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Biomedical subjects

I Skoog

Publications and source records attributed to I Skoog.

84 records · Page 5Linked to original sources
PubMedDate not supplied

The influence of dementia on the prevalence of urinary and faecal incontinence in 85-year-old men and women.

The influence of dementia on the prevalence of urinary and faecal incontinence was investigated in a random sample (n = 485) of the total population of 85-year-olds from the city of Gothenburg, Sweden. The subjects were assessed by a psychiatric interview, physical examinations, computed tomography of the head and analysis of cerebrospinal fluid. Urinary and faecal incontinence were assessed by a urotherapist. Dementia, urinary and faecal incontinence were defined according to strict, internationally accepted criteria. The prevalences of urinary and faecal incontinence, and dementia were 38%, 17% and 29% respectively. Demented men (50%) and women (60%) were more often urinary incontinent than non-demented men (18%) and women (36%). Faecal incontinence was more prevalent in demented (34.8%) than non-demented subjects (6.7%). Both urinary and faecal incontinence were more prevalent in women (43% and 20% respectively) than men (27% and 11%, respectively). The prevalences of urinary and faecal incontinence, and dementia were higher in residents of a nursing home or hospital (74%, 51% and 92%, respectively) than in subjects living at home (32%, 9% and 18%, respectively). Of the demented subjects resident in an institution, 78% were incontinent compared with 37% living at home. Incontinence aids were used by 18% of the men and 33% of the women, and their use increased with increasing severity of dementia. Dementia influenced the prevalence of urinary incontinence, and both conditions independently of each other strongly influenced the need for institutional care.

Journal Article↗
PubMedDate not supplied

Significance of decreased lumbar CSF levels of HVA and 5-HIAA in Alzheimer's disease.

The monoamine metabolites homovanillic acid (HVA), 5-hydroxy-indoleacetic acid (5-HIAA) and 4-hydroxy-3-methoxy-phenylglycol (HMPG) were determined in lumbar cerebrospinal fluid (CSF) of 123 patients with Alzheimer's disease (AD) and 57 healthy controls. Despite CSF sampling under strictly standardized conditions, a wide variability in values among both patients and controls was found, as well as fluctuations in repeated samples from individual patients. This suggests that several unknown factors influence the lumbar CSF levels of monoamine metabolites. The AD group showed significantly lower mean levels of HVA (p less than 0.0001) and 5-HIAA (p less than 0.0001) than the control group. A relation between severity of disease and HVA was also found. The widespread neurotransmitter disturbance in AD, together with the nonspecificity of reduced lumbar HVA and 5-HIAA levels, suggests that the changes are nonspecific, secondary to the cerebral degeneration in AD.

Aged↗
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Vascular factors and Alzheimer disease.

Vascular risk factors are normally associated with cerebrovascular disease, which may lead to vascular dementia (VaD). Several recent studies suggest that there is increased risk of developing Alzheimer disease when exposed to these same vascular risk factors. In addition to old age, hypertension, peripheral arterial disease, certain types of cardiovascular disorders, diabetes mellitus, and smoking are now considered risk factors for late-onset Alzheimer disease. In this review, we examine several vascular factors and peripheral vascular pathophysiology implicated in Alzheimer disease and suggest certain mechanisms that might promote the association of vascular factors and late-onset Alzheimer disease. We support the implication that prevention or management of peripheral vascular disease may prevent or delay the onset of Alzheimer disease or mixed dementia.

Alzheimer Disease↗
PubMedDate not supplied

The influence of white matter lesions on neuropsychological functioning in demented and non-demented 85-year-olds.

White matter lesions on computed tomography of the head were studied in relation to neuropsychological functioning in subjects from a representative sample of non-demented (n = 134) and demented (n = 98) 85-year-olds. Non-demented subjects with white matter lesions (n = 46) scored significantly lower in tests of verbal ability (Synonyms), spatial ability (Block Design, Clock Test), perceptual speed (Identical forms), secondary memory (Thurstone Picture Memory), basic arithmetic (Coin Test) and the global cognitive screening test Mini-Mental State Examination than non-demented subjects without white matter lesions (n = 88). Demented subjects with white matter lesions (n = 67) scored significantly lower in tests of spatial ability (Block Design and Clock Test) and secondary memory (free recall in the MIR memory test, Ten-word memory test I and II) and in the Mini-Mental State Examination than demented subjects without white matter lesions (n = 31). It is concluded that white matter lesions contribute to cognitive decline in both non-demented and demented elderly subjects.

Aged↗
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A longitudinal population study of the mini-mental state examination in the very old: relation to dementia and education.

We examined the Mini-Mental State Examination (MMSE) in relation to the prevalence and incidence of dementia in a representative population sample (n = 494), followed from age 85 to 88. The study included a neuropsychiatric examination (including the MMSE) and a key informant interview conducted by a psychiatrist. Dementia was defined according to the DSM-III-R. Among non-demented 85-year-olds, 75% of those who scored below the cut-off score of 23/24 and 37% of those scoring 24-25 became demented during the follow-up. Non-demented 85-year-olds who did not develop dementia during the following 3 years had a mean decline in MMSE score of 0.6 per year, while those who became demented decreased by 2.3 points per year. A decrease of 4 or more points during the 3 years had a sensitivity of 83% and a specificity of 80% for a diagnosis of dementia. High and low MMSE score at base-line was related to a smaller decrease in MMSE score between age 85 and 88. Higher education was related to higher scores on MMSE at age 85 and to a smaller decline in scores between age 85 and 88. Change in MMSE score in non-demented individuals is small especially among individuals with high education. Non-demented individuals scoring below 26 should receive close attention, as a high proportion are at risk of developing dementia.

Aged↗
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Detection of dementia in primary care: the Linköping study.

We examined to what extent dementia and cognitive impairment are detected in a primary health care centre. A systematic sample of patients aged 70 years and above, who attended a primary health care centre for a doctor's consultation (n = 350) were examined with a neuropsychiatric examination and an interview with a close informant. Dementia was diagnosed according to DSM-III-R. Medical records from the health centre were examined for entries on cognitive decline or dementia, other diagnoses and prescribed drugs. The prevalence of dementia was 16.3% and a further 3.1% had questionable dementia. Cognitive disturbances or dementia were noted in case records in 15 out of 57 (26%) demented cases, and in 1 out of 11 (9%) questionable dementias. Compared to non-demented patients, the demented had more diagnoses and a higher number of prescribed drugs. Severity and duration of dementia were associated with an increased detection.

Aged↗
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Blood pressure and risk of dementia: results from the Rotterdam study and the Gothenburg H-70 Study.

The association between blood pressure and dementia is debated. Results from population-based studies on blood pressure and dementia are inconclusive, and most are performed in subjects younger than 80 years of age. We examined the relation between blood pressure and dementia and the possible effect modification of this relation by age in a pooled dataset based on two prospective population-based studies. Subjects came from the Rotterdam study (n = 6,668), a longitudinal population-based study among subjects aged 55 years and over, and from the Gothenburg H-70 Study (n = 317), a study on subjects aged 85 years at baseline. Screening and diagnostic procedures for assessment of dementia were similar at baseline and follow-up and comparable between studies. We estimated relative risks of dementia using Cox proportional hazards regression analysis, adjusted for age, gender and study location. The average follow-up was 2.1 years. During this period, 196 subjects developed dementia. The risk of dementia decreased with increasing blood pressure level (per 10 mm Hg systolic blood pressure: RR = 0.93, 95% CI = 0.88-0.99; per 10 mm Hg diastolic blood pressure: RR = 0.89, 95% CI = 0.79-1.00). This association was confined to subjects who used anthypertensive medication. Persons who were demented at baseline had a stronger blood pressure decline during follow-up than those who were non-demented. This study suggests an inverse association between blood pressure and dementia risk in elderly persons on antihypertensive medication. Possibly, they may need higher blood pressure levels to maintain an adequate cerebral perfusion. Alternatively, lower blood pressure may be secondary to brain lesions in preclinical stages of dementia.

Age Factors↗
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Risk factors for vascular dementia: a review.

In recent years, interest in vascular causes of dementia has increased and it has been proposed that vascular dementia (VAD) may be more common than previously supposed. This may have important implications, because VAD at present may be more amenable to prevention and treatment than Alzheimer's disease (AD). Several vascular factors have been related to cognitive decline and dementia in the elderly, including stroke and white matter disease. However, while numerous case-control studies have been concerned with the risk factors for AD, studies on risk factors for VADs are rare. The problems inherent in the diagnostic criteria make it difficult to interpret the results from the few studies that have been performed. Generally, risk factors for multi-infarct dementia are supposed to be the same as those for stroke, and include hypertension, diabetes mellitus, advanced age, male sex, smoking and cardiac diseases. White matter dementia has mainly been related to hypertension. Recent research suggests that vascular factors may also be important in AD, especially in the late-onset type. In stroke patients, dementia has been associated with higher age, less formal education, cerebral atrophy, left-sided or bilateral infarcts, volume of macroscopic infarcts, bilateral symptoms, previous stroke and white matter lesions. The pathogenetic mechanism through which these factors cause dementia is still not clear. Furthermore, it is not known if risk factors for VAD differ from those found in stroke patients. There is now an urgent need for further research on risk factors for VAD and on factors related to dementia in subjects with cerebrovascular disorders.

Cerebrovascular Disorders↗
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Subclinical dementia: relevance of cognitive symptoms and signs.

In 1971 and 1972, a representative sample of 70-year-old people (n = 392) from a population study was rated with regard to psychiatric symptoms and signs. Subjects showing evidence of dementia of any degree, including slight and questionable, were excluded (n = 18). The remaining 374 subjects were followed longitudinally for 9 years. Thirty-eight subjects developed severe dementia during this period. They were compared to those who did not with regard to 19 reported and 17 observed items concerning general psychopathology, seven reported items concerning sleep, and a global rating of mental health. Five items correlated with the development of severe dementia: number of remembered dreams per week, latency of speech, speed of speech, difficulties in finding words, and memory for recent events. A stepwise logistic regression procedure demonstrated that a low frequency of remembered dreams, a reduced memory for recent events, and difficulties in finding words made independent contributions to the prediction of dementia. There were no differences with regard to affective items. There were no differences between the subjects who developed senile dementia of the Alzheimer type and those with multi-infarct dementia. The results thus support the hypothesis that symptoms pertaining to cognitive functions are the first to appear in the development of dementia.

Aged↗
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The prevalence of white-matter lesions on computed tomography of the brain in demented and nondemented 85-year-olds.

The prevalence of white-matter lesions on computed tomography was studied in a representative sample of 85-year-olds living in Gothenburg, Sweden. The study included a psychiatric examination, interview of a close informant, neuropsychological examination, physical examination, comprehensive laboratory tests, electrocardiogram, chest x-ray, computed tomography scan of the head, and cerebrospinal fluid analysis. The diagnoses of dementia and other mental disorders were made according to DSM-III-R criteria. The prevalence of white-matter lesions in demented subjects was 68.9%, and in nondemented, 33.8%. Their prevalence was not increased in any mental disorder other than dementia. All severities of dementia and the subtypes, Alzheimer's disease, vascular dementia, and other types of dementia, had a significantly higher prevalence of white-matter lesions than did nondemented subjects. The risk for dementia, but not its severity, increased with the severity of these lesions. A stepwise logistic regression analysis showed that both white-matter lesions and infarcts on computed tomography contributed independently to dementia. White-matter changes may be a contributing cause of dementia in the oldest old, or may represent a disease entity of its own. They are important to recognize since they may be potentially preventable, or even treatable.

Aged↗
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Prevention of vascular dementia.

Stroke is an important public health problem worldwide. Those at high risk of stroke may be at high risk of cognitive impairment and dementia after stroke. Modifiable cardiovascular risk factors in midlife including hypertension, alcohol use, cigarette smoking, and certain dietary factors may be important targets for prevention of vascular causes of cognitive impairment. These same types of factors may also be associated with Alzheimer disease. Better control of cardiovascular disease risk factors might lead to delay or prevention of vascular dementia and Alzheimer disease.

Alcohol Drinking↗