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 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We determined the prevalence of dementia in 927 patients with acute ischemic stroke aged greater than or equal to 60 years in the Stroke Data Bank cohort based on the examining neurologist's best judgment. Diagnostic agreement among examiners was 68% (kappa = 0.34). Of 726 testable patients, 116 (16%) were demented. Prevalence of dementia was related to age but not to sex, race, handedness, educational level, or employment status before the stroke. Previous stroke and previous myocardial infarction were related to prevalence of dementia although hypertension, diabetes mellitus, atrial fibrillation, and previous use of antithrombotic drugs were not. Prevalence of dementia was most frequent in patients with infarcts due to large-artery atherosclerosis and in those with infarcts of unknown cause. Computed tomographic findings related to prevalence of dementia included infarct number, infarct site, and cortical atrophy. Among 610 patients who were not demented at stroke onset, we used methods of survival analysis to determine the incidence of dementia occurring during the 2-year follow-up. Incidence of dementia was related to age but not sex. Based on logistic regression analysis, the probability of new-onset dementia at 1 year was 5.4% for a patient aged 60 years and 10.4% for a patient aged 90 years. With a multivariate proportional hazards model, the most important predictors of incidence of dementia were a previous stroke and the presence of cortical atrophy at stroke onset.
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PMID:Dementia in stroke survivors in the Stroke Data Bank cohort. Prevalence, incidence, risk factors, and computed tomographic findings. 234 88

Percutaneous endoscopic gastrostomy (PEG) has become the preferred method of nutritional support in virtually every patient in whom this procedure is technically feasible because of its apparent technical facility, cost containment, and bedside insertion. PEG can, however, be associated with serious complications and death. This is a report of three patients who developed life-threatening abdominal wall abscesses and four patients who died after PEG insertion. The patients ranged in age from 30 to 80 years, four female and three male. Complicating medical conditions included cirrhosis, diabetes, heart-lung transplantation, neurological dysfunction, and psychosis. The four patients who died were all noted to have had unsatisfactory adhesion between the gastric serosa and the anterior abdominal wall, resulting in large gastric defects where the PEG had been placed and intraperitoneal contamination with gastric contents and feedings. Three additional patients developed abdominal wall abscesses requiring operative debridement. The patient considered to be high risk for surgical gastrostomy may be a higher risk for PEG. Alternatives to PEG should be considered in patients with poor nutritional status or debilitating medical conditions, or in patients undergoing immunosuppressive therapy and steroid use. Psychosis and dementia should be considered relative contraindications to PEG because these patients may dislodge the gastrostomy tube, resulting in severe wound infection and, possibly, death.
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PMID:Fatal and disastrous complications following percutaneous endoscopic gastrostomy. 249 84

The only detailed analysis of dialysis termination by viable patients was reported by Neu and Kjellstrand (N Engl J Med 1986; 314: 14-20) from the USA. We analysed a similar series from Halifax, Nova Scotia, to add to our understanding of this important mode of treatment rejection by dialysis patients. Of 178 chronic dialysis patients at risk from January 1982 to May 1987, 11 viable patients (6%) stopped dialysis (16% of all patient deaths) after a mean of 22 +/- 7 months of therapy. Mean age at death was 67 +/- 5 years. The majority of these patients were receiving in-centre haemodialysis. Six patients independently decided to stop therapy, while in three cases physicians first proposed termination. In only two cases did the family propose termination. All patients died in hospital a mean of 10 +/- 2 days after the last dialysis. Dementia was the reason for stopping treatment in only two cases, while chronic heart failure with poor exercise tolerance was the major precipitant. One patient suffered from diabetes mellitus. We were not able to differentiate patients terminating therapy from those continuing treatment on the basis of age or co-morbidity, suggesting that subjective patient perception of their condition is a critical factor in stopping dialysis.
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PMID:Death from dialysis termination. 250 85

The influence of vinpocetine on glibenclamide steady state plasma levels was investigated in 18 patients suffering from type II diabetes and symptoms of dementia. During the study patients continued to follow their individual scheme of glibenclamide intake and 10 mg vinpocetine were given t.i.d. from day 2 to 5. Glibenclamid as well as glucose plasma levels were repeatedly determined on the first day of the trial and compared to those on the fifth day where patients had received additional vinpocetine medication for four days. Time point comparisons were employed to exclude clinically relevant changes of glibenclamide bioavailability and kinetics. The data of this trial show that vinpocetine does not interfere with the kinetics of glibenclamide. Thus, it can be concluded that the comedication with vinpocetine does not represent a potential risk for a possible drug interaction in case of antidiabetics treatment with glibenclamide.
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PMID:Glibenclamide steady state plasma levels during concomitant vinpocetine administration in type II diabetic patients. 251 64

We have prospectively followed over a 5-year period 434 volunteers who were at intake ambulatory, functional, presumably nondemented, and between 75 and 85 years of age. Fifty-six (an incidence of 3.53 per 100 person-years at risk) developed a progressive dementia: 32 met diagnostic criteria for Alzheimer's disease (AD) (an incidence of 2.0 per 100 person-years at risk), 15 had vascular or mixed dementia, and 9 had other disorders or remain undiagnosed. New cases of dementia were as common as myocardial infarction and twice as common as stroke. Risk factors for both dementia and AD were age (over 80) and gender (female); other reported risk factors such as family history, prior head injury, thyroid disease, maternal age, and smoking were not risk factors for AD in this elderly cohort. Prior stroke was the major risk factor for vascular or mixed dementia; diabetes and left ventricular hypertrophy but not a history of hypertension per se were also risk factors for vascular dementia. The major predictor of the development of AD was the mental status score on entry. The 58.5% of the cohort who made zero to two errors on a 33-item mental status test had a less than 0.6% per year chance of developing AD, whereas the 16% of the cohort with five to eight errors on this test developed AD at a rate of over 12% per year. Thus, it is possible to identify a large cohort of 80-year-olds who are at low risk for AD and a smaller cohort at very high risk.
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PMID:Development of dementing illnesses in an 80-year-old volunteer cohort. 271 31

The author evaluated 142 patients aged 65 years or older with microbial keratitis. There were relatively high rates of Pseudomonas aeruginosa infection unassociated with contact lens wear and of Streptococcus pneumoniae infection. The rates of quasicommensal and enteric infections were not proportionately elevated. Corneal disease, use of topical corticosteroids and use of contact lenses were the main predisposing factors. Patients with diabetes mellitus, dementia or chronic alcoholism appeared to be at higher risk. Trauma was rarely a factor. Complications requiring surgery were common. Corneal perforation developed in 20% of the patients, and endophthalmitis developed in 6%. The elderly often do not tolerate intensive topical antibiotic treatment well. Supplementary subconjunctival antibiotic injections under local anesthesia may be necessary. Corneal tissue glue, tarsorrhaphy and conjunctival flaps are probably underused in this age group.
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PMID:Causes and management of bacterial keratitis in the elderly. 273 Oct 71

A case of mitochondrial encephalomyopathy (Kearns-Sayre syndrome) with corneal endothelial abnormality is reported. A 22-year-old woman had retinitis pigmentosa, external ophthalmoplegia, complete heart block, ataxia, muscle weakness, dementia, sensorineural hearing loss, and was of short stature. Renal dysfunction, diabetes mellitus, and amenorrhea were also observed. Biopsy revealed decreased cytochrome c oxidase (complex IV) activity in muscle mitochondria. The corneal endothelium examined by specular microscope showed decreased cell density, severe polymegathism, and pleomorphism in both eyes. To our knowledge, this is the first report concerning primary corneal endothelial abnormality in a case with mitochondrial encephalomyopathy. The corneal endothelium is one of the tissues that could be affected by the enzyme deficiency present in this disease.
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PMID:Corneal endothelium in a case of mitochondrial encephalomyopathy (Kearns-Sayre syndrome). 274 82

The institutionalized elderly are at risk for developing fluid volume depletion with progression to hypernatremia. This is particularly common in patients transferred to an acute care setting from a nursing home. A marked reduction in intracellular fluid and the increase in body fat associated with normal aging predispose the elderly to water loss with very little environmental prompting. Conditions contributing to the development of fluid volume deficit include febrile illness, utilization of enteral supplements, gastrointestinal bleeding, use of loop diuretics, renal failure, prolonged vomiting, diarrhea, diabetes, and disability induced fluid restriction. This can lead to apathy and confusion, which are often incorrectly attributed to dementia. The utilization of Roy's Adaptation Model to this problem focuses on the regulator subsystem and the physiologic mode.
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PMID:Managing hypernatremia in fluid deficient elderly. 274 41

This clinical study of watershed infarct was carried out in two hospitals for elderly patients. The purpose of this study was an investigation of the clinical specificity of this type of infarct as compared with other types of infarcts. The most important point was to determine which patients with this type of infarct usually become demented. The items of investigation were brain CT findings, measurements of the width of the ventricles and the extent of sylvian fissures from CT images, blood pressure, past history of hypertension, diabetes mellitus, alcohol use and smoking, blood analysis of total cholesterol, HDL-cholesterol, hematocrit, hemoglobin A1 and uric acid and the incidence of patients in whom dementia had improved from the previous state. From CT findings, we classified all patients with brain infarcts into 4 groups; 173 patients with central infarcts, 56 patients with watershed infarcts, 20 patients with subcortical lesions of the Binswanger type and 11 patients with occlusion of main brain arteries. Among all investigated patients, there were 56 non-demented and 162 demented (74.3%) patients. Among the patients with watershed infarcts, there were 10 non-demented and 45 (81.8%) demented patients. In the group of demented patients with watershed infarcts, females were four times as many as males. Demented patients with watershed infarcts in the right hemisphere were twice as frequent as those with infarcts in the left hemisphere, while the number of non-demented patients with this type of infarct in right hemisphere was the same as that in the left hemisphere.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Clinical study of watershed infarct dementia]. 279 79

With the graying of America, more older persons will be driving. Physiological changes associated with normal aging and diseases that commonly affect the elderly may compromise their ability to drive safely. Although all states have regulations governing driving licensure, few offer specific guidelines regarding older persons. Accordingly, much of the responsibility for determining medical competence to drive and counseling patients in this regard is left to physicians. Normal physiologic changes may limit sensory information, particularly visual, available to the driver. In addition, chronic diseases in older persons including coronary artery disease, dementia and other neurologic disorders, diabetes mellitus, and drug use may increase the risk of crashes while driving. Once the question of competence to operate an automobile has been raised, ethical dilemmas must be addressed regarding the benefit of continued driving for the individual versus the risk to that person and society as a whole. In this article, we review the medical grounds for determining competence to drive, discuss ethical implications, and report current legal regulations for physicians and aging drivers. Future directions and possible areas for further research are outlined.
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PMID:The aging driver. Medicine, policy, and ethics. 305 52


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