Incidence of dementia in a rural community in Spain: the Girona cohort study

BACKGROUND: Information on dementia incidence in Spanish populations is still scarce, and there is a dearth of prospective studies. OBJECTIVE: To estimate the incidence rates of dementia, Alzheimer's disease (AD) and vascular dementia (VaD) in a population cohort aged 75 and over in a rural area in Spain. METHODS: A prospective population cohort study over a 5-year period in 8 rural villages in the province of Girona. The baseline study in 1990 identified 200 prevalent cases of dementia. The dementia-free cohort included 1,260 persons aged 75 and over. This was the sample used for the incidence study. We rescreened and selectively reexamined this group in 1995 using a two-phase procedure consisting of a screening interview at home using the MMSE. Diagnoses of dementia, AD and VaD were established using the Cambridge Examination for Mental Disorders of the Elderly for surviving participants. For deceased participants, we used the Retrospective Collateral Dementia Interview to establish a diagnosis of dementia and AD according to DSM-III-R diagnostic criteria. RESULTS: Information was obtained for 91% of the subjects at risk; 122 incident cases of dementia were identified. Incidence rates per 1,000 person-years at risk were 23.2 (95% CI = 19.1-27.3) for dementia, 10.8 (95% CI = 7.8-13.7) for AD and 9.5 (95% CI = 6.7-12.1) for VaD. All dementia subtypes showed an age-dependent pattern. Females had a relative risk of 1.8 (95% CI = 1.0-3.4) to develop AD. The inclusion of deceased cases with manifestations of dementia increased the rate of dementia incidence in 7.1 cases/1,000 person-years at risk. CONCLUSION: Incidence rates were similar to those reported by other cohort studies. All dementia subtypes increased with age, but incidence rates did not increase exponentially in the oldest old. Females were at increased risk for AD. The inclusion of information about dementia symptoms from relatives of deceased participants was useful in order to avoid underestimation of the dementia incidence rates. Underestimation of the incidence rates was more important in those aged 75-84 years.     

AIDS and dementia: a quantitative neuropsychological study of unselected Danish patients

Retrospective studies of hospitalized patients with the acquired immune deficiency syndrome (AIDS) have indicated that dementia occur in the majority of cases. In order to study the occurrence of dementia among AIDS patients, we conducted a controlled study of 16 unselected cases with a battery of neuropsychological tests known to be sensitive to brain damage of various etiologies. Except for fatigue, mental complaints and neuropsychiatric signs of dementia were generally sparse. As a group, the AIDS patients' performance in the neuropsychological tests did not differ from that of matched, healthy controls. Based on analyses of individual test results only one patient performed significantly inferior to what should be expected. The diagnosis of dementia should not be ascribed to AIDS victims on account of non-specific psycho-behavioral deviations that may represent a normal psychologic reaction to the disease, extreme fatigue, or both. Further, frequency measures of dementia in AIDS, based on large, unselected groups and with sufficient control, are still lacking. However, our study indicates that dementia is a less frequent complication of AIDS than so far assumed.     

Persistence of psychiatric disorders in a cohort of HIV/AIDS patients in South Africa: a 6-month follow-up study

BACKGROUND: Psychiatric disorders in HIV/AIDS are common, emerging soon after diagnosis or during the subsequent course of illness. However, there are few prospective studies on the rates of psychiatric disorders in HIV/AIDS, particularly in the context of the developing world. METHODS: Sixty-five patients with recently diagnosed HIV were interviewed on presentation to a hospital-based HIV clinic and then 6 months later. On both interviews, the patients were assessed using the MINI International Neuropsychiatric Interview, the Carver Brief COPE, and the Sheehan Disability Scale. Exposure to negative life events and risk behaviors was also evaluated. RESULTS: The overall prevalence of psychiatric disorders in the follow-up period remained high (56% of patients had at least one psychiatric disorder at baseline, and 48% of patients had at least one psychiatric disorder at 6 months). Depression and posttraumatic stress disorder (PTSD) were the most prevalent disorders at both baseline (34.9% and 14.8%) and follow-up (26% and 20%), respectively. More than half of all patients with depression at baseline improved (16 of 29; 55.1%). However, there was a new onset of both depression (4 of 49; 8.1%) and PTSD (12 of 17; 70.5%) on follow-up. In univariate analysis, depression on follow-up was significantly associated with: (a) disability in work/social/family functioning, (b) greater number of negative life events, and (c) a decline in CD4 lymphocyte count. Univariate analysis also revealed that a diagnosis of PTSD on follow-up was significantly associated with (a) a longer duration of infection and (b) baseline disability in work/social/family functioning. However, in multivariate analysis, only disability scores predicted the diagnoses of major depression and PTSD on follow-up assessment. Persistence of risky sexual behaviour was also noted, with a significantly higher number of participants reporting nonuse of condom on follow-up. There appeared to be a shift from maladaptive coping behaviors to more adaptive coping behaviors over the 6-month period. CONCLUSION: The rate of psychiatric disorders in HIV/AIDS patients was consistent over time. These findings emphasize the importance of regular evaluation for psychiatric disorders in HIV/AIDS patients, not only at the commencement of treatment but also during subsequent follow-up visits.     

Risperidone in chronic schizophrenia: a detailed audit, open switch study and two-year follow-up of patients on depot medication.

Little information exists on the medium- to long-term outcome of switching patients with schizophrenia from traditional depot to atypical oral antipsychotic agents. By detailed clinical audit, we identified a representative group of 102 patients of an Irish psychiatric service with DSM-IV chronic schizophrenia and on depot neuroleptics for a mean of 15 years. Of 69 eligible to participate, 33 entered a 6-month switch study of risperidone, with limited follow-up of consenters and non-consenters at 1 and 2 years. At 6 months, 23 of 33 were still on risperidone and had small significant improvements in clinical and extrapyramidal side effects, QOL and adjunct medication measures over baseline. At 12 months, 19 of 33 were still on risperidone, reducing to 13 of 33 at 2 years. At 2 years, of 32 surviving consenters to switch, 19 had suffered clinically detrimental events and were no longer on risperidone, compared to none of the 33 surviving non-consenters, who were all still on depot. These findings suggest that switching from depot to risperidone may encounter high rates of refusal and attrition subsequent to switch. While a majority of switched patients may improve to least 6 months, audit plus switch may have clinically unfavourable effects on others over a 2-year follow-up period [corrected].     

Chronic effects of dopaminergic replacement on cognitive function in Parkinson's disease: a two-year follow-up study of previously untreated patients.

BACKGROUND: The cognitive effects of dopaminergic treatment in Parkinson's disease (PD) are still controversial. OBJECTIVE: To evaluate, in previously untreated patients with PD, whether chronic dopaminergic stimulation produces significant cognitive changes; whether they are sustained beyond the period of a few months; and whether the cognitive status of two motor-comparable groups is differently affected by levodopa and pergolide. DESIGN AND SUBJECTS: Parallel, randomized open study with blind neuropsychologic evaluation of 20 consecutive de novo patients with PD before and 3, 6, 12, 18, and 24 months after monotherapy with levodopa (n = 10) or pergolide (n = 10; 6-month monotherapy; pergolide + levodopa thereafter). RESULTS: Both treatments were associated with a significant improvement in motor scores and in tests assessing learning and long-term verbal and visual memory, visuospatial abilities, and various frontal tasks. While improvement in motor scores persisted, improvement in activities of daily living and in semantic fluency, Luria's rhythm and motor and long-term memory tests was not sustained at the 24-month examination. Further, performance on attentional, short-term memory, and the Stroop tests did not change over the course of the study. CONCLUSIONS: Both treatments were associated with incomplete but long-lasting (18 mos) improvement in many cognitive tasks which declined thereafter, suggesting that dopaminergic replacement is not enough to compensate for all cognitive deficits of PD.     

Incidence of dementia and cognitive decline in over-75s in Cambridge: overview of cohort study

This paper summarises the methods and some of the findings of a large cohort study of dementia and cognitive decline in subjects aged over 75 years in Cambridge, particularly regarding the incidence wave. From a sample of 1968 subjects previously studied in a prevalence study in 1985–1987, survivors were restudied at 2.4 years, in a two-stage design employing the Mini; Mental State Examination (MMSE) and the Cambridge Examination for Mental Disorders of the Elderly (CAMDEX). High incidence rates of dementia were found, which rose steeply with age, particularly for Alzheimer's disease. New minimal dementia and milder cognitive impairment were also common. Cognitive decline on the MMSE showed a near normal, non-bimodal distribution. The sample has since been restudied at intervals for a total of up to 9 years to document longitudinal cognitive change. Brains have been obtained for post mortem neuropathological and molecular biological study, particularly of the early sequential changes associated with cognitive decline and dementia. Accepted: 18 February 1998     

The course of thyroid abnormalities during lithium treatment: a two-year follow-up study.

A total of 116 patients on lithium treatment were followed up for 2 years to determine the course and the clinical relevance of thyroid abnormalities. Elevated thyroid-stimulating hormone (TSH) concentrations were transitory in most patients, except those with serum antithyroid antibodies. The patients who initially had microsomal antibodies remained positive, with an increase in titre in two-thirds of cases. Three young patients of both sexes developed thyroid autoimmunity early in the treatment. The risk of developing hypothyroidism was higher in women, especially in the presence of antibodies. TSH concentrations were significantly lower when carbamazepine was combined with lithium.     

Social and clinical consequences of cognitive deficits in early psychosis: a two-year follow-up study of first-admitted patients

OBJECTIVE: To explore whether baseline memory and executive deficits predicted poor social and clinical outcome over the 2 years following a first admission for psychosis, regardless of categorical diagnosis. METHOD: Cognitive functioning was assessed in first-admitted subjects with psychosis (n=35) with a neuropsychological battery of tests measuring executive, language and memory functions. Social and clinical outcome were assessed at 6-monthly intervals over a two-year follow-up using multiple sources of information. RESULTS: A dose-response relationship was found between visual and verbal memory performance at first admission and clinical outcome over the 2-year follow-up: the poorer the memory performance, the more likely the risk of presenting with psychotic symptoms and rehospitalization. Poor baseline performance on the WCST executive function predicted better medication adherence. No association was found between cognitive performance and occupational or residential outcome. CONCLUSION: Cognitive performance was a better predictor of clinical than social outcome in this sample of first-episode patients. The association between cognitive deficits and poor social outcome may be more marked in subjects with chronic psychosis than in first-episode subjects. The finding that cognitive deficits predict better medication adherence is in need of further exploration.     

Muscle biopsy in AIDS and ARC: analysis of 50 patients

We report a large spectrum of histological muscle abnormalities in 50 homosexual men with AIDS and ARC. We encountered moth-eaten fibers in 76%, angulated fibers in 76%, type groupings in 62%, type 2 fiber atrophy in 58%, mononuclear endomysial and/or perimysial and/or perivascular infiltrates in 36%, necrosis and phagocytosis in 30% and target fibers in 6%. Two patients showed vasculitis and two others showed perifascicular atrophy. On the whole, 96% of the biopsies showed substantial abnormalities. Muscle involvement in AIDS seems more common than previously suspected.     

Survival in a population-based cohort of dementia patients: predictors and causes of mortality.

OBJECTIVES: To examine predictors of survival time and causes of mortality in a population-based cohort of demented subjects.DESIGN: Longitudinal naturalistic follow-up study.SETTING: A rural area in The Netherlands.PARTICIPANTS: The study population consisted of 102 demented subjects derived from a population-based, two-stage prevalence study of dementia among subjects aged 65 and over. MEASUREMENTS AND ANALYSIS: Survival analysis was performed using the Realized Probability of Dying as a measure of survival time. Adjustment for duration and severity at study entry was employed in all analyses.RESULTS: A substantial excess mortality was present among demented subjects as compared with their non-demented birth cohort. Disorders related to dementia, such as cachexia, dehydration and pneumonia, were major causes of death. Variables related to severity of functional impairment, aphasia and a shorter duration at study entry predicted a shorter survival in the study population.     

Hydroxyethyl starch for hypervolemic hemodilution in patients with acute ischemic stroke: a randomized,placebo-controlled phase II safety study

BACKGROUND: Hypervolemic hemodilution (HH) with hydroxyethyl starch (HES) significantly increases cerebral blood flow and thus may reduce ischemic tissue damage in the penumbra zones when given within the therapeutic time window. The objective of this study was to investigate the safety of a 10% solution of HES 130/0.4 versus 0.9% saline solution in acute ischemic stroke by the incidence of adverse events (AEs). METHODS: In a controlled, double-blind, randomized, multicenter, phase II, parallel-group study, 106 patients with acute ischemic stroke received high-dose HH with HES 130/0.4 or placebo within 6 h of symptom onset with a randomization ratio of 2:1 in favor of HES therapy. RESULTS: There were no significant differences between the groups with regard to the incidence of the specific AEs (cardiovascular events, bleeding complications, allergic reactions) assessed over days 1-30, or mortality over days 1-8. In addition, global tests of efficacy showed a trend towards a better functional outcome with HES therapy; however, the study was not designed to prove efficacy. CONCLUSIONS: High-dose HH with HES or NaCl was generally safe and well tolerated. Safety profiles were similar for the two treatment groups, and there was a nonsignificant trend towards a better functional outcome with HES therapy.     

Socioeconomic deprivation and extended hospitalization in severe mental disorder: a two-year follow-up study

OBJECTIVE: This study examined the association between socioeconomic deprivation and extended hospitalization in severe mental disorder, after taking account of confounding variables. METHODS: A representative sample of 660 inpatients from South Auckland, New Zealand, was followed for two years from their index admission. Additional data were collected during the index admission for a subsample of 291 patients. RESULTS: Greater levels of socioeconomic deprivation in the inpatient's neighborhood of residence was associated with extended hospitalization after adjustment for demographic factors and primary diagnosis but not after adjustment for comorbid diagnosis, chronicity, function, and severity. Most extended hospitalizations were related to poor illness recovery. CONCLUSIONS: People from more deprived areas are likely to need longer psychiatric admissions, mostly because of the association between deprivation and having more disabling symptoms and a comorbid psychiatric diagnosis. Interventions to prevent psychiatric hospitalization, reduce duration of stay, and enhance recovery must be tested among those with greater levels of socioeconomic deprivation.     

Incidence and causes of nondegenerative nonvascular dementia: a population-based study

BACKGROUND: Information on the incidence of nondegenerative and nonvascular dementia is limited. DESIGN: We used the records-linkage system of the Rochester Epidemiology Project to ascertain incident cases of dementia in Rochester, Minn, from January 1, 1990, through December 31, 1994. To define causes of dementia, we reviewed all diagnoses, imaging study results, laboratory test results, and clinical courses, as recorded historically in the patient dossier. RESULTS: We found 560 incident cases of dementia, and 60 of them (10.7%) had onset before the age of 70 years (younger-onset group). Forty-three cases (7.7%) were due to nondegenerative nonvascular causes and represented 30.0% of the total in the younger-onset group, but only 5.0% of the total in the older-onset group (aged 70-99 years). The most common nondegenerative nonvascular causes were cancer with or without brain metastases (n = 13), chronic alcoholism (n = 7), and chronic mental illness (n = 11). There were no cases of dementia due to normal-pressure hydrocephalus, subdural hematoma, hypothyroidism, vitamin B12 deficiency, or neurosyphilis. There were 2 individuals with acute confusion due to subdural hematoma and 1 with hypothyroidism whose cognition normalized with therapy. CONCLUSIONS: Nondegenerative nonvascular causes were more common than expected in patients with a younger onset of dementia. None of the patients with dementia reverted to normal with treatment of the putative reversible cause.     

Sense of humor and survival among a county cohort of patients with end-stage renal failure: a two-year prospective study

OBJECTIVE: To explore the significance of sense of humor for survival in a county cohort of patients diagnosed with end-stage renal failure. This diagnosis is a life-threatening condition that calls upon coping skills and regular dialysis. METHOD: All patients receiving dialysis in the county of S?r-Tr?ndelag during February of one year (N= 52) were invited. Forty-one completed the survey and had complete data (78.9%). Predictors were related to survival status two years later. Three blocks of predictors were tested: 1) age, gender and education; 2) duration of disease, number of dialyses per week, and co-morbidity; and 3) quality of life and sense of humor. Confounding effects of variables in blocks one and two were controlled for using Cox survival analysis. RESULTS: Nineteen patients (46.3 %) died over the 2-year observation period. Survival decreased with higher age at time of survey (p < .044), but was not significantly predicted by variables in block two. A highly significant increase in survival was due to the psychological variables of block three (p <.001) essentially accounted for by sense of humor (p < .005). Those who scored above the median in sense of humor increased their odds for survival by on average 31%. CONCLUSIONS: Sense of humor appeared to mediate better coping and, therefore, protected against detrimental effects of disease-related stressors upon survival.     

Country of birth and suicide: a follow-up study of a national cohort in Sweden.

The aim of this study was to examine whether the hypothesized association between country of birth and suicide rates remains after adjustment for age, marital status, socioeconomic status, and hospitalization due to psychiatric disorders or substance abuse. A Swedish cohort of 4.4 million individuals aged 25-64 years was followed from January 1, 1994, to December 31, 1999 for suicide. Suicide rates varied according to country of birth. Among men the highest risk of suicide was found among men from Finland. Among women the highest risk of suicide was found among women from Finland, Poland, and Eastern Europe. Key factors to prevent suicide include early detection and treatment of psychiatric disorders and/or substance abuse, especially among certain population groups.     

Multimodal sensory and motor evoked potentials in a two-year follow-up study of MS patients with relapsing course

Serial recording of multimodal sensory (pattern reversal visual, brainstem auditory, median and tibial somatosensory) and motor evoked potentials during a 2-year period was performed on a group of 25 patients with relapsing multiple sclerosis. A new, 10-degree evoked potentials abnormality scale was introduced. In contrast to the insignificant common trend of both the mean individual EP latency parameters and the mean expanded disability status scale and evoked potentials abnormality scale to deteriorate the changes in both expanded disability status scale (p less than 0.05) and evoked potentials abnormality scale (p less than 0.01) were significant using a 1-point criterion for change and non-parametric testing. Changes in both scales differed in about 50% of patients; contrary to bidirectional changes in the clinical scale, no improvement in the evoked potential scale was found. The introduction of an evoked potentials abnormality scale based on separate cut-off step-like criteria may increase the robustness of evoked potential changes due to the activity of the disease in longitudinal studies.