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K Engedal

Publications and source records attributed to K Engedal.

At least 19 recordsLinked to original sources
PubMed2006

Apolipoprotein E epsilon4 and impaired episodic memory in community-dwelling elderly people: a marked sex difference. The Hordaland Health Study.

BACKGROUND: Among elderly people without dementia, the apolipoprotein E epsilon4 allele (APOE4) has been associated with cognitive deficit, particularly in episodic memory, but few reports are available on whether this association differs by sex. METHODS: In a community-dwelling Norwegian cohort of 2181 elderly people (55% women), aged 70-74 years, episodic memory was examined in relation to sex and APOE4 zygosity, with the Kendrick Object Learning Test (KOLT). RESULTS: Possession of at least one APOE4 allele had a modest, detrimental effect on episodic memory in women, whereas in men, heterozygotes were unaffected and homozygotes had markedly lower scores across the distribution of KOLT scores. This sex difference was found consistently in all analyses: on comparing means and medians, examining trends across quintiles, and studying the distribution of scores and the risk of cognitive impairment. Results were broadly similar when adjusted for known determinants of cognition and also when severely impaired participants were excluded. The adjusted odds ratio (OR) of cognitive impairment in women was shown to be 1.8 (95% confidence interval (CI): 1.1 to 2.8) for heterozygotes and 1.1 (0.3 to 3.7) for homozygotes; the adjusted OR in men was observed to be 1.1 (0.6 to 2.1) for heterozygotes and 10.7 (4.7 to 24) for homozygotes. CONCLUSIONS: Although the harmful effect of APOE4 on episodic memory was modest in women, the risk was found to occur in about 30%. APOE4 was observed to have a dramatic effect on episodic memory in men, but only in homozygotes, who comprised about 3% of men: the whole male homozygous group showed a marked shift to lower memory scores.

Aged↗
PubMed2006

3-year study of donepezil therapy in Alzheimer's disease: effects of early and continuous therapy.

Delays in the diagnosis of Alzheimer's disease, and, therefore, delays in treatment, may have a detrimental effect on a patient's long-term well-being. This study assessed the effects of postponing donepezil treatment for 1 year by comparing patients treated continuously for 3 years with those who received placebo for 1 year followed by open-label donepezil for 2 years. Patients (n = 286) with possible or probable Alzheimer's disease (according to DSM-IV, NINCDS-ADRDA, and Mini-Mental State Examination criteria; see text) were randomized to receive donepezil (5 mg/day for 4 weeks, 10 mg/day thereafter) or placebo (delayed-start group) for 1 year. Of the 192 completers, 157 began a 2-year, open-label phase of donepezil treatment. Outcome measures were the Gottfries-Bråne-Steen scale, the Mini-Mental State Examination, the Global Deterioration Scale, the Progressive Deterioration Scale, the Neuropsychiatric Inventory, and safety (adverse events). Mixed regression analysis was used to compare changes between the groups over 3 years on the efficacy measures. There was a trend for patients receiving continuous therapy to have less global deterioration (Gottfries-Bråne-Steen scale) than those who had delayed treatment (p = 0.056). Small but statistically significant differences between the groups were observed for the secondary measures of cognitive function (Mini-Mental State Examination; p = 0.004) and cognitive and functional abilities (Global Deterioration Scale; p = 0.0231) in favor of continuous donepezil therapy. Over 90% of the patients in both cohorts experienced one treatment-emergent adverse event; most were considered mild or moderate. In conclusion, patients in whom the start of treatment is delayed may demonstrate slightly reduced benefits as compared with those seen in patients starting donepezil therapy early in the course of Alzheimer's disease. These data support the long-term efficacy and safety of donepezil.

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PubMed2006

Homocysteine measurements in geriatric patients.

OBJECTIVE: Homocysteine measurements may be relevant in geriatric medicine as homocysteine has been identified as an independent risk factor for prevalent disorders such as occlusive arterial vascular disease, cognitive impairment and dementia. The aim of the present study was to study diagnostic correlates of plasma total homocysteine (tHcy) in geriatric in-patients. MATERIAL AND METHODS: Blood samples for the analysis of tHcy and related factors like serum vitamin B12, serum folate, red blood cell folate and clinical data were collected from geriatric patients (n=114) in stable clinical condition. RESULTS: Almost 40% of the patients had tHcy values above 20 micromol/L. tHcy correlated significantly with serum folate, serum vitamin B12, serum creatinine and congestive heart failure, but not with red blood cell folate, cerebrovascular disease, coronary heart disease or cognitive impairment. CONCLUSIONS: Hyperhomocysteinaemia seems to be frequent in geriatric patients and might primarily be an indicator of low folate and high creatinine values.

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PubMed2006

Cognitive impairments in acute lacunar stroke.

BACKGROUND: The present study investigated the prevalence of cognitive deficits in acute lacunar stroke, validated the Mini Mental State Examination (MMSE) in detecting cognitive impairments in lacunar patients, and identified predictors of such deficits. METHODS: Seventy-one patients with lacunar stroke performed a comprehensive cognitive screening between day 2 and day 7 of their stay. The test battery included Trail Making Test A, Verbal Fluency, Object Learning Test, Ullevål Aphasia Screening, and Assessment of Stroke and other Brain Damage regarding motor apraxia, rational apraxia and visuospatial ability. RESULTS: Exactly 57.7% scored outside cutoff in at least one of the cognitive tests. Using a rigorous cutoff for MMSE (28/29 points) and the test battery as comparison, the sensitivity and specificity of MMSE were 0.69 and 0.67, respectively. Only male sex was significantly related to the presence of cognitive deficits (pathologic score on at least one of the tests--odds ratio 4.41, 95% confidence interval 1.45-13.43). CONCLUSION: Many lacunar stroke patients suffer cognitive problems. Male patients are at particular risk. MMSE failed to identify 30% of the patients diagnosed with cognitive deficits, and we suggest that lacunar stroke patients be offered a comprehensive cognitive screening, even when MMSE is normal.

Acute Disease↗
PubMed2005

Low blood pressure is a better predictor of cognitive deficits than the apolipoprotein e4 allele in the oldest old.

OBJECTIVE: To study the correlates of cognitive deficits in persons 80 years and older. MATERIALS AND METHODS: Data from 271 individuals between 80 and 102 years of age, drawn from a central registrar (response rate 50%) were analyzed regarding e apolipoprotein E (Apo-E) polymorphism, blood pressure (BP), homocysteine, sex, age and education as predictors for low score on Mini Mental Status Examination (MMSE). RESULTS: Low systolic and diastolic BP were highly associated with low score on the MMSE, followed by age and Apo-E e4. No relationship was found between Apo-E allele groups and BP. Homocysteine, sex, and education were only of marginal importance. CONCLUSIONS: Hypotension is an important factor for performance on the MMSE. To some extent, this was also true for having the Apo-E e4 allele. A combined effect on cognition for these two factors was not found.

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PubMed2003

Accuracy of CT scan measurements of the medial temporal lobe in routine dementia diagnostics.

BACKGROUND: Atrophy of the medial part of the temporal lobe is seen in Alzheimer's disease (AD). We studied the usefulness of CT scan measurements of the medial temporal lobe (MTL) in elderly with suspected dementia. METHODS: MTL measurements were done with callipers by three raters, blinded to the diagnosis and to each other, on scans from 110 subjects with suspected dementia from a memory clinic in Oslo, Norway and 36 participants included in the OPTIMA study, Oxford, England. RESULTS: The correlation between the MTL and the Mini-Mental State Examination (MMSE) was very low, and there was a marked overlap between Alzheimer and cognitively unimpaired subjects. The inter-rater reliability was lower on the Norwegian than on the OPTIMA scans (R = 0.48 vs R = 0.68), but this was partly explained by larger MTL readings (4.5 mm after adjustment for age, gender and MMSE sumscore) on the OPTIMA scans as the reliability was confounded by MTL width and was higher at larger MTLs. A wider scan width (3 mm vs 2 mm in the OPTIMA scans) can also contribute to differences in reliability. CONCLUSIONS: The published threshold values regarding the CT scan MTL measurements for the diagnosis of AD may be invalid when applied by other radiology departments without a local standardisation and validation.

Aged↗
PubMed2001

A 1-year, randomized, placebo-controlled study of donepezil in patients with mild to moderate AD.

OBJECTIVE: To evaluate the long-term clinical efficacy and safety of donepezil versus placebo over 1 year in patients with mild to moderate AD. METHODS: Patients (n = 286; mean age, 72.5 years) with possible or probable AD from five Northern European countries were randomized to receive either donepezil (n = 142; 5 mg/day for 28 days, followed by 10 mg/day) or placebo (n = 144) for 1 year. RESULTS: The study was completed by 66.9% of the donepezil- and 67.4% of the placebo-treated patients. The benefit of donepezil over placebo was demonstrated by the Gottfries-Bråne-Steen (a global assessment for rating dementia symptoms) total score at weeks 24, 36, and 52 (p < 0.05) and at the study end point (week 52, last observation carried forward; p = 0.054). Advantages of donepezil over placebo were also observed in cognition and activities of daily living (ADL) assessed by the Mini-Mental State Examination at weeks 24, 36, and 52, and the end point (p < 0.02) and by the Progressive Deterioration Scale at week 52 and the end point (p < 0.05). Adverse events (AE) were recorded for 81.7% of donepezil- and 75.7% of placebo-treated patients, with 7% of donepezil- and 6.3% of placebo-treated patients discontinuing because of AE. Treatment response to donepezil was not predicted by APOE genotype or sex in this population. CONCLUSION: As the first 1-year, multinational, double-blinded, placebo-controlled study of a cholinesterase inhibitor in AD, these data support donepezil as a well tolerated and effective long-term treatment for patients with AD, with benefits over placebo on global assessment, cognition, and ADL.

Aged↗
PubMed2001

High prevalence of anxiety symptoms in hospitalized geriatric patients.

OBJECTIVE: To examine the prevalence of anxiety symptoms in hospitalized geriatric patients. DESIGN: Controlled cross-sectional study. SUBJECTS: Ninety-eight geriatric in-patients and 68 healthy home-dwelling controls of similar age recruited from senior citizen centres. OUTCOME MEASURE: Anxiety measured as a current emotional state by Spielberger's State-Trait Anxiety Inventory (STAI). RESULTS: The geriatric patients scored significantly higher than the controls. Applying Spielberger's recommended cut-off of 39/40 on the STAI sumscore, 41% of the female and 47% of the male geriatric patients might be suspected of suffering from significant anxiety symptoms. Patients with chronic obstructive pulmonary disease tended to score higher; otherwise no relationship was found between the STAI sumscore and type of chronic somatic disease, nor between the STAI sumscore and number of drugs in regular use. CONCLUSIONS: STAI proved feasible for use in the elderly. The scoring on the STAI is high in geriatric in-patients. Further studies are needed to clarify to what extent this relates to a high prevalence of anxiety disorders.

Aged↗
PubMed2001

Psychometric properties of the state part of the Spielberger State-Trait Anxiety Inventory (STAI) in geriatric patients.

BACKGROUND: A conspicuously high score on the state part of the State-Trait Anxiety Inventory (STAI) has been observed among geriatric inpatients who are neither demented nor critically ill; 43% of them had a sumscore that, according to Spielberger's criteria, would reflect clinically relevant anxiety symptoms. OBJECTIVES: To explore the reasons for this high score. METHODS: 101 geriatric inpatients and 68 healthy controls of similar age, living at home and recruited through senior citizen centres participated in a controlled cross-sectional study. RESULTS: High item-scores were more frequent on the symptom-negative items than on the symptom-positive items. Multi-group factor analysis produced two factors termed 'well-being' and 'nervousness', which had a moderate correlation (0.61). The intercept was much higher on 'well-being' than on 'nervousness', showing that a lack of well-being contributes significantly to the high score on the STAI. This confounds the sumscore. However, the geriatric inpatients nevertheless had a high score on the factor 'nervousness'. Female controls scored higher than males on both factors, whereas among the geriatric patients neither age nor gender related to them. CONCLUSIONS: The STAI state sumscore is a biased indicator of anxiety in geriatric inpatients owing to confounding by well-being. The most important cause for the observed high score on the STAI state instrument in geriatric patients relates to a reduced well-being.

Aged↗
PubMed2000

Study on COgnition and Prognosis in the Elderly (SCOPE): baseline characteristics.

The Study on COgnition and Prognosis in the Elderly (SCOPE) is a multi-centre, prospective, randomized, double-blind, parallel-group study. The primary objective of SCOPE is to assess the effect of the angiotensin II type 1 (AT1) receptor blocker, candesartan cilexetil 8-16 mg once daily, on major cardiovascular events in elderly patients (70-89 years of age) with mild hypertension (DBP 90-99 and/or SBP 160-179 mmHg). The secondary objectives of the study are to test the hypothesis that antihypertensive therapy can prevent cognitive decline (as measured by the Mini Mental State Examination, MMSE) and dementia, and to assess the effect of therapy on total mortality, myocardial infarction (MI), stroke, renal function, and hospitalization. A total of 4964 patients from 15 participating countries were recruited during the randomization phase of SCOPE, exceeding the target population of 4000. The mean age of the patients at enrolment was 76 years, the ratio of male to female patients was approximately 1:2, and 52% of patients were already being treated with an antihypertensive agent at enrolment. The majority of patients (88%) were educated to at least primary school level. At randomization, mean sitting blood pressure values were SBP 166 mmHg and DBP 90 mmHg, and the mean MMSE score was 28. Previous cardiovascular disease in the study population included myocardial infarction (4%), stroke (4%) and atrial fibrillation (4%). Men, more often than women, had a history of previous MI, stroke and atrial fibrillation. A greater percentage of men were smokers (13% vs 6% in women) and had attended university (11% vs 3% of women). Of the randomized patients, 21% were 80 years of age. In this age group smoking was less common (4% vs 10% for 70-79-year-olds) and fewer had attended university (4% vs 7% for 70-79-year-olds). The incidence of MI was similar in both age groups. However, stroke and atrial fibrillation had occurred approximately twice as frequently in the older patients. The patients' mean age at baseline was similar in the participating countries, and most countries showed the approximate 1:2 ratio for male to female patients. There was also little inter-country variation in terms of mean SBP, DBP or MMSE score. However, there was considerable regional variation in the percentage of patients on therapy prior to enrolment.

Aged↗
PubMed1999

Study on COgnition and Prognosis in the Elderly (SCOPE).

The Study on COgnition and Prognosis in the Elderly (SCOPE) is a multicentre, prospective, randomized, double-blind, parallel-group study designed to compare the effects of candesartan cilexetil and placebo in elderly patients with mild hypertension. The primary objective of the study is to assess the effect of candesartan cilexetil on major cardiovascular events. The secondary objectives of the study are to assess the effect of candesartan cilexetil on cognitive function and on total mortality, cardiovascular mortality, myocardial infarction, stroke, renal function, hospitalization, quality of life and health economics. Male and female patients aged between 70 and 89 years, with a sitting systolic blood pressure (SBP) of 160-179 mmHg and/or diastolic blood pressure (DBP) of 90-99 mmHg, and a Mini-Mental State Examination (MMSE) score of 24 or above, are eligible for the study. The overall target study population is 4000 patients, at least 1000 of whom are also to be assessed for quality of life and health economics data. After an open run-in period lasting 1-3 months, during which patients are assessed for eligibility and those who are already on antihypertensive therapy at enrolment are switched to hydrochlorothiazide 12.5 mg o.d., patients are randomized to receive either candesartan cilexetil 8 mg once daily (o.d.) or matching placebo o.d. At subsequent study visits, if SBP remains >160 mmHg, or has decreased by <10 mmHg since the randomization visit, or DBP is >85 mmHg, study treatment is doubled to candesartan cilexetil 16 mg o.d. or two placebo tablets o.d. Recruitment was completed in January 1999. At that time 4964 patients had been randomized. All randomized patients will be followed for an additional 2 years. If the event rate is lower than anticipated, the follow-up will be prolonged.

Aged↗
PubMed1998

Social and depressive stress suffered by spouses of patients with mild dementia.

OBJECTIVE: To identify stressors and their correlates in spouses of patients with mild dementia. DESIGN: Retrospective study of patient records. SETTING: Patients attending a Memory Clinic at Ullevaal Hospital in Oslo. SUBJECTS: 92 mildly demented patients living at home (mean age 75.7 years, 51% women, mean MMSE score 22.3) and their spouses. MAIN OUTCOME MEASURES: Frequency and types of stress suffered by spouses using validated and factor-analyzed instruments as measures. RESULTS: Twenty-five per cent or more of the spouses reported often/always having problems with the following: being depressed by the situation, having difficulties getting away on holiday, social life being affected, household routines being upset, and sleep being interrupted. Factor analysis of the Greene Caregiver Stress Scale (15 items) identified two factors; 'Social stress' and 'Depressive stress'. Social stress was associated with the patient's I-ADL level, and depressive stress with mood and behaviour of the patient. The depressive symptomatology of the patient as expressed by the spouses was related to both depressive and social stress, whereas cognitive function, as measured by the MMSE, was not an independent predictor of carer strain. CONCLUSION: Even in mildly demented patients, symptoms of carer stress are frequent. Supportive strategies such as early diagnosis, information for carers and intervention strategies are discussed.

Activities of Daily Living↗
PubMed1998

Analysis of sonographic features in the differentiation of fibroadenoma and invasive ductal carcinoma.

OBJECTIVE: The purpose of this study was to determine the predictive power of sonographic tumor descriptors in the differentiation of fibroadenoma from invasive ductal carcinoma of the breast. SUBJECTS AND METHODS: Three hundred thirty-six tumors (142 fibroadenomas and 194 invasive ductal carcinomas) of the breast diagnosed using sonography were prospectively recorded with respect to the shape, contour, echo texture, echogenicity, sound transmission, and surrounding tissue of the tumors. Evaluation included odds and odds ratios of single sonographic features as well as sensitivity, specificity, and positive and negative predictive values of combinations of features. Tumor descriptors were also evaluated using multiple logistic regression analysis after adjustment for age and clinical examination. RESULTS: Irregular shape and contour, extensive hypoechogenicity, shadowing, echogenic halo, and distortion of surrounding tissue were the findings with the highest predictive value of malignancy. A thin echogenic pseudocapsule was the most important sonographic finding predictive of the benign nature of a solid mass. Echo texture was of little value in the differentiation of breast tumors. Age and clinical examination remained important predictors in a clinically referred patient population because a palpable mass in an elderly patient is most likely a carcinoma. We saw considerable overlap of most sonographic features in both benign and malignant tumors. However, using strict sonographic criteria and a combination of descriptors, we found a negative predictive value of 100% in palpable and 96% in impalpable tumors. CONCLUSION: A combination of tumor descriptors gave negative predictive values approaching 100%, allowing downgrading of solid breast masses with a high degree of confidence. Extensive sonographic features analysis in patients with indeterminate clinical and mammographic findings has the potential for downgrading a tumor and possibly obviating the need for excision in a subgroup of patients. Further investigations may provide standardization of sonographic descriptor analysis and establishment of the combination of the most predictive features that would be useful in daily practice.

Adult↗
PubMed1997

[Selection of patients for geriatric treatment--a quality assurance project].

Numerous patients admitted to acute hospitals for emergency treatment are elderly, 75 years and above. These patients often have multiple diseases and severe functional limitations and disabilities. Trials have shown that geriatric assessment programmes carried out in hospital settings improve the prognosis of survival, and can prevent or postpone functional decline. However, correct selection of patients is necessary in order to succeed. The aim of this development project was to describe how a geriatric team could screen hospital in-patients for geriatric treatment. The characteristics of 102 patients selected for geriatric treatment were compared to the criteria for a geriatric patient as defined by Laake. There was a high level of agreement between the global clinical assessment made by the geriatric team and Laake's criteria.

Geriatric Assessment↗
PubMed1997

[Memory clinic--ambulatory examination in suspected dementia].

Dementia and confusion are frequently overlooked by general practitioners. A memory clinic was established at the Department of Geriatric Medicine, Ullevål Hospital in September 1990 with the intention of creating a standardized programme for diagnosing dementia and cognitive impairment in the elderly in an out-patient setting. The activities and services offered by the clinic are described: diagnoses, information to patients, their family and staff in the primary health care system about the symptoms and treatment of dementia. In addition, advice is given on follow-up care and how to apply for care through the national health service. There has been a great demand for the services of the Memory Clinic, and we believe that the methods used are adequate in an out-patient setting. The concept could easily be transferred to other specialist clinics involved with the elderly, and parts of the programme could also be used by general practitioners.

Aged↗
PubMed1997

[Geriatric psychiatry--a specialty gaining recognition].

Services for elderly, mentally ill people have developed in response to changing needs in society. In 1990 most of the 650 beds allocated to elderly patients in psychiatric hospitals were occupied by long-term care patients. Outpatient programmes hardly existed. In 1995 about 400 beds were allocated to geriatric psychiatry. They were served by 40 physicians and 20 psychologists. Out-patients' clinics were established. Most of the in-patients were short-term admissions. Nowadays, departments of geriatric psychiatry define themselves as diagnostic and short-term units. About a third of the in-patients suffer from dementia, a third from depression, and a third from various other psychiatric disorders. The authors recommend that a special unit for geriatric psychiatry should be established in every county in Norway. Funds should be allocated for professorships at all universities.

Aged↗