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Query: UMLS:C0011570 (depression)
 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Alzheimer's disease is the most common cause of progressive dementia in older adults. Diagnosis is based on a careful history, a thorough physical examination and appropriate laboratory studies. Although the pathology of Alzheimer's disease is well described, the etiology remains unknown. The only well-established risk factors are advanced age and family history. Management problems frequently include depression, delirium, wandering, urinary incontinence and iatrogenic disease.
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PMID:New perspectives in the management of Alzheimer's disease. 223 49

Clinical impression suggests that many cases of detrusor instability are psychosomatic. We evaluated 63 women with urinary incontinence and 27 continent controls using the Minnesota Multiphasic Personality Inventory, Uplift and Hassle Scales, and a structured questionnaire screening sexual dysfunction. All incontinent women underwent diagnostic urodynamic studies including uroflowmetry, subtracted water cystometry with provocation, and urethral closure pressure profilometry. Thirty-five women had genuine stress incontinence and 28 had detrusor instability, including nine with mixed incontinence. No differences in psychological test results were noted between the detrusor-instability and genuine-stress-incontinence groups. On the Minnesota Multiphasic Personality Inventory, subjects with detrusor instability scored significantly higher than controls on the hypochondriasis (P = .006), depression (P = .01), and hysteria (P = .0009) scales. Compared with continent controls, the detrusor-instability group reported a lower frequency of uplifts (P less than .05) and a greater intensity of hassles (P less than .05). Both incontinent groups reported more sexual dysfunction than did controls. We conclude that many women with urinary incontinence have abnormal psychological and sexual test results reflecting moodiness, feelings of helplessness and sadness, pessimism, general hypochondriasis/somatization, and sexual dysfunction. These abnormalities appear to be associated with urinary incontinence in general rather than with specific diseases of the urinary tract.
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PMID:Psychosexual study of women with detrusor instability. 229 16

Alzheimer's disease is characterized by progressive cognitive decline. However, little is known about the "typical" rate of decline, the degree of individual heterogeneity evident in decline, or the types of factors that influence such decline. This study investigated these questions in a sample of 106 patients with Alzheimer's disease, assessed at 1-5 points in time, spanning up to three years. At each time point, the Mini-Mental State Exam, a measure of global cognitive function, was administered to all patients. Measures of behavioral disturbance (including the presence/absence of hallucinations, depression, incontinence, wandering, and agitation), health status (including presence/absence of neurological, cardiovascular, and other diseases), and descriptive information (such as gender, age at time of onset, and duration of deficits) were obtained at entry into the study. A two-stage random effects regression model was fit to the data and then used to assess the effect of these behavioral, health, and descriptive measures on the rate of decline. Results indicate that the rate of cognitive decline in Alzheimer's disease is quite variable. Patients with various health and behavioral problems declined at a rate between 1.4 and 5 times faster than patients without such problems. Alcohol abuse, additional neurological disease, and agitation were significantly related to rate of decline. Overall number of problems was not. The association of these problems with accelerated decline may have prognostic and treatment implications.
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PMID:Cognitive deterioration in Alzheimer's disease: behavioral and health factors. 231 49

In recent years, accurate preoperative diagnosis has been increasingly emphasized as an important therapeutic aspect of urinary incontinence in women. Forty patients suffering from recurrent stress incontinence underwent a dura-sling operation, i.e. loop surgery. The mean period od incontinence complaints prior to secondary surgery was 2.6 years. Follow-up urodynamic parameters revealed a slight improvement in urethral closure pressure (UCP) as well as significant improvement in functional urethral length and depression quotient. Radiologic investigations before and after sling surgery demonstrated good morphological results (angle beta). One year after surgery, 85% of the women had both clinical and urodynamic continence. Medium-term micturition complaints, however, have to be accepted in some of the patients.
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PMID:Urodynamic and radiologic parameters before and after loop surgery for recurrent urinary stress incontinence. 234 80

1. Studies of carbachol-induced contractions on mini-pig bladder tissue strips in vitro demonstrated that antagonist drugs produced a rank order of potency similar to that observed in guinea-pig tissues: propantheline approximately atropine greater than oxybutynin greater than dicyclomine greater than HHSiD greater than imipramine greater than terodiline approximately AF-DX 116. The drugs appeared to show competitive antagonism and the tissues exhibited resistance to complete cholinergic blockade. 2. Cytometry performed in vivo on awake mini-pigs also showed that i.v. cholinergic antagonists produced a dose-dependent depression of peak intravesical bladder pressure (PvesP) during slow filling of the bladder using urethral catheters, with a rank order of potency: atropine greater than oxybutynin approximately propantheline greater than HHSiD approximately dicyclomine greater than terodiline. Other parameters of the cystometrogram were unaffected by the antagonists, except for residual volume, which generally increased after drug treatment. 3. Hexahydrosiladifenidol (HHSiD), an ileal-selective competitive muscarinic antagonist, was about as effective an antagonist as the clinically useful drugs oxybutynin or dicyclomine, both in vitro and in vivo, suggesting that HHSiD may have useful therapeutic effects for the treatment of urinary incontinence. 4. Correlation of the rank order of potency for muscarinic antagonism between mini-pigs and guinea-pigs was very high in vitro (r = 0.97, P less than 0.05), as was the correlation among the drugs for their ability to depress PvesP of the cystometrogram in vivo (r = 0.89, P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Mini-pig urinary bladder function: comparisons of in vitro anticholinergic responses and in vivo cystometry with drugs indicated for urinary incontinence. 235 87

Clinical features at the initial examination of 42 patients with probable Alzheimer's disease were tested for prognostic value at subsequent follow-up of 54 +/- 25 months. These potential prognostic features were of three types: degree of severity features (eg, IQ scores); variable clinical features (eg, extrapyramidal signs); and individual distinguishing features (eg, gender, education, and age). The power of these potential prognostic features to predict prognosis was assessed using the Kaplan-Meier life-tables method and the Cox proportional hazards model. Three clinical end points were considered: total dependence in activities of daily living; incontinence; and institutionalization at follow-up. Degree of severity features (subtests of the Wechsler Adult Intelligence Scale-Revised and the Wechsler Memory Scale, and the Clinical Severity Score) predicted subsequent dependence in activities of daily living, incontinence, and institutionalization. Historical disease duration, age, gender, family history of dementia, retrospective rate of progression, anxiety, psychosis, depression, and extrapyramidal signs did not influence prognosis. These results suggest that initial degree of severity ("how far") rather than variation in the rate of progression ("how fast") best predicts prognosis in the early to intermediate stages of Alzheimer's disease. The relationship of disease severity to prognosis should be taken into account before concluding that there are subtypes of Alzheimer's disease that have different rates of progression.
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PMID:The prognosis in Alzheimer's disease. 'How far' rather than 'how fast' best predicts the course. 237 90

Between 1984 and 1987 31 patients underwent a colposuspension according to Burch for stress urinary incontinence. Seventeen women were available for clinical and urodynamic follow-up after an average of 17.6 months. Clinically, 2 women had postoperative stress-urge incontinence and 2 had stress incontinence only. 13 (77%) patients were continent while straining, 9 (53%) patients complained of urge and voiding disorders, 7 reported post micturition dribble, 2 patients lost urine during intercourse. Urodynamically, 14 (82%) patients were continent during straining, 3 showed mild stress incontinence. The functional urethra length and urethral closure pressure at rest were unchanged. The urethral pressure under stress, depression quotient, and transmission factor increased significantly. The average uroflow sank from 16.8 ml/s to 7.8 ml/s, reflecting the subjective voiding disorders. Bladder compliance was unchanged. We saw no autonomous detrusor contractions and thus no correlation with subjective urge complaints.
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PMID:[Urodynamic results of Burch colposuspension]. 237 88

Case S.S. 59 years of age, male. At the age of 25, he had admitted to sanatorium for 7 years because of pulmonary tuberculosis. After his discharge, at the age of 45, he had started complaining of depressive mood or the idea of suicide and admitted to a mental hospital. Psychiatric diagnosis was depression and slight mental retardation. Shortly after, his depressive mood was improved, but his hypochondriac attitude was unchanged. No tendency toward dementia was proven. At the age of 54, he became enable to walk. Neurologically, pyramidal and some sort of extrapyramidal signs, dysarthria, disturbance of swallowing, fecal and urinary incontinence became apparent. Laboratory data showed scarcely any abnormality. At the age of 59, he died of bronchopneumonia. Neuropathologically, moderate degeneration of dentate nucleus, slight degeneration of pyramidal tract from medulla oblongata to spinal cord, striatum, substantia nigra were found. Neither senile plaques nor neurofibrillary changes could be seen throughout central nervous system. The most important finding is the presence of peculiar acidophilic bodies. They are round or oval, 10 approximately 20 mu in diameter and distributed in dentate nucleus, oculomotor nucleus, central grey of midbrain, superior colliculus, putamen, pallidum, subthalamic nucleus, Zona incerta, hypothalamus, Locus coeruleus, reticular formation of midbrain and pons, pontine nucleus, raphe nucleus, vestibular nucleus, inferior olive in order of number of the bodies. These bodies are scattered in so-called ground substance, and have no relations to any cell bodies or cell processes.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[An autopsy case with peculiar acidophilic bodies in the dentate nucleus and brain stem, associated with degeneration of the pyramidal-extrapyramidal systems]. 241 58

In 555 stress-induced urinary incontinent and 119 continent women patients, we studied the history, clinical and urodynamic investigations to define the hypotonic urethra and to find out important etiological factors of the low urethral closure pressure. The linear depression of the urethral pressure and the urethral closure pressure at rest--well known from literature--has been confirmed in this study. With hypotonic urethra, closure pressure values were found to be below the simple standard deviation from a norm-curve. Also, in cases of stress urinary incontinence, we found a nearly linear depression of closure pressure. The stress incontinent patients could be divided in two groups: 46% with hypotonic urethra, 54% with nearly normal closure pressure. History of former incontinence surgery, but also of other operations such as simple abdominal or vaginal hysterectomy, is correlated with low urethral closure pressure. The degree of closure pressure is correlated with shortening of the functional urethral length. The maximum closure pressure shifts distally. Women, who, despite hypotonic urethras, are continent, build up a positive closure pressure throughout a broad zone of the functional urethral length. Contrarily, in the case of incontinent patients, even a weak coughing spasm, which does not even break through the bladder sphincter in maximum closure, can cause opening of the urethra and establishment of pressure equilibration between bladder and urethra.
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PMID:[Definition and etiologic factors of hypotonic urethra in relation to urinary stress incontinence in the female]. 258 28

A comprehensive evaluation of incontinence using office-based techniques may discover reversible problems such as delirium, urinary infections, vaginitis, depression, drug effects, endocrinologic causes, immobility, or impaction. Treatment of these causes may alleviate incontinence. Bedside urodynamics are a sensitive, specific, and useful office-based technique that can identify detrusor instability, overflow incontinence, or stress incontinence. Low urinary flow rate, difficulty with catheterization, slow bladder filling or severe urgency, bladder capacity over 600 ml, and post-void residual over 150 ml need referral. Patients with hematuria, recurrent infections, recent surgery or pelvic irradiation, and pelvic or prostatic masses also need further evaluation. A number of medical and behavioral therapies are available for stress incontinence and detrusor instability that can substantially reduce incontinence, but most patients with overflow have more complicated problems requiring further evaluation, surgery, or long-term bladder drainage.
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PMID:Practical management of urinary incontinence. 268 69


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