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Sideman AB, Ma M, Hernandez de Jesus A, Alagappan C, Razon N, Dohan D, Chodos A, Al-Rousan T, Alving LI, Segal-Gidan F, Rosen H, Rankin KP, Possin KL, Borson S. Primary Care Pracitioner Perspectives on the Role of Primary Care in Dementia Diagnosis and Care. JAMA Netw Open 2023; 6:e2336030. [PMID: 37768660 PMCID: PMC10539983 DOI: 10.1001/jamanetworkopen.2023.36030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 08/22/2023] [Indexed: 09/29/2023] Open
Abstract
Importance Although the barriers to dementia care in primary care are well characterized, primary care practitioner (PCP) perspectives could be used to support the design of values-aligned dementia care pathways that strengthen the role of primary care. Objective To describe PCP perspectives on their role in dementia diagnosis and care. Design, Setting, and Participation In this qualitative study, interviews were conducted with 39 PCPs (medical doctors, nurse practitioners, and doctors of osteopathic medicine) in California between March 2020 and November 2022. Results were analyzed using thematic analysis. Main Outcomes and Measures Overarching themes associated with PCP roles in dementia care. Results Interviews were conducted with 39 PCPs (25 [64.1%] were female; 16 [41%] were Asian). The majority (36 PCPs [92.3%]) reported that more than half of their patients were insured via MediCal, the California Medicaid program serving low-income individuals. Six themes were identified that convey PCPs' perspectives on their role in dementia care. These themes focused on (1) their role as first point of contact and in the diagnostic workup; (2) the importance of long-term, trusting relationships with patients; (3) the value of understanding patients' life contexts; (4) their work to involve and educate families; (5) their activities around coordinating dementia care; and (6) how the care they want to provide may be limited by systems-level constraints. Conclusions and Relevance In this qualitative study of PCP perspectives on their role in dementia care, there was alignment between PCP perspectives about the core values of primary care and their work diagnosing and providing care for people living with dementia. The study also identified a mismatch between these values and the health systems infrastructure for dementia care in their practice environment.
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Affiliation(s)
- Alissa Bernstein Sideman
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
- Department of Humanities and Social Sciences, University of California, San Francisco
- Department of Neurology, University of California, San Francisco
- Global Brain Health Institute, University of California, San Francisco
| | - Melissa Ma
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
| | | | - Cecilia Alagappan
- Global Brain Health Institute, University of California, San Francisco
| | - Na'amah Razon
- Department of Family and Community Medicine, University of California, Davis, Sacramento
| | - Daniel Dohan
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
| | - Anna Chodos
- Division of Geriatrics, Department of Medicine, University of California, San Francisco
| | - Tala Al-Rousan
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla
| | - Loren I Alving
- California Alzheimer's Disease Center, University of California, San Francisco at Fresno
| | - Freddi Segal-Gidan
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles
| | - Howie Rosen
- Department of Neurology, University of California, San Francisco
| | | | | | - Soo Borson
- Department of Family Medicine, Keck School of Medicine, University of Southern California, Los Angeles
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Lee YH, Huang SW, Chen CK, Hong JP, Chen YW, Lin HW. Conventional Synthetic Disease-Modifying Anti-Rheumatic Drugs and the Risk of Vascular Dementia in Patients with Spondyloarthritis: A Database Cohort Study. J Clin Med 2023; 12:jcm12030950. [PMID: 36769598 PMCID: PMC9917485 DOI: 10.3390/jcm12030950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 01/20/2023] [Accepted: 01/22/2023] [Indexed: 01/28/2023] Open
Abstract
Axial spondyloarthritis (axSpA) is a chronic inflammatory rheumatic disease that mainly affects the axial bones, and dementia is characterized by a decline in cognitive function, leading to dependence in everyday activity. Although the association between dementia and ankylosing spondylitis has been investigated, the influence of axSpA medication on dementia risk is unclear. The aim of this study was to investigate the risk of dementia among axSpA patients and if the conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) can reduce the risk of dementia. Patients with axSpA whose data were recorded during 2004-2008 and who were followed up until the end of 2010 were recruited. A control cohort was matched by age and sex. A Cox multivariate proportional hazards model was applied to analyze the risk factors for dementia. The hazard ratio (HR) and adjusted HR (aHR) were estimated between the study and control cohorts. The effects of csDMARDs and steroid use on the risk of different types of dementia were also analyzed. In total, 2341 and 11,705 patients constituted the axSpA and control cohort, respectively. The axSpA cohort had a greater risk of vascular dementia (aHR = 2.09 (1.36-3.20). The risk of dementia (aHR = 1.01 (0.55-1.85) did not significantly differ between patients with axSpA who received csDMARDs. In conclusion, patients with axSpA are at a risk of vascular dementia, which could be reduced by csDMARDs.
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Affiliation(s)
- Yu-Hao Lee
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei 23561, Taiwan
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
- Graduate Institute of Sports Science, National Taiwan Sports University, Taoyuan City 33301, Taiwan
| | - Shih-Wei Huang
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei 23561, Taiwan
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
- Graduate Institute of Sports Science, National Taiwan Sports University, Taoyuan City 33301, Taiwan
| | - Chih-Kuang Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Taoyuan, Taiwan School of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Jia-Pei Hong
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei 23561, Taiwan
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - Yi-Wen Chen
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei 23561, Taiwan
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - Hui-Wen Lin
- Department of Mathematics, Soochow University, Taipei 11102, Taiwan
- ICF Research Center, Shuang Ho Hospital, Taipei Medical University, New Taipei 23561, Taiwan
- Correspondence: ; Tel.: +886-2-2881-9471 (ext. 6701); Fax: +886-2-8861-1230
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Eraslan Boz H, Koçoğlu K, Akkoyun M, Tüfekci IY, Ekin M, Özçelik P, Akdal G. The influence of stimulus eccentricity on prosaccade outcomes in patients with Alzheimer's Disease dementia at an early stage and amnestic mild cognitive impairment. J Clin Exp Neuropsychol 2022; 44:713-729. [PMID: 36856708 DOI: 10.1080/13803395.2023.2183937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
INTRODUCTION Prosaccade task is a widely used objective method to evaluate reflexive saccade and visual attention. The study aimed to investigate prosaccade stimulus eccentricity, compare prosaccade parameters in patients with Alzheimer's disease dementia (AD), amnestic mild cognitive impairment (aMCI), and neurotypical adults (NA), and examine the relationship between prosaccade and neuropsychological tests. METHODS Thirty patients with AD, 34 with aMCI, and 32 NA were included in the study. Eye movements were recorded with the EyeLink 1000 Plus in the prosaccade task, and this study evaluated cognitive function with comprehensive neuropsychological tests assessing attention, memory, executive function, visuospatial function, and language domains. RESULTS The correct saccade rates of patients with AD were significantly lower than NA in the 5° and 10° stimulus eccentricities. Patients with AD had significantly longer latencies in the 10° stimulus eccentricity than those with aMCI and NA. Patients with aMCI did not differ in prosaccade performance compared to NA. Prosaccade parameters were significantly correlated with all cognitive domains. As the amplitude of the stimuli increased, the rate of correct saccades decreased, while the express saccade rate, latency, amplitude, and peak velocity increased. CONCLUSION Our findings that correct saccade rates and latency may be distinguishing parameters of early AD are promising. This study also found that stimulus eccentricity affects prosaccade measures in AD, MCI, and NA.
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Affiliation(s)
- Hatice Eraslan Boz
- Department of Neurosciences, Dokuz Eylül University, Institute of Health Sciences, Izmir, Türkiye.,Department of Neurology, Unit of Neuropsychology, Dokuz Eylül University, Izmir, Türkiye
| | - Koray Koçoğlu
- Department of Neurosciences, Dokuz Eylül University, Institute of Health Sciences, Izmir, Türkiye
| | - Müge Akkoyun
- Department of Neurosciences, Dokuz Eylül University, Institute of Health Sciences, Izmir, Türkiye
| | - Işıl Yağmur Tüfekci
- Department of Neurosciences, Dokuz Eylül University, Institute of Health Sciences, Izmir, Türkiye
| | - Merve Ekin
- Department of Neurosciences, Dokuz Eylül University, Institute of Health Sciences, Izmir, Türkiye
| | - Pınar Özçelik
- Department of Neurosciences, Dokuz Eylül University, Institute of Health Sciences, Izmir, Türkiye
| | - Gülden Akdal
- Department of Neurosciences, Dokuz Eylül University, Institute of Health Sciences, Izmir, Türkiye.,Department of Neurology, Dokuz Eylül University, Izmir, Türkiye
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Noe CR, Noe-Letschnig M, Handschuh P, Noe CA, Lanzenberger R. Dysfunction of the Blood-Brain Barrier-A Key Step in Neurodegeneration and Dementia. Front Aging Neurosci 2020; 12:185. [PMID: 32848697 PMCID: PMC7396716 DOI: 10.3389/fnagi.2020.00185] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 05/27/2020] [Indexed: 12/18/2022] Open
Abstract
The vascular endothelium in the brain is an essential part of the blood-brain-barrier (BBB) because of its very tight structure to secure a functional and molecular separation of the brain from the rest of the body and to protect neurons from pathogens and toxins. Impaired transport of metabolites across the BBB due to its increasing dysfunction affects brain health and cognitive functioning, thus providing a starting point of neurodegenerative diseases. The term “cerebral metabolic syndrome” is proposed to highlight the importance of lifestyle factors in neurodegeneration and to describe the impact of increasing BBB dysfunction on neurodegeneration and dementia, especially in elderly patients. If untreated, the cerebral metabolic syndrome may evolve into dementia. Due to the high energy demand of the brain, impaired glucose transport across the BBB via glucose transporters as GLUT1 renders the brain increasingly susceptible to neurodegeneration. Apoptotic processes are further supported by the lack of essential metabolites of the phosphocholine synthesis. In Alzheimer’s disease (AD), inflammatory and infectious processes at the BBB increase the dysfunction and might be pace-making events. At this point, the potentially highly relevant role of the thrombocytic amyloid precursor protein (APP) in endothelial inflammation of the BBB is discussed. Chronic inflammatory processes of the BBB transmitted to an increasing number of brain areas might cause a lasting build-up of spreading, pore-forming β-amyloid fragments explaining the dramatic progression of the disease. In the view of the essential requirement of an early diagnosis to investigate and implement causal therapeutic strategies against dementia, brain imaging methods are of great importance. Therefore, status and opportunities in the field of diagnostic imaging of the living human brain will be portrayed, comprising diverse techniques such as positron emissions tomography (PET) and functional magnetic resonance imaging (fMRI) to uncover the patterns of atrophy, protein deposits, hypometabolism, and molecular as well as functional alterations in AD.
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Affiliation(s)
- Christian R Noe
- Department of Medicinal Chemistry, University of Vienna, Vienna, Austria
| | | | - Patricia Handschuh
- Neuroimaging Lab (NIL), Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Chiara Anna Noe
- Department of Otorhinolaryngology, University Clinic St. Poelten, St. Poelten, Austria
| | - Rupert Lanzenberger
- Neuroimaging Lab (NIL), Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
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Sagiadinou M, Plerou A. Brief Cognitive Tests in the Case of Dementia and Alzheimer's Disease Early Diagnosis. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1195:127-135. [PMID: 32468467 DOI: 10.1007/978-3-030-32633-3_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Nowadays, Alzheimer's disease (AD) diagnosis is considered to be a crucial and extremely complex process. Nevertheless, psychometric tools, like Mini-Mental State Evaluation (MMSE), are used to address cognitive function assessment and clinical evaluation processes. However, MMSE's sensitivity in the diagnosis of mild cognitive impairment is debatable in terms of education, age, or nationality. Typical psychometric tools with the use of "paper and pencil" methods combined with physiology measurements are proposed in order to enhance validity and effectiveness in the case of Alzheimer's disease cognitive deficits. The objective of this review study is to highlight the effectiveness of brief cognitive tests (BCT) in the case of dementia and Alzheimer's disease screening. Authors' future work will focus on the application of BCT in MCI diagnosis and evaluation.
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Affiliation(s)
| | - Antonia Plerou
- Department of Informatics, Ionian University, Corfu, Greece
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Fowler ME, Triebel KL, Cutter GR, Schneider LS, Kennedy RE. Progression of Alzheimer's Disease by Self-Reported Cancer History in the Alzheimer's Disease Neuroimaging Initiative. J Alzheimers Dis 2020; 76:691-701. [PMID: 32538844 PMCID: PMC7928167 DOI: 10.3233/jad-200108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Cross-sectional studies suggest self-reported cancer history is associated with decreased risk of Alzheimer's disease (AD). However, little is known about how self-reported cancer affects longitudinal AD progression, the primary outcome in clinical trials and observational studies. OBJECTIVE To determine self-reported cancer history's effect on longitudinal AD progression in an observational study. METHODS We utilized data from the Alzheimer's Disease Neuroimaging Initiative (ADNI) to evaluate progression to AD by self-reported all-cancer, breast, prostate, colorectal, or non-melanoma skin cancer history. Linear mixed effects models were used to examine baseline differences and rates of progression on the Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog) by self-reported cancer history. Age at AD onset was examined using consensus clinical diagnoses with Cox proportional hazards regression. RESULTS Among 1,271 participants, models revealed no significant differences in progression over time but did reveal significantly lower baseline ADAS-Cog score, indicating better cognition at a given age in those with self-reported cancer history. Cox models indicated those with self-reported cancer history had significantly later age of AD onset (HR: 0.67, 95% CI: 0.53-0.85) after adjustment for covariates. CONCLUSION Participants with self-reported cancer history entered ADNI with better cognition and later age of AD onset, but progressed similarly to participants without such history, indicating differences in AD between those with and without self-reported cancer history emerge early in the disease course. Such differences in longitudinal progression by self-reported cancer history could affect AD trials and observational studies, given the current focus on early disease course. Further investigation is warranted with detailed longitudinal assessment of cancer and AD.
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Affiliation(s)
- Mackenzie E. Fowler
- Department of Epidemiology, University of Alabama, Birmingham, Birmingham, AL, USA
| | - Kristen L. Triebel
- Department of Neuropsychology, University of Alabama, Birmingham, Birmingham, AL, USA
| | - Gary R. Cutter
- Department of Biostatistics, University of Alabama, Birmingham, Birmingham, AL, USA
| | - Lon S. Schneider
- University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Richard E. Kennedy
- Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama, Birmingham, Birmingham, AL, USA
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Staff NP, Jones DT, Singer W. Mesenchymal Stromal Cell Therapies for Neurodegenerative Diseases. Mayo Clin Proc 2019; 94:892-905. [PMID: 31054608 PMCID: PMC6643282 DOI: 10.1016/j.mayocp.2019.01.001] [Citation(s) in RCA: 97] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 10/17/2018] [Accepted: 01/02/2019] [Indexed: 12/13/2022]
Abstract
Mesenchymal stromal cells are multipotent cells that are being used to treat a variety of medical conditions. Over the past decade, there has been considerable excitement about using MSCs to treat neurodegenerative diseases, which are diseases that are typically fatal and without other robust therapies. In this review, we discuss the proposed MSC mechanisms of action in neurodegenerative diseases, which include growth factor secretion, exosome secretion, and attenuation of neuroinflammation. We then provide a summary of preclinical and early clinical work on MSC therapies in amyotrophic lateral sclerosis, multiple system atrophy, Parkinson disease, and Alzheimer disease. Continued rigorous and controlled studies of MSC therapies will be critical in order to establish efficacy and protect patients from possible untoward effects.
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Lin YR, Chou LC, Chen HC, Liou TH, Huang SW, Lin HW. Increased Risk of Dementia in Patients With Systemic Lupus Erythematosus: A Nationwide Population-Based Cohort Study. Arthritis Care Res (Hoboken) 2017; 68:1774-1779. [PMID: 27111329 DOI: 10.1002/acr.22914] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 03/25/2016] [Accepted: 04/05/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Systemic lupus erythematosus (SLE) is a systemic autoimmune disorder characterized by varied clinical symptoms and can be comorbid with neuropsychiatric disorders. However, the association between SLE and dementia risk in patients with SLE remains unclear. In this study, we evaluated the incidence of dementia in patients with SLE. METHODS Patients were recruited from a nationwide cohort in 2004-2008 and categorized as SLE (n = 1,074; patients diagnosed with SLE) or non-SLE (n = 5,370; age- and sex-matched controls). Each patient was followed for up to 7 years, until either receiving a diagnosis of dementia or until December 31, 2010. Data were analyzed using the Kaplan-Meier method and Cox regression analysis. RESULTS The incidence rate of dementia was higher in the SLE cohort (357 per 100,000 person-years) than in the non-SLE cohort (180 per 100,000 person-years). Patients with SLE had a higher risk of dementia than did those without SLE (crude hazard ratio [HR] 1.92; P < 0.05). Cox regression analysis revealed an adjusted HR for dementia in the SLE cohort of 2.14 (P < 0.001), after adjustment for other comorbid diseases and variables. CONCLUSION Patients with SLE have a higher risk of dementia.
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Affiliation(s)
- Yu-Ru Lin
- Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Lin-Chuan Chou
- Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Hung-Chou Chen
- Shuang Ho Hospital and College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Tsan-Hon Liou
- Shuang Ho Hospital, College of Medicine, and Graduate Institute of Injury Prevention, Taipei Medical University, Taipei, Taiwan
| | - Shih-Wei Huang
- Shuang Ho Hospital and College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Hui-Wen Lin
- Soochow University and Evidence-Based Medicine Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
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Huang SW, Wang WT, Chou LC, Liou TH, Lin HW. Risk of Dementia in Patients with Spinal Cord Injury: A Nationwide Population-Based Cohort Study. J Neurotrauma 2016; 34:615-622. [PMID: 27539630 DOI: 10.1089/neu.2016.4525] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Spinal cord injury (SCI) can cause physical disability and psychological distress; however, whether SCI is a risk factor for dementia is unclear. This study evaluated the incidence of dementia in patients with SCI. Study participants were recruited from a nationwide cohort during 2004-2007 and categorized into SCI (patients diagnosed with SCI; n = 941) and non-SCI (age- and sex-matched controls; n = 5060) cohorts. Each participant was followed for 7 years until diagnosis of dementia or December 31, 2010, whichever occurred first. Data were subjected to Kaplan-Meier and Cox regression analyses. The incidence of dementia was significantly higher in the SCI cohort (1106 per 100,000 person-years) than in the non-SCI cohort (p < 0.001). Patients with SCI had a significantly higher risk of dementia than did those without SCI (crude hazard ratio [HR] = 2.14, 95% confidence interval [CI], 1.57-2.92, p < 0.001 vs. adjusted HR = 1.95, 95% CI, 1.43-2.67, p < 0.001). Further analysis found that there is no statistical significance of higher risk for developing Alzheimer's disease among SCI patients, but that SCI patients were at higher risk of developing other types of dementia than the control cohort (crude HR = 1.88, 95% CI, 1.33-2.63, p < 0.001 vs. adjusted HR = 1.90, 95% CI, 1.35-2.68, p < 0.001). In conclusion, patients with SCI are at high risk of dementia, and effective dementia prevention strategies are recommended for comprehensive SCI care.
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Affiliation(s)
- Shih-Wei Huang
- 1 Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University , Taipei, Taiwan .,2 Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University , Taipei, Taiwan .,7 Graduate Institute of Sports Science, National Taiwan Sport University, Taoyuan, Taiwan
| | - Wei-Te Wang
- 3 Department of Physical Medicine and Rehabilitation, Changhua Christian Hospital , Changhua, Taiwan
| | - Lin-Chuan Chou
- 1 Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University , Taipei, Taiwan
| | - Tsan-Hon Liou
- 1 Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University , Taipei, Taiwan .,2 Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University , Taipei, Taiwan .,4 Graduate Institute of Injury Prevention and Control, Taipei Medical University , Taipei, Taiwan
| | - Hui-Wen Lin
- 5 Department of Mathematics, Soochow University , Taipei, Taiwan .,6 Evidence-Based Medicine Center, Wan Fang Hospital, Taipei Medical University , Taipei, Taiwan
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Huang SW, Chang KH, Escorpizo R, Chi WC, Yen CF, Liao HF, Chang FH, Chiu WT, Lin JW, Liou TH. Functioning and disability analysis by using WHO Disability Assessment Schedule 2.0 in older adults Taiwanese patients with dementia. Disabil Rehabil 2015; 38:1652-63. [DOI: 10.3109/09638288.2015.1107636] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Soyluk O, Bahat G. Higher failure of female older asthma patients in use of inhalants: is it due to older age and/or cognition problems? Clin Interv Aging 2015; 10:1897-9. [PMID: 26664102 PMCID: PMC4669092 DOI: 10.2147/cia.s96783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Ozlem Soyluk
- Division of Endocrinology and Metabolism, Istanbul University, Capa, Istanbul, Turkey
| | - Gulistan Bahat
- Division of Geriatrics, Department of Internal Medicine, Istanbul Medical School, Istanbul University, Capa, Istanbul, Turkey
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Fonseca-Santos B, Gremião MPD, Chorilli M. Nanotechnology-based drug delivery systems for the treatment of Alzheimer's disease. Int J Nanomedicine 2015; 10:4981-5003. [PMID: 26345528 PMCID: PMC4531021 DOI: 10.2147/ijn.s87148] [Citation(s) in RCA: 142] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Alzheimer's disease is a neurological disorder that results in cognitive and behavioral impairment. Conventional treatment strategies, such as acetylcholinesterase inhibitor drugs, often fail due to their poor solubility, lower bioavailability, and ineffective ability to cross the blood-brain barrier. Nanotechnological treatment methods, which involve the design, characterization, production, and application of nanoscale drug delivery systems, have been employed to optimize therapeutics. These nanotechnologies include polymeric nanoparticles, solid lipid nanoparticles, nanostructured lipid carriers, microemulsion, nanoemulsion, and liquid crystals. Each of these are promising tools for the delivery of therapeutic devices to the brain via various routes of administration, particularly the intranasal route. The objective of this study is to present a systematic review of nanotechnology-based drug delivery systems for the treatment of Alzheimer's disease.
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Affiliation(s)
- Bruno Fonseca-Santos
- Department of Drugs and Medicines, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara, São Paulo, Brazil
| | - Maria Palmira Daflon Gremião
- Department of Drugs and Medicines, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara, São Paulo, Brazil
| | - Marlus Chorilli
- Department of Drugs and Medicines, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara, São Paulo, Brazil
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Huang SW, Lin JW, Liou TH, Lin HW. Cohort study evaluating the risk of hip fracture among patients with dementia in Taiwan. Int J Geriatr Psychiatry 2015; 30:695-701. [PMID: 25351738 DOI: 10.1002/gps.4209] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2014] [Revised: 08/03/2014] [Accepted: 08/12/2014] [Indexed: 11/11/2022]
Abstract
BACKGROUND To investigate the incidence and risk of hip fracture among dementia patients METHODS This is a retrospective population-based 7-year cohort study using case-control matched analysis database from Taiwan's Longitudinal Health Insurance Database 2005. Patients were diagnosed with codes or International Classification of Diseases-9-CM codes of dementia, between 1 January 2004 and 31 December 2006. The prevalence and the adjusted odds ratio of hip fracture among dementia patients and the controls were estimated. RESULTS We enrolled 3101 patients with dementia in the dementia cohort and 12,404 (1:4) patients in the control group. Of these, 202 patients experienced hip fractures. The incidence of hip fracture was 1178 per 100,000 person-years in the dementia cohort and 624 per 100,000 person-years in the comparison cohort. The hip fracture hazard ratio during the follow-up period was 1.89 (95% confidence interval [CI] 1.60-2.23, p < 0.001) for dementia patients. After adjusting for the covariates, the hazard ratio of hip fracture was 1.41 (95% CI, 1.19-1.69, p < 0.001) for dementia patients. CONCLUSION People with dementia experience an increased incidence of hip fracture and are at a higher risk of sustaining a hip fracture in the future. Proper and effective hip fracture-prevention strategies are essential for dementia patients.
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Affiliation(s)
- Shih-Wei Huang
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Jia-Wei Lin
- Department of Neurosurgery, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Tsan-Hon Liou
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.,Graduate Institute of Injury Prevention, Taipei Medical University, Taipei, Taiwan
| | - Hui-Wen Lin
- Department of Mathematics, Soochow University, Taipei, Taiwan.,Evidence-Based Medicine Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
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de Rivero Vaccari JP, Brand FJ, Sedaghat C, Mash DC, Dietrich WD, Keane RW. RIG-1 receptor expression in the pathology of Alzheimer's disease. J Neuroinflammation 2014; 11:67. [PMID: 24694234 PMCID: PMC3977677 DOI: 10.1186/1742-2094-11-67] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 03/25/2014] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Neuroinflammation plays a critical role in the pathogenesis of Alzheimer's disease (AD) and involves activation of the innate immune response via recognition of diverse stimuli by pattern recognition receptors (PRRs). The inflammatory inducers and precise innate signaling pathway contributing to AD pathology remain largely undefined. RESULTS In the present study we analyzed expression levels of innate immune proteins in temporal and occipital cortices from preclinical (no cognitive impairment, NCI, N = 22) to mild cognitive impairment (MCI, N = 20) associated with AD pathology (N = 20) and AD patients (N = 23). We found that retinoic acid-inducible gene-I (RIG-1) is significantly elevated in the temporal cortex and plasma in patients with MCI. In addition, primary human astrocytes stimulated with the RIG-1 ligand 5'ppp RNA showed increased expression of amyloid precursor protein (APP) and amyloid-β (Aβ), supporting the idea that RIG-1 is involved in the pathology of MCI associated with early progression to AD. CONCLUSION These findings suggest that RIG-1 may play a critical role in incipient AD.
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Affiliation(s)
- Juan Pablo de Rivero Vaccari
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Frank J Brand
- Department of Physiology & Biophysics, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Christina Sedaghat
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Deborah C Mash
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Department of Molecular and Cellular Pharmacology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - W Dalton Dietrich
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Robert W Keane
- Department of Physiology & Biophysics, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL 33136, USA
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15
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Liu GT, Volpe NJ, Galetta SL. Disorders of higher cortical visual function. Neuroophthalmology 2010. [DOI: 10.1016/b978-1-4160-2311-1.00009-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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16
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Khouzam HR, Emes R. Late life psychosis: assessment and general treatment strategies. ACTA ACUST UNITED AC 2008; 33:127-43. [PMID: 18004028 DOI: 10.1007/s12019-007-0016-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2007] [Revised: 11/30/1999] [Accepted: 04/27/2007] [Indexed: 10/22/2022]
Abstract
With the increased number of elderly patients suffering from mental illness, an increased incidence of psychiatric conditions including psychotic disorders is also expected. When psychosis occurs in the elderly, its assessment and treatment may pose a challenge for primary care clinicians and caregivers. This article will review the assessment and treatment of late life psychosis.
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Affiliation(s)
- Hani Raoul Khouzam
- Chemical Dependency Treatment Program, VA Central California Health Care System, Fresno, CA 93703, USA.
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17
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Abstract
As our society ages, age-related diseases assume increasing prominence as both personal and public health concerns. Disorders of cognition are particularly important in both regards, and Alzheimer's disease is by far the most common cause of dementia of aging. In 2000, the prevalence of Alzheimer's disease in the United States was estimated to be 4.5 million individuals, and this number has been projected to increase to 14 million by 2050. Although not an inevitable consequence of aging, these numbers speak to the dramatic scope of its impact. This article focuses on Alzheimer's disease and the milder degrees of cognitive impairment that may precede the clinical diagnosis of probable Alzheimer's disease, such as mild cognitive impairment.
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Shah KR, Carr D, Roe CM, Miller JP, Coats M, Morris JC. Impaired physical performance and the assessment of dementia of the Alzheimer type. Alzheimer Dis Assoc Disord 2004; 18:112-9. [PMID: 15494615 DOI: 10.1097/01.wad.0000127441.77570.f3] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
CONTEXT Impaired physical performance may confound the clinical assessment of dementia of the Alzheimer type (DAT). OBJECTIVES Determine whether: (1) Physical Performance Test (PPT) scores are associated with the Clinical Dementia Rating (CDR), (2) PPT scores are correlated with clinical measures of health, and (3) impaired physical performance affects the clinical assessment of DAT. DESIGN A retrospective and cross-sectional study. SETTING An Alzheimer's Disease Research Center. PARTICIPANTS Ninety-nine research volunteers aged 85 years and older were assessed from September 1997 through July 1999; 45 had DAT (CDR = 0.5-2), and 54 were nondemented controls. MEASUREMENTS Clinical health history, daily functioning, physical and neurologic status, CDR, sum of boxes, and total PPT score were obtained during clinical evaluation. Independently assessed psychometric measures of verbal and nonverbal episodic and semantic memory, visuospatial abilities, and psychometric speed yielded to a factor score representing general cognitive function. Our outcome measure was the CDR (ie, the clinical dementia rating, where higher scores indicate greater dementia severity). RESULTS The majority (88%) of subjects in this sample of demented and nondemented older adults had some degree of physical impairment as measured by the PPT. Correlational analyses identified clinically important relationships (/taub/ > 0.30, p < 0.05) between impaired PPT performance, higher CDR rating, and poor general health, including difficulty ambulating. The correlation between PPT performance and dementia severity (taub = -0.36) decreased after controlling for cognitive ability (taub = -0.19). The correlation between the cognitive factor score and dementia severity when PPT performance was controlled (taub = -0.60) was similar to the unadjusted correlation of the factor score with dementia severity (taub = -0.64). CONCLUSIONS The presence of some degree of physical impairment was common in our sample, and PPT scores correlated with both physical and cognitive impairment. Nevertheless, Alzheimer Disease Research Center clinicians appear able to successfully distinguish between physical and cognitive causes of functional impairment and assign a CDR rating that accurately reflects DAT severity in individuals with impaired physical performance.
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Affiliation(s)
- Kamini R Shah
- Department of Internal Medicine, Washington University, St. Louis, MO 63108, USA
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19
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Knopman DS, Boeve BF, Petersen RC. Essentials of the proper diagnoses of mild cognitive impairment, dementia, and major subtypes of dementia. Mayo Clin Proc 2003; 78:1290-308. [PMID: 14531488 DOI: 10.4065/78.10.1290] [Citation(s) in RCA: 134] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Loss of cognitive function in the elderly population is a common condition encountered in general medical practice. Diagnostic criteria and approaches have become more refined and explicit in the past several years. Precise diagnosis is feasible clinically. In this article, the precursor state and major subtypes of dementia are considered. Mild cognitive impairment is the term given to patients with cognitive impairment that is detectable by clinical criteria but does not produce impairment in daily functioning. When daily functioning is impaired as a result of cognitive decline, dementia is the appropriate syndromic label. Specific causes of dementia tend to have distinctive clinical presentations: the anterograde amnesic syndrome of Alzheimer disease; the syndrome of dementia with cerebrovascular disease; the syndrome of Lewy body dementia with its distinctive constellation of extrapyramidal features, disordered arousal, and dementia; the behavioral-cognitive syndrome of frontotemporal dementia; the primary progressive aphasias; and the rapidly progressive dementias. Because dementia syndromes have distinctive natural histories, precise diagnosis leads to a better understanding of prognosis. As new treatments become available for Alzheimer disease, the most common of the dementias, accurate diagnosis allows the appropriate patients to receive treatment.
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Affiliation(s)
- David S Knopman
- Department of Neurology and Alzheimer's Disease Research Center, Mayo Clinic, Rochester Minn 55905, USA
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20
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Patterson C, Gauthier S, Bergman H, Cohen C, Feightner JW, Feldman H, Grek A, Hogan DB. The recognition, assessment and management of dementing disorders: conclusions from the Canadian Consensus Conference on Dementia. Can J Neurol Sci 2001; 28 Suppl 1:S3-16. [PMID: 11237309 DOI: 10.1017/s0317167100001165] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE i) To develop evidence based consensus statements on which to build clinical practice guidelines for primary care physicians towards the recognition, assessment and management of dementing disorders; ii) to disseminate and evaluate the impact of these statements and guidelines built on these statements. OPTIONS Structured approach to assessment, including recommended laboratory tests, choices for neuroimaging and referral; management of complications (especially behaviour problems and depression) and use of cognitive enhancing agents. POTENTIAL OUTCOMES: Consistent and improved clinical care of persons with dementia; cost containment by more selective use of laboratory investigations, neuroimaging and referrals; appropriate use of cognitive enhancing agents. EVIDENCE Authors of each background paper were entrusted to: perform a literature search, discover additional relevant material including references cited in retrieved articles; consult with other experts in the field and then synthesize information. Standard rules of evidence were applied. Based upon this evidence, consensus statements were developed by a group of experts, guided by a steering committee of eight individuals from the areas of Neurology, Geriatric Medicine, Psychiatry, Family Medicine, Preventive Health Care and Health Care Systems. VALUES Recommendations have been developed with particular attention to the context of primary care and are intended to support family physicians in their ongoing assessment and care of patients with dementia. BENEFITS, HARMS AND COSTS Potential for improved clinical care of individuals with dementia. A dissemination and evaluation strategy will attempt to measure the impact of the recommendations. RECOMMENDATIONS See text. VALIDATION Four other sets of consensus statements and/or guidelines have been published recently. These recommendations are generally congruent with our own consensus statements. The consensus statements have been endorsed by relevant bodies in Canada.
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Affiliation(s)
- C Patterson
- Department of Medicine, McMaster University, Hamilton, ON, Canada
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Hsu YY, Du AT, Schuff N, Weiner MW. Magnetic resonance imaging and magnetic resonance spectroscopy in dementias. J Geriatr Psychiatry Neurol 2001; 14:145-66. [PMID: 11563438 PMCID: PMC1857299 DOI: 10.1177/089198870101400308] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article reviews recent studies of magnetic resonance imaging and magnetic resonance spectroscopy in dementia, including Alzheimer's disease, frontotemporal dementia, dementia with Lewy bodies, idiopathic Parkinson's disease, Huntington's disease, and vascular dementia. Magnetic resonance imaging and magnetic resonance spectroscopy can detect structural alteration and biochemical abnormalities in the brain of demented subjects and may help in the differential diagnosis and early detection of affected individuals, monitoring disease progression, and evaluation of therapeutic effect.
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Affiliation(s)
- Y Y Hsu
- Magnetic Resonance Unit, Department of Veterans Affairs Medical Center, San Francisco 94121, USA
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22
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Abstract
Research in the field of aging and dementia is moving forward at a rapid pace, in both basic biology of dementing disorders and clinical investigations. These two approaches to research on aging and dementia need to advance in parallel, such that when work on the pathophysiology of these disorders is translated into therapeutic practice, the appropriately characterized clinical cohorts will be available for therapeutic trials of these treatment strategies.
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Affiliation(s)
- R C Petersen
- Alzheimer Disease Research Center, Department of Neurology, Mayo Clinic, Rochester, Minnesota 55905, USA.
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Abstract
As the population of elderly patients continues to increase world-wide, the importance of identifying patients with dementia in primary care practices will increase. Our ability to see patients for an extended period of time may enable primary care physicians to identify patients with dementia early in their disease process. This enables patients, families, and caregivers to initiate treatment early, with the hope that future research will identify successful treatment modalities. This article discusses the identification of dementing syndromes, the importance of identifying familial needs and coping strategies, and the importance of caregiver stress.
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Affiliation(s)
- D F Howarth
- Department of Family Medicine, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, New Brunswick, New Jersey 08903-0019, USA
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25
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Abstract
Older adults are an important segment of the population that has specific health care needs. Their unique biopsychosocial characteristics impact the presentation, evaluation, and management of psychiatric illnesses. This article describes how common psychiatric disorders present in an aging population. Research in this area is relatively new and much more information is still needed. Close attention should be paid to new knowledge as it emerges about this growing population.
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Affiliation(s)
- B D Bair
- Salt Lake City VA Medical Center GRECC, Utah, USA
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27
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Affiliation(s)
- V G Evidente
- Mayo Graduate School of Medicine, Mayo Clinic Scottsdale, AZ 85259, USA
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28
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García Ruiz PJ, Gómez-Tortosa E, del Barrio A, Benítez J, Morales B, Vela L, Castro A, Requena I. Senile chorea: a multicenter prospective study. Acta Neurol Scand 1997; 95:180-3. [PMID: 9088388 DOI: 10.1111/j.1600-0404.1997.tb00092.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Senile chorea (SC) is characterized by the presence of late onset, generalized chorea with no family history and no dementia. It is unclear whether it is a distinct clinical entity or represents late onset Huntington's disease (HD) with an undetected family history. In order to clarify this issue, we carried out a prospective, multicenter study of suspected cases of SC. Since 1994 we identified six cases that met clinical criteria for SC. Their study included routine lab tests, cerebral MRI, neuropsychological assessment, and lastly gene IT15 analysis. An abnormal expansion of the (CAG)n repeat was found in three patients. Although there were no criteria for dementia, most neuropsychological tests revealed mild to moderate deficits, particularly in visuospatial and prefrontal tasks, m all six patients, those that were finally diagnosed as having late onset "sporadic" HD, but also in patients that finally had SC. This study provides further evidence on the existence of SC; however, the distinction from late onset "sporadic" HD seems not to be possible on clinical grounds unless a genetic study is carried out. Some cases of suspected "SC" have late onset "sporadic" HD.
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Affiliation(s)
- P J García Ruiz
- Department of Neurology and Genetics, Fundación Jiménez Díaz, Madrid, Spain
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Abstract
OBJECTIVE To highlight articles pertaining to geriatric health maintenance and provide clinicians with current evidence supportive of or opposed to screening or treatment for various diseases and conditions. METHOD We conducted a computer-assisted search of the relevant medical literature and summarized the results of pertinent studies in the elderly population. RESULTS The geriatric population is progressively increasing in numbers. Unfortunately, no consensus exists about health maintenance in this population. To date, the United States Preventive Services Task Force has made several recommendations about preventive services; however, they did not specifically focus on the geriatric age-group. We outline their guidelines and discuss our clinical practices in a wide variety of encounters with geriatric patients. CONCLUSION The efficacy of many screening tests and interventions for preventing illness in elderly patients is unclear. As the general population continues to age, further research in this area will be important.
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Affiliation(s)
- S M Scheitel
- Division of community Internal Medicine, Mayo Clinic Rochester, Rochester, Minnesota, USA
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30
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Abstract
Cobalamin (vitamin B12) is an essential nutrient derived exclusively from bacterial sources. It is an essential cofactor for three known enzymatic reactions. Untreated deficiency, caused by either the autoimmune disease pernicious anemia or nutritional lack, results in a macrocytic anemia and/or subacute combined degeneration of the spinal cord and is eventually fatal. Cobalamin in serum is bound to two proteins, transcobalamin and haptocorrin. The former is responsible for the essential delivery of cobalamin to most tissues. Inadequate tissue availability of cobalamin results in increased concentration of methylmalonic acid and homocyst(e)ine due to inhibition of methylmalonyl-CoA mutase and methionine synthase, respectively. Strict vegetarians have long been known to be at risk of cobalamin deficiency, which develops insidiously over many years. It is now clear that a significant number of the elderly and HIV-positive individuals are also at increased risk of deficiency. Any individual with reduced ability to split cobalamin from food-protein may also become deficient even though intrinsic factor is present. Diagnosis of cobalamin deficiency has frequently relied on total serum cobalamin and the Schilling test. Newer approaches such as analysis of methylmalonic acid, homocyst(e)ine, holotranscobalamin, anti-intrinsic factor antibodies, and serum gastrin may provide more cost-effective testing, as well as identify those with a covert deficiency.
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Affiliation(s)
- H V Markle
- Centenary Health Centre, Scarborough, Ontario, Canada
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