926 resultados para Dementia
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BACKGROUND AND PURPOSE: Most of the neuropathological studies in brain aging were based on the assumption of a symmetrical right-left hemisphere distribution of both Alzheimer disease and vascular pathology. To explore the impact of asymmetrical lesion formation on cognition, we performed a clinicopathological analysis of 153 cases with mixed pathology except macroinfarcts. METHODS: Cognitive status was assessed prospectively using the Clinical Dementia Rating scale; neuropathological evaluation included assessment of Braak neurofibrillary tangle and Ass deposition staging, microvascular pathology, and lacunes. The right-left hemisphere differences in neuropathological scores were evaluated using the Wilcoxon signed rank test. The relationship between the interhemispheric distribution of lesions and Clinical Dementia Rating scores was assessed using ordered logistic regression. RESULTS: Unlike Braak neurofibrillary tangle and Ass deposition staging, vascular scores were significantly higher in the left hemisphere for all Clinical Dementia Rating scores. A negative relationship was found between Braak neurofibrillary tangle, but not Ass staging, and vascular scores in cases with moderate to severe dementia. In both hemispheres, Braak neurofibrillary tangle staging was the main determinant of cognitive decline followed by vascular scores and Ass deposition staging. The concomitant predominance of Alzheimer disease and vascular pathology in the right hemisphere was associated with significantly higher Clinical Dementia Rating scores. CONCLUSIONS: Our data show that the cognitive impact of Alzheimer disease and vascular lesions in mixed cases may be assessed unilaterally without major information loss. However, interhemispheric differences and, in particular, increased vascular and Alzheimer disease burden in the right hemisphere may increase the risk for dementia in this group.
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English summary: A woman's lot : wives as caregivers to their demented husbands
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A. Costanza, K. Weber, S. Gandy, C. Bouras, P. R. Hof, P. Giannakopoulos and A. Canuto (2011) Neuropathology and Applied Neurobiology37, 570-584 Contact sport-related chronic traumatic encephalopathy in the elderly: clinical expression and structural substrates Professional boxers and other contact sport athletes are exposed to repetitive brain trauma that may affect motor functions, cognitive performance, emotional regulation and social awareness. The term of chronic traumatic encephalopathy (CTE) was recently introduced to regroup a wide spectrum of symptoms such as cerebellar, pyramidal and extrapyramidal syndromes, impairments in orientation, memory, language, attention, information processing and frontal executive functions, as well as personality changes and behavioural and psychiatric symptoms. Magnetic resonance imaging usually reveals hippocampal and vermis atrophy, a cavum septum pellucidum, signs of diffuse axonal injury, pituitary gland atrophy, dilated perivascular spaces and periventricular white matter disease. Given the partial overlapping of the clinical expression, epidemiology and pathogenesis of CTE and Alzheimer's disease (AD), as well as the close association between traumatic brain injuries (TBIs) and neurofibrillary tangle formation, a mixed pathology promoted by pathogenetic cascades resulting in either CTE or AD has been postulated. Molecular studies suggested that TBIs increase the neurotoxicity of the TAR DNA-binding protein 43 (TDP-43) that is a key pathological marker of ubiquitin-positive forms of frontotemporal dementia (FTLD-TDP) associated or not with motor neurone disease/amyotrophic lateral sclerosis (ALS). Similar patterns of immunoreactivity for TDP-43 in CTE, FTLD-TDP and ALS as well as epidemiological correlations support the presence of common pathogenetic mechanisms. The present review provides a critical update of the evolution of the concept of CTE with reference to its neuropathological definition together with an in-depth discussion of the differential diagnosis between this entity, AD and frontotemporal dementia.
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Computational anatomy with magnetic resonance imaging (MRI) is well established as a noninvasive biomarker of Alzheimer's disease (AD); however, there is less certainty about its dependency on the staging of AD. We use classical group analyses and automated machine learning classification of standard structural MRI scans to investigate AD diagnostic accuracy from the preclinical phase to clinical dementia. Longitudinal data from the Alzheimer's Disease Neuroimaging Initiative were stratified into 4 groups according to the clinical status-(1) AD patients; (2) mild cognitive impairment (MCI) converters; (3) MCI nonconverters; and (4) healthy controls-and submitted to a support vector machine. The obtained classifier was significantly above the chance level (62%) for detecting AD already 4 years before conversion from MCI. Voxel-based univariate tests confirmed the plausibility of our findings detecting a distributed network of hippocampal-temporoparietal atrophy in AD patients. We also identified a subgroup of control subjects with brain structure and cognitive changes highly similar to those observed in AD. Our results indicate that computational anatomy can detect AD substantially earlier than suggested by current models. The demonstrated differential spatial pattern of atrophy between correctly and incorrectly classified AD patients challenges the assumption of a uniform pathophysiological process underlying clinically identified AD.
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Revisi sobre leficcia de les intervencions dirigides a cuidadorsinformals de malalts amb demncia per a reduir els nivells de morbiditatpsicolgicaAntecedentsLenvelliment de la poblaci est relacionat amb laugment de la prevalena dedemncies tals com la malaltia dAlzheimer. El carcter progressiu, incapacitanti irreversible de la malaltia dAlzheimer comporta dependncia i demanda,obligant laparici dun cuidador informal per cobrir les necessitats del malalt.Amb levoluci de la malaltia, augmenta lexigncia de les cures i el cuidador esveu en risc de patir alteracions a qualsevol nivell, principalment a nivellpsicolgic.Objectius1. Avaluar lefectivitat de les intervencions dirigides a cuidadors informals depersones amb demncia per a reduir la morbiditat psicolgica, segons latipologia de les intervencions i els seus components.2. Avaluar lefectivitat de les intervencions dirigides a cuidadors informals depersones amb demncia per a reduir la morbiditat psicolgica, segons lescaracterstiques sociodemogrfiques del cuidador i la persona que rep lescures, el tipus de crrega i els instruments de mesura.Material i mtodesEs va realitzar una revisi bibliogrfica en les bases de dades: MEDLINEPubMed, CSIC-IME, CUIDEN i Biblioteca Cochrane Plus sobre lesintervencions dirigides a cuidadors informals de demncia o Alzheimerdestudis publicats entre el gener de 2002 i febrer de 2013. Els criteris dinclusivan ser: cuidadors informals que convisquessin amb la persona a qui donen lescures i sense remuneraci econmica, persones amb demncia o Alzheimer noinstitucionalitzades, intervencions comparades entre un grup experimental i ungrup control, prioritat per revisions sistemtiques i metanlisis. La mostra finalla van composar 7 estudis.ResultatsLes diferents intervencions analitzades van mostrar dades estadsticamentsignificatives tot i produir efectes discrets en les diferents variables demorbiditat psicolgica. Les intervencions psicoeducatives i les intervencionsdirigides als pacients van resultar efectives en la millora de la sensaci debenestar i la simptomatologia del malalt. Les intervencions psicolgiques vanincidir en la sobrecrrega i la depressi. Les intervencions de suport vanproduir un augment dels coneixements, habilitats i de la xarxa social delcuidador. El dia de descans va disminuir lestrs, lansietat i la crrega objectivaper els efectes van ser a curt termini. Les intervencions mltiplesestructurades van mostrar una disminuci del risc dinstitucionalitzaci. Lesintervencions centrades en la resoluci de problemes, superiors a 6 sessions oaquelles que havien realitzat seguiment, van mostrar efectes a llarg termini finsals 12 mesos. Altres intervencions prctiques com les realitzades al domicili oamb tecnologia, no van mostrar suficient evidncia cientfica. El sexe i ledat delcuidador aix com la relaci de parentesc amb el malalt van mostrar difernciesen els efectes de les intervencions.ConclusionsLes intervencions shan de planificar en funci de les necessitats del cuidadorja que no hi ha cap intervenci que incideixi en totes les variables de morbiditatpsicolgica. La variabilitat de tipologia i composici de les intervencions, lesdiferncies sociodemogrfiques del cuidador i la persona que rep les cures i lescaracterstiques dels estudis influeixen en lheterogenetat de resultats de larevisi. Aquests fets limiten la contundncia de resultats pel que cal seguirinvestigant
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Highly active anti-retroviral therapy (HAART) has almost abolished HIV-related mortality and serious opportunistic diseases; among them, AIDS-related dementia. However, minor forms of cognitive dysfunction, have not disappeared, and even increased in frequency. Ageing of HIV+ patients, insufficient penetration of anti-viral drugs into the brain with continuous low-grade viral production and inflammation may play a role. Minor cognitive dysfunction in HIV infection shares some clinical and pathophysiological features with neuro-degenerative diseases, in particular Alzheimers disease. It can thus be postulated that, such in Alzheimer disease, anti-cholinesterase drugs might also be efficacious in AIDS-related minor cognitive dysfunction. This hypothesis has not been tested yet however A clinical trial using ravistigmine is starting this spring in patients with HIV-associated cognitive dysfunction in Geneva and Lausanne.
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Lobjectiu daquest estudi s crear un programa de prevenci de la demncia a partir dactivitats i ocupacions significatives. Sutilitzar la metodologia quantitativa i es realitzar un estudi experimental i seqencial. Lestudi es realitzar al medi rural, concretament a Ripoll (Sant Bernab). Per tal de poder obtenir la els participants per la realitzaci de lestudi sutilitzar el mostreig aleatori estratificat amb el qual sobtindr dos grups de 16 persones de 50 a 55 anys. Els instruments que sutilitzaran per tal de poder obtenir les dades de lestudi sn el Qestionari internacional dactivitat fsica (2002), la bateria neuropsicolgica anomenada Test de Barcelona abreviat (1997), Lescala de qualitat de vida (2008), i per acabar sutilitzar el Test KIMED (2004). Una primera limitaci pot ser que lajuntament no ens faciliti les dades per tal de poder realitzar el mostreig aleatori estratificat per tal de poder aconseguir la mostra. Tamb pot ser que lajuntament no cedeixi el lloc per tal de poder realitzar la intervenci. Un altre possible limitaci pot ser el temps atmosfric. I per acabar tamb ens podem torbar amb labandonament del programa per part dun o ms participants.
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L'any 2011 la malaltia d'Alzheimer es situava com la quarta causa de mort ms freqent amb un augment de fins a 11.907, ms del doble de morts que l'any 2000 (INE). Aquestes dades demostren l'augment del nmero de persones que pateixen una demncia a mesura que envelleixen i una de les explicacions s l'augment de l'esperana de vida. Per aquest motiu l'estudi de la qualitat de vida ha adquirit una gran importncia des de la dcada dels 90. La qualitat de vida s un concepte especialment subjectiu pel fet que cada persona la viu segons la prpia percepci de salut i benestar i el grau d'adaptaci a l'entorn que l'envolta. Per aquest motiu es planteja un programa de psicoestimulaci integral (PPI) centrat en les individualitats de cada persona: valors, interessos, histria ocupacional..., des de la filosofia de la Terpia Ocupacional. El projecte est elaborat mitjanant la metodologia qualitativa utilitzant l'enquesta en profunditat semi-estructurada per a realitzar les entrevistes i obtenir la informaci principal a l'inici i al final del programa juntament amb tota la informaci que s'obtingui de l'observaci participant del dia a dia de cada un dels professionals per tal d'estudiar fins a quin punt aquesta atenci centrada en la persona contribueix a millorar la qualitat de vida de les persones afectades de Malaltia d'Alzheimer que reben tractaments no farmacolgics com el proposat en aquest projecte. Com a tot estudi es poden trobar alguns factors condicionants com pot ser l'evoluci prpia de la malaltia amb les conseqncies negatives que aix comporta i/o el nmero de participants que formen la mostra.
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The Cognitive Performance Scale (CPS) was initially designed to assess cognition in long term care residents. Subsequently, the CPS has also been used among in-home, post-acute, and acute care populations even though CPS' clinimetric performance has not been studied in these settings. This study aimed to determine CPS agreement with the Mini Mental Status Exam (MMSE) and its predictive validity for institutionalization and death in a cohort (N=401) of elderly medical inpatients aged 75 years and over. Medical, physical and mental status were assessed upon admission. The same day, the patient's nurse completed the CPS by interview. Follow-up data were gathered from the central billing system (nursing home stay) and proxies (death). Cognitive impairment was present in 92 (23%) patients according to CPS (score >or= 2). Agreement with MMSE was moderate (kappa 0.52, P<.001). Analysis of discordant results suggested that cognitive impairment was overestimated by the CPS in dependent patients with comorbidities and depressive symptoms, and underestimated in older ones. During follow-up, subjects with abnormal CPS had increased risks of death (adjusted hazard ratio (adjHR) 1.7, 95% CI 1.0-2.8, P=.035) and institutionalization (adjHR 2.7, 95% CI 1.3-5.3, P=.006), independent of demographic, health and functional status. Interestingly, subjects with abnormal CPS were at increased risk of death only if they also had abnormal MMSE. The CPS predicted death and institutionalization during follow-up, but correlated moderately well with the MMSE. Combining CPS and MMSE provided additional predictive information, suggesting that domains other than cognition are assessed by professionals when using the CPS in elderly medical inpatients.
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Providing or withholding nutrition in severely disabled elderly persons is a challenging dilemma for families, health professionals, and institutions. Despite limited evidence that nutrition support improves functional status in vulnerable older persons, especially those suffering from dementia, the issue of nutrition support in this population is strongly debated. Nutrition might be considered a basic need that not only sustains life but provides comfort as well by patients and their families. Consequently, the decision to provide or withhold nutrition support during medical care is often complex and involves clinical, legal, and ethical considerations. This article proposes a guide for health professionals to appraise ethical issues related to nutrition support in severely disabled older persons. This guide is based on an 8-step process to identify the components of a situation, analyze conflicting values that result in the ethical dilemma, and eventually reach a consensus for the most relevant plan of care to implement in a specific clinical situation. A vignette is presented to illustrate the use of this guide when analyzing a clinical situation.
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Alzheimer's disease is the most prevalent form of progressive degenerative dementia; it has a high socio-economic impact in Western countries. Therefore it is one of the most active research areas today. Alzheimer's is sometimes diagnosed by excluding other dementias, and definitive confirmation is only obtained through a post-mortem study of the brain tissue of the patient. The work presented here is part of a larger study that aims to identify novel technologies and biomarkers for early Alzheimer's disease detection, and it focuses on evaluating the suitability of a new approach for early diagnosis of Alzheimers disease by non-invasive methods. The purpose is to examine, in a pilot study, the potential of applying Machine Learning algorithms to speech features obtained from suspected Alzheimer sufferers in order help diagnose this disease and determine its degree of severity. Two human capabilities relevant in communication have been analyzed for feature selection: Spontaneous Speech and Emotional Response. The experimental results obtained were very satisfactory and promising for the early diagnosis and classification of Alzheimers disease patients.
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Alzheimers disease (AD) is the most prevalent form of progressive degenerative dementia and it has a high socio-economic impact in Western countries, therefore is one of the most active research areas today. Its diagnosis is sometimes made by excluding other dementias, and definitive confirmation must be done trough a post-mortem study of the brain tissue of the patient. The purpose of this paper is to contribute to im-provement of early diagnosis of AD and its degree of severity, from an automatic analysis performed by non-invasive intelligent methods. The methods selected in this case are Automatic Spontaneous Speech Analysis (ASSA) and Emotional Temperature (ET), that have the great advantage of being non invasive, low cost and without any side effects.
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Critical reading and careful interpretation of results of the medical literature is a difficult task for primary care physicians. Being aware of common potential pitfalls that may bias results of a study is helpful. Among common pitfalls, odds ratios are often interpreted as relative risks, which overestimate the impact of a risk factor. Randomized controlled trials assessing the effectiveness of a new drug or a new target disease often use surrogate markers instead of clinical events as outcomes. Results of these trials should be considered with caution before using their results for clinical practice. For screening, observational studies often yield potentially biased or conflicting results. As clinical guidelines and expert opinions are often conflicting, primary care physicians should wait for results of large clinical trials in clinical events before changing their practice for screening or new drugs.
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ENABLE -projektin loppukongressi Oslossa 21. - 23.6.2004
