1/18. Estrogen for dementia-related aggression in elderly men.OBJECTIVE: To report the use of conjugated estrogens for aggression in two elderly men with dementia and to review the available literature relating to estrogen use for aggression in the elderly. CASE SUMMARIES: Case 1. A 78-year-old white man had probable Alzheimer dementia and aggression (verbal and physical) that was nonresponsive to antipsychotic, antidepressant, and mood stabilizer therapy. However, conjugated estrogens 1.875 mg/d reduced his physical aggression, as evidenced by a 75% decline in aggressive episodes, per 24-hour nursing reports and progress notes. Case 2. A 78-year-old African-American man with vascular dementia, physical aggression, and sexual inappropriateness was unsuccessfully managed with several antipsychotic and benzodiazepine trials. He did, however, exhibit a decline in physical and sexual aggression by 80%, as well as a 55% reduction in sexual comments, after daily treatment with conjugated estrogens 0.625 mg. Estrogen was well tolerated by both patients. DATA SOURCES: medline (January 1966-May 1998) and PsychLit (January 1974-May 1998) database searches were performed to identify case reports, letters, or clinical trials discussing estrogen use in aggressive elderly patients. CONCLUSIONS: As with previous reports, these cases suggest that conjugated estrogens may be used to reduce physical and sexual aggression associated with dementia in elderly men. Additional study is needed to determine the exact role of this alternative pharmacologic intervention.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/18. The effects of AbetaPP mutations and APOE polymorphisms on cerebral amyloid angiopathy.Analysis of causative mutations and genetic risk factors aid in the understanding of important processes of cerebral amyloid angiopathy (CAA) in humans. We identified a mutation at a novel site of the beta-amyloid precursor protein (AbetaPP) gene associated with familial CAA; this mutation causes an aspartate to asparagine substitution at position 23 of the Abeta peptide. Neuropathological analysis of a 68-year-old man with this mutation showed dramatic Abeta deposition in blood vessels, diffiuse parenchymal Abeta deposits, dystrophic neurites and neurofibrillary tangles. The Abeta deposition showed complete co-localization of Abeta40 and Abeta42, compared to the predominant Abeta42 deposition seen in AD. We hypothesize that the loss of an acidic residue at position 23 of Abeta might be important in the process of Abeta aggregation on smooth muscle cells on the cerebrovasculature. We also analyzed how the apolipoprotein E (APOE) gene might influence aggregation of Abeta by examining the physical association of apoE domains with Abeta via immunohistochemistry. We found that the lipid-binding domain of apoE was more strongly associated with Abeta than the receptor-binding domain, and that 40% of all Abeta deposits had no apoE bound to them. We suggest that the initial deposition of Abeta occurs in the absence of apoE, and that the process of Abeta deposit growth or stabilization is apoE-dependent.- - - - - - - - - - ranking = 0.2keywords = physical (Clic here for more details about this article) |
3/18. Practice guidelines for recreation therapy in the care of people with dementia.Activity is a basic human need expressed in work and leisure pursuits. Unfortunately, people with dementia have a low rate of activity participation because of associated physical and cognitive constraints. Recently, the American Therapeutic Recreation association (ATRA) held a consensus meeting to address this issue and formulate practice guidelines for recreation therapy in the care of people with dementia. The consensus document presents an evidence-based intervention theory that draws on the science of two disciplines: nursing and recreation therapy. This article reports on the ATRA guidelines and illustrates their applicability in a case study of a resident with severe aggression associated with dementia.- - - - - - - - - - ranking = 0.2keywords = physical (Clic here for more details about this article) |
4/18. Exacerbation of psychosis by misinterpretation of physical symptoms.Impaired processing of perceptual information is often a prominent aspect of psychotic disorders. Physical symptoms such as pain or discomfort may be either incorrectly perceived or misinterpreted by psychotic patients. Presented here is a series of cases in which somatic symptoms occurred in psychotic patients and worsened their psychotic states but only later were recognized as physical problems. Psychotic patients may be unable to comprehend or describe their physical symptoms adequately. Physical disorders of psychotic patients may be overlooked if clinicians are not vigilant and thorough in assessing the patients' complaints, especially if such complaints sound delusional or bizarre.- - - - - - - - - - ranking = 1.2keywords = physical (Clic here for more details about this article) |
5/18. Progressive posterior cortical dysfunction: a clinicopathologic series.BACKGROUND: Atypical presentations of neurodegenerative dementing disorders include the syndrome of progressive posterior cortical dysfunction (PPCD) involving selective higher order visuospatial deficits. The neuropathologic correlates of PPCD remain poorly defined. methods: This is a retrospective case series of 27 individuals (14 men, 13 women) diagnosed clinically with PPCD. Participants were either enrolled in the Alzheimer's Disease research Center (ADRC) or referred to the memory diagnostic center of an urban academic medical center. Clinical evaluations included physical and neurologic examinations, the Clinical dementia Rating (CDR), and psychometric measures. Neuropathologic examinations were completed in 21 individuals with PPCD. Psychometric measures from 65 individuals with mild dementia of the Alzheimer type (DAT) enrolled in the ADRC were used for comparison. RESULTS: Neuropathologic etiologies of PPCD were alzheimer disease (AD) (n = 13), AD plus parkinson disease (n = 1), AD-Lewy body variant (n = 2), dementia with lewy bodies plus progressive subcortical gliosis of Neumann (n = 1), corticobasal degeneration (n = 2), and prion-associated diseases: Creutzfeldt-Jakob disease (n = 1) and fatal familial insomnia (n = 1). Confirming the clinical impression, psychometric profiles for individuals with PPCD differed from those of people with DAT alone and revealed disproportionate deficits on measures of visuospatial ability. CONCLUSIONS: AD was the most frequent cause of PPCD in this series, although non-Alzheimer's dementing disorders also should be considered.- - - - - - - - - - ranking = 0.2keywords = physical (Clic here for more details about this article) |
6/18. Reversible dementia: a case of cryptococcal meningitis masquerading as Alzheimer's disease.A 70-year-old man presented to us in 1994 with a three-year history of worsening dementia. With the exceptions of a Mini-Mental State exam score of 20 and an inability to tandem walk, his physical and neurological examinations were normal. His past medical history revealed that in 1992 he had been evaluated at another institution for memory impairment and bifrontal headaches. A spinal tap had been done in 1992 showing elevated protein, reduced glucose, and a pleocytosis; his CSF fungal culture and cryptococcal antigen test were negative. He subsequently was lost to follow-up, and although his headaches had resolved, his mental status had continued to worsen. In 1994 his CSF cryptococcal antigen was positive, and his CSF fungal culture grew C. neoformans. He gradually improved with treatment for cryptococcal meningitis (CM). With the exception of mild memory impairment, in 2003 he and his family thought that his mental status had returned to normal. This case emphasizes that: 1) CM should always be kept in the differential diagnosis of dementia; 2) CM may be extremely insidious and difficult to diagnose; and 3) if one is to rule out unequivocally all possible reversible causes of dementia, one should perform a spinal tap.- - - - - - - - - - ranking = 0.2keywords = physical (Clic here for more details about this article) |
7/18. Environmental reduplicative paramnesia in a case of atypical Alzheimer's disease.A 79-year-old patient with neuropathologically confirmed Alzheimer's disease (AD) presented with a selective environmental reduplicative paramnesia (RP), the belief that one or more environments exist simultaneously in two or more physical locations. Clinical presentation and neuropathological examination revealed an atypical form of AD. High neurofibrillary tangle densities were observed in the frontal and temporal association cortex, whereas the parietal and entorhinal cortex, as well as the hippocampus, were nearly spared. These findings are compared to those reported in frontal and frontotemporal variants of AD and discussed in the light of current anatomoclinical models for environmental RP.- - - - - - - - - - ranking = 0.2keywords = physical (Clic here for more details about this article) |
8/18. Does this patient have primary progressive aphasia?Primary progressive aphasia (PPA) is a distinct clinical entity in which the patient develops language deficits while other cognitive domains remain relatively preserved until late in the course of the illness. The diagnosis can be relatively clear through an appropriate diagnostic approach based on the history and physical examination. There is no cure, but speech therapy is beneficial in this illness.- - - - - - - - - - ranking = 0.2keywords = physical (Clic here for more details about this article) |
9/18. Clinically managing disruptive behavior on the ward.1. The inability to manage disruptive yelling has lead to the overuse of physical restraints, inappropriate use of psychotropic medications, and provoked feelings of powerlessness, helplessness, and frustration among caregivers that could detract from the overall quality of care. 2. Behavioral analysis provides a framework for caregivers to identify, modify, and develop practical means to alleviate and to monitor a problem. 3. Noisy behavior can become more manageable by combining the effects of improved environment, continuous monitoring and simplification of medication, individualized nursing care, and a sense of creativity. 4. caregivers need to examine their own feelings and behavior and to understand that they have a responsibility to create an environment in which their clients can respond positively.- - - - - - - - - - ranking = 0.2keywords = physical (Clic here for more details about this article) |
10/18. Alzheimer's disease with prominent visual symptoms. Clinical and metabolic evaluation.The authors examined eight patients with dementia of the Alzheimer's type (DAT), five with prominent visual symptoms early in the illness (VS) and three with no visual symptoms (NVS). Results of neuro-ophthalmologic examinations on VS patients showed relatively consistent abnormalities in figure copying, color vision tested by isochromatic plates, and stereopsis. Cerebral glucose metabolism determined by 18F-fluoro-2-deoxyglucose positron emission tomography (PET) was unchanged in primary visual cortex of VS and NVS patients compared with 12 normal volunteers of similar age and sex. Glucose metabolism in VS patients was decreased by 45 and 34% in left and right visual association cortex (P less than 0.01 and P less than 0.05, respectively) and 34 and 37% in left and right inferior parietal cortex (P less than 0.05) compared with controls; NVS patients had no significant metabolic alteration in these areas. Symptoms, physical examination, and metabolic imaging imply that these patients are a heterogenous but distinct clinical subgroup of DAT often with mild dementia who have visual symptoms due primarily to visual agnosia.- - - - - - - - - - ranking = 0.2keywords = physical (Clic here for more details about this article) |
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