1/34. neurofibrillary tangles in the dementia of "normal pressure" hydrocephalus.Routine neuropathological examination could not explain the dramatic improvement exhibited by one patient with "normal pressure" hydrocephalus after shunting. The improved patient contrasted remarkably with the unchanged condition of four others also shunted successfully. The five brains were analysed by quantitative morphometry to determine the degree of neurofibrillary tangle formation in mesial temporal neurons. The density of tangle-bearing nerve cells in the four unimproved cases was markedly greater than in age-matched control brains from nineteen normal subjects, and fell in the same range as that of eight dements with neuropathologically confirmed Alzheimer's disease. The density of the one who recovered was within normal limits. The duration of dementia before shunting, and the total duration of dementia in these five patients rank in the same order as their degree of neurofibrillary formation. Furthermore, a positive linear correlation exists between the Tangle Indices and the total duration of dementia. The data suggest that early diagnosis may improve the chances of reversing the dementia of normal pressure hydrocephalus before histological alterations prove too severe.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/34. Reversible dementia in idiopathic normal pressure hydrocephalus. A case report.OBJECTIVE: To present a woman with idiopathic normal pressure hydrocephalus (NPH) showing marked improvement in mental function after shunt operation. DESIGN: Case report. SETTING: primary health care. PATIENT: The clinical symptoms of gait disturbance, occasional urine incontinence and severely impaired mental function typical of NPH were all present. Although dementia predominated in the clinical picture, the diagnosis was confirmed by computer tomography (CT) and cerebrospinal fluid infusion test and cisternography. MAIN OUTCOME MEASURES: A marked improvement of mental functions was observed after shunt operation. RESULTS: Mini Mental State Examination score before shunt operation was 9 compared with 20 one year after operation. Also ventricle size was reduced as evaluated by CT scan. CONCLUSION: This reported case contrasts previous reports concluding that shunt responsive patients have only slight mental disturbances without significant improvement of mental status after shunt operation.- - - - - - - - - - ranking = 0.83333333333333keywords = pressure (Clic here for more details about this article) |
3/34. Dementia in the elderly--a search for treatable illnesses.Forty patients with senile dementia were evaluated prospectively with laboratory and radiologic investigations, including computerized axial transverse tomography. Five patients were believed to have potentially treatable illnesses causing the dementia. After treatment, the dementia in one patient with hypothyroidism was completely resolved. One patient with pernicious anemia was markedly improved, and a second patient with hypothyroidism was somewhat improved. One patient with a brain tumor was not treated, and a severely demented patient with possible normal pressure hydrocephalus died shortly after shunting without improvement. The discovery of these unsuspected illnesses and the gratifying response to treatment in some suggests the importance of systematic evaluation in all patients with senile dementia.- - - - - - - - - - ranking = 0.16666666666667keywords = pressure (Clic here for more details about this article) |
4/34. Spontaneous intracranial hypotension causing reversible frontotemporal dementia.Spontaneous intracranial hypotension (SIH) causes postural headache and neurologic symptoms owing to traction and brain compression. A 66-year-old man with chronic headache and progressive personality and behavioral changes typical of frontotemporal dementia was examined. He had MRI findings of SIH with low CSF pressure. His headache, dementia, and imaging abnormalities abated after treatment with prednisone. SIH can cause reversible frontotemporal dementia, and should be considered when dementia and behavioral changes are accompanied by headache.- - - - - - - - - - ranking = 0.16666666666667keywords = pressure (Clic here for more details about this article) |
5/34. Reversible leukoencephalopathy in cerebral amyloid angiopathy presenting as subacute dementia.This report concerns a 71-year-old woman who had rapid progressive dementia along with myocloni and increased blood pressure. Cranial computed tomography and magnetic resonance imaging scans showed bilateral widespread white matter changes with mass effect. A brain biopsy revealed an amyloid angiopathy in leptomeningeal as well as cerebral cortex arteries. After 2 months of antihypertensive treatment, a dramatic improvement of cognitive functions and a spectacular regression of leukoencephalopathy were observed. We suggest that hypertensive encephalopathy may worsen or reveal cerebral amyloid angiopathy.- - - - - - - - - - ranking = 0.16666666666667keywords = pressure (Clic here for more details about this article) |
6/34. The pressures felt by informal carers of people with dementia.Caring for people with dementia is complex and demanding, and informal carers carry out much of the care. In this article, Madeline Armstrong outlines the different types of dementia and discusses the psychological approaches to care. Informal carers experience many stressors when caring for people with dementia and Admiral nurses play an important role in supporting carers.- - - - - - - - - - ranking = 0.66666666666667keywords = pressure (Clic here for more details about this article) |
7/34. Evidence of subnormal function of association cortex in presenile dementia.Regional cerebral blood flow (rCBF) was measured in 23 patients with organic dementia (17 patients with Alzheimer's disease and six with low-pressure hydrocephalus [LPH]). The flow of gray matter was significantly reduced, especially in occipito-parieto-temporal regions, as well as frontally in some patients. During activation with psychologic tests, reading, etc., the flow augmentation in the association areas in the demented patients was not as marked as in nondemented controls. Instead, in some patients, a flow diminution was recorded in the same regions (intellectual steal). Organic dementia appears to be accompanied by a low activity in the association cortex and a reduced ability to activate these regions during mental effort.- - - - - - - - - - ranking = 0.16666666666667keywords = pressure (Clic here for more details about this article) |
8/34. Treatment of mania in dementia with electroconvulsive therapy.Symptoms of mania have been given inadequate attention as a source of agitated behavior in the dementia patient. Characterized by elevation in mood or grandiosity, pressured speech, and impulsivity, mania is common among the elderly population, with a prevalence approaching 20% in some studies. Because it is so highly associated with behavioral agitation, mania has a significant impact on patient management, and can often lead to the institutionalization of difficult patients. Here we present a case series of three elderly individuals who had signs of mania in conjunction with dementia. Refractory to psychotropic medications, all were given an acute plus maintenance courses of right-unilateral electroconvulsive therapy (ECT). The patients achieved significant improvement in signs of mania and agitation, as well as in mental status scores. We conclude that a short course of ECT, followed by maintenance treatments every 2 weeks, can contribute significantly to the management of dementia patients whose behavioral agitation is associated with signs of mania.- - - - - - - - - - ranking = 0.16666666666667keywords = pressure (Clic here for more details about this article) |
9/34. Combined paravertebral lumbar plexus and parasacral sciatic nerve block for reduction of hip fracture in a patient with severe aortic stenosis.PURPOSE: To report the use of a combined paravertebral lumbar plexus and parasacral sciatic nerve block for reduction of hip fracture in an elderly patient with severe aortic stenosis. Clinical features: In an 87-yr-old lady with severe aortic stenosis and fracture of the right trochanter due to a fall, a combined right-sided paravertebral lumbar plexus and parasacral sciatic nerve block was used successfully for operative reduction of the fracture. A moderate amount of phenylephrine was required to maintain adequate systemic blood pressure despite the largely unilateral nature of the blocks. CONCLUSION: Combined paravertebral lumbar plexus and parasacral sciatic nerve block can be a viable alternative to general anesthesia and epidural or spinal block for hip surgery in patients with severe aortic stenosis.- - - - - - - - - - ranking = 0.16666666666667keywords = pressure (Clic here for more details about this article) |
10/34. air support therapy: ethical considerations.Pressure ulcers are a major health problem for the elderly population in the united states. Billion of health care dollars are spent for hospitalization, air support therapy, wound care products, and nursing care. In addition, the cost in human suffering is priceless. Many patients with pressure ulcers have several chronic diseases that make wound healing difficult. nurses must begin to examine the ethical principles that guide their care of these patients. This article focuses on some ethical issues related to the care of patients with pressure ulcers and the difficulties encountered with pressure ulcer care. Careful analysis of the goals of pressure ulcer treatment may help nurses develop ethical guidelines to direct them in the care of these patients.- - - - - - - - - - ranking = 0.66666666666667keywords = pressure (Clic here for more details about this article) |
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