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Biomedical subjects

R Sulkava

Publications and source records attributed to R Sulkava.

At least 73 records · Page 4Linked to original sources
PubMed1995

White matter hyperintensities on MRI in the neurologically nondiseased elderly. Analysis of cohorts of consecutive subjects aged 55 to 85 years living at home.

BACKGROUND AND PURPOSE: We undertook this study to evaluate the frequency and risk factors of white matter hyperintensities seen on T2-weighted MR imaging. We examined cohorts of neurologically nondiseased elderly subjects participating in a general-community study, the Helsinki (Finland) Aging Brain Study. Cohorts of consecutive subjects aged 55, 60, 65, 70, 75, 80, and 85 years (n = 20, 18, 20, 18, 19, 18, and 15, respectively; total, n = 128) were divided into a young-old (age < 75 years, n = 76) group and an old-old (age > or = 75 years, n = 52) group. METHODS: Frequency of hyperintensities seen on T2-weighted axial and coronal MR images (0.02 T) was rated using a four-point scale in periventricular and centrum semiovale areas. RESULTS: The majority of the subjects showed only mild white matter hyperintensities, which were more frequent in the periventricular areas. Age was the most important factor to explain the presence of hyperintensities. A logistic regression analysis related periventricular hyperintensities in the entire group to central atrophy (odds ratio [OR], 4.7; 95% confidence interval [CI], 1.7 to 12.9) and silent infarcts (OR, 5.6; 95% CI, 1.0 to 19.8); among the young-old, hyperintensities related to diabetes (OR, 17.0; 95% CI, 1.9 to 154.2) and central atrophy (OR, 14.7; 95% CI, 3.5 to 61.8). Centrum semiovale hyperintensities related in the entire group to cardiac arrhythmia (OR, 4.0; 95% CI, 1.0 to 15.5), central atrophy (OR, 3.9; 95% CI, 1.2 to 12.4), and silent infarcts (OR, 3.6; 95% CI, 1.0 to 12.5). CONCLUSIONS: These mild white matter hyperintensities in the neurologically nondiseased elderly related especially to age and also to concomitant silent infarcts, atrophy, and some vascular risk factors. The known factors, however, explained only part of the variation. The young-old and old-old groups showed different associations. In contrast to former assumptions, the presence of white matter hyperintensities among the aged is likely to be linked to other as yet unidentified age-related factors.

Aged↗
PubMed1995

Lack of association of apolipoprotein E allele epsilon 4 with late-onset Alzheimer's disease among Finnish centenarians.

No association between Alzheimer's disease (AD) and apolipoprotein E type epsilon 4 (ApoE epsilon 4) phenotype was found among centenarians in Finland (N = 179). The data are based on ascertainment of all centenarians in Finland in 1991. All examinations were conducted during 1991. The diagnoses of dementia and AD were based on clinical grounds, conforming to DSM-III-R and NINCDS-ADRDA criteria. The percentage of ApoE epsilon 4 alleles among the centenarians was 8.7% (31 of 358 alleles). This is significantly lower than percentages found in younger Finnish populations. Thirty (16.8%) of the 179 centenarians were epsilon 4 allele carriers. One hundred fifty-one (84.4%) of the centenarians were women. Twenty-eight (18.5%) of the women had at least one epsilon 4 allele, as did two (7.1%) of the men. The prevalence of clinically diagnosed AD was 26.8%; 44% of the subjects were cognitively normal, 23% had signs of cognitive decline or at most mild dementia (with no differential diagnosis), and 6% had a dementia clinically diagnosed as being due to some cause other than AD. For AD cases versus cognitively normal subjects, the odds ratio associated with being a carrier of the epsilon 4 allele was 1.34 (p = 0.64; 95% CI = [0.5, 3.3]). Among women, the odds ratio was 0.99 (p = 1.0; 95% CI = [0.4, 2.6]). There were fewer, but not significantly so, epsilon 4 carriers among subjects with cognitive decline or at most mild dementia (12.2%) than there were among the cognitively normal subjects (16.5%). The AD patients had no evidence of difficulty standing on a flat stationary surface unless the surface suddenly moved.(ABSTRACT TRUNCATED AT 250 WORDS)

Age of Onset↗
PubMed1994

Chromosome 14-encoded Alzheimer's disease: genetic and clinicopathological description.

A family of Finnish descent with very-early-onset Alzheimer's disease has been identified. Genetic analysis of this family eliminated the amyloid precursor protein gene as the pathogenic locus, but strongly implicated a locus on chromosome 14q23.4 between D14S52 and D14S55. The early age at onset of the disease (average, 36 years; range, 35-39 years), the rapid progression, and the early and prominent myoclonus, while they appear to be frequent findings in the chromosome 14-encoded form of Alzheimer's disease, raised the clinical suspicion of prion disease. However, sequencing the prion gene-coding region of 2 affected members of the pedigree failed to show any abnormality. Apart from the presence of modest cortical vacuolar change, the pathological features of our index patient appeared typical of Alzheimer's disease with abundant senile plaques immunoreactive with beta-amyloid, but not with prion protein antibodies.

Adult↗
PubMed1994

Neurofilament profile in olfactory mucosa of patients with a clinical diagnosis of Alzheimer's disease.

In an attempt to find a reliable peripheral marker of Alzheimer's disease (AD), pieces of olfactory mucosa were removed by biopsy from 11 patients with probable AD and from eight control patients. The samples were analysed immunocytochemically using monoclonal and polyclonal antibodies. The olfactory and peripheral neurons of the olfactory mucosa in both AD and control patients typically exhibited immunoreactivity to neurofilament (NF) triplet proteins, including both phosphorylated and non-phosphorylated epitopes, as well as to synaptophysin, but lacked reactivity to other intermediate filament proteins, microtubule-associated protein 2 and tau. Our results do not support the recent findings suggesting the lack of NF proteins in olfactory neurons or the preferential phosphorylated status of NF proteins in olfactory neurons solely in AD.

Adolescent↗
PubMed1994

Staging the severity of dementia: comparison of clinical (CDR, DSM-III-R), functional (ADL, IADL) and cognitive (MMSE) scales.

The Helsinki Aging Study is based on a random sample of 795 subjects aged 75 years (N = 274), 80 years (N = 266) and 85 years (N = 255). Ninety-three demented patients were found. All were assessed for severity of dementia by Clinical Dementia Rating (CDR) scale by a general practitioner and according to the DSM-III-R criteria by a neurologist. The Mini-Mental State Examination (MMSE) was carried out by a community nurse and the Index of ADL and the IADL-scale by a close informant. The correlation of the severity of dementia between the DSM-III-R criteria and the CDR scale was moderate. The overall agreement was 64.5% and the Kappa index 0.56. The CDR scale tended to put patients in milder categories than the DSM-III-R criteria. The correlation between the clinical scales and categorized MMSE was moderate to fair. The overall agreement between MMSE and DSM-III-R criteria was 64% (Kappa 0.44) and between MMSE and CDR scale 55% (Kappa 0.33%). The dispersion of the functional scales (ADL, IADL) was much greater indicating that there were also other factors influencing the functional capacity than the degree of dementia. Different methods in staging dementia give different results thus influencing for instance the results of epidemiological studies. Functional scales are needed in clinical practice in addition to the assessment of the severity of dementia. The CDR scale is useful in assessing the need for support services.

Activities of Daily Living↗
PubMed1993

White matter changes in healthy elderly persons correlate with attention and speed of mental processing.

OBJECTIVE: To evaluate the association between white matter changes (leukoaraiosis [LA]) seen on magnetic resonance imaging and cognitive functions. DESIGN: Survey of cohorts of neurologically healthy elderly subjects derived consecutively from a population-based random sample. SETTING: General community, the Helsinki (Finland) Aging Brain Study. SUBJECTS: Cohorts of neurologically healthy subjects aged 55, 60, 65, 70, 75, 80, and 85 years (n = 20, 18, 19, 18, 17, 17 and 11 subjects, respectively; total N = 120). MEASURES: Leukoaraiosis was rated in the periventricular areas (0 to 24) and the centrum semiovale (0 to 24); also, a total LA score was obtained (0 to 48). The neuropsychological test battery covered memory, verbal intellectual and constructional functions, language, speed and attention, and speed of mental processing, as well as simple psychomotor speed. RESULTS: Low age-related LA scores and deterioration of cognitive functions were obtained in the normal subjects. When controlling for age, we found that speed and attention, together with the speed of mental processing measured by the Trail Making A and the Stroop tests, correlated with the total LA score. However, there was wide variation between subjects. Comparing groups with and without LA proved the association of LA with Trail Making A time, Stroop test result (words/time and difference/time), and the compound score of speed and attention. Presence of periventricular LA was especially related to speed of mental processing. CONCLUSION: Leukoaraiosis could explain some of the intellectual impairment in the elderly, especially that of slowing of distinct motor and attentional functions, as well as slowing of mental processing. Mild LA in normal aged subjects could also signal brain at risk for further cognitive impairment.

Aged↗
PubMed1993

Prevalence of dementia in the city of Helsinki.

The Helsinki Aging Study is based on a random sample of 795 subjects aged 75-years (N = 274), 80-years (N = 266) and 85-years (N = 255). A clinical examination including Clinical Dementia Rating (CDR)-scale was carried out in 82% of the cases. 93 demented subjects were found, 17 of whom had mild dementia. The prevalence of moderate and severe dementia was 2.9%, 10.3% and 23.3% in the age groups of 75-year-olds, 80-year-olds and 85-year-olds, respectively. If we take into account also the mild cases, we get the prevalence of dementia 4.6%, 13.1% and 26.7% in the above mentioned age groups, respectively. The proportion of mild dementias was lower than expected, which probably reflects both the difficulties to recognize mild dementia in an elderly population and the relatively small compensatory capacity of elderly people.

Activities of Daily Living↗
PubMed1992

The demented elderly in the city of Helsinki: functional capacity and placement.

OBJECTIVE: To study prevalence, functional capacity, and placement of demented patients in a randomly selected population. DESIGN: Survey. SETTING: Random sample from population registry of the City of Helsinki. PARTICIPANTS: Nine hundred subjects aged 75 years, 80 years and 85-years, 300 in each group. MEASUREMENTS: For each participant, we completed a questionnaire for the subject and an informant and a functional-capacity scale and Mini-Mental Status Examination by a community nurse, including the Clinical Dementia Rating (CDR) scale. Subjects with CDR of 0.5 or greater were examined by a neurologist who diagnosed the presence or absence of dementia according to DSM-III-R. RESULTS: Ninety-three subjects of the 656 whose CDR was known were found to have dementia. Three-quarters of them lived in institutions, and they comprised 33%, 60%, and 68% of all institutionalized patients in the above-mentioned age groups, respectively. Community residents suffering from dementia often lived with a caring relative and needed many services. A considerable part of the need was not met. CONCLUSIONS: In the older age groups, the need for institutional placement due to dementia is great. According to our study, it seems unlikely that these patients could be cared for in any other way, at least not on a large scale. The need for services for home-dwelling patients is also great, and the relatives carry a heavy load in taking care of demented patients.

Activities of Daily Living↗
PubMed1992

Correction for age, education and other demographic variables in the use of the Mini Mental State Examination in Finland.

The population-based Helsinki Aging Study was comprised of three age groups: 75-, 80- and 85-year-olds. A random sample of 511 subjects completed the Mini Mental State Examination (MMSE) and were assessed on the Clinical Dementia Rating-scale (CDR). According to the CDR results 446 subjects were screened as non-demented. Of these subjects 30% scored below or at 24 MMSE points. Age, education and social group had a significant effect on the MMSE scores, even after excluding the demented cases. Together they explained 10% of the total variance within the MMSE. Social group correlated with education. The MMSE scores were corrected according to age and education. Adjustment of the originally used cutpoint of 24 resulted in cutpoints of 25 and 26 among the 75-year-olds, in the low and high education groups respectively; 23 and 26 in the 80-year-olds; 22 and 23 in the 85-year-olds.

Age Factors↗
PubMed1991

Diagnosis of multi-infarct dementia.

Multi-infarct dementia (MID) is commonly considered a dementia syndrome evolving in connection with multiple ischemic brain lesions, without other changes known to cause dementia. The ischemic brain lesions result from various vascular mechanisms, and different brain mechanisms are involved in the genesis of MID. Typical features for MID are abrupt onset of cognitive symptoms, stepwise deterioration of mental functioning, and focal neurologic symptoms or signs, but in 20% of cases the onset is insidious and the course is even. The main steps in diagnosis of MID include diagnosis of dementia, diagnosis of specific causes of dementia and secondary factors potentially aggravating cognitive decline, and demonstration of ischemic brain changes assumed to be responsible for the evolution of dementia. Methods used for clinical diagnosis of MID include clinical history and examination, brain imaging, ischemic scores, neurophysiologic investigations, and a variety of laboratory investigations designed to detect concomitant illness. According to strict clinical criteria for MID, the accuracy of the antemortem diagnosis as verified postmortem in one series was approximately 90%.

Dementia, Multi-Infarct↗
PubMed1991

99Tcm-HMPAO SPECT in suspected dementia.

To evaluate the usefulness of 99Tcm-hexamethylpropyleneamine oxime (HMPAO) single photon emission computed tomography (SPECT) in suspected dementia we studied 160 consecutively imaged elderly patients from our hospital's memory disorder clinic. The diagnosis was based on clinical data, laboratory tests, neuropsychological examination, computed tomography (CT) and EEG. The patients were divided into six diagnostic categories: Alzheimer's disease (AD), multi-infarct dementia (MID), frontal lobe-type dementia (FTD), vascular encephalopathy not fulfilling the criteria of dementia, specific organic conditions, and psychiatric disorders. SPECT images were assessed without knowing the clinical diagnosis, and divided into AD pattern, FTD pattern, MID pattern, abnormal but unclassifiable, and normal. Twenty-three of 36 patients with clinical AD, 25/33 patients with clinical MID, and 2/5 patients with clinical TFD had compatible SPECT patterns. SPECT distinguished AD from MID in the majority (80%) of cases. In patients with depression or anxiety SPECT was abnormal in 16/21 cases, suggesting that SPECT may give early clues to the presence of an underlying organic disease in such elderly patients. Thus, SPECT with 99Tcm-HMPAO seems to be useful in the diagnosis of suspected dementia.

Aged↗
PubMed1991

Platelet membrane fluidity in Alzheimer's disease and multi-infarct dementia: a spin label study.

The membrane fluidity of platelets isolated from 15 patients with probable Alzheimer's disease (AD), 11 patients with probable multi-infarct dementia (MID), and 7 neurologically healthy controls was studied by electron spin resonance (ESR) spectroscopy employing spin label techniques. Spin label I(12,3) probed the shallow site (hydrophilic region) and spin label I(5, 10) the deeper site (hydrophobic region) of the platelet membrane. With both probes, a significant increase in membrane fluidity was observed in patients with AD and MID, as compared to age-matched controls. However, there were no significant differences in fluidity between AD and MID patients. Our results suggest an increased platelet membrane fluidity in dementias, but the change seems not to be specific to AD.

Aged↗
PubMed1990

Pattern of language impairment is different in Alzheimer's disease and multi-infarct dementia.

Language impairment was assessed in 33 patients with Alzheimer's disease (AD), in 52 patients with multi-infarct dementia (MID), and in 86 elderly community residents. The investigation included the D-Test Battery based on the Luria's Neuropsychological Investigation for all subjects. An extended battery of Luria's language items was used for 30 demented patients (11 AD and 19 MID patients) and 86 controls. The changes in language functions in normal subjects could be clearly differentiated from those seen in patients with mild dementia. The patients with different degrees of dementia differed also significantly from each other in regard to language impairment. Moreover, patients with AD and MID appeared to have different patterns of language impairment although the severity of dementia and the levels of orientation, mnestic, and conceptual functions were equal. AD was associated especially with a defect in understanding of grammatical structures and MID with disorders in recognition of words, naming, and repetition. The differential diagnostic capacity of 23 selected language items proved to be 97% between AD, MID, and control subjects. The results indicate that the examination of language functions is valuable in the differential diagnosis of dementia.

Aged↗
PubMed1989

White matter low attenuation on CT in Alzheimer's disease.

White matter low attenuation (WMLA) was seen on CT in 19.7% of 61 patients with probable Alzheimer's disease. Presence of WMLA was associated with higher age, more severe degree of dementia, and increased CSF/serum albumin ratio, but not with cardiovascular disorders. WMLA on CT might be related to minor vascular events, or Alzheimer patients with WMLA could even constitute their own subtype.

Aged↗
PubMed1988

Oligoclonal immunoglobulin bands in cerebrospinal fluid of patients with Alzheimer's disease and vascular dementia.

We examined serum and cerebrospinal fluid (CSF) of 16 patients with Alzheimer's disease (AD), 28 patients with vascular dementia (VD), their age-matched controls and multiple sclerosis (MS) patients in order to evaluate the humoral immune response within the central nervous system both quantitatively and qualitatively. Intra-blood-brain barrier (BBB) protein synthesis was calculated by CSF IgG index. The presence of oligoclonal banding (OCB) was investigated with agarose isoelectric focusing (IEF) followed by immunoblotting with antihuman IgG. No patient with AD and only 4 patients with VD had slightly elevated IgG indexes, and no statistically significant differences in the indexes were found between the two groups. No bands were found in the CSF of AD patients but 3 VD patients had OCB in both serum and CSF. One VD patient had bands in serum but no bands in CSF. No kappa or lambda free light chains were found in those demented patients with demonstrable bands in the CSF and serum. No OCB were found in control sera and CSF. For comparison, the majority of patients with MS had OCB in CSF. Thus, no consistent increase of intrathecal protein synthesis was found in patients with AD and VD. Methodological differences explain at least part of the conflicting results published earlier.

Aged↗