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Biomedical subjects

B Winblad

Publications and source records attributed to B Winblad.

At least 325 records · Page 18Linked to original sources
PubMed1993

Memory complaints of elderly people in a population survey: variation according to dementia stage and depression.

OBJECTIVE: To study the relationship between subjective memory complaints, cognitive functioning, and clinical diagnosis of dementia. DESIGN: Cross-sectional, total-population survey. MEASUREMENTS: A two-phase study was done. All 2368 were screened by Mini-Mental State Examination (MMSE). Then the 314 who screened positive and a sample of 354 who screened negative were examined clinically (by examining the subject and interviewing an informant) for DMS-III-R criteria for dementia, Clinical Dementia Rating (CDR) scale for severity of dementia and the presence of memory complaints or depressed mood. SETTING: An area in Stockholm, Sweden. PARTICIPANTS: All inhabitants of the area (2368) born in 1912 or before, living at home or in institutions. RESULTS: A greater percentage of informants reported marked memory impairment than did the subjects themselves. Neither the informants' nor the subject' reports differed according to the type of dementia, but they differed clearly according to the stage of dementia. Informants reported memory impairment more frequently as dementia severity increased, while the subjects' complaints of marked memory impairment were most common in mild-moderate dementia. Furthermore, non-demented subjects with marked complaints performed more poorly on the MMSE. Subjects with depressed mood were also more likely to complain about their memory, both in the demented and non-demented groups. CONCLUSION: Our data show the validity of the informants' reports about the subjects' memory deficits. Moreover, the study confirmed the clinical impression that the patient's own complaints should not be ignored, as subjects in the mild stage of dementia often have some insight into their own memory deficit. However, depressed individuals may underestimate their own memory, and individuals with moderate-severe dementia may overestimate theirs.

Aged↗
PubMed1993

Biochemical pathology and treatment strategies in Alzheimer's disease: emphasis on the cholinergic system.

The neurochemical pathology of Alzheimer's disease (AD) has been consistently shown to involve cholinergic degeneration in the cerebral cortex. This together with evidence from experimental animal studies showing that cholinergic neurones play a role in learning and memory processes has formed the basis of the cholinergic hypothesis of Alzheimer's dementia and the major rationale for neurotransmitter replacement therapy of the disorder.

Acetylcholine↗
PubMed1993

Long-term treatment with tacrine (THA) in Alzheimer's disease--evaluation of neuropsychological data.

Long-term effects of tacrine (THA) on cognitive functions of very mild AD patients were studied. The stability of possible positive changes following prolonged treatment and the effect of increased dose was also studied. Three patients were treated with tacrine (80 mg/day) and the effect on cognitive functions was measured with a neuropsychological test battery. Two of the patients (Pats 1 and 4) showed clear positive changes in all parameters measured. The third patient (Pat 5) did not show as clear positive responses. The effect of the initial treatment dose diminished over time. After raising the dose two of the patients showed improvement in cognitive tests reaching their initial level of performance or even better in most of the tests. This positive effect was not as clear in patient 5. After 13 months of tacrine all patients still showed positive changes in some of the tests. Compared to a hypothetical progression curve for untreated AD patients the patients treated with tacrine seemed to have slower progression. In conclusion, it seems that long-term positive effects on cognitive functions of AD patients can be reached with tacrine and it seems to be possible to slow down the progression of the disease. However, to reach long-term positive effects increasing doses seem to be needed. AD patients seem to differ in their response to tacrine.

Aged↗
PubMed1993

EEG regional changes during long-term treatment with tetrahydroaminoacridine (THA) in Alzheimer's disease.

Three patients with Alzheimer's disease of mild type received long-term treatment with THA at doses between 40 mg to 160 mg daily. This study describes the effects of THA on EEG, seen during long-term and high dose treatments. After short-term treatment, the changes of the mean frequency in the temporal and parieto-occipital regions varied between patients, but in the frontal region a significant increase of the mean frequency was seen in all patients. The EEG improvement seen in the frontal region was more significant than that for the other regions at low dose of THA (80 mg). During long-term treatment, we observed different types of EEG changes. The early improvement seen in two patients was temporary and reverted to the pre-treatment value. In a third patient who did not show marked improvement after short-term treatment, an improvement was seen in all regions after longer treatment. Treatment with high doses of THA (120 mg or 160 mg) induced a marked increase in the mean frequency not only in the frontal region but also in the temporal and parieto-occipital regions. Higher doses of THA seem to affect larger areas of the brain than lower doses of THA.

Alzheimer Disease↗
PubMed1993

Accuracy of the Mini-Mental Status Examination as a screening test for dementia in a Swedish elderly population.

The aim of this study was to determine the accuracy of the Mini-Mental Status Examination (MMSE) as a screening test for dementia in an elderly Swedish population. All the inhabitants over 74 years of age in one area of Stockholm took the MMSE. The test was then compared to the clinical diagnosis of dementia. With a cut-off point of 23/24, the MMSE had a sensitivity of 87%, specificity of 92%, and positive predictive value (PPV) of 69%. Age, sex, and education did not substantially affect the specificity and the PPV, but had a slight effect on the sensitivity. The main causes of the false positives were somatic and psychiatric disorders. These results are in agreement with studies performed with similar methods and comparable populations.

Age Factors↗
PubMed1993

Application of DSM-III-R criteria for major depressive episode to elderly subjects with and without dementia.

OBJECTIVE: The aim of the present study was to see how DSM-III-R criteria for a major depressive episode functioned in a representative sample of elderly subjects with and without dementia. METHOD: Data were used from a population-based study of individuals 75 years old or older living in Stockholm. Subjects were screened for dementia by using the Mini-Mental State. Subjects with scores of 23 or lower as well as age- and sex-matched subjects with scores of 24 or higher were given a medical examination. Dementia was diagnosed according to DSM-III-R and staged for severity by using the Washington University Clinical Dementia Rating Scale. The Comprehensive Psychopathological Rating Scale was used to record symptoms of depression, which were then classified according to DSM-III-R criteria for a major depressive episode. Data on depressive symptoms were available for 643 individuals: 213 with and 430 without dementia. A principal component analysis was carried out on the nine symptoms from criterion. A for a major depressive episode. RESULTS: The depressive symptoms clustered into two groups: mood disturbance and motivation disturbance. The mood disturbance symptoms were most frequent in subjects with mild dementia and less frequent in those with more severe dementia; the subjects with the most severe dementia had the highest rates of motivation disturbance symptoms. CONCLUSIONS: The different manifestations of depression in elderly patients with and without dementia should be taken into account when making the diagnosis of major depression. Further research is needed on the manifestations of depressive symptoms in the elderly in order to validate the diagnostic criteria.

Aged↗
PubMed1993

Abuse is in the eye of the beholder. Report by family members about abuse of demented persons in home care. A total population-based study.

In a population-based study 219 family members of cognitively impaired elderly (casegroup) and 255 family members of cognitively healthy elderly (control-group) were interviewed about their situation as a caregiver to an old person. Twenty-six family members in the case-group reported abusive behavior in the care of the elderly at home. These family members are compared with 154 family members in the control-group, reporting other coping strategies than abusive. In the abusive group most of the elderly were in a mild stage of dementia, and the family members reported more strain in the care situation. The family members were older, judged their health as deteriorated, and were mostly living together with the dependent elderly.

Activities of Daily Living↗
PubMed1993

Relationship between bilingual demented immigrants and bilingual/monolingual caregivers.

This study illuminates the relationship between bilingual demented patients and bilingual/monolingual caregivers during morning care sessions regarding the promotion of integrity in demented persons. Seven demented Finnish immigrants were videotaped during morning care together with bilingual and monolingual Swedish-speaking caregivers. A phenomenological-hermeneutic analysis of the videotapes was performed based on Ricoeur's philosophy. The structural analysis was made by means of the Erikson theory of "eight stages of man." Comparisons were made regarding demented immigrants' relationships with Swedish-Finnish speaking and Swedish speaking caregivers respectively. Three different patterns of relationship were seen: positive, negative, and mixed relationship. The study showed that bilingual caregivers' relationships with bilingual patients was positive or mainly positive (mixed), while the monolingual Swedish speaking caregivers had severe problems communicating with the same patients and therefore had more difficulties creating a positive relationship with them. It seems important that bilingual caregivers engage in the care of demented bilingual patients in order to help them use their latent competence and show themselves more clearly in the communication with their caregivers.

Acculturation↗
PubMed1993

ADL capacity and loneliness among elderly persons with cognitive impairment.

Advancing age brings a natural weakening of functions, making the individual rely more on support from the community and next-of-kin. The purpose of this study was to investigate, in relation to subjective loneliness, the ADL dependence of elderly persons with and without impaired cognitive capacity. 264 persons were interviewed. The Mini-Mental State Examination was used as a screening instrument for obtaining a cognitively-impaired and a normal group of elderly. Persons with impaired cognitive capacity who experienced loneliness had the greatest ADL dependence.

Activities of Daily Living↗
PubMed1993

How to run a brain bank: potentials and pitfalls in the use of human post-mortem brain material in research.

Brain banks for neurological diseases serve as a link between the clinician, the neuropathologist and the basic scientist who require brain tissue samples from patients who have undergone a thorough clinical investigation and whose brains have been subjected to detailed neuropathological analysis. In order to provide research groups with post-mortem brain tissue from patients who show clinical signs of dementia such as Alzheimer's disease (AD), senile dementia of Alzheimer type (SDAT), vascular dementia including multi-infarct dementia (MID) and mixed dementia, a brain bank was established at Huddinge University Hospital at the end of 1988. The brain bank provides either rapidly or slowly frozen tissue samples, tissue samples fixed in formalin (short/long fixation time), cerebrospinal fluid (CSF), and blood samples. Average postmortem times are from 3-47 hours. The information available on the cases includes the clinical diagnosis, the premortem clinical investigation with behavioral observations, psychometric and neuropsychological test data, premortem medication, cause of death, agonal state, pH in brain and CSF, and the general anatomic and neuropathologic assessments leading to the final diagnosis.

Autopsy↗
PubMed1992

[Alzheimer's disease--an amyloid disease of the brain].

During recent years, Alzheimer's disease (AD) has attracted increasing interest among clinicians and neuropathologists throughout the world. The amyloid core of the neuritic plaques found in the brains of individuals with the disease has been shown to be composed of a distinct peptide formed through proteolytic degradation of a large precursor protein, the Alzheimer amyloid precursor protein (APP), which exists in at least three isoforms differing from each other in the splicing of the primary transcript from which they derive. Although the physiological function of APP remains unknown, it has been suggested to function as a protease inhibitor and to be important to the blood coagulation system. The gene encoding APP is located on the long arm of chromosome 21. Individuals with Down's syndrome (trisomy 21) often develop AD in early middle age, suggesting that the 50 percent increase in APP, gene expression may promote the development of the disease. Mutations in the APP gene have also been shown to be associated, probably pathogenetically with familial forms of AD. The conclusions drawn from these studies include (i) that the amyloidosis associated with AD is probably a central pathogenetic factor and (ii) that the development of drugs capable of inhibiting amyloidosis might be an appropriate strategy for the treatment of AD.

Alzheimer Disease↗
PubMed1992

Preservation of Gi-protein inhibited adenylyl cyclase activity in the brains of patients with Alzheimer's disease.

The coupling of inhibitory guanine nucleotide binding (Gi) proteins to the adenylyl cyclase signal transduction complex was compared in 4 brain regions from a series of Alzheimer's disease and matched control subjects by measuring the inhibition of membrane enzyme activities in response to guanosine 5'-[beta gamma-imido]diphosphate (Gpp[NH]p) and aluminium fluoride (AlF4-). Basal adenylyl cyclase activities were significantly lower in preparations of angular gyrus and frontal and temporal cortices, but not cerebellum, from the Alzheimer's disease cases compared to controls. Gpp[NH]p and AlF4- gave significant inhibitions of adenylyl cyclase activity in all brain regions. The magnitude of these inhibitions, when corrected for altered basal activities, were similar for the Alzheimer's disease and control cases. These results indicate that there is no impairment of Gi-protein mediated inhibition of adenylyl cyclase activity in Alzheimer's disease brain.

Adenylyl Cyclases↗
PubMed1992

Hippocampal nerve growth factor levels are related to spatial learning ability in aged rats.

Brain nerve growth factor (NGF) was determined in two groups of aged rats: 'good' and 'poor' performers. The animals were selected out of a population of 40 aged rats (26-28 months old) trained in a spatial learning task. Animals performing well in the test had significantly higher NGF in the hippocampus when compared to 'poor' performers. No differences in the levels of NGF were found in the cortex, septum and cerebellum. The results implicate hippocampal NGF in cognitive functioning of aged rats, and suggests that the forebrain cholinergic neuronal atrophy which has been observed in cognitively impaired aged rats may be due to reduced availability of target-derived NGF.

Aging↗
PubMed1992

Increased expression of brain-derived neurotrophic factor mRNA in rat hippocampus is associated with improved spatial memory and enriched environment.

Enriched environment has been shown to enhance learning and memory and to induce morphological changes in the hippocampus. We report that rats housed in an enriched environment showed improved performance in the Morris water maze and decreased spontaneous motor activity. Exposure to behavioural tests increased expression of the mRNA that encodes brain-derived neurotrophic factor in the hippocampus. This was not seen when rats subjected to impoverished housing were tested suggesting that environmental history of the animal is of importance to induce expression of brain-derived neurotrophic factor in the hippocampus that may promote neuronal changes related to learning and memory.

Analysis of Variance↗
PubMed1992

Clinical diagnosis of Alzheimer's disease and other dementias in a population survey. Agreement and causes of disagreement in applying Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition, Criteria.

In a population survey aimed to detect cases of Alzheimer's disease and other dementias, two preliminary diagnoses were made independently with the purpose of using the concordant diagnoses as final diagnoses. Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition, diagnostic criteria were followed. The 668 subjects examined were selected from the population of an area in Stockholm, Sweden, aged 75 years or more, with the Mini-Mental State Examination used as a screening test. The agreement on dementia diagnosis was moderate (kappa = .54) and could be clearly improved (kappa = .70) with modifications to the diagnostic criteria, such as adding a category of questionable dementia and giving more guidelines in the definition of impairment of a function. The agreement on the diagnosis of Alzheimer's disease vs vascular dementia vs secondary dementia was substantial (kappa = .67) when the cases with concordant dementia diagnoses were examined.

Aged↗
PubMed1992

Nicotinic and muscarinic subtypes in the human brain: changes with aging and dementia.

Different effects of normal aging on muscarinic and nicotinic receptor subtypes were observed in postmortem brain tissue from different regions of the human brain. A significant decrease in M1 and M2 receptors was found in cerebral cortex, while the M1 and especially the M2 receptors increased with age in the thalamus. A similar pattern of changes was also observed when using (-)3H-nicotine as ligand for nicotinic receptors in the cortex and thalamus. No significant changes in nicotinic receptor binding were observed with age in the cortex or thalamus when using 3H-acetylcholine as ligand. Nicotinic and muscarinic receptors in the brain are not equally affected in dementia disorders. A marked loss of high affinity nicotinic receptors was observed in cortical tissue from patients with Alzheimer's disease and with multi-infarct dementia (MID). The muscarinic receptors were (both M1 and M2) increased in Alzheimer cortical tissue while they were decreased in MID.

Adolescent↗