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Biomedical subjects

T Hope

Publications and source records attributed to T Hope.

At least 55 records · Page 3Linked to original sources
PubMed1998

An investigation of satiety in ageing, dementia, and hyperphagia.

OBJECTIVE: To investigate satiety in young, middle-aged, and elderly healthy adults, and in nonhyperphagic and hyperphagic elderly people with dementia. Previous work suggested hyperphagia in dementia was due to increased hunger and absence of satiation. METHODS: The primary measure of satiety was the amount of food eaten in an ad libitum meal, given 1 hr after a fixed preload. Three types of preload were used, high- and low-energy milkshakes and water. The effect of age was investigated by comparing the three groups of healthy adults. The effect of dementia was investigated by comparing the two demented groups with healthy elderly. RESULTS: Measurements suggested that accuracy of compensation for preload energy differences decreased with age and was absent in people with dementia. DISCUSSION: Lack of compensatory response in the elderly, particularly those with dementia, indicates the need for monitoring food intake to prevent over- or undereating.

Adult↗
PubMed1998

The feasibility of electronic tracking devices in dementia: a telephone survey and case series.

BACKGROUND: Patients with dementia who go out unaccompanied are at risk of accidents or getting lost. It is not known whether they could benefit from electronic tracking devices or whether such devices are practically feasible. METHOD: The likely demand for an electronic tracking device was assessed by means of a telephone survey of a convenience sample of 99 carers. The practical feasibility of a tracking system was assessed in 24 patients with dementia. RESULTS: The telephone survey suggested that 20% of patients were at continuing risk of traffic accidents and 45% were at continuing risk of getting lost. About 7% could have benefited from using the device at the time of survey and a further 11% could have benefited at an earlier point in their illness. In the feasibility study, only nine patients consistently used the device. In two patients, it was successfully used in a search. One patient was injured by a passing vehicle when he had got lost out of range of the device. A major barrier to using the device was recognizing the risk of getting lost before it happened. CONCLUSION: Significant numbers of patients are at risk. Electronic tracking devices may occasionally be useful in carefully selected cases.

Accidents, Traffic↗
PubMed1998

Predictors of institutionalization for people with dementia living at home with a carer.

OBJECTIVE: This article examines the relationships between behaviour, psychological functioning, the caring environment and subsequent institutionalization in patients with dementia living at home with a carer. DESIGN: Longitudinal study of behaviour in dementia, with a nested case-control study to investigate predictors of institutionalization. SETTING: Subjects with dementia, known to service, living at home with a carer. All lived in Oxfordshire, UK. PARTICIPANTS: 100 people with dementia (Alzheimer's disease and/or vascular dementia) who were living at home with a carer at the start of the study. MEASURES: At 4-monthly intervals, the carers were interviewed and the subjects with dementia were assessed cognitively. Subjects' behaviour and psychological functioning were assessed using the Present Behavioural Examination. RESULTS: The characteristics which best predicted institutionalization 1 year later were: excessive night-time activity; immobility or difficulty in walking; incontinence; being away from a carer for more than 16 hours a week; and being cared for by a female. Aggressive behaviour was not associated with an increased chance of entry into an institution 1 year later, although it was more prevalent 4 months before entering an institution. CONCLUSIONS: Both behaviour and psychological functioning and the caring environment can help in predicting which patients with dementia currently living at home will enter an institution 1 year later. These predictors are not the same as those which are the immediate cause of institutionalization.

Activities of Daily Living↗
PubMed1998

Natural history of hyperphagia and other eating changes in dementia.

OBJECTIVE: To investigate the natural history of overeating (hyperphagia) and its elements during the course of dementia. DESIGN: Prospective longitudinal study of overeating (hyperphagia) in dementia. Two studies were carried out: (1) hyperphagia and associated eating changes were investigated as part of a larger prospective 10-year study into behaviour changes, using carers' reports; (2) an observational study to investigate hyperphagia quantitatively; this took place over the course of a year by means of direct observation of test meals in a normal environment. SETTING: Subjects with dementia living in Oxfordshire, UK. PARTICIPANTS: (1) 99 people with dementia, living at home with a carer, with data for more than 1 year. (2) Nine people with a diagnosis of Alzheimer's disease who were hyperphagic. MEASURES: (1) The Present Behavioural Examination was used at 4-monthly intervals to assess the subjects' behaviour and psychological functioning. (2) Food intake, macronutrient choice and the microstructure of eating were measured using a standardized test meal. RESULTS: (1) Severe or persistent hyperphagia was reported in 23% of the sample and carers reported a clear onset to hyperphagia with a median duration of 16 months. (2) From direct observation, each person who was hyperphagic was seen to maintain a constant eating rate in test meals during the course of a year but meals ended earlier as hyperphagia decreased. CONCLUSIONS: Hyperphagia is common in dementia, it occurs over a single restricted period, mainly during the middle stages of dementia, and is not significantly related to age, sex, diagnosis, medication or activity.

Aged↗
PubMed1998

Psychiatric symptoms in patients with dementia predict the later development of behavioural abnormalities.

BACKGROUND: Cross-sectional studies of non-cognitive symptoms in dementia show that patients with psychotic symptoms tend to have more disturbed behaviour. However, it is not known whether individuals who experience psychiatric symptoms early in dementia are more prone to develop behavioural problems later in the illness. METHOD: The behaviour of 86 community-dwelling subjects with dementia was intensively studied for 4 years or until death, using an informant interview which was administered every 4 months on a median of eight occasions. The extent to which psychiatric symptoms, age, sex and cognitive function predicted clinically significant physical aggression or motor hyperactivity was assessed. RESULTS: Physical aggression was predicted by sad appearance and motor hyperactivity was predicted by persecutory ideas. These associations were robust, remaining significant over 2, 3 and 4 years of follow-up and were independent of cognitive function, age, sex and duration of illness. CONCLUSIONS: There may be two distinct longitudinal syndromes of non-cognitive symptoms in dementia. This suggests that important aberrant behaviours in late dementia may share pathophysiological mechanisms with psychiatric symptoms in early dementia.

Aged↗
PubMed1998

Getting lost in dementia: a longitudinal study of a behavioral symptom.

The occurrence of episodes of getting lost was examined in 104 subjects with dementia who were assessed every 4 months over 5 years. All subjects were initially living at home with a caregiver who could give good information. Forty-three subjects needed to be brought back home at least once. Five subjects repeatedly got lost. Forty-six subjects were kept behind locked doors at some point. Subjects who got lost were more likely to become permanently resident in institutions (odds ratio = 7.3; 95% confidence interval: 3.0 to 17.8). Patients who performed better on a behavioral test of topographical memory were less likely to get lost over the subsequent 5 years (negative predictive value: 90%). The risk of patients with dementia getting lost is substantial and requires frequent intervention by caregivers. This risk is a major reason for institutionalization. A simple test may help in assessing the risk of getting lost in patients with dementia.

Aged↗
PubMed1997

HIV-1 infection of nondividing cells through the recognition of integrase by the importin/karyopherin pathway.

The karyophilic properties of the HIV-1 nucleoprotein complex facilitate infection of nondividing cells such as macrophages and quiescent T lymphocytes, and allow the in vivo delivery of transgenes by HIV-derived retroviral vectors into terminally differentiated cells such as neurons. Although the viral matrix (MA) and Vpr proteins have previously been shown to play important roles in this process, we demonstrate here that integrase, the enzyme responsible for mediating the integration of the viral genome in the host cell chromosome, can suffice to connect the HIV-1 preintegration complex with the cell nuclear import machinery. This novel function of integrase reflects the recognition of an atypical bipartite nuclear localization signal by the importin/karyopherin pathway.

Cell Differentiation↗
PubMed1997

Do neuroleptic drugs hasten cognitive decline in dementia? Prospective study with necropsy follow up.

OBJECTIVE: To investigate the contribution of neuroleptic drugs to cognitive decline in dementia. DESIGN: Two year prospective, longitudinal study consisting of interviews every four months, with necropsy follow up. SETTING: Community settings in Oxfordshire. SUBJECTS: 71 subjects with dementia, initially living at home with informant. MAIN OUTCOME MEASURES: Cognitive function (score from expanded minimental state examination); behavioural problems (physical aggression, hallucinations, persecutory ideas, and disturbance of diurnal rhythm); and postmortem neuropathological assessment (cortical Lewy body pathology). RESULTS: The mean (SE) decline in cognitive score in the 16 patients who took neuroleptics was twice that in the patients who did not (20.7 (2.9) v 9.3 (1.3), P = 0.002). An increased rate of decline was also associated with aggression, disturbed diurnal rhythm, and persecutory ideas. However, only use of neuroleptics and severity of persecutory ideas were independently associated with more rapid cognitive decline when all other variables were adjusted for. The start of neuroleptic treatment coincided with more rapid cognitive decline: median rate of decline was 5 (interquartile range 8.5) points per year before treatment and 11 (12) points per year after treatment (P = 0.02). Cortical Lewy body pathology did not account for association between neuroleptic use and more rapid decline. CONCLUSIONS: Neuroleptic drugs that are sometimes used to treat behavioural complications of dementia may worsen already poor cognitive function. Randomised controlled trials are needed to confirm a causal relation.

Aged↗
PubMed1997

Behaviour changes in dementia. 1: Point of entry data of a prospective study.

OBJECTIVE: This article analyses behaviour changes in dementia at the point of entry to a longitudinal study. DESIGN: Prospective, longitudinal study of behaviour in dementia, with autopsy follow-up. SETTING: Subjects with dementia, living at home with a carer. All lived in Oxfordshire, UK. PARTICIPANTS: Ninety-seven people with dementia (Alzheimer's disease and/or vascular dementia) who were living at home with a carer. MEASURES: At 4-monthly intervals, the carers were interviewed and the subjects with dementia were assessed cognitively. Subjects' behaviour was assessed using the Present Behavioural Examination. This is an investigator-based, semi-structured interview consisting of eight main sections covering many different aspects of behaviour. The 121 main questions, with 66 further 'nested' questions, have been shown to have high reliability. RESULTS: This article analyses the types of behaviour change reported by carers at the point of entry to this long-term study. Few correlations were found between behaviour and age, gender and time since onset of dementia. Some types of behaviour were significantly more prevalent in those with greater cognitive impairment. CONCLUSIONS: Many of these changes create problems for carers, for example increased aggressive behaviour, wandering, wakefulness at night, incontinence and persecutory ideas. In general, they are more prevalent in people with more severe dementia.

Aged↗
PubMed1997

Behaviour changes in dementia. 2: Are there behavioural syndromes?

OBJECTIVE: To establish whether robust behavioural 'syndromes' can be identified from among the widely heterogeneous behavioural changes which occur in dementia. DESIGN: Longitudinal, prospective study with follow-up at 4 and 8 months. SETTING: Community settings in Oxfordshire, UK. PARTICIPANTS: 97 elderly people with a diagnosis of Alzheimer's disease or vascular dementia (in many cases confirmed by postmortem examination) and who were living at home with a carer. MEASURES: Each subject's behaviour was assessed in detail at each interview using the Present Behavioural Examination to assess subject's behaviour over the preceding 4 weeks. Seventeen key behaviour items which were both common and clinically important were selected for further analysis. RESULTS: Three syndromes were identified: (a) overactivity (walking more, walking aimlessly, trailing the carer or checking where the carer was); (b) aggressive behaviour (physical aggression, aggressive resistance, verbal aggression); (c) psychosis (anxiety, persecutory ideas and hallucinations). The same syndromes were found using data collected at three different time points and by using a variety of statistical techniques, confirming their robustness. CONCLUSIONS: Overactivity, aggressive behaviour and psychosis form three distinct behavioural syndromes in dementia.

Aged↗
PubMed1997

Hyperphagia in dementia: 1. The use of an objective and reliable method for measuring hyperphagia in people with dementia.

Up to one third of dementia sufferers eat an increased quantity of food, compared with their premorbid intake, at some stage during the dementia. A proportion of these eat extraordinarily large quantities if food intake is not restricted. In order to investigate this phenomenon in detail, a reliable and standardized method of quantifying the degree of hyperphagia is required. We report the development of such a method. Twenty-six people with dementia, who were reported by their carers to be hyperphagic, were compared with 14 matched non-hyperphagic controls with dementia and 14 matched normal elderly. Subjects were offered two standardized meals, under specified conditions, ad libitum. One meal consisted of a single food, the other of a mixture of foods. The total energy intake provided a reliable measure of the degree of hyperphagia. The single food meal was more reliable but the mixed meal was a more sensitive measure of the hyperphagia.

Aged↗