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Biomedical subjects

K Laake

Publications and source records attributed to K Laake.

At least 55 records · Page 3Linked to original sources
PubMed1995

The set test as a diagnostic tool in elderly outpatients with suspected dementia.

The set test was validated in 138 outpatients (mean age 74 years, 65% women) against a global clinical assessment using the DSM-III-R criteria for dementia. The test proved to have low sensitivity even at cutpoints close to a full score, and 12 of 72 patients diagnosed with dementia had a full score. We were unable to confirm the hypothesis that the set test can distinguish between vascular and Alzheimer's type of dementia. Used in its original form, the set test does not seem to be an appropriate diagnostic tool in the setting of a memory clinic.

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PubMed1995

The Barthel ADL index: factor structure depends upon the category of patient.

The validity and reliability of the Barthel index were studied in 60 geriatric patients, 87 stroke patients, and 102 patients with hip fracture, using a factor analysis methodology which explicitly accounts for the ordinal nature of the scoring on each item. The findings substantiate that the Barthel index is unidimensional among stroke patients, but not among geriatric patients or patients with hip fracture. In the latter two groups, one factor related to mobility, the other to bodily functions. A sum-score to characterize geriatric and hip fracture patients does not take into account the complex structure of the Barthel index.

Activities of Daily Living↗
PubMed1995

Spectrum of mutations induced by methyl and ethyl methanesulfonate at the hprt locus of normal and tag expressing Chinese hamster fibroblasts.

This work describes the isolation and characterization of methyl methanesulfonate (MMS) and ethyl methanesulfonate (EMS) induced 6-thioguanine-resistant mutants in normal and Escherichia coli tag gene expressing Chinese hamster fibroblast, RJKO, cells. It was previously shown that increased removal of 3-alkylated adenine, effected by 3-methyladenine DNA glycosylase I (Tag), reduces the frequencies of hprt mutations induced by alkylating agents which produce mostly N-alkylation (MMS and EMS) to half the normal rate. In order to identify which type of mutation is suppressed by increased 3-alkyladenine repair we have determined the DNA base sequence changes of the hprt cDNA in 61 independent MMS- and EMS-induced mutant clones. For both cell types and irrespective of the agent used, the majority of mutations were GC to AT transitions originating in the non-transcribed strand. Only 6/55 base substitutions occurred at AT base pairs: five AT to GC transitions and one AT to CG transversion. Six mutations were found to be deletions. These results indicate that 3-alkylated adenines in DNA are not directly premutagenic. The fact that the mutation frequency is reduced by increased 3-alkyladenine removal might be explained by postulating the existence in mammalian cells of an SOS-like response turned on by cytotoxic lesions like 3-alkyladenine, or, alternatively, that increased removal of 3-alkyladenine increases the number of single-strand breaks in DNA, which stalls DNA replication and allows a prolonged time for DNA repair by the alkyltransferase.

Alkylation↗
PubMed1995

A low, 'normal' score on the Mini-Mental State Examination predicts development of dementia after three years.

OBJECTIVES: To study whether a low, "normal" sumscore (i.e., 24 or higher) on the Mini-Mental Status Examination (MMSE) near the cutpoint usually employed for identifying persons with cognitive impairment predicts later development of dementia. DESIGN: A prospective study of a random sample of nondemented persons aged 75 years and older, according to DSM-III criteria, with follow-ups after 3 and 6 years. PARTICIPANTS: The subjects were 215 persons living at home, mean age 81 years, 81% women. Their mean MMSE sumscore at the start of the study (T0) was 27.9 (range 24-30). MAIN RESULTS: A low MMSE sumscore at T0 was identified as a statistically strongly significant predictor of dementia after 3 years (P < .001), when more than 40% of those with a sumscore of 24 or 25 at T0 had become demented. A similar, although weaker and statistically nonsignificant, trend was observed for the risk after 6 years in relation to MMSE scoring at baseline. CONCLUSION: Persons with a sumscore of 24 or 25 and classified as not suffering from dementia according to the DSM-III criteria are at high risk of developing dementia within 3 years.

Activities of Daily Living↗
PubMed1995

Blood reticulocyte count and plasma lactate dehydrogenase activity are positively related to the free fatty acid/albumin ratio in geriatric patients.

The objective of this study was to investigate the in vivo relationship between plasma free fatty acid (FFA)/albumin molar ratio and indicators of cellular damage. A case series study was carried out in 20 geriatric patients in a stable clinical condition. Their plasma albumin concentration was in the range 26-42 g l-1. There was a significant positive correlation between the FFA/albumin ratio and (a) reticulocyte count (r = 0.61, p = 0.006), (b) lactate dehydrogenase activity (r = 0.69, p = 0.002), and (c) haptoglobin concentration (r = 0.46, p = 0.05). The haemoglobin concentration was inversely related to relative reticulocyte count (r = -0.55, p = 0.01). Absolute and relative reticulocyte counts were positively associated (r = 0.92, p < 0.0001). The results are in accordance with the contention that a high FFA/albumin ratio in vivo may elicit cellular damage. Further studies are required to elucidate to what extent a high FFA/albumin ratio might be causally related to diseases.

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PubMed1993

The Barthel ADL index: scoring by the physician from patient interview is not reliable.

Using the Barthel index, a physician's ADL scoring based upon clinical interviews of 59 elderly nursing-home patients was compared with the scoring by nurses based upon observations over time (the reference method). The scoring by the doctor was higher than that by the nurses (mean score 14.3 vs 12.2), and 11.1). Use of the kappa statistics on each item of the Barthel ADL index showed that, in general, the agreement was poor between physician's scoring and the reference method. However, information collected by the physician on Barthel index items reflecting mobility demonstrated fair to good agreement among patients with a higher score on the Mini-Mental Status.

Activities of Daily Living↗
PubMed1993

Withdrawing long-term diuretic treatment among elderly patients in general practice.

The aim of this study was to elaborate, implement and evaluate a strategy for discontinuation of long-term diuretic treatment in elderly patients in general practice. Thirty-three patients were enrolled for a supervised step-down and withdrawal of diuretics. After withdrawal, the patients were followed up for 6 months or until diuretic treatment was re-established. Withdrawal was successful according to the protocol in 18 cases. Diuretic withdrawal failed and the treatment was re-established in 15 cases, four of which were sudden cardiovascular events. Most withdrawal failures were identified by routine examinations through the follow-up programmes, thus they had few consequences for the patients. This demonstrates that careful follow-up is essential after diuretic withdrawal. Our findings support the view that a large proportion of elderly patients on diuretics may not need such treatment.

Aged↗
PubMed1992

The Mini-Mental State Examination: identifying the most efficient variables for detecting cognitive impairment in the elderly.

OBJECTIVES: To study how well the scoring on each item of the MMSE relates to the sum-score when the purpose is to identify persons with cognitive impairment, and to identify an equally effective subset of MMSE items for predicting cognitive impairment. DESIGN: Retrospective survey of MMSE data for 850 elderly. SETTING: A variety of clinical settings. PARTICIPANTS: Mean age 82 years (range 54 to 99), 74% women. The subjects were of three different categories: geriatric in-patients, patients living under supervision, and elderly people living independently at home. RESULTS: Five of the binomial ("State," "Town," "Name a pencil," "Name a watch," "Read and obey") and one of the polychotomous MMSE variables ("Learn three words and repeat immediately") had low sensitivity and gave high percentages of misclassifications versus the sumscore dichotomized at the cut-point 23/24. Univariate logistic regression indicated that the three remaining polychotomous variables ("Spell backwards," "Recall three words," and "Three-stage command") can be scored binomially. Two factors were identified on factor analysis. Logistic regression analysis showed that 12 of the original 20 items predicted the sumscore dichotomized at 23/24 with only 3% misclassifications. Validation against the psychogeriatrician's diagnosis showed that this 12-items MMSE derivative performs as well as the full MMSE. CONCLUSIONS: Six of the 20 MMSE variables perform poorly regarding sensitivity and misclassifications versus the sumscore at cut-point 23/24. Two additional items did not contribute to the prediction of a low/high sumscore. The remaining 12 MMSE items can all be scored binomially and produce a sumscore which is equally as effective as the sumscore of the full MMSE when the purpose is to identify elderly patients with cognitive impairment.

Activities of Daily Living↗
PubMed1991

[Testing of a simple information program to improve elderly patients' knowledge about their medication].

The programme, which was provided as a supplement to the standard information on the patient's medication upon discharge from hospital, consisted of oral information about which drugs to use and how to take them, a medication card, and one page of general information on how to take drugs. The programme was tested in an open, controlled manner in 24 test and 23 control patients, mean age 80 years. The results revealed that the patients' knowledge about their medication was generally good at follow-up four weeks later. The test group achieved a significantly higher score on questions about the technique for taking oral medication and why this is important. It is concluded that this type of information should be supplied when elderly patients are discharged from hospital.

Age Factors↗
PubMed1991

Absorption of paracetamol from suppositories in geriatric patients with fecal accumulation in the rectum.

The bioavailability of paracetamol from suppositories was studied in 16 geriatric in-patients in stable clinical condition; 9 had significant amounts of feces in the rectum. Rectal accumulation of feces reduced the peak plasma paracetamol concentration by 32% (p = 0.05) and the AUC0-8h by 27% (p = 0.04). The peak concentration, however, appeared earlier among patients with rectal accumulation of feces. Compared to findings in 6 healthy young controls, geriatric patients had higher plasma concentrations of the main paracetamol metabolites.

Acetaminophen↗
PubMed1990

[Medication among pensioners in homes for the aged and nursing homes].

The prescribing of drugs was studied in 378 patients living in 12 homes for the aged in the county of Aust-Agder, Norway. The mean number of regular drugs was 4.7. Out of a total of 378 patients, more than 8 drugs were prescribed to one out of four and only 13 received no drugs at all. 30% of the prescriptions referred to over-the-counter drugs. Laxatives (10.4%), vitamins (9.0%), and pscychotropics (8.2%) were the three most commonly prescribed classes of drugs. Multiple linear regression analysis showed that the most significant predictor of the number of drugs prescribed to a patient is the doctor in charge.

Aged↗
PubMed1990

[What do health care institutions do to inform the aged and train them in the correct use of drugs?].

We reviewed the routines for providing information on drugs, and for training in the use of drugs and aids to medication in hospital and nursing homes by interviewing 11 ward supervisors. We found that little attention was given to systematic training in the use of drugs, training and aids to medication as part of the patient rehabilitation. All wards informed the patients about the type and dosage of drugs to be taken after discharge. However, printed information from the Norwegian Medicines Control Authority was not used to any significant extent. Lack of time was stated as the major reason for not providing more systematic information and training on drug usage as part of the rehabilitation programme for elderly inpatients.

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PubMed1990

Lower mortality of demented nursing home residents. A two-year survival study.

The mortality of 318 patients residing permanently in a nursing home was analyzed over two years in a retrospective study. Survival analysis showed that age was significantly associated with increased mortality, and dementia with decreased mortality. The results may to some extent explain the large percentage of demented patients in nursing homes, and provide some support for the hypothesis that demented patients accumulate in the nursing homes, partly due to inappropriate community services for these patients, leading to a relatively early institutionalization.

Age Factors↗