Latest & greatest articles for dementia

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Top results for dementia

642. Dementia: Screening

Dementia: Screening Screening for Dementia U.S. Preventive Services Task Force Screening for Dementia Release Date: 2003 / Summary of Recommendations The U.S. Preventive Services Task Force (USPSTF) concludes that the evidence is insufficient to recommend for or against routine screening for dementia in older adults. Rating: . Rationale : The USPSTF found good evidence that some screening tests have good sensitivity but only fair specificity in detecting cognitive impairment and dementia (...) care settings. The accuracy of diagnosis, the feasibility of screening and treatment in routine clinical practice, and the potential harms of screening (e.g., labeling effects) are also unknown. The Task Force therefore could not determine whether the benefits of screening for dementia outweigh the harms. Supporting Documents Screening for Dementia, 2003 ( , 207 KB) ( , 289 KB) Systematic Evidence Review ( ; )

Publication 3262003

643. Multifactorial intervention after a fall in older people with cognitive impairment and dementia presenting to the accident and emergency department: randomised controlled trial.

Multifactorial intervention after a fall in older people with cognitive impairment and dementia presenting to the accident and emergency department: randomised controlled trial. 12521968 2003 01 10 2003 01 24 2014 06 11 1756-1833 326 7380 2003 Jan 11 BMJ (Clinical research ed.) BMJ Multifactorial intervention after a fall in older people with cognitive impairment and dementia presenting to the accident and emergency department: randomised controlled trial. 73 To determine the effectiveness (...) of multifactorial intervention after a fall in older patients with cognitive impairment and dementia attending the accident and emergency department. Randomised controlled trial. 274 cognitively impaired older people (aged 65 or over) presenting to the accident and emergency department after a fall: 130 were randomised to assessment and intervention and 144 were randomised to assessment followed by conventional care (control group). Two accident and emergency departments, Newcastle upon Tyne. Primary outcome

BMJ2003 Full Text: Link to full Text with Trip Pro

644. Estrogen plus progestin and the incidence of dementia and mild cognitive impairment in postmenopausal women: the Women's Health Initiative Memory Study: a randomized controlled trial.

Estrogen plus progestin and the incidence of dementia and mild cognitive impairment in postmenopausal women: the Women's Health Initiative Memory Study: a randomized controlled trial. 12771112 2003 05 28 2003 06 12 2016 10 17 0098-7484 289 20 2003 May 28 JAMA JAMA Estrogen plus progestin and the incidence of dementia and mild cognitive impairment in postmenopausal women: the Women's Health Initiative Memory Study: a randomized controlled trial. 2651-62 Postmenopausal women have a greater risk (...) than men of developing Alzheimer disease, but studies of the effects of estrogen therapy on Alzheimer disease have been inconsistent. On July 8, 2002, the study drugs, estrogen plus progestin, in the Women's Health Initiative (WHI) trial were discontinued because of certain increased health risks in women receiving combined hormone therapy. To evaluate the effect of estrogen plus progestin on the incidence of dementia and mild cognitive impairment compared with placebo. The Women's Health

JAMA2003

645. End-of-life care and the effects of bereavement on family caregivers of persons with dementia.

End-of-life care and the effects of bereavement on family caregivers of persons with dementia. 14614169 2003 11 17 2003 11 24 2016 10 19 1533-4406 349 20 2003 Nov 13 The New England journal of medicine N. Engl. J. Med. End-of-life care and the effects of bereavement on family caregivers of persons with dementia. 1936-42 Although family caregiving has been intensively studied in the past decade, little attention has been paid to the impact of end-of-life care on caregivers who are family members (...) of persons with dementia or to the caregivers' responses to the death of the patient. Using standardized assessment instruments and structured questions, we assessed the type and intensity of care provided by 217 family caregivers to persons with dementia during the year before the patient's death and assessed the caregivers' responses to the death. Half the caregivers reported spending at least 46 hours per week assisting patients with activities of daily living and instrumental activities of daily

NEJM2003

646. Cholinesterase inhibitors for dementia with Lewy bodies.

Cholinesterase inhibitors for dementia with Lewy bodies. BACKGROUND: Dementia with Lewy bodies (DLB) was first described in 1983, and clinical diagnostic criteria were published in the early to mid 1990s. It has been suggested DLB may account for up to 15-25% of cases of dementia among people aged over 65, although autopsy suggests much lower rates. Characteristic symptoms are dementia, marked fluctuation of cognitive ability, early and persistent visual hallucinations and spontaneous motor (...) and neuropsychiatric symptoms in DLB. OBJECTIVES: To assess the use of cholinesterase inhibitors in DLB. SEARCH STRATEGY: The trials were identified from a search of the Specialized Register of the Cochrane Dementia and Cognitive Improvement Group on 25 February 2002 using the terms 'lewy body', 'Lewy bodies' and 'Lewy'. This register contains records from all major health care databases and trial databases and is updated regularly. SELECTION CRITERIA: Randomized, double-blind trials in which treatment

Cochrane2003

647. Cognitive rehabilitation and cognitive training for early-stage Alzheimer's disease and vascular dementia.

Cognitive rehabilitation and cognitive training for early-stage Alzheimer's disease and vascular dementia. BACKGROUND: Memory problems are a defining feature of the early stages of Alzheimer's disease (AD) and vascular dementia. Cognitive training and cognitive rehabilitation are specific approaches designed to address everyday memory difficulties. OBJECTIVES: The main aim was to evaluate the effectiveness and impact of cognitive training and cognitive rehabilitation interventions aimed (...) at improving memory functioning for people in the early stages of Alzheimer's disease or vascular dementia. The two types of intervention were considered separately. SEARCH STRATEGY: The CDCIG Specialized Register, which contains records from MEDLINE, EMBASE, CINAHL, PsycINFO and many other databases, was searched on 9 April 2003. SELECTION CRITERIA: RCTs comparing cognitive rehabilitation or cognitive training interventions with comparison conditions, and reporting outcomes for the person with dementia

Cochrane2003

648. Folic acid with or without vitamin B12 for cognition and dementia.

Folic acid with or without vitamin B12 for cognition and dementia. BACKGROUND: Folates are vitamins essential to the development of the central nervous system. Insufficient folate activity at the time of conception and early pregnancy can result in congenital neural tube defects. In adult life folate deficiency has been known for decades to produce a characteristic form of anaemia ("megaloblastic"). More recently degrees of folate inadequacy, not severe enough to produce anaemia, have been (...) , dementia and Alzheimer's disease. There is therefore interest in whether dietary supplements of folic acid (an artificial chemical analogue of naturally occurring folates) can improve cognitive function of people at risk of cognitive decline associated with ageing or dementia, whether by affecting homocysteine metabolism or through other mechanisms. There is a risk that if folic acid is given to people who have undiagnosed deficiency of vitamin B12 it may lead to neurological damage. Vitamin B12

Cochrane2003

649. Homeopathy for dementia.

Homeopathy for dementia. BACKGROUND: Dementia is a common illness in older people and has major implications for individuals with the disease, their carers and society. A meta-analysis of population based studies in Europe found the prevalence of dementia in individuals over 65 to be 6.4%. Homeopathy (also spelt "homoeopathy") is a popular form of "complementary" or "alternative" treatment. Some studies have found evidence for efficacy of homeopathic treatment for some conditions, but any (...) mechanism of action of the ultra molecular dilutions used in homeopathy is not comprehensible in terms of current scientific concepts. OBJECTIVES: To evaluate the effectiveness and safety profile of homeopathically prepared medications used in treating dementia, as established by randomized controlled trials. SEARCH STRATEGY: The trials were identified from a search of the Specialized Register of the Cochrane Dementia and Cognitive Improvement Group on 10 May 2002 using the terms alum*, homeop*, "nat

Cochrane2003

650. Propentofylline for dementia.

Propentofylline for dementia. BACKGROUND: Propentofylline is a novel therapeutic agent for dementia that readily crosses the blood-brain barrier and acts by blocking the uptake of adenosine and inhibiting the enzyme phosphodiesterase. In vitro and in vivo its mechanism of action appears to be twofold; it inhibits the production of free radicals and reduces the activation of microglial cells. It therefore interacts with the inflammatory processes that are thought to contribute to dementia (...) , and given its mechanism of action is a possible disease modifying agent rather than a purely symptomatic treatment. OBJECTIVES: To determine the clinical efficacy and safety of propentofylline for people with dementia. SEARCH STRATEGY: The trials were identified from a search of the Specialized Register of the Cochrane Dementia and Cognitive Improvement Group on 5 February 2003. Aventis, the manufacturing pharmaceutical company, was asked for data from unpublished studies but declined to enter

Cochrane2003

651. Acetyl-L-carnitine for dementia.

Acetyl-L-carnitine for dementia. BACKGROUND: Dementia is a common mental health problem affecting 5% of those over 65. Various pathological processes are linked to memory impairment in dementia, particularly those affecting the cholinergic neurotransmitter system. Acetyl-l-carnitine (ALC) is derived from carnitine and is described as having several properties which may be beneficial in dementia. This includes activity at cholinergic neurons, membrane stabilization and enhancing mitochondrial (...) . OBJECTIVES: The objective of this review is to establish whether Acetyl-l-carnitine is clinically effective in the treatment of people with dementia. SEARCH STRATEGY: The trials were identified from a search of the Specialized Register of the Cochrane Dementia and Cognitive Improvement Group on 8 January 2003 using the terms acetyl-l-carnitine, l-carnitine acetyl ester, acetylcarnitine. SELECTION CRITERIA: All double-blind, randomized, trials involving people with dementia in which treatment with ALC

Cochrane2003

652. Donepezil for dementia due to Alzheimer's disease.

Donepezil for dementia due to Alzheimer's disease. BACKGROUND: Alzheimer's disease is the most common cause of dementia in older people. One of the aims of therapy is to inhibit the breakdown of a chemical neurotransmitter, acetylcholine, by blocking the relevant enzyme. This can be done by a group of chemicals known as cholinesterase inhibitors. However, some (like tacrine) are associated with adverse effects such as hepatotoxicity, but donepezil (E2020, Aricept) is safer. OBJECTIVES (...) : The objective of this review is to assess whether donepezil improves the well-being of patients with dementia due to Alzheimer's disease. SEARCH STRATEGY: The Cochrane Dementia and Cognitive Improvement Group's Specialized Register was searched using the terms 'donepezil', 'E2020' and 'Aricept' on 9 October 2002. This Register contains up-to-date records of all major health care databases and many ongoing trial databases. Members of the Donepezil Study Group and Eisai Inc were contacted. SELECTION CRITERIA

Cochrane2003

653. Validation therapy for dementia.

Validation therapy for dementia. BACKGROUND: Validation therapy was developed by Naomi Feil between 1963 and 1980 for older people with cognitive impairments. Initially, this did not include those with organically-based dementia, but the approach has subsequently been applied in work with people who have a dementia diagnosis. Feil's own approach classifies individuals with cognitive impairment as having one of four stages in a continuum of dementia: these stages are Mal orientation, Time (...) . OBJECTIVES: To evaluate the effectiveness of validation therapy for people diagnosed as having dementia of any type, or cognitive impairment SEARCH STRATEGY: The trials were identified from the Specialized Register of the Cochrane Dementia and Cognitive Improvement Group (CDCIG) on 8 January 2003 using the terms validation therapy, VTD and emotion-oriented care. The Specialized Register at that time contained records from the following databases: MEDLINE, EMBASE, CINAHL, PSYCLIT, and SIGLE and many

Cochrane2003

654. Withholding the artificial administration of fluids and food from elderly patients with dementia: ethnographic study.

Withholding the artificial administration of fluids and food from elderly patients with dementia: ethnographic study. OBJECTIVE: To clarify the practice of withholding the artificial administration of fluids and food from elderly patients with dementia in nursing homes. DESIGN: Qualitative, ethnographic study in two phases. SETTING: 10 wards in two nursing homes in the Netherlands. PARTICIPANTS: 35 patients with dementia, eight doctors, 43 nurses, and 32 families. RESULTS: The clinical course (...) of dementia was considered normal and was rarely reason to begin the artificial administration of fluids and food in advanced disease. Fluids and food seemed to be given mainly when there was an acute illness or a condition that needed medical treatment and which required hydration to be effective. The medical condition of the patient, the wishes of the family, and the interpretations of the patients' quality of life by their care providers were considered more important than living wills and policy

BMJ2002 Full Text: Link to full Text with Trip Pro

655. The dementias.

The dementias. Dementia affects about 5% of the elderly population over age 65 years and has an unexplained predominance in women and a low rate in some cultures. Different forms of dementia are now distinguished-Alzheimer's disease, dementia with Lewy bodies, frontotemporal dementia, and dementia secondary to disease, such as AIDS dementia. However, such nosological boundaries are being re-evaluated because different dementias are believed to have common underlying neuropathology (...) . Neurochemical and neurobiological research has led to advances in understanding causes of dementia, and functional imaging has allowed identification of possible biomarkers; from these, a range of potential treatment approaches have arisen that focus on enhancement of neurotransmitter function, intervention at the level of amyloid production and deposition, and reduction of secondary risk factors such as hypertension, depression, and hypolipidaemia. Molecular diagnostic testing and genetic counselling

Lancet2002

656. Abnormality of gait as a predictor of non-Alzheimer's dementia.

Abnormality of gait as a predictor of non-Alzheimer's dementia. BACKGROUND: Neurologic abnormalities affecting gait occur early in several types of non-Alzheimer's dementias, but their value in predicting the development of dementia is uncertain. METHODS: We analyzed the relation between neurologic gait status at base line and the development of dementia in a prospective study involving 422 subjects older than 75 years of age who lived in the community and did not have dementia at base line (...) follow-up (median duration, 6.6 years), there were 125 newly diagnosed cases of dementia, 70 of them cases of Alzheimer's disease and 55 cases of non-Alzheimer's dementia (47 of which involved vascular dementia and 8 of which involved other types of dementia). Subjects with neurologic gait abnormalities had a greater risk of development of dementia (hazard ratio, 1.96 [95 percent confidence interval, 1.30 to 2.96]). These subjects had an increased risk of non-Alzheimer's dementia (hazard ratio, 3.51

NEJM2002

657. Prevalence of neuropsychiatric symptoms in dementia and mild cognitive impairment: results from the cardiovascular health study.

Prevalence of neuropsychiatric symptoms in dementia and mild cognitive impairment: results from the cardiovascular health study. CONTEXT: Mild cognitive impairment (MCI) may be a precursor to dementia, at least in some cases. Dementia and MCI are associated with neuropsychiatric symptoms in clinical samples. Only 2 population-based studies exist of the prevalence of these symptoms in dementia, and none exist for MCI. OBJECTIVE: To estimate the prevalence of neuropsychiatric symptoms in dementia (...) and MCI in a population-based study. DESIGN: Cross-sectional study derived from the Cardiovascular Health Study, a longitudinal cohort study. SETTING AND PARTICIPANTS: A total of 3608 participants were cognitively evaluated using data collected longitudinally over 10 years and additional data collected in 1999-2000 in 4 US counties. Dementia and MCI were classified using clinical criteria and adjudicated by committee review by expert neurologists and psychiatrists. A total of 824 individuals completed

JAMA2002

658. Prevalence of dementia in institutional care.

Prevalence of dementia in institutional care. Information about dementia prevalence in residential and nursing care homes helps these institutions to meet residents' needs. We combined residential characteristics ascertained at a screening interview in 1991-93 with dementia diagnoses from assessment interviews in the UK Medical Research Council Cognitive Function and Ageing Study, a population-based study of 13004 elderly people. Almost 5% of people aged 65 years or older lived in institutions (...) --34% (95% CI 30-39) of individuals with dementia. Within institutions, dementia prevalence was 62% (52-71), and was slightly higher in women than in men, with no increase by age. That most residents have dementia has implications for the type of care that institutions provide.

Lancet2002

659. Association between conformational mutations in neuroserpin and onset and severity of dementia.

Association between conformational mutations in neuroserpin and onset and severity of dementia. BACKGROUND: The aggregation of specific proteins is a common feature of the familial dementias, but whether the formation of neuronal inclusion bodies is a causative or incidental factor in the disease is not known. To clarify this issue, we investigated five families with typical neuroserpin inclusion bodies but with various neurological manifestations. METHODS: Five families with neurodegenerative (...) sections were stained and the topographic distribution of the neuroserpin inclusions plotted. FINDINGS: Each of the families was heterozygous for an amino acid substitution that affected the conformational stability of neuroserpin. The least disruptive of these mutations (S49P), as predicted by molecular modelling, resulted in dementia after age 45 years, and presence of neuroserpin inclusions in only a few neurons. By contrast, the most severely disruptive mutation (G392E) resulted, at age 13 years

Lancet2002

660. Patient and caregiver characteristics and nursing home placement in patients with dementia.

Patient and caregiver characteristics and nursing home placement in patients with dementia. CONTEXT: The decision to institutionalize a patient with dementia is complex and is based on patient and caregiver characteristics and the sociocultural context of patients and caregivers. Most studies have determined predictors of nursing home placement primarily according to patient or caregiver characteristics alone. OBJECTIVE: To develop and validate a prognostic model to determine the comprehensive (...) predictors of placement among an ethnically diverse population of patients with dementia. DESIGN, SETTING, AND PARTICIPANTS: The Medicare Alzheimer's Disease Demonstration and Evaluation study, a prospective study at 8 sites in the United States, with enrollment between December 1989 and December 1994 of 5788 community-living persons with advanced dementia. MAIN OUTCOME MEASURES: Time to nursing home placement throughout a 36-month follow-up period, assessed by interview and review of Medicare records

JAMA2002