Prevalence of associated diseases in different types of dementia among elderly institutionalized patients: analysis of 3447 records

OBJECTIVE: To determine the prevalence of dementia in a population of hospitalized or institutionalized elderly patients, and that of associated diseases according to dementia type. DESIGN: Retrospective analysis of a database of diagnostic codes. SUBJECTS: All patients admitted to 1 of the 4 geriatric units participating in the study at the Charles Foix Hospital between 1980 and 1989. MEASUREMENTS: All diagnoses mentioned in the discharge summary that could cause or contribute to hospitalization were recorded for each patient. A final list of 54 different diagnoses could be recorded for each patient. Dementia was subdivided into 3 subtypes: Alzheimer dementia (DAT), vascular dementia (VD), and other types of dementia (unclassifiable dementia). MAIN RESULTS: The study involved 3447 patients aged 81.0 +/- 8.3 years, of whom 27.7% were men. Dementia was the most frequent disease in this population (34.3%); Alzheimer disease was responsible for 15%, vascular dementia for 9.5%, and other types for 9.8%. The average number of associated diseases was 3.23 +/- 2.10 in the Alzheimer dementia group, 4.73 +/- 2.38 in the vascular dementia group, and 3.96 +/- 2.26 in the nondemented group. Parkinson disease was present in 15.5% of patients with unclassifiable dementia, compared with 7.6% in the nondemented group (P < 0.001). There were significantly more diseases commonly seen in bedridden patients in the group of patients with both other types of dementia and Parkinson disease than in the group of other types of dementia patients without Parkinson disease (P < 0.01). CONCLUSION: Dementia was the most common disease observed in our elderly institutionalized population. Alzheimer patients had significantly fewer associated diseases than nondemented patients, whereas the reverse was found in the vascular dementia group. The co-existence of Parkinson disease and dementia in our population was associated with the poorest health status, as these patients were more likely to present simultaneously such conditions as pressure sores, incontinence, dehydration, or iatrogenesis.     

Transgenic mice expressing Alzheimer amyloid precursor proteins

Nearly a decade after the identification of the Alzheimer amyloid precursor protein (APP) gene several groups of investigators have created transgenic mice expressing APP that simulate some of the prominent behavioral and pathological features of Alzheimer's disease (Quon et al., 1991; Games et al., 1995; Hsiao et al., 1995, 1996; Moechars et al., 1996; Sturchler-Pierrat et al., 1997). These features, which are present to various degrees in different lines of mice, include age-related impairment in learning and memory, neuronal loss, gliosis, neuritic changes, amyloid deposition, and abnormal tau phosphorylation. No mouse model exhibiting every neuropathological feature of Alzheimer's disease exists. Whether an exact simulation of Alzheimer neuropathology is required to understand neural dysfunction in Alzheimer's disease is unclear. Various mouse models of Alzheimer's disease are summarized in this article.     

Frontal type dementia and amyotrophic lateral sclerosis. 3 cases with (HmPAO Tc99m) single-photon emission tomography study

Three cases of rapid onset neuropsychological frontal dementia preceded the development of sporadic amyotrophic lateral sclerosis by 12 to 24 months. HmPAO Tc99m scintigraphy demonstrated hypoactivity in the cortex, predominantly in the frontal region. Three hypotheses are discussed: 1) coincidence between two degenerative diseases, Alzheimer's disease or Pick's disease and ALS; 2) an amyotrophic form of Creutzfeld Jakob disease; 3) pre-senile dementia associated with a motoneuron disease, a clinical pathology entity recently described by Mitzuyama.     

Annotation: the impact of puberty

Tau Isolated from paired helical filaments, aberrant structures that appear in Alzheimer disease (AD) patients' brains, show at least two posttranslational modifications: phosphorylation (Grundke-Iqbal et al., 1986; Ihara et al., 1986) and glycation (Ledesma et al., 1994; Yan et al., 1994). To test whether these modifications could affect the capacity of tau to self-aggregate, recombinant tau was phosphorylated and glycated, and its capacity to form polymers analyzed. Our results indicate that on phosphorylation and glycation, the capacity of tau to form aggregates increases, and that glycation of tau could stabilize the assembled polymers and could facilitate formation of bundles from these polymers.     

Prevalence of dementia in older Japanese-American men in Hawaii: The Honolulu-Asia Aging Study

OBJECTIVE: To determine prevalence of dementia and its subtypes in Japanese-American men and compare these findings with rates reported for populations in Japan and elsewhere. DESIGN AND SETTING: The Honolulu Heart Program is a prospective population-based study of cardiovascular disease established in 1965. Prevalence estimates were computed from cases identified at the 1991 to 1993 examination. Cognitive performance was assessed using standardized methods, instruments, and diagnostic criteria. PARTICIPANTS: Subjects were 3734 Japanese-American men (80% of surviving cohort) aged 71 through 93 years, living in the community or in institutions. MAIN OUTCOME MEASURES: Age-specific, age-standardized, and cohort prevalence estimates were computed for dementia (all cause) defined by 2 sets of diagnostic criteria and 4 levels of severity. Prevalence levels for Alzheimer disease and vascular dementia were also estimated. RESULTS: Dementia prevalence by Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised ranged from 2.1% in men aged 71 through 74 years to 33.4% in men aged 85 through 93 years. Age-standardized prevalence was 7.6%. Prevalence estimates for the cohort were 9.3% for dementia (all cause), 5.4% for Alzheimer disease (primary or contributing), and 4.2% for vascular dementia (primary or contributing). More than 1 possible cause was found in 26% of cases. The Alzheimer disease/vascular dementia ratio was 1.5 for cases attributed primarily to Alzheimer disease or vascular dementia. CONCLUSIONS: Prevalence of Alzheimer disease in older Japanese-American men in Hawaii appears to be higher than in Japan but similar to European-ancestry populations. Prevalence of vascular dementia appears to be slightly lower than in Japan, but higher than in European-ancestry populations. Further cross-national research with emphasis on standardized diagnostic methods is needed.     

The role of cytokines during rejection of foetal pig and foetal mouse pancreas grafts in nonobese diabetic mice

Senile dementia of Alzheimer's type is frequently an underlying cause of accidental death of elderly persons. Neuropathological diagnosis of dementia is therefore crucial to assess the contribution of dementia to the cause of accident. The authors applied two conventional neuropathological criteria described by Khachaturian and Mirra, et al. to three forensic autopsy cases of dementia-related accidental death. In all cases, the number of neocortical senile plaque, a hallmark of dementia, could not fulfill both criteria. This result indicates that foregoing neuropathological criteria derived from fully developed dementia are hardly applicable to elderly persons who died in an early stage of dementia in forensic settings. Further investigation will be required to establish a diagnostic criterion of early stage of dementia.     

Frontotemporal dementia and Alzheimer disease: evaluation of cortical atrophy with automated hemispheric surface display generated with MR images

PURPOSE: To determine the features of cortical atrophy in frontotemporal dementia (FTD) and Alzheimer disease by using a hemispheric surface display generated with magnetic resonance (MR) images. MATERIALS AND METHODS: The extent of cortical atrophy was evaluated with automated MR hemispheric surface display and volumetry in 18 patients with FTD and in 18 matched patients with Alzheimer disease. Results were compared with those in 18 healthy, matched control subjects. RESULTS: Most cortical regions were significantly atrophic in FTD and Alzheimer disease. The frontal and anterior temporal lobes were significantly more atrophic in FTD than in Alzheimer disease. The mean hemispheric-to-intracranial volume ratio in patients with FTD (56.2%) and those with Alzheimer disease (58.4%) was significantly smaller than the ratio in the control subjects (66.0%). Asymmetry of hemispheric volume was significantly larger in the FTD group than in the Alzheimer disease and control groups. CONCLUSION: Cortical atrophy in FTD is more widespread than was previously thought. Asymmetric frontal and anterior temporal atrophy is a distinctive feature of FTD and distinguishes it from Alzheimer disease. Hemispheric surface display is a useful complement to tomographic images and is useful for the evaluation of focal cortical atrophy in degenerative dementias, especially FTD.     

Alzheimer's disease and its Lewy body variant: a clinical analysis of postmortem verified cases

OBJECTIVE: The authors compared clinical findings of Alzheimer's disease and the so-called Lewy body variant of Alzheimer's disease. METHOD: Available data were analyzed on the clinical features of 58 patients with Alzheimer's disease and 24 patients with the Lewy body variant of Alzheimer's disease who underwent postmortem examination. RESULTS: The proportion of men was significantly larger in the Lewy body variant group than in the Alzheimer's disease group (66.7% versus 34.5%), and, concordantly, the Lewy body variant group was slightly taller. The prevalence of hallucinations and delusions was significantly higher in Lewy body variant subjects than the Alzheimer's disease subjects, but there were no significant differences between the two groups in educational attainment, family history of dementia, age at onset, duration of illness, cognitive impairment, overall severity of illness, or neuropsychological findings. Patients with the Lewy body variant of Alzheimer's disease tended to experience more frequent extrapyramidal side effects of neuroleptics than did the patients with Alzheimer's disease, but for patients in the two groups who were not exposed to neuroleptics, there was little difference in frequency of extrapyramidal side effects. CSF concentration of homovanillic acid (HVA) was significantly lower in the Lewy body variant patients, even when correction was made for height. CONCLUSIONS: The Lewy body variant of Alzheimer's disease may be suspected in elderly male dementia patients who otherwise meet criteria for Alzheimer's disease but who manifest significant psychiatric symptoms and neuroleptic-induced extrapy-ramidal side effects and have low levels of CSF HVA.     

The clinical diagnosis and misdiagnosis of senile dementia of Lewy body type (SDLT)

BACKGROUND: Current clinical classifications do not contain specific diagnostic categories for patients with senile dementia of the Lewy body type (SDLT), recently proposed as the second commonest neuropathological cause of dementia in the elderly. This study determines how existing clinical diagnosis systems label SDLT patients and suggests how such patients may be identified. METHOD: A range of clinical diagnostic criteria for dementia were applied to case notes of autopsy-confirmed SDLT (n = 20), dementia of Alzheimer type (DAT; n = 21) and multi-infarct dementia (MID; n = 9) patients who had received psychogeriatric assessment. The predictive validity of each set of clinical criteria was calculated against the external criterion of neuropathological diagnosis. RESULTS: Many SDLT patients erroneously met criteria for MID (35% with Hachinski scores > or = 7) or for DAT (15% by NINCDS 'probable AD', 35% by DSM-III-R DAT and 50% by NINCDS 'possible AD'). Up to 85% of SDLT cases could be correctly identified using recently published specific criteria. CONCLUSIONS: SDLT usually has a discernible clinical syndrome and existing clinical classifications may need revision to diagnose correctly such patients.     

Neuropsychological comparison between dementia of Alzheimer type and multiple subcortical infarction by easily applicable test battery

We compared the neuropsychological findings between dementia of Alzheimer type (DAT) and multiple subcortical infarction (MSI) using easily applicable test battery. Patients with DAT (N = 27) fulfilled the criteria of NINCDS-ADRDA for probable DAT and belonged to the mild degree in the DSM-III-R criteria for dementia. Patients with MSI (N = 30) scored more than 7 points in Hachinski Ischemic Score and were physically independent (Rankin Disability Scale < or = 3). Patients with DAT showed significantly more impaired performance than MSI in Mini-Mental State Examination, copy and delayed recall of Rey-Osterrieth Complex Figure Test and trial 5 of Rey Auditory-Verbal Learning Test, while patients with MSI achieved fewer categories and made more perseverative errors on Wisconsin Card Sorting Test than patients with DAT. Among these tests, delayed recall of Rey-Osterrieth Complex Figure Test seemed to be the most sensitive to discriminate DAT from MSI. These findings were thought to be compatible with the pathological facts that the degenerative process progresses from temporo-parietal lobe in DAT and frontal-subcortical region in MSI.     

Quantitative analysis of HLA DR expression and lymphocytic infiltrate in laryngeal cancer including clinical and morphological correlations

Neuroendocrine tumors of the lung represent a group of controversial pulmonary neoplasms regarding their classification, criteria for diagnosis, predictors of future behavior, and therapy. The histologic criteria for their classification rest heavily on the proposed by Arrigoni et al. in 1972, for atypical carcinoid (AC). According to these authors AC has mitoses between 5 and 10 per 10 high power fields (HPF), necrosis, hypercellularity and disorganized architecture. The survival analysis performed by Flieder et al. (1997) for a variety of clinical and histologic features revised the histologic criteria for separating AC from typical carcinoid (TC) and proposed a range of mitotic counts between 2 and 20 per HPF for AC. From 1978 until 1997, 77 resected pulmonary carcinoids were reclassified for TCs and ACs according to Flieder's et al. histologic criteria. The clinical and pathological various features were studied for the group of 62 TCs and 15 ACs. 77 patients (pts) entered the study: 29(38%) males and 48(62%)females; mean age 43 years, range 18-75 years, 46 pts underwent lobectomies, 16 bilobectomies, 12 pneumonectomies and 3 wedge resections. The patients with TC were younger than those with AC (males: 40 vs 50 years and females 42 vs 49 years). TCs were significantly smaller than ACs (mean diameter respectively: 24 mm vs 33 mm). Fifty four (87%) of TCs and all ACs had central localization. The time of patients observation ranged from 2 months to 18 and half years; 2 patients with TC died due to tumours progression; 3 due to other diseases. Regional lymph node metastases occurred in 10% TCs and 33% ACs (p = 0.032). The heterotopic bone formation appeared in 11(18%) TCs and 2(13%) ACs. The mitotic counts for AC range between 2 and 6 per 10 HPF, accompanied by small foci of necrosis in 2 cases. Peripheral carcinoids showed a spindle-cell morphology. The performed study has highlighted the new concept of the carcinoids classification and the importance of the mitotic counts as histologic criteria for AC diagnosis. The data based on the largest in Polish literature lung carcinoids collection.     

Psychiatric symptoms in patients with dementia treated in a psychogeriatric day hospital

Sixty-five consecutive patients with dementia, treated at a psychogeriatric day hospital, were studied regarding prevalence of psychiatric symptoms. The clinical diagnoses were dementia of the Alzheimer type (n = 19), vascular dementia (n = 27), mixed Alzheimer's disease and vascular dementia (n = 13), vascular dementia of frontal type (n = 2), and other diseases (n = 4). Mean age at referral was 75.6 +/- 6.6 years and the average treatment time was 21 +/- 14 months. About 90% of the patients showed one or several significant psychiatric symptoms during the course of dementia. Most common were delirious episodes, anxiety, sleep disturbances, and depressed mood. The relationship between clinical features and the type and duration of dementia was analyzed. Sleep disturbances and depressed mood often appeared early, whereas misidentification and delusions became more prevalent later in the course of dementia. The results indicate that the psychogeriatric day hospital may offer effective and flexible care and support to demented persons living at home.     

Spinal motion in lumbar degenerative disc disease

We have measured the dynamic movement of the lumbar spine in 57 patients with degenerative lumbar disc disease. Each completed a questionnaire which recorded pain and subjective signs and symptoms. From plain lateral radiographs, the subjects were graded using the criteria of Kellgren and Lawrence and those of Lane et al, which are both based on the severity of degenerative changes. Measurements of the height of the disc space and the vertebral height were obtained and expressed as a ratio. We found no relationship between the characteristics of spinal movement and the overall grading of degenerative disc disease with either system. Both were influenced (p < 0.01) by age, walking distance, severity of symptoms, drug intake and frequency of pain. The present systems for grading degenerative disc disease from plain lateral radiographs have limited application.     

Risk factors for clinically diagnosed Alzheimer's disease: a case-control study of a Greek population

Many efforts have been made to trace the causes of Alzheimer's disease (AD). There are, however, many points of controversy among reports from the same country as well as among reports from different countries. The current study is a case-control study to determine the risk factors in the development of AD in Greece. Sixty-five patients with AD and 69 age-matched controls were examined. All patients with AD fulfilled the DSM-IV criteria for AD and NINCDS-ADRDA criteria for probable AD. Demographic characteristics such as gender, current marital status, who he/she is living with, education, main place of residence in childhood, adulthood, and late life, occupational hazards, patient's medical history (history of diabetes mellitus and hypertension), life habits like alcohol consumption and smoking, and a history of head trauma, heart attack, stroke, parkinsonism, or depression were collected from the subject or from an informant. A family history of selected diseases (hypertension, diabetes mellitus, dementia, Parkinson's disease, Down's syndrome, stroke) was also elicited. Ages of father and mother at birth were also recorded. Chi-square test, Kruskal-Wallis analysis of variance, cluster analysis, and logistic regression analysis were used for statistical analysis. The results (chi-square test) showed a statistically significant difference between patients with dementia of the Alzheimer type and controls as far as marital status (p = .04), the subject's history of major depressive episode (p = .02), and family history of dementia (p = .002) were concerned. Logistic regression analysis results produced a complex model of family aggregation of dementia, with patients with a history of depression and family history of dementia having an up to seven times higher risk of developing AD. These findings, especially a family history of dementia, are consistent with most of the literature.     

Evidence for a recommended dietary allowance for vitamin C from pharmacokinetics: a comment and analysis

The current recommended dietary allowance (RDA) for vitamin C, as proposed by the Food and Nutrition Board/National Research Council in 1980 and reconfirmed in 1989, is 60 mg daily for nonsmoking adult males. Levine et al. [Levine, M., Conry-Cantilena, C., Wang, Y., Welch, R. W., Washko, P. W., et al. (1996) Proc. Natl. Acad. Sci. USA 93, 3704-3709], based on a study of vitamin C pharmacokinetics in seven healthy men, have now proposed that the RDA should be increased to 200 mg daily. I have examined, in brief, the experimental and conceptual bases for this new recommendation and its implications for public health and nutrition policy and programs. Using, for illustrative purposes only, data extracted from each of two recent dietary surveys of noninstitutionalized adult males living in households in the Netherlands and the United States, it is predicted that the prevalence of intakes inadequate to meet the individual's own requirement would be about 96% or 84%, respectively, if the criteria of adequacy used for derivation of the 200 mg RDA are accepted. Depending upon the particular average requirement value for ascorbic acid that might be derived from their data, the proposal by Levine et al. would mean a desirable increase in mean intakes in these two populations by as much about 2-to 3-fold. Hence, before an action of this kind is to be recommended, an answer must be sought to the question whether current experimental data including the criteria selected (saturation kinetics) are adequate to establish a new set of requirements for vitamin C, which then carry such profound policy implications. This will require critical assessment of all of the available evidence emerging from laboratory, clinical, and epidemiological studies to determine whether it provides a sufficient rationale for accepting criteria of vitamin C adequacy such as those proposed by Levine et al. and the requirement estimates so derived.     

Progressive degenerative aphasia: clinical and neuroradiological observations in 18 cases

INTRODUCTION: In some types of degenerative dementia aphasia is the main disorder. In primary progressive aphasia. (PPA) atrophy is limited to the dominant peri-sylvan region. We present 18 cases of progressive aphasia of degenerative origin, with or without dementia. MATERIAL AND METHODS: We describe the clinical and neuro-radiological findings in 3 patients with 'aphasic dementia and motor neuron disease (ADMND)', 7 with 'semantic dementia' (DS), and 4 with 'fronto-temporal dementia' with 'marked non-fluent aphasia' (AFTD). Criteria published in recent years were used. RESULTS: In patients with ADMND non-fluent aphasia progressed to global aphasia, with dementia occurring after 2-9 months, and death after an average of 17 months. In cases with SD, initial anomic aphasia progressed to transcortical sensory or global aphasia, and in patients with AFTD, Broca's aphasia or motor transcortical aphasia progressed to global aphasia. Seven of these patients had been initially diagnosed as having PPA and became demented after two years or more. In most of the cases the cognitive disorder had the characteristics of fronto-temporal dementia. All cases had cortical atrophy or asymmetrical cortical or cortico-subcortical atrophy. The 4 cases of non-fluent PPA were not demented after 21 months-6 years of illness, and showed perisylvan and left fronto-temporopolar atrophy. CONCLUSIONS: The PPA may correspond to the initial form of at least three varieties of dementia, usually the fronto-temporal type. Dementia occurs after two years or more, except in patients with motor neurone disease, when there is a latent period of less than one year.     

The efficacy of Ginkgo biloba on cognitive function in Alzheimer disease

OBJECTIVE: To determine the effect of treatment with Ginkgo biloba extract on objective measures of cognitive function in patients with Alzheimer disease (AD) based on formal review of the current literature. METHODS: An attempt was made to identify all English and non-English-language articles in which G. biloba extract was given to subjects with dementia or cognitive impairment. Inclusion criteria for the meta-analysis were (1) sufficiently characterized patients such that it was clearly stated there was a diagnosis of AD by either Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition, or National Institute of Neurological Disorders and Stroke-Alzheimer's Disease and Related Disorders Association criteria, or there was enough clinical detail to determine this by our review; (2) clearly stated study exclusion criteria, ie, those studies that did not have stated exclusions for depression, other neurologic disease, and central nervous system-active medications were excluded; (3) use of standardized ginkgo extract in any stated dose; (4) randomized, placebo-controlled and double-blind study design; (5) at least 1 outcome measure was an objective assessment of cognitive function; and (6) sufficient statistical information to allow for meta-analysis. RESULTS: Of more than 50 articles identified, the overwhelming majority did not meet inclusion criteria, primarily because of lack of clear diagnoses of dementia and AD. Only 4 studies met all inclusion criteria. In total there were 212 subjects in each of the placebo and ginkgo treatment groups. Overall there was a significant effect size of 0.40 (P<.0001). This modest effect size translated into a 3% difference in the Alzheimer Disease Assessment Scale-cognitive subtest. CONCLUSIONS: Based on a quantitative analysis of the literature there is a small but significant effect of 3- to 6-month treatment with 120 to 240 mg of G. biloba extract on objective measures of cognitive function in AD. The drug has not had significant adverse effects in formal clinical trials but there are 2 case reports of bleeding complications. In AD, there are limited and inconsistent data that preclude determining if there are effects on noncognitive behavioral and functional measures as well as on clinician's global rating scales. Further research in the area will need to determine if there are functional improvements and to determine the best dosage. Additional research will be needed to define which ingredients in the ginkgo extract are producing its effect in individuals with AD.     

A comparison of the MMPI-2 restructured clinical (RC) and clinical scales in a substance abuse treatment sample.

The Minnesota Multiphasic Personality Inventory-2 (MMPI-2) restructured clinical (RC) scales were designed to assess the underlying distinctive core components of the MMPI-2 clinical scales in order to enhance discriminant and convergent validity. Analyses utilizing inpatient and outpatient mental health treatment samples (Tellegen et al., 2003) have demonstrated improvements in the psychometric functioning of the RC scales in comparison with the original clinical scales. The current study extends these analyses by comparing the RC and original clinical scales in a sample of 1,284 men assessed at intake to a substance abuse treatment program in a VA setting. Results indicate that the RC scales demonstrate a general improvement in psychometric properties, with some increases in convergent and discriminant validity compared to their clinical scale counterparts. These results replicate Tellegen et al.'s (2003) findings in a different type of treatment setting and with different criteria, and complement their report by examining the validity of scales RC3 and RC9, for which Tellegen et al. (2003) did not have appropriate criteria. Implications for deliverers of psychological services in public sector settings are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A population study on blood-brain barrier function in 85-year-olds: relation to Alzheimer's disease and vascular dementia

We investigated blood-brain barrier (BBB) function in relation to Alzheimer's disease (AD) and vascular dementia (VAD) in the very elderly. Sixty-five 85-year-old persons from a population-based sample were followed for 3 years; 29 were demented at age 85 (13 with AD, 14 with VAD, and 2 with other dementias), 7 developed dementia during follow-up, and 29 remained nondemented. CSF/serum albumin ratio was used as as a measure of BBB function. Dementia was defined according to the DSM-III-R, AD according to the NINCDS-ADRDA criteria, and VAD according to the NINDS-Association Internationale pour la Recherche et l'Enseignement en Neurosciences (AIREN) criteria. Mean CSF/serum albumin ratio was higher in all dementias (8.5 +/- 4.3; p = 0.007) and in the subtypes AD (8.9 +/- 5.3; p = 0.046) and VAD (8.7 +/- 3.5; p = 0.002) than in nondemented individuals (versus 6.5 +/- 2.0), but it was not related to dementia severity. Nondemented women at age 85 (n = 3) who developed dementia during the follow-up had a higher CSF/serum albumin ratio than those not developing dementia (10.4 +/- 2.0 versus 6.0 +/- 1.9; p = 0.007). Nondemented individuals lacking the apolipoprotein E epsilon3 allele (n = 4) had a higher CSF/serum albumin ratio (9.3 +/- 0.8 versus 6.6 +/- 2.1; p = 0.029) than other individuals. A relative BBB dysfunction is associated with both AD and VAD among very elderly individuals. This finding is possibly found early in the disease before the onset of clinical dementia.     

Uterine packing in the combined management of obstetrical hemorrhage

Alzheimer disease, Pick disease and senile dementia are all characterized by similar morphological changes, both macroscopic and microscopic, and similar psychiatric symptoms. All three should, therefore, be viewed as aspects of one disease, which is termed Alzheimer-type dementia. Nothing contradicts the view that immune complexes take part in the etiology of Alzheimer-type dementia. There are various types of immune complexes and so their points of action in the organism may vary. There might be two main means of preventing Alzheimer-type dementia: the first could be named the serological (basic) and the second relying on pharmacotherapy (additional). Pharmacological prevention of disease might be aided by the use of parasympathomimetic drugs, e.g. pilocarpine.