March 2000
international
abstracts:
home
transplantation
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March 2000 international |
| alzheimer's
issues: february 2003 november 2002 august 2002 may 2002 february 2002 november 2001 august 2001 may 2001 february 2001 november 2000 august 2000 june 2000 march 2000 november 1999 may 1999 february 1999 september 1998 june 1998 march 1998 december 1997 |
IN THIS ISSUERISK FACTORS AND NATURAL
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| A. OTT, MD, PHD, R.P. STOLK, MD, PHD, F. VAN HARSKAMP, MD, H.A.P. POLS, MD, PHD, ET AL, UTRECHT, THE NETHERLANDS |
| C.HELMER, MD, D. DAMON, MD, L. LETENNEUR, PHD, C. FABRIGOULE, PHD, ET AL, PARIS, FRANCE, ANN ARBOR, MI |
| K.M. MEHTA, DSC, A. OTT, MD, PHD, S. KALMIJN, MD, PHD, A.J.C. SLOOTER, MD, PHD, ET AL, ROTTERDAM, THE NETHERLANDS |
| A-K. BERGER, MSC, L. FRATIGLIONI, MD, PHD, Y. FORSELL, MD, PHD, ET AL, STOCKHOLM AND UPPSALA, SWEDEN |
| EDITORIAL COMMENT |
Tzourio et al confirmed the association between high
blood pressure and cognitive decline, whereas a full supplement of Alzheimer
Disease and Associated Disorders summarize the results of the First Osaka
Conference on Vascular Dementia; a representative abstract is that of Rockwood
et al on subtypes of Vascular Dementia. |
| CHRISTOPHE TXOURIO,
MD, PHD, CAROLE DUFOUIL, PHD, PIERRE DUCIMETIÈRE, PHD, ANNICK ALPÉROVITCH, MSC, FOR THE EVA STUDY GROUP, PARIS, FRANCE |
| KENNETH ROCKWOOD, JOHN BOWLER, TIMO ERKINJUNTTI, VLADIMIR HACHINSKI, ET AL, HALIFAX, NS, LONDON, UK, HELSINKI, FINLAND, LONDON, ON |
| EDITORIAL COMMENT |
Behavioural and psychological symptoms in dementia (BPSD) are
common serious problems that affect quality of life for both patient
and caregiver. Some of the most troublesome behaviours are
aggression and resistiveness to care, which often result in the need
to institutionalize the patient with dementia. In a 10-year
longitudinal study of patients with dementia originally living at
home, Keene et al noted that 96% of patients presented with severe
or persistent aggressive behaviours at some point in their course.
Verbal and physical aggression, and aggressive resistiveness to care
frequently lasted for years and would persist until the death of the
patient. Stewart et al suggest the Executive Interview (EXIT), a brief
assessment scale for executive dysfunction, was much more strongly
correlated with resistiveness to care than overall cognitive
dysfunction as measured by the MMSE. Assessment of
frontal/subcortical function in patients with dementia may help to
predict aggressive, resistive behaviours.
First line pharmacotherapy for BPSD should be treatment with an atypical antipsychotic (e.g. risperidone) based upon recent well designed RCTs. Unfortunately, these agents are only modestly effective for many patients, and a large variety of other drugs have been used including antidepressants, anticonvulsants, and benzodiazepines. In the first RCT of conjugated estrogens for the treatment of aggressive behaviours in dementia, Kyomen et al suggest that doses as low as 0.625 mg per day can significantly decrease total aggression and the frequency of aggressive incidents within the first week of therapy. In a fascinating study comparing Alzhemier's disease patients with and without
visual hallucinations (Chapman et al), visual acuity was significantly
more impaired in patients with hallucinations, and none of the patients
with visual hallucinations had normal acuity. When vision was improved
by refraction in a portion of the patients with hallucinations, most of
these patients were free of hallucinations on follow-up. |
| JANET KEENE, TONY HOPE, CHRISTOPHER G. FAIRBURN, ROBIN JACOBY, ET AL, OXFORD, UK |
| JONATHAN T. STEWART,
MD, EDUARDO GONZALEZ-PEREZ, MD, YILIANG ZHU, PHD, BRUCE E. ROBINSON, MD, MPH, BAY PINES, FL |
| HELEN H. KYOMEN, MD, MSC, ANDREW SATLIN, MD, JOHN HENNEN, PHD, JEANNE Y. WEI, MD, PHD, BOSTON, BELMONT, FRAMINGHAM, NATICK, MA |
| FIONA M. CHAPMAN,
FRC, OPHTH, JANE DICKINSON, MRCP, FRC, OPHTH, IAN MCKEITH, MRC, PSYCH, MD, CLIVE BALLARD, MRC PSYCH, MD, NEWCASTLE, UK |
THE FOLLOWING WEBSITES WERE JUDGED BY
THE EDITORS TO BE OF INTEREST.
Alzheimer Society of Canada http://www.alzheimer.ca
Alzheimer's Association http://www.alz.org
Alzheimer's Disease Education & Referral (ADEAR) Center http://www.alzheimers.org
