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 51,768 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Depressive symptoms, due either major depression or clinically significant, subsyndromal depression, occur commonly in the course of Alzheimer's disease. For a variety of clinical and methodological reasons, this remains an area that begs for new investigation. At the very least, these depressive symptoms should be viewed as a cause of significant and treatable "excess disability" (Kramer and Reifler, 1992). Demented patients with clinically significant depression (e.g., depressed mood, significant loss of appetite, insomnia, fatigue, irritability, and agitation) should be considered for a trial of antidepressant therapy, even when they fail to meet full diagnostic criteria for major depression. These symptoms will, in most instances, respond to antidepressant therapy. The "rules" for treatment of depression in dementia are slightly different than for cognitively intact patients: (a) start low, go slower, (b) pay attention to cognitive toxicity of all medication combinations, and (c) depressive symptoms do not persist as long as in cognitively intact patients. Current treatments, especially those SSRI's like fluoxetine and sertraline that have cognitive enhancing effects, should be considered the "first line" antidepressants. We need to emphasize early detection and treatment of depressive symptoms in dementia in all arenas.
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PMID:Depression and Alzheimer's disease. 980 20

Ten teachers made recordings during one normal working day using a portable DAT recorder and a head-mounted microphone. In addition, the subjects filled in a questionnaire of signs of vocal fatigue. The speech samples were selected from the first and last lesson from three points representing the beginning, middle and end part of the lesson, respectively. To standardize the samples, 30 [a] vowels from stressed syllables were chosen for spectral analysis. The level of the fundamental and second formant regions (L1), the level of frequency ranges 2-5 kHz (L2) and 5-10 kHz (L5) were measured. From these measurements the parameters L1-L0, L1-L2 and L1-L5 were formed and used in the analyses as well as the energy levels below and above 1 kHz (alpha). Statistically significant changes were observed in the following parameters: the L1-L2 and L1-L5 differences, and the alpha ratio. In general, there was an increase in the energy content of the high frequency components due to vocal loading. The subjective reports revealed a statistically significant relationship with the spectral characteristics.
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PMID:Working-day effects on the spectral characteristics of teaching voice. 981 82

Dementias and other severe cognitive dysfunction states pose a daunting challenge to existing medical management strategies. An integrative, early intervention approach seems warranted. Whereas, allopathic treatment options are highly limited, nutritional and botanical therapies are available which have proven degrees of efficacy and generally favorable benefit-to-risk profiles. This review covers five such therapies: phosphatidylserine (PS), acetyl-l-carnitine (ALC), vinpocetine, Ginkgo biloba extract (GbE), and Bacopa monniera (Bacopa). PS is a phospholipid enriched in the brain, validated through double-blind trials for improving memory, learning, concentration, word recall, and mood in middle-aged and elderly subjects with dementia or age-related cognitive decline. PS has an excellent benefit-to-risk profile. ALC is an energizer and metabolic cofactor which also benefits various cognitive functions in the middle-aged and elderly, but with a slightly less favorable benefit-to-risk profile. Vinpocetine, found in the lesser periwinkle Vinca minor, is an excellent vasodilator and cerebral metabolic enhancer with proven benefits for vascular-based cognitive dysfunction. Two meta-analyses of GbE demonstrate the best preparations offer limited benefits for vascular insufficiencies and even more limited benefits for Alzheimer's, while "commodity" GbE products offer little benefit, if any at all. GbE (and probably also vinpocetine) is incompatible with blood-thinning drugs. Bacopa is an Ayurvedic botanical with apparent anti-anxiety, anti-fatigue, and memory-strengthening effects. These five substances offer interesting contributions to a personalized approach for restoring cognitive function, perhaps eventually in conjunction with the judicious application of growth factors.
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PMID:A review of nutrients and botanicals in the integrative management of cognitive dysfunction. 1038 79

Despite numerous studies the relationship between depression and Alzheimer's disease has not yet been clarified. The high prevalence of depression in Alzheimer's disease has been confirmed but the data on its incidence vary. Generally, depressed mood is the most prevalent symptom in 0-86% of dementia syndrome, minor depression, dysthymia is considered to be present in 20-30% of patients and major depression is least frequent. It seems confirmed that depression may be considered to be a risk factor for dementia, but the coincidence of these two diseases remains still unknown. Since the symptoms of depression and dementia are very similar, the clinical picture brings other controversies. Loss of energy, speech paucity, poor attention and concentration, diminished interest and psychomotor slowness cannot differentiate dementia from depression, the disability level seems to be the only differentiating factor. Depression may be suspected in case of changes in functional level, complaints about pain and diurnal variation of symptoms. From the practical point of view the type of contact and the willingness of perform tests are among the crucial symptoms. Sometimes, it is difficult to separate apathy and pathological crying from depression. The pathomechanism of depression in dementia is not known. The role of serotoninergic and cholinergic transmission changes, alterations of glucocorticoid cascade and presence of apoE are considered but without evident results.
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PMID:[Depression and Alzheimer's disease]. 1040 20

There has been an increasing number of patients with dementia in Japan. Although such patients were hospitalized longer than in other countries, the length of the hospital stay is becoming shorter due to changes in insurance systems. Therefore, the families of such patients are experiencing greater stress. In order to investigate the efficacy of a group structured intervention, 20 family caregivers participated in a series of five weekly sessions, each of which consisted of an educational approach, problem-solving techniques, psychological support, and relaxation. All family caregivers were women whose ages ranged from 47-66 years (mean= 54.7 +/- 4.4). The period of care at home ranged from 1-12 years (mean= 5.8 +/- 2.7). Concerning the original disease of patients, 10 had vascular dementia and 8 had senile dementia of Alzheimer type (Alzheimer disease). Two psychometries, i. e., Profile of Mood States (POMS) and General Health Questionnaire-30 (GHQ-30), were administered pre- and post-intervention. The results indicated that there was significant improvement (p<0.05) in the scores of depression, anger-hostility, fatigue, confusion in the POMS, and physical symptoms, anxiety-mood disorder, and suicidality-depression in the GHQ-30. This preliminary study suggests that this kind of intervention appears quite effective for relieving the emotional and physical discomfort suffered by family caregivers.
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PMID:A structured intervention for family caregivers of dementia patients: a pilot study. 1053 Jun 24

A proline-rich polypeptide (PRP) complex, subsequently called Colostrinin, was isolated from ovine colostrum. The complex showed immunomodulatory properties in mice, rats, and chickens, inducing maturation and differentiation of thymocytes. It was recently found that Colostrinin is a cytokine-like factor that acts as an inducer of interferon gamma (IFN-gamma) and other cytokines in human peripheral blood and cord blood leukocyte cultures and has psycho-immuno-enhancing activity in volunteers. These observations prompted us to study the effect of Colostrinin on patients with Alzheimer's disease (AD). Forty six AD patients were divided into 3 groups and randomly assigned to receive orally either Colostrinin (100 microg per tablet, every second day), commercially available bioorganic selenium (100 microg selenium per tablet, every second day) or placebo tablets. One cycle of the treatment lasted 3 weeks and was separated from the next cycle by a 2 week hiatus. Each patient received 10 cycles of treatment during the year of the clinical trial. Outcomes were assessed by psychiatrists blinded to the treatment assignment. Eight of the 15 AD patients treated with Colostrinin improved and in the 7 others the disease had stabilized. In contrast, none of the 31 patients from the selenium or placebo groups with similar mild or moderate AD improved. The administration of selenium promoted stabilization in 13 of the 15 patients, whereas in the placebo group only 8 of the 16 patients were stabilized at the 12 month trials end-evaluation. Colostrinin was found to be a remarkably safe drug. Mild and transient effects were anxiety, stimulation, insomnia, and tiredness. The results obtained showed that oral administration of Colostrinin improves the outcome of AD patients with mild to moderate dementia. The results are very encouraging and deserve further research.
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PMID:Colostrinin: a proline-rich polypeptide (PRP) complex isolated from ovine colostrum for treatment of Alzheimer's disease. A double-blind, placebo-controlled study. 1060 95

Maintenance of health is dependent on numerous regulatory interactions between organ systems. This review discusses interorgan communication between the nervous, endocrine, and immune systems and environmental and genetic influences on this neuroendocrine immune circuitry. Stresses of multiple types, including psychological and exposure to chemicals and infectious agents, may combine to enhance neuroimmunotoxicology. Altered nervous system functions can alter immunity which could result in exacerbation of infections, cancers or other immune-associated problems. Inversely, aberrant immune system activities could lead to pathologies associated with altered nervous activities, such as Alzheimer's disease, chronic fatigue, or multiple sclerosis. The nervous, endocrine and immune circuitry is multi-directional, and a chemical, physical or emotional stress could upset the homeostasis.
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PMID:Central/peripheral nervous system and immune responses. 1066 90

The elderly population is increasing as baby boomers are beginning to approach retirement. People 65 years of age or older already constitute approximately one eighth of the U.S. population; this proportion is expected to double in the next 50 years. Older Americans have their own population-specific health challenges, such as Alzheimer's disease, osteoporosis, adult-onset diabetes, prostate cancer, menopause, and hypertension. Human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) are seldom discussed within this community. Prevention, counseling, testing, and education efforts are not being directed their way. In addition, few practitioners are experts both in HIV and health problems associated with aging, resulting in misdiagnosis, especially in the early stages when AIDS symptoms such as fatigue, weight loss, night sweats, and diminished appetite are dismissed as part of the aging process. Very few HIV-related social support services have been aimed at the needs of the elderly, perhaps because older Americans are not suspected to be sexually active or are assumed to be in a monogamous, heterosexual relationship. Older Americans are not suspected of drug use. Yet many are sexually active, often demonstrating risky sexual behavior, such as dispensing with the use of condoms; and the isolation that frequently accompanies old age can lead to alcoholism and injectable drug use. This article examines methods suggested in the literature both in terms of primary and secondary prevention of HIV/AIDS in older Americans. The cost of these efforts is enumerated, and organizations who gear their efforts in reaching and educating older Americans regarding their risks are described.
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PMID:HIV in older Americans: an epidemiologic perspective. 1081 63

Melatonin is synthesized and secreted during the dark period of the light-dark cycle. The rhythmic nocturnal melatonin secretion is directly generated by the circadian clock, located in mammals within the suprachiasmatic nucleus (SCN), and is entrained to a 24-hour period by the light-dark cycle. The periodic secretion of melatonin may be used as a circadian mediator to any system that can 'read' the message. In addition, direct effects of the hormone on the SCN could explain some of the melatonin effects on the circadian system. Duration of the melatonin nocturnal secretion is directly proportional to the length of the night and it has experimentally been demonstrated to be the critical parameter for photoperiod integration. The sites and mechanisms of action of melatonin for circadian and photoperiodic responses are far from being elucidated, but action through specific membrane receptor sites starts to emerge. A possible bicompartmental model of distribution for melatonin, the first compartment in plasma acting on peripheral organs and the second in the cerebrospinal fluid affecting neurally mediated functions at a much higher concentration, has recently been proposed. From earlier studies it was concluded that melatonin administration to humans reduces sleep latency and induces sleepiness and fatigue. More recently, the effect of lower pharmacologic or physiologic doses of melatonin was examined in different laboratories. These studies included young normal volunteers and patients with chronic insomnia, as well as dementia patients exhibiting sundowning syndrome. Irrespective of the method of assessment, melatonin showed effects in insomniac patients in most studies. With some exceptions, melatonin administration reduced sleep latency and/or increased total sleep time and sleep efficiency. Furthermore, melatonin was more effective when given to elderly insomniacs, or Alzheimer disease patients, although sleep improvement was not strictly correlated with prior levels of the hormone.
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PMID:A critical assessment of the melatonin effect on sleep in humans. 1102 39

Fatigue is a complex symptom prevalent in informal caregiving. When role demands exceed caregiver resources, fatigue ensues and caregiving can be compromised. The purpose of this study was to compare perceptions of fatigue among older adults (N = 92) caring for spouses with Alzheimer's disease, Parkinson's disease, or cancer with a control group of older adults (N = 33) whose spouses required no extra care. Caregiving elders reported more fatigue, less energy, and more sleep difficulty than did control participants. All caregiving groups reported similar levels of fatigue, energy, sleep, and self-reported health even though there were marked differences regarding spousal status. Health care providers can support older caregivers in monitoring their own health and in recognizing the need for services that support the caregiving role.
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PMID:Fatigue among elders in caregiving and noncaregiving roles. 1151 67


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