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M Rainer

Publications and source records attributed to M Rainer.

15 recordsLinked to original sources
PubMed2002

Vienna Transdanube Aging "VITA": study design, recruitment strategies and level of participation.

The Vienna Transdanube Aging study "VITA" is a prospective, interdisciplinary cohort-study of all 75-years old inhabitants of the 21. and 22. district of Vienna (n = 1,745), which started in May 2000. The study design is described in this paper for the first time. The main scientific question of the study concerns the prediction of incident dementia in the elderly. The main statistical analysis will compare 8 predictors: episodic memory, verbal fluency, subjective memory complaints, depression, APOE-epsilon4, MAO-B activity in thrombocytes, MRT hippocampal atrophy, and MRT atrophy of the substantia innominata. The whole investigation comprises medical and psychosocial interviews, psychological tests, psychiatric and neurological scales, blood characteristic, genetic factors and cranial magnetic resonance imaging. Various variables will be compared with each other concerning sensitivity and specificity of prediction of cognitive decline. The dependent variable of the intended statistical analysis will be the individual's difference between Mini Mental State Examination scores at the two times of investigation. A high level of participation in geriatric epidemiological studies increases the general applicability of results but recruitment procedures must not ignore the individual's right to privacy and integrity. Using a liberal recruitment procedure as recommended by the local ethics commission the level of participation is between 36.7% and 44.3%.

Aged↗
PubMed2002

Sustained improvement of cognition and global function in patients with moderately severe Alzheimer's disease: a double-blind, placebo-controlled study with the neurotrophic agent Cerebrolysin.

BACKGROUND: In a recent study, Cerebrolysin (Cere), a compound with neurotrophic activity, has been shown to be effective in the treatment of mild to moderate Alzheimer's disease (AD). A subgroup analysis of this double-blind, placebo-controlled study was performed to assess the effects of Cere in cases with more advanced forms of AD. PATIENTS AND METHODS: Patients received infusions of 30 ml Cere or placebo five days/week for four weeks. This treatment was repeated after a two-months therapy-free interval. Effects on cognition, global function, behavioural symptoms and activities of daily living were evaluated 4, 12, 16, and 28 weeks after the beginning of the infusions. 109 patients with MMSE scores <20 were included in this analysis. RESULTS: The responder rate of the Cere group was 65% on the CGI, compared to 24.5% in the placebo group (p < 0.004). In the ADAS-cog, a score difference of 4.1 points in favour of Cere was observed (p < 0.0001). Notably, improvements were largely maintained in the Cere group up to the week 28 visit. CONCLUSION: The data clearly demonstrate the efficacy of Cere treatment in moderate to severe forms of AD with sustained treatment effects on cognition and global function even after discontinuation of treatment.

Aged↗
PubMed2002

Improved global function and activities of daily living in patients with AD: a placebo-controlled clinical study with the neurotrophic agent Cerebrolysin.

BACKGROUND: Cerebrolysin (Cere) is a peptidergic, neurotrophic drug which has been shown to improve cognitive performance and global function of Alzheimer's disease (AD) patients in earlier trials. In this study, we have attempted to replicate this findings with particular emphasis on functional improvement of the patients. PATIENTS AND METHODS: Patients received infusions of 30 ml Cere or placebo five days/week for six consecutive weeks. Patients had to have a diagnosis of AD and a MMSE score of 14-25 inclusive. Effects on cognition, global function, and activities of daily living were evaluated 3, 6, and 18 weeks after the beginning of the infusions. RESULTS: Significant improvement of cognitive function, clinical global impression and activities of daily living were seen after the end of the therapy. The effects were most pronounced in the DAD score, a measure for the capability to perform activities of daily living. Interestingly, and in line with the findings of earlier studies, the treatment effect of Cere was maintained after cessation of treatment up to the week 18 assessment. CONCLUSION: The data confirm the findings of earlier trials and clearly demonstrates that Cere leads to functional improvement of patients with AD. The sustained treatment effect of Cere after withdrawal has been confirmed.

Activities of Daily Living↗
PubMed2002

[Family caregiver help and self-help in Alzheimer dementia].

Beside the loss of the memory capacity, non-cognitive disturbances occur up to 70%-90% in patients suffering from Alzheimer's disease due to pathological changes in the brain. Delusion, hallucination and changes of the circadian rhythm can appear in addition to the five kinds of disorder--agitation, aggressive behaviour, screaming, depression and constant hyperkinesia. The consequences of these changes in perception and behaviour constitute severe problems for the patient as well as for the main caregiver. The burden of caring often exceeds their energy and resources. Not only do many of those caregivers suffer themselves from exhaustion but also from feelings of guilt and depression. The therapeutic concept includes the involvement of the relatives through information, support, counselling and guidance as much as the investigation of the causes and interrelation of the problematic behaviour in each individual case and further involves the carer in creating a concept to deal in an optimal way with the patient.

Adaptation, Psychological↗
PubMed2001

Naftidrofuryl in the treatment of vascular dementia.

The design of this study was based on the European guidelines for the treatment of Alzheimer's disease. After a placebo run-in period of 4 weeks, patients with a diagnosis of vascular dementia (VaD) were randomised to receive either 400 mg naftidrofuryl/day, 600 mg naftidrofuryl/day or placebo for 6 months. The patients were assessed using the ADAS-cog, the SCAG, the NOSGER and the CGI item 2 scale. The primary analysis was undertaken on the ITT population. At the end of the study, significantly more patients in the treatment groups showed no deterioration on both ADAS-cog and SCAG scales compared with placebo (400 mg p = 0.005, 600mg p = 0.015). There were also significant differences between the active and placebo groups for the individual scales. This study has demonstrated that treatment with naftidrofuryl can slow the rate of deterioration of patients with vascular dementia.

Aged↗
PubMed2001

Cognitive relapse after discontinuation of drug therapy in Alzheimer's disease: cholinesterase inhibitors versus nootropics.

In a cross-sectional study of outpatients diagnosed with dementia of the Alzheimer type who had been treated with a broad variety of drugs supposed to improve cognition or to delay cognitive decline, we have investigated the effects of abruptly discontinuing therapy on cognition. Termination of therapy with any cholinesterase inhibitor was associated with a cognitive decline during the following 6-7 weeks which was significantly more pronounced than that experienced by patients who had received nootropic drugs or calcium channel blockers (3.41 vs. 1.17 points on the ADAS-Cog scale; -1.14 vs. -0.06 points on the MMSE scale). This effect was not modified by gender, apolipoprotein E genotype, or the extent of ventricular enlargement on CT scans. Its magnitude was comparable to the cognitive response observed in published clinical trials when cholinesterase therapy commenced, and also with the data obtained during a 6-week placebo washout phase.

Acetylcholinesterase↗
PubMed2001

A 28-week, double-blind, placebo-controlled study with Cerebrolysin in patients with mild to moderate Alzheimer's disease.

Cerebrolysin (Cere) is a compound with neurotrophic activity which has been shown to be effective in the treatment of Alzheimer's disease (AD) in earlier trials. The efficacy and safety of repeated treatments with Cere were investigated in this randomized, double-blind, placebo-controlled, parallel-group study. One hundred and forty-nine patients were enrolled (76 Cere; 73 placebo). Patients received i.v. infusions of 30 ml Cere or placebo 5 days per week for 4 weeks. This treatment was repeated after a 2-month therapy-free interval. Effects on cognition and clinical global impressions were evaluated 4, 12, 16, and 28 weeks after the beginning of the infusions using the Clinical Global Impression (CGI) and the Alzheimer's Disease Assessment Scale-cognitive subpart (ADAS-cog). All assessments, including the 28-week follow-up visit were performed under double-blind conditions. At week 16, the responder rate of the Cere group was 63.5% on the CGI, compared to 41.4% in the placebo group (P < 0.004). In the ADAS-cog, an efficacy difference of 3.2 points in favour of Cere was observed (P < 0.0001). Notably, improvements were largely maintained in the Cere group until week 28, 3 months after the end of treatment. Adverse events were recorded in 43% of Cere and 38% of placebo patients. Cere treatment was well tolerated and led to significant improvement in cognition and global clinical impression. A sustained benefit was still evident 3 months after drug withdrawal.

Aged↗
PubMed2000

No evidence for cognitive improvement from oral nicotinamide adenine dinucleotide (NADH) in dementia.

Reduced nicotinamide adenine dinucleotide (NADH) is advertised as an over-the-counter product or dietary supplement to treat Alzheimer's disease. We performed a 3-month open-label study with oral 10 mg/day NADH with 25 patients with mild to moderate dementia of the Alzheimer, vascular, and fronto-temporal types in addition to their current cholinomimetic drug medication. In 19 patients who completed the study, we found no evidence for any cognitive effect as defined by established psychometric tests. We conclude that NADH is unlikely to achieve cognitive improvements in an extent reported earlier, and present theoretical arguments against an effectiveness of this compound in dementia disorders.

Administration, Oral↗
PubMed1999

Receptor test (pupillary dilatation after application of 0.01% tropicamide solution) and determination of central nervous activation (Fourier analysis of pupillary oscillations) in patients with Alzheimer's disease.

Memory loss and severe cognitive deficits in Alzheimer patients are supposed to be related to a reduction of acetylcholine as well as to central nervous deactivation. For the investigation of cholinergic deficits and deactivation, we used computer-assisted pupillometry. Cholinergic deficits caused by a particularly severe loss of cholinergic neurons may be responsible for cognitive and mnemonic performance deficits. The control of the pupillary diameter represents a balance between cholinergic and adrenergic innervation and is influenced directly or indirectly by central and autonomic nervous system inputs. Either of these systems could be affected in Alzheimer patients. A reduced innervation of the target muscle through neuronal cell death, axon retraction, reduced release, increased reuptake of altered amounts or function of neurotransmitter receptors seems to affect the pupillary response to cholinergic antagonists in Alzheimer patients. There is, however, no relationship between pupillary diameter and central deactivation, but between central nervous activation and pupillary oscillations which reflect the physiological corticodiencephalic activity, a relationship has to be assumed. Frequencies and amplitudes of pupillary oscillations measured by means of Fourier analysis are modulated corticodiencephalically. Therefore, Alzheimer patients were compared to healthy controls with respect to their pupillary diameters and responses to an acetylcholine antagonist. Twenty-nine patients, aged between 55 and 85 years, suffering from mild to moderate Alzheimer's disease (AD) and 29 normal controls of similar age (56-85 years) participated in the study. The cholinergic receptors of the pupil were blocked by the acetylcholine antagonist tropicamide. It could be assumed that the larger the pupillary dilatation, the larger the extent of cognitive deficits. Alzheimer patients show abnormal acetylcholine neurotransmission. Changes of pupillary diameter after instillation of 1 drop of 0.01% tropicamide solution were measured and Fourier analysis of pupillary oscillations was performed. Times of measurement were: 0 (baseline), 20, 40, 60, 80, and 100 min. After 4 min tropicamide was instilled. Forty min after the instillation of tropicamide into the left eye, the Alzheimer patients showed a pronounced dilatation of 41.57%. The dilatation in normal controls was 28.5%. Fourier analysis of pupillary oscillations (sum of frequency bands = power) demonstrated a marked deactivation (low amplitudes in low-frequency bands, but in contrast to our expectations no higher amplitudes in the higher frequency bands) in patients with AD which remained constant at all times of measurement. By means of discriminant analysis of pupillary diameter and pupillary oscillations (frequency band 0.00-1 Hz), 89. 7% were correctly predicted to be Alzheimer patients, 89% to be normal controls.

Aged↗
PubMed1999

[Non-cognitive symptom profiles in dementia--experience from psychiatric services and memory clinics].

OBJECTIVE: To assess the non-cognitive symptoms in 153 consecutive dementia patients admitted to our psychiatric ward or seen at the gerontopsychiatric ambulance and Memory Clinic. METHODS: We used the Global Deterioration Scale, the Hachinski Ischaemia Score, the Hamilton Psychiatric Rating Scale for Depression, and the Mini-Mental State Exam as staging tools in a cross-sectional design. A semi-quantitative 34-item questionnaire based on the Columbia University Scale for Psychopathology was employed to assess non-cognitive symptoms as reported by caregivers. RESULTS: All patients had disturbances of affect, 95% of behavior and 71% of motivation, while 52% and 29% had delusions and hallucinations, respectively. Delusions, but not hallucinations, were correlated with verbal and physical aggressiveness. Factor analysis extracted three complex variables which accounted for 40.6 percent of the observed total variance, and which were subsequently interpreted as manifestations of agitation, burdensome behavior, and depression. Using these variables, we then identified three categories of patients: Agitated, debilitated, and depressive-anxious. Depression and anxiety were most common 3-4 years after diagnosis. Patients with Alzheimer's disease had less severe behavioral and psychotic symptoms than those with other types of dementia. Agitation, depression, and loss of competence in daily living had a greater impact on caregivers than aggression and psychotic symptoms. CONCLUSION: The non-cognitive symptom profile is related to the type of dementia, and shifts dynamically with disease progression.

Adult↗
PubMed1997

Therapeutic results with Cerebrolysin in the treatment of dementia.

BACKGROUND: In the present study patients suffering from dementia were treated with an infusion therapy using the neurotrophic drug Cerebrolysin. The effectiveness of the therapy was examined under conditions of daily clinical practice. METHODS: 645 Patients were treated with 30 ml Cerebrolysin daily. The average period of treatment was 17.8 days. Prior to treatment patients were diagnosed according to DSM-III-R. In addition a differential diagnostic examination using the Hachinski Ischemic Score was performed. Clinical symptoms and the Clinical Global Impression (CGI) were determined before and after therapy. RESULTS: Cerebrolysin therapy led to a significant (p < 0.001) improvement in memory for 62% of the patients. 65% showed improvement in concentration, 50% in mood and fatigue, and 47% improved in vertigo. An improvement in the Clinical Global impression was observed in approximately 80% of the patients. The improvement of symptoms was significantly larger (p < 0.05) in younger, less afflicted patients than in the older, more seriously ill patients. The unusual good tolerance of Cerebrolysin was especially noteworthy. CONCLUSIONS: The present study confirms the results of earlier clinical studies with Cerebrolysin in the treatment of Alzheimer patients and patients with vascular dementia in which similar responder rates were observed. The significant dependence of therapeutic success on the length and severity of illness confirms that timely pharmacological intervention leads to best therapeutic results.

Aged↗
PubMed1996

Alcohol-induced organic cerebral psychosyndromes: partial reversal of cognitive impairments assisted by dihydroergocristine.

Chronic alcohol abusers show a specific pattern of cerebral damage associated with cognitive and behavioral defects known as the organic cerebral psychosyndrome, which is partially reversible upon discontinuation of ethanol consumption. To assess the potential of nootropic drug therapy in alcohol rehabilitation in a double-blind study design, 56 consecutive patients who participated in routine rehabilitation therapy received 2 x 3 mg/day dihydroergocristine or placebo in tablet form over 6-13 weeks. Forty-nine patients completed the protocol. Although significant improvement was seen in both groups, we could document a specific cognitive restitution effect attributable to dihydroergocristine. Significant differences in favor of the active drug group were demonstrated by Mini-Mental State Examination, Syndrome Brief Test, Paired Words Test, in the neuropsychiatric Brief Cognitive Rating Scale assessments, and in the Clinical Global Impression of Change rating. No significant between-group differences were found in the Digit Symbol Test and the Block Design Test as well as in the Brief Psychiatric Rating Scale (BPRS). Dihydroergocristine was equivalent to placebo in terms of subjective drug tolerance, lack of side effects, and laboratory parameters. Based on this profile of efficacy and safety, we recommend dihydroergocristine as an adjuvant drug in alcohol rehabilitation.

Adult↗