| 61. |
- Pellfolk, Tony, 1976-, et al.
(författare)
-
Risk factors for falls among residents with dementia living in group dwellings
- 2009
-
Ingår i: International psychogeriatrics. - United Kingdom : Cambridge University Press. - 1041-6102 .- 1741-203X. ; 21:1, s. 187-194
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Falls are a major cause of morbidity and mortality among elderly people, and people with dementia run an increased risk of falling. The aim of this study is to identify risk factors for falls in people with dementia. METHOD: The study was performed over a six-month period in northern Sweden using a sample of 160 residents living in 20 group dwellings for people with dementia. RESULTS: Sixty-four residents (40%) sustained at least one fall during the period. The total number of falls during the study period was 191, and the fall incidence was 2.6 per person year (169 falls/130 residents). Using logistic regression analysis, the independent risk factors strongly associated with falling were: requiring help with hygiene, displaying verbally disruptive/attention-seeking behavior, able to rise from a chair, walking with assistive devices, and participating in outdoor walks. These factors explained 36.1% of the variance in falls with a concordance of 79.6%. Thirty-five percent of the falls occurred between 9 pm and 6 am, with a peak between 5 pm and 6 pm. Symptoms preceding the falls were anxiety (31.1%) and confusion (13.3%). CONCLUSION: Among residents with dementia it is important to identify those who run an increased risk of falling and need more careful supervision, especially in the evening and during the night. In addition, the causes of anxiety and confusion have to be prevented and treated.
|
|
| 62. |
- Åberg, Anna Cristina
(författare)
-
Gender comparisons of function-related dependence pain and insecurity in geriatric rehabilitation
- 2006
-
Ingår i: Journal of Rehabilitation Medicine. - : Medical Journals Sweden AB. - 1650-1977 .- 1651-2081. ; 38:1, s. 73-79
-
Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To evaluate possible gender differences regarding the effect of intervention in geriatric rehabilitation, expressed in terms of change in function-related dependence, pain and insecurity. DESIGN: Comparative study. PARTICIPANTS: A total of 110 women and 44 men undergoing geriatric rehabilitation. METHODS: Performance-based assessments with use of the General Motor Function assessment scale. Non-parametric statistics were mainly used. RESULTS: The women showed higher degrees of function-related dependence, pain and insecurity on admission than the men. Both women and men displayed significant improvement in all 3 variables during the rehabilitation period. However, the positive changes regarding pain and insecurity were according to the analyses of systematic group changes, at a low degree among the men, probably because of the low levels on admission. Gender comparisons of proportions with positive intervention outcome indicated that a significantly larger proportion of the women showed a positive treatment effect after intervention, with a difference in recovery of 19% in dependence, 23% in pain and 33% in insecurity (p<0.05). CONCLUSIONS: Gender differences in disability, with higher degrees of function-related dependence, pain and insecurity among women on admission for geriatric rehabilitation, can be diminished during the rehabilitation period. These promising results may have relevance for the public health of the elderly population.
|
|
| 63. |
- Nilsson, Anna-Karin, et al.
(författare)
-
C-reactive protein: vascular risk marker in elderly patients with mental illness.
- 2008
-
Ingår i: Dementia and Geriatric Cognitive Disorders. - : S. Karger AG. - 1420-8008 .- 1421-9824. ; 26:3, s. 251-256
-
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.
|
|
| 64. |
- Nilsson, Karin, et al.
(författare)
-
Association between plasma homocysteine levels and mortality in elderly patients with mental illness.
- 2009
-
Ingår i: Dementia and Geriatric Cognitive Disorders. - : S. Karger AG. - 1420-8008 .- 1421-9824. ; 27:6, s. 579-583
-
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.
|
|
| 65. |
- Nilsson, Karin, et al.
(författare)
-
Elevated plasma homocysteine concentration in elderly patients with mental illness is mainly related to the presence of vascular disease and not the diagnosis
- 2007
-
Ingår i: Dementia and Geriatric Cognitive Disorders. - : S. Karger AG. - 1420-8008 .- 1421-9824. ; 24:3, s. 162-168
-
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.
|
|
| 66. |
- Nilsson, Karin, et al.
(författare)
-
Homocysteine, cystatin C and N-terminal-pro brain natriuretic Peptide. Vascular risk markers in elderly patients with mental illness.
- 2008
-
Ingår i: Dementia and Geriatric Cognitive Disorders. - : S. Karger AG. - 1420-8008 .- 1421-9824. ; 25:1, s. 88-96
-
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.
|
|
| 67. |
|
|
| 68. |
- Nilsson, Karin, et al.
(författare)
-
Plasma Homocysteine and Vascular Disease in Psychogeriatric Patients.
- 2006
-
Ingår i: Dementia and Geriatric Cognitive Disorders. - : S. Karger AG. - 1420-8008 .- 1421-9824. ; 21:3, s. 148-154
-
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.
|
|
| 69. |
- Nilsson, Karin, et al.
(författare)
-
Plasma Homocysteine, Cobalamin/Folate Status, and Vascular Disease in a Large Population of Psychogeriatric Patients.
- 2006
-
Ingår i: Dementia and Geriatric Cognitive Disorders. - : S. Karger AG. - 1420-8008 .- 1421-9824. ; 22:4, s. 358-366
-
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.
|
|
| 70. |
- Nilsson, Karin, et al.
(författare)
-
Plasma Homocysteine Concentration and Its Relation to Symptoms of Vascular Disease in Psychogeriatric Patients.
- 2005
-
Ingår i: Dementia and Geriatric Cognitive Disorders. - : S. Karger AG. - 1420-8008 .- 1421-9824. ; 20:1, s. 35-41
-
Tidskriftsartikel (refereegranskat)abstract
- <i>Background:</i> There is a high frequency of elevated plasma total homocysteine (tHcy) concentrations in elderly patients with mental disorders. Psychogeriatric patients with a history of vascular disease exhibit a significantly higher plasma tHcy concentration than patients without vascular disease. <i>Method:</i> The main reason for the present study is to further investigate the association between plasma tHcy concentration and vascular disease in psychogeriatric patients. We therefore investigated 152 psychogeriatric patients and determined plasma tHcy and its most important determinants (serum folate and serum cobalamin, serum cystatin C and serum creatinine). The patients were divided into two groups according to the presence of vascular disease. Eighty-seven patients had concomitant vascular disease. We also analysed the natriuretic peptide N-terminal pro brain natriuretic peptide (NT-proBNP) and protein S-100B in serum. NT-proBNP is a marker for congestive heart failure, whereas protein S-100B is a marker for brain damage. <i>Results:</i> The plasma tHcy concentration is elevated in the presence of dementia or vascular disease in psychogeriatric patients. The presence of dementia or vascular disease is also associated with higher age, renal impairment and lower serum folate concentration than in patients without dementia or vascular disease. Furthermore, we observed elevated serum concentrations of NT-proBNP in patients with dementia or vascular disease as a sign of poorer cardiovascular status. Likewise, protein S-100B concentrations were elevated in patients with dementia or vascular disease, possibly indicating brain damage in these groups of patients. <i>Conclusion:</i> The high frequency of comorbidity of vascular disease and mental illness indicates a possibility to prevent and treat psychogeriatric disease by actively counteracting vascular disease in patients with psychogeriatric symptoms. Routine determination of NT-proBNP is valuable for obtaining information about cardiovascular status.
|
|
