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Biomedical subjects

M Viitanen

Publications and source records attributed to M Viitanen.

At least 127 records · Page 7Linked to original sources
PubMed1992

Clinical diagnosis of Alzheimer's disease and other dementias in a population survey. Agreement and causes of disagreement in applying Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition, Criteria.

In a population survey aimed to detect cases of Alzheimer's disease and other dementias, two preliminary diagnoses were made independently with the purpose of using the concordant diagnoses as final diagnoses. Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition, diagnostic criteria were followed. The 668 subjects examined were selected from the population of an area in Stockholm, Sweden, aged 75 years or more, with the Mini-Mental State Examination used as a screening test. The agreement on dementia diagnosis was moderate (kappa = .54) and could be clearly improved (kappa = .70) with modifications to the diagnostic criteria, such as adding a category of questionable dementia and giving more guidelines in the definition of impairment of a function. The agreement on the diagnosis of Alzheimer's disease vs vascular dementia vs secondary dementia was substantial (kappa = .67) when the cases with concordant dementia diagnoses were examined.

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PubMed1992

Quantitative estimation of brain white matter abnormalities in elderly subjects using magnetic resonance imaging.

Twenty-five elderly subjects were examined with brain magnetic resonance imaging (MRI). The subjects were divided into two groups: those with Mini-Mental State Examination (MMSE) scores above 25, and those subjects with MMSE scores between 18 and 24. The degree of white matter abnormalities (WMA) (expressed as relative volumes) as well as the presence of cerebrovascular risk factors were evaluated in the two groups. We found that a) subjects with low MMSE scores had significantly larger relative volumes of WMA than the subjects with higher scores, b) a significant correlation (rs = 0.53, p < 0.009) between MMSE scores and the relative volume of WMA was also established, and c) a weak significant correlation (rs = -0.51, p < 0.05) between arterial blood pressure and WMA was found in the subjects with high MMSE scores. Besides these findings no other correlations between the presence of cerebrovascular risk factors and WMA were found in any of the groups.

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PubMed1992

Clinical staging of dementia in a population survey: comparison of DSM-III-R and the Washington University Clinical Dementia Rating Scale.

In a population survey in Stockholm, 224 dementia cases were staged using two scales: the Washington University Clinical Dementia Rating Scale and DSM III-R. Both scales had to be modified by adding additional specifications and, in the case of DSM III-R, a new category of questionable dementia. After modification, the comparison of the two scales showed good agreement when all stages were analyzed (kappa = 0.60), but moderate agreement on the questionable and mild stages (kappa = 0.47). These results confirm the staging of mild dementia as the most problematic issue. Finally, the scales both showed moderate agreement with the categorized Mini-Mental State Examination (MMSE) (0-17 for severe and moderate forms; 18-23 for mild cases). Our data suggest new cut-off points for the MMSE when used as a staging scale.

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PubMed1992

Occurrence of dementia in advanced age: the study design of the Kungsholmen Project.

The Kungsholmen Project is a study on elderly people living in a parish of Stockholm, Sweden. The study uses a longitudinal approach with the principal purpose of determining the natural history of Alzheimer's disease and other dementias. The study population consists of all 2,368 inhabitants of the Kungsholmen area in Stockholm, aged 75 years and above in October, 1987. The study design consists of three phases. Phase I consists of a screening test used in order to identify the 'possible' dementia cases; phase II is a complete clinical examination carried out in order to reach a final diagnosis of dementia; in phase III the whole population is reexamined in order to ascertain new cases of dementia. DSM-IIIR criteria for dementia and different types of dementia are used. The final diagnosis is based on a consensus using two preliminary diagnoses, made separately by different physicians.

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PubMed1991

Serum dehydroepiandrosterone sulfate in Alzheimer's disease and in multi-infarct dementia.

Circulating levels of dehydroepiandrosterone sulfate (DHEAS) and cortisol were studied in 86 patients with dementia; 45 with Alzheimer's disease and 41 with multi-infarct dementia. Compared to an elderly control group, after adjustment for age and sex, patients with Alzheimer's disease were found to have lower serum levels of DHEAS. We found a covariation between serum albumin and DHEAS levels, which may be of importance regarding peripheral hormone concentration in patients with dementia. These findings may provide evidence for a role of DHEAS in amnestic disorder in humans, either reflecting or contributing to the course of dementing diseases.

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PubMed1991

Catecholamine excretion in old age.

Catecholamine excretion was studied in two groups of nonhospitalized subjects, 60 and 80 years of age, N = 35 and 29, respectively. Urinary 24h dopamine excretion exhibited an age-related decline (p = 0.001). There was a sex difference for dopamine excretion; men had higher excretion levels (p = 0.04). Twenty-four-hour excretion of epinephrine and norepinephrine was slightly higher in 60- than in 80-year-old individuals (NS). Smoking was associated with a considerable increase in epinephrine (p = 0.001) and norepinephrine (p = 0.04) excretion. Body mass index was negatively correlated to epinephrine excretion (r = -0.27; p less than 0.05). When analyzed with a multi-way analysis of variance with analysis of covariance, significant influences of age on dopamine excretion, of creatinine clearance on dopamine and norepinephrine excretion, and of smoking on epinephrine excretion were seen. Thus, factors such as age, gender, body mass, kidney function and smoking habits considerably influence catecholamine excretion in elderly people.

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PubMed1991

The generalizability of training gains in dementia: effects of an imagery-based mnemonic on face-name retention duration.

The generalizability of the results from a case study on the effects of an imagery mnemonic on face-name recall in dementia was examined (Hill, Evankovich, Sheikh, & Yesavage, 1987). Seven patients with Alzheimer's disease (AD) and 1 patient with multi-infarct dementia (MID) were trained by using the method devised by Hill et al. Application of the mnemonic increased the time during which face-name associations could be held in memory for 1 AD patient, and this improvement was maintained in a 1-month follow-up assessment. However, no training gains were observed for the remaining 7 patients, thus questioning the generalizability of this method in enhancing memory in dementia.

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PubMed1991

Semantic organization and verbal episodic memory in patients with mild and moderate Alzheimer's disease.

The objective of the present research was to investigate the relationship between semantic organization and cue utilization in mildly and moderately demented patients with Alzheimer's disease (AD). In Experiment 1, subjects were presented with two lists of words: a list with semantically unrelated words and a list with words from four semantic categories presented randomly intermixed. Free recall was assessed and following the organizable list, subjects received a cued recall test. Normal controls, as opposed to mildly and moderately demented patients, showed higher performance in the organizable list as compared to the random list. In addition, normal controls and mildly demented patients benefited from semantic cues in the organizable list and performed at a higher level in total recall as compared to free recall. In Experiment 2, subjects were presented with two lists of words: a list with words from four semantic categories presented randomly intermixed and a list with words from four semantic categories presented clustered, together with information about the organization of the list. Free recall and cued recall, with the category names serving as cues, were assessed. Free recall performance of normal controls was higher in the clustered than in the organizable list, whereas no such effect was observed for the AD patients. Normal controls and mildly demented patients performed at a higher level in total as compared to free recall in both lists, whereas this effect was present only in the clustered list for the moderately demented patients. The overall pattern of results indicates that there are conditions under which memory facilitation from semantic organization may be obtained in AD.

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PubMed1991

Care of demented patients with severe communication problems.

Two time-studies and an interview study were carried out at a geriatric clinic. The aim was to elucidate how much time caregivers use for direct patient care in their contact with severely demented patients compared with non-demented patients as well as how they experience the care of demented patients in a task assignment care system. The analysis showed that more time was used to help non-demented patients than demented patients with the same ADL-performance. Five types of patient reactions to communicative attempts made by the caregivers were described: the patient seems to enjoy contact, he avoids contact, contact leads to aggression, he reacts only sporadically to contact and he does not show any reactions to it. The caregivers described negative reactions to demented patients with communication problems. Communication problems seem to be a threat to caregivers' commitment.

Activities of Daily Living↗
PubMed1991

Prevalence of Alzheimer's disease and other dementias in an elderly urban population: relationship with age, sex, and education.

We studied the prevalence of different types of dementia in an elderly population in Stockholm, Sweden, in relation to age, sex, and education. The study confirmed Alzheimer's disease (AD) as the most frequent type of dementia and the positive association of dementias with age, even in the most advanced ages. In contrast to previously reported data, we found the same proportion of AD and vascular dementia in the different age strata, and no sex differences regarding the prevalence of different dementia types. Finally, less educated people had a higher prevalence of all dementias, due essentially to a higher prevalence of alcoholic dementia and unspecified type of dementia. The prevalence of AD was similar across different levels of education.

Age Factors↗
PubMed1990

Prognosis after stroke in diabetic patients. A controlled prospective study.

Cohorts of diabetic (n = 121) and non-diabetic (n = 584) patients were prospectively followed for up to ten years after having suffered from a stroke. All but six of the diabetic patients had Type 2 (non-insulin-dependent) diabetes mellitus. The diabetic patients had more risk factors associated with stroke: heart failure (p less than 0.001) and angina pectoris (p less than 0.001), than the non-diabetic patients. Neither body mass index nor blood pressure levels differed between the groups at admission. Haematocrit levels were higher in the diabetic group (p less than 0.01). The diabetic patients were more commonly afflicted by cerebral embolism and to a lesser extent by transient ischaemic attacks than the non-diabetic patients. When calculated by log-rank tests, the diabetic group had an increased risk of death (p less than 0.001), recurrent stroke (p = 0.001), and of myocardial infarction (p = 0.001) after the initial stroke. Autopsy-verified causes of death between the groups did not differ significantly, although half of all deaths during the period one to six months after stroke were caused by pulmonary embolism in the diabetic group. Thus, diabetes increases the risk of death after a stroke, and it also increases among stroke survivors the risk of recurrent stroke and myocardial infarction.

Cerebrovascular Disorders↗
PubMed1990

Decreased uptake and binding of 11C-nicotine in brain of Alzheimer patients as visualized by positron emission tomography.

Positron emission tomography of the brain following intravenous injection of (+) (R) and (-) (S) N-[11C-methyl]nicotine showed a marked reduced uptake of both isomers, especially the (R) form, in Alzheimer patients as compared to age-matched controls. The significantly larger difference between the uptake values of the (S)- and (R)-enantiomers of 11C-nicotine in Azheimer brains may be of diagnostic value.

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PubMed1989

Hormones in 'young' and 'old' elderly: pituitary-thyroid and pituitary-adrenal axes.

Changes of the pituitary-thyroid and pituitary-adrenal hormone axes with age and possible differences between the sexes in the elderly were studied in 60-year-old (n = 39) and 80-year-old (n = 34) non-hospitalized subjects. The 80-year-old age group had a significantly lower response of thyrotropin (TSH) to thyrotropin-releasing hormone (TRH; p less than 0.05). Otherwise, there were no significant differences between the two age groups. Sex differences were found for plasma arginine vasopressin and cortisol excretion (higher values in men), and free thyroxine index, TSH and prolactin response to TRH (higher values in women). Cortisol levels after dexamethasone were negatively correlated to body mass index. There were no differences in hormone levels between smokers and non-smokers. In obtaining reference values for hormones in old age it is important to consider possible changes after the age of 60 years and to adjust for gender and body mass.

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PubMed1988

Risk of recurrent stroke, myocardial infarction and epilepsy during long-term follow-up after stroke.

The risk of recurrent stroke, myocardial infarction and epilepsy was analyzed in a population-based cohort of 409 stroke patients (mean age 72 years) observed for 3.5-7 years. As assessed by the life table technique, the proportion of survivors in the cohort was 69 +/- 5% at 1 year and 38 +/- 7% at 5 years. During the first year, the risk for recurrent stroke was 14 +/- 4%, and the accumulated risk for stroke recurrence at 5 years was 37 +/- 10%. The probability for myocardial infarction was estimated to be 7 +/- 3% at 1 year and 19 +/- 8% at 5 years. The risk of recurrent stroke was enhanced in patients of high age and with a history of cardiac failure (p less than 0.05), whereas the risk of myocardial infarction was associated with high age, angina pectoris and diabetes mellitus (p less than 0.05). The risk of epilepsy was 3 +/- 2% at 1 year and 5 +/- 4% at 5 years. The considerable risk of recurrent stroke, myocardial infarction and epilepsy adds to the sequelae of the initial cerebrovascular accident.

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