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A Kurz

Publications and source records attributed to A Kurz.

At least 163 records · Page 9Linked to original sources
PubMed1993

Symptom progression in Alzheimer's disease: relation to onset age and familial aggregation. Results of a longitudinal study.

We investigated the hypotheses that symptom progression in Alzheimer's disease is related to onset age and familial aggregation. In a psychiatric outpatient clinic we examined a cohort of 265 consecutively admitted patients 90 of which were diagnosed mild to moderate Alzheimer's disease according to the ICD-10 research criteria. Within twelve months follow-up 73 cases of these 90 patients were investigated twice. We found that early onset cases compared to late onset cases as well as patients with a familial aggregation compared to patients without such an aggregation were no different with respect to the rate of symptom progression in Alzheimer's disease. Furthermore, the hypothesis that early onset cases with a familial aggregation more rapidly deteriorate cognitively compared to late onset cases without such an aggregation could not be confirmed. Our results suggest that the large interindividual variation of symptom progression in Alzheimer's disease cannot be explained by onset age and familial aggregation.

Aged↗
PubMed1993

Forced-air warming maintains intraoperative normothermia better than circulating-water mattresses.

The hypothesis that forced-air warming preserves core temperature better than circulating-water mattresses was tested in: (a) 16 adults undergoing major maxillofacial surgery, including radical node resection and flap reconstruction; (b) 53 adults undergoing hip arthroplasty, having approximately 25% of their body surface area available for warming; (c) 20 infants undergoing minor maxillofacial surgery; and (d) 10 young children undergoing pelvic or femoral osteotomies. Patients having each type of surgery were randomly assigned to forced-air warming (approximately 40 degrees C) or conductive warming using a full-length circulating-water mattress at 40 degrees C. Forced-air warming was applied to the legs of the adults undergoing maxillofacial surgery and to one arm, the shoulders, and the neck in the adults undergoing hip arthroplasty; a U-shaped, tubular forced-air cover was positioned around the pediatric patients. Core temperatures increased in all patients given forced-air warming and decreased or remained constant in those without active warming. Furthermore, we needed to decrease the temperature of the warmer from high to medium (approximately 37 degrees C) in most patients assigned to forced-air warming to prevent hyperthermia. After 15 h of anesthesia, rectal temperatures in the adults undergoing maxillofacial surgery were 3.4 degrees C higher in the forced-air group (P < 0.01). After 4 h of anesthesia, esophageal temperatures had increased 0.8 +/- 0.5 degrees C in the patients warmed with forced-air and decreased 0.8 +/- 0.3 degrees C in those warmed by circulating-water mattresses (P < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Thermoregulatory response thresholds during spinal anesthesia.

Reportedly, during spinal anesthesia, the shivering threshold is reduced approximately 1 degree C but the vasoconstriction threshold remains normal. Such divergence between the shivering and vasoconstriction thresholds is an unusual pattern of thermoregulatory impairment and suggests that the mechanisms of impairment during regional anesthesia may be especially complex. Accordingly, we sought to define the pattern of thermoregulatory impairment during spinal anesthesia by measuring response thresholds. Seven healthy women volunteered to participate on two study days. On one day, we evaluated thermoregulatory responses to hypothermia and hyperthermia during spinal anesthesia; on the other day, responses were evaluated without anesthesia. Upper body skin temperature was kept constant throughout the study. The volunteers were warmed via the lower body and cooled by central venous infusion of cold fluid. The core temperatures triggering a sweating rate of 40 g.m-2 x h-1, a finger flow of 0.1 mL/min, and a marked and sustained increase in oxygen consumption were considered the thermoregulatory thresholds for sweating, vasoconstriction, and shivering, respectively. Spinal anesthesia significantly decreased the thresholds for vasoconstriction and shivering, and the decrease in each was approximately 0.5 degree C. The range of temperatures not triggering thermoregulatory responses (those between sweating and vasoconstriction) was 0.9 +/- 0.6 degree C during spinal anesthesia. The synchronous decrease in the shivering and vasoconstriction thresholds during spinal anesthesia is consistent with thermoregulatory impairment resulting from altered afferent thermal input.

Adult↗
PubMed1993

[Reversibility of dementia in hypothyroidism].

Thirteen percent of all dementia disorders are potentially reversible. Hypothyroidism is among the most frequent causes of reversible dementias. Although it is generally accepted that dementia symptoms in hypothyroidism can be significantly reduced, many questions about the therapeutic efficacy are unexplained. It has not been systematically investigated which psychopathological symptoms respond well to thyroid hormone substitution, how long the treatment should last and whether duration of symptoms or severity of dementia have an influence on the degree of remission of psychopathological impairment. We investigated these questions in two prospectively studied cases with dementia in hypothyroidism.

Dementia↗
PubMed1992

Alzheimer's disease: identical phenotype of familial and non-familial cases.

Ninety outpatients with Alzheimer's disease according to ICD-10 diagnostic draft criteria were studied to test the hypothesis that cases with a familial aggregation are different from cases without such an aggregation with respect to cognitive impairment. In all cases the diagnosis of Alzheimer's disease was confirmed by prospective observation within 12 months of initial evaluation. Patients were divided into two groups: one consisting of 23 patients with a familial aggregation, the other consisting of 67 patients without secondary cases among first-degree relatives. By means of t-tests differences in impairment of cognitive functions between the groups were calculated. The results did not yield statistically significant differences between the groups for any of the neuropsychologically investigated cognitive deficits. Thus the hypothesis that the presence of a familial aggregation may lead to a distinct phenotype in Alzheimer's disease was not confirmed.

Aged↗
PubMed1992

[Psychopathologic disorders at the onset of Alzheimer's disease].

The investigation of patients with Alzheimer's disease was based on the following questions: which symptoms occur at onset, which cognitive, non cognitive and neurological symptoms already appear in early stages of the disease and how frequent are they? Memory impairment was the most frequent symptom at onset. However apathy and deficits in word finding did also occur at the beginning of the disease' clinical manifestation. It is generally suggested that symptoms in mild Alzheimer's disease are confined to impairment of memory, orientation, and language. In contrast to that our results suggest that psychopathological symptoms in mild Alzheimer's disease may cover a wide range of cognitive and non cognitive deficits.

Activities of Daily Living↗
PubMed1992

[Symptom severity and symptom progression in Alzheimer's disease-- comparison between two cases with early and late onset].

Since the first description of Alzheimer's disease rapid symptom progression and relatively severe cognitive symptoms have been frequently associated with early onset age, while slow symptom progression and relatively mild cognitive symptoms were often related to late onset age. In a longitudinal study of 90 patients with mild to moderate Alzheimer's disease we investigated these hypotheses. We found that neither severity of cognitive symptoms nor symptom progression in Alzheimer's disease were associated with onset age. In addition, a comparison of extreme groups (group 1: less than 60 years of age; group 2: greater than 75 years of age), taken from the study sample, showed similar results with respect to the independent variables. The results of this study suggest that the interindividual variability of cognitive impairment as well as the large variation of symptom progression in Alzheimer's disease cannot be explained by onset age.

Age Factors↗
PubMed1991

[Visual evoked potentials in Alzheimer's and Parkinson disease].

Harding et al. suggested at first that an increase of P2 latency in flash VEP without an increase of P2 latency in pattern reversal VEP may be a diagnostic marker of Alzheimer's disease. Up to now there is no convincing evidence for this hypothesis. The purpose of the present study was to examine this hypotheses in an extended group of patients with Alzheimer's disease (n = 36). In addition, a group of patients with Parkinson's disease (n = 8) without dementia syndrome and a group of healthy elderly controls (n = 46) was investigated in order to determine the sensitivity and specificity of these VEP parameters. The results confirmed significant group differences between patients with Alzheimer's disease and healthy controls concerning the increase of Flash P2 latency and unchanged latency of P2 in the pattern reversal VEP. No significant correlations were found between duration of illness and mental test scores. The group differences of P2 latency in the flash VEP for patients with Parkinson's disease and healthy controls were also significant. Therefore, the increase of flash P2 latency in VEP does not seem to be specific for Alzheimer's disease nor for dementia syndrome. The pathological mechanism causing the flash P2 latency increase in a remarkable number of neuropsychiatric patients should be elucidated in further experimental investigations.

Aged↗
PubMed1991

[Manifestations of Alzheimer's disease in daily living].

From the perspective offered by diagnostic criteria, cognitive rating scales and psychometric tests, Alzheimer's disease appears to be primarily a continuous decline of memory and intelligence. Changes in other areas of behaviour often go unrecognized at examination or are considered insignificant. A completely different view is offered by the reports of care-givers. Here, impairment of everyday activities, abnormal emotional and social behaviours are the most important features. To examine the everyday manifestation of Alzheimer's disease at greater detail, a questionnaire for care-givers was developed. Observations of patients' behaviours as recorded on this instrument demonstrate the presence of significant changes of affect and drive even in mild stages of the disorder. They show only weak associations with cognitive symptoms and cannot be explained as psychological reactions. The non-cognitive aspects of Alzheimer's disease deserve particular diagnostic and therapeutic interest.

Activities of Daily Living↗
PubMed1991

[Time perspective in the treatment of elderly depressed patients].

Coping with depressive illness in old age is impeded by particular strains: an increasing incidence of loss events, physical constraints, lack of social support and narrowing prospects for the future may lead to relapse as well as retarded recovery or chronification. Treatment directed toward long-term rehabilitation therefore requires, in addition to medical measures, psychotherapeutic and social interventions which help the patient cope with past loss, solve current problems and open up new perspectives for the future. This integration would overcome a dichotomy, still prevalent in psychotherapy for the elderly, between retrospection and life review on the one hand, activation and extension of competence on the other--or "involution" versus "evolution". A therapeutic approach which thus integrates personal aspects of the past, present and future may also combine various methods such as reminiscence therapy, interpersonal therapy, behavioral and social interventions.

Adaptation, Psychological↗
PubMed1990

[Dementia in hypothyroidism].

Hypothyroidism is one of the most frequent causes of potentially reversible dementia. According to present knowledge, symptoms of mental impairment begin insidiously and show a slow progression. They may precede the typical somatic manifestations of thyroid dysfunction. Almost complete remission of dementia may be expected from hormone substitution when the diagnosis is established early. The pathogenetic mechanisms which may have important implications for other forms of dementia are still imperfectly understood.

Dementia↗
PubMed1990

The onset of Alzheimer's disease. A longitudinal case study and a trial of new diagnostic criteria.

We had the opportunity to document the onset of presenile Alzheimer's disease in a female patient who presented at a very early stage and was followed for 18 months at close intervals. Disturbances of memory, of intellectual abilities, and of language were the initial symptoms, which caused significant impairment of working performance several months before becoming apparent at home. The clinically evident progression of the disease was confirmed by psychometric tests but was overlooked by cognitive screening batteries and by global severity ratings. In the absence of any signs of brain atrophy, even on repeated X-ray computed tomography, a severe temporoparietal reduction of glucose metabolism was disclosed by positron emission tomography. The typical case demonstrated several imperfections of newly introduced diagnostic criteria in their ability to identify early Alzheimer's disease. Improvements for some of these deficiencies are suggested.

Aged↗