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Biomedical subjects

B Winblad

Publications and source records attributed to B Winblad.

At least 199 records · Page 11Linked to original sources
PubMed1997

Psychiatric disturbances and the use of psychotropic drugs in a population of nonagenarians.

The present study examined the prevalence of dementia, anxiety syndromes, depression, psychotic symptoms, sleep disturbance and the use of psychotropic drugs in a population of 330 nonagenarians. Subjects underwent an extensive medical examination, and information on sociodemographic characteristics, mental health, physical health and psychotropic drug use was collected. The prevalence of dementia in the study sample was 46.7% according to DSM-III-R criteria. Demented persons had more often psychotic symptoms (11.7% versus 3.4%) and anxiety syndromes (5.2% versus 1.1%) than non-demented. Depression was equally prevalent in both the demented and non-demented (8.4% versus 7.4%), whereas sleep disturbance was a more common complaint in non-demented persons. Half of the study sample (49.7%) used some sort of psychotropic drug, with the most common being hypnotics and the least common being antidepressants. However, the rate of specific treatment was low, especially for depression, indicating the need for more knowledge concerning the recognition of depression in the very elderly.

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PubMed1997

Cost of illness due to dementia in Sweden.

The gross cost of illness due to dementia was estimated to be SEK30.7 billion in 1991 while the net cost was estimated to be SEK20 billion. The sensitivity analysis showed a variation between SEK20 billion and SEK36 billion in 1991.

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PubMed1997

Autoradiographic characterization of [3H]inositol (1,4,5) trisphosphate and [3H]inositol (1,3,4,5) tetrakisphosphate binding sites in human brain.

Autoradiographic techniques were used to investigate the characteristics of tritiated inositol(1,4,5)trisphosphate ([3H]IP3) and inositol (1,3,4,5) tetrakisphosphate ([3H]IP4) binding to human brain. In brain sections [3H]IP3 exhibited a two-site binding with KD values of 87 nM and 9.3 microM respectively for the higher and lower affinity sites. [3H]IP4 also bound to two sites with KD values of 43 nM and 1.4 microM, respectively. With the conditions fixed in this study, [3H]IP3 and [3H]IP4 autoradiography in the cortex, caudate, hippocampus and cerebellum were performed. The most prominent [3H]IP3 binding among these regions was found in the cerebellum, particularly in the molecular layer. Within the hippocampus, the subiculum and the CA1 region showed much more prominent binding than the other subfields. [3H]IP4, binding was fairly homogeneous in the regions studied, with the exception of a slightly higher binding in the molecular layer of the cerebellum.

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PubMed1997

EEG-microstates in mild memory impairment and Alzheimer's disease: possible association with disturbed information processing.

The only available functional neuroimaging methods reaching the time resolution of human information processing are EEG and MEG. Since spectral analysis implies analysis of longer time epochs, the high temporal resolution of EEG is partly lost. By dividing the EEG in the time-domain into segments of similar spatial distribution on the scalp (microstates) it has been possible to assess patterns of neuronal activity representing the information process currently performed by the brain. In the present study alterations of EEG microstates in subjective (n = 31) and objective (n = 38) memory impairment as well as in probable Alzheimer disease (DAT: n = 64) compared to healthy controls (n = 21) were investigated. The main findings were reduced segment durations and a more anterior center of gravity of the microstate topography in DAT. With more pronounced cognitive dysfunction larger window sizes were found. Shorter microstates and larger windows reflect more rapidly changing spatial activation patterns, and are interpreted as an impaired capability to establish stable brain states necessary for normal brain function. The anteriorization of the microstates is consistent with results in the frequency domain and may reflect neuropathological changes in DAT.

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PubMed1997

Elevated protein levels of protein phosphatases PP-2A and PP-2B in astrocytes of Alzheimer's disease temporal cortex.

Previous studies have shown that activities of the protein phosphatases PP-2A and PP-2B towards the microtubule associated protein tau are reduced in Alzheimer's disease (AD) frontal cortex (Gong et al., 1993, 1995), suggesting that PP-2A and PP-2B are involved in the hyperphosphorylation of tau in AD. Most recently, we found that protein levels of PP-2A and PP-2B are elevated in postsynaptic supernatant (S2) fractions prepared from AD temporal cortex, and that the activities of these enzymes were not significantly different between AD and control cases (Pei et al., in press). In the present study, we found that astroglia positive for PP-2A and PP-2B immunoreactivities were greater in numbers in AD medial temporal cortex, compared to controls. GFAP levels, as determined by indirect ELISA, were approximately 1.5 times greater in the P1 (500 x g) fraction from AD temporal cortex, compared to controls. GFAP levels in the P1 fraction showed significant correlations with PP-2A and PP-2B levels in the postsynaptic S2 (20,000 x g) fraction from the same brains. These results suggest that astrogliosis probably accounts for the increased levels of PP-2A and PP-2B in the S2 fraction in AD brain and that the levels of these enzymes per neuron are likely to be decreased.

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PubMed1997

Blood pressure and dementia in the elderly: epidemiologic perspectives.

High blood pressure is associated with an increased risk of vascular dementia as a result of ischemic stroke and other cerebrovascular events or lesions. However, there is insufficient epidemiologic evidence indicating that blood pressure is involved in the etiology of Alzheimer's disease. Clinical studies suggest that episodes of hypotension may cause cerebral hypoperfusion and play a role in the development of dementia. Lowering of blood pressure in dementia, especially Alzheimer's disease, may be due to the dementia process itself or to the characteristics of the disease. Recent large clinical trials have shown that antihypertensive drugs may not significantly affect cognitive performance, but no data are available regarding their potential effects in decreasing the risk of dementia by lowering the incidence of cerebrovascular events. Some data suggest that the blood pressure-dementia relationship may be age-dependent.

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PubMed1997

Diagnosis of Alzheimer's disease. Report of an International Psychogeriatric Association Special Meeting Work Group under the cosponsorship of Alzheimer's Disease International, the European Federation of Neurological Societies, the World Health Organization, and the World Psychiatric Association.

Current knowledge with respect to the diagnosis of Alzheimer's disease (AD) is reviewed. There is agreement that AD is a characteristic clinicopathologic entity that is amenable to diagnosis. The diagnosis of AD should no longer be considered one of exclusion. Rather, the diagnostic process is one of recognition of the characteristic features of AD and of conditions that can have an impact on presentation or mimic aspects of the clinicopathologic picture. The present availability of improved prognosis, management, and treatment strategies makes the proper, and state-of-the-art, diagnosis of AD a clinical imperative in all medical settings. Concurrently, information regarding the relevance and applicability of current diagnostic procedures in diverse cultural settings must continue to accrue.

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PubMed1997

Autoradiographic characterisation of [35S]GTP gamma S binding sites in rat brain.

The binding of [35S]GTP gamma S was characterised with autoradiography in rat brain. The binding was saturable, but the rate of dissociation was very slow. Analysis of binding isotherms revealed one class of binding sites with a Kd of 0.8 microM. The specific binding was 98%. Different guanine nucleotides were all able to compete with [35S]GTP gamma S binding. However, no displacement was seen by the ATP-analogue App[NH]p, indicating that [35S]GTP gamma S does not bind to ATP-sites. Autoradiograms showed a highly homogenous distribution of [35S]GTP gamma S binding, in grey as well as in white matter. However, the pattern changed dramatically in the presence of GTP, which, unlike the non-hydrolysable GTP-analogues Gpp[NH]p and GTP gamma S, did not displace [35S]GTP gamma S binding throughout the brain. In white matter areas the binding was potently displaced, while in many grey matter areas, e.g., the striatum, the binding was seen to increase. This GTP-induced increase in [35S]GTP gamma S binding was strongly Mg(2+)-dependent, with an optimum at 10 mM. This, together with the finding that the regional effects of GTP correspond well to previously reported distribution of low Km GTPase, suggest that the levels of binding of [35S]GTP gamma S in the presence of GTP may reflect functional G-protein activity.

Animals↗
PubMed1997

Major strain and coping strategies as reported by family members who care for aged demented relatives.

This study is based on a previous investigation into 46 caregivers' experience of burden and burnout when caring for a demented elderly relative. The aim of this study was to describe caregivers who develop or experience burnout (group A) and caregivers without experience of burnout (group B) and how they cope with major strain. The interviews focused on the caregivers' descriptions of their major strain (the demented person's memory difficulties and change in behaviour and the caregivers' experiences of their feelings of loss and their new role) and what they did, thought and felt in these situations. The interviews were coded and categorized and a chi-square test was performed. It was found that those in group A more often used an emotion-focused strategy (grieving, worrying and self-accusation). They were also the only ones using wishful thinking and stoicism as strategies. Those in group B used a problem-focused strategy more often (confronting the problem, seeking information and seeking social support). Another interesting finding was that the caregivers in group B frequently used the emotion-focused strategy of acceptance in combination with seeking information and seeking social support. To mix approaches like these seems to be an effective choice of strategy. It was also found that the caregivers' gender seems to have an effect on the coping strategy. The demented person's domicile did not, however, appear to result in any significant difference.

Adaptation, Psychological↗
PubMed1997

Caring for a demented elderly person--burden and burnout among caregiving relatives.

Fifty-two family caregivers for demented elderly people were investigated for burden and burnout experiences. A structured burden questionnaire and the Burnout Measure were used. Burnout is described in relation to the caregiver's gender, age, family relationship and the demented person's living place. Older wives and daughters were the most likely to report burnout in their lives. Some siblings and daughters-in-law also risked developing burnout. Regression analysis showed that limitation in social life, poor health and a lack of positive outlook on caring were the most important independent variables explaining variance in burnout among caregivers. There was no difference in burnout experiences between caregivers having their demented elderly person living at home and those having them in an institution.

Adult↗
PubMed1997

Cognitive changes in very old persons with dementia: the influence of demographic, psychometric, and biological variables.

Longitudinal changes in global cognitive functioning, indexed by the Mini-Mental State Examination (MMSE), in subjects with dementia (Alzheimer's disease and vascular dementia) were examined. The roles of several demographic, psychometric, and biological indices in predicting cognitive deterioration were also examined. The sample consisted of 36 very old (M age at entry = 83.0 years, range = 75-95) adults with dementia from a community-based study. Subjects were tested on two occasions separated by approximately 2.5 years. Results indicated significant longitudinal decline in MMSE scores over the retest interval; the average decline was estimated as 2.43 (SD = 1.81) points per year. Several factors were associated with cognitive deterioration. Higher initial MMSE scores were associated with greater deterioration, whereas superior forward digit span and Block Design at entry were associated with attenuated decline, once differences in baseline severity were accounted for. By contrast, a variety of other putatively important variables exhibited no relationship to decline, including age, gender, education, onset age, dementia type, backward digit span, as well as a number of biological parameters (e.g., vitamin B12, folic acid). The results suggest that although the magnitude of cognitive deterioration in dementia is highly variable, several indicators may be useful predictors of future changes in cognitive functioning.

Age of Onset↗
PubMed1997

Drug use by demented and non-demented elderly people.

AIM: to determine the use of drugs by demented and non-demented elderly people in a population, by dementia status and type, age, sex and accommodation type. METHOD: data were obtained from the Kungsholmen project, a longitudinal community study of people over 75 in Stockholm, Sweden. RESULTS: 85% used at least one medicinal drug, and of these 12% were demented. Mean numbers of drugs used were 2.8 for demented and 3.2 for non-demented people. 45% of demented people and 38% of non-demented people used psychotropic agents. Psychotropic use was higher in women and increased with institutionalization. Antipsychotic agents were used more by demented (22%) than by non-demented (3.5%) people: this was largely explained by differences in accommodation type. The odds ratio (OR) for use of antipsychotics by those in institutions compared with those living in their own homes was 9.32. Opioids were commonly prescribed for demented people. The proportions taking opioids in those using analgesics were 42% in demented and 23% in non-demented people (OR 2.07). Laxatives were used by 18% of the demented people in institutions compared with 39% of non-demented people in institutions. CONCLUSION: being in an institution had a stronger association with the use of certain drugs (e.g. psychotropics) than did dementia status. Demented people, especially those in institutions, used a large number of antipsychotics and opioids, but fewer laxatives and minor analgesics. Prescribers and institutional staff should be aware of these factors so they can optimize patient treatment.

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PubMed1997

Heritability for Alzheimer's disease: the study of dementia in Swedish twins.

BACKGROUND: Alzheimer's disease has been thought to have familial and sporadic forms, and several genetic defects have been identified that chiefly explain early-onset familial cases. In this study, our purpose was to detect all cases of dementia in an established twin registry and to estimate total extent of genetic contribution to liability to Alzheimer's disease. METHODS: At the first stage, members of the registry were screened for dementia, using in-person or telephone mental status testing. At the second stage, those who screened positively and their partners were referred for clinical work-ups, including neuropsychological assessment, physician examination, laboratory tests, and neuroimaging. Clinical diagnoses were assigned at a multidisciplinary consensus conference. Probandwise concordance rates were examined by zygosity, and structural modeling was applied to the data to estimate genetic and environmental influences, using both single- and multiple-threshold models. RESULTS: Sixty-five pairs were identified in which one or both was demented. The probandwise concordance rate for Alzheimer's disease among monozygotic pairs was 67%; the corresponding figure for dizygotic pairs was 22%. Heritability of liability to Alzheimer's disease was estimated to be .74; to any dementia, .43. The other variance is attributable to environmental influences. CONCLUSIONS: Findings indicate a substantial genetic effect for these predominantly late-onset Alzheimer's disease cases. At the same time, structural modeling results and large intra-pair differences in age of onset suggest that environmental factors are also important in determining whether and when an individual may develop dementia.

Age of Onset↗
PubMed1997

Dementia and driving: an attempt at consensus.

The number of older drivers in Sweden will be rapidly increasing during the next decades. A possible relationship exists between the increased relative crash risk of older drivers and the prevalence of age-related diseases such as dementia. However, a clear-cut policy for evaluating driving competence in demented persons is still lacking. In recognition of this fact, the Swedish National Road Administration invited a group of researchers to formulate a consensus on the issue of driving and dementia. This consensus document is aimed at providing primary care physicians with practical advice concerning the assessment of cognitive status in relation to driving. Suggestions are based on a review of existing research and discuss the use of general and driving-specific sources of information available to the physician. Consensus was reached on the statement that a diagnosis of moderate to severe dementia precludes driving and that certain individuals with mild dementia should be considered for a specialized assessment of their driving competence.

Aged↗
PubMed1997

Changes in motor performance in persons with Parkinson's disease after exercise in a mountain area.

For one week in autumn, over a period of three consecutive years, a total of 12 persons with Parkinson's disease (PD) participated in daily walks of about 4 kilometers in a mountain area in Sweden in order to train rhythm, balance and coordination on the soft heaths. These persons were 60-78 years of age and had been found to be between stage 1 and stage 3 on the Hoehn and Yahr Staging Scale. The aim of the study was to find out whether a week of daily walks in the Swedish mountains would affect the motor performance of persons with PD, objectively and quantitatively assessed by a computer-assisted, opto-electronic movement analysis program, the Posturo-Locomotor-Manual (PLM) test. As compared with those before the journey, the results showed improved motor performance both immediately after the walking week and also at 3 but not 6 months later. The first year of participation showed the most pronounced improvements. The results demonstrate a long-lasting improvement in decreased movement time, indicating enhanced general motor performance and also an improved simultaneous index (SI), indicating a possible effect on the central nervous system. These findings, along with participants' narratives about what they did after returning home, may be indicative of strengthened self-confidence.

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PubMed1997

Clinical correlates of low blood pressure in very old people: the importance of cognitive impairment.

OBJECTIVE: To identify the medical conditions associated with low blood pressure in very old people. DESIGN: A population-based, cross-sectional study. SETTING: Two neighboring communities in Stockholm, Sweden. SUBJECTS: Participants were 319 male and 1070 female participants, with the mean age of 85.0 years (SD = 5.8). MEASUREMENTS: Blood pressure recording, pulse rate counting, and Mini-Mental State Examination (MMSE) were conducted by trained nurses. Information on illness condition and activities of daily living (ADL) status was self-reported or gathered from proxy respondents. The computerized inpatient register system was also used for collecting the data of illness condition. Systolic pressure less than 130 mm Hg and diastolic pressure less than 70 mm Hg were defined as low systolic and diastolic pressure, respectively. MMSE score less than 24 was considered to indicate cognitive impairment. MAIN RESULTS: In multiple logistic regression analyses, low systolic pressure was related to slower pulse rate (< or = 60 per minute), heart failure, ADL limitation, and cognitive impairment, and low diastolic pressure was related to increasing age, slower pulse rate, cardiac dysrhythmia, ADL limitation, and cognitive impairment. People with diabetes mellitus were less likely to be in the low systolic pressure group. 34.9% of the prevalence of low systolic pressure, and 17.9% of the prevalence of low diastolic pressure was associated with cognitive impairment. CONCLUSIONS: Low blood pressure in the very old may be associated with poor functional status, cardiac insufficiency and, more importantly, cognitive impairment. It would be expected that low blood pressure is associated with increased mortality in this age group.

Activities of Daily Living↗
PubMed1997

Suicidal thoughts and associated factors in an elderly population.

This study examined the prevalence of suicidal thoughts and associated factors in an elderly population. Data for 969 elderly subjects from a population-based study were used, and examinations by physicians, including psychiatric examination and informants' interview, were assessed. In total, 13.3% of the subjects had had suicidal thoughts during the last 2 weeks (10.8% fleetingly and 2.5% frequently). Of those who had had fleeting suicidal thoughts, 26.7% also had major depression, while 50% of those who had frequent suicidal thoughts were depressed. In addition, suicidal thoughts were associated with increased disability in daily living, institutionalization, visual problems and the use of psychotropic drugs. It is concluded that a careful psychiatric assessment is necessary when suicidal thoughts are expressed by an elderly person.

Activities of Daily Living↗