1/51. In-vivo demonstration of dopaminergic degeneration in dementia with lewy bodies.With the dopaminergic presynaptic ligand FP-CIT and single photon emission tomography we have shown a severe dopaminergic degeneration in a patient with a necropsy confirmed diagnosis of dementia with lewy bodies (DLB). We suggest that functional imaging of the nigrostriatal dopamine pathway helps to distinguish DLB from Alzheimer's disease during life.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
2/51. physicians' decision-making in incompetent elderly patients: a comparative study between austria, germany (East, West), and sweden.In order to investigate to what extent various determinants in the decision-making process for the treatment of severely ill incompetent patients are influenced by cultural and sociopolitical factors, 540 physicians in austria, germany (East and West), and sweden, countries representing different healthcare systems, were surveyed using a self-administered questionnaire. It provided three case vignettes with different levels of information about the patient's treatment wishes in case of incompetence in a life-threatening situation. We found a general trend to a lower level of treatment in line with the patient's wishes when the information provided was more detailed. Remarkably, a substantial number of doctors did not comply with the patient's wishes. Ethical concerns and patient's wishes appeared as the most important factors whereas religious beliefs of the physician and hospital costs scored lowest. Because of the variability of treatment decisions and the importance of various factors determining the decision-making, an advance directive may be a feasible way of reducing the number of conflicts in critical situations. We recommend that ethical issues of clinical practice should be emphasized in the medical curriculum and in the training of physicians.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
3/51. Transient epileptic amnesia in dementia: a treatable unrecognized cause of episodic amnestic wandering.The authors present two patients with dementia who displayed recurrent transient episodes of amnestic wandering and disorientation characterized by getting lost in familiar environments. At other times these patients did not wander or become disoriented. The inability to recall any information during these episodes, and the marked difference of the episodic amnesia exacerbations from the progressive amnesia characteristic of alzheimer disease seen in these patients led to their evaluation. These clinical episodes and the bilateral interictal epileptiform electroencephalographic changes found in both patients led to the diagnosis of transient epileptic amnesia, a syndrome that can be diagnostically elusive. These transient amnestic wandering events subsided after treatment with antiepileptic drugs in both patients. The authors suggest that transient wandering of this type may be caused by ictal events or postictal confusional states. This report emphasizes the importance of recognizing transient epileptic amnesia as an easily treatable cause of episodic behavioral abnormalities responsive to antiepileptic therapy, especially in those patients who have a markedly inconsistent pattern of wandering, disorientation in familiar settings, and amnesia exacerbation manifested by no recall of the emotional stress of getting lost or of any information during these episodes. Recognition of this type of behavioral disruption and its proper treatment can lead to improved quality of life for these patients, maintain these patients in their homes and out of chronic care institutions longer, and facilitate the community's and caretaker's interactive roles with the patient.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
4/51. [18F]FDG-PET study in dementia with lewy bodies and Alzheimer's disease.1. The authors report two siblings with dementia with lewy bodies (DLB). Both the older brother and the younger sister underwent positron emission tomography (PET) studies with [18F]-2-fluoro-deoxy-D-glucose (FDG) during life. The FDG-PET study demonstrated unique and pronounced metabolic impairment in the occipital cortex in both patients. The clinical diagnosis of DLB in the sister was confirmed by autopsy. 2. FDG-PET images from 11 patients with Alzheimer's disease (AD), 7 patients with DLB and 10 age-matched normal subjects were obtained and analyzed by the statistical parametric mapping (SPM) method. The SPM demonstrated a widespread metabolic reduction in the DLB group. The reduction was particularly pronounced in the visual association cortex in the DLB group compared to the AD group irrespective of clinical severity of the disease. 3. These findings suggest that functional neuroimaging techniques, including FDG-PET, will provide a valuable diagnostic aid to differentiate DLB from AD, and this will help detect DLB patients in the early stage of the disease.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
5/51. Using music therapy to help a client with Alzheimer's disease adapt to long-term care.The purpose of this case study is to illustrate how music therapy can be used to help the elderly successfully adjust to living in a long-term care (LTC) facility. LTC residents, particularly those with Alzheimer's disease or related dementia, may exhibit behaviors such as depression, withdrawal, anxiety, emotional liability, confusion, and memory difficulties, frequently related to the disorder, but often exacerbated by difficulty in adjustment to the change in lifestyle. The subject of this case study demonstrated these symptoms. music therapy helped him adjust to life in a LTC setting by improving his quality of life and enhancing his relationships with those around him. As chronicled in this study, music therapy may facilitate a resident's adjustment to life in a LTC facility. N.B. names and identifying information have been changed to protect privacy.- - - - - - - - - - ranking = 4keywords = life (Clic here for more details about this article) |
6/51. Palliative pain therapy at the end of life and forensic medicine issues.An 83-year-old woman with a history of Alzheimer's disease and breast cancer died at home while receiving palliative pain therapy with oral morphine from her family for metastatic breast cancer. Allegations of mistreatment were made, and this case was ultimately referred to the Office of the Chief Medical Examiner, State of maryland. An autopsy failed to identify any injuries or residual cancer, leaving no anatomic explanation for the pain that had been presumed to be metastatic breast carcinoma involving bone. The blood free morphine concentration was 5,200 ng/ml, and the total morphine concentration was 15,000 ng/ml. This case demonstrates the challenges and difficulties in forensic medicine when faced with the interpretation of toxicologic results at the end of life.- - - - - - - - - - ranking = 5keywords = life (Clic here for more details about this article) |
7/51. down syndrome and Alzheimer's disease: a link between development and aging.A subset of aged individuals with down syndrome (DS) exhibits the clinical features of Alzheimer's disease (AD) but our ability to detect dementia in this population is hampered by developmental differences as well as the sensitivity of existing test tools. Despite the apparent clinical heterogeneity in aged individuals with DS, age-associated neuropathology is a consistent feature. This is due to the fact that trisomy 21 leads to a dose-dependent increase in the production of the amyloid precursor protein and subsequently the production of the amyloidogenic fragments leading to early and predominant senile plaque formation. A review of the existing literature indicates that oxidative damage and neuroinflammation may interact to accelerate the disease process particularly in individuals with DS over the age of 40 years. By combining clinical information with measures of brain-region specific neuropathology we can "work backwards" and identify the earliest and most sensitive clinical change that may signal the onset of AD. For the past 50 years, investigators in the fields of mental retardation, developmental disabilities, and aging have been interested in the curious link between AD and DS. The morphologic and biochemical origins of AD are seen in the early years of the lifespan for individuals with DS. Study of the process by which AD evolves in DS affords an opportunity to understand an important link between development and aging. This review will focus on advances in the molecular and clinical basis of this association.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
8/51. Failed challenge with quetiapine after neuroleptic malignant syndrome with conventional antipsychotics.neuroleptic malignant syndrome (NMS) is an uncommon but potentially life-threatening adverse effect associated with conventional antipsychotic agents. The syndrome is characterized by muscular rigidity, hyperpyrexia, altered consciousness, and autonomic dysfunction. Few cases of quetiapine-induced NMS have been reported. A 54-year-old man was unsuccessfully challenged with quetiapine after conventional antipsychotic-induced NMS.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
9/51. Emotional well-being in a person with dementia.Self-reported mood and observations of affect are often used as indicators of emotional well-being. The purpose of this case study was to (a) describe the self-reported mood and affective pattern of an older man with severe cognitive impairments, (b) assess consistency in his responses to mood state, (c) compare mood pattern to premorbid personality, and (d) determine the concordance between self-reported mood and observed affect. Observations of mood and affect were taken three times per day for 35 days. There was concordance between self-reported mood and observed affect. The participant was consistent in his responses to mood 75% of the time. The pattern of self-reported mood reflected the participant's long-standing personality traits of extraversion and neuroticism. Results, although not generalizable, demonstrate the need to consider the perspective of the person with dementia when addressing quality-of-life issues in research and practice.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
10/51. Evaluating end-of-life care from the perspective of the patient's family.This article is written from personal experiences with the recent death of the authors' mother. It highlights the problems the authors encountered, while acknowledging the positive aspects of treatment during a difficult time. The overall purpose is to improve end-of-life care by advancing policy through research, legislation, and education. The impetus for writing this article is personal experience, but its larger purpose is to address issues that many readers will face in the future and suggest possible reforms, especially in the area of education.- - - - - - - - - - ranking = 5keywords = life (Clic here for more details about this article) |
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