Biomedical subjects

A Kurz

Publications and source records attributed to A Kurz.

194 records · Page 11Linked to original sources

PubMedDate not supplied

Association analysis of genes involved in cholesterol metabolism located within the linkage region on chromosome 10 and Alzheimer's disease.

Epidemiological studies identified a higher risk of developing Alzheimer's disease (AD) among subjects with elevated cholesterol levels. This association may be caused by a modulation of the amyloid precursor protein (APP) processing in response to the cellular cholesterol content. High cholesterol levels may favor the amyloidogenic pathway by inhibition of the alpha-secretase probably leading to elevated beta-Amyloid (Abeta) production. The identification of a linkage peak on chromosome 10q using high Abeta as quantitative trait led us to examine polymorphisms of genes located on chromosome 10 involved in cholesterol metabolism, like Lipase A (LIPA), Cholesterol 25 hydroxylase (CH25H), and FLJ22476, a high density lipoprotein binding related protein. Using 286 patients with AD and 162 controls we analyzed several single nucleotide polymorphisms (SNPs) within LIPA, CH25H, and FLJ22476. None of the polymorphisms showed significant association with AD which contradicts recent findings on CH25H. From our results we conclude that the investigated genetic variations do not contribute to the genetic risk of AD.

Aged↗

PubMedDate not supplied

Association of CSF apolipoprotein E, Abeta42 and cognition in Alzheimer's disease.

A significant association between CSF Abeta42 and cognition in patients with Alzheimer's disease (AD) homozygous for the epsilon3 allele of the apolipoprotein E (apoE) has been described. In this study we extended our observations on apoE, as another plaque component, and investigated the association between CSF apoE concentrations and cognitive performance after stratification for the apoE genotype in 62 patients with AD, 19 other forms of dementia and 18 controls. CSF Abeta42 and apoE concentrations were significantly and positively associated with Mini Mental State Examination (MMSE) score in AD (Abeta42: r = 0.332; P = 0.026; apoE: r = 0.386; P = 0.006). For Abeta42 this association was exclusively present in epsilon3 homozygotes (r = 0.44; P = 0.014), whereas apoE was correlated with MMSE in epsilon4 hetero- or homozygotes subjects (epsilon4/epsilonX: r = 0.638; P = 0.004: epsilon4/epsilon4; r = 0.812; P = 0.05). No association was observed between CSF concentrations of Abeta42 and apoE. The significant relationship between MMSE and CSF Abeta42 in epsilon3 homozygotes and apoE in epsilon4 hetero- and homozygotes respectively may suggest that both proteins may be associated independently from each other with cognitive decline.

Aged↗

PubMedDate not supplied

Lidocaine does not depress reflex dilation of the pupil.

BACKGROUND AND OBJECTIVES: Pupillary dilation in response to dermatomal electrical stimulation is one method of determining sensory block level during combined epidural and general anesthesia. Use of this technique may, however, be confounded by systemic absorption of epidurally administered local anesthetics. Accordingly, the effects of intravenous lidocaine on the magnitude and duration of reflex pupillary dilation were evaluated. METHODS: Six volunteers were each anesthetized twice with desflurane 3.5-6.0%. During one anesthetic, intravenous lidocaine was administered to a plasma concentration of 5.3 +/- 1.5 micrograms/mL. When the plasma concentrations were stable, a 5-second tetanic electrical stimulus was applied. Pupil size was then recorded for 8 minutes. RESULTS: Lidocaine, at plasma concentrations near 5 micrograms/mL, did not significantly alter the pupillary response to electrical stimulation. In contrast, stimulus-induced increase in heart rate was obliterated. Painful stimulation did not increase systolic blood pressure in either case. CONCLUSIONS: Typical plasma lidocaine concentrations observed during epidural anesthesia are unlikely to prevent the use of pupillary responses to evaluate sensory block level.

Adult↗

PubMedDate not supplied

[The use of a rapid infusion system in orthopedics].

Major orthopedic surgery such as partial resection of the pelvis and subsequent implantation of a prosthesis is highly connected with massive bleeding. Therefore we tested the hypothesis that the use of a rapid infusion device, which was originally designed for liver transplantations, can prevent hypovolemic shock. We studied 20 patients: in one group (n = 10) the iv volume was given in a conventional way (37 degrees C) by use of pressure infusion bags. Patients of the second group (n = 10) received the iv volume via the Rapid Infusion system (Haemonetics Corp., Braintree, MA). We can conclude that with this new device for rapid volume replacement it is possible to keep the patient's vital functions stable even during times of excessive bleeding and to prevent from metabolic consequences following hypovolemic shock.

Adult↗

PubMedDate not supplied

A 2-year follow-up of behavioural and psychological symptoms in Alzheimer's disease.

BACKGROUND: The aim was to examine the longitudinal occurrence and persistence of behavioural and psychological symptoms of dementia (BPSD) in Alzheimer's disease (AD). METHODS: Following 60 patients with mild to severe AD over a period of 2 years with annual evaluations, the prospective occurrence and persistence of BPSD in AD were determined by using the Behavioural Abnormalities in AD Rating scale (BEHAVE-AD). Clinical and demographic features of the AD patients were analysed for their association with course features of these symptoms. RESULTS: All of the 60 AD patients experienced BPSD at some point during the 2-year period, particularly agitation was present in every patient within this period. 2-year persistence of BPSD in AD was frequently observed in patients with agitation and with depressiveness, with less frequency in patients with anxiety and aggressiveness, but not in patients with delusions or hallucinations. 2-year persistent aggressiveness was associated with older age and more functional impairment. More functional impairment was also related to 2-year non-persistent hallucinations. CONCLUSIONS: Counselling AD patients and their families and tailoring therapeutic strategies should take into account the different modi of BPSD in AD occurring and persisting longitudinally and interacting with functional disturbances.

Aged↗

PubMedDate not supplied

Reduction of regional cerebral blood flow and cognitive impairment in patients with Alzheimer's disease: evaluation of an observer-independent analytic approach.

The aim of the study was to evaluate an observer-independent semiquantitative analysis of brain imaging by single-photon emission computed tomography (SPECT) in patients with Alzheimer's disease (AD). Patients (n = 45, mean age 70 +/- 11 years) with a clinical diagnosis of AD according to NINCDS/ADRDA criteria were examined by 99mTc-ethylcysteine dimer SPECT. Following anatomic normalization and data extraction using three-dimensional stereotactic surface projection, a pixelwise comparison of ECD uptake was performed with the reference values of 10 cognitive intact controls of comparable age. The global relative decrease of cerebral blood flow in cortical association areas showed a significant inverse association with the overall level of cognitive functioning as assessed with the Mini Mental State Examination and with the cognitive section (CAMCOG) of the Cambridge Mental Disorders of the Elderly Examination. There were significant region-specific associations between left temporoparietal perfusion deficit and language performance and between right temporoparietal regional cerebral blood flow reduction and praxis. The results suggest that this observer-independent analysis of SPECT data provides a valid assessment of the pattern and severity of cortical perfusion abnormalities in patients with AD.

Adult↗

PubMedDate not supplied

Deterioration of spontaneous speech in AD patients during a 1-year follow-up: homogeneity of profiles and factors associated with progression.

This longitudinal study measured the rate of spontaneous speech decline in patients with Alzheimer's disease (AD) at a 1-year follow-up and determined the effect of clinical and demographic factors on that rate. In addition the pattern of spontaneous speech impairment was examined. The expected pattern of spontaneous speech impairment with prominent disturbances of communication and semantics, moderate disturbances of automatic speech, but with retained phonematic structures, was found at baseline and at follow-up in the majority of our rather large sample (n = 63). This result is discussed in terms of intrafunctional homogeneity and of selective involvement of neuronal systems in AD. There was a trend for a more rapid language decline in patients with a family history of dementia. No relationship was detected between the rate of spontaneous speech decline and other clinical and demographic factors, with the exception of initial spontaneous speech impairment.

Aged↗

PubMedDate not supplied

Changes of the relative severity of naming, fluency and recall impairment in the course of dementia of the Alzheimer type.

In a longitudinal study of 90 patients with mild to moderate dementia of the Alzheimer type (DAT) we investigated the relative severity of impairment in a confrontation naming, a categorical word fluency and a word list recall task. Severity of impairment was assessed in comparison to a healthy age-matched control group. At baseline, confrontation naming and fluency deficits were about equally often the most severe deficit. The number of patients with most severe naming deficits increased from mild to moderate dementia and from baseline to 1-year follow-up. Word recall was the most severe deficit only in a minority of patients. An addition of lexical-semantic and visual-perceptive dysfunctions is discussed as a possible cause for the shift towards naming deficits in the course of the disease.

Aged↗

PubMedDate not supplied

Is impaired recall in dementia of the Alzheimer type a consequence of a contextual retrieval deficit?

Eighty-eight patients with mild to moderate dementia of the Alzheimer type were tested in a word list and a spatial pattern recall task. With increasing degree of dementia severity we found a decline in the initial recall scores while learning curves over five consecutive trials remained normal in the mildly demented patients. Furthermore, there was a loss of the primacy effect in the word list task in our moderately demented patients. These findings are consistent with the pattern that have been reported after medial temporal lobe dysfunction. The data are discussed in the framework of cognitive dual process theories of memory as indicators of a contextual retrieval deficit.

Aged↗

PubMedDate not supplied

[Alzheimer's disease: experience, perception and reactions of patients].

Clinical research into Alzheimer's disease has predominantly focused on standardized assessment of cognitive impairment and behavioral changes. The description of feelings and attempts of adaptation of patients with Alzheimer's disease is a neglected area. Here we present five statements, each given by a patient with Alzheimer's disease, and investigate perception and attempts of adaptation contained in these statements. Important consequences for the care of patients with Alzheimer's disease are discussed.

Adaptation, Psychological↗

PubMedDate not supplied

[The elderly patient with dementia in the family: principles of counseling relatives].

For the majority of demented elderly persons the family is the most important resource of support. Living with a demented family member lays a heavy strain on the care-givers. Appropriate counselling may reduce the care-givers' burden and enable them to be more effective. In the present report, some general guidelines of family support are proposed, summarising two years of experience in a special outpatient clinic for the demented elderly.

Adaptation, Psychological↗

PubMedDate not supplied

[Tacrine: progress in treatment of Alzheimer's disease?].

The cholinesterase inhibitor tacrine exerts a marked therapeutic effect only at a dose which is not tolerated by many patients because of the gastrointestinal side effects and hepatotoxicity of the drug. In patients who tolerate a high dose of tacrine the mean increase in cognitive abilities is roughly equivalent to the decline which occurs within 1 year in an untreated group. At a high dose tacrine may also temporarily delay the progression of symptoms of Alzheimer's disease. Only a minority of patients with mild to moderate Alzheimer's disease can be treated with tacrine. For them, however, tacrine is the most promising treatment option presently available.

Aged↗

PubMedDate not supplied

[The apolipoprotein E gene and Alzheimer disease phenotype].

The relevance of the apolipoprotein E epsilon 4 allele as risk factor for Alzheimer's disease is independent of age. This was demonstrated in 126 patients and 72 healthy controls. The age in both groups varied between 44 and 95 years. An earlier onset of symptoms among carriers of the epsilon 4 allele, however, was observed only in the oldest patients. This may reflect a selection bias which is due to the association of the epsilon 4 allele with two competitive age-dependent risks: for Alzheimer's disease and for coronary heart disease. In a subsample of 64 patients who had participated in a longitudinal study no relationship was found between the apolipoprotein E genotype and clinical symptoms or symptom progression.

Adult↗

PubMedDate not supplied

[A systematic genetic-epidemiologic family study of patients with Alzheimer disease--experience with the MIRAGE study in Germany].

A register of the families of 60 patients with Alzheimer's disease was established with two questionnaires (the Family History Questionnaire and the Patient History Questionnaire). These questionnaires, instruments of the MIRAGE study, were translated into German. 35% of the families had more than one family member affected with dementia. The frequencies of the risk factors that were studied were surprisingly high. The responses of the family members to the study were very positive and encourage further investigation in the field of genetic epidemiology in Alzheimer's disease.

Aged↗