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Biomedical subjects

G Bråne

Publications and source records attributed to G Bråne.

At least 19 recordsLinked to original sources
PubMed2001

Hyperactivity in the hypothalamic-pituitary-adrenal axis in demented patients with delirium.

Occurrence of delirium is known to be related to, among other things, organic brain disorder, somatic disease and old age. It has been hypothesized that delirium is also associated with stress. Disturbances of the hypothalamic-pituitary-adrenal (HPA) system have been found in delirious patients in various studies. The aim of the present study was to determine the activity in the HPA axis in demented patients to ascertain whether the stress regulating system was more disturbed in patients with delirium than in those without delirium. Demented inpatients with no acute medical illness were included in the study. Basal cortisol levels in serum were measured and dexamethasone suppression test (DST) was performed. The most important finding of the study was a strong relationship between delirium and DST pathology irrespective of age and severity of dementia. It is suggested that certain demented individuals have an impaired HPA system and a low delirium threshold and respond to stress with delirium.

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PubMed1996

Influence of dinner music on food intake and symptoms common in dementia.

The influence of dinner music on food intake and symptoms common in dementia such as depressed mood, irritability and restlessness was studied. The study was carried out in a nursing-home ward in Sweden. Soothing music was played as dinner music for weeks, Swedish tunes form the 1920s and 1930s for two weeks and pop music for two weeks. Prior to these periods, there was one week without music, and at the end of the intervention there was a two-week control period. The effects of the intervention were assessed by psychological ratings and by weighing the food helpings. It was found that during all three music periods the patients ate more in total. The difference was particularly significant for the dessert. The staff were thought to be influenced by the music, as they served the patients more food, both main course and dessert, whenever music was played. The patients were less irritable, anxious and depressed during the music periods. The results of the study suggest that dinner music, particularly soothing music, can reduce irritability, fear-panic and depressed mood and can stimulate demented patients in a nursing-home ward into eating more.

Affect↗
PubMed1996

Neuropsychological assessment of dementia: state of the art.

A comprehensive neuropsychological examination includes an assessment of both cognitive functions and personality characteristics. In order to evaluate dementia, the patient's present as well as the premorbid functioning has to be assessed, which is performed by means of tests, behavioral observations, rating scales, and inquiries. These methods are used for diagnostic purposes, for differential diagnostics, follow-up studies, and for evaluation of treatment effects. Recent research has shown that neuropsychological methods have a high sensitivity and specificity in detection of dementia, utilizing measures of episodic memory. For staging of dementia, episodic memory as well as other cognitive functions are necessary. The effectiveness of dementia differentiation by means of neuropsychological methods varies from quite good regarding frontal lobe degeneration to less good regarding cerebrovascular dementias, probably due to the variation in site, extent, number, and temporal characteristics of the lesion. Future development is required regarding methods for evaluation of premorbid functioning, instruments for assessment of executive functions, and personality characteristics in dementia. Furthermore, brain-behavior studies are needed to learn more about the relation between neuropsychological measures vs neuropathology, neurochemistry, and neuroimaging.

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PubMed1994

Regulation of the hypothalamic-pituitary-adrenal axis in dementia disorders.

In 163 patients with dementia disorders, subdivided into Alzheimer's disease with early onset (AD; n = 40), senile dementia of the Alzheimer type (SDAT; n = 56), vascular dementia (VAD; n = 45) and dementia of unspecified type (NUD; n = 22) the dexamethasone suppression test (DST) was performed. The patients were rated according to the DSM-III-R criteria as having mild, moderate or severe dementia and were also assessed using the GBS scale which gives a profile of the dementia syndrome. In the total group of dementia there were significant correlations between severity of dementia and post-DST levels. The frequency of pathological DST also correlated significantly with the severity of dementia. In the subgroups of dementia a strong correlation between severity of dementia and high post-DST cortisol levels was found only in the VAD group. Between the subgroups of dementia disorders there were no significant differences in basal cortisol levels. The percentage of pathological DST was lowest in the AD group (40%). It was somewhat higher in the VAD group (49%), still higher in the SDAT group (54%) and highest in the NUD group (59%). When the relationship between post-DST cortisol levels and GBS scores was analyzed, significant correlations were found mainly in the VAD group. There intellectual impairment, anxiety, fear-panic and restlessness correlated significantly with post-DST cortisol levels. The results indicate hypothalamic overactivity in a substantial number of demented patients. In VAD and to a certain extent also in SDAT a disconnection between cortical areas, including the hippocampus, and the hypothalamus is assumed. Overactivity in the hypothalamic-pituitary-adrenal (HPA) axis is due to stress, and an insufficient feedback system leads to chronic stress adaptation failure.

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PubMed1994

Hypothalamic dysfunction in dementia.

In 40 patients with Alzheimer's disease (AD) 56 patients with senile dementia of Alzheimer type (SDAT) and 45 patients with vascular dementia (VAD) degree of dementia was rated into mild, moderate and severe according to DSM-III-R and on the GBS scale. Basal cortisol levels were determined and a dexamethasone test (DST) performed. Basal cortisol levels were high in all the dementia groups. Forty percent of AD patients, 54% of SDAT patients and 49% of VAD patients were non suppressors. Significant correlations between post DST cortisol levels and rated variables were seen mainly in the VAD group. The pathological DST could hardly be explained by presence of depression. In dementia, especially those with white matter disturbances, disconnections between cortical areas (hippocampus) and hypothalamus can be assumed explaining a reduced inhibitory tone on hypothalamus. When characterizing VAD patients with pathological DST these patients were significantly more intellectually impaired, showed higher degree of anxiety, restlessness and fear-panic than VAD patients with normal DST. Some behaviourial disturbances in dementia disorders may be a consequence of HPA over activity rather than a consequence of the dementia process itself.

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PubMed1993

Nurse-patient interaction after training in integrity promoting care at a long-term ward: analysis of video-recorded morning care sessions.

Morning care is a complex and problematic task for the demented patient, who has problems in understanding and coping with the situation. A training programme of integrity promoting care was given to the staff of a long-term ward and improvements of care were implemented during a 3 month intervention period. To evaluate possible effects, different parameters were used and compared with the data of a control ward. This report describes how caregivers behaved towards demented patients during morning care, before and after the training, and how patients' behaviour changed. The results are based on behaviour samples from 10 patients and 10 caregivers during 99 video-recorded morning care sessions, "double blindly" analysed. The number of coding schemes was 483, each consisting of 93 questions. The most prominent differences observed after the intervention were the increased number of opportunities to take part in decisions and activities given to the patients by the caregivers, more co-operation from patients, and finally an increase in verbal contact initiated both by patients and caregivers. It seems reasonable to suggest that when the environment was made more adequate and the demented patients could cope with it, they could use latent abilities that were not manifest in a less adequate environment.

Activities of Daily Living↗
PubMed1990

Effects of the training of integrity--promoting care on the interaction at a long-term ward. Analysis of video-recorded social activities.

A training programme in integrity-promoting care was given the staff of a long-term ward and practised during a three months intervention period. The effects were analysed in different parameters and compared with a control ward. This report describes analysis of video-recorded interactions (12 hs) during social activities between demented patients and caregivers and changes induced by the programme. The video-recorded episodes, containing mainly music and coffee sessions were interpreted from a model on interaction with demented patients suggested by Athlin & Norberg. The results indicate that the training programme and the guidance during the intervention resulted in increased understanding of demented patients' situation among the staff. They became more sensitive, adapted their cues and made the environment easier to interpret for the patients. This in turn led to the fact that the patients appeared more sensitive and clear in their cues. A positive circle developed.

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PubMed1989

[The reliability of the Danish translation of the Gottfires-Bråne-Steen scale].

The Gottfries-Bråne-Steen scale (GBS) is assessed for use in evaluating functional deficiencies in demented persons. The scale is translated into different languages, and reliability studies have been published from Sweden and Norway. This investigation is a reliability study of the Danish version. Fourty-nine patients were rated by several independent raters from the staff at the same time. Preceding this, all raters had been video-trained in the use of the scale. The results show that the scale has sufficient and satisfactory inter-rater reliability. It is concluded that the Danish version of the GBS-scale is also a useful tool for evaluating dementia processes and therapeutic measures.

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PubMed1989

[Functional levels in nursing homes residents assessed by the Gottfries-Bråne-Steen scale].

Thirty-three inhabitants in a nursing home were evaluated by the Gottfries-Bråne-Steen scale. The evaluation showed that more than one third of the residents had marked dementia, especially with intellectual symptoms. The residents showed a high degree of motoric problems. It is concluded that dementia is a common cause for placement in a nursing home, although it seldom is recorded in detail as such before admission.

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PubMed1989

[Placing of patients with dementia in nursing homes as evaluated by the Gottfries-Bråne-Steen scale].

Sixteen gerontopsychiatric inpatients were compared with 33 residents in a somatic nursing home by Gottfries-Bråne-Steen scale. Both groups showed symptoms of mental deterioration of intellectual and also emotional character. The gerontopsychiatric inpatients showed significantly more emotional deterioration than the others. It was concluded, that especially the emotional defect in combination with intellectual deterioration is the cause of the placement in a psychiatric ward.

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PubMed1989

Monoamine metabolites in cerebrospinal fluid and behavioral ratings in patients with early and late onset of Alzheimer dementia.

Patients with Alzheimer disease (AD, onset less than 65 years of age, n = 13) and senile dementia of the Alzheimer type (SDAT, onset greater than or equal to 65 years of age, n = 28) were investigated for cerebrospinal fluid (CSF) content of homovanillic acid (HVA), 5-hydroxyindoleacetic acid (5-HIAA) and 3-methoxy-4-hydroxy-phenylglycol (MHPG) and compared with a group of controls (n = 26). A geriatric rating scale, the Gottfries-Bråne-Steen scale, was used to assess impairment of motor performance, intellectual and emotional functioning, and symptoms common in dementia disorders. The HVA levels in CSF were significantly lower in the AD group than in the SDAT group and controls. MHPG was slightly but significantly increased in the SDAT group when compared with the controls. The HVA and 5-HIAA concentrations were correlated negatively with impairment of motor performance in the SDAT group; 5-HIAA correlated positively with impaired performance in the AD group; and 5-HIAA/HVA ratios were correlated positively with the performance variables. HVA correlated significantly and negatively with "impaired wakefulness" and "inability to increase tempo" in the SDAT group. 5-HIAA and the ratio 5-HIAA/HVA correlated significantly and positively with some items measuring intellectual and emotional impairment. In the AD group, "anxiety" and "fear-panic" correlated positively with 5-HIAA and "restlessness" with MHPG. The data indicate qualitative differences in the CSF monoamine pattern between AD and SDAT.

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PubMed1989

Elevated CSF somatostatin concentrations in demented patients parallel improved psychomotor functions induced by integrity-promoting care.

Elderly demented patients from 2 nursing homes participated in this study. An experimental group (n = 17) was subjected to a 3-month program with integrity-promoting care resulting in emotional, intellectual and physical activation, whereas a control group (n = 18) had no change from the regular ward care. Dementia rating scales and psychological tests were administered before the start of the study and at the end of the 3-month study period. Lumbar punctures were performed at the same time for assessment of neuropeptide concentrations (somatostatin (SRIF), arginine vasopressin (AVP) and corticotropin-releasing factor) in the cerebrospinal fluid (CSF). In the control group no significant changes were found in the ratings before and after the study. In contrast, improvements in intellectual and motor functioning were observed in the experimental group. Concomitantly, the SRIF concentrations in CSF were significantly elevated in the experimental group and not affected in the control group. The CSF AVP concentrations were reduced in both groups at the end of the study, but considerably more in the control group. It is concluded that environmental factors can improve intellectual and motor functioning in demented patients and also alter CSF biochemical measures of dementia.

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PubMed1988

Effects of environmental stimulation on biochemical and psychological variables in dementia.

The nursing care of a group of moderately demented patients (n = 11) in a nursing home was improved as a result of an education of the staff. Thus the patients were subjected to an increased emotional and intellectual stimulation during the ordinary daily care and participated in group sessions twice a week. In order to evaluate the effects of the treatment, psychological parameters and cerebrospinal fluid (CSF) HVA (homovanillic acid), 5-HIAA (5-hydroxyindole acetic acid) and HMPG (4-hydroxy, 3-metoxyphenylglucol) were quantified before and after a 2-month treatment period. A group of similar patients (n = 13) in another nursing home constituted a control group. The ratings of concentration, absent mindedness and recent memory showed a more favorable development in the treatment group than in the control group where an intellectual deterioration was evident. Restlessness was rated higher in the treatment group after the treatment period, while the psychological testings showed no significant changes between the groups. CSF HVA concentrations increased in the treatment group and decreased in the control group (P less than 0.05). No change was evident in 5-HIAA or HMPG concentrations in either group. The results suggest that environmental factors influence biochemical markers of transmitter activity which thus possibly may be of etiological importance in dementia.

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PubMed1986

Normal aging and dementia disorders--coping and crisis in the family.

At present we have limited possibilities to treat dementia disorders. One way to intervene in the progress is to support the family. In this investigation the situation of the family and the primary caregivers to patients with dementia disorders are studied. One group consists of 171 patients admitted to a geropsychiatric unit. Relatives to these patients were interviewed. A subgroup of these patients were formed consisting of 28 patients with Alzheimer's disease and senile dementia of Alzheimer type. The patients in this group were rated with a geriatric scale for measuring dementia. In another group of 28 long-stay patients on a geriatric ward the level of dementia and the family situation was studied. As a control group 26 individuals from a county in Sweden was chosen, all of them 85 years of age or older. They were considered the most healthy individuals in the area in this age group. The need of support for these individuals was studied. The results indicate that individuals in high age, although considered healthy, need much support. All the families to patients with dementia disorders need support more or less. Either group therapy or individual psychotherapy can be given. Adequate formal help from the society and psychological support to the primary caregivers probably delay institutionalization.

Adaptation, Psychological↗
PubMed1983

Alaproclate: a pharmacokinetic and biochemical study in patients with dementia of Alzheimer type.

Alaproclate, a specific inhibitor of neuronal serotonin re-uptake, was given to 12 patients with dementia of Alzheimer type. The drug was rapidly absorbed and an elimination half-life of 7.1 +/- 0.9 h (+/- SD, n = 8) was calculated. Plasma protein binding for alaproclate was 82 +/- 1%. Two weeks of repeated administration produced plasma concentrations of alaproclate similar to those predicted from a single dose. The pharmacological effect of the drug was demonstrated by an inhibition of serotonin uptake in the patients' platelets and a reduction of the serotonin concentration in blood. Global rating of clinical efficacy showed a positive effect of alaproclate in five of the patients, mainly regarding emotional functions.

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PubMed1982

A new rating scale for dementia syndromes.

A new scale, the GBS-scale, is constructed for rating dementia syndromes. The scale is divided into four subscales measuring motor, intellectual and emotional functions and different symptoms characteristic for dementia. The scale can be used by physicians, psychologists and registered nurses. The reliability of the scale is tested by rating 100 patients in somatic and psychogeriatric long-term care. The raters worked independently of each other and were recommended to confer with the staff about the status of the patient. The agreement between the raters was good. The validity of the scale was tested by comparing it with another geriatric rating scale. High correlations between the two scales were seen and indicated that the new scale measures dementia syndromes. The new scale measures degree of dementia and profiles of dementia syndromes. It is constructed in such a way that it can measure changes in dementia symptoms over a certain amount of time. Thus, it can be used in evaluating effect of treatment. It is not, however, meant to be a diagnostic scale.

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