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L Bäckman

Publications and source records attributed to L Bäckman.

At least 19 recordsLinked to original sources
PubMed1997

Rescue therapy with tacrolimus (FK 506) in renal transplant recipients--a Scandinavian multicenter analysis.

All renal allograft recipients (n = 32) in Sweden and Norway who were converted from cyclosporin (CyA)-based immunosuppression to FK 506 (tacrolimus) between October 1992 and June 1995 were analyzed retrospectively. The reasons for conversion were acute refractory rejection (n = 21), chronic rejection (n = 4), and suspected CyA toxicity (n = 6); one patient was converted for psychological reasons. The mean time from transplantation to conversion was 29 (range 1-243) weeks and there was a mean follow-up of 46 (2-143) weeks. Overall graft survival was 59%, with graft survival 52% in patients converted because of acute rejection, 50% in patients converted because of chronic rejection, and 83% in patients converted because of CyA toxicity. There was no significant correlation between preconversion serum creatinine and outcome. Seventy-two percent of the patients had significant side effects during FK 506 treatment, the most frequent ones being neurological and gastrointestinal symptoms. These improved after dose reduction. Two patients became overimmunosuppressed and developed lymphoma. One patient died of the primary kidney disease, hemolytic uraemic syndrome. We conclude that FK 506 therapy is able to salvage kidneys with acute refractory rejection and that it is an alternative in patients with CyA toxicity. However, the risk of overimmunosuppression must be considered.

Administration, Oral↗
PubMed1996

Influences of intentionality at encoding and retrieval on memory in adulthood and old age.

This research investigated whether different memory functions are differentially affected by the adult aging process. Four groups of normal adults (18-35, 60-68, 69-78, and 79-91 years of age) were presented with a set of pictures of faces with first names and surnames. Subjects were instructed to memorize the faces and the surnames for subsequent memory tests. Memory performance was assessed in four ways: stem completion of surnames; recognition of faces; recognition of surnames and recognition of first names. These memory tests varied in terms of intentionality at encoding and retrieval. The stem completion task involved intention at encoding, but not at retrieval, and thus served as a measure of implicit memory. With respect to the three explicit memory tasks, recognition of faces and surnames involved intention at both encoding and retrieval, whereas recognition of first names involved intention at retrieval, but not at encoding. Results indicated no age-related differences in implicit memory, as assessed by the stem completion test. In addition, there was an age-related deficit in recognition of faces and surnames, although there were no age-related differences in recognition of first names. The overall pattern of results suggests that age-related deficits in memory may be most likely to occur when there are demands of conscious mental activity at encoding and retrieval.

Adolescent↗
PubMed1996

The influence of depressive symptomatology on episodic memory functioning among clinically nondepressed older adults.

The authors examined a community-based sample of 303 clinically nondepressed individuals aged 75 through 96 years on 4 recall tasks: free recall of rapidly presented random words, free recall of slowly presented random words, free recall of organizable words, and cued recall of organizable words. Using a classification taxonomy that identified mood- and motivation-related symptoms of depression, it was found that motivation-related symptoms had a negative effect on performance across all tasks, whereas mood-related symptoms had no effects. In addition, motivation-related symptoms negatively influenced the ability to benefit from more study time but had no effect on the ability to make use of item organization or category cues. An analysis of the specific motivation-related symptoms suggested that symptoms that may affect the ability to focus and sustain attention (e.g., concentration difficulties, lack of interest) were most strongly associated with performance deficits.

Affect↗
PubMed1996

Effects of serum vitamin B12 and folate status on episodic memory performance in very old age: a population-based study.

We examined the relationship between low levels of serum vitamin B12 (< 200 pmol/L) and folic acid (< 11 nmol/L), separately or combined, and episodic memory performance in very old age. Participants with low serum vitamin values were compared with a control group matched for age and educational level. Participants (N = 250) were selected from a group of nondemented, community-dwelling persons ages 75-96. Episodic memory was tested by means of free recall and recognition of slowly and rapidly presented words. Results indicated a deterioration in both free recall and recognition as a function of serum vitamin status. However, no linear effects of vitamin levels on memory were observed, indicating that vitamin B12 and folic acid status may effect memory only among individuals at the low end of the distribution. We speculate that the vitamin-related memory deficit may reflect encoding problems, possibly due to alterations in brain metabolism.

Age Factors↗
PubMed1996

Episodic remembering in a population-based sample of nonagenarians: does major depression exacerbate the memory deficits seen in Alzheimer's disease?

Population-based samples of normal old adults and people with major depression (MD), Alzheimer's disease (AD), and coexisting MD and AD (MD + AD) between 90 and 100 years of age were assessed in face recognition, word recall, and object recall. Results indicated a consistent pattern across tasks: no differences between the normal old and the MD participants or between the AD and MD + AD participants in any task, a clear performance decrement in the AD and MD + AD participants in all task variables reflecting long-term episodic memory, and no group differences in those variables reflecting short-term memory. These data suggest that depression in very old age may not exacerbate the episodic memory deficit that accompanies AD. Further, differences between normal old and MD participants in episodic memory tasks appear to be negligible among the oldest old. The general lack of effects of MD may be due to the fact that those symptoms of this disease that are most likely to affect memory functioning (e.g., loss of energy, concentration difficulties) are common in AD as well as in nondepressed people in the 10th decade of life.

Aged↗
PubMed1996

Age differences in episodic memory, semantic memory, and priming: relationships to demographic, intellectual, and biological factors.

This study examined age differences in episodic memory, semantic memory, and priming using a random sample of 1,000 men and women from 10 age groups (35, 40, 45, . . . 80 years). The main purpose was to determine whether an age effect existed after differences on various demographic, intellectual, and biological factors had been controlled for. The simple correlations of age with episodic and semantic memory performance were found to be significant, whereas no relationship was found between age and levels of priming. After controlling for differences on the background factors, age predicted episodic but not semantic memory performance. It is proposed that the failure to account for the age effect on episodic memory is because it is caused by age-related neuronal changes.

Adult↗
PubMed1996

Utilizing compensatory task conditions for episodic memory in Alzheimer's disease.

Numerous recent studies have addressed the question of whether memory can be improved in patients with Alzheimer's disease (AD). Evidence from both experimental studies and intervention work suggests that AD exerts a substantial effect not only on memory functioning in general, but also influences the potential for memory improvement. Contrary to previous claims, however, several recent studies indicate that AD patients can utilize cognitive support to improve memory under certain conditions. To achieve performance gains from experimental manipulations or intervention procedures in AD, it appears that cognitive support must be provided at the time of both information acquisition and subsequent information retrieval. In addition, there is evidence that cognitive intervention in AD stands a greater chance of succeeding when the training is based on functions that are relatively well preserved as opposed to functions that are severely impaired.

Alzheimer Disease↗
PubMed1996

A new microemulsion formulation of cyclosporin: pharmacokinetic and clinical features.

Cyclosporin (cyclosporin A) has been used as an immunosuppressive agent after organ transplantation for more than 15 years. The bioavailability of cyclosporin in its conventional oral formulation 'Sandimmun' displays considerable inter- and intra-patient variability. Absorption is also bile dependent. Recently, a new galenic formulation of cyclosporin was introduced, 'Neoral', which is a water-free microemulsion of cyclosporin. The microemulsion creates micelles which are absorbed in the small bowel without the presence of bile. Pharmacokinetic studies in healthy volunteers clearly demonstrate an increased bioavailability of the microemulsion formulation of cyclosporin, measured as an increase in maximum drug concentration (Cmax) and area under the drug concentration-time curve, and a reduced time to Cmax. These findings have been confirmed in kidney, liver and heart transplant recipients. With the microemulsion formulation, an improved prediction of cyclosporin concentrations has probably attributed to the decrease found in the variability of cyclosporin absorption. This could probably enable easier and more reliable monitoring of cyclosporin concentrations after transplantation. So far, data on the effects of conversion from the conventional to the microemulsion formulation of cyclosporin are only available in a limited number of patients and with a limited follow-up period. The main questions are related to what the long term consequences of the improved bioavailability of the microemulsion formulation will be. Further long term studies are needed in order to answer these questions. In the present review, we report on the pharmacokinetic properties of, and on clinical experience after solid organ and bone marrow transplantation with, the microemulsion formulation.

Cyclosporine↗
PubMed1995

The relationship between the mini-mental state examination and cognitive functioning in normal elderly adults: a componential analysis.

The relationship between the Mini-Mental State Examination (MMSE) and selected cognitive performance indices was examined in a sample of 251 non-demented adults over 75 years of age. MMSE items were divided into I 1 binomial content domains and an examination of these revealed that only seven had sufficient variability to predict cognitive performance. A factor analysis with these items yielded three factors, reflecting memory, spatial skill, and the ability to follow commands. After controlling for age and education, these factor scores were included as predictors of specific cognitive tasks including two measures of free recall, and two measures of visuospatial skill. The memory factor score was a strong predictor of the two free recall tasks and block design. The spatial factor score contributed to the prediction of the two visuospatial measures, as well as free recall of organizable words. The results suggest that, in normal ageing, the predictive value of the MMSE is due to subset of cognitively demanding items that are heavily influenced by both memory and visuospatial skills.

Aged↗
PubMed1995

Episodic memory and visuospatial ability in detecting and staging dementia in a community-based sample of very old adults.

BACKGROUND: This study examined the efficacy of a cognitive test battery in detecting and staging dementia in a community-based sample of very old adults. METHOD: The sample consisted of 398 nondemented and 108 demented adults taken from all the inhabitants in the Kungsholmen parish of Stockholm, Sweden (2,368 individuals), aged 75 years and older, who were part of a large-scale epidemiological study on aging and dementia. Participants received a cognitive test battery that consisted of specialized episodic memory tasks, as well as standardized psychometric measures of visuospatial ability and primary memory. RESULTS: A discriminant analysis revealed that highly supported episodic memory tasks (recognition, cued recall) were primarily responsible for correctly classifying normal old adults (94.5%) from those with the diagnosis of dementia (66.7%). Using the Mini-Mental State Exam (MMSE) as the criterion of dementia severity, a correct classification of 88.9% was achieved for mildly demented subjects and 77.8% for moderately demented subjects. Visuospatial tasks made the greatest contribution in distinguishing those at different levels of dementia severity. CONCLUSION: The results of this investigation indicate that cognitively supported measures assessing episodic memory may be particularly useful in the detection of dementia, whereas visuospatial measures are more effective in staging the disease. Consistent with biological models of the progression of dementia, this suggests that visuospatial abilities may deteriorate later and/or at a slower rate than episodic memory skills in the early stages of dementia. It is noteworthy that these conclusions are based on samples of very old adults taken from the general population.

Aged↗
PubMed1995

Effects of multifactorial memory training in old age: generalizability across tasks and individuals.

This study examined the generalizability of gains following multifactorial memory training in healthy older adults across tasks and individuals; 46 subjects were randomly assigned to either a control group or to a multifactorial training group (encoding operations, attentional functions, relaxation). The criterion task was recall of concrete words, and there were three transfer tasks: recall of objects, recall of subject-performed tasks, and recall of abstract words. Results indicated that multifactorial training gave rise to performance gains in the criterion task that were sustained after 6 months. Transfer of gains and maintenance of transfer were observed for object recall only, indicating a restricted range of generalizability. Pretraining scores alone predicted posttraining scores, whereas age, education, and level of global cognitive functioning (Mini-Mental State Examination) did not contribute reliably to the magnitude of training-related gains.

Age Factors↗
PubMed1995

The role of demographic and life style variables in utilizing cognitive support for episodic remembering among very old adults.

This research investigated the influence of individual difference variables within demographic and life-style domains on episodic recall tasks in which the level of cognitive support increased incrementally. The community-based sample consisted of 253 healthy older adults taken from the Kungsholmen parish in Stockholm, Sweden. Utilizing hierarchical regression procedures, two questions were addressed with regard to the selected individual difference variables: (a) the degree to which they could predict episodic recall and (b) whether they differentially influenced the magnitude of performance gains from the provision of cognitive support in the form of study time, item organizability, and retrieval cues. The results showed that age was negatively related to performance, whereas education and participation in social activities exerted a positive influence on performance. Exercise was also positively related to performance, but only in the least supported tasks. With regard to utilization of cognitive support, education was positively related to performance benefits from more study time and item organizability, age was negatively related to the effect of item organizability, and social activity was positively associated with the ability to benefit from retrieval cues. These results highlight the role of individual difference measures in episodic memory functioning in late adulthood and indicate that these variables are important in predicting the extent to which older adults are able to utilize cognitive support to enhance episodic recall.

Adaptation, Psychological↗
PubMed1995

RASP: a system for the analysis of memory tasks.

The purpose of this paper is to introduce a system for the analysis of memory tasks. The system involves four basic task dimensions, derived from an ecological analysis of memory functioning: Reproductivity (R), Acquisition (A), Sufficiency (S), and Productivity (P). Three studies are reported in which professional memory psychologists were asked to rate sets of standard laboratory and more ecologically relevant memory tasks in terms of the four RASP dimensions. In general, results implied independence across the two sets of tasks between the four dimensions. Interrater reliabilities were found to be modest to high. However, it was suggested that RASP best be used as a tool for understanding the meaningful relations that exist among dimensions within general sets or pools of tasks, for different classes of tasks, as well as for prototypical tasks. We argue that, especially when the relationship between RASP profiles for two particular tasks is crossvalidated by behavioral data, and conflict with assumptions about what memory systems or processes are involved, then there is a potential for conceptual refinement. This refinement could be attained either through an increased theoretical generalization, or through an increased theoretical precision. Based on obtained RASP information at the level of classes of tasks (e.g., episodic vs. semantic) as well as at a prototypical task level (e.g., word recall vs. prose recall), several intriguing memory phenomena are discussed. Finally, we suggest that RASP may serve as a tool for reducing the number of task-specific assumptions of what systems and processes mediate memory performance.

Humans↗
PubMed1995

Determinants of functional abilities in dementia.

OBJECTIVES: To determine the extent to which selected variables within demographic, psychometric, and memory domains can predict functional abilities in dementia. DESIGN: Hierarchical regression analyses were employed to predict functional abilities, while controlling for disease severity, using the Mini-Mental State Exam (MMSE). SETTING AND PARTICIPANTS: A total of 2368 inhabitants of Kungsholmen parish in Stockholm, Sweden, aged 75 years of age or older. Eighty-one subjects with confirmed dementia (MMSE, M = 17.9; SD = 5.26) were selected from the study population. The mean age was 84.5 years (SD = 5.58), and 72% were female. MEASUREMENTS: Participants received a battery of standardized neuropsychological instruments and selected experimental tasks that measured visuospatial ability as well as primary and episodic memory. Self-care was assessed using the Katz index of activities of daily living (ADL); instrumental activities of daily living (IADL) were assessed through the primary caregiver, who responded to questions related to functional competence of the participant. RESULTS: Hierarchical regression procedures revealed that disease severity was the strongest predictor of ADL and IADL performance. Controlling for disease severity, a measure of visuoperception (Poppelreuter's figures) also made a significant contribution to the explanatory variance in both ADL and IADL function. Beyond disease severity and visuoperception, years of schooling and disease duration were marginally predictive of IADL performance. CONCLUSION: It is possible to predict functional abilities in dementia on the basis of individual difference variables. Multiple variables were initially correlated with ADL and IADL performance; however, after controlling for disease severity, visuoperception was the only predictor of ADL scores. In addition to visuoperception, IADL scores were also marginally predicted by education and disease duration. These findings highlight the importance of peripheral sensory processes in adaptive function in dementia. They also suggest that although many variables may be correlated with functional ability, their explanatory role, particularly with regard to self-care skills, is diminished in the presence of the disease.

Activities of Daily Living↗
PubMed1994

FK506 trough levels in whole blood and plasma in liver transplant recipients. Correlation with clinical events and side effects.

FK506 trough levels were measured by ELISA in paired whole-blood and plasma samples in 59 liver transplant recipients. Patients with nephrotoxicity had higher FK506 whole-blood and plasma levels (27.5 +/- 3.2 ng/ml and 1.44 +/- 0.14 ng/ml) than patients with stable liver function (15.2 +/- 2.1 ng/ml and 0.98 +/- 0.15 ng/ml, P < 0.05 and P < 0.01, respectively). Patients with acute rejection had FK506 whole-blood and plasma levels within the same range as patients with stable liver function. Patients with severe neurotoxicity had significantly higher FK506 whole-blood and plasma levels (31.3 +/- 6.8 ng/ml and 3.9 +/- 1.4 ng/ml) in comparison with patients with mild-to-moderate neurotoxicity (18.1 +/- 2.4 ng/ml and 1.1 +/- 0.13 ng/ml) (P = 0.048 and P < 0.001, respectively). Long-term use of FK506 was associated with a significant reduction in glomerular filtration rate at 1-year posttransplant in patients on primary FK506 treatment (33%, P < 0.001). The reduction in glomerular filtration rate correlated with the yearly mean FK506 plasma but not with whole-blood levels or FK506 dose. There was a correlation between FK506 whole-blood and plasma levels (r = 0.713, P < 0.001) but not between the levels (whole blood or plasma) and FK506 dose (mg/day or mg/kg/day). The mean FK506 whole-blood and plasma levels were 14.1 +/- 0.26 ng/ml and 0.96 +/- 0.75 ng/ml, respectively. There was a large intra- and interpatient variability in the ratio between whole-blood and plasma levels (range 1.0-73.5), with a mean ratio of 18.0 +/- 0.28 (+/- SEM). In conclusion, monitoring of FK506 trough levels is of importance to avoid nephro- and neurotoxicity, but monitoring is only of limited help to avoid acute rejection. Monitoring of FK506 levels in plasma seems to be superior to that in whole blood.

Adult↗