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Biomedical subjects

C G Gottfries

Publications and source records attributed to C G Gottfries.

At least 37 records · Page 2Linked to original sources
PubMed1998

Is there a difference between elderly and younger patients with regard to the symptomatology and aetiology of depression?

There are some differences between younger and older people regarding the symptomatology of depressive disorders. Elderly people report less depressed mood. There is a high rate of anxiety in elderly patients with major depressive disorders compared with younger depressive patients. The high coexistence of anxiety and depression in the elderly suggests that depression is part of a depression-anxiety syndrome. Depression in elderly people is often hidden behind somatic symptoms, either because of somatization of the disorder or because of accentuation of symptoms of concomitant illness. Cognitive impairment caused by depression is usually referred to as pseudo-dementia or depression with dementia, and it is important to differentiate this condition from predementia. These types of symptoms are more common in elderly than in younger patients. Psychotic symptoms are also seen to a greater extent in the elderly. Some of the differences seen between younger and older people regarding the symptomatology of depressive disorders may be due to pathoplastic effects of aging and to differences between birth cohorts. Moreover, the aetiology of depression is more heterogeneous in elderly people than in younger. Inheritance has a lower impact in elderly people. However, biochemical changes in the aging brain and changes in neurodegenerative disorders are of importance. In these disorders, disturbances of the monoamines are recorded which evidently reduce the threshold for depression in the elderly. Depression is seen concomitantly with some somatic disorders. In several of these disorders, the illness presents initially with depression. Psychosociogenic factors also have importance for depression in late life. Married adults are at lower risk for depression than unmarried ones, and 30% of spouses of demented patients develop depressive disorders.

Adult↗
PubMed1998

Simple steps to diagnosis at primary care centres.

The prevalence of depression in elderly people varies strongly with the diagnostic criteria and methodology used, but it is often reported 12-15%. During a period of 3 months 1189 patients at two primary care centres were asked to participate in a study there a Swedish version of the Geriatric Depression Scale, GDS-20, were used. One-thousand and two patients were rated, and further analysis showed that 12.9% suffered from affective disorders. Depression in elderly is underdiagnosed in primary care centres. A screening instrument such as the GDS-20 is of value in identifying patients with depression. The 10 doctors who participated in the study found the GDS-20 easy to handle and it is recommended to be used at every primary care centre.

Aged↗
PubMed1998

A population study on blood-brain barrier function in 85-year-olds: relation to Alzheimer's disease and vascular dementia.

We investigated blood-brain barrier (BBB) function in relation to Alzheimer's disease (AD) and vascular dementia (VAD) in the very elderly. Sixty-five 85-year-old persons from a population-based sample were followed for 3 years; 29 were demented at age 85 (13 with AD, 14 with VAD, and 2 with other dementias), 7 developed dementia during follow-up, and 29 remained nondemented. CSF/serum albumin ratio was used as as a measure of BBB function. Dementia was defined according to the DSM-III-R, AD according to the NINCDS-ADRDA criteria, and VAD according to the NINDS-Association Internationale pour la Recherche et l'Enseignement en Neurosciences (AIREN) criteria. Mean CSF/serum albumin ratio was higher in all dementias (8.5 +/- 4.3; p = 0.007) and in the subtypes AD (8.9 +/- 5.3; p = 0.046) and VAD (8.7 +/- 3.5; p = 0.002) than in nondemented individuals (versus 6.5 +/- 2.0), but it was not related to dementia severity. Nondemented women at age 85 (n = 3) who developed dementia during the follow-up had a higher CSF/serum albumin ratio than those not developing dementia (10.4 +/- 2.0 versus 6.0 +/- 1.9; p = 0.007). Nondemented individuals lacking the apolipoprotein E epsilon3 allele (n = 4) had a higher CSF/serum albumin ratio (9.3 +/- 0.8 versus 6.6 +/- 2.1; p = 0.029) than other individuals. A relative BBB dysfunction is associated with both AD and VAD among very elderly individuals. This finding is possibly found early in the disease before the onset of clinical dementia.

Aged↗
PubMed1997

Homozygous thermolabile methylenetetrahydrofolate reductase in schizophrenia-like psychosis.

The gene for methylenetetrahydrofolate reductase (MTHFR) has shown polymorphism in the general human population. In its homozygous form, a C677T mutation occurs in more than 5% of the grown-up population and produces a thermolabile variant which reduces the overall enzyme activity to less than 30% of normal. We investigated patients with schizophrenia-like psychosis. If hyperhomocysteinemic, their DNA-genotype for thermolabile C677T mutation was determined. Seven of 11 patients, six males and one female, were homozygous for thermolabile MTHFR. One male patient was heterozygous and all three normal homozygotes were females. In the patients who were homozygous for the C677T mutation, the homocysteine concentrations did not respond to vitamin B12 but were normalized by folate supplementation. In the normal homozygotes, however, the homocysteine concentrations were reduced by vitamin B12 alone. Our results suggest that homozygosity for thermolabile MTHFR is a risk factor for schizophrenia-like psychosis. Possibly, this risk may be reduced by folate supplementation.

Adolescent↗
PubMed1997

Recognition and management of depression in the elderly.

The Geriatric Depression Scale (GDS) is intended for easy measurement of symptoms of depression in elderly patients. The scale initially had 30 items but was reduced to a 15-item scale (GDS-15). This scale was translated into Swedish. However, five items were added: insomnia, anxiety, panic, aches and pain, and hypochondria. A total of 1002 elderly patients were rated by a research nurse using this scale. The results showed that 13.3% of the patients were considered to have affective disorders. The introduction of selective serotonin reuptake inhibitors has been of great importance for elderly patients, as these patients have difficulty in tolerating traditional tricyclic antidepressants. In a study of 133 elderly depressed patients, including those with somatic disorders and dementia, citalopram was tested. This drug provided significantly greater improvement than placebo. In another, inter-Nordic study, including 98 patients, citalopram was tested in patients with Alzheimer-type dementia. Depressed mood, and also other emotional disturbances, improved in these patients. Ratings have shown that in victims of Alzheimer-type dementia and vascular dementia, about 80% suffer from emotional disturbances. Drugs that influence both serotonin and noradrenaline metabolism have been introduced recently; these are of great interest in the treatment of elderly people.

Aged↗
PubMed1997

Confusional State Evaluation (CSE): an instrument for measuring severity of delirium in the elderly.

BACKGROUND: Delirium or confusional state is a common mental disorder in the elderly. To follow changes in symptoms over time and to evaluate the efficacy of treatment of delirium, a reliable and valid instrument for measuring degrees of delirium is essential. METHOD: An observer's rating scale with 22 items, the Confusional State Evaluation (CSE), was developed. Scores on 12 of the items were summarised to a "confusion score". Based on ratings of 71 demented and non-demented elderly patients with delirium, the interrater reliability and validity of the scale was studied. RESULTS: Agreement between two independent raters was fair to excellent (weighted kappa 0.38-0.93). The correlation between the "confusion score" of the scale and the global rating by a psychogeriatrician was good (r = 0.79). CONCLUSIONS: The CSE seems to be a reliable and valid measuring instrument which can be useful in following the course of confusion in elderly patients.

Aged↗
PubMed1997

Increased concentrations of homocysteine in the cerebrospinal fluid in patients with fibromyalgia and chronic fatigue syndrome.

Twelve outpatients, all women, who fulfilled the criteria for both fibromyalgia and chronic fatigue syndrome were rated on 15 items of the Comprehensive Psychopathological Rating Scale (CPRS-15). These items were chosen to constitute a proper neurasthenic subscale. Blood laboratory levels were generally normal. The most obvious finding was that, in all the patients, the homocysteine (HCY) levels were increased in the cerebrospinal fluid (CSF). There was a significant positive correlation between CSF-HCY levels and fatiguability, and the levels of CSF-B12 correlated significantly with the item of fatiguability and with CPRS-15. The correlations between vitamin B12 and clinical variables of the CPRS-scale in this study indicate that low CSF-B12 values are of clinical importance. Vitamin B12 deficiency causes a deficient remethylation of HCY and is therefore probably contributing to the increased homocysteine levels found in our patient group. We conclude that increased homocysteine levels in the central nervous system characterize patients fulfilling the criteria for both fibromyalgia and chronic fatigue syndrome.

Adult↗
PubMed1996

Cholecystokinin peptides and receptor binding in Alzheimer's disease.

Cholecystokinin (CCK) is a peptide that can be found in the cerebral cortex in high concentrations and is involved in learning and memory as well as neurodegenerative processes. Cortical brain samples from 9 patients with Alzheimer's disease and 9 matched control cases were studied with respect to the concentrations of various molecular forms of CCK and the CCK receptor binding characteristics. No differences were found between patients and controls in any of these measures. Significant correlations were found between the concentrations of CCK-8 sulphated and the three nonsulphated CCK peptides measured. In addition, the concentrations of CCK-4 and CCK-5 showed a highly significant and positive correlation.

Age of Onset↗
PubMed1996

Influence of vitamin B12 on brain methionine adenosyltransferase activity in senile dementia of the Alzheimer's type.

The influence of vitamin B12 on the activity of methionine adenosyltransferase (MAT) in postmortem brains of patients with senile dementia of the Alzheimer's type (SDAT) was investigated. In samples of cortex gyrus frontalis from SDAT patients with normal and low levels of serum B12, MAT Vmax was significantly increased by 25% and 19%, respectively. MAT Vmax from a SDAT group chronically treated with B12 was similar to controls. In contrast to cortex gyrus frontalis, no significant alterations were seen in MAT activity in nucleus caudatus. This study provides evidence that SDAT is associated with significant alterations in transmethylation mechanisms in specific regions of the brain. The relationship between blood levels of B12 and the actual status of this vitamin in the brain influencing the rates of synthesis of both methionine and SAM may, however, be far more complex and cannot be directly clarified on the basis of the present human brain results.

Age of Onset↗
PubMed1996

Membrane components separate early-onset Alzheimer's disease from senile dementia of the Alzheimer type.

Brain tissue from 12 subjects with pure Alzheimer's disease (AD) and 21 subjects with senile dementia of the Alzheimer type (SDAT) was investigated for membrane lipids and compared with that in age-matched controls. In brain tissue from the patients with AD, phospholipids were significantly decreased compared with that from SDAT patients and controls, cholesterol was reduced compared with that in controls, and gangliosides were significantly reduced in all gray-matter areas investigated compared with those in both SDAT subjects and controls. A reduction in gangliosides also occurred in the SDAT group, but it was smaller. In the white matter, the pattern of changes was the opposite. Phospholipids, cholesterol, cerebroside, and sulfatide were significantly reduced in the frontal-lobe white matter in the SDAT group compared with that in age-matched controls and AD patients. Gangliosides in the cerebrospinal fluid also separated AD from SDAT and controls. The findings indicate synapse degeneration as an important pathogenetic factor in AD. This disorder should be separated from SDAT, in which white-matter degeneration appears to be more prominent.

Aged↗
PubMed1996

Long-term treatment of elderly individuals with emotional disturbances: an open study with citalopram.

In the present open study, the long-term safety, tolerability, and efficacy of citalopram in the treatment of elderly people with emotional disturbances were studied. One hundred twenty-three elderly patients with symptoms of depression-anxiety were included. Most of the patients (76%) were demented. Fifty-two patients completed a 12-month treatment. Irritability, depressed mood, anxiety, restlessness, and fear-panic were significantly reduced. The severity of illness from baseline to Month 9 was rated as significantly improved. The side effects were infrequent and mostly mild.

Affective Symptoms↗
PubMed1996

Reductions in membrane proteins and lipids in basal ganglia of classic Alzheimer disease patients.

Gangliosides and major membrane components were determined in caudate nucleus, putamen, and hippocampus of 12 cases with Alzheimer disease (AD) type I, also termed presenile or pure AD, and in age-matched controls. The concentration of gangliosides, a marker for axodendritic arborization, was reduced to 71% in caudate nucleus, 82% in putamen, and 66% in hippocampus of that in the controls. Significant diminution of total dry solids, protein, and phospholipids was also found in caudate nucleus and was most pronounced in hippocampus. The early signs of extrapyramidal features have been emphasized in AD type I. We now provide evidence that the neostriatum is affected in AD type I (the putamen, however, to a lesser extent than the caudate nucleus). The biochemical changes in these nuclei can be significantly related to scores of impairment of motor performance.

Adult↗
PubMed1996

Scandinavian experience with citalopram in the elderly.

Depression is a common disorder among the elderly. Its prevalence is estimated at 12-15%. A multifactorial genesis must be considered. Depression in the elderly often manifests itself in an atypical way, with a somatized clinical picture. As tricyclics are generally too toxic for elderly people, the use of selective serotonin reuptake inhibitors (SSRIs) must be considered in this patient group. Citalopram is an SSRI drug with an attractive pharmacokinetic profile, i.e. few side effects and a low potential for interaction with other drugs. In two inter-Nordic studies, this drug significantly improved emotional disturbances in patients with dementia disorders. Significant improvement, with a response rate of 53%, was also seen in elderly people with depression as assessed using the Hamilton Depression Rating Scale. Sixty-six per cent of these patients also suffered from physical illness and had other drug treatment. The drug was well tolerated.

Age Factors↗
PubMed1996

Stepwise comparative status analysis (STEP): a tool for identification of regional brain syndromes in dementia.

A method for clinical examination of patients with dementia, stepwise comparative status analysis (STEP), is presented. It combines psychiatric and neurologic status examination methods to identify certain common dementia symptoms by which the patient's regional brain symptom profile can be determined. Fifty status variables (items) are estimated with respect to occurrence and severity. The analysis is performed in three steps. The scores on the 'primary' variables reflect observations of single dementia symptoms. These scores form the basis for the assessment of the 'compound' variables, which in turn form the basis for evaluation of the 'complex' variables, one of which describes the patient's regional (predominant) brain syndrome (subcortical, frontosubcortical, frontal, frontoparietal, parietal, or global). In 96 mildly and moderately demented inpatients, the global (42%) and frontosubcortical (31%) were the most common. Ninety-one percent of the patients with vascular dementia had a predominant frontal and/or subcortical symptomatology.

Aged↗