Cases reported "Alzheimer Disease"

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1/811. 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. ( info)

2/811. Apnea syndrome in a patient with Alzheimer dementia under chlormethiazole treatment: a clinical experience report.

    sleep apnea syndromes in conjunction with dementia have attracted considerable interest among geropsychiatrists in recent years. This clinical case report describes a demented and delirious elderly patient with a history of alcoholism who developed a sleep apnea syndrome under treatment with chlormethiazole. The risk of chlormethiazole treatment may be underestimated in vulnerable patients, e.g. those suffering from severe respiratory diseases or dementia. Alternative treatments for delirious states need to be evaluated instead. ( info)

3/811. New directions for care of Alzheimer's disease and dementia.

    A consortium of home care agencies has created a training program that not only ensures low staff turnover but greatly enhances care for patients with Alzheimer's disease and dementia. Using specialized training and an emphasis on knowledge-based care, this program proves that self-esteem is the key to success--for home care aides as well as patients. ( info)

4/811. Early-onset Alzheimer's disease caused by a novel mutation at codon 219 of the presenilin-1 gene.

    Mutations in the presenilin 1 (PS1) gene are responsible for approximately 50% of early onset autosomal-dominant Alzheimer's disease cases. A PCR based mutation detection method, chemical cleavage of mismatch, was used to detect a novel PS1 mutation in the coding sequence of the PS1 gene. Sequencing confirmed a T to C transition altering a leucine to proline at codon 219 of the PS1 gene. This is a novel mutation in exon 7 of the PS1 gene occurring outside the transmembrane regions of IV and V. ( info)

5/811. Initiating and monitoring cholinesterase inhibitor treatment for Alzheimer's disease.

    The availability of acetylcholinesterase inhibitors for the treatment of Alzheimer's disease raises a number of clinical and ethical questions. Many of the guidelines published in an attempt to tackle these questions lack either clinical or scientific validity. Against this background a model is proposed whereby specialist monitoring using formal tests is neither appropriate nor necessary to determine whether an individual patient should continue or stop treatment. Instead the primary care physician should refer potentially suitable patients for specialist assessment to confirm the diagnosis/He/she should then initiate, monitor, and discontinue treatment based on the establishment of realistic treatment goals agreed with the patient/carer at the outset. ( info)

6/811. suicide in two patients with a diagnosis of probable alzheimer disease.

    Two patients meeting the criteria for probable alzheimer disease (AD) who were participating in a phase 3 clinical program with eptastigmine, a cholinesterase inhibitor, committed suicide. The first patient committed suicide by a self-inflicted gunshot wound to the head. The second patient committed suicide by jumping from a 19th story window. These two patients shared several clinical features with those found in the literature: being at the early stages of the disease, having a high level education, with preserved insight, having access to firearms, and being aware of not responding to pharmacological treatment. ( info)

7/811. Using the towel bath to give tender care in dementia: a case example.

    Using the "towel" bath to clean the skin for such residents as Helen results in a reduction of agitation and an increase in comfort as the skin is cleansed. The "towel" bath is a very useful technique which should be incorporated into educational training programs for any care provider who will be working with persons with dementia. It is a procedure that can be adapted to the care of the most challenging resident and will help staff begin to display person-centred care for the resident who is afraid of care procedures and responds negatively as a result. The procedure itself addresses the issues of water temperature and privacy in a way that traditional basin bathing makes difficult. The "towel" bath should be included in the practice repertoire and used on a regular basis by all practitioners who work in this area of geriatric specialty. ( info)

8/811. Treatment of obsessive-compulsive disorder using clomipramine in a very old patient.

    OBJECTIVE: To describe the effect of the tricyclic drug clomipramine in a very old patient with obsessive-compulsive disorder and Alzheimer dementia. CASE SUMMARY: A 93-year-old woman had a history of obsessive-compulsive disorder since early adulthood. The obsession consisted of remembering names of famous people and the compulsion consisted of excessive list making. With the onset of memory loss secondary to alzheimer disease, she became increasingly anxious and compulsive as a result of a failure to remember. After nine weeks on fluoxetine she became jittery and more confused. After a two-week wash-out period, she was given a nine-week course of clomipramine that was carefully titrated up to a therapeutic concentration. RESULTS: At the completion of clomipramine treatment, the patient no longer felt driven to recall the names of famous people. Her score from the Yale-Brown Obsessive-Compulsive Scale dropped from 29 to 3. Her Folstein Mini-Mental State Examination score increased from 21 to 23. CONCLUSIONS: clomipramine appeared much more effective and better tolerated than fluoxetine in this very old patient despite its potential anticholinergic effect and the coexistence of alzheimer disease. ( info)

9/811. frontotemporal dementia and Alzheimer's disease: differential diagnosis.

    This report addresses the clinical differentiation of Alzheimer's disease (AD) from frontotemporal dementia (FTD), including Pick's disease. The accuracy of a clinical diagnosis of a dementing disorder is determined in part by the prior probability (base rates) of the disorder, which predicts an overwhelming likelihood of a diagnosis of AD, because the prevalence of AD is much greater than FTD. The clinical features of the disorder also determine the accuracy of diagnosis. Recent studies have reported an improvement in the differential diagnosis of FTD, utilizing the Lund-Manchester criteria. patients with FTD typically have early noncognitive behavioral changes with relatively spared cognition, frontal atrophy and enlargement of the Sylvian fissures on CT and MRI scans, and frontal-temporal deficits on SPECT or PET scans. In contrast, AD patients have early cognitive changes with relatively preserved personality and behavior, hippocampal and medial-temporal lobe atrophy on CT or MRI scans, and parietotemporal SPECT or PET deficits. ( info)

10/811. A presenilin-1 Thr116Asn substitution in a family with early-onset Alzheimer's disease.

    mutation in the presenilin-1 (PS-1) gene at chromosome 14q24.3 is the most common cause of autosomal dominant early-onset Alzheimer's disease. Here, we report a novel missense mutation in the presenilin-1 gene found in a three-generation Danish family with autopsy-verified early-onset Alzheimer's disease. Two affected first-degree relatives in two generations were found to be heterozygous for a cytosine to adenine transversion at the second position of codon 116, which changes the amino acid at that position from threonine to asparagine. This conservative amino acid substitution occurs in an evolutionary highly conserved region of the PS-1 protein and is associated with onset of the disease between age 35 and 41 years and 4-8 years' duration of the disease. Analysis of amyloid beta-protein (A beta) deposition in brain specimens from one affected family member showed predominance of A beta 42(43). Onset and progression of the disease were very similar in two sibs homozygous for the epsilon 3 allele and the epsilon 4 allele, respectively, of the polymorphic apolipoprotein E locus. The lack of effect of the high risk epsilon 4/epsilon 4 genotype on the disease in this family corroborates and extends previous observations that the presence of one copy of the epsilon 4 allele does not modulate PS-1 associated Alzheimer's disease. ( info)
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