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Biomedical subjects

L Gustafson

Publications and source records attributed to L Gustafson.

At least 55 records · Page 3Linked to original sources
PubMed1997

Orthostatic hypotension and low blood pressure in organic dementia: a study of prevalence and related clinical characteristics.

OBJECTIVE: To determine the prevalence of orthostatic hypotension (OH), low blood pressure and dizziness, falls and fractures in patients with organic dementia. DESIGN: We prospectively studied 151 patients, assessing the prevalence of OH, hypertension, heart disorders, diabetes mellitus and the use of medication possibly associated with OH. SETTING: The patients were admitted to our psychogeriatric clinic as part of routine clinical investigation of their dementia. PATIENTS: Forty-six patients with Alzheimer's disease (AD), 28 patients with frontotemporal dementia (FTD) and 77 patients with vascular dementia (VaD) were investigated. MAIN OUTCOME MEASURE: Due to the paucity of information about the prevalence of OH in organic dementia, this study is mainly explorative in nature, thus preventing explicit hypothesis formulation. However, clinical impressions indicated a higher prevalence of OH in organic dementia than normally seen in healthy elderly. RESULTS: OH/low blood pressure was present in 39-52% of the patients. The majority reached their maximum systolic decrease within 5 minutes of standing, but in 20-30% the maximum blood pressure drop occurred after 5 minutes or later. In 38%, the systolic blood pressure drop was more than 40 mm Hg. Hypertension and heart disease was found only in AD and VaD, with no difference between those with and without OH/low blood pressure. Falls and fractures were common in orthostatic and hypotensive patients, with an incidence of more than 50% in AD and VaD. CONCLUSIONS: The results support our clinical impressions that OH and low blood pressure is common and an important factor in organic dementia.

Accidental Falls↗
PubMed1996

Orthostatic hypotension in organic dementia: relationship between blood pressure, cortical blood flow and symptoms.

Regional cerebral blood flow was measured in 35 patients with organic dementia (Alzheimer's disease, n = 13, vascular dementia, n = 17, frontotemporal dementia, n = 5) and orthostatic hypotension. Measurements were performed during supine rest and during head-up tilt (60 degrees). Despite marked blood pressure falls, few patients had symptoms of orthostatic hypotension. All three dementia groups had a decrease in regional cerebral blood flow in the frontal lobes during head-up tilt, but no change in mean hemispheric flow. All patients had a consistent drop in their systolic blood pressure upon head-up tilt, with a wide variation over time. The findings suggest that orthostatic hypotension needs to be considered, and actively sought for, in organic dementia as many patients may lack the typical symptoms of orthostatic hypotension, despite a marked fall in blood pressure.

Aged↗
PubMed1996

Prevalence of thyroid hormone abnormalities in elderly patients with symptoms of organic brain disease.

Analysis of the serum concentrations of free thyroid hormones (fT3, fT4) and thyrotropin (TSH) in 173 psychogeriatric patients (94 females and 79 males, mean age 79 +/- 8 years) disclosed that the hormone levels were related to sex, psychiatric diagnosis, medication and the presence of nonthyroid illness (NTI). Subnormal concentrations of thyroid hormones and/or TSH were found in 25% of the patients. In addition, fT3 and fT4 concentrations were significantly lower (p < 0.05 and p < 0.001, respectively) in demented males compared with demented females although the levels were within the reference limits. Strongly negative correlations between fT3 and age (p < 0.001), and between fT3 and the sedimentation rate (SR) (p < 0.01) were found in demented but not in non-demented patients. These correlations were most pronounced in (age) or restricted to (SR) demented males. In addition, the correlation between fT3 and Hb was strongly positive (p < 0.001) in demented as well as in nondemented patients, particularly in males. The concentration of fT4 was positively correlated to Hb in demented males (p < 0.001), whereas TSH concentration was positively correlated to Hb in demented females (p < 0.05). The results show that TSH is not sufficient as the sole screening assay for evaluation of possible thyroid dysfunction in psychogeriatric patients. In addition, central (hypothalamic?) hypothyroidism may be present in a substantial amount of psychogeriatric patients, as we found an adequate TSH response to exogenous thyrotropin-releasing hormone (TRH) also in patients with decreased fT3/fT4 and no signs of non thyroid diseases. Furthermore, there was an apparent lack of correlation between thyroid hormone levels and dementia (or subgroups of dementia), even though thyroid hormone abnormalities seemed to be rather common in frontotemporal dementia (38%) and non specified dementia (36%).

Age Distribution↗
PubMed1996

A dynamic long-term care system for the demented elderly.

The dynamic processes and the way they interact in shaping a care system for demented patients are analyzed and discussed. The development of disability/dependency, interpreted in a simulation model based on Katz's index of ADL and Berger's scale "Rating the severity of senility," gave insight into the interplay of four care levels: psychogeriatric long-term care for patients with severe behavioral disturbances, nursing-home care for patients with highly reduced ADL capacity who are often moderately to severely demented, group-living care for the demented with less dominating ADL dependency, and residential care for the elderly frail with or without symptoms of dementia. For each facility in this chain of care, characteristics in patients' symptomatology and behavior could also be identified. Resources necessary in order to fulfill goals in caring differed between each facility.

Activities of Daily Living↗
PubMed1996

Psychiatric symptoms in patients with dementia treated in a psychogeriatric day hospital.

Sixty-five consecutive patients with dementia, treated at a psychogeriatric day hospital, were studied regarding prevalence of psychiatric symptoms. The clinical diagnoses were dementia of the Alzheimer type (n = 19), vascular dementia (n = 27), mixed Alzheimer's disease and vascular dementia (n = 13), vascular dementia of frontal type (n = 2), and other diseases (n = 4). Mean age at referral was 75.6 +/- 6.6 years and the average treatment time was 21 +/- 14 months. About 90% of the patients showed one or several significant psychiatric symptoms during the course of dementia. Most common were delirious episodes, anxiety, sleep disturbances, and depressed mood. The relationship between clinical features and the type and duration of dementia was analyzed. Sleep disturbances and depressed mood often appeared early, whereas misidentification and delusions became more prevalent later in the course of dementia. The results indicate that the psychogeriatric day hospital may offer effective and flexible care and support to demented persons living at home.

Aged↗
PubMed1996

Correlation between clinical characteristics and cerebrospinal fluid neuropeptide Y levels in dementia of the Alzheimer type and frontotemporal dementia.

Neuropeptide Y (NPY) has been shown to be involved in the control of several neuroendocrine functions. Moreover, in animal models, NPY produces behavioral effects that are similar to those induced by anxiolytics. We studied NPY-like immunoreactivity (NPY-LI) in cerebrospinal fluid (CSF) in two primary degenerative dementias, Alzheimer disease (AD, n = 34) and frontotemporal dementia (FTD, n = 22) and correlated the CSF NPY-LI levels with clinical characteristics, as rated with the Organic Brain Syndrome scale. There were significant correlations between NPY-LI and such clinical items as suspiciousness, anxiousness, restlessness-agitation, and irritability in both AD and FTD. AD patients, but not FTD patients, showed a significant negative correlation between NPY-LI and duration of the disease. Thus, the study found significant correlations between CSF NPY-LI and emotional symptoms and behavior in organic dementia.

Adult↗
PubMed1996

Hyperhomocysteinaemia--a common finding in a psychogeriatric population.

Plasma homocysteine concentration is a sensitive marker for cobalamin and folate deficiency. The previously reported high incidence of increased plasma homocysteine in psychogeriatric patients and the association between reduced concentrations of cobalamin, folate and neuropsychiatric symptoms led to the present study on 741 consecutive psychogeriatric patients. The concentrations of plasma homocysteine correlated significantly with blood folate, serum cobalamin and serum creatinine both in demented (n = 295) and in non-demented patients with other psychiatric disorders (n = 215). Plasma homocysteine concentrations were significantly increased in both the demented and the non-demented patients, whereas only the demented patients had lower blood folate and serum creatinine concentrations than 163 control subjects. Almost all of the different diagnostic groups of demented and non-demented patients exhibited significantly increased plasma homocysteine concentrations compared with control subjects. Significantly decreased blood folate concentrations were mainly found in the different diagnosis groups of demented patients. Plasma homocysteine concentrations in both demented and non-demented patients with serum cobalamin and blood folate above the lower 20th percentile of these vitamins in the control subjects were also studied. Despite these vitamin concentrations, both groups of patients still exhibited significantly higher plasma homocysteine concentrations than the control subjects, which may indicate an increased frequency of impaired genetic capacity to metabolize homocysteine in these patients. Patients with either dementia of vascular cause or a history of other occlusive arterial disease had a significantly higher plasma homocysteine concentration than those without a history of vascular disease.

Aged↗
PubMed1996

What is dementia?

Dementia is a descriptive term derived from the Latin root de mens, indicating an observable decline in mental abilities. It is an acquired clinical syndrome characterised by deterioration of mental functioning in its cognitive, emotional and conative aspects. The concept is comprehensive with several different clinical profiles and courses. The diagnosis of dementia implies that several mental faculties are involved and exclude isolated neuropsychiatric disturbances such as amnesia and aphasia which occur with focal brain lesions. Description and classification of dementia conditions have however to deal with the problem that the word "dementia" might have different meanings in different contexts. It might denote a clinical syndrome irrespective of etiology, but also imply that the etiology of this syndrome is brain dysfunction. Moreover, the term dementia is sometimes used in a wider sense to describe the underlying brain disease from its early subtle manifestations to advanced stages of severe deterioration. By definition this deterioration previously was progressive and irreversible with little hope for the patient. Clinical experience however has changed our views, and it is now accepted that the course of dementia can be progressive, static or remittent.

Aged↗
PubMed1994

Plasma homocysteine in relation to serum cobalamin and blood folate in a psychogeriatric population.

Plasma homocysteine, serum cobalamin and blood folate were analysed in 296 consecutive patients referred to a psychogeriatric department for diagnosis of mental disease. Plasma homocysteine correlated with positive significance with age and serum creatinine, and with negative significance with serum cobalamin and blood folate. Approximately 35-40% of the patients with low serum cobalamin (< 150 pmol l-1) or low blood folates (< 150 nmol l-1) exhibited normal values of plasma homocysteine (< 19.9 mumol l-1). Possibly, these patients do not have a deficiency of the vitamins in the tissue. At least 7.5% of the patients with serum cobalamin levels (> 150 pmol l-1) showed an inexplicably increased level of plasma homocysteine. These patients might have a deficiency of tissue cobalamin despite the normal serum cobalamin levels. The effect of cobalamin supplementation for 7-10 days on plasma homocysteine was tested in 62 patients with different levels of serum cobalamins. We found the most pronounced decrease of plasma homocysteine in the patients with lowest serum cobalamin levels and in the patients with highest plasma homocysteine, indicating that the percentage decrease of the initial concentration of plasma homocysteine could reflect the degree of cobalamin deficiency. Folate supplementation for 7-10 days reduced plasma homocysteine not only in patients with folate deficiency but also in those with a normal folate status, and even in patients with cobalamin deficiency. The latter patients further reduced their plasma homocysteine after additional cobalamin treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1993

Physostigmine and tetrahydroaminoacridine treatment of Alzheimer's disease.

The cholinergic hypothesis of Alzheimer's disease (AD) was tested in two doubleblind crossover studies. Physostigmine given intravenously to 10 AD patients for two hours caused improvement of reaction time and EEG and increased regional cerebral blood flow (rCBF) in the temporoparietal cortex. 17 AD patients (mean age 62.6 +/- 6.8 years) obtained three types of treatment: tetrahydroaminoacridine (THA), THA + lecithin and placebo in randomized order. Each treatment period was 6 weeks. The mean THA dose was 104 +/- 20 mg/day. There were differences in outcome between groups of patients over the total 26 weeks treatment period. The subclassification in responders, unchanged and deteriorated was supported by rCBF, EEG and psychometric testing.

Alzheimer Disease↗
PubMed1992

Mechanism of activation of liver glycogen synthase by swelling.

The mechanism linking the stimulation of liver glycogen synthesis to swelling induced either by amino acids or hypotonicity was studied in hepatocytes, in gel-filtered liver extracts, and in purified preparations of particulate glycogen to which glycogen-metabolizing enzymes are bound. High concentrations of KCl, but not of potassium glutamate, were found to inhibit glycogen synthesis in permeabilized hepatocytes. Similarly, physiological concentrations (30-50 mM) of Cl- ions were also found to inhibit synthase phosphatase in vitro, whereas 10-20 mM Cl- ions, a concentration found in swollen hepatocytes, did not inhibit synthase phosphatase. Synthase phosphatase activity was more sensitive to inhibition by Cl- ions at low (0.1%) than at high (1%) concentrations of glycogen. By contrast, 10 mM glutamate and aspartate, a concentration observed in hepatocytes incubated with glutamine or proline, stimulated synthase phosphatase in vitro. Therefore, it is proposed that the fall in intracellular Cl- concentration as well as the increase in intracellular glutamate and aspartate concentrations, that are observed in swollen hepatocytes in the presence of amino acids, are responsible, at least in part, for the stimulation of synthase phosphatase and, hence, of glycogen synthesis.

Animals↗
PubMed1992

A novel mutation in the beta-protein coding region of the amyloid beta-protein precursor (APP) gene.

A novel mutation, a C to T transition at base pair 2124 in exon 17 of the amyloid beta-protein precursor (APP) gene, has been identified by direct sequencing of amplified DNA from two Alzheimer's disease (AD) patients. A simple oligonucleotide-hybridization procedure was developed to allow population studies of this DNA variation. The mutation, which is silent at the protein level, was present in 2 out of 12 investigated AD patients, in 1 out of 60 non-AD patients and in 1 out of 30 healthy individuals. The mutation can be used as a new marker for linkage studies involving the APP gene, although more comprehensive population studies are required to determine the status of the mutation as a possible risk factor for the development of AD.

Alzheimer Disease↗
PubMed1992

Redistribution of blood flow in the cerebral cortex of normal subjects during head-up postural change.

Regional cerebral blood flow was measured in 21 normotensive subjects during supine rest and during head-up tilt to 70 degrees. The results showed significant and consistent regional cerebral blood flow changes in the frontal areas with lower relative flow distribution values (percentage of mean flow) during head-up tilt than during supine rest. The lower frontal flow distribution values during tilt were not related to habituation, to repeated measurements, or to the estimated level of arterial CO2 which was derived from expired end-tidal CO2 levels. None of the subjects had orthostatic hypotension and there was no significant difference in mean hemispheric blood flow between lying down and standing up. There was no significant gender difference in regional cerebral blood flow, although female subjects tended to have higher mean hemispheric flow than males in both postures. It remains to be established whether the flow decreases in the frontal cortex are caused by cerebral functional factors or by haemodynamic mechanisms.

Adult↗