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Tuppurainen H, Määttä S, Könönen M, Julkunen P, Kautiainen H, Hyvärinen S, Vaurio O, Joensuu M, Vanhanen M, Aho-Mustonen K, Mervaala E, Tiihonen J. Navigated and individual α-peak-frequency-guided transcranial magnetic stimulation in male patients with treatment-refractory schizophrenia. J Psychiatry Neurosci 2024; 49:E87-E95. [PMID: 38428970 PMCID: PMC10914400 DOI: 10.1503/jpn.230063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 08/25/2023] [Accepted: 12/07/2023] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND Previous electroencephalography (EEG) studies have indicated altered brain oscillatory α-band activity in schizophrenia, and treatment with repetitive transcranial magnetic stimulation (rTMS) using individualized α-frequency has shown therapeutic effects. Magnetic resonance imaging-based neuronavigation methods allow stimulation of a specific cortical region and improve targeting of rTMS; therefore, we sought to study the efficacy of navigated, individual α-peak-frequency-guided rTMS (αTMS) on treatment-refractory schizophrenia. METHODS We recruited medication-refractory male patients with schizophrenia or schizoaffective disorder in this doubleblind, sham-controlled study. We randomized patients to a 3-week course of either active αTMS or sham stimulation applied to the left dorsolateral prefrontal cortex (DLPFC). We assessed participants with the Positive and Negative Syndrome Scale (PANSS) and the Clinical Global Impression Scale (CGI) at baseline and after treatment. We conducted a follow-up assessment with the PANSS 3 months after intervention. RESULTS We included 44 patients. After treatment, we observed a significantly higher PANSS total score (p = 0.029), PANSS general psychopathology score (p = 0.027) and PANSS 5-factor model cognitive-disorganized factor score (p = 0.011) in the αTMS group than the sham group. In addition, the CGI-Improvement score was significantly higher among those who received αTMS compared with sham stimulation (p = 0.048). LIMITATIONS The limited number of study participants included only male patients. Depression was not formally evaluated. CONCLUSION Navigated αTMS to the left DLPFC reduced total, general psychopathological, and cognitive-disorganized symptoms of schizophrenia. These results provide evidence for the therapeutic efficacy of individual α-peak-frequency-guided rTMS in treatment-refractory schizophrenia. CLINICAL TRIAL REGISTRATION NCT01941251; ClinicalTrials.gov.
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Affiliation(s)
- Heli Tuppurainen
- From the Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland (Tuppurainen, Hyvärinen, Vaurio, Joensuu, Vanhanen, Aho-Mustonen, Tiihonen); the Department of Clinical Neurophysiology, Kuopio University Hospital, Kuopio, Finland (Määttä, Könönen, Julkunen, Mervaala); the Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland (Könönen); the Department of Technical Physics, University of Eastern Finland, Kuopio, Finland (Julkunen); the Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland (Kautiainen); the Folkhälsan Research Center, Helsinki, Finland (Kautiainen); Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland (Mervaala); the Department of Clinical Neuroscience, Karolinska Institutet, and Center for Psychiatry Research, Stockholm City Council, Stockholm, Sweden (Tiihonen)
| | - Sara Määttä
- From the Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland (Tuppurainen, Hyvärinen, Vaurio, Joensuu, Vanhanen, Aho-Mustonen, Tiihonen); the Department of Clinical Neurophysiology, Kuopio University Hospital, Kuopio, Finland (Määttä, Könönen, Julkunen, Mervaala); the Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland (Könönen); the Department of Technical Physics, University of Eastern Finland, Kuopio, Finland (Julkunen); the Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland (Kautiainen); the Folkhälsan Research Center, Helsinki, Finland (Kautiainen); Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland (Mervaala); the Department of Clinical Neuroscience, Karolinska Institutet, and Center for Psychiatry Research, Stockholm City Council, Stockholm, Sweden (Tiihonen)
| | - Mervi Könönen
- From the Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland (Tuppurainen, Hyvärinen, Vaurio, Joensuu, Vanhanen, Aho-Mustonen, Tiihonen); the Department of Clinical Neurophysiology, Kuopio University Hospital, Kuopio, Finland (Määttä, Könönen, Julkunen, Mervaala); the Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland (Könönen); the Department of Technical Physics, University of Eastern Finland, Kuopio, Finland (Julkunen); the Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland (Kautiainen); the Folkhälsan Research Center, Helsinki, Finland (Kautiainen); Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland (Mervaala); the Department of Clinical Neuroscience, Karolinska Institutet, and Center for Psychiatry Research, Stockholm City Council, Stockholm, Sweden (Tiihonen)
| | - Petro Julkunen
- From the Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland (Tuppurainen, Hyvärinen, Vaurio, Joensuu, Vanhanen, Aho-Mustonen, Tiihonen); the Department of Clinical Neurophysiology, Kuopio University Hospital, Kuopio, Finland (Määttä, Könönen, Julkunen, Mervaala); the Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland (Könönen); the Department of Technical Physics, University of Eastern Finland, Kuopio, Finland (Julkunen); the Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland (Kautiainen); the Folkhälsan Research Center, Helsinki, Finland (Kautiainen); Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland (Mervaala); the Department of Clinical Neuroscience, Karolinska Institutet, and Center for Psychiatry Research, Stockholm City Council, Stockholm, Sweden (Tiihonen)
| | - Hannu Kautiainen
- From the Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland (Tuppurainen, Hyvärinen, Vaurio, Joensuu, Vanhanen, Aho-Mustonen, Tiihonen); the Department of Clinical Neurophysiology, Kuopio University Hospital, Kuopio, Finland (Määttä, Könönen, Julkunen, Mervaala); the Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland (Könönen); the Department of Technical Physics, University of Eastern Finland, Kuopio, Finland (Julkunen); the Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland (Kautiainen); the Folkhälsan Research Center, Helsinki, Finland (Kautiainen); Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland (Mervaala); the Department of Clinical Neuroscience, Karolinska Institutet, and Center for Psychiatry Research, Stockholm City Council, Stockholm, Sweden (Tiihonen)
| | - Soile Hyvärinen
- From the Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland (Tuppurainen, Hyvärinen, Vaurio, Joensuu, Vanhanen, Aho-Mustonen, Tiihonen); the Department of Clinical Neurophysiology, Kuopio University Hospital, Kuopio, Finland (Määttä, Könönen, Julkunen, Mervaala); the Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland (Könönen); the Department of Technical Physics, University of Eastern Finland, Kuopio, Finland (Julkunen); the Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland (Kautiainen); the Folkhälsan Research Center, Helsinki, Finland (Kautiainen); Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland (Mervaala); the Department of Clinical Neuroscience, Karolinska Institutet, and Center for Psychiatry Research, Stockholm City Council, Stockholm, Sweden (Tiihonen)
| | - Olli Vaurio
- From the Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland (Tuppurainen, Hyvärinen, Vaurio, Joensuu, Vanhanen, Aho-Mustonen, Tiihonen); the Department of Clinical Neurophysiology, Kuopio University Hospital, Kuopio, Finland (Määttä, Könönen, Julkunen, Mervaala); the Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland (Könönen); the Department of Technical Physics, University of Eastern Finland, Kuopio, Finland (Julkunen); the Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland (Kautiainen); the Folkhälsan Research Center, Helsinki, Finland (Kautiainen); Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland (Mervaala); the Department of Clinical Neuroscience, Karolinska Institutet, and Center for Psychiatry Research, Stockholm City Council, Stockholm, Sweden (Tiihonen)
| | - Mikko Joensuu
- From the Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland (Tuppurainen, Hyvärinen, Vaurio, Joensuu, Vanhanen, Aho-Mustonen, Tiihonen); the Department of Clinical Neurophysiology, Kuopio University Hospital, Kuopio, Finland (Määttä, Könönen, Julkunen, Mervaala); the Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland (Könönen); the Department of Technical Physics, University of Eastern Finland, Kuopio, Finland (Julkunen); the Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland (Kautiainen); the Folkhälsan Research Center, Helsinki, Finland (Kautiainen); Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland (Mervaala); the Department of Clinical Neuroscience, Karolinska Institutet, and Center for Psychiatry Research, Stockholm City Council, Stockholm, Sweden (Tiihonen)
| | - Matti Vanhanen
- From the Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland (Tuppurainen, Hyvärinen, Vaurio, Joensuu, Vanhanen, Aho-Mustonen, Tiihonen); the Department of Clinical Neurophysiology, Kuopio University Hospital, Kuopio, Finland (Määttä, Könönen, Julkunen, Mervaala); the Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland (Könönen); the Department of Technical Physics, University of Eastern Finland, Kuopio, Finland (Julkunen); the Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland (Kautiainen); the Folkhälsan Research Center, Helsinki, Finland (Kautiainen); Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland (Mervaala); the Department of Clinical Neuroscience, Karolinska Institutet, and Center for Psychiatry Research, Stockholm City Council, Stockholm, Sweden (Tiihonen)
| | - Kati Aho-Mustonen
- From the Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland (Tuppurainen, Hyvärinen, Vaurio, Joensuu, Vanhanen, Aho-Mustonen, Tiihonen); the Department of Clinical Neurophysiology, Kuopio University Hospital, Kuopio, Finland (Määttä, Könönen, Julkunen, Mervaala); the Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland (Könönen); the Department of Technical Physics, University of Eastern Finland, Kuopio, Finland (Julkunen); the Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland (Kautiainen); the Folkhälsan Research Center, Helsinki, Finland (Kautiainen); Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland (Mervaala); the Department of Clinical Neuroscience, Karolinska Institutet, and Center for Psychiatry Research, Stockholm City Council, Stockholm, Sweden (Tiihonen)
| | - Esa Mervaala
- From the Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland (Tuppurainen, Hyvärinen, Vaurio, Joensuu, Vanhanen, Aho-Mustonen, Tiihonen); the Department of Clinical Neurophysiology, Kuopio University Hospital, Kuopio, Finland (Määttä, Könönen, Julkunen, Mervaala); the Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland (Könönen); the Department of Technical Physics, University of Eastern Finland, Kuopio, Finland (Julkunen); the Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland (Kautiainen); the Folkhälsan Research Center, Helsinki, Finland (Kautiainen); Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland (Mervaala); the Department of Clinical Neuroscience, Karolinska Institutet, and Center for Psychiatry Research, Stockholm City Council, Stockholm, Sweden (Tiihonen)
| | - Jari Tiihonen
- From the Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland (Tuppurainen, Hyvärinen, Vaurio, Joensuu, Vanhanen, Aho-Mustonen, Tiihonen); the Department of Clinical Neurophysiology, Kuopio University Hospital, Kuopio, Finland (Määttä, Könönen, Julkunen, Mervaala); the Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland (Könönen); the Department of Technical Physics, University of Eastern Finland, Kuopio, Finland (Julkunen); the Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland (Kautiainen); the Folkhälsan Research Center, Helsinki, Finland (Kautiainen); Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland (Mervaala); the Department of Clinical Neuroscience, Karolinska Institutet, and Center for Psychiatry Research, Stockholm City Council, Stockholm, Sweden (Tiihonen)
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Hallikainen I, Martikainen J, Lin PJ, Cohen JT, Lahoz R, Välimäki T, Hongisto K, Väätäinen S, Vanhanen M, Neumann PJ, Hänninen T, Koivisto AM. The Progression of Alzheimer's Disease Can Be Assessed with a Short Version of the CERAD Neuropsychological Battery: The Kuopio ALSOVA Study. Dement Geriatr Cogn Dis Extra 2014; 4:494-508. [PMID: 25685140 PMCID: PMC4296232 DOI: 10.1159/000369159] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background/Aims Measuring and predicting Alzheimer's disease (AD) progression is important in order to adjust treatment and allocate care resources. We aimed to identify a combination of subtests from the Consortium to Establish a Registry for Alzheimer's Disease Neuropsychological Battery (CERAD-NB) that best correlated with AD progression in follow-up as well as to predict AD progression. Method A total of 236 participants with very mild [Clinical Dementia Rating (CDR) = 0.5] or mild AD (CDR = 1.0) at baseline were followed up for 3 years. The CERAD-NB and Mini-Mental State Examination (MMSE) were used to assess cognition, and the CDR scale sum of boxes (CDR-sb) was employed to evaluate AD progression. Generalized estimating equations were used to develop models to predict and follow up disease progression. Results Performance declined on all CERAD-NB subtests. The ability of the separate subtests to distinguish between groups (baseline CDR = 0.5 or 1.0) diminished during follow-up. The best combination of subtests that explained 62% of CDR-sb variance in follow-up included verbal fluency, constructional praxis, the clock drawing test, and the MMSE. Baseline values of the same combination predicted 37% of the CDR-sb change. Conclusion A short version of the CERAD-NB subtests provides a promising and time-efficient alternative for measuring cognitive deterioration during AD follow-up. Although the initial signs of AD include memory difficulties, it may be useful to assess non-memory tasks in follow-up.
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Affiliation(s)
- Ilona Hallikainen
- School of Educational Sciences and Psychology, Kuopio, Finland ; Neurology, Institute of Clinical Medicine, Kuopio, Finland
| | - Janne Martikainen
- Pharmacoeconomics and Outcomes Research Unit, School of Pharmacy, Kuopio, Finland
| | - Pei-Jung Lin
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Mass., USA
| | - Joshua T Cohen
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Mass., USA
| | | | - Tarja Välimäki
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland ; Development, Clinical Education and Research Unit of Nursing, Kuopio, Finland
| | | | - Saku Väätäinen
- Pharmacoeconomics and Outcomes Research Unit, School of Pharmacy, Kuopio, Finland
| | | | - Peter J Neumann
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Mass., USA
| | - Tuomo Hänninen
- Neurology, NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - Anne Maria Koivisto
- Neurology, Institute of Clinical Medicine, Kuopio, Finland ; Neurology, NeuroCenter, Kuopio University Hospital, Kuopio, Finland
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Vanhanen M, Hakola P, Ilonen T, Tiihonen J. Word List Learning in Patients with Polycystic Lipomembranous Osteodysplasia with Sclerosing Leukoencephalopathy. Dement Geriatr Cogn Dis Extra 2013; 3:10-5. [PMID: 23569454 PMCID: PMC3618099 DOI: 10.1159/000346857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background/Aims Polycystic lipomembranous osteodysplasia with sclerosing leukoencephalopathy (PLOSL) is a rare hereditary disease that is characterized by a combination of progressive presenile dementia and sclerosing leukoencephalopathy with bone cysts. No quantitative information on verbal memory functioning in PLOSL patients compared with control subjects is available. Methods 23 patients with PLOSL and 23 control subjects were examined with a version of the 10-word list-learning task. Learning curves were compared between the patients and the matched control subjects. Results Compared with the control subjects, PLOSL patients with moderate or severe dementia were impaired in both learning trials and delayed recall on the 10-word list-learning test. Conclusion Progressive degeneration of brain structures affecting the hippocampus and the medial temporal lobe with advanced PLOSL disease contributes to an inefficient verbal learning process.
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Affiliation(s)
- Matti Vanhanen
- Department of Forensic Psychiatry, University of Eastern Finland and Niuvanniemi Hospital, Kuopio, Finland
- *Matti Vanhanen, Niuvanniemi Hospital, Niuvantie 65, FI–70240 Kuopio (Finland), E-Mail
| | - Panu Hakola
- Department of Forensic Psychiatry, University of Eastern Finland and Niuvanniemi Hospital, Kuopio, Finland
| | - Tuula Ilonen
- Department of Psychiatry, University of Turku, Turku, Finland
| | - Jari Tiihonen
- Department of Forensic Psychiatry, University of Eastern Finland and Niuvanniemi Hospital, Kuopio, Finland
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Ilonen T, Hakola P, Vanhanen M, Tiihonen J. Rorschach assessment of personality functioning in patients with polycystic lipomembranous osteodysplasia with sclerosing leukoencephalopathy. Acta Neuropsychiatr 2012; 24:236-44. [PMID: 25286817 DOI: 10.1111/j.1601-5215.2011.00626.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Objective: To date no studies have investigated the personality functioning underlying patients diagnosed with polycystic lipomembranous osteodysplasia with sclerosing leukoencephalopathy (PLOSL) using the performance-based Rorschach test.Methods: We scored and interpreted the Rorschach protocols of eight carefully diagnosed PLOSL patients according to Exner's Comprehensive System. The structural variables in the Rorschach are organised around the seven dimensions of personality functioning that they assess: coping style and resources, organising information, perceiving events, forming concepts and ideas, handling of emotions, self-perception and interpersonal perception.Results: As a group PLOSL patients had many personality liabilities when contrasted with typical avoidant non-patient adults. A majority of patients showed an avoidant coping style (Lambda > 0.99), low productivity and poor verbal output in the low number of responses and few Blends. Also, they showed limited available resources to cope with problem-solving test. Problems in organising information efficiently, and perceiving events realistically as well as signs of disturbed thinking and concept formation were observed in many patients. Handling of emotions was characterised by avoidance of emotional stimuli but at the same time poor affect modulation. Capacities to view themselves and others were thoroughly limited.Conclusions: PLOSL tends to have repercussions throughout the personality functioning. In line with clinical findings and later neuroradiological and neuropathological examinations the Rorschach revealed personality features typical for frontal type of dementia.
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Affiliation(s)
- Tuula Ilonen
- Department of Psychiatry, University of Turku, Turku, Finland
| | - Panu Hakola
- Department of Forensic Psychiatry, University of Eastern Finland, Kuopio, Finland
| | | | - Jari Tiihonen
- Department of Forensic Psychiatry, University of Eastern Finland, Kuopio, Finland
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Hallikainen I, Koivisto AM, Paajanen T, Hiltunen A, Karppi P, Vanhanen M, Välimäki T, Herukka SK, Soininen H, Hänninen T. Cognitive and Neuropsychiatric Symptom Differences in Early Stages of Alzheimer's Disease: Kuopio ALSOVA Study. Dement Geriatr Cogn Dis Extra 2012; 2:209-18. [PMID: 22719747 PMCID: PMC3379731 DOI: 10.1159/000338231] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background/Aim Alzheimer's disease (AD) causes impairment in memory and other cognitive functions as well as neuropsychiatric symptoms and limitations in the activities of daily living (ADL). The aim of this study was to examine whether demographic variables, dementia severity, ADL and neuropsychiatric symptoms are associated with cognition in very mild or mild AD. Methods We analyzed the baseline data of 236 patients with very mild or mild AD participating in a prospective AD follow-up study (ALSOVA). The Consortium to Establish a Registry for Alzheimer's Disease neuropsychological battery total score was used in the evaluation of the global cognitive performance. Results Cognition was associated with dementia severity and ADL but not with neuropsychiatric symptoms. ADL functions were associated with both cognitive performance and neuropsychiatric symptoms. Conclusion Even patients with very mild or mild AD may exhibit neuropsychiatric symptoms not related to cognitive impairment. The results of this study emphasize the importance of taking a multidimensional approach to the diagnostic and prognostic evaluation of AD patients already in the early stages of the disease.
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Affiliation(s)
- Ilona Hallikainen
- Institute of Clinical Medicine, Neurology, University of Eastern Finland, Mikkeli, Finland
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Karttunen K, Karppi P, Hiltunen A, Vanhanen M, Välimäki T, Martikainen J, Valtonen H, Sivenius J, Soininen H, Hartikainen S, Suhonen J, Pirttilä T. Neuropsychiatric symptoms and quality of life in patients with very mild and mild Alzheimer's disease. Int J Geriatr Psychiatry 2011; 26:473-82. [PMID: 21445998 DOI: 10.1002/gps.2550] [Citation(s) in RCA: 156] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2009] [Accepted: 04/16/2010] [Indexed: 11/11/2022]
Abstract
BACKGROUND Neuropsychiatric symptoms (NPS) are common manifestations of Alzheimer' s disease (AD). OBJECTIVE To examine the prevalence and significance of NPS in very mild and mild AD patients with emphasis on their influence on the well-being of the patients and their caregivers. METHODS The participants were 240 patient-caregiver dyads who participated in a prospective, controlled rehabilitation study (ALSOVA). Three Quality of Life (QoL) instruments were used; generic 15D, disease-specific QoL-AD and Visual Analog Scale (VAS). The disease-specific QoL-AD was both self-rated and caregiver rated. Other scales used were Mini-Mental State Examination (MMSE), Clinical Dementia Rating (CDR), ADCS-ADL, Neuropsychiatric Inventory (NPI) and Beck Depression Inventory (BDI). RESULTS NPS were present in 76.5% of patients with very mild AD (CDR 0.5) and in 84.9% of patients with mild to moderate AD (CDR 1). The most frequent symptoms were apathy, depression, irritability, and agitation. The strongest predictor of self-reported QoL-AD scores was depressive symptoms whereas functional decline and presence of NPS predicted poor caregiver ratings of patients' QoL. However, caregiver depression also influenced significantly their ratings. CONCLUSION NPS are common even in the early stages of AD. NPS were significantly associated with caregiver assessment of the patient's QoL but not with patients' self-assessed QoL. Depression decreases QoL, but may remain unrecognized in AD patients, emphasizing the need for careful and structured assessment of NPS before deciding on the appropriate treatment.
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Hämäläinen A, Grau-Olivares M, Tervo S, Niskanen E, Pennanen C, Huuskonen J, Kivipelto M, Hänninen T, Tapiola M, Vanhanen M, Hallikainen M, Helkala EL, Nissinen A, Vanninen RL, Soininen H. Apolipoprotein E epsilon 4 allele is associated with increased atrophy in progressive mild cognitive impairment: a voxel-based morphometric study. NEURODEGENER DIS 2008; 5:186-9. [PMID: 18322386 DOI: 10.1159/000113698] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The apolipoprotein E (APOE) epsilon4 allele is a risk factor for Alzheimer's disease. Earlier studies have shown differences in brain structure according to the APOE epsilon4 status. OBJECTIVE To assess possible differences in brain structure according to the APOE epsilon4 status in mild cognitive impairment (MCI) subjects in relation to conversion to dementia. METHODS In a follow-up study of 56 MCI subjects, 13 MCI subjects progressed to dementia (PMCI) during a mean follow-up time of 31 months. Brain structure differences in both stable MCI (SMCI) and PMCI epsilon4 carriers and noncarriers in the baseline MRI scan were assessed with voxel-based morphometry. RESULTS The SMCI epsilon4 carriers had atrophy in the amygdala and hippocampus compared to the SMCI noncarriers. The PMCI epsilon4 carriers revealed atrophy of the left inferior frontal gyrus and parietal cortex compared to the PMCI noncarriers. CONCLUSION The rate of brain atrophy in certain brain areas may be increased in epsilon4-positive MCI subjects progressing to dementia.
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Affiliation(s)
- A Hämäläinen
- Department of Neuroscience and Neurology, University of Kuopio and Brain Research Unit, Clinical Research Center, Mediteknia, Kuopio, Finland
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Hämäläinen A, Tervo S, Grau-Olivares M, Niskanen E, Pennanen C, Huuskonen J, Kivipelto M, Hänninen T, Tapiola M, Vanhanen M, Hallikainen M, Helkala EL, Nissinen A, Vanninen R, Soininen H. Voxel-based morphometry to detect brain atrophy in progressive mild cognitive impairment. Neuroimage 2007; 37:1122-31. [PMID: 17683950 DOI: 10.1016/j.neuroimage.2007.06.016] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2007] [Revised: 06/05/2007] [Accepted: 06/16/2007] [Indexed: 10/23/2022] Open
Abstract
Recent research has shown an increased rate of conversion to dementia in subjects with mild cognitive impairment (MCI) compared to controls. However, there are no specific methods to predict who will later develop dementia. In the present study, 22 controls and 56 MCI subjects were followed on average for 37 months (max. 60 months) and studied with magnetic resonance imaging (MRI) at baseline to assess changes in brain structure associated to later progression to dementia. Voxel-based morphometry (VBM) was used to investigate gray matter atrophy. During the follow-up, 13 subjects progressed to dementia. At baseline, no differences were detected in age or education between the control and MCI subjects, but they differed by several neuropsychological tests. The stable and progressive MCI subjects differed only by CDR sum of boxes scores and delayed verbal recall, which were also significant predictors of conversion to dementia. At the baseline imaging, the MCI subjects showed reduced gray matter density in medial temporal, temporoparietal as well as in frontal cortical areas compared to controls. Interestingly, the progressive MCI subjects showed atrophy in the left temporoparietal and posterior cingulate cortices and in the precuneus bilaterally, and a trend for hippocampal atrophy when compared to the stable MCI subjects. We conclude that widespread cortical atrophy is present already two and a half years before a clinical diagnosis of dementia can be set.
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Affiliation(s)
- Anne Hämäläinen
- Department of Neurology, University of Kuopio and Brain Research Unit, Clinical Research Center, Mediteknia, and Kuopio University Hospital, Finland
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9
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Tapiola T, Pennanen C, Tapiola M, Tervo S, Kivipelto M, Hänninen T, Pihlajamäki M, Laakso MP, Hallikainen M, Hämäläinen A, Vanhanen M, Helkala EL, Vanninen R, Nissinen A, Rossi R, Frisoni GB, Soininen H. MRI of hippocampus and entorhinal cortex in mild cognitive impairment: a follow-up study. Neurobiol Aging 2006; 29:31-8. [PMID: 17097769 DOI: 10.1016/j.neurobiolaging.2006.09.007] [Citation(s) in RCA: 114] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2006] [Revised: 08/16/2006] [Accepted: 09/15/2006] [Indexed: 11/15/2022]
Abstract
The concept of mild cognitive impairment (MCI) has been proposed to represent a transitional stage between normal aging and dementia. We studied the predictive value of the MRI-derived volumes of medial temporal lobe (MTL) structures, white matter lesions (WML), neuropsychological tests, and Apolipoprotein E (APOE) genotype on conversion of MCI to dementia and AD. The study included 60 subjects with MCI identified from population cohorts. During the mean follow-up period of 34 months, 13 patients had progressed to dementia (9 to Alzheimer's disease (AD)). In Cox regression analysis the baseline volumes of the right hippocampus, the right entorhinal cortex and CDR sum of boxes predicted the progression of MCI to dementia during the follow-up. In a bivariate analysis, only the baseline volumes of entorhinal cortex predicted conversion of MCI to AD. The Mini-Mental State Examination (MMSE) score at baseline, WML load, or APOE genotype were not significant predictors of progression. The MTL volumetry helps in identifying among the MCI subjects a group, which is at high risk for developing AD.
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Affiliation(s)
- Tero Tapiola
- Department of Neuroscience and Neurology, University of Kuopio, Brain Research Unit, Clinical Research Center, Mediteknia, 70211 Kuopio, Finland.
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10
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Vanhanen M, Koivisto K, Moilanen L, Helkala EL, Hänninen T, Soininen H, Kervinen K, Kesäniemi YA, Laakso M, Kuusisto J. Association of metabolic syndrome with Alzheimer disease: a population-based study. Neurology 2006; 67:843-7. [PMID: 16966548 DOI: 10.1212/01.wnl.0000234037.91185.99] [Citation(s) in RCA: 203] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To assess the association of metabolic syndrome (MetS) with Alzheimer disease (AD). METHODS The authors derived subjects from a population-based study of 980 randomly selected elderly subjects. After exclusion of all non-Alzheimer dementia cases, the final study population included 959 subjects (337 men and 622 women) aged 69 to 78 years. The presence of MetS was defined according to the National Cholesterol Education Program (Adult Treatment Panel III) criteria, and the diagnosis of AD was based on the criteria of the National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association. RESULTS Of the study subjects, 418 (43.6%) had MetS. Probable or possible AD was diagnosed in 45 subjects (4.7%). AD was more frequently detected in subjects with MetS than in subjects without MetS (7.2 vs 2.8%; p < 0.001). The prevalence of AD was higher in women with MetS vs women without the syndrome (8.3 vs 1.9%; p < 0.001), but in men with MetS, the prevalence of AD was not increased (3.8 vs 3.9%; p = 0.994). In univariate logistic regression analysis, MetS was significantly associated with AD (odds ratio [OR] 2.71; 95% CI 1.44 to 5.10). In multivariate logistic regression analysis including also apolipoprotein E4 phenotype, education, age, and total cholesterol, MetS was significantly associated with AD (OR 2.46; 95% CI 1.27 to 4.78). If only nondiabetic subjects were included in the multivariate analysis, MetS was still significantly associated with AD (OR 3.26; 95% CI 1.45 to 7.27). CONCLUSION Metabolic syndrome is associated with Alzheimer disease in elderly subjects.
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Affiliation(s)
- M Vanhanen
- Department of Neurology and Neuroscience, Kuopio University Hospital and the University of Kuopio, Finland.
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11
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Pennanen C, Testa C, Boccardi M, Laakso MP, Hallikainen M, Helkala EL, Hänninen T, Kivipelto M, Könönen M, Nissinen A, Tervo S, Vanhanen M, Vanninen R, Frisoni GB, Soininen H. The effect of apolipoprotein polymorphism on brain in mild cognitive impairment: a voxel-based morphometric study. Dement Geriatr Cogn Disord 2006; 22:60-6. [PMID: 16682795 DOI: 10.1159/000093263] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/30/2005] [Indexed: 11/19/2022] Open
Abstract
We investigated the effect of apolipoprotein E (ApoE) on the whole brain in 51 individuals with mild cognitive impairment using voxel-based morphometry. Between cases heterozygous for the ApoE epsilon4 (n = 15) and those who were ApoE epsilon4 noncarriers (n = 28), only the right parahippocampal gyrus, with the entorhinal cortex included, reached the level of statistical significance. In cases homozygous for the epsilon4 allele (n = 8) versus noncarriers, the greatest atrophy was located in the right amygdala followed by the right parahippocampal gyrus, the left amygdala and the left medial dorsal thalamic nucleus.
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Affiliation(s)
- Corina Pennanen
- Department of Neuroscience and Neurology,University of Kuopio, Canthia, Kuopio, Finland.
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12
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Pennanen C, Testa C, Boccardi M, Laakso MP, Hallikainen M, Helkala EL, Hänninen T, Kivipelto M, Könönen M, Nissinen A, Tervo S, Vanhanen M, Vanninen R, Frisoni GB, Soininen H. P2–172: The pattern of brain atrophy in mild cognitive impaired carriers of ApoE allele ϵ4: A voxel based morphometry study. Alzheimers Dement 2006. [DOI: 10.1016/j.jalz.2006.05.1010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Corina Pennanen
- Department of Neuroscience and NeurologyUniversity of KuopioKuopioFinland
- Department of Neurology and Department of RadiologyKuopio University HospitalKuopioFinland
| | - Cristina Testa
- Laboratory of Epidemiology & NeuroimagingIRCCS San Giovanni di Dio - FBFBresciaItaly
- Machine Vision LaboratoryDepartment of Mathematics and Computer ScienceUniversity of UdineUdineItaly
| | - Marina Boccardi
- Laboratory of Epidemiology & NeuroimagingIRCCS San Giovanni di Dio - FBFBresciaItaly
| | - Mikko P. Laakso
- Department of Neuroscience and NeurologyUniversity of KuopioKuopioFinland
- Department of Neurology and Department of RadiologyKuopio University HospitalKuopioFinland
| | | | | | - Tuomo Hänninen
- Department of NeurologyKuopio University HospitalKuopioFinland
| | - Miia Kivipelto
- Department of Neuroscience and NeurologyUniversity of KuopioKuopioFinland
- Department of NeurologyKuopio University HospitalKuopioFinland
| | - Mervi Könönen
- Department of Clinical RadiologyKuopio University HospitalKuopioFinland
| | | | - Susanna Tervo
- Department of Neuroscience and NeurologyUniversity of KuopioKuopioFinland
- Department of NeurologyKuopio University HospitalKuopioFinland
| | - Matti Vanhanen
- Department of NeurologyKuopio University HospitalKuopioFinland
| | - Ritva Vanninen
- Department of Clinical RadiologyKuopio University HospitalKuopioFinland
| | - Giovani B. Frisoni
- Laboratory of Epidemiology & NeuroimagingIRCCS San Giovanni di Dio - FBFBresciaItaly
- AFaR- Associazione Fatebenefratelli per la RicercaRomeItaly
| | - Hilkka Soininen
- Department of Neuroscience and NeurologyUniversity of KuopioKuopioFinland
- Department of NeurologyKuopio University HospitalKuopioFinland
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13
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Pennanen C, Tapiola M, Tervo S, Kivipelto M, Hänninen T, Pihlajamäki M, Laakso MP, Hallikainen M, Vanhanen M, Helkala EL, Vanninen R, Nissinen A, Testa C, Frisoni G, Soininen H. IC–P–048: MRI in mild cognitive impairment and predictive value to dementia on a follow–up study. Alzheimers Dement 2006. [DOI: 10.1016/j.jalz.2006.05.2253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Corina Pennanen
- Department of Neuroscience and NeurologyUniversity of Kuopio and Brain Research UnitClinical Research CenterMeditekniaKuopioFinland
- Department of Neurology and Department of RadiologyKuopio University HospitalKuopioFinland
| | - Mia Tapiola
- Department of Neuroscience and NeurologyUniversity of Kuopio and Brain Research UnitClinical Research CenterMeditekniaKuopioFinland
| | - Susanna Tervo
- Department of Neuroscience and NeurologyUniversity of Kuopio and Brain Research UnitClinical Research CenterMeditekniaKuopioFinland
- Department of NeurologyKuopio University HospitalKuopioFinland
| | - Miia Kivipelto
- Department of Neuroscience and NeurologyUniversity of Kuopio and Brain Research UnitClinical Research CenterMeditekniaKuopioFinland
- Department of NeurologyKuopio University HospitalKuopioFinland
| | - Tuomo Hänninen
- Department of NeurologyKuopio University HospitalKuopioFinland
| | - Maija Pihlajamäki
- Department of Neuroscience and NeurologyUniversity of Kuopio and Brain Research UnitClinical Research CenterMeditekniaKuopioFinland
- Department of NeurologyKuopio University HospitalKuopioFinland
| | - Mikko P. Laakso
- Department of Neuroscience and NeurologyUniversity of Kuopio and Brain Research UnitClinical Research CenterMeditekniaKuopioFinland
- Department of Neurology and Department of RadiologyKuopio University HospitalKuopioFinland
| | | | - Matti Vanhanen
- Department of NeurologyKuopio University HospitalKuopioFinland
| | | | - Ritva Vanninen
- Department of Clinical RadiologyKuopio University HospitalKuopioFinland
| | | | - Cristina Testa
- Laboratory of Epidemiology & NeuroimagingIRCCS San Giovanni di Dio - FBFBresciaItaly
- Machine Vision LaboratoryDepartment of Mathematics and Computer ScienceUniversity of UdineUdineItaly
| | - Giovanni Frisoni
- Laboratory of Epidemiology & NeuroimagingIRCCS San Giovanni di Dio - FBFBresciaItaly
- AFaR - Associazione Fatebenefratelli per la RicercaRomeItaly
| | - Hilkka Soininen
- Department of Neuroscience and NeurologyUniversity of Kuopio and Brain Research UnitClinical Research CenterMeditekniaKuopioFinland
- Department of NeurologyKuopio University HospitalKuopioFinland
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14
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Pennanen C, Testa C, Laakso MP, Hallikainen M, Helkala EL, Hänninen T, Kivipelto M, Könönen M, Nissinen A, Tervo S, Vanhanen M, Vanninen R, Frisoni GB, Soininen H. A voxel based morphometry study on mild cognitive impairment. J Neurol Neurosurg Psychiatry 2005; 76:11-4. [PMID: 15607988 PMCID: PMC1739300 DOI: 10.1136/jnnp.2004.035600] [Citation(s) in RCA: 159] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Mild cognitive impairment (MCI) is the most widely used concept in classifying cognitive impairment in the elderly who do not fulfil the criteria for dementia. MCI is considered to confer an increased risk of progressing to dementia and most often Alzheimer's disease (AD). Various approaches such as imaging of the brain have been applied to predict the conversion of MCI to dementia. A number of volumetric magnetic resonance imaging (MRI) studies have detected atrophy of the medial temporal lobe in subjects with MCI, but for the other cerebral regions the results have been inconsistent. OBJECTIVE To study the pattern of brain atrophy in MCI. METHODS Thirty two controls and 51 individuals with MCI deriving from population based cohorts were studied by MRI using voxel based morphometry. The threshold of t maps was set at p < 0.001. RESULTS Individuals with MCI had significant unilateral atrophy in the medial temporal lobe on the right side. Less extensive atrophy was found elsewhere-for example, in the temporal lobe, left superior parietal lobule, left anterior cingulate gyrus, and bilaterally in the thalami. CONCLUSIONS The MRI findings in MCI resemble those seen in early AD.
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Affiliation(s)
- C Pennanen
- Department of Neurology, Bldg. 5, Kuopio University Hospital, POB 1777, 70211 Kuopio, Finland
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15
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Pennanen C, Kivipelto M, Tuomainen S, Hartikainen P, Hänninen T, Laakso MP, Hallikainen M, Vanhanen M, Nissinen A, Helkala EL, Vainio P, Vanninen R, Partanen K, Soininen H. Hippocampus and entorhinal cortex in mild cognitive impairment and early AD. Neurobiol Aging 2004; 25:303-10. [PMID: 15123335 DOI: 10.1016/s0197-4580(03)00084-8] [Citation(s) in RCA: 402] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2002] [Revised: 03/14/2003] [Accepted: 03/27/2003] [Indexed: 11/20/2022]
Abstract
Magnetic resonance imaging (MRI) has been suggested as a useful tool in early diagnosis of Alzheimer's disease (AD). Based on MRI-derived volumes, we studied the hippocampus and entorhinal cortex (ERC) in 59 controls, 65 individuals with mild cognitive impairment (MCI) and 48 patients with AD. The controls and individuals with MCI were derived from population-based cohorts. Volumes of the hippocampus and ERC were significantly reduced in the following order: control > MCI > AD. Stepwise discriminant function analysis showed that the most efficient overall classification between controls and individuals with MCI subjects was achieved with ERC measurements (65.9%). However, the best overall classification between controls and AD patients (90.7%), and between individuals with MCI and AD patients (82.3%) was achieved with hippocampal volumes. Our results suggest that the ERC atrophy precedes hippocampal atrophy in AD. The ERC volume loss is dominant over the hippocampal volume loss in MCI, whereas more pronounced hippocampal volume loss appears in mild AD.
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Affiliation(s)
- Corina Pennanen
- Department of Neuroscience and Neurology, University of Kuopio and Brain Research Unit, Clinical Research Center, Mediteknia, P.O. Box 1627, FIN-70 211 Kuopio, Finland
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16
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Tervo S, Kivipelto M, Hänninen T, Vanhanen M, Hallikainen M, Mannermaa A, Soininen H. Incidence and risk factors for mild cognitive impairment: a population-based three-year follow-up study of cognitively healthy elderly subjects. Dement Geriatr Cogn Disord 2004; 17:196-203. [PMID: 14739544 DOI: 10.1159/000076356] [Citation(s) in RCA: 193] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/13/2003] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Mild cognitive impairment (MCI) has attracted considerable interest as a potential predictor of Alzheimer's disease (AD). Both the apolipoprotein E (ApoE) epsilon4 allele and vascular factors have been associated with a higher risk for AD, recently they have also been linked to the risk of MCI. OBJECTIVES To estimate the incidence of MCI among cognitively healthy elderly subjects during a 3-year follow-up, and to evaluate the impact of demographic and vascular factors as well as the ApoE epsilon4 allele on the conversion to MCI. METHODS At baseline, the cognitive abilities of 806 out of 1,150 eligible subjects (aged 60-76 years) from a population-based sample were examined. Cognitively intact subjects (n = 747) were followed for an average of 3 years. RESULTS 66 subjects (8.8%) had converted to MCI. The global incidence rate of MCI was 25.94/1,000 person-years. Persons with higher age (OR 1.08, 95% CI 1.01-1.16), ApoE epsilon4 allele carriers (OR 2.04, 95% CI 1.15-3.64) and persons with medicated hypertension (OR 1.86, 95% CI 1.05-3.29) were more likely to convert to MCI than those individuals of lower age and without an ApoE epsilon4 allele or medicated hypertension. Persons with high education (OR 0.79, 95% CI 0.70-0.89) were less likely to convert to MCI than persons with low or no education. In subjects with both the ApoE epsilon4 allele and medicated hypertension, the crude OR for conversion was 3.92 (95% CI 1.81-8.49). In subjects with cardiovascular disease, the crude OR for conversion was 2.13 (95% CI 1.26-3.60). Gender, elevated blood pressure, diabetes or cerebrovascular disease had no significant effect on the conversion to MCI. CONCLUSION Higher age, the presence of at least one ApoE epsilon4 allele and medicated hypertension are independent risk factors, but high education is a protective factor for MCI. The results suggest that vascular factors may have an important role in the pathogenesis of MCI.
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Affiliation(s)
- Susanna Tervo
- Department of Neuroscience and Neurology, Brain Research Unit, Clinical Research Centre, Mediteknia, University of Kuopio, Kuopio, Finland.
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17
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Abstract
OBJECTIVES Mild cognitive impairment (MCI) has been suggested as a term for a boundary area between normal aging and dementia, especially Alzheimer's disease (AD). In follow-up studies, more than 50% of MCI subjects have been converted to dementia in 3-4 years. However, the epidemiology of MCI is not well known. This study was designed to determine the prevalence of MCI in an elderly population. METHODS A total of 806 subjects (60-76 years of age) from a population-based random sample of 1150 subjects living in the city of Kuopio in eastern Finland were evaluated. Neuropsychological tests and a structured interview including the modified Clinical Dementia Rating (CDR) were used to apply the diagnostic criteria of MCI as proposed by Mayo Clinic Alzheimer's Disease Research Centre. Thus, subjects having a test score more than 1.5 SDs below the age appropriate mean in memory tests and a CDR score of 0.5 but no dementia, were diagnosed as having MCI. RESULTS A total of 43 subjects, 5.3%, met the MCI criteria. MCI was more prevalent in older and less-educated subjects, but no difference was found between men and women. The CDR appeared to be the most important part of the criteria. The memory tests had less impact on prevalence variables. CONCLUSIONS The low prevalence of MCI indicate that in a population-based study design its criteria may identify a more homogeneous group of subjects at the lower end of the cognitive continuum as contrasted with various other criteria of cognitive impairment in the elderly population. This is compatible with follow-up studies showing a high probability of dementia in the MCI group. Thus, probable candidates for trials of preventive intervention for dementia can be screened from the elderly population using these diagnostic criteria.
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Affiliation(s)
- T Hänninen
- Department of Neuroscience and Neurology, University of Kuopio, Finland.
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18
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Helkala EL, Lakka T, Vanhanen M, Tuomainen TP, Ehnholm C, Kaplan GA, Salonen JT. Associations between apolipoprotein E phenotype, glucose metabolism and cognitive function in men. An explorative study in a population sample. Diabet Med 2001; 18:991-7. [PMID: 11903399 DOI: 10.1046/j.0742-3071.2001.00588.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIMS To investigate the associations of the apolipoprotein E phenotype (apoE) and disturbed glucose metabolism with cognitive function in a random population sample. METHODS A cross-sectional study was conducted, in which 528 men aged 54 or 60 years were recruited randomly from a larger population-based sample of 1516 men. A subject was defined as having abnormal glucose tolerance (AGT), if he had a clinical diagnosis of diabetes, with either dietary or oral antidiabetic treatment or showed impaired glucose tolerance in an oral glucose tolerance test. The subjects were divided into three groups according to apolipoprotein E phenotypes: (a) E2/4, E3/4 or E4/4 (apoE E4); (b) E 3/3 (apoE E3); and (c) E2/2 or E2/3 (apoE E2). Memory function was examined using a word-list learning with Buschke's selective reminding method and test. Executive functions were assessed with the Trail Making Test A and B. RESULTS Those subjects with apoE E2 and abnormal glucose metabolism demonstrated the worst cognitive executive control compared to other groups. Simple cognitive speed did not differ between the groups. CONCLUSIONS The exploratory analyses revealed that subjects with apoE E2 allele and AGT had worse glycaemic control and cognitive executive control compared to other groups. Different apolipoprotein phenotypes together with impaired glucose tolerance may have different cumulative adverse effects on age-related cognitive performance. Some subgroups of subjects may be especially vulnerable to cognitive impairment.
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Affiliation(s)
- E L Helkala
- Department of Public Health and General Practice of University of Kuopio, Kuopio, Finland.
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19
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Affiliation(s)
- L Kanerva
- Section of Dermatology, Finnish Institute of Occupational Health, Topeliuksenkatu 41 aA, FIN-00250 Helsinki, Finland
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20
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Vanhanen M, Kivipelto M, Koivisto K, Kuusisto J, Mykkänen L, Helkala EL, Hänninen T, Kervinen K, Kesäniemi YA, Laakso MP, Soininen H, Laakso M. APOE-epsilon4 is associated with weight loss in women with AD: a population-based study. Neurology 2001; 56:655-9. [PMID: 11245719 DOI: 10.1212/wnl.56.5.655] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate whether the APOE-epsilon4 allele is associated with weight loss in patients with AD or in nondemented elderly subjects. BACKGROUND Weight loss has been considered a typical feature of AD. APOE-epsilon4 is a risk factor for AD and was recently proposed to be associated with weight loss in elderly women. It is not known whether APOE-epsilon4 is associated with weight loss in patients with AD or in the general population. METHODS Weight and BMI measurements at an average interval of 3.5 years and APOE phenotype determination were performed in an elderly population (n = 980), including 46 patients with AD and 911 control subjects at the end of the follow-up. RESULTS On average, patients with AD with the epsilon4 allele lost 1.9 +/- 4.0 kg (BMI 0.8 +/- 1.8 kg/m2) whereas epsilon4 noncarriers gained 1.2 +/- 3.8 kg (BMI 0.4 +/- 1.5 kg/m2) (both p < 0.05), after controlling for diabetes and exercise. However, when men and women were analyzed separately, weight loss was observed only in those women with AD with the epsilon4 allele. Clinically significant weight loss, defined as loss of > or = 5% of body weight, occurred more frequently in both patients with AD (30% versus 6%; p < 0.05) and control subjects (28% versus 18%; p < 0.001) carrying the epsilon4 allele. CONCLUSIONS The APOE-epsilon4 allele may contribute to the unexplained weight loss in AD, especially in women.
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Affiliation(s)
- M Vanhanen
- Department of Neurology of the Kuopio University Hospital, Finland.
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Abstract
OBJECTIVES To assess the prevalence of enzyme sensitisation in the animal feed industry. METHODS A cross sectional study was conducted in four animal feed factories, where several enzymes had been used in powder form for 7-9 years. Before this study, enzymes in liquid form had started to be used. Sensitisation to enzymes was examined by skin prick and radioallergosorbent (RAST) tests. Altogether 218 workers were tested; 140 people in various tasks in manufacturing, where exposure to various organic dusts and to enzymes was possible, and 78 non-exposed office workers. The workers were interviewed for work related respiratory and skin symptoms. Total dust concentrations were measured by a gravimetric method. The concentrations of protease and alpha-amylase were measured with catalytic methods and that of xylanase with an immunological method. RESULTS Ten workers (7%) were sensitised to enzymes in the exposed group of 140, whereas none were sensitised in the non-exposed group. Six of the sensitised people had respiratory symptoms at work: two of them especially in connection with exposure to enzymes. Enzyme concentrations in the air varied greatly: xylanase from less than 0.8 ng/m(3) up to 16 ng/m(3), alpha-amylase from less than 20 ng/m(3) up to 200 ng/m(3), and protease from less than 0.4 ng/m(3)up to 2900 ng/m(3). On average, highest xylanase and alpha-amylase concentrations were found in the various manufacturing sites, whereas the highest protease concentrations were found in areas of high total dust. CONCLUSIONS Industrial enzymes may cause allergies in the animal feed industry. There is a need to assess exposure to enzymes at various phases of production, and to minimise exposures.
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Affiliation(s)
- M Vanhanen
- Finnish Institute of Occupational Health, Topeliuksenkatu 41 aA, FIN-00250, Helsinki, Finland.
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22
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Alanko K, Tuomi T, Vanhanen M, Pajari-Backas M, Kanerva L, Havu K, Saarinen K, Bruynzeel DP. Occupational IgE-mediated allergy to Tribolium confusum (confused flour beetle). Allergy 2000; 55:879-82. [PMID: 11003453 DOI: 10.1034/j.1398-9995.2000.00572.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND We report on IgE-mediated allergy in a worker caused by Tribolium confusum (confused flour beetle). These beetles lived in the "old" flour to which he was exposed in his work. CASE REPORT A 35-year-old, nonatopic mechanic in a rye crispbread factory developed rhinitis, conjunctivitis, and asthmatic symptoms, as well as urticaria on his wrists, lower arms, hands, neck, and face, during the maintenance and repair of machines contaminated by flour. This flour had been in and on the machines for a long time, and it contained small beetles. The patient did not suffer any symptoms when handling fresh, clean flour. RESULTS Skin prick tests with standard environmental allergens, storage mites, enzymes, flours, and molds were negative. A prick test with flour from the machines gave a 10-mm reaction. An open application of the same flour caused urticarial whealing on the exposed skin. Prick tests with fresh flour from the factory were negative. A prick test with minced T. confusum from the flour in the machines gave a 7-mm reaction. Histamine hydrochloride 10 mg/ml gave a 7-mm reaction. Specific serum IgE antibodies to T. confusum were elevated at 17.2 kU/l. Prick tests with the flour from the machines were negative in five control patients. CONCLUSIONS The patient had occupational contact urticaria, rhinitis, conjunctivitis, and asthmatic symptoms from exposure to flour. His symptoms were caused by immediate allergy to the beetle T. confusum. Immediate allergy to this beetle has rarely been reported in connection with respiratory symptoms, but it may be more common. Contact urticaria from this source has not been reported before.
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Affiliation(s)
- K Alanko
- Finnish Institute of Occupational Health, Helsinki
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Vanhanen M, Tuomi T, Tupasela O, Keskinen H, Tuppurainen M, Hytönen M, Tarvainen K, Kanerva L, Nordman H. Cellulase allergy and challenge tests with cellulase using immunologic assessment. Scand J Work Environ Health 2000; 26:250-6. [PMID: 10901118 DOI: 10.5271/sjweh.539] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES This study attempted to develop and evaluate a challenge test for diagnosing allergic asthma and rhinitis due to cellulase. METHODS Challenge tests in a chamber were performed on 11 persons sensitized to cellulase. Four different enzyme-lactose mixtures, starting from a 0.03% mixture, were used. The enzyme dust was generated from a dry enzyme preparation mixed with lactose powder, using pressurized air. The cellulase concentration in the air was measured with an immunochemical method. RESULTS Nasal, pharyngeal, or bronchial symptoms could be elicited at cellulase air concentrations of 1 to 1300 microg/m3. A dose-response relationship was observed for symptoms in repeated challenge tests with increasing concentrations of cellulase. For 2 persons skin symptoms could also be reproduced. CONCLUSION The challenge method proved to be a practical means with which to simulate conditions at the worksite and elicit the specific respiratory symptoms of the patients.
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Affiliation(s)
- M Vanhanen
- Finnish Institute of Occupational Health, Helsinki.
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Hanninen T, Hallikainen M, Vanhanen M, Soininen H. Prevalence of mild cognitive impairment: A population-based study in elderly subjects. Neurobiol Aging 2000. [DOI: 10.1016/s0197-4580(00)82252-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
OBJECTIVES To assess the prevalence of enzyme sensitisation in the detergent industry. METHODS A cross sectional study was conducted in a detergent factory. Sensitisation to enzymes was examined by skin prick and radioallergosorbent (RAST) tests. 76 Workers were tested; 40 in manufacturing, packing, and maintenance, and 36 non-exposed people in management and sales departments. The workers were interviewed for work related respiratory and skin symptoms. Total dust concentrations were measured by a gravimetric method, and the concentration of protease in air by a catalytic method. RESULTS Nine workers (22%) were sensitised to enzymes in the exposed group of 40, whereas none were sensitised in the non-exposed group. All the sensitised people had symptoms at work; all had rhinitis and one had asthma. Protease concentrations were generally < 20 ng/m3, but occasional peak values up to 80 ng/m3 were detected in the packing and maintenance tasks, and high values of > 1 microgram/m3 in the mixing area. CONCLUSION Despite the use of encapsulated enzyme preparations, high enzyme concentrations in workplace air are possible, resulting in a higher risk of sensitisation than expected.
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Affiliation(s)
- M Vanhanen
- Finnish Institute of Occupational Health, Helsinki, Finland.
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Affiliation(s)
- L Kanerva
- Section of Dermatology, Finnish Institute of Occupational Health, Helsinki
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Vanhanen M, Kuusisto J, Koivisto K, Mykkänen L, Helkala EL, Hänninen T, Riekkinen P, Soininen H, Laakso M. Type-2 diabetes and cognitive function in a non-demented population. Acta Neurol Scand 1999; 100:97-101. [PMID: 10442450 DOI: 10.1111/j.1600-0404.1999.tb01045.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To study if type-2 (non-insulin-dependent) diabetes mellitus (NIDDM) is associated with cognitive dysfunction independently of clinically diagnosed dementia in an elderly population. MATERIAL AND METHODS Cognitive function was investigated with a brief neuropsychological test battery in a non-demented elderly population consisting of 183 NIDDM (World Health Organization, 1985) patients and 732 non-diabetic subjects. RESULTS Patients with NIDDM were impaired in the Trail-Making Test parts A and C, which may be a reflection of mildly affected frontal lobe/executive functions. Women with NIDDM performed better than non-diabetic subjects in the Mini-Mental State Examination. CONCLUSIONS We conclude that NIDDM per se is not associated with impaired memory in the elderly, and the minor defects observed in tests of frontal lobe/executive functions are unlikely to affect daily living. In the non-demented population aged 69 78 years, NIDDM does not carry a significant risk of cognitive dysfunction, when compared to the non-diabetic subjects.
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Affiliation(s)
- M Vanhanen
- Department of Neurology, University Hospital of Kuopio, Finland
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Jäkälä P, Riekkinen M, Sirviö J, Koivisto E, Kejonen K, Vanhanen M, Riekkinen P. Guanfacine, but not clonidine, improves planning and working memory performance in humans. Neuropsychopharmacology 1999; 20:460-70. [PMID: 10192826 DOI: 10.1016/s0893-133x(98)00127-4] [Citation(s) in RCA: 138] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The present study compares, using a double-blind, placebo controlled design the effects of two alpha 2-agonists, clonidine (0.5, 2, and 5 micrograms/kg) and guanfacine (7 and 29 micrograms/kg) on spatial working memory, planning and attentional set-shifting, functions thought to be dependent on the "central executive" of the prefrontal cortex. Blood pressure and the subjective feeling of sedation were affected equally by clonidine and guanfacine. The 0.5 microgram/kg and 5 micrograms/kg doses of clonidine disrupted spatial working memory, but the medium dose had no effect. The 0.5 and 2 micrograms/kg doses of clonidine increased impulsive responding in the planning test. The 5 micrograms/kg dose of clonidine slowed responding at effortful levels of planning and attentional set-shifting tests. The 29 micrograms/kg dose of guanfacine improved spatial working memory and planning. Guanfacine had no effect on attentional set-shifting. These data indicate that guanfacine improved planning and spatial working memory, but clonidine dose-dependently disrupted performance. It is possible that the greater selectivity of guanfacine for alpha 2A-adrenoceptor subtype may underlie its differences from clonidine.
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Affiliation(s)
- P Jäkälä
- Department of Neuroscience and Neurology, University of Kuopio, Finland
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Jäkälä P, Sirviö J, Riekkinen M, Koivisto E, Kejonen K, Vanhanen M, Riekkinen P. Guanfacine and clonidine, alpha 2-agonists, improve paired associates learning, but not delayed matching to sample, in humans. Neuropsychopharmacology 1999; 20:119-30. [PMID: 9885792 DOI: 10.1016/s0893-133x(98)00055-4] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The present study compares the effects of two alpha 2-agonists, clonidine (0.5, 2, and 5 micrograms/kg, p.o.) and guanfacine (7 and 29 micrograms/kg, p.o.) in young healthy volunteers on their performance in visual paired associates learning (PAL) and delayed matching to sample (DMTS) visual short-term recognition memory tests. In the PAL test, clonidine 2 and guanfacine 29 micrograms/kg improved the subjects' performance. In the DMTS test, clonidine at 5 micrograms/kg delay-dependently impaired performance accuracy, and at 2 and 5 micrograms/kg it also slowed responses. Guanfacine had no effect on DMTS test performance. Clonidine 5 and guanfacine 29 micrograms/kg equally increased subjective feelings of sedation and reduced blood pressure. The results suggest that both clonidine and guanfacine facilitated PAL learning by improving "frontal strategies," but only clonidine disrupted "mneomonic processing" decreasing DMTS accuracy. The greater selectivity of guanfacine for alpha 2A-adrenoceptor subtype may explain the different profile of action of the drugs.
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Affiliation(s)
- P Jäkälä
- Department of Neuroscience and Neurology, University of Kuopio, Finland
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Abstract
The literature on cognitive function and Alzheimer's disease in non-insulin-dependent diabetes, impaired glucose tolerance and hyperinsulinaemia are briefly summarized. Neuropsychological, epidemilogical and endocrine contributions are reviewed, with an emphasis on the insulin hypothesis as a potential pathophysiological mechanism for Alzheimer's disease.
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Affiliation(s)
- M Vanhanen
- Department of Neurology, University and University Hospital of Kuopio, Finland.
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Affiliation(s)
- L Kanerva
- Finnish Institute of Occupational Health, Helsinki, Finland
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Vanhanen M, Koivisto K, Kuusisto J, Mykkänen L, Helkala EL, Hänninen T, Riekkinen P, Soininen H, Laakso M. Cognitive function in an elderly population with persistent impaired glucose tolerance. Diabetes Care 1998; 21:398-402. [PMID: 9540022 DOI: 10.2337/diacare.21.3.398] [Citation(s) in RCA: 135] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To study cognitive function in an elderly population with persistent impaired glucose tolerance (IGT). RESEARCH DESIGN AND METHODS Fasting and postload 2-h plasma glucose and insulin levels were determined at baseline in a population-based sample of 1,300 people and repeated an average of 3.5 years later in 980 subjects. At follow-up, cognitive function was evaluated in subjects with persistent normal glucose tolerance (NGT; n = 506) and IGT (n = 80) with a brief neuropsychological test battery. RESULTS Subjects with persistent IGT scored lower in the Mini-Mental State Examination (MMSE) and in the Buschke Selective Reminding Test long-term memory scores. Multiple linear regression analysis revealed that age, education, and insulin levels (either fasting or 2-h value) were associated with the MMSE score in subjects with persistent IGT. Other potential risk factors for impaired cognitive function were not significantly associated with the MMSE score. CONCLUSIONS Our study showed that persistent IGT in the elderly is associated with mildly impaired cognitive function, and hyperinsulinemia may account for this association.
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Affiliation(s)
- M Vanhanen
- Department of Neurology, Kuopio University Hospital, Finland.
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Kuusisto J, Koivisto K, Mykkänen L, Helkala EL, Vanhanen M, Hänninen T, Kervinen K, Kesäniemi YA, Riekkinen PJ, Laakso M. Association between features of the insulin resistance syndrome and Alzheimer's disease independently of apolipoprotein E4 phenotype: cross sectional population based study. BMJ 1997; 315:1045-9. [PMID: 9366728 PMCID: PMC2127678 DOI: 10.1136/bmj.315.7115.1045] [Citation(s) in RCA: 289] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To determine the association between features of the insulin resistance syndrome and Alzheimer's disease. DESIGN Cross sectional population based study. SUBJECTS 980 people aged 69 to 78 (349 men, 631 women). SETTING Population of Kuopio, eastern Finland. MAIN OUTCOME MEASURES Presence of features of the insulin resistance syndrome and diagnosis of Alzheimer's disease by detailed neurological and neuropsychological evaluation. RESULTS 46 (4.7%) subjects were classified as having probable or possible Alzheimer's disease. In univariate analyses, apolipoprotein E4 phenotype (odds ratio; 95% confidence interval 3.24: 1.77 to 5.92), age (1.16; 1.05 to 1.29), low level of education (0.82; 0.72 to 0.93), low total cholesterol concentration (0.77; 0.59 to 1.00), high systolic blood pressure (1.01; 1.00 to 1.03), high fasting and 2 hour plasma glucose concentrations (1.11; 1.01 to 1.23 and 1.08; 1.03 to 1.13, respectively), high fasting and 2 hour insulin concentrations (1.05; 1.02 to 1.08 and 1.003; 1.00 to 1.01, respectively), and abnormal glucose tolerance (1.86; 1.23 to 2.80) were significantly associated with Alzheimer's disease. In multivariate analysis including apolipoprotein E4 phenotype, age, education, systolic blood pressure, total cholesterol concentration, fasting glucose concentration, and insulin concentration, apolipoprotein E4 phenotype, age, education, total cholesterol, and insulin were significantly associated with Alzheimer's disease. In 532 non-diabetic subjects without the e4 allele hyperinsulinaemia was associated with an increased risk for Alzheimer's disease (prevalence of disease 7.5% v 1.4% in normoinsulinaemic subjects, P = 0.0004). In contrast, in the 228 with the e4 allele hyperinsulinaemia had no effect on the risk of disease (7.0% v 7.1%, respectively). CONCLUSION Features of the insulin resistance syndrome are associated with Alzheimer's disease independently of apolipoprotein E4 phenotype.
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Affiliation(s)
- J Kuusisto
- Department of Medicine, Kuopio University Hospital, Finland
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34
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Vanhanen M, Tuomi T, Nordman H, Tupasela O, Holmberg PC, Miettinen M, Mutanen P, Leisola M. Sensitization to industrial enzymes in enzyme research and production. Scand J Work Environ Health 1997; 23:385-91. [PMID: 9403470 DOI: 10.5271/sjweh.236] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES This study investigated sensitization to industrial enzymes in Finnish enzyme production and in Finnish laboratories. METHODS A cross-sectional study was conducted in 2 plants producing industrial enzymes and in their product development and research laboratories. Sensitization to enzymes and environmental allergens was examined by skin prick tests and specific immunoglobulin E determinations (radioallergosorbent test). The employees were interviewed for work-related respiratory symptoms. Altogether 173 employees were examined. RESULTS The skin prick test showed 21 employees (12%) to be sensitized to one or more enzymes. Sixteen positive persons also had specific immunoglobulin E. Atopy was distinctly associated with enzyme sensitization. An exposure-response relationship was found for enzyme sensitization and for respiratory symptoms during work. For sensitization, the exposure-response linear trend was statistically significant. It weakened but remained statistically significant after stratification for atopy. For symptoms, likewise, the exposure-response linear trend was statistically significant, and the statistical significance remained after stratification for atopy. CONCLUSION The study confirmed that industrial enzymes are potent sensitizers. The handling of dry enzymes in laboratory work may cause sensitization. Sensitization may even follow minute degrees of exposure, such as among office personnel. Atopics are more susceptible to sensitization than nonatopics. Nonatopics are also clearly at risk; the demonstrated exposure-response relationship emphasizes the need for and advantages of proper exposure control.
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Affiliation(s)
- M Vanhanen
- Finnish Institute of Occupational Health, Helsinki
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35
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Affiliation(s)
- L Kanerva
- Finnish Institute of Occupational Health, Helsinki, Finland
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36
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Vanhanen M, Koivisto K, Karjalainen L, Helkala EL, Laakso M, Soininen H, Riekkinen P. Risk for non-insulin-dependent diabetes in the normoglycaemic elderly is associated with impaired cognitive function. Neuroreport 1997; 8:1527-30. [PMID: 9172168 DOI: 10.1097/00001756-199704140-00041] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
We studied cognitive function in normoglycaemic elderly subjects at different risk levels for developing non-insulin-dependent diabetes mellitus (NIDDM) and in patients with NIDDM. Risk for NIDDM was considered increased if both 2 h glucose and insulin values on oral glucose tolerance testing were higher than the median in normoglycaemic subjects, and low if the respective values were lower than the median. The increased risk group showed impairment on tests of immediate and delayed memory, attention, visuomotor speed and verbal fluency. Moreover, the increased risk group did not differ from patients with NIDDM on any cognitive tests. Our results suggest that increased risk for NIDDM is associated with widely affected cognitive function in the normoglycaemic elderly, highlighting the importance of healthy living habits.
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Affiliation(s)
- M Vanhanen
- Department of Neurology, A.I. Virtanen Institute of Kuopio University, Finland
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37
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Helkala EL, Koivisto K, Hanninen T, Vanhanen M, Kuusisto J, Mykkanen L, Laakso M, Riekkinen P. Stability of age-associated memory impairment during a longitudinal population-based study. J Am Geriatr Soc 1997; 45:120-2. [PMID: 8994504 DOI: 10.1111/j.1532-5415.1997.tb00996.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Vanhanen M, Karhu J, Koivisto K, Pääkkönen A, Partanen J, Laakso M, Riekkinen P. ERPs reveal deficits in automatic cerebral stimulus processing in patients with NIDDM. Neuroreport 1996; 7:2767-71. [PMID: 8981464 DOI: 10.1097/00001756-199611040-00072] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We compared auditory event-related potentials (ERPs) and neuropsychological test scores in nine patients with non-insulin-dependent diabetes mellitus (NIDDM) and in nine control subjects. The measures of automatic stimulus processing, habituation of auditory N100 and mismatch negativity (MMN) were impaired in patients. No differences were observed in the N2b and P3 components, which presumably reflect conscious cognitive analysis of the stimuli. A trend towards impaired performance in the Digit Span backward was found in diabetic subjects, but in the tests of secondary or long-term memory the groups were comparable. Patients with NIDDM may have defects in arousal and in the automatic ability to redirect attention, which can affect their cognitive performance.
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Affiliation(s)
- M Vanhanen
- Department of Neurology, University Hospital, Kuopio, Finland
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Vanhanen M, Tuomi T, Hokkanen H, Tupasela O, Tuomainen A, Holmberg PC, Leisola M, Nordman H. Enzyme exposure and enzyme sensitisation in the baking industry. Occup Environ Med 1996; 53:670-6. [PMID: 8943831 PMCID: PMC1128573 DOI: 10.1136/oem.53.10.670] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To assess the exposure to enzymes and prevalence of enzyme sensitisation in the baking industry. METHODS A cross sectional study was conducted in four bakeries, one flour mill, and one crispbread factory. Sensitisation to enzymes, flours, and storage mites was examined by skin prick and radioallergosorbent (RAST) tests. 365 workers were tested. The workers were interviewed for work related respiratory and skin symptoms. Total dust concentrations were measured by a gravimetric method, and the concentration of alpha-amylase in air was measured by a catalytic method. An immunochemical method was used for measuring cellulase and xylanase in air. RESULTS Total measured dust concentrations were from 0.1 to 18 mg/m3, with highest values in dough making areas of bakeries. The alpha-amylase concentrations generally followed the total dust concentrations and reached the highest values < 6.6 micrograms/m3 in the same areas. Cellulase and xylanase varied with concentrations < 180 ng/m3 and < 40 ng/m3, respectively, in the flour mill and the crispbread factory. No cellulase, but concentrations of 1-200 ng/m3 xylanase, were found in the bakeries, probably indicating the natural xylanase activity of wheat. 12 workers (8%) in the bakeries, three (5%) in the flour mill, and four (3%) in the crispbread factory were skin prick positive to enzymes. The corresponding percentages of positive reactions to flours were 12%, 5%, and 8%. CONCLUSIONS The study confirmed that industrial enzymes in baking used as additives in a powdered form pose a risk of sensitisation. The no effect air concentrations for industrial enzymes are not known. Based on present knowledge, however, lowering exposures and eliminating short and high peaks by technical measures would lower the risk of sensitisation. This would be most effectively accomplished by shifting to non-dusty products.
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Affiliation(s)
- M Vanhanen
- Finnish Institute of Occupational Health, Helsinki, Finland
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Helkala EL, Koivisto K, Hanninen T, Vanhanen M, Kervinen K, Kuusisto J, Mykkanen L, Kesaniemi YA, Laakso M, Riekkinen P. Memory functions in human subjects with different apolipoprotein E phenotypes during a 3-year population-based follow-up study. Neurosci Lett 1996; 204:177-80. [PMID: 8938259 DOI: 10.1016/0304-3940(96)12348-x] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The apolipoprotein E epsilon4 allele is the most common risk factor for Alzheimer's disease (AD). The epsilon2 allele may play a protective role in AD. Our previous cross-sectional study showed that in non-demented elderly subjects the epsilon2 allele is associated with better learning ability than other alleles. We wished to investigate the influence of different apolipoprotein E (apoE) phenotypes on cognitive functions in a 3-year follow-up study starting with a random sample of 917 non demented elderly subjects. Episodic memory was examined with the List Learning Test (Buschke's selective reminding method), as well as with immediate and delayed recall of figures. Retrieval from semantic memory was assessed with the Category and Verbal Fluency tests. Constructional abilities were examined by copying figures. Attention functions were examined with the Trail Making A and B tests. A total of 632 subjects completed the 3-year follow-up study. The subjects with apoE phenotypes E2/2 or E2/3 were able to maintain their verbal learning performance, while the learning ability of the subjects with other apoE phenotypes deteriorated. We suggest that successful mental aging may be at least in part associated with genetic factors.
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Affiliation(s)
- E L Helkala
- Department of Neurology, Kuopio University Hospital and University of Kuopio, Finland
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Riekkinen P, Soininen H, Helkala EL, Partanen K, Laakso M, Vanhanen M, Riekkinen P. Hippocampal atrophy, acute THA treatment and memory in Alzheimer's disease. Neuroreport 1995; 6:1297-300. [PMID: 7669991 DOI: 10.1097/00001756-199506090-00017] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
We designed the present study to investigate the hypothesis that progression of hippocampal pathology may decrease the therapeutic effects of anti-cholinesterase drug, tetrahydroaminoacridine, on memory functioning in Alzheimer's disease (AD) patients. Memory, visuoconstructive, executive and vigilance functions were assessed after administration of placebo (p.o.; two placebo sessions) and tetrahydroaminoacridine (one session for 25 and 75 mg, p.o.). Eight patients performed better on list learning test during tetrahydroaminoacridine 75 mg than after placebo or tetrahydroaminoacridine 25 mg. The responders performed during baseline examination better than the non-responders in executive and some declarative memory functions, and had higher MMSE scores than the non-responders. The responders had larger left and right hippocampi than the non-responders. The hippocampal volume correlated with list learning performance. The results suggest that severe hippocampal atrophy may block memory improving effect of an anticholinesterase drug, tetrahydroaminoacridine.
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Affiliation(s)
- P Riekkinen
- Department of Neurology, University of Kuopio, Finland
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Helkala EL, Koivisto K, Hänninen T, Vanhanen M, Kervinen K, Kuusisto J, Mykkänen L, Kesäniemi YA, Laakso M, Riekkinen P. The association of apolipoprotein E polymorphism with memory: a population based study. Neurosci Lett 1995; 191:141-4. [PMID: 7644133 DOI: 10.1016/0304-3940(95)11575-h] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Several studies have shown an association between the apolipoprotein epsilon 4 allele and Alzheimer's disease (AD). The allele epsilon 2 has been associated with survival and longevity. We wanted to examine whether the relationship between cognitive efficiency and apolipoprotein E polymorphism (APOE) exists in a random sample of 916 non-demented elderly subjects. Episodic memory was examined with the list learning test, and with immediate and delayed recall of the figures. Semantic memory was examined with the Category and Verbal Fluency Tests. Constructional abilities were examined by copying the figures. Attention functions were examined with Trail Making A and B tests. We found that subjects with APOE E2/2 and 2/3 phenotypes showed better learning ability than those subjects with the APOE E2/4, 3/4 or 4/4 phenotypes. Impaired memory was not related to the excess of cardiovascular diseases in the subjects with APOE E2/4, 3/4, 4/4 phenotypes. Thus they may be associated, at least partly, with genetic factors.
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Affiliation(s)
- E L Helkala
- Department of Neurology, Kuopio University Hospital, Finland
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Koivisto K, Reinikainen KJ, Hänninen T, Vanhanen M, Helkala EL, Mykkänen L, Laakso M, Pyörälä K, Riekkinen PJ. Prevalence of age-associated memory impairment in a randomly selected population from eastern Finland. Neurology 1995; 45:741-7. [PMID: 7723964 DOI: 10.1212/wnl.45.4.741] [Citation(s) in RCA: 106] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Aging has multiple effects on memory in normal subjects. However, information on the prevalence of age-associated memory impairment (AAMI) is scanty. We studied the prevalence of AAMI in a randomly selected population of 1,049 subjects aged 60 to 78 years from eastern Finland. Research criteria proposed by the National Institute of Mental Health (NIMH) Work Group were applied. We calculated prevalence rates for AAMI by the inclusion criteria alone (subjective and objective memory impairment and no dementia) as well as by the inclusion and exclusion criteria (evidence of any neurologic or other medical disorder that could produce cognitive deterioration) for the total study population, for both sexes, and for four age groups (60 to 64, 65 to 69, 70 to 74, and 75 to 78 years). Subjective memory impairment was present in 76.3% of the subjects. Prevalence rates for objective memory impairment ranged from 31.9 to 78.4% in individual tests. A total of 564 subjects (239 men, 325 women) were classified as having AAMI by the inclusion criteria alone, giving a prevalence rate of 53.8% (men, 57.4%; women, 51.3%). When we included the exclusion criteria, the prevalence of AAMI decreased to 38.4% (men, 42.5%; women, 35.7%). By both methods, age- and sex-specific prevalence rates were highest in the youngest group, aged 60 to 64 years, and lowest in the oldest group, aged 75 to 78 years. We conclude that the prevalence of AAMI, by the diagnostic criteria of the NIMH Work Group, is high in the elderly Finnish population.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- K Koivisto
- Department of Neurology, University of Kuopio, Finland
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Abstract
Enzymes can cause allergic asthma and rhinitis. Although patients sometimes complain of symptoms in their throat, we have not been able to find any published report of pharyngeal edema caused by exposure to enzymes. We present the case of a maintenance foreman who worked in a factory producing enzymes, and who had pharyngeal edema, asthma, and rhinitis at work. Prick tests for cellulase enzyme and cellulase RAST were positive. The causal association between his pharyngeal symptoms and cellulase was demonstrated with inhalation provocation tests in an exposure chamber.
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Affiliation(s)
- M Hytönen
- Institute of Occupational Health, Helsinki, Finland
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Kuusisto J, Koivisto K, Kervinen K, Mykkänen L, Helkala EL, Vanhanen M, Hänninen T, Pyörälä K, Kesäniemi YA, Riekkinen P. Association of apolipoprotein E phenotypes with late onset Alzheimer's disease: population based study. BMJ 1994; 309:636-8. [PMID: 8086986 PMCID: PMC2541512 DOI: 10.1136/bmj.309.6955.636] [Citation(s) in RCA: 130] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To determine the association between the e4 allele of apolipoprotein E and Alzheimer's disease in a randomly selected population sample. DESIGN Cross sectional population based study. SUBJECTS 980 people aged 69 to 78 (349 men, 631 women). SETTING Population of Kuopio, eastern Finland. MAIN OUTCOME MEASURES Presence of e4 allele and diagnosis of Alzheimer's disease by detailed neurological and neurophysiological evaluation. RESULTS 46 (4.7%) subjects were classified as having probable or possible Alzheimer's disease. The frequency of the apolipoprotein E e4 allele was 0.359 in patients with Alzheimer's disease and 0.165 subjects without dementia (P < 0.0001). The prevalence of Alzheimer's disease was 2.9% in subjects with no e4 alleles, 7.6% in subjects with one e4 allele, and 21.4% in subjects with two e4 alleles of apolipoprotein E. CONCLUSIONS Allele e4 of apolipoprotein is associated with Alzheimer's disease in a dose-response fashion in a randomly selected elderly population.
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Affiliation(s)
- J Kuusisto
- Department of Medicine, Kuopio University Hospital, Finland
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Kuusisto J, Koivisto K, Mykkänen L, Helkala EL, Vanhanen M, Hänninen T, Pyörälä K, Riekkinen P, Laakso M. Essential hypertension and cognitive function. The role of hyperinsulinemia. Hypertension 1993; 22:771-9. [PMID: 8225537 DOI: 10.1161/01.hyp.22.5.771] [Citation(s) in RCA: 76] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The relation between hypertension and cognitive function is not well established. Therefore, we examined cognitive function in a random sample of 744 nondiabetic elderly inhabitants of Kuopio, East Finland. Five brief neuropsychological tests known to be sensitive to cognitive impairment due to dementia--the Mini-Mental State Examination (MMSE), the Trail Making Test (TMT), the Buschke Selective Reminding Test (BSR), Russell's Adaptation of the Visual Reproduction Test (HVR), and the Verbal Fluency Test (VFT)--were used to evaluate cognitive function. The performance of the hypertensive group (n = 378) was impaired in almost all test items compared with that of the normotensive group (n = 366), but the difference between these two groups was statistically significant in 5 of 19 test items only. Moreover, within the hypertensive group, hyperinsulinemic (fasting plasma insulin > 17.9 mU/L) hypertensive subjects (n = 57) scored worse than normoinsulinemic hypertensive subjects (n = 321) in 16 of 19 test items and worse than the normotensive subjects in the same 16 of 19 test items. The difference between the hyperinsulinemic hypertensive and normotensive groups was significant in 11 test items that reflected complex cognitive function such as calculation, language, semantic memory, and problem solving. This difference in neuropsychological tests among the three study groups (normotensive, normoinsulinemic hypertensive, and hyperinsulinemic hypertensive subjects) persisted after adjustment for fasting plasma glucose, age, sex, and education in 3 test items measuring calculation, copying, and semantic memory. Thus, essential hypertension in the elderly is associated with an impairment in complex cognitive function.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- J Kuusisto
- Department of Medicine, Kuopio University Hospital, Finland
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Soininen H, Partanen J, Jousmäki V, Helkala EL, Vanhanen M, Majuri S, Kaski M, Hartikainen P, Riekkinen P. Age-related cognitive decline and electroencephalogram slowing in Down's syndrome as a model of Alzheimer's disease. Neuroscience 1993; 53:57-63. [PMID: 8469312 DOI: 10.1016/0306-4522(93)90284-m] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
We studied quantitative electroencephalogram and neuropsychological performance in an aging series of 31 patients with Down's syndrome and compared the findings with those of 36 patients with probable Alzheimer's disease and age-matched controls. We found an age-related decline of cortical functions and slowing of the electroencephalogram in Down's syndrome patients aged from 20 to 60 years. Slowing of the electroencephalogram, i.e. the decrease of the peak frequency, was significantly related to Mini-Mental status scores, and visual, praxic and speech functions, as well as memory in the Down patients, similar to the Alzheimer patients. Similar correlations were not demonstrated for young or elderly controls. This study provides neuropsychological and electrophysiological data to suggest that studying Down's syndrome patients of different ages can serve as a model for progression of Alzheimer's disease.
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Affiliation(s)
- H Soininen
- Department of Neurology, University of Kuopio, Finland
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