Alzheimer Disease: Engedal K

Engedal K. · No affiliation provided · Tidsskr Nor Laegeforen. · Pubmed #11107915 No free full text.

This publication has no abstract.

Engedal K. · Nasjonalt kompetansesenter for aldersdemens, Ullevål universitetssykehus, 0407 Oslo. · Tidsskr Nor Laegeforen. · Pubmed #15880157 links to  free full text

Abstract: BACKGROUND: About 75% of nursing homes patients in Norway suffer from dementia, though only half of them have a dementia diagnosis. No consensus exists on how or when to do an assessment for dementia in the nursing home. MATERIAL AND METHODS: The paper is based on a search on Medline and personal experience in the field. RESULTS AND INTERPRETATION: Dementia assessment in nursing homes should be done in a co-operation between a physician, a nurse and an occupational therapist. The physician should carry out a Mini-Mental State Examination and a clock test, a physical and mental examination, an assessment of depressive symptomatology, and see to it that the thyroid function is measured. A CT scan of the brain should be done in cases with short duration of dementia symptomatology. A nurse and an occupational therapist should interview a family member and assess the patient's functioning by means of the Informant questionnaire on cognitive decline in the elderly and the Clinical dementia rating scale, or a similar assessment tool. Memantine could be a treatment for some patients with moderate to severe degrees of dementia, while acetylcholinesterase inhibitors could be useful for some patients with mild to moderate degrees of dementia of the Alzheimer type. Anti-dementia drug therapy must be individualised.

Braekhus A, Engedal K. · Nevrologisk avdeling, Rikshospitalet, 0027 Oslo. · Tidsskr Nor Laegeforen. · Pubmed #15114387 links to  free full text

Abstract: BACKGROUND: Vascular dementia is defined as dementia caused by cerebrovascular disease and is seen as the most common cause of dementia after Alzheimer's disease. In our opinion, vascular dementia is an ill-defined term; this proposition is discussed in this article. MATERIAL AND METHODS: The concept of vascular dementia is discussed based on the literature and our own clinical experience. RESULTS: The prevalence of vascular dementia varies markedly across different studies and several clinical diagnostic criteria are used. There has been an ongoing debate as to which radiological changes are associated with vascular dementia; we question the use of neuropathological changes as a diagnostic gold standard. Several studies have shown similarities between dementia of the Alzheimer type and vascular dementia regarding risk factors and symptomatology. INTERPRETATION: We conclude that the concept of vascular dementia should be re-evaluated. It is important to establish valid and reliable criteria for vascular dementia, especially in the light of the therapeutic consequences.

Øksengård AR, Engedal K. · Nasjonalt kompetansesenter for aldersdemens Geratrisk avdeling Ullevål universitetssykehus 0407 Oslo. · Tidsskr Nor Laegeforen. · Pubmed #11961985 No free full text.

Abstract: BACKGROUND: To supply relevant information about the genetics of Alzheimer's disease. MATERIALS AND METHODS: Data from the literature (Medline) and personal experiences. RESULTS: Two well-known risks for developing Alzheimer's disease are established: advanced age and genetic factors. Mutations linked to autosomal dominant familial Alzheimer's disease are known in chromosomes 21, 14 and 1. A non-mendelian Alzheimer's disease with complex aetiology is linked to the apolipoprotein E in chromosome 19. INTERPRETATION: Children of patients with Alzheimer's disease have a three to four fold increased risk of developing the disease compared to a person without a parent with Alzheimer's disease. The diagnostic benefit of apolipoprotein E genotyping is still uncertain.

Engedal K. · Nasjonalt kompetansesenter for aldersdemens Ullevål universitetssykehus 0407 Oslo. · Tidsskr Nor Laegeforen. · Pubmed #11961983 No free full text.

Abstract: BACKGROUND: Dementia is one of the most common conditions in the elderly. In Norway the total prevalence is about 60,000. MATERIAL AND METHODS: The paper is based on the author's clinical experience and a review of the literature. RESULTS: No biological marker exists for Alzheimer's disease and other dementias. The diagnostic work-up thus consists of a comprehensive clinical neuropsychological, physical and psychiatric examination. Imaging of the brain could be useful in the differential diagnostic work-up. In mild cases and cases of suspected dementia, the work-up is carried out in specialist health care. Moderate and severe cases are assessed on primary care. There is currently no cure for dementia disorders, although acetylcholinesterase inhibitors may prove effective for Alzheimer's disease and Lewy body dementia. Behavioural and psychiatric symptoms can be pharmacologically treated. INTERPRETATION: A careful diagnostic work-up must be carried out to diagnose dementia. Symptomatic treatment is available and should be initiated.

Wimo A, Winblad B, Engedal K, Soininen H, Verhey F, Waldemar G, Wetterholm AL, Mastey V, Haglund A, Zhang R, Miceli R, Chin W, Subbiah P, Anonymous00005. · Department of Family Medicine, Umeå University, Umeå, Sweden. · Dement Geriatr Cogn Disord. · Pubmed #12457078 No free full text.

Abstract: The costs and consequences of donepezil versus placebo treatment in patients with mild to moderate Alzheimer's disease (AD) were evaluated as part of a 1-year prospective, double-blind, randomized, multinational clinical trial. Patients received either donepezil (n = 142; 5 mg/day for 28 days followed by 10 mg/day according to the clinician's judgement) or placebo (n = 144). Unit costs were assessed in 1999 Swedish kronas (SEK) and converted to US dollars (USD). Donepezil-treated patients gained functional benefits relative to placebo on the Progressive Deterioration Scale (p = 0.042) and Instrumental Activities of Daily Living scale (p = 0.025) at week 52. Caregivers of donepezil-treated patients spent an average of 400 h less annually providing care than caregivers of placebo-treated patients. Mean annual healthcare costs were SEK 137,752 (USD 16,438) per patient for the donepezil group and SEK 135,314 (USD 16,147) in the placebo group. With the average annual cost of donepezil at SEK 10,723 (USD 1,280) per patient, the SEK 2,438 (USD 291) cost difference represented a 77% cost offset. When caregiver time and healthcare costs were included, mean annual costs were SEK 209,244 (USD 24,969) per patient in the donepezil group and SEK 218,434 (USD 26,066) in the placebo group, a total saving associated with donepezil treatment of SEK 9,190 (USD 1,097) per patient [95% CI of SEK -43,959 (USD -5,246), SEK 25,581 (USD 3,053); p = 0.6]. The positive effects on the efficacy outcome measures combined with no additional costs from a societal perspective indicate that donepezil is a cost-effective treatment, representing an improved strategy for the management of patients with AD.

Winblad B, Engedal K, Soininen H, Verhey F, Waldemar G, Wimo A, Wetterholm AL, Zhang R, Haglund A, Subbiah P, Anonymous00311. · Karolinska Institutet, Alzheimer's Disease Research Center, Division of Geriatric Medicine, Huddinge Hospital B, Stockholm, Sweden. · Neurology. · Pubmed #11502918 No free full text.

Abstract: OBJECTIVE: To evaluate the long-term clinical efficacy and safety of donepezil versus placebo over 1 year in patients with mild to moderate AD. METHODS: Patients (n = 286; mean age, 72.5 years) with possible or probable AD from five Northern European countries were randomized to receive either donepezil (n = 142; 5 mg/day for 28 days, followed by 10 mg/day) or placebo (n = 144) for 1 year. RESULTS: The study was completed by 66.9% of the donepezil- and 67.4% of the placebo-treated patients. The benefit of donepezil over placebo was demonstrated by the Gottfries-Bråne-Steen (a global assessment for rating dementia symptoms) total score at weeks 24, 36, and 52 (p < 0.05) and at the study end point (week 52, last observation carried forward; p = 0.054). Advantages of donepezil over placebo were also observed in cognition and activities of daily living (ADL) assessed by the Mini-Mental State Examination at weeks 24, 36, and 52, and the end point (p < 0.02) and by the Progressive Deterioration Scale at week 52 and the end point (p < 0.05). Adverse events (AE) were recorded for 81.7% of donepezil- and 75.7% of placebo-treated patients, with 7% of donepezil- and 6.3% of placebo-treated patients discontinuing because of AE. Treatment response to donepezil was not predicted by APOE genotype or sex in this population. CONCLUSION: As the first 1-year, multinational, double-blinded, placebo-controlled study of a cholinesterase inhibitor in AD, these data support donepezil as a well tolerated and effective long-term treatment for patients with AD, with benefits over placebo on global assessment, cognition, and ADL.

Sommer OH, Aga O, Cvancarova M, Olsen IC, Selbaek G, Engedal K. · Innlandet Hospital Trust, Department of Geriatric Psychiatry, Reinsvoll, Norway. · Dement Geriatr Cogn Disord. · Pubmed #19182483 No free full text.

Abstract: BACKGROUND/AIMS: To evaluate the efficacy of oxcarbazepine (OXC) in the treatment of agitation and aggression in patients with Alzheimer's disease, vascular dementia or both. METHODS: This is an 8-week, multicenter, randomized, double-blind, placebo-controlled trial carried out independently of the pharmaceutical industry. Changes in the agitation and aggression subscore of the Neuropsychiatric Inventory (NPI) were the primary outcomes. The secondary out- comes were the changes in the caregivers' total burden scores (measured by the NPI) and changes in the Brief Agitation Rating Scale (BARS). RESULTS: In total, 103 institutionalized patients at 35 sites were randomized to the trial. After 8 weeks, no statistically significant differences were found between the 2 groups for all outcomes. A trend was observed in favor of the OXC group in the reduction in the scores on the BARS (p = 0.07). CONCLUSION: This study found no significant effect of OXC in treatment of agitation and aggression in patients with dementia.

Kirkevold Ø, Engedal K. · Norwegian Centre for Dementia Research, Vestfold Mental Health Care Trust, Tønsberg, Norway. · Scand J Caring Sci. · Pubmed #19068049 No free full text.

Abstract: BACKGROUND: Quality of care (QoC) in nursing homes has many aspects and various proxies have been used to evaluate it. In only a few studies several proxies for quality have been combined into a common variable. OBJECTIVE: To explore which variables are associated with low QoC in few and several areas respectively. METHODS: A structured interview of the patients' primary carer of 1926 patients in 251 wards was carried out. Questions about different kinds of quality deficiencies during the last 7 days were recorded. Eight main types of quality deficiencies were used to construct a linear outcome variable called number of quality deficiencies (NQD) with values from zero to eight. Patient characteristics such as sex, age, function in activities of daily living (ADL), behaviour and mental capacity were recorded. Type of ward, staffing, size of ward, type of institution and formal education of the staff, were also recorded. RESULTS: More than half of the patients in Norwegian nursing homes experienced two or more quality deficiencies in the care during 1 week. The variables that were strongest associated with NQD, were present of aggressive behaviour, low level of functioning in ADL and moderate-to-severe dementia. Staffing level and type of ward had also a significant influence on the model.

Selbaek G, Kirkevold Ø, Engedal K. · Research Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway. · Scand J Caring Sci. · Pubmed #18801019 No free full text.

Abstract: BACKGROUND: In a number of countries Special Care Units (SCUs) have been established to meet the particular needs of patients with dementia. The criteria for SCUs are poorly defined and often not met. AIM: To assess the frequency distributions of dementia, psychiatric and behavioural symptoms and the use of psychotropic medication in SCUs and Regular Units (RUs) across different regions. METHODS AND MATERIAL: By means of a structured interview, comprising the Neuropsychiatric Inventory, the Clinical Dementia Rating Scale and Lawton's Physical Self-maintenance scale, a representative sample of 1163 nonselected nursing home patients was assessed. In addition, information was collected from the patients' records. RESULTS: Overall SCU patients were significantly more likely to be younger, to have higher level of functioning, to have dementia, to exhibit clinically significant psychiatric and behavioural symptoms and to receive psychotropic medication. There were significant differences across regions in terms of psychiatric and behavioural symptoms and the use of psychotropic medication. The ratio of accommodation in SCUs to that in RUs varied across the regions. CONCLUSION: Patients in SCUs and patients in RUs are distinct nursing home populations. Regional differences, which might be due to diverse ratios of SCUs, are evident.

Rosness TA, Haugen PK, Engedal K. · Department of Geriatric Medicine, Ullevaal University Hospital, Norwegian Centre for dementia research, Oslo, Norway. · Aging Ment Health. · Pubmed #18791893 No free full text.

Abstract: OBJECTIVES: To examine the provision of support to patients with frontotemporal dementia (FTD) and their family carers compared with patients with early onset Alzheimer's dementia (AD) and their carers, and the carers' satisfaction with the support. METHOD: Data came from 60 dyads of patients with dementia and their principal family carers, 23 subjects with frontotemporal dementia and their 23 carers, and 37 subjects with early onset Alzheimer's disease and their 37 carers. RESULTS: Patients with a frontotemporal dementia diagnosis were significantly more frequently offered stays in nursing homes (p = 0.04). Carers of patients with frontotemporal dementia were significantly less satisfied with the provision of information about the disease compared with carers of early onset Alzheimer's disease patients (p = 0.05) and were significantly less satisfied with counseling and follow-up advice (p = 0.05). CONCLUSION: Changes of personality in patients with frontotemporal dementia may be the major reason why they were offered more stays in institutions. These family carers tend to be less satisfied with the provision of support they received from the specialist health service compared to carers of Alzheimer's disease patients, and are in need of more, and other forms of support.

Skjerve A, Nordhus IH, Engedal K, Braekhus A, Nygaard HA, Pallesen S, Haugen PK. · Department of Clinical Psychology, University of Bergen, Bergen, Norway. · Int Psychogeriatr. · Pubmed #18377698 No free full text.

Abstract: BACKGROUND: Brief cognitive tests represent a first step in the assessment of elderly people referred to outpatient clinics because of cognitive impairment. The aim of this study is to determine sensitivity, specificity and likelihood ratio for a positive result (LR+) for the brief cognitive tests Seven Minute Screen (7MS) and Syndrom Kurztest (SKT) in an outpatient sample of elderly patients with no dementia or mild dementia. METHODS: Ninety-five patients aged 65 years or more from 10 Norwegian geriatric and psychogeriatric outpatient clinics were included in the study. All the subjects had a Mini-mental State Examination score of 22-30. A consensus diagnosis of dementia according to ICD-10 was established by an expert panel that considered data from a standardized assessment protocol blinded for 7MS and SKT results. RESULTS: Subjects were diagnosed with mild dementia (n = 69) or no dementia (n = 26). Sensitivity for 7MS was 71%, specificity 73% and LR+ was 2.6. Sensitivity for SKT was 65%, specificity 65% and LR+ was 1.9. CONCLUSION: Sensitivity, specificity and LR+ for 7MS and SKT were unacceptably low in this outpatient sample.

Rosness TA, Haugen PK, Passant U, Engedal K. · Norwegian Centre for Dementia Research, Department of Geriatric Medicine, Ullevaal University Hospital, Oslo, Norway. <> · Int J Geriatr Psychiatry. · Pubmed #18302319 No free full text.

Abstract: OBJECTIVE: To compare the time taken to establish a clinical diagnosis of Frontotemporal dementia (FTD) relative to a diagnosis of early onset Alzheimer's dementia (AD). METHODS: The data came from 89 patients under the age of 65 years, 52 of whom met the Manchester-Lund criteria for Frontotemporal dementia; 20 of these came from Lund University Hospital in Sweden. The other 32 patients with FTD along with 37 subjects who fulfilled the ICD-10 criteria for early onset Alzheimer's disease were recruited from four memory clinics and two neurology departments in Norway. RESULTS: For FTD patients in Norway it took 59.2 months (SD 36.1) from the onset of illness until a clinical FTD diagnosis was made. The corresponding time period for FTD patients in Sweden is 49.5 months (SD 24.5) and for AD patients in Norway 39.1 months (SD 19.9). The time from the first visit to a medical doctor until a diagnosis was made for the FTD patients in Norway was 34.5 months (SD 22.6), for the Swedish FTD patients 23.1 months (SD 22.4) and for the AD patients 25.9 months (SD 13.1). In all, 71% of FTD patients and 30% of AD patients initially received a non-dementia diagnosis. CONCLUSION: More knowledge about early presenting cognitive and behavioural signs of FTD is needed in both primary and secondary health care to reduce the time period needed to establish a clinical diagnosis of FTD.

Skjerve A, Nordhus IH, Engedal K, Pallesen S, Braekhus A, Nygaard HA. · Department of Clinical Psychology, University of Bergen, Bergen, Norway. · Int J Geriatr Psychiatry. · Pubmed #17152118 No free full text.

Abstract: BACKGROUND AND OBJECTIVE: The Seven Minute Screen (7MS) is a brief cognitive case-finding instrument for dementia. The test is composed of four subtests that assess performance with regard to orientation, memory, visuospatial ability and language. The objective of this study was to describe 7MS performance in a normal sample of people aged 65 years and older. METHOD: The subjects were 66 Norwegian community-dwellers who met selection criteria modified from the Mayo Older American Normative Studies standard. Mean age was 73.2 years, age range was 65-93 years, and mean Mini-Mental State Examination score was 29.06, range 26-30. RESULTS: Analysis of the 7MS subtests revealed relatively modest influence of age, education and gender on test performance. The composite 7MS performance scores were associated with education. Normal performance was expressed as means, standard deviations and percentile values for the age groups 65-74 years and 75 + years. CONCLUSION: 7MS performance is described for a normal sample. These data have the potential to increase the clinicians' ability to interpret 7MS test results.

Lehmann DJ, Refsum H, Nurk E, Warden DR, Tell GS, Vollset SE, Engedal K, Nygaard HA, Smith AD. · OPTIMA, Oxford Centre for Gene Function, University Laboratory of Physiology, Parks Road, Oxford OX1 3PT, UK. · J Neurol Neurosurg Psychiatry. · Pubmed #16595618 links to  free full text

Abstract: BACKGROUND: Among elderly people without dementia, the apolipoprotein E epsilon4 allele (APOE4) has been associated with cognitive deficit, particularly in episodic memory, but few reports are available on whether this association differs by sex. METHODS: In a community-dwelling Norwegian cohort of 2181 elderly people (55% women), aged 70-74 years, episodic memory was examined in relation to sex and APOE4 zygosity, with the Kendrick Object Learning Test (KOLT). RESULTS: Possession of at least one APOE4 allele had a modest, detrimental effect on episodic memory in women, whereas in men, heterozygotes were unaffected and homozygotes had markedly lower scores across the distribution of KOLT scores. This sex difference was found consistently in all analyses: on comparing means and medians, examining trends across quintiles, and studying the distribution of scores and the risk of cognitive impairment. Results were broadly similar when adjusted for known determinants of cognition and also when severely impaired participants were excluded. The adjusted odds ratio (OR) of cognitive impairment in women was shown to be 1.8 (95% confidence interval (CI): 1.1 to 2.8) for heterozygotes and 1.1 (0.3 to 3.7) for homozygotes; the adjusted OR in men was observed to be 1.1 (0.6 to 2.1) for heterozygotes and 10.7 (4.7 to 24) for homozygotes. CONCLUSIONS: Although the harmful effect of APOE4 on episodic memory was modest in women, the risk was found to occur in about 30%. APOE4 was observed to have a dramatic effect on episodic memory in men, but only in homozygotes, who comprised about 3% of men: the whole male homozygous group showed a marked shift to lower memory scores.

Winblad B, Wimo A, Engedal K, Soininen H, Verhey F, Waldemar G, Wetterholm AL, Haglund A, Zhang R, Schindler R. · Karolinska University Hospital Huddinge, Stockholm, Sweden. · Dement Geriatr Cogn Disord. · Pubmed #16508298 No free full text.

Abstract: Delays in the diagnosis of Alzheimer's disease, and, therefore, delays in treatment, may have a detrimental effect on a patient's long-term well-being. This study assessed the effects of postponing donepezil treatment for 1 year by comparing patients treated continuously for 3 years with those who received placebo for 1 year followed by open-label donepezil for 2 years. Patients (n = 286) with possible or probable Alzheimer's disease (according to DSM-IV, NINCDS-ADRDA, and Mini-Mental State Examination criteria; see text) were randomized to receive donepezil (5 mg/day for 4 weeks, 10 mg/day thereafter) or placebo (delayed-start group) for 1 year. Of the 192 completers, 157 began a 2-year, open-label phase of donepezil treatment. Outcome measures were the Gottfries-Bråne-Steen scale, the Mini-Mental State Examination, the Global Deterioration Scale, the Progressive Deterioration Scale, the Neuropsychiatric Inventory, and safety (adverse events). Mixed regression analysis was used to compare changes between the groups over 3 years on the efficacy measures. There was a trend for patients receiving continuous therapy to have less global deterioration (Gottfries-Bråne-Steen scale) than those who had delayed treatment (p = 0.056). Small but statistically significant differences between the groups were observed for the secondary measures of cognitive function (Mini-Mental State Examination; p = 0.004) and cognitive and functional abilities (Global Deterioration Scale; p = 0.0231) in favor of continuous donepezil therapy. Over 90% of the patients in both cohorts experienced one treatment-emergent adverse event; most were considered mild or moderate. In conclusion, patients in whom the start of treatment is delayed may demonstrate slightly reduced benefits as compared with those seen in patients starting donepezil therapy early in the course of Alzheimer's disease. These data support the long-term efficacy and safety of donepezil.

Macijauskiene J, Engedal K. · Clinic of Geriatrics, Kaunas University of Medicine, A. Mickeviciaus 9, 44307 Kaunas, Lithuania. · Medicina (Kaunas). · Pubmed #15687753 links to  free full text

Abstract: Lithuania, like many European countries, is facing the problem of ageing population. The ageing society is accompanied by an increase in the prevalence of the disorders that are characteristic for old age. This article presents an overview of the current situation with respect to care of patients with dementia in Lithuania. Calculations based on epidemiological studies in other countries reveal that at least 31,000 persons may be suffering from dementia in Lithuania, with 6407 new cases occurring each year. Management of persons with dementia is mainly conducted by psychiatrists and neurologists with a few geriatricians. Mental health centers with interdisciplinary teams assure medical treatment, primary diagnosis of dementia, family consultations, managing of social and psychological problems and visits to homes when needed. Institutional services and home help services for persons with dementia are scarce and underdeveloped. Our future priorities in developing care for people with dementia are to improve the timely diagnosis and comprehensive management of dementia with the establishment of a continuity of high quality social services with special emphasis on home help and the support of family members.

Engedal K, Braekhus A, Gjerstad L. · Nasjonalt kompetansesenter for aldersdemens, Ullevål universitetssykehus, 0407 Oslo. · Tidsskr Nor Laegeforen. · Pubmed #15229711 links to  free full text

This publication has no abstract.

Oksengaard AR, Haakonsen M, Dullerud R, Engedal K, Laake K. · Department of Geriatric Medicine, Ullevaal University Hospital, Oslo, Norway. · Int J Geriatr Psychiatry. · Pubmed #12673606 No free full text.

Abstract: BACKGROUND: Atrophy of the medial part of the temporal lobe is seen in Alzheimer's disease (AD). We studied the usefulness of CT scan measurements of the medial temporal lobe (MTL) in elderly with suspected dementia. METHODS: MTL measurements were done with callipers by three raters, blinded to the diagnosis and to each other, on scans from 110 subjects with suspected dementia from a memory clinic in Oslo, Norway and 36 participants included in the OPTIMA study, Oxford, England. RESULTS: The correlation between the MTL and the Mini-Mental State Examination (MMSE) was very low, and there was a marked overlap between Alzheimer and cognitively unimpaired subjects. The inter-rater reliability was lower on the Norwegian than on the OPTIMA scans (R = 0.48 vs R = 0.68), but this was partly explained by larger MTL readings (4.5 mm after adjustment for age, gender and MMSE sumscore) on the OPTIMA scans as the reliability was confounded by MTL width and was higher at larger MTLs. A wider scan width (3 mm vs 2 mm in the OPTIMA scans) can also contribute to differences in reliability. CONCLUSIONS: The published threshold values regarding the CT scan MTL measurements for the diagnosis of AD may be invalid when applied by other radiology departments without a local standardisation and validation.

Øksengård AR, Haakonsen M, Dullerud R, Babovic A, Laake K, Engedal K. · Geriatrisk avdeling, Ullevål universitetssykehus 0407 Oslo. · Tidsskr Nor Laegeforen. · Pubmed #11998736 No free full text.

Abstract: BACKGROUND: Neuroimaging can provide valuable information in the diagnostic work-up of patients presenting with suspected dementia. MATERIAL AND METHODS: Based on our experience from a memory clinic at Ullevål University Hospital in Oslo, Norway and on relevant literature identified on Medline, we give an overview of the use of neuroimaging methods in patients with suspected dementia. RESULTS AND INTERPRETATION: CT of the brain should be offered to all patients with suspected dementia as CT can provide essential diagnostic information regarding focal cerebral pathology (tumour, haemorrhage, normal pressure hydrocephalus). A CT scan is of no value in the diagnostic evaluation of patients with mild to moderate Alzheimer's disease as age-related atrophy may be a confounding factor. CT is necessary to reveal infarcts when vascular dementia is suspected, but lacks sensitivity in the detection of diffuse cerebrovascular disease. MRI is recommended in younger patients and may be used to diagnose subcortical lesions, e.g. leukoariosis. The accuracy of SPECT in the assessment of patients with cognitive impairment is not yet established though it seems to be a promising method for the detection of frontotemporal dementia. Functional MR may play a role in the work-up of dementia in the future.

Thommessen B, Aarsland D, Braekhus A, Oksengaard AR, Engedal K, Laake K. · Department of Geriatric Medicine, Ullevaal Hospital, Oslo, Norway. · Int J Geriatr Psychiatry. · Pubmed #11802235 No free full text.

Abstract: OBJECTIVE: To characterize the psychosocial burden on spouses living with the elderly suffering from mild dementia, stroke and Parkinson's disease, and to identify patient characteristics associated with it. Materials and methods Data on patient-spouse couples came from three studies of patients with stroke (36 couples), mild dementia (92 couples) and Parkinson's disease (58 couples). The psychosocial burden was recorded by the 15-item Relatives' Stress Scale (RSS). A factor analysis of this instrument produced a one-factor solution (CFI = 0.98) consisting of eight items with good face validity and acceptable reliability within each diagnostic group (Cronbach's alpha range 0.66-0.69). Covariates of this factor were identified using structural equation modeling (SEM) by regression on patient's age, gender, cognitive function (MMSE), activities of daily living (ADL) and depressive symptoms (MADRS). RESULTS: Disorganization of household routines, difficulties with going away for holidays, restrictions on social life, and the disturbances of sleep were the most frequently reported problems in all three groups. According to the mean sumscore on the RSS, the perceived psychosocial burden was similar across the diagnostic groups. In the final SEM model, a lower cognitive function of the patient was associated with a higher psychosocial burden on the spouses of patients with stroke (beta = -1.3, p = 0.01) and Parkinson's disease (beta = -0.89, p < 0.01), while in the dementia group, only an insignificant trend was demonstrated. In the dementia group, a significantly higher burden was identified on female spouses (beta = -0.56, p = 0.04). A heavier burden of care was also associated with depressive symptoms in the patients with Parkinson's disease. In neither group did the final model disclose any effect of ADL function on the spouse's psychosocial burden. CONCLUSION: Spouses caring for patients with dementia, stroke and Parkinson's disease perceive a similar type and level of psychosocial burden, independent of the disease. The cognitive functioning of the patient is a particularly important factor in this, especially when caring for patients with stroke or Parkinson's disease.