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Biomedical subjects

G R Swanwick

Publications and source records attributed to G R Swanwick.

At least 19 recordsLinked to original sources
PubMed1999

Initiating and monitoring cholinesterase inhibitor treatment for Alzheimer's disease.

The availability of acetylcholinesterase inhibitors for the treatment of Alzheimer's disease raises a number of clinical and ethical questions. Many of the guidelines published in an attempt to tackle these questions lack either clinical or scientific validity. Against this background a model is proposed whereby specialist monitoring using formal tests is neither appropriate nor necessary to determine whether an individual patient should continue or stop treatment. Instead the primary care physician should refer potentially suitable patients for specialist assessment to confirm the diagnosis/He/she should then initiate, monitor, and discontinue treatment based on the establishment of realistic treatment goals agreed with the patient/carer at the outset.

Activities of Daily Living↗
PubMed1999

The association between demographic factors, disease severity and the duration of symptoms at clinical presentation in elderly people with dementia.

OBJECTIVE: To determine the association between factors unrelated to the disease process, the duration of symptoms and the degree of cognitive or functional impairment in elderly patients presenting with dementia. METHOD: The living situation, educational level, age, gender and diagnosis based on standardized criteria were recorded for 209 elderly patients presenting to a memory clinic with dementia. Cognitive and functional deficits were measured with the cognitive section of the Cambridge Mental Disorders of the Elderly Examination combined with the Mini-Mental State Examination and the abbreviated version of the Blessed dementia scale, respectively. RESULTS: 129 patients had a diagnosis of probable Alzheimer's disease, 19 had probable ischaemic vascular dementia and 61 had mixed dementia. There was no effect of diagnosis on duration of symptoms or dementia severity at the time of presentation. Patients living with a son or daughter were more functionally impaired than those living alone or with a spouse. Males had higher cognitive scores but did not have milder functional deficits. Patients with only a primary-school education had a trend towards lower cognitive scores at presentation but did not have more functional deficits. CONCLUSIONS: The gender of the patient and the relationship to the carer are associated with cognitive and functional scores at the time of presentation in patients with dementia.

Age Factors↗
PubMed1999

Prognostic value of electrophysiological markers in Alzheimer's disease.

The authors assessed the usefulness of event-related potentials (ERP) and flash visual evoked potentials (FVEP) as prognostic markers in a sample of 25 subjects with probable Alzheimer's disease (AD). ERP and FVEP recordings were obtained from 21 and 23 subjects, respectively. Ranking of the annual rate of change in cognitive scales vs. baseline ERP/FVEP latencies was compared, and those with longer FVEP N(2) component latencies showed slower subsequent rates of decline (tau=0.32; z=2.16; P=0.015), suggesting that further study of FVEP responses as prognostic markers in AD is warranted.

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PubMed1998

Assessment of progression and prognosis in 'possible' and 'probable' Alzheimer's disease.

OBJECTIVE: The objective of this study was to assess the rate of progression and clinical predictors of decline in subjects with possible and probable Alzheimer's disease (AD). DESIGN/SETTING: The annual rate of change (ARC) for cognitive/functional scales was calculated for 95 subjects with AD attending a memory clinic. Two consecutive ARCs were calculated for a subgroup of 39 subjects. RESULTS: The ARCs were relatively normally distributed; however, there was a large degree of variability. Neither age nor duration of symptoms at presentations were predictive of the rate of decline. However, the data suggested an effect of gender, with males having a greater rate of decline in cognition (p = 0.02). Finally, the rate of progression over the first year did not predict the subsequent ARC (p = 0.25). CONCLUSIONS: The high variability in ARCs observed in this study and poor correlation between consecutive ARCs suggest that neither mean ARC values nor the previous rate of decline can be used to aid clinicians in the assessment of response to acetylcholinesterase inhibitors or other specific treatments for AD.

Age Factors↗
PubMed1998

Hypothalamic-pituitary-adrenal axis dysfunction in Alzheimer's disease: lack of association between longitudinal and cross-sectional findings.

OBJECTIVE: The authors examined longitudinal hypothalamic-pituitary-adrenal (HPA) axis function in Alzheimer's disease. METHOD: Cortisol levels of 30 patients with Alzheimer's disease and 17 healthy elderly subjects were measured before and after administration of dexamethasone. These measures were repeated at 9-month intervals in the patients with Alzheimer's disease. RESULTS: At baseline, cortisol levels were higher in the Alzheimer's disease group before and after dexamethasone administration. Although only two of the four patients whose cortisol levels were not suppressed by dexamethasone also had high cortisol levels before dexamethasone administration, basal and postdexamethasone cortisol levels were correlated. HPA axis dysfunction correlated with severity of dementia at baseline but was not stable longitudinally and did not increase with follow-up. CONCLUSIONS: There was no association between longitudinal and cross-sectional findings. The longitudinal data were not consistent with a role for the glucocorticoid cascade hypothesis (that hippocampal cell loss in Alzheimer's disease results in hypercortisolism, which in turn acts as a co-factor in further degeneration) in the pathophysiology of mild and moderate Alzheimer's disease.

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PubMed1997

Behaviour disturbance and other predictors of carer burden in Alzheimer's disease.

OBJECTIVE: To investigate predictors of carer burden in Alzheimer's disease (AD). DESIGN: Two cohorts were formed, one comprising AD patients, the other comprising their primary carers. The relationship of patient and carer variables to carer burden was investigated. SETTING: An urban hospital memory clinic. PARTICIPANTS: A convenience sample of 50 patients meeting NINCDS-ADRDA for probable AD, age range 60-87, and their primary carers, age range 31-84. MEASURES: The Cambridge Cognitive Examination (CAMCOG), the Mini-Mental State Examination (MMSE), the Baumgarten et al. Dementia Behaviour Disturbance Scale, the Blessed-Roth Dementia Scale, the Personal Self-Maintenance Scale, the Zarit Burden Interview and the Vaux et al. Social Support Appraisals (SS-A) and Social Support Behaviours (SS-B) Scales. RESULTS: Daughters were particularly prone to burden. Neither patient cognitive nor functional status predicted burden. Behaviour disturbance in particular, and informal support were significant, but independent, predictors of carer burden. CONCLUSIONS: In this study increased carer burden was related independently to increased levels of patient behaviour disturbance and decreased levels of informal social support. This may have relevance to appropriate interventions for carers. As the study was based on a convenience sample of memory clinic attenders, replication in less highly selected samples is desirable.

Adaptation, Psychological↗
PubMed1996

Utility of ischemic scores in the differential diagnosis of Alzheimer's disease and ischemic vascular dementia.

Despite new developments in the concept of vascular dementia, the Hachinski Ischemic Score (HIS) and its modified versions continue to be widely used in the clinical differentiation of Alzheimer's disease (AD) and ischemic vascular dementia (IVD). The sensitivity of the HIS and two modified versions in the diagnosis of AD, IVD, and single infarcts in a large, geriatric population with mild cognitive impairment (N = 100) was evaluated. Sensitivity for identification of AD was greater than 90% but was less than 70% for IVD. Over one third of patients with one or more infarcts on computed tomographic brain scans and 63% of mixed cases were classified as having probable AD. It is concluded that ischemic scores may be useful at predicting prevalence rates if individual case accuracy is ignored. Despite being sensitive to identifying AD, ischemic scores are insensitive to both cerebral infarction and IVD and cannot reliably exclude IVD. Finally, patients with mixed dementia should not be expected to have intermediate scores.

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PubMed1996

Use of the clock drawing task in the diagnosis of mild and very mild Alzheimer's disease.

The purpose of this study was to examine the utility of the clock drawing task (CDT) in differentiating between patients with mild and very mild Alzheimer's disease (AD) and normal controls. Thirty normal elderly individuals and 30 patients with probable AD were entered into the study and asked, in a standard fashion, to draw a clock from memory. All the clocks were scored according to two previously described standardized scoring systems, and the accuracy of classification into normal or AD groups was determined. Both CDT scales could discriminate between moderate AD and normal aging but lacked sensitivity in the very mild AD cases; mild cases showed intermediate sensitivity. In conclusion, the CDT as a test for AD is insensitive in the early-stage cases, but sensitivity improves with increasing severity of dementia. The CDT is unlikely to be useful in distinguishing between AD in its early stages and normal aging.

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PubMed1996

Clinical application of electrophysiological markers in the differential diagnosis of depression and very mild Alzheimer's disease.

BACKGROUND: Current evidence indicates that, on their own, neither flash visual evoked responses (FVEPs) nor event related potentials (ERPs) are sufficiently useful to the clinician in the very early stages of memory dysfunction. However, the possibilities for the combined use of these measures has not been fully explored. METHODS: This study examined the clinical utility of combined FVEP and ERP-P300 component latencies as predictive markers in 16 patients with Alzheimer's disease, 15 patients with depression, and 21 control subjects. RESULTS: There were significant group differences in FVEP P2 latency (P = 0.004) between the controls and both the depressive patients and those with very mild Alzheimer's disease. There were no statistically significant group differences for the ERP component (N2/P300) amplitudes or latencies. The P300 component latency was positively correlated with both the FVEP N2 and FVEP P2 component latencies in the patients with Alzheimer's disease but not in the control subjects or the depressed patients. A discriminant function, using two ERP and two FVEP component measures, gave an overall correct classification rate for dementia of 78%. In this study of very mildly impaired patients the FVEP latencies provided a more sensitive marker for the presence of cognitive dysfunction than P300 latency delay. CONCLUSIONS: The findings support the use of multimodal evoked potentials in the differential diagnosis of very mild Alzheimer's disease and normal aging.

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PubMedDate not supplied

Distinguishing between patients with depression or very mild Alzheimer's disease using the Delayed-Word-Recall test.

The present study investigated the accuracy of an extended version of the Delayed Word Recall (DWR) test in distinguishing patients with very mild Alzheimer's disease (AD) (Mini Mental State Examination score > or = 23) from community-dwelling depressed/dysthymic patients. The DWR test was administered to 26 non-depressed patients who, at the time of DWR administration or on follow-up, fulfilled NINCDS/ADRDA criteria for probable AD, and to 20 age-matched non-dementing patients with a diagnosis of major depression (n = 12) or dysthymia (n = 8) according to DSM-III-R criteria. Sensitivity and specificity were, respectively, 96 and 100% for DWR free recall, and 92 and 100% for DWR recognition. In this study both DWR free recall and recognition measures were highly sensitive and specific in distinguishing very-mild-AD patients from depressed/dysthymic patients. The investigation of more severely depressed patients is warranted.

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