PubMed Health⌕ Search

Biomedical subjects

T Hope

Publications and source records attributed to T Hope.

At least 19 recordsLinked to original sources
PubMed1998

An investigation of satiety in ageing, dementia, and hyperphagia.

OBJECTIVE: To investigate satiety in young, middle-aged, and elderly healthy adults, and in nonhyperphagic and hyperphagic elderly people with dementia. Previous work suggested hyperphagia in dementia was due to increased hunger and absence of satiation. METHODS: The primary measure of satiety was the amount of food eaten in an ad libitum meal, given 1 hr after a fixed preload. Three types of preload were used, high- and low-energy milkshakes and water. The effect of age was investigated by comparing the three groups of healthy adults. The effect of dementia was investigated by comparing the two demented groups with healthy elderly. RESULTS: Measurements suggested that accuracy of compensation for preload energy differences decreased with age and was absent in people with dementia. DISCUSSION: Lack of compensatory response in the elderly, particularly those with dementia, indicates the need for monitoring food intake to prevent over- or undereating.

Adult↗
PubMed1997

HIV-1 infection of nondividing cells through the recognition of integrase by the importin/karyopherin pathway.

The karyophilic properties of the HIV-1 nucleoprotein complex facilitate infection of nondividing cells such as macrophages and quiescent T lymphocytes, and allow the in vivo delivery of transgenes by HIV-derived retroviral vectors into terminally differentiated cells such as neurons. Although the viral matrix (MA) and Vpr proteins have previously been shown to play important roles in this process, we demonstrate here that integrase, the enzyme responsible for mediating the integration of the viral genome in the host cell chromosome, can suffice to connect the HIV-1 preintegration complex with the cell nuclear import machinery. This novel function of integrase reflects the recognition of an atypical bipartite nuclear localization signal by the importin/karyopherin pathway.

Cell Differentiation↗
PubMed1997

Do neuroleptic drugs hasten cognitive decline in dementia? Prospective study with necropsy follow up.

OBJECTIVE: To investigate the contribution of neuroleptic drugs to cognitive decline in dementia. DESIGN: Two year prospective, longitudinal study consisting of interviews every four months, with necropsy follow up. SETTING: Community settings in Oxfordshire. SUBJECTS: 71 subjects with dementia, initially living at home with informant. MAIN OUTCOME MEASURES: Cognitive function (score from expanded minimental state examination); behavioural problems (physical aggression, hallucinations, persecutory ideas, and disturbance of diurnal rhythm); and postmortem neuropathological assessment (cortical Lewy body pathology). RESULTS: The mean (SE) decline in cognitive score in the 16 patients who took neuroleptics was twice that in the patients who did not (20.7 (2.9) v 9.3 (1.3), P = 0.002). An increased rate of decline was also associated with aggression, disturbed diurnal rhythm, and persecutory ideas. However, only use of neuroleptics and severity of persecutory ideas were independently associated with more rapid cognitive decline when all other variables were adjusted for. The start of neuroleptic treatment coincided with more rapid cognitive decline: median rate of decline was 5 (interquartile range 8.5) points per year before treatment and 11 (12) points per year after treatment (P = 0.02). Cortical Lewy body pathology did not account for association between neuroleptic use and more rapid decline. CONCLUSIONS: Neuroleptic drugs that are sometimes used to treat behavioural complications of dementia may worsen already poor cognitive function. Randomised controlled trials are needed to confirm a causal relation.

Aged↗
PubMed1997

Behaviour changes in dementia. 1: Point of entry data of a prospective study.

OBJECTIVE: This article analyses behaviour changes in dementia at the point of entry to a longitudinal study. DESIGN: Prospective, longitudinal study of behaviour in dementia, with autopsy follow-up. SETTING: Subjects with dementia, living at home with a carer. All lived in Oxfordshire, UK. PARTICIPANTS: Ninety-seven people with dementia (Alzheimer's disease and/or vascular dementia) who were living at home with a carer. MEASURES: At 4-monthly intervals, the carers were interviewed and the subjects with dementia were assessed cognitively. Subjects' behaviour was assessed using the Present Behavioural Examination. This is an investigator-based, semi-structured interview consisting of eight main sections covering many different aspects of behaviour. The 121 main questions, with 66 further 'nested' questions, have been shown to have high reliability. RESULTS: This article analyses the types of behaviour change reported by carers at the point of entry to this long-term study. Few correlations were found between behaviour and age, gender and time since onset of dementia. Some types of behaviour were significantly more prevalent in those with greater cognitive impairment. CONCLUSIONS: Many of these changes create problems for carers, for example increased aggressive behaviour, wandering, wakefulness at night, incontinence and persecutory ideas. In general, they are more prevalent in people with more severe dementia.

Aged↗
PubMed1997

Behaviour changes in dementia. 2: Are there behavioural syndromes?

OBJECTIVE: To establish whether robust behavioural 'syndromes' can be identified from among the widely heterogeneous behavioural changes which occur in dementia. DESIGN: Longitudinal, prospective study with follow-up at 4 and 8 months. SETTING: Community settings in Oxfordshire, UK. PARTICIPANTS: 97 elderly people with a diagnosis of Alzheimer's disease or vascular dementia (in many cases confirmed by postmortem examination) and who were living at home with a carer. MEASURES: Each subject's behaviour was assessed in detail at each interview using the Present Behavioural Examination to assess subject's behaviour over the preceding 4 weeks. Seventeen key behaviour items which were both common and clinically important were selected for further analysis. RESULTS: Three syndromes were identified: (a) overactivity (walking more, walking aimlessly, trailing the carer or checking where the carer was); (b) aggressive behaviour (physical aggression, aggressive resistance, verbal aggression); (c) psychosis (anxiety, persecutory ideas and hallucinations). The same syndromes were found using data collected at three different time points and by using a variety of statistical techniques, confirming their robustness. CONCLUSIONS: Overactivity, aggressive behaviour and psychosis form three distinct behavioural syndromes in dementia.

Aged↗
PubMed1997

Hyperphagia in dementia: 1. The use of an objective and reliable method for measuring hyperphagia in people with dementia.

Up to one third of dementia sufferers eat an increased quantity of food, compared with their premorbid intake, at some stage during the dementia. A proportion of these eat extraordinarily large quantities if food intake is not restricted. In order to investigate this phenomenon in detail, a reliable and standardized method of quantifying the degree of hyperphagia is required. We report the development of such a method. Twenty-six people with dementia, who were reported by their carers to be hyperphagic, were compared with 14 matched non-hyperphagic controls with dementia and 14 matched normal elderly. Subjects were offered two standardized meals, under specified conditions, ad libitum. One meal consisted of a single food, the other of a mixture of foods. The total energy intake provided a reliable measure of the degree of hyperphagia. The single food meal was more reliable but the mixed meal was a more sensitive measure of the hyperphagia.

Aged↗
PubMed1997

Hyperphagia in dementia: 2. Food choices and their macronutrient contents in hyperphagia, dementia and ageing.

Up to one third of dementia sufferers eat an increased quantity of food compared with their premorbid intake, at some stage during the dementia. In addition, over half of people with dementia are reported, by their carers, to show a marked change in food choice, particularly an increased liking for sweet food. The macronutrient content of foods chosen and the ratio of sweet to savoury foods were investigated experimentally using a standardized mixed meal. Three subject groups were studied: 17 people with dementia who were reported by their carers to overeat and who ate excessively under experimental conditions; 14 people with dementia who ate a normal amount; and, normal, non-demented controls (18 under 50 years old and 14 over 50 years old). The results showed that the normal elderly people chose a lower proportion of high-protein food than the young. The proportion of protein eaten was lower in people with dementia than in age-matched controls and was even lower in the hyperphagic dementia group. The proportion of sweet food eaten was higher in people with dementia and even higher in people with dementia who were hyperphagic. Various mechanisms to account for the results are discussed.

Adult↗
PubMed1997

Cognitive impairment in medical inpatients. I: Screening for dementia--is history better than mental state?

BACKGROUND: evaluation of the short version of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) and the Abbreviated Mental Test (AMT) as screening tools for dementia in medical inpatients. METHODS: 201 patients over 65 were assessed. Assessment included administration of the AMT, a delirium screening instrument and a brief psychiatric interview. Relatives were interviewed and the IQCODE administered. Diagnostic and Statistical Manual (DSM) IIIR diagnoses of various causes of cognitive impairment were made. Sensitivity and specificity values of the screening tests for a DSM IIIR diagnosis of dementia were calculated. RESULTS: our study suggests that the IQCODE is more accurate than the AMT as a screening instrument for dementia. Using a cut-off point of > 3.44, sensitivity and specificity of the IQCODE for diagnosing dementia were 100 and 86% respectively. Equivalent values for the AMT (cut-off point < 8) were 96 and 73%. It was possible to use the IQCODE in eight of the 10 patients unable to complete the AMT. CONCLUSION: using both the IQCODE and a brief cognitive function test when screening for dementia in medical inpatients will maximize the number of patients who can be screened.

Aged↗
PubMed1997

Cognitive impairment in medical inpatients. II: Do physicians miss cognitive impairment?

AIM: to study the recognition of cognitive impairment in elderly medical inpatients by medical staff. METHODS: 201 patients over 65 were assessed by administration of standard cognitive screening tests and an interview with relatives. We made Diagnostic and Statistical Manual (DSM) IIIR diagnoses of various causes of cognitive impairment and clinical diagnoses for those patients not fulfilling DSM IIIR criteria. Medical notes were scrutinized for any mention of cognitive impairment. RESULTS: 46% of the patients found to be cognitively impaired by the researcher had no record of cognitive impairment in the medical notes. However, 14 out of 15 of the patients with DSM IIIR delirium, and 22 out of the 26 patients with DSM IIIR dementia, were identified as cognitively impaired by the physicians. This suggests that the physicians were detecting the vast majority of patients with clinically significant cognitive impairment.

Aged↗
PubMed1997

Ethics and the GMC core curriculum: a survey of resources in UK medical schools.

OBJECTIVES: To study the resources available and resources needed for ethics teaching to medical students in UK medical schools as required by the new GMC core curriculum. DESIGN: A structured questionnaire was piloted and then circulated to deans of medical schools. SETTING: All UK medical schools. RESULTS: Eighteen out of 28 schools completed the questionnaire, the remainder either indicating that their arrangements were "under review" (4) or not responding (6). Among those responding: 1) library resources, including video and information technology were found to be fairly well developed; 2) many schools had a good supply of handouts and sample cases for teaching; 3) most had a written syllabus, and 4) two-thirds examined in the subject. However, many schools indicated that there was an urgent need for: 1) full-time teachers (most ethics teaching is still by part-time and voluntary staff); funding for books and journals, and 3) additional teaching materials (including further case vignettes, handouts and sample exam questions). CONCLUSIONS: There has been a considerable overall improvement in resources for medical ethics teaching since the time of the last national survey (The Pond Report). However, provision varies widely from medical school to medical school. The particular needs identified were for full-time teachers, library resources and teaching materials. Wider use of existing organisations concerned with medical ethics could help to meet these needs.

Curriculum↗
PubMed1997

Manchester and Oxford University Scale for the psychopathological assessment of dementia.

There is increasing awareness of the importance of psychopathological and behavioral changes in dementia and a need for a technique to measure these noncognitive features. Such a schedule should keep screening questions to a minimum, include a severity measure, exclude symptoms resulting from physical illness, be as brief as possible, and not mix domains of psychopathology. To test the reliability, sensitivity, and validity of a newly developed test, 30 carers were interviewed four times during 6 weeks. An obligatory stem question in each category was followed by supplementary questions. The interviewer recorded the presence of each symptom, its severity, when each symptom started, its duration, and whether it was still present. To detect the presence of delusions, the informant was asked about the patient's insight. Satisfactory differences in mean kappa values were demonstrated in test-retest and interrater reliability and validity compared with other techniques. This test may be useful to measure the outcome of drug trials, for correlating psychopathological and behavioral changes with autopsy findings and in epidemiological surveys.

Aged↗