Gene/Protein Disease Symptom Drug Enzyme Compound
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 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

One hundred and seventeen elderly residents of seven geriatric health facilities located in Tokyo participated in this study. The Mini-Mental State, Metamemory in Adulthood, Geriatric Depression Health Scale and demographic questionnaires were used in face-to-face interviews. The subjects were 32 males and 85 females, with a mean age of 83.08 years. Depression was found to be a key factor for explaining metamemory. Depression accounted for 17% of the variance in capacity and 23% in change. There were no differences between the mild cognitive impairment group and the cognitively intact group on achievement, capacity, change, locus and strategy subscales. When depression was considered as a moderating factor, a difference arose between two cognitive levels. History of stroke was not related to metamemory in this study; however, future studies should emphasize memory awareness in brain injury residents since 41% of the sample had a history of CVA.
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PMID:Memory awareness among Japanese nursing facility residents. 1048 50

Clinical geriatric therapy has shown to be beneficial and cost-effective. However, little is known about its long-term results. Based on GEMIDAS (Geriatric Minimal Data Set), a multicenter-Database of the German Federal Association of 140 Clinical Geriatric Institutions, we conducted a one-year-follow-up pilot study focusing on medical and functional results, including needs of technical aids and nursing. Mortality was 16% at 1 year. Two thirds of the deceased had died during the first half year, many with severe stroke. Among the 840 survivors, 81.1% lived in their private housing, 14.5% in nursing homes, 4.4% were actually hospitalized. 37.3% suffered from recurrent diseases such as stroke (5.2%), bone fractures (4.5%), heart attacks (2.1%), severe infections (1.1%), needing hospitalization in 31.9%, repeatedly in 6.9% of the survivors. Technical aids were regularly used in about 80%. Personal help was often necessary and was provided by relatives (66.9%), professional nursing (39.8%), neighbors (5.7%), only 6% of the patients needed no help. The initial functional gain (mean Barthel-Index from 53.4 to 72.3 points) diminished to 59.6 points during follow-up, with similar patterns for most of the single Barthel-items. Our results confirm the initial benefit and clearly show a significant long-term effect of clinical geriatric rehabilitation. For stabilization and further functional improvement, specific and continuous rehabilitation efforts seem to be crucial.
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PMID:[Quality assurance in geriatric rehabilitation hospital treatment. Long-term medical and functional outcome]. 1078 3

Geriatric patients with major depression present clinical challenges not encountered in younger individuals, including a greater incidence of medical comorbidity, higher rates of multiple medication use, changes in drug metabolism due to age or physical illness, and increased sensitivity to antidepressant side effects. Nevertheless, successful treatment of depressive disorders in the elderly improves mental and physical functioning, decreases morbidity and perhaps mortality, and enhances quality of life. Recent research indicates that newer antidepressants are effective for late life depression and safer for older individuals. Among newer antidepressants, venlafaxine has a pharmacological profile that makes it an attractive choice for geriatric patients. It has limited potential to interact with other medications because it only weakly inhibits the cytochrome P450 system and binds to plasma proteins at a low level. Dosing may have to be adjusted for patients with renal failure, but typically not for those with liver disease or other medical conditions. Data from three double-blind and four open clinical trials support the safety and efficacy of venlafaxine for geriatric depression. Patients may experience transient, generally tolerable side effects such as insomnia, nausea, agitation, or dry mouth early in treatment, but more serious problems such as falls or cardiac rhythm disturbances seem to be rare. Treatment emergent hypertension occurs in a small percentage of older patients, generally at doses above 150 mg/day. Finally, emerging data suggest that venlafaxine may be effective for conditions such as stroke, anxiety, and neuropathic pain that frequently accompany depressive disorders in the elderly.
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PMID:Efficacy of venlafaxine in geriatric depression. 1109 16

This paper has reviewed the documentation on the clinical efficacy of choline alphoscerate, a cholinergic precursor, considered as a centrally acting parasympathomimetic drug in dementia disorders and in acute cerebrovascular disease. Thirteen published clinical trials, examining in total 4054 patients, have evaluated the use of choline alphoscerate in various forms of dementia disorders of degenerative, vascular or combined origin, such as senile dementia of the Alzheimer's type (SDAT) or vascular dementia (VaD) and in acute cerebrovascular diseases, such as transitory ischemic attack (TIA) and stroke. Analysis has assessed the design of each study, in particular with respect to experimental design, number of cases, duration of treatment and tests used to evaluate drug clinical efficacy. Most of the ten studies performed in dementia disorders were controlled trials versus a reference drug or placebo. Overall, 1570 patients were assessed in these studies, 854 of which in controlled trials. As detected by validated and appropriate tests, such as Mini Mental State Evaluation (MMSE) in SDAT and Sandoz Clinical Assessment Geriatric (SCAG) in VaD, administration of choline alphoscerate significantly improved patient clinical condition. Clinical results obtained with choline alphoscerate were superior or equivalent to those observed in control groups under active treatment and superior to the results observed in placebo groups. Analysis stresses the clear internal consistency of clinical data gathered by different experimental situations on the drug effect, especially with regard to the cognitive symptoms (memory, attention) characterising the clinical picture of adult-onset dementia disorders. The therapeutic usefulness of choline alphoscerate in relieving cognitive symptoms of chronic cerebral deterioration differentiates this drug from cholinergic precursors used in the past, such as choline and lecithin. Three uncontrolled trials were performed with choline alphoscerate in acute cerebrovascular stroke and TIA, totalling 2484 patients. The results of these trials suggest that this drug might favour functional recovery of patients with cerebral stroke and should be confirmed in future investigations aimed at establish the efficacy of the drug in achieving functional recovery of patients with acute cerebrovascular disease.
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PMID:Choline alphoscerate in cognitive decline and in acute cerebrovascular disease: an analysis of published clinical data. 1158 21

The relationship between staff and patient ratings of activity restrictions (Barthel Index, BI) was investigated in 120 elderly stroke patients (on average 78 years old) using the Rasch model and the rating scale analysis. In addition, the relationship between the rated activity restrictions and measures from the Geriatric Assessment was analyzed. We found good patient-staff agreement (r = 0.90) with the poorest agreement in the item "bathing" of the BI. There was also a highly significant correlation between staff and patient ratings and the Tinetti Gait and Balance Scales (r = 0.72 and r = 0.76, respectively). Correlations between other measures of the Geriatric Assessment and the rated activity restrictions were low explaining less than 8% of variance. Our findings merit the use of patient ratings of activity restrictions in stroke outcome research. However, self-ratings of activity restrictions were measured by an unstructured interview and it cannot be ruled out that this method had an influence on the correlation between self-rating and staff rating.
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PMID:[Agreement on the Barthel Index. A rapid analysis of other and self-assessment in elderly stroke patients]. 1208 May 73

Increases in blood pressure (BP), particularly systolic BP, have traditionally been considered to be a normal or "physiologic" component of the aging process. However, it is now clear that elevated BP, particularly systolic BP, represents a pathophysiologic manifestation of altered cardiovascular physiology and structure, ultimately manifesting as increased cardiovascular morbidity and mortality (myocardial infarction, stroke, and total cardiovascular death rates). More than one half of the population aged 65 or older have hypertension, defined as BP > or = 140/90 mm Hg. Framingham data indicate that the risk of coronary heart disease increases with lower diastolic BP at any level of systolic BP > or = 120 mm Hg, thus further stressing the importance of pressure-induced arterial vascular compliance changes and introducing pulse pressure as an important predictor of cardiovascular risk. Geriatric hypertension is generally of a salt-sensitive nature and often associated with impaired baroreflex function. Reduction in sodium intake is important and effective in older patients, and should be initiated before or together with drug therapy. Encouraging data from clinical trials now strongly support the aggressive anti-hypertensive treatment of elderly patients. A recent meta-analysis of eight outcome trials evaluating the risks of treated and untreated isolated systolic hypertension has demonstrated a 30% reduction in combined fatal and nonfatal stroke, a 26% reduction in fatal and nonfatal cardiovascular events, and a 13% reduction in total mortality. Those drugs effective in younger patients also appear effective in the elderly; low-dose thiazides (alone or in combination with potassium sparing agents), beta blockers, long-acting dihydropyridine calcium antagonists, angiotensin-converting enzyme inhibitors, and angiotensin receptor blockers all have demonstrated efficacy. In selecting an agent, it is important to consider comorbid disease states, and to recognize the potential of all nonsteroidal anti-inflammatory drugs, whether conventional or cyclooxygenase-2 specific, to increase BP or interfere with other antihypertensive agents. In general, the elderly should be treated to target BP levels identical to those suggested for younger patients, although a more gradual reduction to target, perhaps with an intermediate BP goal of < 160 mm Hg, may be advisable.
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PMID:High blood pressure in the geriatric population: treatment considerations. 1209 71

The aim of this research is to determine which factors affect the self-care capacity of veterans self-pay care institution residents and to build a predictive model of their level of independence. Our study included 404 residents of a veterans care institution. Our data collection involved an integrated, multidisciplinary approach. The tools used by each group were all of high validity and reliability. The resulting data was entered into SPSS statistic software, and then analyzed by related coefficients, Mann- Whitney test, Kruskal-Wallis H test, and stepwise multiple regression. This analysis showed that 12.1% of residents were self-care dependent. Residents medical conditions (stoke, arthritis), physical function (tinnitus, fall), cognitive function (Mini-Mental State Examination score, Geriatric Depression Scale Short-Form score, Acute Confusion Behavior Scale score), and social function (frequency of exercise per week, frequency of visitors), showed correlation with self-care capacity. The predictive model of self-care capacity was built as follows: Self-care predictive value = 93.022 -.274 x GDS score +.196 x MMSE score - 3.222 x Stroke - 1.262 x Arthritis +.225 x Exercise per week. This model explained 10.5% of the total variance. The results of this research can act as a basis for elderly admission to and transfer from veterans care institutions and can be a reference for recommending relevant nursing service. This research also provides important information for those who wish to improve the self-care capacity of care institution residents.
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PMID:Predictive factors of self-care capacity in veterans care institution residents. 1224 22

In this study, we investigated the association of lipids with ischemic stroke and its different subtypes in elderly patients. In particular, lipid parameters not extensively investigated so far in previous case-control studies specifically focused in the old population, such as lipoprotein Lp (a) and Apoproteins AI (ApoAI) and B (ApoB), have been taken into account. Seventy nine patients (mean age 83 +/- 7.4, range 67-99), consecutively admitted to a Geriatric Ward between January 1998 and June 2000 with acute stroke (first event) were studied. A complete clinical and laboratory assessment, including neurological evaluation, head CT scan, carotid ultrasonography and ECG, was employed to define the clinical and etiologic stroke subtype, according to standardized criteria. Fasting blood samples were collected within 48 h from admission, for determination of total cholesterol (TC), triglycerides (TG), High Density Lipoprotein-cholesterol (HDL-C), Lp(a), ApoAI and ApoB; Low Density Lipoprotein-Cholesterol (LDL-C) was estimated by Friedwald formula. Eighty eight age and sex-matched outpatients, referred to the hospital for non-inflammatory disorders of joints and musculoskeletal system, served as controls. Patients showed HDL-C and HDL-C/ApoAI ratio significantly lower than controls, with higher LDL-C/HDL-C ratio. Analysis on quartiles of lipoprotein concentrations showed also a significant increase in odds of stroke for LDL-C concentrations over 100 mg/dl, in absence of a linear relationship between LDL-C levels and risk. Multiple logistic regression, adjusting for non-lipid risk factors for stroke, confirmed the independent association of low HDL-C and HDL-C/ApoAI with all strokes, as well as with each subtype. In conclusion, these data suggest that lipids give some contribution to stroke risk even in the elderly, with a more prevalent role for HDL than LDL, and that lipid profile assessment must be taken into account in estimating the individual risk of stroke.
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PMID:The role of lipid profile in determining the risk of ischemic stroke in the elderly: a case-control study. 1284 73

The high rates of hospitalization in nursing home residents are as well known as the hazards of in-hospital treatment especially in this group of frail older people. Moreover, hospital admissions cause considerable costs. The objective of the study was to analyze why nursing home residents are admitted for in-hospital geriatric care, and to form hypotheses of how to prevent these admissions without loss of quality of care. Reason of admission, comorbidity, competence and length of in-hospital stay were assessed in all nursing home residents referred to the Geriatric Centre at the University Hospital of Heidelberg over 12 months. There were 245 admissions of 231 nursing home residents (83.1% female; age 84.2 +/- 7.10 years). Comorbidity was substantial (77% urinary incontinence, 69% dementia, 40% stool incontinence, 22% pressure ulcers), and 56% of residents needed assistance in using the toilet before admission. Mean length of in-hospital stay was 32.6 days (median 29 days). Out of a total amount of 7983 days of in-hospital care, 3627 (45%) were caused by falls and fractures, 2039 (26%) by cardiovascular events (mainly ischemic stroke), 835 (11%) by infections and 495 (6%) by problems concerning nutrition. Most of the leading causes of admission of nursing home residents to in-hospital geriatric care might be affected by improvements in nursing home care. Thus, data suggest that hospitalization rates might be substantially reduced by targeted prevention and therapy as well as by structural measures to improve case management in the nursing homes. Such interventions should be developed and proved in controlled studies.
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PMID:[Causes for in-hospital treatment of nursing home residents]. 1293 32

To study the validity of the Orpington scale as a predictive instrument of functional prognosis in patients with stroke. More exactly, to know their ability to assess the admission of patients into Geriatric Units of Medium Stay (GUMS) and the influence of other variables of the Comprehensive Geriatric Assessment (CGA) to take into account for the patients admission into such Units. The protocols of the patients older than 65 year admitted with a stroke and surveyed by the Department of Neurology to the Geriatric Unit from the 1st October of 1999 to the 30th June of 2000 were revised. From the 139 patients revised 49% were moved into GUMS and 34% were discharged to their home. The admission into GUMS of patients in subacute phase of a stroke is determined by mental and functional factors that the Orpington scale do not consider by itself. The Orpington scale, into the CGA, gives additional information to the CGA regarding the admission of patients into these Units.
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PMID:[The Orpington scale. An evaluation tool in cerebrovascular disorders]. 1296 13


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