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Biomedical subjects

M Viitanen

Publications and source records attributed to M Viitanen.

136 records · Page 8Linked to original sources
PubMed1988

Life satisfaction in long-term survivors after stroke.

Different aspects of the quality of life before and after stroke were registered for 62 communicable, representative long-term (4-6 years) survivors, who reported the global and domain specific life satisfaction that they experienced (7 items, 6 graded-ordinal scales). Reference subjects were 60 healthy individuals in two age cohorts (60-61 years, n = 34; 79-81 years, n = 26) none of whom had been hospitalized during the last seven years prior to the investigation. The main finding is that, after the stroke, at least one aspect of the quality of life had decreased for 61% of them; this concerned global, sexual and leisure satisfaction mainly. Moreover, persisting motor impairment and ADL-disability had a negative effect on several aspects of life satisfaction. As nearly 30% of the non-impaired and the non-disabled interviewees reported decreased global life satisfaction, these changes indicate that they do not cope psychosocially with the stroke as such nor with its sequelae. In contrast, the levels of life satisfaction were similar for the 60-61 and 79-81 year-old interviewees, clinically healthy respondents, indicating stability in the quality of life that they experienced from late middle age into senectitude. For the patients, social integration estimated normatively did not covariate significantly with post-stroke satisfaction derived from social relationships.

Activities of Daily Living↗
PubMed1987

Determinants of long-term mortality after stroke.

Risk factors of death for a population of 409 patients with well-defined cerebrovascular disease (patients with subarachnoidal hemorrhage excluded) admitted to the Stroke Unit were studied with the aid of the life table technique, log rank test, and multivariate analysis with BMDP's program for regression on the survival curves with Cox's proportional hazard model. The estimated proportion of survivors was 77% after three months, 69% after one year, and 32% after five years. Patients with intracerebral hemorrhage and embolic cerebral infarction had the worst outcome. Impaired consciousness on admission was the most important risk factor of death followed by high age, previous cardiac failure, diabetes mellitus and male sex.

Adult↗
PubMed1987

Autopsy-verified causes of death after stroke.

In a population-based sample of 409 stroke patients, autopsy was performed in 82 of the 95 patients who died during the first three months and in 61 of the 128 patients dying thereafter. The dominant causes of death, as verified by autopsy, were cerebrovascular disease in the first week (90%), pulmonary embolism in the second to fourth week (30%), bronchopneumonia during the second and third months (27%) and cardiac disease, mainly myocardial infarction, later than three months after the stroke (37%). Death was attributed to causes other than the brain lesion in 59% of the patients with ischemic and in 24% of the patients with hemorrhagic stroke (p less than 0.01). Age and sex had little influence on the distribution of causes of death. Fatal pulmonary embolism and bronchopneumonia surprisingly often occurred in ambulatory patients. An intracardiac thrombus was present in 20% of deceased patients with atrial fibrillation, and in 17% of cases with a history of myocardial infarction. When attempts are made to reduce mortality (and morbidity) after stroke, there would seem to be a considerable potential for prevention and early treatment of complications, such as pulmonary embolism, bronchopneumonia and cardiac disorders.

Adult↗
PubMedDate not supplied

Copying and handwriting ability in the screening of cognitive dysfunction in old age.

Geometric copying and handwriting tests are often assessed in the screening of cognitive deficiency in the elderly. The aim of the study was to show the regression of geometrical copying and handwriting with increasing cognitive impairment in old age. The study is population-based and includes 668 subjects aged 75 years and older, living in an inner-city area of Stockholm. The subjects were asked to copy a cube, two pentagons, a rhombus, two intersecting rectangles, and a circle. They were also asked to write a complete sentence spontaneously, a sentence from dictation and their name. Geometric copying and handwriting skills decreased in direct proportion to decreased cognitive functioning. The skills most sensitive to small changes in cognition were copying the cube and the pentagons. Other skills were less sensitive to small changes: writing a complete sentence, copying a rhombus, two rectangles and writing one's name. However, copying and handwriting appear to complement each other. Copying of the rectangles and rhombus is more useful than the other figures because these two can be discriminated throughout different stages of dementia. Sentence writing from dictation and signature can be used to evaluate severely impaired subjects because these skills seem to be retained longer than the spontaneous sentence writing.

Journal Article↗
PubMedDate not supplied

Levels of serum creatinine and estimated creatinine clearance over the age of 75: a study of an elderly Swedish population.

Serum creatinine was measured and creatinine clearance estimated using the Cockcroft-Gault (C-G) formula, in elderly people participating in a population study of the elderly, the Kungsholmen Project. This is an ongoing longitudinal study which was begun in 1987 and comprised all people in a district of Stockholm, born in 1912 or earlier. Out of 2368 people 1810 participated. In 1362 cases, serum creatinine and an estimation of the creatinine clearance could be obtained. The mean age of these elderly people was 81 years, and 92% were living in their own homes. A linear regression model showed that the weight of the elderly decreased by age, indicating a decrease in muscle mass. However, this was not accompanied by a decrease in serum creatinine levels. When creatinine clearance was estimated using the C-G formula, a significant decline with age was seen at an average rate of 1.2 ml/min per year. It declined from 52 ml/min at age 75 to 27 ml/min at age 95. The mean for the whole study group was 44.6 ml/min. Our data suggest that the glomerular filtration rate may be very low in the oldest old and that there is a continuing decline with increasing age, even in a population where a high number of the elderly are still living in their own homes. Furthermore, the lack of major changes in serum creatinine levels with age supports the idea that this parameter is not a reliable measure of renal function in the elderly.

Journal Article↗
PubMedDate not supplied

Tacrine restores cholinergic nicotinic receptors and glucose metabolism in Alzheimer patients as visualized by positron emission tomography.

Three patients with Alzheimer's disease, a 68-year-old woman with mild dementia and 2 men (aged 64 and 72 years) with moderate dementia were treated orally with the cholinesterase inhibitor tacrine (tetrahydroaminoacridine), 80 mg daily, for several months. The patients were investigated using positron emission tomography (PET) prior to, and after 3 weeks and 3 months of treatment. The PET studies involved a multi-tracer system consisting of [18F]-fluoro-deoxy-glucose (18F-FDG) (tracer for glucose metabolism); 11C-butanol (cerebral blood flow) and (S)(-)- and (R)(+)-[N-11C-methyl]-nicotine (nicotinic receptors; cholinergic neural activity). Tacrine treatment increased the uptake of 11C-nicotine to the brain. Significant reduced difference in uptake between the two enantiomers (S)(-)- and (R)(+)11C-nicotine was observed in the frontal and temporal cortices after tacrine treatment in all three patients. The kinetic analysis indicated increased binding of (S)(-)11C-nicotine in brain compatible with a restoration of nicotinic cholinergic receptors. The most pronounced effect was observed after 3 weeks and 3 months treatment in the patient with mild dementia. An increase in cerebral glucose utilization was found in the 68-year-old patient with mild dementia but also slightly in the 64-year-old man with moderate dementia when treated with tacrine for 3 months. Tacrine administration did not affect cerebral blood flow. The PET data obtained after 3 weeks of tacrine treatment was paralleled by improvement in neuropsychological performance. This study shows in vivo by PET neurochemical effects induced in brain by treatment with tacrine to Alzheimer patients. Intervention with tacrine in the early course of the disease might be necessary for clinical improvement.

Aged↗
PubMedDate not supplied

Intracerebroventricular infusion of nerve growth factor in three patients with Alzheimer's disease.

Nerve growth factor (NGF) is important for the survival and maintenance of central cholinergic neurons, a signalling system impaired in Alzheimer's disease. We have treated 3 patients with Alzheimer's disease with a total of 6.6 mg NGF administered continuously into the lateral cerebral ventricle for 3 months in the first 2 patients and a total of 0.55 mg for 3 shorter periods in the third patient. The patients were extensively evaluated with clinical, neuropsychological, neurophysiological and neuroradiological techniques. Three months after the NGF treatment ended, a significant increase in nicotine binding was found in several brain areas in the first 2 patients and in the hippocampus in the third patient as studied by positron emission tomography. A clear cognitive amelioration could not be demonstrated, although a few neuropsychology tests showed slight improvements. The amount of slow-wave cortical activity as studied by electroencephalography was reduced in the first 2 patients. Two negative side effects occurred with NGF treatment: first, a dull, constant back pain was observed in all 3 patients, which in 1 patient was aggravated by axial loading resulting in sharp, shooting pain of short duration. When stopping the NGF infusion, the pain disappeared within a couple of days. Reducing the dose of NGF lessened the pain. Secondly, a marked weight reduction during the infusion with a clear weight gain after ending the infusion was seen in the first 2 patients. We conclude from this limited trial that, while long-term intracerebroventricular NGF administration may cause certain potentially beneficial effects, the intraventricular route of administration is also associated with negative side effects that appear to outweigh the positive effects of the present protocol. Alternative routes of administration, and/or lower doses of NGF, perhaps combined with low doses of other neurotrophic factors, may shift this balance in favor of positive effects.

Aged↗
PubMedDate not supplied

Aspirin, NSAIDs, risk of dementia, and influence of the apolipoprotein E epsilon 4 allele in an elderly population.

In a cohort study, 1,301 subjects free of dementia at baseline in the Kungsholmen Project were followed up to 6 years. We studied the association between use of aspirin and non-steroidal anti-inflammatory drugs (NSAIDs), incidence of Alzheimer's disease (AD) and overall dementia, and the influence of the apolipoprotein E epsilon4 allele. In stratified analyses, a relative risk (RR) of 1.80 (95% CI 1.14-2.83) for AD was seen, in the apoE epsilon4-negative group using aspirin. This implicates a possible different mechanism of developing AD in this group. We also found a possible protective effect of NSAIDs against AD, since no one who used NSAIDs for around 3 years had developed AD 3 years later. One user developed vascular dementia, and a low point value of risk was seen, however, not significant (RR 0.23; 95% CI 0.03-1.68). This could be due to the small samples in our study, or to comorbidity contributing to the development of dementia in this elderly population.

Aged↗
PubMedDate not supplied

Beta-adrenergic blockade after stroke. A preliminary closed cohort study.

To collect background data for a prospective clinical trial of beta-blocking agents in the prevention of deaths after stroke, the long-term prognosis in 60 patients discharged from a stroke unit on beta-blocker therapy was compared with the outcome in 60 matched patients with stroke but without beta-blockers. Matching included sex, age, type of stroke, and presence or absence of hypertension and cardiac failure. Thirteen patients (22%) in the beta-blocker group died during a median followup of 41 months. Of the 60 patients not on beta-blockade at discharge, 21 (35%) died during a median followup of 36 months. By life-table technique and log-rank test, the relative risk for death was 0.60:1.00 (p = 0.14). During followup, 12 recurrent strokes were observed in patients on beta-blockers and 19 in patients without beta-blockers (relative risk 0.57:1.00; p = 0.12). It appeared that the reduction in mortality could only marginally be ascribed to fewer deaths from myocardial infarction; other causes of death were also less frequent in beta-blocker-treated patients. The results emphasize that supplementary information on the effect of beta-blocking agents on mortality after stroke is needed before a larger trial of beta-blocker therapy in patients with manifest cerebrovascular disease can be initiated.

Actuarial Analysis↗