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Biomedical subjects

B Winblad

Publications and source records attributed to B Winblad.

At least 91 records · Page 5Linked to original sources
PubMed1997

Diagnosis of Alzheimer's disease. Report of an International Psychogeriatric Association Special Meeting Work Group under the cosponsorship of Alzheimer's Disease International, the European Federation of Neurological Societies, the World Health Organization, and the World Psychiatric Association.

Current knowledge with respect to the diagnosis of Alzheimer's disease (AD) is reviewed. There is agreement that AD is a characteristic clinicopathologic entity that is amenable to diagnosis. The diagnosis of AD should no longer be considered one of exclusion. Rather, the diagnostic process is one of recognition of the characteristic features of AD and of conditions that can have an impact on presentation or mimic aspects of the clinicopathologic picture. The present availability of improved prognosis, management, and treatment strategies makes the proper, and state-of-the-art, diagnosis of AD a clinical imperative in all medical settings. Concurrently, information regarding the relevance and applicability of current diagnostic procedures in diverse cultural settings must continue to accrue.

Aged↗
PubMed1997

Autoradiographic characterisation of [35S]GTP gamma S binding sites in rat brain.

The binding of [35S]GTP gamma S was characterised with autoradiography in rat brain. The binding was saturable, but the rate of dissociation was very slow. Analysis of binding isotherms revealed one class of binding sites with a Kd of 0.8 microM. The specific binding was 98%. Different guanine nucleotides were all able to compete with [35S]GTP gamma S binding. However, no displacement was seen by the ATP-analogue App[NH]p, indicating that [35S]GTP gamma S does not bind to ATP-sites. Autoradiograms showed a highly homogenous distribution of [35S]GTP gamma S binding, in grey as well as in white matter. However, the pattern changed dramatically in the presence of GTP, which, unlike the non-hydrolysable GTP-analogues Gpp[NH]p and GTP gamma S, did not displace [35S]GTP gamma S binding throughout the brain. In white matter areas the binding was potently displaced, while in many grey matter areas, e.g., the striatum, the binding was seen to increase. This GTP-induced increase in [35S]GTP gamma S binding was strongly Mg(2+)-dependent, with an optimum at 10 mM. This, together with the finding that the regional effects of GTP correspond well to previously reported distribution of low Km GTPase, suggest that the levels of binding of [35S]GTP gamma S in the presence of GTP may reflect functional G-protein activity.

Animals↗
PubMed1997

Major strain and coping strategies as reported by family members who care for aged demented relatives.

This study is based on a previous investigation into 46 caregivers' experience of burden and burnout when caring for a demented elderly relative. The aim of this study was to describe caregivers who develop or experience burnout (group A) and caregivers without experience of burnout (group B) and how they cope with major strain. The interviews focused on the caregivers' descriptions of their major strain (the demented person's memory difficulties and change in behaviour and the caregivers' experiences of their feelings of loss and their new role) and what they did, thought and felt in these situations. The interviews were coded and categorized and a chi-square test was performed. It was found that those in group A more often used an emotion-focused strategy (grieving, worrying and self-accusation). They were also the only ones using wishful thinking and stoicism as strategies. Those in group B used a problem-focused strategy more often (confronting the problem, seeking information and seeking social support). Another interesting finding was that the caregivers in group B frequently used the emotion-focused strategy of acceptance in combination with seeking information and seeking social support. To mix approaches like these seems to be an effective choice of strategy. It was also found that the caregivers' gender seems to have an effect on the coping strategy. The demented person's domicile did not, however, appear to result in any significant difference.

Adaptation, Psychological↗
PubMed1997

Caring for a demented elderly person--burden and burnout among caregiving relatives.

Fifty-two family caregivers for demented elderly people were investigated for burden and burnout experiences. A structured burden questionnaire and the Burnout Measure were used. Burnout is described in relation to the caregiver's gender, age, family relationship and the demented person's living place. Older wives and daughters were the most likely to report burnout in their lives. Some siblings and daughters-in-law also risked developing burnout. Regression analysis showed that limitation in social life, poor health and a lack of positive outlook on caring were the most important independent variables explaining variance in burnout among caregivers. There was no difference in burnout experiences between caregivers having their demented elderly person living at home and those having them in an institution.

Adult↗
PubMed1997

Cognitive changes in very old persons with dementia: the influence of demographic, psychometric, and biological variables.

Longitudinal changes in global cognitive functioning, indexed by the Mini-Mental State Examination (MMSE), in subjects with dementia (Alzheimer's disease and vascular dementia) were examined. The roles of several demographic, psychometric, and biological indices in predicting cognitive deterioration were also examined. The sample consisted of 36 very old (M age at entry = 83.0 years, range = 75-95) adults with dementia from a community-based study. Subjects were tested on two occasions separated by approximately 2.5 years. Results indicated significant longitudinal decline in MMSE scores over the retest interval; the average decline was estimated as 2.43 (SD = 1.81) points per year. Several factors were associated with cognitive deterioration. Higher initial MMSE scores were associated with greater deterioration, whereas superior forward digit span and Block Design at entry were associated with attenuated decline, once differences in baseline severity were accounted for. By contrast, a variety of other putatively important variables exhibited no relationship to decline, including age, gender, education, onset age, dementia type, backward digit span, as well as a number of biological parameters (e.g., vitamin B12, folic acid). The results suggest that although the magnitude of cognitive deterioration in dementia is highly variable, several indicators may be useful predictors of future changes in cognitive functioning.

Age of Onset↗
PubMed1997

Drug use by demented and non-demented elderly people.

AIM: to determine the use of drugs by demented and non-demented elderly people in a population, by dementia status and type, age, sex and accommodation type. METHOD: data were obtained from the Kungsholmen project, a longitudinal community study of people over 75 in Stockholm, Sweden. RESULTS: 85% used at least one medicinal drug, and of these 12% were demented. Mean numbers of drugs used were 2.8 for demented and 3.2 for non-demented people. 45% of demented people and 38% of non-demented people used psychotropic agents. Psychotropic use was higher in women and increased with institutionalization. Antipsychotic agents were used more by demented (22%) than by non-demented (3.5%) people: this was largely explained by differences in accommodation type. The odds ratio (OR) for use of antipsychotics by those in institutions compared with those living in their own homes was 9.32. Opioids were commonly prescribed for demented people. The proportions taking opioids in those using analgesics were 42% in demented and 23% in non-demented people (OR 2.07). Laxatives were used by 18% of the demented people in institutions compared with 39% of non-demented people in institutions. CONCLUSION: being in an institution had a stronger association with the use of certain drugs (e.g. psychotropics) than did dementia status. Demented people, especially those in institutions, used a large number of antipsychotics and opioids, but fewer laxatives and minor analgesics. Prescribers and institutional staff should be aware of these factors so they can optimize patient treatment.

Aged↗
PubMed1997

Heritability for Alzheimer's disease: the study of dementia in Swedish twins.

BACKGROUND: Alzheimer's disease has been thought to have familial and sporadic forms, and several genetic defects have been identified that chiefly explain early-onset familial cases. In this study, our purpose was to detect all cases of dementia in an established twin registry and to estimate total extent of genetic contribution to liability to Alzheimer's disease. METHODS: At the first stage, members of the registry were screened for dementia, using in-person or telephone mental status testing. At the second stage, those who screened positively and their partners were referred for clinical work-ups, including neuropsychological assessment, physician examination, laboratory tests, and neuroimaging. Clinical diagnoses were assigned at a multidisciplinary consensus conference. Probandwise concordance rates were examined by zygosity, and structural modeling was applied to the data to estimate genetic and environmental influences, using both single- and multiple-threshold models. RESULTS: Sixty-five pairs were identified in which one or both was demented. The probandwise concordance rate for Alzheimer's disease among monozygotic pairs was 67%; the corresponding figure for dizygotic pairs was 22%. Heritability of liability to Alzheimer's disease was estimated to be .74; to any dementia, .43. The other variance is attributable to environmental influences. CONCLUSIONS: Findings indicate a substantial genetic effect for these predominantly late-onset Alzheimer's disease cases. At the same time, structural modeling results and large intra-pair differences in age of onset suggest that environmental factors are also important in determining whether and when an individual may develop dementia.

Age of Onset↗
PubMed1997

Dementia and driving: an attempt at consensus.

The number of older drivers in Sweden will be rapidly increasing during the next decades. A possible relationship exists between the increased relative crash risk of older drivers and the prevalence of age-related diseases such as dementia. However, a clear-cut policy for evaluating driving competence in demented persons is still lacking. In recognition of this fact, the Swedish National Road Administration invited a group of researchers to formulate a consensus on the issue of driving and dementia. This consensus document is aimed at providing primary care physicians with practical advice concerning the assessment of cognitive status in relation to driving. Suggestions are based on a review of existing research and discuss the use of general and driving-specific sources of information available to the physician. Consensus was reached on the statement that a diagnosis of moderate to severe dementia precludes driving and that certain individuals with mild dementia should be considered for a specialized assessment of their driving competence.

Aged↗
PubMed1997

Changes in motor performance in persons with Parkinson's disease after exercise in a mountain area.

For one week in autumn, over a period of three consecutive years, a total of 12 persons with Parkinson's disease (PD) participated in daily walks of about 4 kilometers in a mountain area in Sweden in order to train rhythm, balance and coordination on the soft heaths. These persons were 60-78 years of age and had been found to be between stage 1 and stage 3 on the Hoehn and Yahr Staging Scale. The aim of the study was to find out whether a week of daily walks in the Swedish mountains would affect the motor performance of persons with PD, objectively and quantitatively assessed by a computer-assisted, opto-electronic movement analysis program, the Posturo-Locomotor-Manual (PLM) test. As compared with those before the journey, the results showed improved motor performance both immediately after the walking week and also at 3 but not 6 months later. The first year of participation showed the most pronounced improvements. The results demonstrate a long-lasting improvement in decreased movement time, indicating enhanced general motor performance and also an improved simultaneous index (SI), indicating a possible effect on the central nervous system. These findings, along with participants' narratives about what they did after returning home, may be indicative of strengthened self-confidence.

Aged↗
PubMed1997

Clinical correlates of low blood pressure in very old people: the importance of cognitive impairment.

OBJECTIVE: To identify the medical conditions associated with low blood pressure in very old people. DESIGN: A population-based, cross-sectional study. SETTING: Two neighboring communities in Stockholm, Sweden. SUBJECTS: Participants were 319 male and 1070 female participants, with the mean age of 85.0 years (SD = 5.8). MEASUREMENTS: Blood pressure recording, pulse rate counting, and Mini-Mental State Examination (MMSE) were conducted by trained nurses. Information on illness condition and activities of daily living (ADL) status was self-reported or gathered from proxy respondents. The computerized inpatient register system was also used for collecting the data of illness condition. Systolic pressure less than 130 mm Hg and diastolic pressure less than 70 mm Hg were defined as low systolic and diastolic pressure, respectively. MMSE score less than 24 was considered to indicate cognitive impairment. MAIN RESULTS: In multiple logistic regression analyses, low systolic pressure was related to slower pulse rate (< or = 60 per minute), heart failure, ADL limitation, and cognitive impairment, and low diastolic pressure was related to increasing age, slower pulse rate, cardiac dysrhythmia, ADL limitation, and cognitive impairment. People with diabetes mellitus were less likely to be in the low systolic pressure group. 34.9% of the prevalence of low systolic pressure, and 17.9% of the prevalence of low diastolic pressure was associated with cognitive impairment. CONCLUSIONS: Low blood pressure in the very old may be associated with poor functional status, cardiac insufficiency and, more importantly, cognitive impairment. It would be expected that low blood pressure is associated with increased mortality in this age group.

Activities of Daily Living↗
PubMed1997

Suicidal thoughts and associated factors in an elderly population.

This study examined the prevalence of suicidal thoughts and associated factors in an elderly population. Data for 969 elderly subjects from a population-based study were used, and examinations by physicians, including psychiatric examination and informants' interview, were assessed. In total, 13.3% of the subjects had had suicidal thoughts during the last 2 weeks (10.8% fleetingly and 2.5% frequently). Of those who had had fleeting suicidal thoughts, 26.7% also had major depression, while 50% of those who had frequent suicidal thoughts were depressed. In addition, suicidal thoughts were associated with increased disability in daily living, institutionalization, visual problems and the use of psychotropic drugs. It is concluded that a careful psychiatric assessment is necessary when suicidal thoughts are expressed by an elderly person.

Activities of Daily Living↗
PubMed1997

Apolipoprotein E epsilon4 allele decreases functional connectivity in Alzheimer's disease as measured by EEG coherence.

OBJECTIVES: The epsilon4 allele of apolipoprotein E (APOE) represents a major biological risk factor for late onset Alzheimer's disease. However, it is still not known whether the APOE genotype affects the progression of the disease, assessed by different functional methods. METHODS: The study sample included 41 patients with probable Alzheimer's disease. Subjects had similar severity of disease, age of onset, and duration of illness, and were subcategorised according to their APOE genotypes: 17 with no epsilon4 allele, 14 with one epsilon4 allele, and 10 with two epsilon4 alleles. The control group consisted of 18 healthy subjects comparable with the patients in age and education. Analysed quantitative EEG (qEEG) variables were the ratio of alpha and theta absolute power and EEG coherence in alpha frequency band, representing major cortical association pathways. RESULTS: There was pronounced EEG slowing in all three patient subgroups compared with the controls for the alpha/theta ratio, but there was no significant difference across the patient subgroups. Patients homozygous for the APOE epsilon4 allele had reduced right and left temporoparietal, right temporofrontal, and left occipitoparietal coherence. Patients without and with one epsilon4 allele showed an overlap between the control group and group with two epsilon4 alleles in coherence measures. CONCLUSIONS: APOE epsilon4 does not influence EEG slowing, an index which reflects severity of the disease in patients with Alzheimer's disease, but seems to be associated with selective decreases in functional connectivity as assessed by EEG coherence. This finding might be of clinical importance when considering different pathogenetic mechanisms.

Age of Onset↗
PubMed1997

Altered neurotransmission and signal transduction: targets for nicergoline treatment.

Although we do not yet have a complete understanding of the molecular mechanisms responsible for the pathophysiology of Alzheimer's disease, it is clear that a drug such as nicergoline, which may have both acute and longer-term effects on the disease, could offer a beneficial and worthwhile approach to treatment.

Adrenergic alpha-Antagonists↗
PubMed1997

Growth hormone stimulates production of interferon-gamma by human peripheral mononuclear cells.

There is substantial evidence for interactions between the immune and endocrine systems at different levels. In the present study we investigated whether human growth hormone (hGH) could stimulate proliferation of interferon-gamma-secreting cells (IFN-gamma-SC), and production of IFN-gamma. Human peripheral blood mononuclear cells (PBMC) taken from 15 normal subjects were incubated with varying doses (200,400,600 and 800 ng/ml) of recombinant hGH. Samples of cells were also incubated with PBS buffer (without hGH) to serve as controls. Effects of hGH were studied by enumerating IFN-gamma-SC and by measuring the concentration of IFN-gamma using an Immunospot assay and an enzyme-linked immunosorbent assay, respectively. The results showed that hGH significantly increased both the number of IFN-gamma-SC and the concentration of IFN-gamma in a dose-dependent manner. The maximum effects were obtained in the presence of (400 ng/ml) hGH (15 +/- .5 IFN-gamma-SC/10(6) PBMC and 300 +/- 55 U/ml IFN-gamma) compared to controls (4 +/- 2 IFN-gamma-SC/10(6) PBMC and 50 +/- 10 U/ml IFN-gamma). The results of the present study suggest that hGH might influence the immune system by stimulating the proliferation of IFN-gamma-SC and the production of IFN-gamma.

Human Growth Hormone↗
PubMed1997

Daughters and sons as caregivers for their demented and non-demented elderly parents. A part of a population-based study carried out in Sweden.

The study focuses on adult children (n = 81) having the main responsibility for parents with dementia (study group). They were compared with children (n = 102) of non-demented parents (reference group). The children were interviewed about burden experienced. The interviews also secured information about the children's co-operation with the informal and formal network and their willingness to remain as caregivers during the progression of the disease or ageing process. The results showed that the daughters reported feeling more affection in their caregiving role than the sons. About one third of the participants in the study could not get relief from someone else. Eighty-nine per cent of the children in the study group and 76% of the children in the reference group were not willing to care for their parents in the family home during the progression of the disease, even if they were employed as caregivers.

Adult↗
PubMed1997

Very old women at highest risk of dementia and Alzheimer's disease: incidence data from the Kungsholmen Project, Stockholm.

OBJECTIVE: To determine the incidence of different types of dementia in the very old, and to explore the relation with age and gender. DESIGN: A dementia-free cohort was followed for an average of three years in Stockholm, Sweden. At the end of the follow-up, the subjects were interviewed by nurses, clinically examined by physicians, and cognitively assessed by psychologists. Deceased cohort members were studied using death certificates, hospital clinical records, and discharge diagnoses. Dementia diagnoses were made according to the DSM-III-R criteria independently by two physicians. PARTICIPANTS: The cohort consisted of 1,473 subjects (75+ years old), of which 987 were clinically examined at follow-up, 314 died before the examination, and 172 refused to participate. RESULTS: During the follow-up, 148 subjects developed dementia. In the age-group 75 to 79, the incidence rates for dementia were 19.6 for women and 12.4 for men per 1,000 person-years, whereas for 90+ year-old subjects the corresponding figures were 86.7 and 15.0 per 1,000 person-years. A similar pattern of distribution by age and gender was seen for Alzheimer's disease. In each age stratum, the incidence rates of dementia and Alzheimer's disease were higher for women than for men. The age-adjusted odds ratio for women was 1.9 for dementia and 3.1 for Alzheimer's disease. CONCLUSIONS: (1) The incidence of dementia increases with age, even in the oldest age groups; (2) women have a higher risk of developing dementia than men, especially at very old ages; (3) this pattern is mainly due to the age and gender distribution of Alzheimer's disease, rather than vascular dementia.

Age Factors↗
PubMed1997

Low blood pressure and five-year mortality in a Stockholm cohort of the very old: possible confounding by cognitive impairment and other factors.

OBJECTIVES: Low blood pressure has often been reported to be related to excess mortality in people over the age of 75 years. This study examined whether other predictors may account for the association. METHODS: A community-based cohort of 1810 people who were aged 75 years and older was followed for 5 years. RESULTS: The relative risk of death was 1.39 (95% confidence interval [CI] = 1.11, 1.73) for people with systolic pressure lower than 130 mm Hg and 1.21 (95% CI = 1.02, 1.43) for those with diastolic pressure lower than 75 mm Hg, compared with corresponding reference groups, when all other variables were simultaneously considered in Cox proportional hazards models. The observed association was present mainly in subjects with at least two of the three conditions (cardiovascular disease, limitation in activities of daily living, or cognitive impairment). The effect of low diastolic pressure on mortality was also significant in those with only cognitive impairment. CONCLUSIONS: Preexisting cardiovascular disease, limitation in activities of daily living, and, more important, cognitive impairment may be responsible for the association of low blood pressure with increased mortality in the very old in that they cause both reductions in blood pressure and excess deaths.

Activities of Daily Living↗