Gene/Protein Disease Symptom Drug Enzyme Compound
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 4,384 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Vascular dementia (VaD) and Alzheimer's disease are sometimes difficult to distinguish due to overlaps in symptomatology, pathophysiology and comorbidity. The issue of differential diagnosis is further complicated by the fact that many patients have concomitant Alzheimer's disease and cerebrovascular disease (CVD) ('mixed' dementia). Each pathology may contribute to varying degrees, giving rise to a continuum of patients in whom pure CVD and pure Alzheimer's disease represent the two extremes. Despite the clear overlap between the conditions, and the prevalence of 'mixed' dementia, a number of criteria for Alzheimer's disease and VaD do not make provision for 'mixed' dementia distinct from the coincidence of any two other dementing illnesses. We will discuss the current diagnostic criteria for VaD, with or without coexisting Alzheimer's disease, in an effort to determine how best to diagnose VaD. These include traditional criteria such as the Diagnostic and Statistical Manual of Mental Disorders or the Hachinski Ischemic Scale, and the more recently developed criteria by the California Alzheimer's Disease Diagnostic and Treatment Centers (CAD-DTC) and the National Institute of Neurological Disorders and Stroke and the Association Internationale pour la Recherche et l'Enseignement en Neurosciences (NINDS-AIREN) International Workshop. The CAD-DTC and NINDS-AIREN rely on neuroimaging--ideally, every patient suspected of dementia should have brain imaging, but although this is possible in clinical trials (for which these criteria were designed), it is not always feasible in population-based epidemiological studies and clinical practice in some countries.
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PMID:Diagnosis of vascular dementia and Alzheimer's disease. 1140 27

Systematic evaluation of end-of-life care in dementia has been hampered by a lack of instruments to specifically address those issues that are unique for persons who are dying with dementia. This study evaluated psychometric properties of three scales designed to measure outcomes of care of persons suffering from terminal dementia. A survey of family caregivers whose loved one died during the past year was conducted using a questionnaire that included questions regarding satisfaction with care, physical and emotional symptoms that occurred during the last 90 days of the care recipient's life, and comfort during the dying process. Three scales were developed based on responses from 156 questionnaires: Satisfaction with Care at the End-of-Life in Dementia (SWC-EOLD), Symptom Management at the End-of-Life in Dementia (SM-EOLD) with Physical and Psychological Symptoms subscales, and Comfort Assessment in Dying with Dementia (CAD-EOLD) with four subscales: Physical Distress, Dying Symptoms, Emotional Distress, and Well Being. The three scales developed and evaluated in this study can be used as outcome measures in studies investigating effectiveness of interventions aimed to improve end-of-life care for individuals with dementia.
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PMID:Scales for evaluation of End-of-Life Care in Dementia. 1172 70

Assessment of suffering is extremely important in dying end-stage dementia patients (ESDP). We have developed and examined the reliability and validity of the Mini-Suffering State Examination (MSSE), in 103 consecutive bedridden ESDP. Main outcome measures included inter-observer reliability and concurrent validity. Reliability of the MSSE questionnaire was satisfactory, with Cronbach alpha values of 0.735 and 0.718 for the two physicians (Ph-1, Ph-2), respectively. The kappa agreement coefficient was 0.791. There was a high agreement for seven items (kappa 0.882-0.972) and a substantial agreement for the other three items (kappa 0.621-0.682) of the MSSE. MSSE was validated versus the comfort assessment in dying with dementia (CAD-EOLD) scale and resulted in a significant Pearson correlation (r=-0.796, P<0.001). We conclude that the MSSE scale is a reliable and valid clinical tool, recommended for evaluating the severity of the patient's condition and the level of suffering of ESDP. Use of MSSE may improve medical management and facilitate communication between patients and caregivers.
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PMID:Measuring the suffering of end-stage dementia: reliability and validity of the Mini-Suffering State Examination. 1469 90

Elderly patients are significantly less likely to receive statins than younger patients possibly because of doubts regarding compliance or concerns regarding the increased likelihood of adverse events and drug interactions. Poor compliance can be expected especially in patients suffering from dementia or depression as well as those whose stage of cardiovascular disease exhibits few symptoms. On the other hand, the clinical significance of CHD events is high in the elderly, and 80% of coronary deaths occur in patients aged over 65 years. The average statistical life expectancy of elderly and old patients is often underestimated. The HPS and PROSPER studies showed that statins reduce mortality and morbidity even in very elderly individuals with a high global cardiovascular risk and/or CAD. Patients up to the age of 79 years should be treated according to the same guidelines as younger patients. Statin therapy should only be considered for patients aged 80 years and older who are at a very high risk for cardiovascular events.
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PMID:[Recommendations for statin therapy in the elderly]. 1534 Jun 98

The lack of valid and reliable instruments designed to measure the experiences of older persons with advanced dementia and those of their health care proxies has limited palliative care research for this condition. This study evaluated the reliability and validity of 3 End-of-Life in Dementia (EOLD) scales that measure the following outcomes: (1) satisfaction with the terminal care (SWC-EOLD), (2) symptom management (SM-EOLD), and (3) comfort during the last 7 days of life (CAD-EOLD). Data were derived from interviews with the health care proxies (SWC-EOLD) and primary care nurses (SM-EOLD, CAD-EOLD) for 189 nursing home residents with advanced dementia living in 15 Boston-area facilities. The scales demonstrated satisfactory to good reliability: SM-EOLD (alpha=0.68), SWC-EOLD (alpha=0.83), and CAD-EOLD (alpha=0.82). The convergent validity of these scales, as measured against other established instruments assessing similar constructs, was good (correlation coefficients ranged from 0.50 to 0.81). The results of this study demonstrate that the 3 EOLD scales demonstrate "internal consistency" reliability and demonstrate convergent validity, and further establish their utility in palliative care dementia research.
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PMID:The validity and reliability of scales for the evaluation of end-of-life care in advanced dementia. 1691 88

After-death reporting by proxies on end-of-life outcomes is used in research and can also be used to target institutions directly to improve practice. We compared the scores of family caregivers and nurses on two End-of-Life in Dementia Scales (EOLD) scales: Symptom Management (SM; range 0-45) over the last 3 months of life and Comfort Assessment in Dying (CAD; range 14-42). Higher scores represent better outcomes. Four Dutch nursing homes retrospectively enrolled 48 decedents with dementia. Total mean scores for family caregivers and nurses were 28.7 (SD 9.6) versus 25.2 (SD 12.7) for the SM and 31.7 (SD 5.5) versus 32.8 (SD 8.2) for the CAD. Mean item scores also did not differ much. Concordance Correlation Coefficients were 0.42 (SM) and 0.04 (CAD). Mean evaluations of end of life with dementia corresponded reasonably well between family and professional caregivers, but correspondence of individual observations was poor to moderate, suggesting serious differences in individual ratings but little systematic difference.
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PMID:Ratings of symptoms and comfort in dementia patients at the end of life: comparison of nurses and families. 1934 75

To evaluate whether there is a relationship between admission serum leptin concentrations and peri-operative myocardial injury, 238 consecutive older patients (mean age 81.9+/-7.9 years; 172 women) with low-trauma hip fracture were assessed. Myocardial injury as defined by elevated serum cardiac troponin I was associated with lower leptin levels analyzed as continuous or categorical variables. Patients with serum leptin concentrations <12ng/ml (medium value) had a two-fold greater increased risk for such complications compared with those with higher leptin levels (odd ratio 2.13, 95% confidence interval 1.06-4.28; p=0.033). This association remained significant after adjustments for age, gender, clinical (history of coronary artery disease [CAD], stroke, hypertension, diabetes, dementia), hematological (red, white, and lymphocyte count, hemoglobin, hematocrit), metabolic (parathyroid hormone [PTH], albumin), renal(creatinine, urea, glomerular filtration rate [GFR]), and inflammatory (C-reactive protein [CRP], ferritin) factors. The predictive value of lower leptin levels increased significantly when used in combination with traditional risk factors for myocardial injury.
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PMID:Serum leptin levels in older patients with hip fracture--impact on peri-operative myocardial injury. 1974 42

Synaptophysin is a specific presynaptic marker for neurons. Loss of synaptophysin occurs in Parkinson's disease, dementia with Lewy bodies and other neurodegenerative diseases. In vitro studies on synaptophysin are important to understand both the function of the protein itself and its implication in the pathogenesis of neurological diseases. In this study, we determined synaptophysin protein expression by Western analysis in 6 different dopaminergic cell lines including one human (SH-SY5Y), two rat (PC12 and N27) and 3 mouse (MN9D, Cath.a and CAD) cell lines. We found that synaptophysin protein is richly expressed in PC12 cells, but much less in other cells we studied. The order of synaptophysin expression from high to low for the other 5 cell lines was CAD> SH-SY5Y> MN9D> Cath.a = N27 cells, with Cath.a and N27 cells expressing almost undetectable content of synaptophysin protein. These data may be useful to other researchers in choosing a dopaminergic cell line as a model system to study the pathophysiology of neuron terminal loss.
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PMID:Expression of synaptophysin protein in different dopaminergic cell lines. 2627 68

Significant advances in positron emission tomography (PET) and magnetic resonance imaging (MRI) brain imaging in the early detection of dementia indicate that hybrid PET/MRI would be an effective tool to screen for dementia in the population living with lifestyle risk factors. Here we investigate the associated costs and benefits along with the needed imaging infrastructure. A demographic analysis determined the prevalence of dementia and its incidence. The expected value of the screening program was calculated assuming a sensitivity and specificity of 0.9, a prevalence of 0.1, a QALY factor of 0.348, a willingness to pay $114,000 CAD and the cost per PET/MRI scan of $2,000 CAD. It was assumed that each head PET/MRI could screen 3,000 individuals per year. The prevalence of dementia is increasing by almost two-fold every 20 years due to the increased population at ages where dementia is more prevalent. It has been shown that a five-year delay in the incidence of dementia would decrease the prevalence by some 45%. In Canada, a five-year delay corresponds to a health care savings of $27,000 CAD per subject per year. The expected value for screening was estimated at $23,745 CAD. The number of subjects to be screened per year in Canada, USA, and China between 60 and 79 was 11,405,000. The corresponding number of head-only hybrid PET/MRI systems needed is 3,800. A brain PET/MRI screening program is financially justifiable with respect to health care costs and justifies the continuing development of MRI compatible brain PET technology.
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PMID:Screening for Dementia Caused by Modifiable Lifestyle Choices Using Hybrid PET/MRI. 3084 96

CDSS (Clinical Decision Support System) is a domain within digital health that aims at supporting clinicians by suggesting the most probable diagnosis based on knowledge obtained from patient data. Usually, decision models used by current CDSS are static, i.e., they are not updated when new data are included, which could allow them to acquire new knowledge and enhance system accuracy. This paper proposes a dynamic decision model that automatically updates itself from classifier models using supervised machine learning algorithms. Our supervised learning process ranks several decision models using classifier performance measures, considering available patient data, filled by the health center, or local clinical guidelines. The decision model with the best performance is then selected to be used in our CDSS, which is designed for the diagnosis of D (Dementia), AD (Alzheimer's Disease), and MCI (Mild Cognitive Impairment). Patient datasets from CAD (Center for Alzheimer's Disease), at the Institute of Psychiatry of UFRJ (Federal University of Rio de Janeiro), and CRASI (Center of Reference in Attention to Health of the Elderly), at Antonio Pedro Hospital of UFF (Fluminense Federal University), are used. The main conclusion is that the proposed dynamic decision model, which offers the ability to be continuously refined with more recent diagnostic criteria or even personalized according to the local domain or clinical guidelines, provides an efficient alternative for diagnosis of Dementia, AD, and MCI.
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PMID:A dynamic decision model for diagnosis of dementia, Alzheimer's disease and Mild Cognitive Impairment. 3300 23


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