A significant association between CSF Abeta42 and cognition in patients with Alzheimer's disease (AD) homozygous for the epsilon3 allele of the apolipoprotein E (apoE) has been described. In this study we extended our observations on apoE, as another plaque component, and investigated the association between CSF apoE concentrations and cognitive performance after stratification for the apoE genotype in 62 patients with AD, 19 other forms of dementia and 18 controls. CSF Abeta42 and apoE concentrations were significantly and positively associated with Mini Mental State Examination (MMSE) score in AD (Abeta42: r = 0.332; P = 0.026; apoE: r = 0.386; P = 0.006). For Abeta42 this association was exclusively present in epsilon3 homozygotes (r = 0.44; P = 0.014), whereas apoE was correlated with MMSE in epsilon4 hetero- or homozygotes subjects (epsilon4/epsilonX: r = 0.638; P = 0.004: epsilon4/epsilon4; r = 0.812; P = 0.05). No association was observed between CSF concentrations of Abeta42 and apoE. The significant relationship between MMSE and CSF Abeta42 in epsilon3 homozygotes and apoE in epsilon4 hetero- and homozygotes respectively may suggest that both proteins may be associated independently from each other with cognitive decline.

Aged↗

PubMedDate not supplied

Ethics in psychiatric diagnosis from a psychodynamic perspective.

The diagnostic evaluation, representing a fundamental activity in psychiatric practice and research, requires a particular ethical responsibility on the part of the clinician. The author proposes the following aspects as being important for a comprehensive and ethically sensitive diagnosis: (a) incorporation of the patient's subjective perspectives and understanding of his/her disease, (b) consideration of the patient's quality of life, (c) assessment of the positive aspects of health, (d) awareness of group-dynamic and psychodynamic factors in the diagnostic situation, (e) the clinician's professional competence, value orientation and personal identity, (f) therapeutic optimism as a basic attitude. The patient's active involvement is emphasized since he is the real expert as far as his individual, social, religious and ethical needs and values are concerned.

Ethics, Medical↗

PubMedDate not supplied

Metabolic regulation of organic osmolytes in tubules from rat renal inner and outer medulla.

Glycerophosphorylcholine (GPC), sorbitol and inositol were quantitated in renal tubule suspensions from inner and outer medulla of untreated Sprague-Dawley rats to study the regulation of organic osmolyte concentrations under different metabolic conditions and varying extracellular osmolalities in vitro. Inner medullary tubules prepared in hypertonic saline (550 mosm/kg) contained osmolyte concentrations comparable to those found in the kidney in vivo. Incubation for up to 8 h at 5 mmol/l glucose increased sorbitol in the inner medullary tubules and medium in an osmolality-dependent fashion, whereas GPC and inositol remained constant. At a given glucose concentration the rate of sorbitol formation decreased linearly with increasing tubular sorbitol concentration, which was regulated by an osmolality-dependent export mechanism. Perturbation of tubular mechanisms by inhibition of glycolysis or oxidative phosphorylation did not change the tubular osmolyte content. In contrast to papilla outer medullary tubules contained only inositol. Lactate added as a metabolic substrate to the outer medullary tubules did not change the cellular inositol levels. In outer medullary tubules osmolality changes (320-710 mosm/kg) had no effect on tubular inositol. Addition of furosemide was without effect, when added in vitro. The results indicate that tubular sorbitol formation is regulated by glucose concentration, the level of tubular sorbitol, and an osmolality-dependent export mechanism. In contrast, cellular inositol and GPC levels seem to be independent of acute changes in tubular metabolism.

Animals↗