Biomedical subjects

L Volicer

Publications and source records attributed to L Volicer.

171 records · Page 10Linked to original sources

PubMedDate not supplied

Dimensions of decreased psychological well-being in advanced dementia.

Evaluation of psychological well-being among persons with an advanced dementia is primarily dependent on verbal and non-verbal cues and behaviors that are observed and interpreted by others. The purpose of the present study was to determine how many components of psychological well-being can be measured. Fifty-seven individuals who were institutionalized for advanced dementia and exhibited agitation or withdrawal were evaluated by direct observations and by interviews with nursing home staff. Engagement was measured by the Lawton Positive Affect scale, visual analog scale, and reported degree of patient's interest in the environment. Mood was measured by a global indicator of mood interpreted from facial expression and two mood items from the Multidimensional Observation Scale for Elderly Subjects. Agitation was measured by a visual analog scale and by the Short Form of the Cohen-Mansfield Agitation Inventory. Correlation analyses and multidimensional scaling provided evidence for three dimensions of psychological well-being: engagement-apathy, happy sad mood, and calm-agitation. Evaluation of these three dimensions is important for measuring quality of care in long-term care settings and for determining effectiveness of therapeutic interventions.

Affect↗

PubMedDate not supplied

Scales for evaluation of End-of-Life Care in Dementia.

Systematic evaluation of end-of-life care in dementia has been hampered by a lack of instruments to specifically address those issues that are unique for persons who are dying with dementia. This study evaluated psychometric properties of three scales designed to measure outcomes of care of persons suffering from terminal dementia. A survey of family caregivers whose loved one died during the past year was conducted using a questionnaire that included questions regarding satisfaction with care, physical and emotional symptoms that occurred during the last 90 days of the care recipient's life, and comfort during the dying process. Three scales were developed based on responses from 156 questionnaires: Satisfaction with Care at the End-of-Life in Dementia (SWC-EOLD), Symptom Management at the End-of-Life in Dementia (SM-EOLD) with Physical and Psychological Symptoms subscales, and Comfort Assessment in Dying with Dementia (CAD-EOLD) with four subscales: Physical Distress, Dying Symptoms, Emotional Distress, and Well Being. The three scales developed and evaluated in this study can be used as outcome measures in studies investigating effectiveness of interventions aimed to improve end-of-life care for individuals with dementia.

Aged↗

PubMedDate not supplied

Inhibition of benzodiazepine receptor binding by urinary extracts: effect of ethanol.

Two fractions which inhibit benzodiazepine receptor binding were isolated from both rat and human urine. The method used involved alkaline methanolysis followed by chloroform extraction and silicic acid chromatography. This method precludes artifactual formation of esters of beta-carboline carboxylic acid (BCC) during the extraction procedure. One of the fractions (fraction E) behaved similarly to methyl ester of BCC on thin-layer chromatography and also had a similar fluorescent spectra. Administration of ethanol to male Sprague-Dawley rats decreased the concentration and the total excretion of both inhibitory fractions in a dose-dependent manner. In a clinical study on males with different family histories of alcoholism, ethanol decreased excretion of fraction E. The excretion was not affected by placebo, and it was similar in family history-positive and family history-negative subjects. These results suggest that ethanol affects the gamma-aminobutyric acid-benzodiazepine receptor complex by changing release, metabolism, and/or excretion of an endogenous benzodiazepine ligand.

Alcoholism↗

PubMedDate not supplied

Effects of medication on parotid salivary flow rates in an individual with dementia of the Alzheimer type.

Data available on the relationship between salivary function and specific drug therapy are sparse. We measured unstimulated and stimulated parotid salivary flow rates associated with the drug therapies. Our ancillary study design is an N = 1 double-blind randomized controlled trial in which the patient undergoes a series of treatment blocks of either placebo or active treatment. The purpose of the parent N of 1 study was to find the "best single drug" treatment for a resistive patient diagnosed with dementia of the Alzheimer type. This study demonstrates that thiothixene was associated with inconsistent effects on parotid flow. Oxazepam had no effect on his parotid function, and diphenhydramine hydrochloride had inconsistent but generally negative effects. The data also show that this individual with dementia of the Alzheimer type had lower baseline unstimulated and stimulated parotid salivary flow rates when compared with mean "normal" values; however, flow rates were above the lowest 10th percentile of "normal" volunteers.

Aged↗

PubMedDate not supplied

Effect of seizures on progression of dementia of the Alzheimer type.

A survey of institutionalized patients with clinical diagnosis of probable dementia of the Alzheimer type (DAT) indicated that 21% of patients developed seizures after the onset of DAT. Of the total of 27 patients, 11 developed seizures at home and 16 after institutionalization. In 9 of 11 patients (82%), who suffered the initial seizure at home, the patients' condition suddenly worsened and required long-term care admission within 6 months of the seizure onset. Language function declined significantly more rapidly in 5 patients with seizures than in controls matched by age and duration of DAT.

Age of Onset↗

PubMedDate not supplied

Eating difficulties in patients with probable dementia of the Alzheimer type.

Seventy-three institutionalized patients suffering from probable dementia of the Alzheimer type (DAT) were surveyed for the presence of eating difficulties. Among 71 patients fed by natural means four different groups emerged: (1) patients who fed themselves (n = 17, 23.9%), (2) patients who had to be fed but posed no other eating problem (n = 13, 18.3%), (3) patients who refused food although they were able to swallow it (n = 18, 25.4%), and (4) patients who choked on liquid and/or solid food, some of whom also refused food (n = 23, 32.4%). Patients who fed themselves were in a less advanced stage of the disease than those who did not, and their average body weight was equal to the ideal weight. The remaining three groups, ie, those with different eating problems, did not differ in mean severity of DAT, and their body weights were significantly lower. The mortality rate during 2 years following the survey was similar in all four groups of patients, although tube feeding was used in only one case. The mortality rate was also similar in patients whose body weights were 20% or more below the median weight for their age, and in patients whose relative body weight was higher. The results of this study suggest that eating difficulties occur in a majority of institutionalized DAT patients, but can be managed without resorting to tube feeding.

Activities of Daily Living↗

PubMedDate not supplied

Treatment of depression in advanced Alzheimer's disease using sertraline.

Effects of sertraline on the affect and food refusal of patients with advanced dementia of the Alzheimer type (DAT are reported. Out of 10 patients with depressed affect, sertraline improved affect in eight. Six of these patients were also refusing food, and sertraline diminished food refusal in five of them. A case report of a patient who had a dramatic improvement in response to sertraline treatment is presented.

1-Naphthylamine↗

PubMedDate not supplied

Hospice approach to the treatment of patients with advanced dementia of the Alzheimer type.

A program that limits the extent of medical treatment in patients with advanced dementia of the Alzheimer type was initiated on an intermediate medical ward. Five levels of care were designed to define options that stress maintenance of patient comfort without striving for a maximal period of survival (hospice approach). An optimal care level for each patient recommended by the staff correlated highly with the severity of dementia, but care levels assigned during meetings of family members with the multidisciplinary team for 40 patients correlated poorly with the staff recommendations and the severity of dementia. Intensive nursing care and comfort measures, which included antipyretics, analgesics, and (if necessary) oxygen and anticholinergics, were provided during the terminal phase. Preliminary results indicate that the mortality did not increase significantly during the first year of this program, although the extent of medical care was limited in all patients, and 62% were not treated with antibiotics if they developed symptoms of pneumonia or urinary tract infection.

Aged↗

PubMedDate not supplied

Less slippery.

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Anti-Bacterial Agents↗