily the grey matter while in AD/SDAT patients the alteration would appear to involve only the white matter. The BBB dysfunction and a possible complement activation, either through antibody-anti- gen activation or other complement activators, was visualized in MID and AD-MID patients as perivascular serum protein deposits in the grey matter, always with a capillary in the center. The occurrence of some serum proteins in plaques, and the previously descibed localization of plaques in close relationship to the capillaries, suggest that altered BBB function and serum factors may be involved in the etiology and maturation of plaques while the etiology and maturation of tangles may not be directly dependent on these factors, as they were never labelled with any of the antisera studied.
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| 8. |
- Steen, B., et al.
(författare)
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Body composition in the elderly estimated with an electrical impedance method.
- 1987
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Ingår i: Comprehensive gerontology. Section A, Clinical and laboratory sciences. - 0902-0071. ; 1:3, s. 102-105
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of the present study was to test the reliability and validity of a new electrical impedance method for estimating body composition in 35 healthy persons and patients in different sex and age groups, and to obtain basal data on the size of different body composition compartments in elderly individuals in health and disease. The reliability studies showed no significant differences with the new method in intraindividual comparisons before and after changing the positions of the electrodes, drinking of water, and overnight fasting, as well as at a double estimation on 2 consecutive days. The results with this method are compared to results from measurements of total body potassium and total body water, and from a four-compartment model technique using total body potassium and total body water. We conclude that the method has an acceptable reliability and validity and should be of great value not only in field studies but also in clinical practice. Data on body composition with the electrical impedance method are obtained from 147 individuals in different groups, namely healthy females, 80-81-year-old males, female patients from a nursing home, and patients of both sexes from a day care unit.
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