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Biomedical subjects

K Laake

Publications and source records attributed to K Laake.

At least 37 records · Page 2Linked to original sources
PubMed1999

Screening by nurses for aphasia in stroke--the Ullevaal Aphasia Screening (UAS) test.

PURPOSE: In Norway, the speech therapist is responsible for the assessment of language impairment after stroke, but many hospitals have no speech therapist. This study therefore developed and evaluated a simple method to be used by nurses to detect aphasia in the acute stage of stroke; the Ullevaal Aphasia Screening (UAS) test. METHOD: The study was carried out among 37 stroke patients admitted to an acute stroke unit. They were assessed by nurses using the UAS, while the results of a comprehensive assessment by a speech therapist acted as the 'gold standard'. RESULTS: The predictive value of a positive test was 0.67 and that of a negative test 0.93; only two out of 28 who screened negative on the UAS were diagnosed with mild aphasia by the speech therapist. The weighted kappa coefficient of agreement was 0.83, indicating a strong agreement between the nurses' and speech therapists' scoring. The screening took 5-15 minutes to complete. CONCLUSION: The Ullevaal Aphasia screening test seems to be a short and valid screening instrument for aphasia in the acute stage of stroke, but further studies would be needed to substantiate the efficacy of the UAS test.

Aged↗
PubMed1999

Predictors of outcome of rehabilitation of elderly stroke patients in a geriatric ward.

PURPOSE: To identify predictors of outcome after 12 months in elderly stroke patients rehabilitated in a geriatric ward. DESIGN: Prospective with evaluation in the subacute phase and after 12 months. SETTING: Geriatric ward and outpatient clinic. SUBJECTS: All stroke patients admitted from the acute unit to a geriatric ward for rehabilitation during a 16-month period (n = 171). MAIN OUTCOME MEASURES: Place of living, mortality and social functioning (Frenchay Activities Index) 12 months following stroke. RESULTS: Age, urinary incontinence and cognitive function were significantly associated with place of living (home versus nursing home) 12 months post stroke in bivariate analyses. However, using multivariate logistic regression analyses, only age (p = 0.005) and urinary incontinence at baseline (p = 0.028) remained independent predictors of place of living. Mortality during the first year was significantly predicted by urinary incontinence and gender (men doing worse), whereas the Barthel Activities of Daily Living (ADL) Index sumscore was the only significant independent predictor of social activities. CONCLUSION: Urinary incontinence at baseline seems to be a most important predictor of outcome 12 months post stroke in geriatric patients. However, with regard to social activities (Frenchay Activities Index), functional impairment in the initial phase as reflected by the Barthel ADL Index supersedes other predictors.

Activities of Daily Living↗
PubMed1999

Loss of heterozygosity at 11q23.1 and survival in breast cancer: results of a large European study. Breast Cancer Somatic Genetics Consortium.

Among the chromosomal regions commonly undergoing deletions in breast tumors is 11q23.1. The genes that are targets for loss of heterozygosity (LOH) in this region is not yet established. One of the candidate genes located in this region is ATM, responsible for the rare autosomal recessive disorder ataxia-telangiectasia (A-T). Interestingly, A-T heterozygotes may have an increased risk of cancer, in particular breast cancer, although this is still controversial. A common assumption has been that the target for the LOH at 11q23.1 in breast carcinoma is the ATM gene, but the area studied has been too large, the density of markers too low, and the number of tumors studied has been too small to draw any firm conclusions. The present study is a multicenter study including 918 breast cancer patients with clinical information and survival data available for most of them. Primary breast tumors were investigated for LOH using a high density of microsatellite markers spanning approximately 6 Mb around the ATM gene. Survival analyses showed that there are most likely one or more candidate genes in a 3-4 Mb region between the markers D11S1819 and D11S927 including the ATM gene. Cancer-specific survival was significantly reduced in patients whose tumors exhibited LOH of markers D11S2179 (within the ATM gene), D11S1778, D11S1294, and D11S1818. The highest survival hazard ratios were 1.8(C11.2-2.8, P = 0.010) and 2.1 (C11.4-3.0, P = 0.0004) for markers D11S2179 and D11S1818, respectively. One or more of these markers are therefore most likely to be located close to or within genes associated with breast cancer survival.

Adult↗
PubMed1998

Validation of the screening instrument for neuropsychological impairment in stroke.

BACKGROUND AND PURPOSE: Full neuropsychological assessment is time-consuming and exhausting for the patient in the early phase of stroke. The screening instrument for neuropsychological impairment in stroke (SINS) is a brief, bedside-applicable instrument designed to screen perceptual and cognitive dysfunction related to functional activities in stroke. It has been developed by physiotherapists to be incorporated in the general assessment of the patient. This study evaluates the validity of the method against a more extensive reference method assessing cognitive function. METHODS AND RESULTS: An unselected group of hospitalized stroke patients (N = 87) was assessed 10 days and 12 months after stroke. Factor analyses (52% explained variance), identified three factors: 'aphasia', 'apraxia' and 'visuocognitive dysfunction'. Receiver operating characteristics (ROC) curves demonstrated that for all factors, high specificity was maintained at the high sensitivity needed for a screening method. Kendall rank correlation coefficients between the scorings on the new instrument and the reference method were high. Effect size analysis showed that the ability of the new instrument to detect change in cognitive functioning during the first year was of the same magnitude as the reference method. CONCLUSIONS: SINS has a high sensitivity regarding cognitive dysfunction, as diagnosed by the more comprehensive and time-consuming reference method. The instrument would be useful as an initial step in the assessment of neuropsychological impairment in stroke patients.

Aged↗
PubMed1998

Falls reported among elderly Norwegians living at home.

BACKGROUND AND PURPOSE: Norway has the highest reported incidence of hip fractures in western Europe. Little is known about the epidemiology of falls in Norway where the winter season is long and dark. The objective of this work was to study reported falls and their consequences among elderly Norwegians living at home. METHODS: A cross-sectional design was used for the study. Interviews were performed in the homes of 431 subjects, aged 67-97 years, living at home. Information on falling was gathered through six questions: whether the subject had fallen during the last six months, and if so, how many falls they had, where the last fall occurred, its perceived reason, the activity the subject had been engaged in when the fall occurred, and the resulting injury. RESULTS: In all, 24.1% of subjects reported falling during the last six months, and 9.5% had suffered more than one fall. Falls were most frequently linked to external events (63.1%). Outdoor falls were more frequent (59.0%; 95% CI = 51.2-82.0) than indoor falls. Older subjects were associated with more frequent indoor falls (p < 0.05), but gender was not significant. Fifty-one per cent of subjects had fallen while walking and 53% had suffered an injury from the last fall. In 13.4% of the women and 16.2% of the men, the last fall had resulted in a fracture. CONCLUSIONS: Compared to the results of other studies from industrialized Western countries, a similar crude fall rate, similar frequency and similar type of injury were found. However, in contrast to other studies, no gender difference was observed with regard to falling, place of falling and fracture rate.

Accidental Falls↗
PubMed1998

Social and depressive stress suffered by spouses of patients with mild dementia.

OBJECTIVE: To identify stressors and their correlates in spouses of patients with mild dementia. DESIGN: Retrospective study of patient records. SETTING: Patients attending a Memory Clinic at Ullevaal Hospital in Oslo. SUBJECTS: 92 mildly demented patients living at home (mean age 75.7 years, 51% women, mean MMSE score 22.3) and their spouses. MAIN OUTCOME MEASURES: Frequency and types of stress suffered by spouses using validated and factor-analyzed instruments as measures. RESULTS: Twenty-five per cent or more of the spouses reported often/always having problems with the following: being depressed by the situation, having difficulties getting away on holiday, social life being affected, household routines being upset, and sleep being interrupted. Factor analysis of the Greene Caregiver Stress Scale (15 items) identified two factors; 'Social stress' and 'Depressive stress'. Social stress was associated with the patient's I-ADL level, and depressive stress with mood and behaviour of the patient. The depressive symptomatology of the patient as expressed by the spouses was related to both depressive and social stress, whereas cognitive function, as measured by the MMSE, was not an independent predictor of carer strain. CONCLUSION: Even in mildly demented patients, symptoms of carer stress are frequent. Supportive strategies such as early diagnosis, information for carers and intervention strategies are discussed.

Activities of Daily Living↗
PubMed1998

Correlates of subjective well-being in stroke patients.

BACKGROUND AND PURPOSE: Data on survival and functioning after stroke needs to be supplemented by measures emphasizing the patients' subjective perception. We studied (1) subjective well-being (SWB) as a latent variable in a common-factor model with four items, (2) the reliability of these four items, and (3) variables related to SWB in stroke patients. METHODS: Data on all stroke patients (n=1417) and a random subsample of stroke-free individuals of similar age (n=1439) were collected from the Nord-Trøndelag Health Survey, a cross-sectional study of 74977 persons. Based on a two-sample factor analysis model, scores of SWB were calculated, and variables explaining SWB were studied in a regression model. RESULTS: Four items were a priori believed to measure SWB as a latent variable ("satisfaction," "strength," "calmness," and "cheerfulness"). This was confirmed by factor analysis. The reliability of these items (the proportion of the variance of the items that can be explained by the common factor) was between .42 and .53. Regression analyses showed a significant effect of having had a stroke, gender (lower SWB in men), age (increasing SWB with increasing age), perceived general health, nervousness, loneliness, sleep problems, social support, and use of analgesics. There was no statistical interaction between these variables and having had a stroke. CONCLUSIONS: Higher SWB after stroke relates to female gender, older age, good general and mental health, and a firm social network.

Adult↗
PubMed1997

[Rehabilitation of elderly stroke patients in a geriatric department. Course and prognosis].

Stroke is an age-related disorder where nearly 70% of the patients are over 70 years of age. More knowledge about the outcome and prognosis among the eldest stroke victims is needed. We studied 171 elderly stroke patients admitted to geriatric wards for rehabilitation. The patients were assessed on admittance to and discharge from hospital, and six and 12 months after the stroke. The mean age was 78.4 years. During the first year, 19% died and 25% were admitted to nursing homes. After 12 months six out of ten patients were living at home. Our results indicate that even elderly stroke patients have a potential for functional improvement after a stroke.

Activities of Daily Living↗
PubMed1997

[Ginseng--no identifiable effect in geriatric rehabilitation].

The consumption of ginseng root has increased greatly in the Western world during the last decades. Because clinical trials have indicated a positive effect of ginseng on physical and psychomotor performance, we have undertaken a trial of Gericomplex to evaluate ginseng as an adjuvant in the treatment and rehabilitation of geriatric patients. The length of stay in hospital and activities of daily living served as the principal study variables, and cognition, somatic symptoms, depression and anxiety were also assessed. No positive effect of Gericomplex as an adjuvant in geriatric rehabilitation was seen.

Activities of Daily Living↗
PubMed1997

[Memory clinic--ambulatory examination in suspected dementia].

Dementia and confusion are frequently overlooked by general practitioners. A memory clinic was established at the Department of Geriatric Medicine, Ullevål Hospital in September 1990 with the intention of creating a standardized programme for diagnosing dementia and cognitive impairment in the elderly in an out-patient setting. The activities and services offered by the clinic are described: diagnoses, information to patients, their family and staff in the primary health care system about the symptoms and treatment of dementia. In addition, advice is given on follow-up care and how to apply for care through the national health service. There has been a great demand for the services of the Memory Clinic, and we believe that the methods used are adequate in an out-patient setting. The concept could easily be transferred to other specialist clinics involved with the elderly, and parts of the programme could also be used by general practitioners.

Aged↗
PubMed1997

[How is it with the "elderly wave"].

Data from Statistics Norway is used in this study of demographic development till 2020 in the population of the very old. There is a marked increase in the percentage of elderly women (80 years and over) in the population, from 2% in 1970 to nearly 5% in 1993. This is related to increased life expectancy and occurred parallel to a reduced rate in cardio-vascular mortality, which also occurred in men. However, in men this reduction is counter balanced by a serious increase, nearly 50%, in age-specific cancer mortality. The predictions for the population seem somewhat ambiguous, in particular as regards the percentage of elderly women, which is underestimated. There are significant regional differences with regard to the expected development in the population of people 80 years and older. On the whole, these differences do not seem to be related to mortality.

Aged↗
PubMed1997

Risk factors for depression in Parkinson disease.

OBJECTIVE: To evaluate whether depression in Parkinson disease (PD) is more closely related to the underlying neuropathological process or to environmental and psychological factors by correlating depression in PD with various clinical and demographic variables. DESIGN: Major depression, level of depressive symptoms as measured with the Montgomery-Aasberg Depression Rating Scale (MADRS), and clinical characteristics were investigated in a community-based cross-sectional study of carefully diagnosed patients with PD. Both bivariate and multivariate correlation analyses were performed to investigate correlations and predictive values of possible risk factors for major depression and MADRS score in PD. SETTING: Depression among patients with PD derived from a prevalence study in the county of Rogaland, Norway. PATIENTS: Two hundred forty-five patients with PD. RESULTS: Impaired cognitive function and the presence of a thought disorder were significant predictors of major depression. A Mini-Mental State Examination sum score below 24 and level 2 or higher on the thought disorder subscale of the Unified Parkinson Disease Rating Scale increased the probability of major depression by a factor of 6.6 and 3.5, respectively. Higher MADRS scores were also associated with lower Mini-Mental State Examination score and higher thought disorder score. In addition, MADRS scores also correlated with more impairment in activities of daily living, presence of motor fluctuations, more evidence of atypical parkinsonism, higher daily doses of levodopa, and younger age on the day on which prevalence was determined. CONCLUSIONS: Most of the observations of this study favor the hypothesis that depression in PD is a primary consequence of brain dysfunction. Situational factors may, however, also contribute to mood changes in PD.

Aged↗
PubMed1997

Screening for ESR mutations in breast and ovarian cancer patients.

In the present study, leukocyte DNA from 143 patients with familial clustering of breast and/or ovarian cancer and tumour DNA from 96 breast carcinomas were screened for base mutations in the estrogen receptor gene (ESR). Three patients with a family history of cancer were carrying a Gly160Cys germline substitution. This alteration was also detected in eight (four females and four males) of 729 controls (366 female, 363 males), indicating that the substitution probably represents a polymorphism. However, in the 229 female controls in whom family history of cancer was known, one of two who had a sister with breast cancer was carrying the variant allele. Hence, a possible clinical significance of the glycine into cysteine cannot be completely ruled out and should be further investigated. Somatic mutations were not detected in any of the tumours studied, and the present data do not provide support for somatic ESR base mutations as an important mechanism for hormonal therapy resistance in estrogen receptor-positive breast carcinomas.

Adult↗
PubMed1997

Loss of heterozygosity at 11q23.1 in breast carcinomas: indication for involvement of a gene distal and close to ATM.

Previous reports have suggested that heterozygotes for ataxia-telangiectasia (A-T) have an increased risk of cancer, in particular breast cancer. The ATM gene, responsible for A-T, was recently cloned. Loss of heterozygosity (LOH) in the chromosome band 11q23, where the ATM gene is located, has been reported in several types of tumours including breast carcinomas. Whether the ATM gene is the target, and the sole target, for the LOH seen in this region is not yet known. In this study, 169 primary breast carcinomas and 10 metastases were examined for allelic imbalance (AI) using 10 microsatellite markers mapping to 11q23.1. Nine of the markers reside within a 10 Mb region surrounding the ATM gene, whereas the tenth locus, APOC-3, is located more than 12 Mb telomeric from this region. The highest frequencies of alteration were found for APOC-3 (45%), and for two markers located approximately 200 and 900 kb telomeric from ATM, D11S1294 (44%) and D11S1818 (44%). The marker located within the ATM gene, D11S2179, was altered in 37% of the informative tumours. The present deletion map indicates that three distinct regions at 11q23.1 may be involved in breast cancer development; one between the markers D11S1294 and D11S1818, a second close to APOC-3, and a third that is possibly the ATM-gene itself.

Adult↗
PubMed1996

[Should Alzheimer disease be treated with tacrine? Review of the literature].

The authors describe the rationale for use of the acetylcholinesterase inhibitor, tacrine, in Alzheimer's disease and critically review the controlled clinical trials using this drug. The data shows that tacrine improves cognition and function, and that 20-40% of the patients may benefit from such treatment. A large proportion of the patients do not tolerate the highest dose, mainly because of an increase in serum liver-enzymes, which is reversible and asymptomatic. The authors recommend that tacrine should be considered for patients with Alzheimer's disease of mild and moderate severity, and present guidelines for clinical use.

Alzheimer Disease↗
PubMed1996

No identifiable effect of ginseng (Gericomplex) as an adjuvant in the treatment of geriatric patients.

This study aimed to examine the effect of ginseng as an adjuvant to treatment and rehabilitation of geriatric patients in a double blind, controlled clinical trial. The treatment group (N = 24) received two capsules of Gericomplex (ginseng, vitamins, minerals and trace elements) daily for 8 weeks, while the control group (N = 25) had identical-looking placebo capsules. Participants consisted of 60 geriatric patients, mean age 77.9 years. The principal study variables were length of stay in hospital, and activities of daily living according to the Barthel ADL Index. Cognitive function was assessed at baseline and after 8 weeks, using the Mini-Mental State Examination, the Kendrick Object Learning test, and the Trail Making test. Somatic symptoms, and symptoms of depression and anxiety were scored on a 23-question version of the Hopkins Symptom Checklist. Length of stay in hospital did not differ in the two groups, which also improved to the same degree on the various functional outcome measures, except for the Kendrick Object Learning test, where the placebo group improved more markedly. In conclusion, no identifiable effect of ginseng as an adjuvant to treatment and rehabilitation of geriatric patients was observed.

Adjuvants, Pharmaceutic↗
PubMed1996

Winter excess mortality: a comparison between Norway and England plus Wales.

Seasonal fluctuations in mortality are associated with age, outdoor temperature, and influenza. The relative excess winter mortality is approximately twice as high in the UK compared with the Scandinavian countries. Using data from Norway and England plus Wales, this study compares the effect of age, temperature and influenza on winter excess mortality in the two countries. Bivariate analyses showed that the excess winter mortality (December-March) in England and Wales was nearly twice as high in old as in middle-aged people, and also markedly higher than in Norway, while the association between excess winter deaths and influenza was of a similar magnitude. In the British data only, a marked and statistically significant negative relationship existed between outdoor temperature and excess winter mortality, corresponding to an increase of approximately 3,500 deaths in England and Wales (approximately 2/10,000 in the population aged 45 years and over) per 1 degree C reduction in winter temperature, after adjustment for age and influenza. Using data from 20 Western European countries, a highly significant positive correlation (R = 0.71, p < 0.001) was found between total mortality rates for the elderly (65 years and over) and relative excess winter mortality.

Age Factors↗