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Biomedical subjects

H Lauter

Publications and source records attributed to H Lauter.

At least 19 recordsLinked to original sources
PubMed1997

Variability of cerebral blood flow deficits in 99mTc-HMPAO SPECT in patients with Alzheimer's disease.

The purpose of this study was to analyse the frequency of the different pathological perfusion patterns in SPECT in a clinical, unselected population of patients with Alzheimer's disease. In 91 patients and 16 control subjects regional cerebral blood flow (rCBF) was measured with Single Photon Emission Computed Tomography (SPECT) using 99mTc-hexa-methyl-propyleneamine oxime (HMPAO). 95% confidence intervals obtained from the perfusion values of the control subjects were used to define normal perfusion ranges. The frequency of perfusion deficits in the left frontal, temporal, parietal and occipital lobes were 62.2%, 60.4%. 70.3% and 23.1%, respectively. In the right hemisphere the corresponding values were 60.4%, 58.2%, 63.7% and 9.9%. With the exception of the occipital lobes these frequencies were not significantly different. The analysis of the perfusion pattern of each patient revealed 35 different combinations of lobes with perfusion deficits. The temporo-parietal perfusion deficits were not more frequent than the temporofrontal perfusion deficits. These results suggest that in the clinical routine a high variety of heterogeneous rCBF patterns have to be expected.

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PubMed1997

[The Chabot case. Assisted suicide from the psychiatric viewpoint].

The international discussion on physician-assisted dying as well as the recent development in North Australia and Oregon point to a growing tendency to favour assisted suicide as against killing on request--last not least for reasons of public acceptance. The decision of the Supreme Court of the Netherlands in a case of suicide assisted by a psychiatrist gives the opportunity to discuss the problem from the psychiatric point of view.

Ethics, Medical↗
PubMed1996

Apolipoprotein E type 4 allele and Alzheimer's disease: effect on age at onset and relative risk in different age groups.

The effect of the apolipoprotein E (apoE) genotype on the age at onset of Alzheimer's disease (AD) and the relative risk conferred by the apoE epsilon 4 allele were studied in 91 patients and 69 healthy age-matched controls. According to the age of presentation, which varied from 44 to 95 years, subjects were divided into four groups. The inheritance of at least one epsilon 4 allele was associated with a significant reduction of the age at onset by 7.7 years among patients who were 83 years or older when examined. A weaker inverse relationship between the epsilon 4 allele and the age at onset was also observed among patients who were aged 44-63 years at presentation. The effect of the epsilon 4 allele was minimal or absent in the two intermediate age categories. The relative risk of AD conferred by the inheritance of at least one epsilon 4 allele showed no consistent age-related pattern. The overall risk expressed as an odds ratio was 5.0 (95% CI 2.4-10.5). With respect to the limitations of the study, we tentatively conclude (1) that the effect of the apoE epsilon 4 allele on the age at onset is not restricted to AD patients of a particular age, in accordance with current hypotheses on the role of apoE gene products in the biology of AD; (2) that the relative risk of AD associated with the epsilon 4 allele is not significantly modulated by age. Although the apoE epsilon 4 allele is an important susceptibility factor for AD occurring in middle age as well as in later life, it is of limited value in routine clinical diagnosis and should not be used for predictive testing in asymptomatic individuals.

Age Factors↗
PubMed1996

[The "neuroleptic threshold"--a review of the literature].

The neuroleptic threshold theory raised the expectation that schizophrenic patients could be treated with an optimal, individual neuroleptic dosage, causing no side effects. Although most existing studies do not fulfill current methodological standards, a few methodologically convincing analyses confirm that good clinical results can be achieved with relatively low dosages (4 mg haloperidol equivalent per day). Thus, the neuroleptic threshold theory and methods related to it deserve further research.

Antipsychotic Agents↗
PubMed1995

[Willingness to participate in dementia research by relatives of Alzheimer patients and family members of cognitively normal persons].

We investigated the willingness to participate in dementia research of relatives of demented (n = 52) and cognitively unimpaired elderly individuals (n = 42). This unrepresentative sample was given a questionnaire to determine the rate of approval with respect to two research examples, the first of which referred to a therapeutic study with potential individual benefits, the second to a diagnostic research project without such benefits. Independent of potential individual benefits, an overwhelming majority acknowledged the necessity for dementia research and consented to participate in the given research examples. The rate of approval was not related to the experiences of the interviewed persons in the care of relatives suffering from dementia.

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PubMed1994

[The apolipoprotein E-epsilon 4 allele is a risk factor for Alzheimer disease with early and late onset].

The apolipoprotein E genotype was determined in 50 patients with clinically diagnosed and prospectively confirmed Alzheimer's disease of mild to moderate severity and in 50 healthy age- and sex-matched controls. The frequency of the epsilon 4 allele was increased in the patients irrespective of the age at onset and of a possible familial transmission of the disease. It was associated with a relative risk of 2.97. In patients who experienced first symptoms after the age of 65 years there was an inverse correlation between the number of epsilon 4 alleles and age at onset. The results suggest that in the absence of amyloid precursor protein mutations and of a gene which has not yet been precisely localized on chromosome 14, apolipoprotein E is involved in the pathogenesis of Alzheimer's disease. It probably exerts its influence by an acceleration or retardation of amyloid formation and/or tau hyperphosphorylation.

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PubMed1992

[The new euthanasia-discussion from the psychiatric viewpoint].

The practice to kill terminally ill patients on their own demand has resulted in the Netherlands in a decriminalisation of active euthanasia which thus has fundamentally changed the way to deal with dying patients. Sooner or later this development will extend to other European countries as well as to the USA. Involuntary euthanasia of severely handicapped newborn children or of demented persons is propagated by the practical ethics of P. Singer and other representatives of utilitarianistic philosophy. According to the standpoint of utilitarianism a human being should only have the right to live as long as he or she is a person, i. e. has rationality and self-consciousness. The next step toward the elimination of elderly people can easily be predicted. For economical reasons these persons may be withheld from life-saving medical treatment or may be supposed to commit suicide. A moral pressure is created to make a decision for suicide as soon as severe invalidity occurs. The consideration of such ideas shows that in today's debate on euthanasia the issue is no longer the right of a few severely and terminally ill human beings to their "own death". Instead, the right to live of a large group of handicapped and "socially useless" or "unproductive" persons is at stake. This is the danger of today's discussion of euthanasia.

Persons with Disabilities↗
PubMed1991

Depressive disorders and dementia: the clinical view.

The relationship between depression and dementia is complex. Transient emotional disturbances and long-lasting depressive disorders may occur as psychological reactions to the loss of mental abilities or as behavioural manifestations of brain injury. On the other hand, major depressive disorder of late onset or of a recurrent type may be superimposed on dementing illness. Depression, particularly in elderly individuals, can manifest itself as a reversible syndrome of dementia that responds favourably to antidepressant treatment. It is not known whether the dementia syndrome of depression represents a quantitative intensification of minor cognitive impairments that can be observed in a large proportion of depressed patients. It also remains doubtful whether dementia in depressed patients has to be considered as an epiphenomenon of pervasive melancholic illness. An alternative explanation would look at such conditions as manifestations of a specific brain dysfunction. Major depression associated with cognitive impairment in stroke patients might be regarded as an example of a reversible dementia dysfunction.

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PubMed1991

[Information-centered family groups for improving compliance in schizophrenic patients].

We tried to improve the compliance in the long-term treatment of schizophrenic patients by psychoeducational groups for relatives of 48 patients over the course of six months. More than 90% of the relatives requested mainly informations concerning the illness and its treatment both at the beginning and at the end of the group sessions. At the beginning only 33% of the relatives thought they could benefit from sharing their experiences with others, afterwards this rate rose to 67%. At first, 49% believed to understand the nature of schizophrenia, at the end this rate was 86%. The importance of medication implying certain side effects was accepted by about 85% before and afterwards. This good quota at the beginning of the group sessions can be explained of this high acceptance rate appears to be a direct result of the group meetings.

Adaptation, Psychological↗
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.

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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

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.

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