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61.
M. P. Walker G. A. Ayre C. H. Ashton V. R. Marsh K. Wesnes E. K. Perry J. T. O'Brien I. G. McKeith C. G. Ballard 《Human psychopharmacology》1999,14(7):483-489
Fluctuating levels of consciousness (FC) are a key feature in neurodegenerative dementias, yet clinical identification is poor, hindering accurate diagnosis. One hundred and nineteen patients (32 Dementia with Lewy Bodies (DLB), 57 Alzheimer's disease (AD) and 30 controls) with clinical scores of FC were assessed using an attentional task. Cortical arousal was assessed in 25 of these patients using electroencephalography. Over 90 s both variability in attention (p<0·0001) and fluctuations in electrocortical activity (p<0·0001) correlated with clinical FC scores, and with each other (p<0·0001). Variability in attention and electrocortical arousal are accurate FC markers and can assist differential diagnosis of AD and DLB. Previous work has underestimated the intensity and hence impact of FC in dementia. Copyright © 1999 John Wiley & Sons, Ltd. 相似文献
62.
Background
During a previous study to define and compare incidence risks of postoperative nausea and vomiting (PONV) for elective laparoscopic and open cholecystectomy at two hospitals in Jamaica, secondary analysis comparing PONV risk in elective open cholecystectomy to that after emergency open cholecystectomy suggested that it was markedly reduced in the latter group. The decision was made to collect data on an adequate sample of emergency open cholecystectomy cases and further explore this unexpected finding in a separate study. 相似文献63.
Cost‐effectiveness of donepezil and memantine in moderate to severe Alzheimer's disease (the DOMINO‐AD trial) 下载免费PDF全文
Martin Knapp Derek King Renée Romeo Jessica Adams Ashley Baldwin Clive Ballard Sube Banerjee Robert Barber Peter Bentham Richard G Brown Alistair Burns Tom Dening David Findlay Clive Holmes Tony Johnson Cornelius Katona James Lindesay Ajay Macharouthu Ian McKeith Rupert McShane John T O'Brien Patrick P J Phillips Bart Sheehan Robert Howard 《International journal of geriatric psychiatry》2017,32(12):1205-1216
Objective
Most investigations of pharmacotherapy for treating Alzheimer's disease focus on patients with mild‐to‐moderate symptoms, with little evidence to guide clinical decisions when symptoms become severe. We examined whether continuing donepezil, or commencing memantine, is cost‐effective for community‐dwelling, moderate‐to‐severe Alzheimer's disease patients.Methods
Cost‐effectiveness analysis was based on a 52‐week, multicentre, double‐blind, placebo‐controlled, factorial clinical trial. A total of 295 community‐dwelling patients with moderate/severe Alzheimer's disease, already treated with donepezil, were randomised to: (i) continue donepezil; (ii) discontinue donepezil; (iii) discontinue donepezil and start memantine; or (iv) continue donepezil and start memantine.Results
Continuing donepezil for 52 weeks was more cost‐effective than discontinuation, considering cognition, activities of daily living and health‐related quality of life. Starting memantine was more cost‐effective than donepezil discontinuation. Donepezil–memantine combined is not more cost‐effective than donepezil alone.Conclusions
Robust evidence is now available to inform clinical decisions and commissioning strategies so as to improve patients' lives whilst making efficient use of available resources. Clinical guidelines for treating moderate/severe Alzheimer's disease, such as those issued by NICE in England and Wales, should be revisited. © 2016 The Authors. International Journal of Geriatric Psychiatry published by John Wiley & Sons Ltd. 相似文献64.
Erskine Daniel Taylor John-Paul Thomas Alan Collerton Daniel McKeith Ian Khundakar Ahmad Attems Johannes Morris Christopher 《神经科学通报》2019,35(2):295-300
<正>Introduction Recurrent complex visual hallucinations are a core clinical feature of dementia with Lewy bodies (DLB) and are typically well-formed, often consisting of figures, such as people or animals [1]. Despite the profound impact upon patients and caregivers in DLB, the aetiopathology of visual hallucinations remains largely unknown. In this article we discuss the anatomy of the human visual system,hypotheses of the genesis of visual hallucinations in DLB, 相似文献
65.
Increased rates of brain atrophy are seen in Alzheimer's disease, but whether rates are similarly increased in other dementias such as Parkinson's disease dementia (PDD) has not been well examined. We determined the rates of brain atrophy using serial magnetic resonance imaging (MRI) in PDD and compared this finding to rates seen in cognitively intact Parkinson's disease (PD) patients and age-matched control subjects. Thirty-one patients (PD = 18, PDD = 13) and 24 age-matched controls underwent serial volumetric 1.5 T MRI scans, approximately 1 year apart. Baseline and repeat scans were registered and quantification of the brain boundary shift integral was used to determine whole-brain atrophy rates. Rates of brain atrophy were significantly increased in PDD (1.12 +/- 0.98%/year) compared to PD (0.31 +/- 0.69%/year; P = 0.018) and control subjects (0.34 +/- 0.76%/year; P = 0.015). There were no differences in atrophy rates between controls and PD (P = 0.79). No correlations between increased atrophy rates and age or dementia severity (Mini-Mental State Examination score) were observed. Serial MRI may be a useful tool for monitoring disease progression in PDD and further studies should investigate its utility for early diagnosis. 相似文献
66.
Interleukin-5 is at 5q31 and is deleted in the 5q- syndrome 总被引:3,自引:0,他引:3
Sutherland GR; Baker E; Callen DF; Campbell HD; Young IG; Sanderson CJ; Garson OM; Lopez AF; Vadas MA 《Blood》1988,71(4):1150-1152
Human interleukin-5 (IL-5) is a selective eosinophilopoietic and eosinophil-activating growth hormone. By in situ hybridization this gene is mapped to chromosome 5q23.3 to 5q32. It is shown to be deleted in two patients with the 5q-syndrome and in one patient previously diagnosed with myelodysplasia whose condition had progressed to acute myeloblastic leukemia. The clustering of other genes involved in hematopoiesis (IL-3, granulocyte-macrophage colony-stimulating factor, feline sarcoma viral oncogene homolog, colony-stimulating factor 1) to the same region as IL-5 suggests a nonrandom localization and raises interesting questions concerning the evolution and regulation of these genes. 相似文献
67.
Emma J Burton Ian G McKeith David J Burn Michael J Firbank John T O'Brien 《The American journal of geriatric psychiatry》2006,14(10):842-849
OBJECTIVE: The objective of this study was to investigate cross-sectional and longitudinal white matter hyperintensity (WMH) changes in older subjects with clinically diagnosed dementia. METHODS: Fluid-attenuated inversion recovery images were acquired one year apart in subjects with dementia with Lewy bodies (DLB), Parkinson disease dementia (PDD), Alzheimer disease (AD), and also healthy elderly comparison subjects. WMH volume was quantified using an automated technique. RESULTS: Baseline WMH (as a percent of brain volume) was significantly greater compared with healthy subjects (N=33, geometric mean WMH: 0.4%) in subjects with AD (N=23 [1.3%], analysis of variance post hoc p <0.001) but not PDD (N=13 [0.6%]) or DLB (N=14 [0.4%]). Increase in WMH volume (as a percent of brain volume) was not significantly different (Kruskal-Wallis p=0.4) between groups (AD median change: 0.08%; DLB: 0.025%; PDD: 0.07%, healthy: 0.02%). Severity of baseline WMH, rather than diagnosis or severity of dementia, was a significant predictor of lesion progression. Rate of change of WMH had no association with change in global cognitive performance. CONCLUSIONS: Significant WMH progression occurs in degenerative dementias with rates influenced by severity of lesions at baseline rather than dementia type or cognitive decline. 相似文献
68.
Erythropoietin and sexual dysfunction 总被引:7,自引:1,他引:6
Lawrence IG; Price DE; Howlett TA; Harris KP; Feehally J; Walls J 《Nephrology, dialysis, transplantation》1997,12(4):741-747
BACKGROUND: Erythropoietin (rHuEpo) therapy has been shown to improve
sexual function in the male dialysis population, with several studies
suggesting a direct effect upon endocrine function, as well as correction
of anaemia. Nevertheless many male dialysis patients receiving rHuEpo
continue to complain of sexual dysfunction. METHODS: At a dedicated renal
impotence clinic, 65 male dialysis patients were screened for endocrine
disturbances. Baseline serum sex hormones were compared between those
receiving and not receiving rHuEpo, using either the two-sample t test or
the Mann-Whitney U test, after assessing for normality. Results from four
patients were excluded on account of either medications (antiemetic
phenothiazines), hepatic dysfunction, or carcinomatosis. RESULTS:
Twenty-five patients (41.0%) were receiving rHuEpo, the recipients and
non-recipients being well matched for haemoglobin (10.19 +/- 0.29 vs 10.55
+/- 0.25 g/dl, n.s.), age (51.1 +/- 1.9 vs 53.6 +/- 2.1 years, n.s.) and
duration of sexual dysfunction (median, 3.0 vs 3.0 years, n.s.). The rHuEpo
recipients had a higher median creatinine (1090 vs 972 micromol/l, P <
0.02), but similar nutritional status to the non-recipients (albumin 41.0
vs 39.0 g/l, n.s.). The total duration of rHuEpo therapy was 0.85 +/- 0.14
years. Prolactin levels were similar in both the rHuEpo recipients and non-
recipients (440 vs 541 mu/l, n.s.), as were LH (11.0 vs 10.5 iu/l, n.s.)
and FSH (8.0 vs 6.5 iu/l, n.s.). However, there were significant elevations
of testosterone (19.8 +/- 1.3 vs 16.1 +/- 1.1 nmol/l, P < 0.05) and sex
hormone binding globulin (SHBG) (40.5 vs 26.0 nmol/l, P < 0.01), with a
trend toward elevated oestradiol (304 vs 248 pmol/l, P = 0.095) in the
rHuEpo-treated group. Forty-eight subjects (78.7%) received peritoneal
dialysis (PD), with the 19 rHuEpo recipients (39.6%) demonstrating
increased serum testosterone (21.0 +/- 1.5 vs 16.6 +/- 1.3 nmol/l, P <
0.05), SHBG (40.5 vs 26.5 nmol/l, P < 0.01), LH (15.0 vs 10.0 iu/l, P
< 0.01) and FSH (12.0 vs 5.3 iu/l, P < 0.05). These differences were
not demonstrated in the 13 haemodialysis (HD) subjects. CONCLUSIONS: Male
dialysis patients complaining of sexual dysfunction after correction of
anaemia with rHuEpo are characterized by higher levels of serum
testosterone and SHBG, but not suppression of hyperprolactinaemia or
hyperoestrogenism. Male PD subjects receiving rHuEpo also demonstrated
increased LH and FSH.
相似文献
69.
70.
Purpose: To determine if the pattern of release of neurotensin from the enkephalin-, neurotensin- and somatostatin-like immunoreactive amacrine cells in response to light and dark is the same as that of the enkephalins and somatostatin. Methods/Results: Both the enkephalins and somatostatin are released at high rates in the dark and at lower rates in the light, and these rate changes are reflected in increasing intracellular levels of the peptides in vivo in the light and decreasing levels in the dark The levels of neurotensin-like immunoreactivity show a similar diurnal light-driven and non-circadian rhythm in vivo. Conclusion: This implies that the actual release rates of neurotensin follow the same patterns as those demonstrated in vitro for the enkephalins and somatostatin. 相似文献