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Biomedical subjects

I Karlsson

Publications and source records attributed to I Karlsson.

At least 19 recordsLinked to original sources
PubMed1998

Absence of basal ganglia amino acid neuron deficits in schizophrenia in three collections of brains.

Amino acid (glutamatergic, GABAergic) neuron deficiency theories of schizophrenia offer plausible explanations of pathogenesis. However, reports of disease-related reductions in amino acid synthesizing enzymes in post-mortem brains are contradictory. We measured neuronal uptake sites for gamma-aminobutyric acid (GABA; [3H]nipecotic acid binding) and nerve terminal/glial uptake sites for L-glutamate (D-[3H aspartate binding) in three independent groups of post-mortem brains from patients with schizophrenia and control subjects. Measurements were also made of the phencyclidine site of the glutamate N-methyl-D-aspartate (NMDA) receptor. Samples from patients showed no reductions in the binding of [3H]nipecotic acid or D-[3H]aspartate in caudate, putamen or globus pallidus. On the contrary, some increased binding of both ligands was observed in patients in many comparisons with controls. There were no clear-cut changes in NMDA receptor binding. The most consistent change in the brain sets was increased [3H]nipecotic acid binding in caudate-putamen. This could be due to neuroleptic treatment. The findings produce no evidence that schizophrenia involves major loss of GABA neuron terminals in the basal ganglia or losses of corticostriatal glutamatergic projections.

ATP-Binding Cassette Transporters↗
PubMed1998

Propentofylline in the treatment of Alzheimer's disease and vascular dementia: a review of phase III trials.

Propentofylline, a neuroprotective glial cell modulator, has been shown in preclinical studies to address some of the common pathological processes of Alzheimer's disease (AD) and vascular dementia (VaD), including glial cell activation and increased production of cytokines, free radicals, and glutamate. To examine whether propentofylline (300 mg t.i.d. taken 1 h before meals) would provide beneficial effects in patients with AD and/or VaD, 901 patients with mild-to-moderate AD and 359 patients with mild-to-moderate VaD were enrolled in four double-blind, placebo-controlled, randomized studies ranging in duration from 6 months to 56 weeks. Propentofylline was found to provide consistent improvements over placebo in efficacy assessments for both AD and VaD patients. In addition, results from a drug withdrawal study suggested that propentofylline does not merely relieve dementia symptoms but slows the progression of the disease itself. Propentofylline had a good safety profile and was generally well tolerated.

Alzheimer Disease↗
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

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↗
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

Influence of dinner music on food intake and symptoms common in dementia.

The influence of dinner music on food intake and symptoms common in dementia such as depressed mood, irritability and restlessness was studied. The study was carried out in a nursing-home ward in Sweden. Soothing music was played as dinner music for weeks, Swedish tunes form the 1920s and 1930s for two weeks and pop music for two weeks. Prior to these periods, there was one week without music, and at the end of the intervention there was a two-week control period. The effects of the intervention were assessed by psychological ratings and by weighing the food helpings. It was found that during all three music periods the patients ate more in total. The difference was particularly significant for the dessert. The staff were thought to be influenced by the music, as they served the patients more food, both main course and dessert, whenever music was played. The patients were less irritable, anxious and depressed during the music periods. The results of the study suggest that dinner music, particularly soothing music, can reduce irritability, fear-panic and depressed mood and can stimulate demented patients in a nursing-home ward into eating more.

Affect↗
PubMed1996

Allelic variation of the streptokinase gene in beta-hemolytic streptococci group C and G isolates of human origin.

Genetic diversity of the streptokinase gene (sk) from 36 strains of S. equisimilis and 54 strains of group G streptococci was examined. The strains were isolated from patients with various streptococcal disease manifestations and healthy carriers. The region of the gene that corresponds to amino acid residues 174-244, was PCR amplified. The amplified product was subjected to MluI, PvuII, DraI and DdeI digestion. Based on the restriction enzyme digestion patterns nine sk alleles were recognized. There was no correlation between the various sk gene alleles and streptococcal disease manifestations. Three of the nine sk gene alleles, sk4, sk7, and sk8, were detected earlier among group A streptococci. The other six alleles were unique to S. equisimilis and group G streptococci. The most common alleles were sk5, found in 21/90 (23%) and sk10 detected in 43/90 (47%) of the strains. Alleles sk1 and sk2, the most frequent among group A streptococci, were not found among the strains in the present investigation. Thus, it appears that the sk gene has been evolving in line with other species distinguishing features of the streptococci.

Alleles↗
PubMed1996

Treatment of non-cognitive symptoms in dementia.

Non-cognitive symptoms are common in dementia. Emotional disturbances such as depression, anxiety and irritability-aggressiveness dominate. Depression is seen in about one third of demented persons. There are findings indicating that degenerative changes in the brain can cause depressive changes. Depression in elderly and in dementia differs from that in younger ages but no diagnostic criteria have yet been evaluated. Anxiety is a common symptom in depression suggesting a depressive-anxiety disorder. Specific serotonin re-uptake inhibitors (SSRI) are efficient in the treatment of both depression and anxiety while tricyclic antidepressants have side effects including cognitive reduction. Irritability and aggressiveness respond to the treatment with SSRI drugs. Such drugs as benzodiazepines and antipsychotics, especially those with anticholinergic effects, can reduce cognitive function in elderly and demented persons but the knowledge, this side effect is insufficient. Antipsychotics without anticholinergic effects should be used for the treatment of psychotic symptoms in demented persons.

Aged↗
PubMed1996

Pharmacologic treatment of noncognitive symptoms of dementia.

Cognitive deterioration in dementia includes many changes besides memory disturbances, including agitation, delusions, hallucinations, anxiety, irritability, and aggressiveness. Antipsychotic drugs are often used to control behavioral symptoms, but their benefits are limited. Depression, which is common in dementia, is often associated with anxiety. Selective serotonin reuptake inhibitors (SSRIs) improve mood and reduce anxiety while causing few side effects; they are also useful in managing irritability. Thus, the SSRIs should be considered the agents of choice for treating noncognitive symptoms associated with dementia. Neuroleptics should be used exclusively in patients with severe behavioral or psychotic symptoms, and only those agents without anticholinergic effects should be administered. Neuroleptics can be coadministered with SSRIs in patients who are extremely aggressive. Anxiolytics may also be effective for shortterm use. Future studies of drugs to treat the noncognitive symptoms of dementia should be placebo controlled and should evaluate the effects of those drugs on cognitive function.

Anxiety↗
PubMed1996

Reduced growth hormone secretion improves insulin sensitivity in adolescent girls with type 1 diabetes.

The aims of the present study were to compare nocturnal growth hormone (GH) secretion, insulin requirements and insulin sensitivity on two occasions in six adolescent girls with type 1 diabetes when the GH secretion was reduced one night by an oral dose of 100 mg of pirenzepine at bedtime. The mean nocturnal intravenous insulin infusion required to maintain a normal constant blood glucose concentration between 24:00 and 07:00 was 53% higher during the night on placebo (p = 0.0212). During the night on pirenzepine, the serum GH area under the curve (AUC) was reduced in all patients to a mean concentration which was 50.1% (15-78%) of that during the night without pirenzepine (p = 0.0036). The nocturnal urinary GH excretion was also reduced in all of the investigated patients (p = 0.0229). Insulin sensitivity in the morning, measured by the euglycaemic hyperinsulinaemic glucose clamp, increased significantly from 115 +/- 51 mg m-2 min-1 after the night on placebo to 205 +/- 67 mg m-2 min-1 after the night on pirenzepine (p = 0.0161). No side-effects were observed during the pirenzepine night. Negative correlations were found between the nocturnal serum GH AUC and the insulin-stimulated glucose metabolism (r = -0.65, p = 0.0241) and between the nocturnal urinary GH excretion and the insulin-stimulated glucose metabolism (r = -0.77, p = 0.0054). In conclusion, the present study shows a relation between GH secretion and insulin resistance in adolescent girls with type 1 diabetes. The administration of pirenzepine acutely reduces GH secretion and improves insulin sensitivity.

Administration, Oral↗
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↗
PubMed1996

Dinner music for demented patients: analysis of video-recorded observations.

At a nursing home ward for demented patients, selections of dinner music were played during three periods of 2 weeks. At the end of the study was a control period. The reactions of five patients to three different types of music were registered by video observations. This study showed that the patients were affected by music, particularly soothing music. For example, it was found that when music was played one of the study's restless patients became unusually calm whereas another fed herself more than usual. The patients spent more time with dinner when music was played. Dinner music made the patients eat more calmly. Music as a nursing tool is an intervention that is simple to realize and worth trying. A tentative conclusion of this study is that music can beneficially affect restless and agitated demented patients.

Aged↗
PubMed1996

Disclosure of basic strengths and basic weaknesses in demented patients during morning care, before and after staff training: analysis of video-recordings by means of the Erikson theory of "eight stages of man".

In the field of care for aging persons, it is commonly understood that personality changes occur in dementia patients. It is reported to be a consistent part of the clinical syndrome and to occur early in the disease. The aim of this study was to investigate if strengths and weaknesses, described by E.H. and J.M. Erikson as basic quality in the person, could be interpreted in severely demented patients during a caring activity, and if a difference in these qualities could be seen after staff completed a training program in "integrity promoting care." The morning care of five patients was video-recorded and a phenomenological-hermeneutic analysis of the patient's and staff's interaction was conducted. The findings indicate that the complex qualities of someone's personality are more preserved than could be expected considering the cognitive handicap. It seems, however, that demented patients need a special, supportive environment for their full mental potential to be realized. It is reasonable to assume that, if the staff are given knowledge of how to create a positive climate for the demented patients and the opportunity to implement it, the patients will show a rich pattern of mental reactions in spite of their dementia.

Aged↗