Dementia

Reality Orientation Thirty Years Later: Are We Still Confused?

Reality Orientation (RO) intervention represents the first significant attempt at rehabilitation programming for the disoriented, institutionalized elderly. Early anecdotal accounts reported sweeping positive effects. A first sign of hope for this severely disabled population, RO rapidly became widely implemented and continues to be a commonly accepted approach by numerous disciplines. However, careful examination of the research and clinical practice literature reveals many difficulties with the conventional RO classroom programme. Reliable research is limited and weakly supports a modest, temporary gain in verbal orientation after involvement in conventional classroom RO. The actual significance of these gains for these severely disabled elderly persons and their caregivers is doubtful. Although not yet clearly articulated, other approaches (eg. sensory stimulation, environmental manipulation) and a reformulation of RO itself are showing promise of effecting a broader range of functional behaviours (eg. self-feeding). Orientation information presented for reassurance, not re-articulation, is proving to be both more nurturing for clients and more clinically significant.

Screaming in elderly persons with dementia

This article presents a critical review of empirical data to guide knowledge development of screaming in elderly persons with dementia. Many reasons have been identified for why humans and animals scream. Studies on elderly populations have focused mostly on factors associated with screaming. Also, a vast selection of interventions for elderly persons with dementia who scream has been tested, but there is little evidence of their efficacy. Better knowledge of screaming in this population is needed. In particular, the meaning of this behaviour must be determined and stronger evidence of the efficacy of interventions must be acquired. In order to develop helpful clinical interventions, it is suggested that diverse research methods be used and that the perspective of all actors involved be considered, including that of the elderly persons, their families and their professional caregivers.

1-Methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) disrupts social memory/recognition processes in the male mouse

Male mice treated with MPTP or vehicle were tested for their ability to demonstrate a memory-recognition response as evaluated in a habituation-dishabituation task. Treatment with MPTP severely disrupted the male's habituation-dishabituation response profile compared to vehicle treated animals. Administration of L-DOPA at 45 min prior to behavioral testing in MPTP animals restored their performance on the habituation-dishabituation test to levels observed in vehicle treated animals. There was also a tendency for L-DOPA to produce enhanced responsiveness in vehicle treated animals. Mice treated with MPTP had significantly reduced concentrations of norepinephrine within the olfactory bulb and hippocampus. Vehicle treated mice administered L-DOPA had significantly increased dopamine concentrations within the corpus striatum. These results suggest that, in addition to its putative effects upon the nigrostriatal dopaminergic system and motor behavior, MPTP is also exerting substantial effects upon other systems. In particular, the noradrenergic system and its potential involvement with memory/recognition processes in the CD-1 mouse appears to be very sensitive to the neurotoxic effects of MPTP.

Nonoxidative ethanol metabolism: expression of fatty acid ethyl ester synthase-III in cultured neural cells

Alcohol metabolism in the human brain has been characterized as essentially nonoxidative in nature, with the esterification of ethanol with fatty acids via fatty acid ethyl ester synthase. This pathway of ethanol metabolism is related to end organ damage in the brain but the neural cell type expressing FAEES has not been identified. In this study human and rodent neuroblastoma and glioma cell lines are assayed for fatty acid ethyl ester synthase activity. Cells with neuronal properties demonstrated higher activity than glioma cell lines. We confirmed the presence of the mRNA for one type of synthase, fatty acid ethyl ester synthase-III in three neuronal cell lines--N1E115 cells, PC12 cells, and SK-N-MC cells. These results support the hypothesis that FAEES activity is expressed chiefly in cells with neuronal properties and suggest that non-oxidative ethanol metabolism is potentially related to the toxic effect of ethanol on the human brain.

Prognostic evaluation in geriatric oncology: problems and perspectives

The optimal management of older patients with malignant diseases may be prevented by two antithetic conditions: inadequate treatment and excessive treatment. A likely root of this problem appears to be paucity of prognostic information, which may hamper management-related decisions in the older person with cancer. The prognostic value of performance status and nutritional status may fade with aging, while the influence of mental, emotional and socioeconomic status on the outcome of neoplastic diseases may become more prominent. The Comprehensive Geriatric Evaluation (CGE), which encompasses emotional mental and social domains in addition to physical health and function, may prove a valuable clue for the selection of those older patients who are suitable candidates for antineoplastic treatment.