Abstract:
OBJECTIVES:To estimate life expectancy of psychogeriatric patients having participated in a reactivation program. To identify prognostic characteristics - on admission - for survival after discharge. DESIGN:A prospective, clinical-empirical observational study. SETTING:A Dutch psychiatric-skilled nursing home. PARTICIPANTS:Psychogeriatric patients (n = 75) suffering from very mild to moderate cognitive function disorders in conjunction with psychiatric function disorders. INTERVENTION:Interdisciplinary reactivation program. MEASUREMENTS:General, functional and diagnostic patient characteristics assessed on admission for the psychogeriatric reactivation program, and survival rate after discharge over a period of 7 years. RESULTS:The probability of survival for patients who were discharged from the psychogeriatric reactivation program to their own homes or to a residential home with restricted support ('independent' group, n = 53) was higher (1/HR = 3.2) than for patients who were discharged to a nursing home ('dependent' group, n = 22). The median survival period of the reference group (community-dwelling elderly people) was 95 months (95% confidence interval, CI: 74-116), that of the 'independent' group 35 months (95% CI: 25-45) and that of the 'dependent' group 13 months (95% CI: 3-22). For the reactivated patients (n = 75), gender was the only general characteristic of prognostic value for survival after discharge (the survival rate for women was higher; hazard ratio (HR) = 3.07; 95% CI: 1.61-5.85). Age was statistically insignificant. One functional characteristic, the Global Deterioration Scale, was of prognostic significance (HR = 1.58; 95% CI: 1.11-2.23). The diagnostic characteristics of prognostic significance were: psychiatric function disorders (paranoia; HR = 2.19; 95% CI: 1.11-4.28), somatic comorbidity (urogenital pathology; HR = 1.83; 95% CI: 1.13-2.94; cardiopulmonary pathology; HR = 1.56; 95% CI: 1.16-2.07) and adequacy of the caregiver system (HR = 0.59; 95% CI: 0.33-1.03). The specific diagnostic classifications of cognitive function disorders (DSM-IV) were not of prognostic significance. It was possible to account for 32% of the variance in survival after discharge. CONCLUSION:The survival rate of the 'independent' group of patients was obviously higher (1/HR = 3.2) than that of the 'dependent' group. There was no overlap in the 95% CI of the median survival period after discharge. The results suggest that with respect to survival the two groups of psychogeriatric patients who participated in the intensive reactivation program differed definitely. Additionally, patients belonging to the 'independent' group had a greater chance to benefit from a reactivation program. The program should pay special attention to the patient characteristics on admission, which demonstrated a significant negative correlation to survival. These patient characteristics belonged to five domains (i.e. gender, cognitive function disorders, psychiatric function disorders, somatic comorbidity and adequacy of the caregiver system) The five dimensions are of clinical interest for optimizing the selection of patients who may derive most benefit from a reactivation program. The development of a valid prognostic instrument is a prerequisite for optimal medical decision-making for such intensive intervention programs, as is the analysis of cost-effectiveness. In order to draw firm conclusions, it is recommended that a large-scale study with a randomized, parallel-group design will be performed. Our group has started such a research program in July 2001.
journal_name
Dement Geriatr Cogn Disordjournal_title
Dementia and geriatric cognitive disordersauthors
Bakker TJ,Duivenvoorden HJ,van der Lee J,Schudel WJdoi
10.1159/000077731keywords:
subject
Has Abstractpub_date
2004-01-01 00:00:00pages
24-31issue
1eissn
1420-8008issn
1421-9824pii
77731journal_volume
18pub_type
临床试验,杂志文章abstract::This study examines the associations between education, cerebral perfusion, and cognitive test performance among 132 patients with Alzheimer's disease. The participants had had between 0 and 19 years of formal schooling, and had either mild or moderate dementia according to the Clinical Dementia Rating Scale. Cerebral...
journal_title:Dementia and geriatric cognitive disorders
pub_type: 杂志文章
doi:10.1159/000085068
更新日期:2005-01-01 00:00:00
abstract:BACKGROUND:The aim of this study was to identify the brain regions associated with the severity of delusions in individuals with Alzheimer's disease (AD) using single-photon emission computed tomography. METHODS:Thirty-five AD patients participated in this study. Multiple regression analysis was performed to identify ...
journal_title:Dementia and geriatric cognitive disorders
pub_type: 杂志文章
doi:10.1159/000295115
更新日期:2010-01-01 00:00:00
abstract:BACKGROUND/AIMS:The aims of this study were to validate the newly developed version of the Addenbrooke's Cognitive Examination (ACE-III) against standardised neuropsychological tests and its predecessor (ACE-R) in early dementia. METHODS:A total of 61 patients with dementia (frontotemporal dementia, FTD, n = 33, and A...
journal_title:Dementia and geriatric cognitive disorders
pub_type: 杂志文章
doi:10.1159/000351671
更新日期:2013-01-01 00:00:00
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journal_title:Dementia and geriatric cognitive disorders
pub_type: 杂志文章
doi:10.1159/000017046
更新日期:1998-07-01 00:00:00
abstract::Age-related changes and the effects of dementia of the Alzheimer type (DAT) were investigated during a visual orienting attention task in which attention was pre-cued to one or other hemifields. Central cues were either valid, neutral, invalid or NoGo (inhibitory). The response time cost-benefit analysis showed a decr...
journal_title:Dementia and geriatric cognitive disorders
pub_type: 杂志文章
doi:10.1159/000106657
更新日期:1997-11-01 00:00:00
abstract:AIMS:Mild cognitive impairment (MCI) usually represents a transitional phase between normal cognitive function and dementia, but not all people with MCI develop dementia because MCI is a clinically and etiologically heterogeneous grouping. The aim of this study was to compare progression rates to Alzheimer's disease (A...
journal_title:Dementia and geriatric cognitive disorders
pub_type: 杂志文章
doi:10.1159/000339159
更新日期:2012-01-01 00:00:00
abstract:OBJECTIVE:The familial aggregation of late-onset Alzheimer's disease (AD) might be caused by the clustering of genetic risk factors in families. This study investigates the influence of variants of candidate genes on the familial aggregation of AD. METHODS:The occurrence of AD was examined in 1,420 first-degree relati...
journal_title:Dementia and geriatric cognitive disorders
pub_type: 杂志文章,多中心研究
doi:10.1159/000079195
更新日期:2004-01-01 00:00:00
abstract:BACKGROUND/AIMS:To investigate neuroanatomical substrates of unawareness of memory deficits in patients with early Alzheimer's disease (AD). METHODS:We compared regional perfusion deficits between AD patients with awareness (n = 19) and unawareness (n = 19). SPECT data were analyzed by statistical brain imaging method...
journal_title:Dementia and geriatric cognitive disorders
pub_type: 杂志文章
doi:10.1159/000119594
更新日期:2008-01-01 00:00:00
abstract::The degeneration of dopaminergic cells in dementia with Lewy bodies (DLB) may provide an important source of additional free radical generation. As a result, the oxidative stress status in DLB could be significantly enhanced. Subsequently, the levels of endogenous antioxidants, which are an indirect measure of free ra...
journal_title:Dementia and geriatric cognitive disorders
pub_type: 杂志文章
doi:10.1159/000069993
更新日期:2003-01-01 00:00:00
abstract:AIMS:To describe the contribution of white matter lesions to the long-term neuropsychological profiles of different groups of clinical diagnoses, and to identify neuropsychological predictors of cognitive impairment in a 10-year follow-up. METHODS:The Lisbon subcohort of the Leukoaraiosis and Disability (LADIS) study ...
journal_title:Dementia and geriatric cognitive disorders
pub_type: 杂志文章
doi:10.1159/000447121
更新日期:2016-01-01 00:00:00
abstract::Metrifonate, through its pharmacologically active metabolite 2,2-dichlorovinyl dimethylphosphate (DDVP), is a long-acting cholinesterase inhibitor for the symptomatic treatment of mild-to-moderate Alzheimer's disease. Clinical studies with Alzheimer patients have demonstrated the favourable safety and tolerability pro...
journal_title:Dementia and geriatric cognitive disorders
pub_type: 杂志文章,评审
doi:10.1159/000051194
更新日期:1998-01-01 00:00:00
abstract::Mild cognitive impairment (MCI) is regarded as a precursor to dementia, but not all patients with MCI develop dementia. We followed up 165 elderly outpatients with MCI for a mean of 3 years. The aims were (1) to investigate the risk of conversion to dementia for different MCI subtypes diagnosed according to standardiz...
journal_title:Dementia and geriatric cognitive disorders
pub_type: 杂志文章
doi:10.1159/000089515
更新日期:2006-01-01 00:00:00
abstract::To elucidate the influence of the alpha1-antichymotrypsin (ACT) polymorphism on Alzheimer-type neuropathological changes and the development of sporadic Alzheimer's disease (AD), we studied the relationship between the ACT polymorphism and the severity of Alzheimer-type neuropathological changes in the brains from AD ...
journal_title:Dementia and geriatric cognitive disorders
pub_type: 杂志文章
doi:10.1159/000017123
更新日期:1999-05-01 00:00:00
abstract:OBJECTIVE:To investigate the relationship between quantitative EEG (qEEG) measurements in frontotemporal dementia (FTD), Alzheimer's disease (AD) and healthy controls and to study to what extent qEEG in FTD and AD or neuropsychological test results of FTD and AD patients or a combination of both contribute to classific...
journal_title:Dementia and geriatric cognitive disorders
pub_type: 杂志文章
doi:10.1159/000067973
更新日期:2003-01-01 00:00:00
abstract::This paper reviews the history of the development of the American Psychiatric Association's Diagnostic and Statistical Manual (DSM) using the diagnostic category of delirium as an example. It also attempts to show how clinical practice and experience has molded the current conceptualization of delirium in DSM-IV. The ...
journal_title:Dementia and geriatric cognitive disorders
pub_type: 历史文章,杂志文章
doi:10.1159/000017171
更新日期:1999-09-01 00:00:00
abstract:BACKGROUND/AIMS:To characterize loss of basic activities of daily living (BADL) in 687 Alzheimer's disease (AD) community-dwelling patients included in the French REAL cohort. METHODS:Patients had mild to moderately severe AD, and the mean age was 77.8 years. Patterns of loss of the 6 BADL were described at inclusion ...
journal_title:Dementia and geriatric cognitive disorders
pub_type: 杂志文章
doi:10.1159/000264632
更新日期:2010-01-01 00:00:00
abstract:BACKGROUND/AIMS:We investigated the histopathological correlates of white matter hyperintensities (WMHs) in participants with Alzheimer's disease (AD) or cerebrovascular disease, and in aged controls. METHODS:We reviewed 57 participants who had neuropathology and in whom neuroimaging was done. In addition to AD pathol...
journal_title:Dementia and geriatric cognitive disorders
pub_type: 杂志文章
doi:10.1159/000366411
更新日期:2015-01-01 00:00:00
abstract:UNLABELLED:The concept of the cognitive reserve (CR) hypothesizes that premorbid factors such as education enable compensation for the manifestation of brain pathology. Accordingly, pathology should be more prominent in individuals with higher CR before becoming clinically apparent. Previously, we found that patients s...
journal_title:Dementia and geriatric cognitive disorders
pub_type: 杂志文章
doi:10.1159/000234912
更新日期:2009-01-01 00:00:00
abstract::In 21 patients suffering from Binswanger's disease (BD) and in 53 patients suffering from Alzheimer's disease, we measured cerebrospinal fluid (CSF) concentrations of somatostatin-like immunoreactivity (SLI), high molecular weight form somatostatin (HMV-SST), somatostatin-25/28 (SST-25/28), somatostatin-14 (SST-14), D...
journal_title:Dementia and geriatric cognitive disorders
pub_type: 杂志文章
doi:10.1159/000106598
更新日期:1997-01-01 00:00:00
abstract:BACKGROUND:Most studies examining episodic memory in Alzheimer disease (AD) have focused on patients' impaired ability to remember information. This approach provides only a partial picture of memory deficits since other factors involved are not considered. OBJECTIVE:To evaluate the recognition memory performance by u...
journal_title:Dementia and geriatric cognitive disorders
pub_type: 杂志文章
doi:10.1159/000452255
更新日期:2017-01-01 00:00:00
abstract::Abnormal tau hyperphosphorylation has been suggested as being one of the central events in the development of neurofibrillary tangles, which are one of the characteristic neuropathological lesions found in Alzheimer's disease (AD) brains. 14-3-3 zeta protein is associated with tau in brain and stimulates tau phosphory...
journal_title:Dementia and geriatric cognitive disorders
pub_type: 杂志文章
doi:10.1159/000119123
更新日期:2008-01-01 00:00:00
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journal_title:Dementia and geriatric cognitive disorders
pub_type: 杂志文章
doi:10.1159/000051241
更新日期:2001-03-01 00:00:00
abstract:BACKGROUND/AIMS:Differences in the gross shape of the corpus callosum (CC) and its subregional areas were investigated on brain MRI of patients with probable Alzheimer's disease (AD) and age- and gender-matched healthy normal control subjects. The AD patients differed from the normal control subjects in terms of a more...
journal_title:Dementia and geriatric cognitive disorders
pub_type: 杂志文章
doi:10.1159/000097371
更新日期:2007-01-01 00:00:00
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journal_title:Dementia and geriatric cognitive disorders
pub_type: 杂志文章
doi:10.1159/000360414
更新日期:2014-01-01 00:00:00
abstract:BACKGROUND:The impact of occupational exposure to solvents on cognitive ageing remains unclear. We examined whether long-term occupational exposure is associated with poor cognitive performance in late midlife. METHODS:Participants in the GAZEL cohort, set up in 1989, are employees of the French national electricity a...
journal_title:Dementia and geriatric cognitive disorders
pub_type: 杂志文章
doi:10.1159/000315498
更新日期:2010-01-01 00:00:00
abstract::Seventeen patients with probable Alzheimer's disease (AD), 7 patients with frontal lobe dementia (FLD) and 19 control subjects (NOR) were examined by (99m)Tc-d,l- hexamethylpropylene amine oxime ((99m)Tc-HMPAO) SPECT. Images were standardised in the same 3D space and averaged within each group. After normalisation, th...
journal_title:Dementia and geriatric cognitive disorders
pub_type: 杂志文章
doi:10.1159/000051255
更新日期:2001-05-01 00:00:00
abstract:BACKGROUND/AIMS:Because poor lung function may be a risk factor for cognitive decline, we aimed to test the association of respiratory function with cognitive function and dementia later in life, as well as potential effect modification by APOE epsilon4 carrier status. METHODS:In a prospective population-based cohort ...
journal_title:Dementia and geriatric cognitive disorders
pub_type: 杂志文章
doi:10.1159/000255600
更新日期:2009-01-01 00:00:00
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journal_title:Dementia and geriatric cognitive disorders
pub_type: 杂志文章
doi:10.1159/000505573
更新日期:2019-01-01 00:00:00
abstract::Recent studies have implicated interleukin-6 (IL-6) in the pathogenesis of Alzheimer's disease (AD). Neuro-inflammatory processes surrounding the amyloid plaques contribute to the progression of AD-related neurodegeneration. IL-6 is a multifunctional inflammatory cytokine which possibly acts as a mediator in the local...
journal_title:Dementia and geriatric cognitive disorders
pub_type: 杂志文章
doi:10.1159/000076352
更新日期:2004-01-01 00:00:00
abstract:AIMS:The aim of this study was to identify physical and mental health and lifestyle predictors of transition from normal cognition to mild cognitive disorder (MCD). METHODS:A total of 2,082 individuals, aged 60-64 years, were assessed at 2 time-points 4 years apart for mild cognitive impairment (MCI) and other MCDs. ...
journal_title:Dementia and geriatric cognitive disorders
pub_type: 杂志文章
doi:10.1159/000229025
更新日期:2009-01-01 00:00:00