| 1. |
- Minthon, Lennart, et al.
(författare)
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Tacrine treatment modifies cerebrospinal fluid neuropeptide levels in Alzheimer's disease
- 1994
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Ingår i: Dementia (Switzerland). - : S. Karger AG. - 1013-7424. ; 5:6, s. 295-301
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Tidskriftsartikel (refereegranskat)abstract
- Biochemical and histochemical studies have demonstrated a widespread deficit in the activity of acetylcholinesterase (AChE) in the brains of patients with Alzheimer's disease (DAT). Multiple disturbances in several transmitter systems have been found. The most consistent neurochemical changes in DAT are reductions in the cholinergic system. The major pharmacological approach today in DAT is based on the cholinergic theory assuming that acetylcholine has a major cortical impact on cognitive processes. Tetrahydroaminoacridine (THA, tacrine) is a centrally active reversible acetylcholinesterase inhibitor. A large number of trials have been performed in patients with DAT. This article was to evaluate whether THA treatment induced neuropeptide alteration in DAT before and after 1 year on oral THA treatment.
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| 2. |
- Elfgren, C., et al.
(författare)
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Neuropsychological tests as discriminators between dementia of Alzheimer type and frontotemporal dementia
- 1994
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Ingår i: International Journal of Geriatric Psychiatry. - : Wiley. - 1099-1166 .- 0885-6230. ; 9:8, s. 635-642
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to examine whether cognitive test performance alone could distinguish patients with dementia of Alzheimer type (DAT) from those with frontotemporal dementia (FTD). Scores from three neuropsychological tests were used as discriminating variables in 28 cases with postmortem verified diagnoses. The selected tests measured verbal ability, visuospatial ability and verbal memory. Eighty-nine per cent of the sample was correctly classified by discriminant analysis. Evaluating the ability of the obtained discriminant function to differentiate between groups of DAT and FTD in a new, clinically diagnosed sample of 38 cases yielded an overall success rate of 84%. The results suggest that cognitive tests may be helpful for differential diagnosis in the context of a neuropsychiatric examination.
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| 3. |
- Elmstahl, S., et al.
(författare)
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Body composition in patients with Alzheimer's disease and healthy controls
- 1992
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Ingår i: Journal of Clinical and Experimental Gerontology. - 0192-1193. ; 14:1, s. 17-31
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Tidskriftsartikel (refereegranskat)abstract
- In Alzheimer's disease (AD), decreased physical activity and nutritional problems are parts of the natural course with probable implications on body composition. Body fat and lean body mass were measured with a bioelectrical impedance method in 25 women who had AD according to the criteria of NINCDS- ADRDA and in 63 health age-matched controls. The patients with AD had 9.5 kg lower body weight (p<0.01), due to almost 4.0 kg lower body fat and 6.0 kg lower lean body mass (p<0.001). This might imply a higher risk for morbidity and mortality. Body weight and lean body mass decreased with age in AD patients but not in the healthy control women. In the control group, the unmarried women had more than 13 kg lower body weight and 9 kg lower body fat than the mean values of all other marital status groups (p<0.01). The maintenance of lean body mass in the very healthy old indicate the possibilities for physical activity.
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| 4. |
- Elmstahl, S., et al.
(författare)
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Quantitative EEG in elderly patients with Alzheimer's disease and healthy controls
- 1994
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Ingår i: Dementia (Switzerland). - : S. Karger AG. - 1013-7424. ; 5:2, s. 119-124
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Tidskriftsartikel (refereegranskat)abstract
- Multichannel (19) EEG were analyzed in 23 female patients with rather advanced late-onset Alzheimer's disease (AD) and compared with 56 age- and sex-matched healthy control subjects. The quantified EEG was correlated with psychometric and clinical variables. The control subjects showed increasing theta activity with age but the EEG changes did not correlate significantly with psychometric features. The AD patients showed highly significant increases in delta and theta activity and decreases in beta activity compared with controls. The EEG changes were most marked over posterior regions of the brain. The individual EEG variables showed a high degree of intercorrelation and an almost complete discrimination between patients and controls was accomplished by taking only the posterior delta activity into account. In a subgroup of 10 patients, in which a Mini Mental test score could be obtained, the score correlated with the relative theta power.
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| 5. |
- Elmståhl, Sölve, et al.
(författare)
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Autonomic cardiovascular responses to tilting in patients with alzheimer's disease and in healthy elderly women
- 1992
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Ingår i: Age and Ageing. - : Oxford University Press (OUP). - 0002-0729 .- 1468-2834. ; 21:4, s. 301-307
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Tidskriftsartikel (refereegranskat)abstract
- The cardiovascular responses to tilting and breathing were studied in 24 patients with late-onset Alzheimer's disease (AD) and 54 healthy control women aged between 75 and 96 years in order to study the parasympathetic and sympathetic heart-rate control. The cardiovascular response to tilting and breathing showed no age-associated decrease in the healthy control women. During rest, the AD patients had lower mean systolic and diastolic blood pressure but the same heart rate as the control patients. After tilting, the AD patients had a greater increase in heart rate, and the mean systolic blood pressure fell to 126 mmHg compared with 160 mmHg in the control women (p<0.001). After the initial acceleration, the following deceleration of the heart rate, an expression of parasympathetic nervous activity, was lower in the AD patients (p <0.001). The deep-breathing test showed no significant difference between the two groups, but the changes of acceleration and brake indices could indicate a dysfunction of the autonomic nervous system since the AD patients were not recumbent.
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| 6. |
- Rahm Hallberg, Ingalill, 1944-
(författare)
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Vocally disruptive behaviour in severely demented patients in relation to institutional care provided
- 1990
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Thirty-seven patients identified as vocally disruptive and a control group, selected from 264 patients at psychogeriatric wards were studied. Tape-recordings of their vocal behaviour, ratings of their functional performance and symptoms related to dementia, observations of their behaviour, activities and interaction with caregivers were performed. Seventeen plus sixteen caregivers were interviewed to give their interpretation of the experience behind the behaviour and describe their own experience of it. The severely demented vocally disruptive patients were found to be significantly more physically dependant, disorientated at the ward and prone to confusional reactions but they had a more preserved speech performance than the controls. The vocal activity expressed such as helplessness, pain, fear and protest. Some were emotionally indifferent and a few expressed positive emotions. Caregivers interpreted the behaviour as an expression of anxiety related to such as abandonment, dissolution and loss of autonomy. They also expressed a strong wish to comfort the patients but felt unable to do so. The patients' daily life was characterized by idleness and solitude. Caring activities and interactions were dominated by physical procedures performed in a fragmentary and rapid way. Two hypotheses are generated. 1. Vocally disruptive behaviour develops influenced by sensory deprivation and the brain damage. 2. The care provided is influenced by caregivers experiencing anxiety in the patients as well as experiencing a conflict between the care they would like to provide and the care they actually provide. This evokes anxiety in them which elicits defence mechanisms leading to emotional withdrawal from the patients and task oriented care. The results are discussed in a nursing perspective based on existential thoughts, psychoanalytic and psychosocial theory.
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| 7. |
- Åkerlund, Britt Mari, 1943-
(författare)
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Dementia care in an ethical perspective : an exploratory study of caregivers' experiences of ethical conflicts when feeding severely demented patients
- 1990
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this study was to explore how caregivers caring for severely demented patients experience ethical conflict situations. Feeding patients in a late state of dementia was chosen as focus. Special attention was paid to analyses of the caregivers' experiences with regard to their feelings, use of force, interpretations of the patients' behaviour and their ethical reasoning.The study was carried out in five separate parts, presented as five papers. A phenomenological - hermeneutic approach was consistent. Personal interviews, a projective defence mechanism test, the Meta Contrast Technique and an analysis of patient/caregiver behaviour as shown in video taped feeding sessions were the methods used.Study participants were forty-one caregivers in psychogeriatric care, registered nurses, licensed practical nurses and nurses' assistants.The result indicated that, when facing ethical decisions the caregivers were caught in a double bind conflict due to the contradicting ethical demands "Keep the patient alive!" and "Don't cause the patient suffering!". The difficulty to interpret what the patients experienced and the impossibility to know for sure what actions would be right or wrong were sources of anxiety. They defined force feeding individually, yet a pattern was found. Some caregivers defined force feeding according to the amount of persuasiveness or violence they had to perform. Some regarded force feeding from a patient wish perspective. A majority combined the two dimensions.The caregivers' ethical reasoning showed that their decision making was to be regarded as a process grounded on ethical rules. Interdependence in the relation caregiver/patient made them develop their reasoning in a direction of existential reasoning.
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| 8. |
- Åström, Sture, 1946-
(författare)
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Attitudes, empathy and burnout among staff in geriatric and psychogeriatric care
- 1990
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This study concerned assessments of attitudes towards demented patients among students and nursing staff as well as attitudes towards active euthanasia, wish to transfer to other jobs, ability of empathy and experience of burnout among nursing staff. The study aimed also to relate experience of burnout to attitudes towards demented patients, ability of empathy and experience of work with demented patients. The study was performed by use of questionnaires, scales measuring attitudes towards demented patients, experience of burnout and ability of empathy. Tape-recorded interviews were also included aiming to explore the staffs experience at work.The results showed that a majority of the students and staff held positive attitudes towards demented patients. A small proportion intended to work solely with demented patients. Staff working in psychogeriatric care and somatic long-term care held more positive attitudes than staff working in acute medical care. Proportions of staff with positive attitudes varied depending on age, duration of employment, education and place of work. A larger proportion of staff in geriatric care than in acute care reported a wish to transfer to another job. LPN’s in nursing homes to the largest proportion stated this wish to transfer.A majority of both students and staff expressed negative attitudes towards active euthanasia to severely demented patients in the finale stage of life. However, most favourable attitudes towards active euthanasia were found among students with shorter health care education and among nurse's aides and LPN’s.The staffs empathy was judged as moderately high and there were no differences found in relation to sex, staff category or place of work.Experience of burnout /tedium varied with the place of work and category of staff. Largest proportions at risk to develop burnout were found among those working in somatic long-term care and psychogeriatric care. RN’s showed lower burnout scores than nurse's aides and LPN’s.Experience of burnout was correlated to attitudes towards demented patients, indicating that the lower burnout score the staff have the more positive are the attitudes. Burnout was also related to the staffs ability of empathy i.e. the lower degree of burnout the higher is the empathie ability. Regression analysis showed that "Experience of feed-back at work” and "Time spent at present place of work" were the most important factors for the staffs experience of burnout.
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