| 1. |
- Söderquist, Fanny
(författare)
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Melatonin in the gastrointestinal tract
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Melatonin is recognised as the pineal hormone regulating sleep and circadian rhythm. It has also been identified in peripheral tissues (mainly in animals) and thought to display a variety of actions, including anti-inflammatory properties, regulation of gastrointestinal (GI) functions, glucose homeostasis and beneficial effects in different tumour types. Patients with irritable bowel disorder commonly exhibit psychiatric co-morbidity and disturbances of the gut-brain axis have been proposed to play a role in these disorders. The focus of this thesis was to study melatonin and melatonin receptors in the normal human GI tract, the pancreas and small intestinal neuroendocrine tumours. The thesis also explores the complex relationship between GI symptoms and underlying psychiatric traits in the context of elevated levels of peripheral melatonin during waking hours.In paper I-II, tissue samples from the normal human GI tract and pancreas and tumour tissue from small intestinal neuroendocrine tumours were analysed for expression of melatonin and melatonin receptors using immunohistochemistry. For tumour patients, melatonin was also analysed in plasma and set in relation to symptoms and outcome. In paper III-IV, a cohort of young adults (18-25 years) seeking psychiatric care was examined for GI symptoms, melatonin levels in saliva, depressive symptoms and anxiety traits. Psychiatric assessments were performed using structured or semi structured interviews. Depressive symptoms were measured using the self-rating version of the Montgomery-Åsberg Depression Rating Scale; GI symptoms were measured using the Gastrointestinal Symptoms Rating Scale for Irritable Bowel Syndrome; and personality traits were evaluated using the Swedish Universities Scales of Personality.Melatonin and melatonin receptors were widely expressed in the normal human gut and pancreas (paper I) but even in small intestinal neuroendocrine tumours known to produce serotonin (paper II). The intensity of the melatonin immunoreactivity in tumour tissue was found to correlate with lower proliferation index. After treatment, plasma levels of melatonin were reduced in tumour patients. Young adult patients seeking psychiatric care reported more GI symptoms than healthy controls, regardless of the currently active psychotropic medication. The level of GI symptoms was associated with severity of depressive symptoms and trait anxiety (paper III). Higher postprandial levels of melatonin were associated with the GI symptoms of bloating and pain (paper IV).In summary, these findings demonstrate the widespread presence of melatonin in the human gut and confirm a link between melatonin, psychiatric health and GI symptoms.
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| 2. |
- Pellas, Johnny
(författare)
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Assessment and psychological treatment of depression in older adults
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Depression is one of the leading causes of disability in older adults worldwide. Many older adults with depression are undetected, and there is a need for brief, scalable psychological treatments for depression that can be delivered remotely.The aims of this thesis were 1) to investigate the diagnostic accuracy of two rating scales (PHQ-9 and GDS-15) for the detection of depression in older adults, and 2) to investigate the feasibility, preliminary efficacy and patients’ experiences of a telephone-based psychological intervention, Behavioral activation with mental imagery (BA-MI), for the treatment of depression in older adults in the context of the covid-19 pandemic. Study I showed that a cutoff of ≥6 on the GDS-15 and ≥5 on the PHQ-9 were optimal to identify major depressive disorder. When identifying both major depressive disorder and subthreshold depression, the optimal cutoff on the GDS-15 was ≥5. Study II was a randomized clinical pilot trial, CoviDep, with a treatment group receiving the BA-MI intervention, and a control group. The drop-out rate was low. Compared to the control group, the treatment group reported a decrease in depressive symptoms throughout the treatment, with a large effect-size at posttreatment. Study III was a long-term follow-up of participants in CoviDep that received the BA-MI intervention. The drop-out rate over time was low, and compared to baseline, decreases in depressive symptoms were observed with a medium effect-size at posttreatment that was maintained 1- and 3 months post-treatment but lower after 6 months. Study IV was a qualitative study. The BA-MI intervention in CoviDep was described as increasing activities and improving mood. Telephone-delivery reduced barriers due to pandemic restrictions but felt less personal and lacking non-verbal communication. Being recognized and talking to a therapist every week was healing, but the manualized mode of treatment seemed to impair the relationship.In sum, this thesis shows that both the GDS-15 and the PHQ-9 are useful tools for the detection of depression in older adults, and adds to the support for telephone-delivered BA for the treatment of depression and indicates that MI-interventions are feasible as an augmentation of BA in older adults.
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| 3. |
- Gingnell, Malin, 1982-
(författare)
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Ovarian Steroid Hormones, Emotion Processing and Mood
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- It is known that some psychiatric disorders may deteriorate in relation to the menstrual cycle. However, in some conditions, such as premenstrual dysphoric disorder (PMDD), symptomatology is triggered mainly by the variations in ovarian steroid hormones. Although symptoms induced by fluctuations in ovarian steroids often are affective, little is known about how emotion processing in women is influenced by variations, or actual levels, of ovarian steroid hormones.The general aim of this thesis was to evaluate menstrual cycle effects on reactivity in emotion generating and controlling areas in the corticolimbic system to emotional stimulation and anticipation, in healthy controls and women with PMDD. A second aim was to evaluate corticolimbic reactivity during long-term administration of exogenous ovarian steroids.In study I, III and IV effects of the menstrual cycle on emotional reactivity in women with PMDD was studied. In study I, women with PMDD in displayed higher amygdala reactivity than healthy controls to emotional faces, not in the luteal phase as was hypothesised, but in the follicular phase. No difference between menstrual cycle phases was obtained in women with PMDD, while healthy controls had an increased reactivity in the luteal phase. The results of study I was further elaborated in study III, where women with PMDD were observed to have an increased anticipatory reactivity to negative emotional stimuli. However, no differences in amygdala reactivity to emotional stimuli were obtained across the menstrual cycle. Finally, in study IV the hypothesis that amygdala reactivity increase in the luteal phase in women with PMDD is linked to social stimuli rather than generally arousing stimuli was suggested, tested and supported.In study II, re-exposure to COC induced mood symptoms de novo in women with a previous history of COC-induced adverse mood. Women treated with COC reported increased levels of mood symptoms both as compared to before treatment, and as compared to the placebo group. There was a relatively strong correlation between depressive scores before and during treatment. The effects of repeated COC administration on subjective measures and brain function were however dissociated with increased aversive experiences accompanied by reduced reactivity in the insular cortex.
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| 4. |
- Edebol, Hanna, 1984-
(författare)
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Global Assessment of Attention Deficit Hyperactivity Disorder : Examining Objective Measures of Hyperactivity, Impulsivity and Inattention in Adults
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this thesis is to examine objective laboratory measures of Attention Deficit Hyperactivity Disorder (ADHD) in adult persons and to develop measures for diagnosis and treatment using a psychometric instrument called the Quantified Behavior Test Plus. The instrument objectively quantifies cardinal symptom manifestations in adult ADHD using motion tracking devices and continuous performance testing. Paper I-IV suggest that ADHD predisposes adult persons to perform poorer on continuous performance tasks and to have higher levels of motor activity while performing these tasks as compared to other clinical as well as non-clinical groups. Performance by adults with ADHD is normalized following stimulant treatment which implicates therapeutic effects and measures of response to treatment and remission for ADHD is suggested.Paper I concludes that the psychometric instrument needs to be calibrated with regard to adult ADHD and emphasizes the importance of a composite measure for the disorder. Paper II generates two new measures, the Weighed Core Symptom scale (WCS) - a composite measure of adult ADHD ranging from 0 to 100, and Prediction of ADHD (PADHD) - a categorical variable of the diagnostic status with good predictive power. A majority of participants with ADHD has low points on WCS (indicating high levels of symptoms) and a majority of non-ADHD normative participants has high points on WCS (indicating low levels of symptoms). Paper III examines WCS and PADHD among complex clinical groups with shared symptoms vis-à-vis ADHD. Here, findings from Paper II are replicated since participants with ADHD present the highest level of global symptoms, followed by participants with bipolar II disorder and borderline personality disorder, participant with diconfirmed ADHD and finally, non-clinical participants has the lowest level of global symptoms. In Paper IV, the measures are proposed as indications of response to treatment and remission after titration with stimulant treatment and WCS indicates response to small changes in dose level.The major findings of the present thesis may be summarized as the construction of two new objective measures for ADHD in adult persons with practical implications for diagnosis and treatment. Hyperactivity is the most specific marker of ADHD in both men and women, followed by the cognitive markers of inattention and impulsivity. The composite measure, WCS, quantifies the global amount of ADHD symptoms and provides the most sensitive measure for the disorder. PADHD and WCS may not replace a thorough neuropsychiatric assessment and further studies promoting diagnostic subtype stratification is suggested. Future studies may want to consider these measures in outcome-based investigations of treatment efficacy as well as in the study of neuropsychological endophenotypes. Practical implications include clinical strategies to enhance objectivity during assessment as well as optimizing beneficial effects of treatment and attaining remission.
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| 5. |
- Aho, Nikolas, 1970-
(författare)
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Victimization, Prevalence, Health and Peritraumatic Reactions in Swedish Adolescents
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this thesis was to expand the knowledge of victimization in children and youth in Sweden. Victimization, prevalence, health and peritraumatic reactions were explored in a cross sectional, representative sample of 5,960 second grade high school students in Sweden. A computerized survey was developed and administered in class room setting.Lifetime victimization was found in 84.1% of the sample (m=83.0%, f=85.2%), and, in relation to the five domains, 66.4% had experienced conventional crime, 24% child maltreatment, 54.4% peer and sibling victimization, 21.8% sexual victimization, and 54% had experienced witness victimization. Females experienced significantly more child maltreatment, peer and sibling victimization, sexual victimization, and witnessed victimization, males more conventional crime (p<0.001). Using logistic regression risk factors for victimization were confirmed by a significant increase OR regarding gender, environment and lack of both parents.Symptoms (TSCC), were clearly associated with both victimizations per se and the number of victimizations. The results indicated a relatively linear increase in symptoms with an increase in number of events experienced. Mental health of the polyvictimized group was significantly worse than that of the non-polyvictimized group, with significantly elevated TSCC scores (t<0.001). Hierarchical regression analysis resulted in beta value reduction when polyvictimization was introduced supporting the independent effect on symptoms. Social anxiety was found in 10.2 % (n = 605) of the total group (n = 5,960). A significant gender difference emerged, with more females than males reporting social anxiety. Elevated PTSS was found in 14.8 % (n=883). Binary logistic regression revealed the highest OR for having had contact with child and adolescent psychiatry was found for the combined group with social anxiety and elevated PTSS (OR = 4.88, 95 % CI = 3.53–6.73, p<001). Significant associations were also found between use of child and adolescent psychiatry and female gender (OR = 2.05, 95 % CI = 1.70–2.45), Swedish birth origin (OR = 1.68, 95 % CI = 1.16–2.42) and living in a small municipality (OR = 1.33, 95 % CI = 1.02–1.73).Mediation models used peritraumatic reactions (PT): total, physiological arousal (PA), peritraumatic dissociation (PD), and intervention thoughts (IT) and JVQ and TSCC. Of the n=5,332 cases, a total of n=4,483 (84.1%) reported at least one victimizing event (m = 83.0%, f = 85.2%). Of these, 74.9% (n=3,360) also experienced a PT reaction of some kind. The effect mediated by PT tot was b= 0.479, BCa CI [0.342 – 0.640], representing a relatively small effect of 7.6%, κ2=0.076, 95% BCa CI [0.054- 0.101]. The mediating effect of JVQ on TSCC was mediated by PD more for males (b=0.394 BCa CI [0.170-0.636]) than for females (b=0.247, BCa CI [0.021-0.469]). The indirect effect of the JVQ on the TSCC tot mediated by the different PT reactions was significant for PD (b=0.355, BCa CI [0.199- 0.523]. In males a mediating effect of PD could be seen in the different models, while females had a more mixed result. IT did not show any indirect effect in males, but had a mixed effect for females.The empirical findings in this thesis lead to the conclusion that victimization is highly prevalent in children and youth and is related to health issues. The association of victimization on symptoms was mediated by peritraumatic reactions. Using a comprehensive instrument such as the JVQ provides the researcher or clinician the opportunity to acquire more complete measurement and also makes it possible to identify polyvictimization, a high-level category of events with severe impact on health.
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| 6. |
- Johansson Capusan, Andrea, 1970-
(författare)
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Environmental and Genetic Influences in Attention Deficit Hyperactivity Disorder (ADHD) and its Comorbidities
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Research in past decades has demonstrated the persistence of attention deficit hyperactivity disorder (ADHD) into adulthood, but many questions regarding prevalence, causes, and comorbidities of ADHD in adults remain to be investigated. Previous research focusing on childhood ADHD identified high heritability. Genetic and environmental influences on ADHD symptoms in adults and their association with comorbid conditions are not fully understood.The overall aim of this thesis was to study adult ADHD symptoms in the population and investigate associations with substance use disorders (SUD) and binge eating. In all four papers, we used population-based self-report data from twins aged 20–46 years from the Swedish Twin Registry. We used twin methods to explore the role of genetic and environmental factors underlying ADHD symptoms and their comorbidities.Study I examined the phenotypic association between ADHD and various forms of SUD. ADHD in adults was strongly associated with alcohol abuse and alcohol dependence, illicit drug use and regular nicotine use, with no differences between ADHD subtypes and no apparent substance preference. In Studies II and IV, we used bivariate twin models to examine the role of genetic and environmental factors in the association of adult ADHD symptoms with alcohol dependence (II) and with binge eating (IV). For ADHD symptoms and alcohol dependence, 64% of the overlap was explained by common genetic factors. The remaining variance was accounted for by environmental factors specific for each twin, with no sex differences for the overlap. Similarly, 91% of the association between ADHD symptoms and binge-eating behaviour was explained by common genetic factors. In Study III, using a within-twin pair analysis, we demonstrated that although most of the association between adult ADHD symptoms and self-reported childhood maltreatment (an environmental risk factor for ADHD) was explained by familial (genetic and environmental) confounding, our results were also consistent with a causal interpretation.In conclusion, adult ADHD symptoms are associated with SUD and binge-eating behaviour. We replicated findings from adolescent studies regarding shared genetic risk factors for alcohol dependence and ADHD symptoms in adults. For binge eating, we showed for the first time that shared genetic factors mainly explained the association with ADHD symptoms. Alterations in mesolimbic reward processing as well as the frontal, executive and inhibitory systems have been described for ADHD, alcohol dependence and binge-eating behaviour, possibly suggesting common genetic and neurobiological factors for all three conditions. Results that support a causal hypothesis regarding the association between childhood maltreatment and ADHD symptoms in adults need follow-up in longitudinal clinical samples that can examine neurobiological underpinnings of environmental effects. Clinically, the results of this thesis support that ADHD in adults be considered and addressed in adults with SUD or binge-eating behaviour. Given the common genetic risk factors and the role of the early childhood environment, family interventions should be considered for these populations.
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| 7. |
- Kastbom, Åsa A., 1971-
(författare)
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Sexual behaviour, debut and identity among Swedish Schoolchildren
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Sexual behaviour among schoolchildren and adolescents is a sparsely researched area and there are delicate methodological obstacles and ethical concerns when conducting such research. Still it is a subject that engages both parents and professionals. A sexualized behaviour or an early sexual debut (younger than 14 years) can be a sign of sexual abuse. It is therefore of importance to describe what is common and what is uncommon sexual behaviour among children and what the consequences of an early or a late sexual debut may be for the individual upon reaching late adolescence. Adolescents who identify themselves as lesbian, gay or bisexual (LGB) are also a group that needs further attention and research since they are often described as having a lower quality of life and more often experience child abuse than heterosexual teens.Aims: The research leading to this thesis had four goals: 1) to elucidate the sexual behaviour of children between the ages of 7 and 13 as observed by their parents, 2) to investigate the relationship between an early sexual debut (before 14 years of age) and socio-demographic data, sexual experience, health, experience of child abuse and behaviour at 18-years-of-age, 3) to explore associations with no sexual debut (no oral, vaginal or anal sex) at the age of 18, and 4) to describe the relationship between sexual identification and socio-demographic background data, sexual behaviour, health and health behaviour, experiences of child sexual and/or physical abuse and present behaviour among Swedish adolescents.Methods: The parents of 418 children answered questionnaires about their child’s behaviour, both general and sexual, and a sample of 3432 Swedish high school students completed a survey about sexuality, health and abuse at the age of 18. In addition, 362 members of the Swedish Federation for Lesbian, Gay, Bisexual and Transgender Rights (RFSL) completed the same survey at a mean age of 21.4 years.Results: Most of the sexual behaviours among the schoolchildren were common, and in part related to, or varied with, age and gender. A small number of sexual behaviours often referred to as sexualised or problematic behaviours (for example, kissing adults with the tongue, imitating intercourse, masturbating in public, and touching other children’s genitals with the mouth) were found to be very unusual or not reported by any parent in this normative group of Swedish children. Among the adolescents, an early debut (younger than 14 years of age) correlated positively with number of partners, experience of oral and anal sex, smoking, drug and alcohol use and antisocial behaviour, such as being violent, lying, stealing and running away from home. Girls with an early sexual debut had significantly more experience of sexual abuse while boys with an early sexual debut were more likely to have a weak sense of coherence, low self-esteem and poor mental health, together with experience of sexual abuse, selling sex and physical abuse. A multiple logistic regression model showed that a number of antisocial acts and health behaviours remained significant, but early sexual debut did not increase the risk of psychiatric symptoms, low self-esteem or low sense of coherence at 18-years-of-age. Just under a quarter (24.6%) of the 3,380 adolescents had not had their sexual debut (no oral, anal or vaginal sex by the age of 18). There was a positive correlation between not debuting sexually at age 18 and a number of factors such as: being more likely to have caring fathers; parents born outside Europe; low sexual desire; lower pornography consumption; lower alcohol and tobacco consumption; less antisocial behavior and fewer experiences of sexual abuse than 18 year olds who had already made their sexua debut. Adolescents with a minority sexual identity more often described their relationship with their parents as based on low care and high overprotection than did their heterosexual peers. The minority adolescents used alcohol and drugs to a significantly higher degree than the heterosexual adolescents. Multivariate analysis showed a positive correlation between a minority sexual identity and experience of anal sex, higher sexual lust, experience of sexual abuse, physical abuse and sexual exploitation. It was more than twice as common to have experience of penetrating sexual abuse and physical abuse with a sexual minority identity.Conclusions: Behaviours usually referred to as sexualised and problematic are uncommon among children at 7-13 years of age. Professionals and should give a child showing a sexualised behaviour special attention and investigate the reasons for the behaviour. Early sexual debut seems to be associated with problematic behaviours during later adolescence, indicating the fact that the early debut for some children is associated with an increased vulnerability, which has to be addressed. Family socio-demographics such as family stability and/or cultural status matter when it comes to time of sexual debut. Personality also seems to matter and further studies are needed to investigate if there is any correlation between personality traits and late sexual debut. Adolescents with no sexual debut at 18 years of age reported fewer antisocial acts, were less likely to smoke and drink alcohol, had less sexual desire and less experience of sexual abuse. Young people with a sexual minority identity (homo- and bisexual) could be seen to have a lower quality of life compared to heterosexual peers and studies need to be done to further explore possible reasons. They have a higher risk of having experience of sexual and physical abuse compared to heterosexual adolescents. Professionals need to be more aware of this group’s additional vulnerability including the increased risk of child abuse and offer different forms of support.
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| 8. |
- Ståhlberg, Ola
(författare)
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Comorbidity across childhood-onset neuropsychiatric disorders
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Attention-Deficit/Hyperactivity Disorder (ADHD), and Autism Spectrum Disorders (ASDs) are clinically found to be comorbid with each other and with other psychiatric conditions to a greater extent than what is previously assumed. It is, however, difficult to capture this complexity using current diagnostic systems, where exclusion criteria prevent simultaneous diagnosis. Thus, in order to describe this complexity and its consequences for the individual, it is important to describe actual comorbidity in different clinical contexts. Aims: The overall purpose of this thesis was to describe the prevalence and comorbidity between ASD and ADHD, and other psychiatric conditions. Specific aims were to: describe comorbidity in a group of adult out-patients with ADHD and/or ASDs (Paper I); investigate the prevalence of personality disorders and describe the personality profiles of the same group (Paper II); describe psychiatric symptoms associated with aggressive behaviors in adult psychiatric patients (Paper III); describe comorbidity in a group of adolescents placed in special youth institutions (Paper IV); and to investigate whether comorbid ADHD and substance abuse is associated with a more negative outcome, that is, more criminal recidivism, health care needs, and untimely death (Paper V). Methods and results: Paper I-II are based on diagnostic and demographic cross-sectional data showing that ADHD and ASD overlap greatly with each other, and that there is a significant overlap between ADHD and bipolar disorder and ASDs and psychosis. Personality disorder diagnoses are also common in these diagnostic groups, showing specific personality profiles associated with ADHD, ASD, and those with comorbid ADHD and ASD. In Paper III aggressive behaviors in a group of policlinic psychiatric patients have been compared with a group of forensic psychiatric patients, and both groups reported similar high levels of aggressive scores. Paper IV is based on cross-sectional data on institutionalized adolescents, which in Paper V has been combined with longitudinal follow-up data. Psychiatric diagnoses in general, and specifically the occurrence of ADHD and ASD, is high. Criminal recidivism and health care use was overall very high, while there were small differences between the groups with comorbid ADHD and SUD, SUD only, and, finally, no SUD in respect to criminal recidivism, health care needs and untimely death. Conclusion: Comorbidity between ADHD and ASD and other psychiatric diagnoses are common among psychiatric patients, and in many cases associated with character immaturity, aggression and personality disorders. It also seems as the outcome over time tends to worsening with increasing comorbidity, especially in cases with comorbid substance abuse and neuropsychiatric disorders. These complex states constitute diagnostic and treatment challenges for psychiatry and its classic divisions between child and adolescent versus adult psychiatry, mental illness versus personality disorders, and psychological versus medical interventions.
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| 9. |
- Westman Andersson, Gunilla
(författare)
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Autism in preschoolers - assessment, diagnostic and gender aspects
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Very early assessment of young boys and girls with suspected autism spectrum disorders (ASD) is widely advocated, but knowledge is limited. Aims: Evaluate methods used in assessment of young children with suspected ASD, identify possible gender differences in clinical presentation, and examine parent/teacher experiences of the diagnostic process. Material and methods: Children (under age 4 years) were recruited after general population screening for ASD in Gothenburg. Different approaches - observation, formal testing, interview, and questionnaire - were used in four sub-studies (I-IV), each relating to 6-20 girls and 20-31 boys. Preschool free-field observation made by an education specialist was compared with structured clinic observation (I). Agreement across clinical first impressions and between such impressions and final comprehensive diagnosis was examined for independent members of a multidisciplinary team (II). Girls and boys were compared as regards diagnosis, developmental profiles and global functioning (III). Parent/teacher experience of assessment was examined (IV). Results: Agreement between observation in preschool and clinic was very good. Preschool observation and parent interview showed good agreement with final diagnosis. No clinical presentation gender differences were found, and correlations between results obtained in different developmental areas were strong. Parents and teachers were satisfied with the assessment and diagnostic process and did not regret that they had taken part in it. Conclusions: Girls and boys with ASD problems identified before 4 years of age are very similar. Preschool observation should be included in the diagnostic process, multidisciplinary assessments are crucial, and early diagnosis is considered important both by parents and preschool teachers.
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| 10. |
- Andin, Ulla
(författare)
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Vascular dementia - classification and clinical correlates
- 2007
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- During the period (1976-1995) a total of 175 consecutive patients (m 88/f 87) with neuropathologically verified vascular dementia (VaD) were examined. 22 patients with pure Alzheimer's Disease (AD) were also studied. All patients were diagnosed and followed at the Department of Psychogeriatrics (Lund University Hospital). The neuropathological examination revealed VaD, sometimes with additional contribution of Alzheimer pathology. The cases were classified as Large Vessel Dementia (LVD), Small Vessel Dementia (SVD) and Hypoperfusive Hypoxic-ischemic Dementia (HHD). The mean age at death was 80 years (range 54-100) and almost identical in the three groups.The results show that VaD is neuropathologically heterogeneous, characterized by one, two or all three types of vascular pathology. The majority of cases (126/175), showed more than one type of brain pathology (vascular or in combination with Alzheimer pathology). There was a large coexistence with Alzheimer pathology (65% of the total 175 cases). 49 cases were pure, with only one type of vascular pathology. SVD was the largest pure group (21% of the total 175 cases). Post mortem verified heart pathology, was twice as common in SVD as in LVD and HHD.Cardio-cerebrovascular features (arrhythmia, congestive heart failure, cardiac infarction, hypertension, orthostatic hypotension and TIA/stroke) were more common in LVD and SVD, than in HHD. The coexistence of Alzheimer pathology did not change these results.Dizziness and unsteadiness or falls were reported in 102 of the 175 VaD patients. Dizziness correlated with hypertension and orthostatic hypotension while unsteadiness correlated only with hypertension. Falls correlated strongly to the use of neuroleptics and hypnotics.Hallucinations/delusions and delirium were reported in many patients and most common in the groups with pure LVD, pure SVD and especially in the SVD with combined Alzheimer pathology.Cardio-cerebrovascular features were more common in patients with AD combined with white matter pathology than those with pure AD. This study illustrates the neuropathological and clinical heterogeneity in VaD. This is of great importance for the understanding, treatment and care of the individual suffering from VaD.
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