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Biomedical subjects

T Erkinjuntti

Publications and source records attributed to T Erkinjuntti.

At least 145 records · Page 8Linked to original sources
PubMed1986

Isolated angiitis of the central nervous system.

Two adults with isolated angiitis of the central nervous system (CNS) are described and the diagnostic criteria of the disease are evaluated. The diagnosis was based on carotid angiogram showing segmental narrowing (a "beaded" appearance) with or without microaneurysms or arterial obstruction, and on clinical observations excluding other underlying diseases. The clinical picture consisted of progressing or fluctuating symptoms and signs of CNS origin. Although the primary etiology of this rare condition remains unknown, treatment with corticosteroids and cyclophosphamide is rewarding. Thus, isolated angiitis of the CNS is treatable, contrary to some earlier assumptions. Therefore, the early diagnosis of isolated angiitis of the CNS is emphasized.

Adult↗
PubMed1986

Dementia among medical inpatients. Evaluation of 2000 consecutive admissions.

Two thousand consecutive patients aged 55 years and older admitted to a department of medicine in a large university hospital were examined for the presence of dementia. The occurrence of moderate and severe dementia was 9.1% for all age groups. It increased from 0.8% in the age group from 55 to 64 years to 31.2% in patients aged 85 years and older. Of the demented patients, 41.4% were delirious at admission, and 24.9% of all delirious patients were demented. Patients with vascular dementia constituted 72.4%, those with primary degenerative dementia 23.0%, and those with specific causes 4.6% of all demented patients. The mean hospitalization time for demented patients was significantly longer, and they needed significantly more daily nursing care, when compared with nondemented patients.

Aged↗
PubMed1985

CSF in Alzheimer's disease. Studies on blood-brain barrier function and intrathecal protein synthesis.

Serum and cerebrospinal fluid (CSF) from 22 ambulatory and 10 institutionalised patients with Alzheimer's disease (AD) and 22 age-matched controls were assayed nephelometrically for concentrations of IgG, IgA, IgM, haptoglobin, transferrin, prealbumin and albumin. The CSF/serum ratio and index were calculated for each protein. In the CSF of ambulatory patients IgG, transferrin and albumin were elevated while the institutionalised patients had higher IgG and IgA levels compared to the controls. The CSF haptoglobin was elevated in institutionalised AD patients compared to those who were ambulatory. The CSF/serum ratio for albumin was elevated in both groups. An increase in the IgG ratio was also found in both groups. The ratios for haptoglobin and prealbumin were markedly increased in the institutionalised patients. CSF indices gave no evidence for increased intrathecal synthesis of any of the proteins investigated. The increased CSF/serum ratios for IgG and albumin and also the higher CSF albumin in patients with AD suggest an increased blood-brain barrier permeability in this disease. The high prealbumin ratio may be related to amyloidogenesis often present in AD.

Aged↗
PubMed1985

CSF beta-endorphin and beta-lipotropin in Alzheimer's disease and multi-infarct dementia.

We measured CSF levels of the opioid peptides beta-endorphin and beta-lipotropin in patients with Alzheimer's disease, multi-infarct dementia and controls. In both dementia groups, the mean concentration of beta-endorphin was significantly lower than in controls. The mean beta-lipotropin levels did not differ significantly in the two groups. The low CSF beta-endorphin level may relate generally to dementia.

Aged↗
PubMed1984

Cerebral NMR and CT imaging in dementia.

Thirteen patients with different types of dementia were studied with nuclear magnetic resonance (NMR) and CT imaging of the brain. The overall correlation between CT and NMR findings was good. Areas of hypodensity in cerebral white matter on CT were especially well visualized in the T2-weighted NMR images. Hypodense areas were seen in the white matter of patients with vascular dementias but not in those with primary degenerative dementias. Thus, the presence or absence of white matter changes may be an important factor in the differential diagnosis of vascular dementia and primary degenerative dementia. On the basis of NMR and CT findings, it was difficult to distinguish between the lacunar state type and Binswanger type of vascular dementia. It is suggested, therefore, that these two subgroups of vascular dementia be commonly named angiopathic dementia.

Aged↗
PubMed1984

Cerebral MR and CT imaging in polycystic lipomembranous osteodysplasia with sclerosing leukoencephalopathy.

Cerebral magnetic resonance (MR) and CT imaging of two patients with polycystic lipomembranous osteodysplasia with sclerosing (PLO-SL) showed widespread progressive central and cortical atrophy. Computed tomography revealed calcifications in the area of the caudate nuclei and putamina in both patients. A reduced volume of brain white matter with deep cortical sulci was the most striking MR finding. Rather short relaxation times in periventricular areas adjacent to ventricular bodies were also observed.

Adult↗
PubMedDate not supplied

Urinary incontinence as a predictor of death and institutionalization in a general aged population.

The prognostic significance of urinary incontinence (UI) was evaluated using the Helsinki (Finland) Aging Study Database, in which a random sample of persons of three age cohorts (75, 80 and 85 years, n=649) was followed for 5 years. The prevalence rates of UI in the three age groups were 10.5%, 20.4% and 28.6%, respectively. UI was also frequent in healthy aged subjects (15.6%), but most common in hospitalized patients (35.3%), in those with severe depression (51.8%), previous stroke (37.6%) or dementia (48.8%). UI had age- and gender-adjusted risk ratios (95% C.I.) for mortality of 1.75 (1.33-2.30) and for long-term institutional care of 2.37 (1.30-3.84). However, after controlling for the presence of dementia, the risk ratios were no longer significant. Thus, UI predicts both death and long-term institutionalization in the general aged population. However, this observation is mainly explained by the close association of UI with dementia.

Journal Article↗
PubMedDate not supplied

Cardiovascular diseases, health status, brain imaging findings and neuropsychological functioning in neurologically healthy elderly individuals.

The aim of our study was to evaluate the relationship between health-related factors, brain imaging findings and cognitive functioning. We examined 113 neurologically healthy subjects from 55 to 85 years of age. Health-related variables included a clinical health evaluation, cardiovascular diseases, and other systemic diseases. The presence of white matter changes and cerebral and peripheral atrophy were obtained with magnetic resonance imaging. Neuropsychological tests measuring verbal memory, visual memory, intellectual and language functions, visuoconstructional functions, flexibility, and speed and attention were administered. Results showed that overall health status was not related to cognition. Subjects, who had both arterial hypertension and white matter changes had difficulties in flexibility. Cardiac failure and white matter changes were related to impairment in visuoconstructional functions, flexibility and attention. Significant speed and attention deficits were observed in subjects with cardiac failure and central atrophy. In conclusion, this study verifies the relationship between hypertension, white matter changes and cognitive functions. We found also specific patterns in relation with cardiac failure, brain imaging findings and cognitive functioning, the most vulnerable domains were visuoconstructional functions, flexibility and attention.

Journal Article↗
PubMedDate not supplied

Vascular dementia: the role of cerebral infarcts.

Although vascular dementia (VaD) is the second most frequent cause of dementia after Alzheimer disease (AD), the concept remains controversial in terms of delineation. The objective of this review is to investigate, from available literature, the role of cerebral infarcts in the pathogenesis of VaD and to identify areas of interest that need further evaluation and research. The incidence of new onset dementia is increased after stroke. Stroke subtypes, total volume of cerebral infarction and functional tissue loss, and location of the lesions are probably the major determinants of VaD. Any cause of stroke can lead to VaD. In some circumstances the causal relation between stroke and dementia is clear: (1) in young patients who are unlikely to have associated Alzheimer pathology; (2) when the cognitive functioning was normal before stroke, impaired immediately after, and does not worsen over time; (3) when the lesions are located in strategic areas; and (4) when a well-defined vasculopathy known to cause dementia is proven. However, several issues remain unsolved in VaD: lack of specificity of the diagnostic criteria; influence of white matter changes and associated Alzheimer pathology; influence of preexisting cognitive status; possibility of having VaD without stroke and the clinical relevance of silent infarcts to VaD; and best therapeutic strategy to be used to prevent VaD and to prevent stroke in patients with VaD. These questions form the basis for proposals for future research.

Cerebral Infarction↗
PubMedDate not supplied

Evaluation of various methods of assessing symptoms of cognitive impairment and dementia.

BACKGROUND AND PURPOSE: The effect of different diagnostic criteria for detecting dementia in both epidemiological and stroke cohort studies has been shown, but comparison between different assessment methods has only seldom been done. We compared both assessment methods and diagnostic criteria for dementia in a large well-defined stroke cohort. SUBJECT AND METHODS: A group of 227 of 486 patients aged 55 to 85 years who 3 months after ischemic stroke completed a comprehensive neuropsychological test battery, structured clinical mental status examination of defined cognitive domains with expanded Mini-Mental State Examination. The criteria for dementia were those of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III, DSM-III-R) and the National Institute of Neurological Disorders and Stroke-Associated Internationale pour la Recherche et l'Enseignement en Neurosciences (NINDS-AIREN). RESULTS: The main differences between clinical and neuropsychological examinations were seen in memory functions: clinically 24.7% and neuropsychologically 54.2% had impairment in short-term memory and 10.4% versus 5.3% in long-term memory. Accordingly, the prevalence of dementia varied greatly: It was clinically 14.1% by DSM-III, 9.7% by DSM-III-R and 8.4% by NINDS-AIREN criteria. The corresponding frequencies based on neuropsychological evaluation were 27.3%, 4.0% and 25.6%. Between these 3 diagnostic criteria the concordance varied in clinical testing between 59.4%-68.8% (kappa 0.72-0.79) and in neuropsychological testing between 14.5%-81.1% (kappa 0.20-0.86). The concordance between clinical and neuropsychological testing was 56.8% (kappa 0.42) by DSM-III, 31.6% (kappa 0.35) by DSM-III-R and 25.5% (kappa 0.24) by NINDS-AIREN. CONCLUSIONS: The frequency of poststroke dementia and cognitive decline varied sharply when different systems of diagnostic classification and methods were used. This may have serious influences on investigation and treatment of patients. We underline the importance of further debate and studies to refine the categories of cognitive impairment used in the setting of CVD.

Aged↗
PubMedDate not supplied

Cerebral MR and CT imaging in Creutzfeldt-Jakob disease.

Magnetic resonance (MR) imaging and CT of three patients with Creutzfeldt-Jakob disease (CJD) showed bilateral cortical atrophy and no apparent white matter changes. Serial examinations revealed the progressive nature of the atrophy, findings compatible with the patients' clinical deterioration. At autopsy some white matter abnormalities were detected in one patient 6 months after MR imaging. The available data suggest that the white matter abnormalities, if present, develop during the final stage of CJD.

Aged↗
PubMedDate not supplied

Correlates of dependent living 3 months after ischemic stroke.

To examine the correlates of dependent living after ischemic stroke, a consecutive cohort of 486 patients aged 55-85 years was examined 3 months after the index stroke. Detailed medical, neurological and radiological stroke evaluation, structured measures of cognition, emotion and behavior, activities of daily living (ADL), physical disability, and assessment of dependent living were performed. Independent correlates of dependent living 3 months after stroke were the presence of the major hemispheral stroke syndrome (odds ratio, OR, 11.8, 95% confidence interval, CI, 7.2-19.9), and a combination of handicap (Rankin Scale, OR 3.9, 95% CI 2.6-6.1), cognition (DSM-III-R dementia, OR 3.9, CI 1.5-10.7, any cognitive decline, OR 4.5, CI 2.0-11.2), and ADL [Functional Activities Questionnaire (FAQ), OR 1.2, 95% CI 1.1-1.2]. The Rankin Scale explained 51.5%, FAQ 5.9% and presence of DSM-III-R dementia or any cognitive decline 3.4% of the total variance between dependent and independent patients after stroke. Independent of the effects of physical disability, presence of cognitive impairment has important functional consequences on stroke patients. Our findings emphasize the importance of the evaluation of cognitive functions in both observational and interventional clinical trials, as well as in treatment planning, rehabilitation and guidance of patients with ischemic stroke.

Activities of Daily Living↗
PubMedDate not supplied

Clinical criteria for vascular dementia: the NINDS-AIREN criteria.

Vascular dementia (VAD) is the second most common cause of dementia. In addition, cerebrovascular disease (CVD) coexists with other causes, including Alzheimer's disease. Cognitive impairment related to CVD may be preventable, and these patients could benefit from therapy. This emphasizes the need for early detection, diagnostic consistency and accuracy of the clinical diagnosis of VAD. A number of current limitations in our knowledge about VAD have restricted the construction of clinical criteria, especially the concept of a behavioral syndrome due to vascular factors affecting the brain, and the main pathophysiological factors related to VAD. The latter include the type, extent, location and tempo of vascular brain lesions, as well as the causality between brain lesions and cognitive impairment. However, relevant information on VAD is beginning to emerge. The NINDS-AIREN Workshop on VAD made an attempt to facilitate international discussion and cooperation by defining consequences of CVD and the criteria for the VAD syndrome, for epidemiological and clinical studies. Here the concepts, pathophysiological factors, current conceptual barriers, and the criteria for the clinical diagnosis are reviewed.

Aged↗
PubMedDate not supplied

The cognitive syndrome of vascular dementia: implications for clinical trials.

Dementia is common among patients with cerebrovascular disease, particularly in a setting of one or more clinically evident strokes. Prior cohort and case studies have suggested that the cognitive syndrome of vascular dementia is characterized by predominant executive dysfunction, in contrast to the deficits in memory and language function that are typical of patients with Alzheimer disease. The course of cognitive decline may also differ between those dementia subtypes, with many, but not all, patients with vascular dementia exhibiting a stepwise course of decline caused by recurrent stroke and most patients with Alzheimer disease exhibiting a gradually progressive course of decline. The findings of prior studies of the cognitive syndrome of vascular dementia must be interpreted with caution, however, because of (1) possible inaccuracies in the determination of the dementia subtype and the loss of precision that might result from pooling heterogeneous subgroups of patients with vascular dementia, (2) difficulties inherent in identifying a pattern of strengths and weaknesses in patients who are required to have memory impairment and other deficits to meet operationalized criteria for dementia, and (3) the use of limited test batteries whose psychometric properties are incompletely understood. Specific questions that should be addressed by future studies are discussed.

Clinical Trials as Topic↗