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Biomedical subjects

A von Gunten

Publications and source records attributed to A von Gunten.

9 recordsLinked to original sources
PubMed2006

The "Protocole d'Examen Cognitif de la Personne Agée - Lausanne" (PECPA-L): a cognitive assessment tool for the French-speaking elderly in Switzerland.

OBJECTIVE: The main objective of this study was to validate and normalize, in the French-speaking population of Switzerland, an empirically derived structured cognitive assessment scale for the elderly. METHOD: 237 healthy elderly and 115 elderly with mild-to-moderate dementia as well as a preliminary sample of 27 subjects with MCI, all community-dwelling, were assessed using the PECPA-L for its validation and normalization using Crohnbach's alpha, rank comparisons, and AUROC measures. RESULTS: The internal consistency of the PECPA-L was good (Crohnbach's Alpha=0.79). The discriminating power of the PECPA-L between the normal elderly and the mildly to moderately demented (AUROC=0.940) and those with MCI (AUROC=0.925) was high. Normal aging does not influence all cognitive domains equally; therefore, the subscores of the PECPA-L vary in their discriminating power between the normal and the demented elderly, with gnosis abilities having the least (AUROC=0.719) and delayed memory performance having the highest (AUROC=0.927) discriminating power. Normative data according to age and education are provided. CONCLUSIONS: The PECPA-L is a highly appropriate tool for the detection and documentation of early cognitive impairment in the French-speaking population in Switzerland while accounting for age and education.

Aged↗
PubMed2005

[Is there a treatment for Alzheimer's disease?].

Alzheimer's disease is a frequent neurodegenerative disease, which affects more than one third of elderly persons over 80 years. No curative treatment is currently available for this disease, but symptomatic treatments have produced significant improvements in patients' condition. Cholinesterase inhibitors should be prescribed for early and moderate stages and memantine for more severe stages of the disease. These drugs have an impact on cognitive performances, may delay functional decline and improve behaviour disturbances. From a preventive perspective, evidence of benefit from early management of vascular risk factors is accumulating. In the near future, the improved comprehension of the underlying mechanisms of Alzheimer's disease will hopefully bring new treatments, thats will delay or modify its course.

Alzheimer Disease↗
PubMed2003

Psychopathological profile in patients with severe bilateral hippocampal atrophy and temporal lobe epilepsy: evidence in support of the Geschwind syndrome?

Bilateral symmetrical hippocampal atrophy (BHA) has been implicated as a possible causal element in various neuropsychiatric disorders, in particular depressive disorder and schizophrenia. To test the hypothesis that bilateral symmetrical severe volume loss of the hippocampi is of causal relevance to these psychiatric syndromes rather than an epiphenomenon we assessed the psychopathology in a group of patients with temporal lobe epilepsy (TLE) and very severe bilateral symmetrical hippocampal atrophy and compared it with that of a patient control group. Patients with TLE and hippocampal volumes smaller than three standard deviations below the mean of a control population were identified and compared with a matched patient population with normal hippocampal volumes. Psychopathology was assessed by blinded trained psychiatrists using the Present State Examination and Neurobehavioral Inventory. The prevalence of psychiatric syndromes was high in both patient groups; however, there was no significant difference between the two groups. With use of the more specific Neurobehavioral Inventory a psychopathological pattern reminiscent of the Geschwind syndrome emerged when patients with BHA were characterized by caregivers. While BHA does not result in an increased prevalence of specific psychiatric syndromes, specific symptoms that characterize the Geschwind syndrome like hypergraphia and hyposexuality might be pathogenically related to hippocampal atrophy.

Adult↗
PubMed2001

[Psychiatric disorders in elderly patients with Parkinson's disease and their treatments].

Parkinson's disease (PD) is a neuropsychiatric disorder. During the course of PD, most patients develop at least one psychiatric syndrome. Depression is the most frequent disorder and affects nearly half of all patients. The use of an increasing number of new drugs, in particular the dopaminergic agents, puts these patients at risk of developing both delirium and psychosis. This article summarizes the different psychiatric syndromes seen in PD and gives an account of the various treatment possibilities.

Age Factors↗
PubMed2000

A volumetric study of hippocampus and amygdala in depressed patients with subjective memory problems.

MRI was used to measure amygdalar and hippocampal volumes in 14 nondemented depressed patients who persistently complained of "memory" difficulties and in 14 control subjects. Mild neuropsychological impairment had been detected in 5 patients before the study but had later improved. The volume of the left amygdala was smaller in depressed subjects, and there was a trend for smaller left hippocampus in the 5 patients who had exhibited mild cognitive impairment. The authors conclude that subjective memory complaints in depressed patients do not translate into a clinical picture of dementia, but that abnormalities in the amygdala and hippocampus may be relevant in explaining affective and cognitive symptoms.

Adult↗
PubMed1998

[Qualitative evaluation of medical compliance].

OBJECTIVE: The effectiveness of CLP (Consultation and liaison psychiatry) interventions in a general hospital is difficult to evaluate; parameters potentially determinant as to effectiveness are numerous. Effectiveness evaluations are almost exclusively restricted to the duration of hospitalization. Since CLP may and often should be manifest beyond discharge, we intended to determine the agreement between our proposition and its execution as a measure of effectiveness. METHOD: We based our analyses principally on the general practitioner's appreciation of the CLP impact, a measure of effectiveness at distance from the consultation by a judge not directly involved in the consulting process. This qualitative assessment is based on a population of 50 patients. RESULTS: Our results suggest that agreement between our proposal and its complete execution is good concerning medication (90%) and referral rate after the hospitalization (85%), average as to liaison suggestions (65%) and clearly weak as to propositions regarding further investigations (< 30%). CONCLUSION: CLP proposals must be as close as possible to the in-patient physician's preoccupations to enhance the probability that they be executed. The concordance as to the proposal and its execution as well as the CLP impact estimation need be evaluated at distance. This evaluation must imply the general practitioner's assessment.

Adult↗
PubMed1998

[Letting the treating physicians speak].

OBJECTIVE: Quality assessment in consultation and liaison psychiatry (CLP) is extremely difficult and must take into account numerous factors. The general practitioner (GP) of the patients seen by CL psychiatrists seems an essential factor to be considered in evaluating CL work. However, as far as we know, no study is doing so. Therefore, we have implied the GP to assess our CL work at the hospital St-Loup-Orbe. METHOD: We put up a qualitative study consisting of semi-structured interviews with 18 GPs caring for 45 patients having been submitted to a psychiatric CL intervention. Furthermore, we invited the GPs to assesses CLP as a specialization as well as CLP practiced at St-Loup-Orbe hospital. RESULTS: Impact is judged by the GPs with regard to the total number as: highly favorable> favorable> indifferent> negative. The GPs' critiques, whether positive or negative, are highly informative. CONCLUSIONS: GPs accept favorably CLP interventions and consider them on the whole as constructive. On the other hand, they are not sufficiently considered as partners during their patients' hospital stay. Furthermore, CLP must evaluate its impact at distance from the consultation and take into account the GPs' assessments to improve CL quality.

Attitude of Health Personnel↗
PubMed1997

Classes of axons and their distribution in the optic nerve of the tree shrew (Tupaia belangeri).

BACKGROUND: It has been suggested that retinal ganglion cells (RGCs) of Tupaia can be subdivided into three classes that correspond to the X, Y, and W classes in the cat. Estimates of these classes as determined by electrophysiological experiments and by histological studies of the retina are at variance. Because the RGC classes differ in axon diameter, this parameter could serve as a reliable criterion for the evaluation of RGC classes and their proportions. METHODS: An electronmicroscopic analysis of four optic nerves was carried out. The density of axons and their diameters was recorded from cross sections in the middle of the nerves. Based on a theoretical model, axons were classified according to the three known RGC classes. In addition, we investigated how axons of different size are distributed within the nerve. RESULTS: On average, the total number of axons is 570,000. More than 99% of axons are myelinated. Axon diameters can be 0.2-3.6 microns, and fiber diameters can be 0.3-4.6 microns. The frequency distributions of axon and fiber diameter are positively skewed and multimodal. Our analysis revealed three distinct axon diameter groups with the following mean axon diameters and proportions: the small or S group: 0.55 micron, 70%; the medium-sized or M group: 0.88 micron, 20%; the large of L group: 1.39 microns, 10%. Density and axon diameter plots produced consistent patterns, according to which axons of different sizes were distributed in the optic nerve. Thick axons are located dorsotemporally and centrally in the nerve. The average diameter value decreases toward the periphery. The smallest values are found at the ventronasal border of the nerve. CONCLUSIONS: The observed axon diameter groups probably arise from functionally distinct RGC types. There is evidence that these groups correspond to functional W, X, and Y RGC classes. Our study also provides the first evidence of the existence of a topographic order of fibers within the nerve of the tree shrew.

Animals↗