Lars Gustafson - Academia.edu (original) (raw)
Papers by Lars Gustafson
Dementia and Geriatric Cognitive Disorders, 1993
Twenty-five out of 26 cases of autopsy-verified frontal lobe degeneration of non-Alzheimer type (... more Twenty-five out of 26 cases of autopsy-verified frontal lobe degeneration of non-Alzheimer type (FLD) were found to have focal frontal or frontotemporal blood flow reductions involving both hemispheres. The deviant case had an asymmetric frontal pathology only apparent on the right side. Focal reduction of blood flow in the frontal lobes is, however, a common and unspecific flow abnormality found in e.g. Pick's disease. Creutzfeldt-Jakob's disease, and in some cases of Alzheimer's disease. Low frontal flow has also been reported in schizophrenia and in toxic encephalopathy. Since a characteristic feature of FLD is a steady progress of the pathology, serial flow measurements extending over several years are especially informative.
Acta Psychiatrica Scandinavica, May 1, 1977
Fifteen chronic alcoholics and 15 presenile patients were matched in pairs with regard to their m... more Fifteen chronic alcoholics and 15 presenile patients were matched in pairs with regard to their mean hemisphere cerebral blood parametersan index of brain metabolism. The distribution of the regional cerebral blood flow was similar in the two groups. The alcoholics performed significantly better in all psychometric tests than the presenile patients and more alcoholics than presenile patients were still employed and working. Nine presenile patients and one alcoholic showed symptoms indicating brain stem dysfunction.
Dementia and Geriatric Cognitive Disorders, Feb 1, 2002
Several studies have shown that plasma total homocysteine (tHcy) concentration is elevated in Alz... more Several studies have shown that plasma total homocysteine (tHcy) concentration is elevated in Alzheimer's disease (AD). However, it is not clear whether elevated plasma tHcy is a primary cause or a consequence of AD. To elucidate this question, we have analysed plasma homocysteine and its determinants in patients with early (EOAD)- and late-onset AD (LOAD) and compared the findings with those in vascular dementia (VaD) and age- and sex-matched control subjects. One of the main findings in the present study is that in EOAD there is no change in the levels of either plasma tHcy or its determinants compared with an age- and sex-matched control group. The fact that plasma tHcy concentration is normal in EOAD thus indicates that elevated plasma tHcy is not the primary cause of the disease. Another main finding is that patients with mixed dementia (AD and VaD) and patients with VaD showed significantly increased plasma tHcy concentration compared with controls and that plasma tHCy concentration in patients with LOAD and a history of additional cardiovascular disease was elevated compared both with AD patients without such a history and with the controls. Thus, there is an association between elevated plasma tHcy and vascular disease. A third main finding is that patients with AD who were followed up for several years showed a clinical deterioration of dementia and an elevation of plasma tHcy concentration. This finding likewise supports the notion that elevated plasma tHcy is not the primary cause of the disease. The findings suggest that elevated plasma tHcy is not the primary cause of the disease. Furthermore, the findings indicate that elevated plasma tHcy might be a reflection of concomitant vascular disease in AD patients.
Clinical Chemistry and Laboratory Medicine, Jan 7, 2004
Early diagnosis of cobalamin deficiency is crucial, owing to the latent nature of this disorder a... more Early diagnosis of cobalamin deficiency is crucial, owing to the latent nature of this disorder and the resulting possible irreversible neurological damage. A normal serum cobalamin concentration does not reliably rule out a functional cobalamin deficiency and there does not at present seem to be any single diagnostic approach to achieve this diagnosis. A new marker for cobalamin status is the serum concentration of cobalamin bound to transcobalamin II (holoTC). Because methods suitable for routine use have been unavailable until recently, the clinical value of low holoTC is still uncertain. Furthermore, there is at the moment no gold standard or true reference method to diagnose subtle cobalamin deficiency, which makes evaluation of the clinical usefulness of holoTC and the estimation of sensitivity and specificity problematic. In this study, we aimed to assess whether low holoTC concentrations are congruent with other biochemical signs of cobalamin deficiency in a group of psychogeriatric patients. The findings in the present study show that holoTC is strongly related to serum cobalamin (0.68; p<0.001 in both patients and controls). Distribution of the different markers for cobalamin/folate status in the 33 patients with low levels of serum holoTC (below 40 pmol/l) showed that 17 patients had normal levels of the other markers for cobalamin status. This may indicate poor specificity of low holoTC for cobalamin deficiency. In 23 out of 176 patients with normal levels of holoTC we observed pathological levels of other markers for cobalamin deficiency. The use of holoTC in the present study group did not give significant additional information other than that given by serum cobalamin and therefore cannot be recommended in this clinical setting.
International Journal of Geriatric Psychiatry, Jul 1, 2003
To retrospectively evaluate pre-diagnostic clinical features (predictors) of mortality in frontot... more To retrospectively evaluate pre-diagnostic clinical features (predictors) of mortality in frontotemporal dementia (FTD). The main aim was to investigate if there were indications against interpreting missing data as signs of absence. 96 cases with FTD, here defined as Dementia in Pick's disease according to ICD-10. The predictors were behavioural/psychiatric features, language impairment and neurological deficits up to the date of diagnosis. Each predictor was rated as present (Yes), absent (No) or not recorded (Missing), and evaluated according to its distribution and mortality pattern: if a feature was not recorded because it was absent, the mortality of the Missing and the No-category should hypothetically be close. Statistical methods included Kaplan-Meier survival curves and Cox regression analyses. Neurological deficits and language impairments were frequently recorded as present or absent, while non-recordings were more prevalent among the behavioural/psychiatric features. Some features were excluded as predictors because they showed too little variation. Analyses of the survival pattern indicated that in some features, the observations of the Missing-category could be interpreted as absence of the symptoms. In other features these observations had to be regarded as truly missing. In the retrospective evaluation of predictors of mortality a method for treating missing data was applied. The interpretation of non-recordings as signs of absence was supported by the analyses of the survival patterns in some of the studied features. However, the study underscores the importance of systematic estimations of pre-diagnostic clinical features in dementia.
American Journal of Neurodegenerative Disease, 2013
Background: In 2011 the C9ORF72 repeat expansion was identified as the most frequent genetic muta... more Background: In 2011 the C9ORF72 repeat expansion was identified as the most frequent genetic mutation underlying FTD and ALS. The main aim of this study was to investigate clinical characteristics in a large C9ORF72-positive FTD family, and to compare these with the neuropathological findings. Methods: The clinical records of 12 related FTD patients were thoroughly evaluated. The five neuropathologically examined cases were revised using additional TDP-43 immuno-stainings. Four cases were screened for the C9ORF72 expansion. Results: All 12 patients fulfilled the criteria for bvFTD. Restlessness and social neglect were often among the first reported symptoms. Psychotic symptoms were reported in 8 patients. Somatic complaints were seen in 7 cases. All the neuropathologically examined cases were TDP-43 positive. Conclusions: The phenotype of this C9ORF72 hexanucleotide expansion carrier family was bvFTD. The clinical symptom profile was strikingly homogenous. Psychotic symptoms and somatic complaints were observed in most of the cases.
American Journal of Neurodegenerative Disease, 2014
Frontotemporal dementia (FTD) is associated with a broad spectrum of clinical characteristics. Th... more Frontotemporal dementia (FTD) is associated with a broad spectrum of clinical characteristics. The objec-FTD. We also examined whether the somatic presentations correlated with protein pathology or regional brain pathology and if the patients with these somatic features showed more depressive traits. Ninety-seven consecutively all medical records were systematically reviewed. The somatic complaints focused on were headache, musculoskeletal, gastro/urogenital and abnormal pain response. Symptoms of somatic character (either somatic complaints and/or abnormal pain response) were found in 40.2%. These patients did not differ from the total group with regard to gender, age at onset or duration. Six patients showed exaggerated reactions to sensory stimuli, whereas three patients showed reduced response to pain. Depressive traits were present in 38% and did not correlate with somatic complaints. Suicidal behavior was present in 17 patients, in 10 of these suicidal behavior was concurrent with somatic complaints. No clear correlation between somatic complaints and brain protein pathology, regional pathology or asymmetric hemispherical atrophy was found. Our results show that many FTD patients suffer from unexplained somatic complaints before and/or during dementia where no clear correlation can be found with protein pathology or regional degeneration. Somatic complaints are not covered by current diagnostic criteria for FTD, but need to be considered in diagnostics and care. The need for prospective studies with neuropathological follow up must be stressed as these phenomena remain unexplained, misinterpreted, bizarre and, in many cases, excruciating.
Clinical Chemistry and Laboratory Medicine, May 1, 2003
Homocysteine (Hcy) is the demethylated derivate of methionine and can be metabolized by two pathw... more Homocysteine (Hcy) is the demethylated derivate of methionine and can be metabolized by two pathways. It is either catabolized by the transulfuration pathway to cysteine or remethylated to methionine mainly by the folate- and cobalamin-dependent enzyme methionine synthase. Previous findings suggest that folate is the most important vitamin determinant of plasma total homocysteine (tHcy) concentration but also that the relation between plasma tHcy levels and levels of cobalamin and folate in the circulation might differ in different populations. In the present study, we have analyzed these parameters in different age groups of healthy subjects and psychogeriatric patients, who are known to have increased plasma tHcy. The present study shows that serum cobalamin concentration is a more important determinant of plasma tHcy concentration than blood folate concentration in the age groups <65 years in both psychogeriatric patients and control subjects, whereas with increasing age blood folate concentration becomes the most important vitamin determinant. The findings of increased plasma tHcy with folate being the main vitamin determinant in the oldest age groups of patients and controls, suggest that tissue levels of folate in elderly subjects are too low and that vitamin supplementation should be given.
Alz Dis Assoc Disorder, 1996
The Journal of Ect, 2005
Our aim was to study the long-term effects of electroconvulsive therapy (ECT) in depression. A to... more Our aim was to study the long-term effects of electroconvulsive therapy (ECT) in depression. A total of 55 patients were followed-up 20 to 24 years after an ECT series; 13 patients were still alive, and 10 agreed to participate in the study. All 55 patients had been investigated with clinical and neuropsychological assessment and with neurophysiological measurements and with regional cerebral blood flow (rCBF) and EEG before the first ECT, 6 months later, and after approximately 1 year. These investigations were repeated in the 10 patients. Before the original ECT series, all patients had suffered from severe mood disorder. At follow-up, the 10 patients showed no clear signs of mood disorder or cognitive impairment. There was a slightly subnormal performance in working memory and in verbal as well as visual episodic memory on all 3 occasions after the ECT series. The rCBF measurement showed a significant average CBF decrease from the first to the last measurement. There was, moreover, a significant rCBF decrease in frontal areas at the last measurement compared with the 3 previous assessments. All ten patients followed-up 20 to 24 years after an ECT series were mentally healthy and thus besides a moderate visual memory dysfunction, no severe side effects were observed with clinical and neuroimaging techniques.
Http Dx Doi Org 10 1207 S15324826an1301_5, Jun 7, 2010
Patients suffering from spider phobia were studied with measurement of regional cerebral blood fl... more Patients suffering from spider phobia were studied with measurement of regional cerebral blood flow (rCBF) when they were looking at a video recording of living spiders. Six patients were studied before and after cognitive psychotherapy with successful outcome in all cases. On each occasion rCBF was measured under 3 conditions: during rest, during exposure to a video recording of neutral nature scenery, and finally while the patient watched a recording of living spiders. The patients who managed to control their emotional reactions without panicking during spider exposure before treatment showed an rCBF increase in prefrontal cortex, more pronounced in the right hemisphere. Following successful treatment, these patients showed an rCBF decrease in this region. In contrast, patients who reported panic during the initial spider exposure showed hypoactivity in the frontal cortex at that time, and then showed an increase in prefrontal rCBF in the spider challenge after cognitive therapy. The psychological improvement from cognitive therapy thus appears to be associated with activation of prefrontal cortex that varies closely with the demands for self-regulation of emotional reactivity.
Dementia (Basel, Switzerland)
ABSTRACT
Acta neurologica Scandinavica. Supplementum
Human Genetics
A novel mutation, a C to T transition at base pair 2124 in exon 17 of the amyloid beta-protein pr... more A novel mutation, a C to T transition at base pair 2124 in exon 17 of the amyloid beta-protein precursor (APP) gene, has been identified by direct sequencing of amplified DNA from two Alzheimer's disease (AD) patients. A simple oligonucleotide-hybridization procedure was developed to allow population studies of this DNA variation. The mutation, which is silent at the protein level, was present in 2 out of 12 investigated AD patients, in 1 out of 60 non-AD patients and in 1 out of 30 healthy individuals. The mutation can be used as a new marker for linkage studies involving the APP gene, although more comprehensive population studies are required to determine the status of the mutation as a possible risk factor for the development of AD.
Lakartidningen
The entire 1902 and 1903 birthyear cohorts in the catchment area of Dalby Community Health Centre... more The entire 1902 and 1903 birthyear cohorts in the catchment area of Dalby Community Health Centre in southern Sweden have been followed with health examinations and interviews every second year since 1969-70. Of the total of 192 subjects, complete data are available for 153. Of 65 subjects surviving at the age of 83, 6 per cent were advanced dementia cases, 11 per cent were in the early stages of dementia, and a further 17 per cent were afflicted with other mental problems requiring help and care. Of those who died before the age of 83, 11 per cent were afflicted with dementia, with a further 4 per cent in the early stages, and 17 per cent had other mental problems. Thus, the overall risk of dementia is at least 16 per cent, but may eventually turn out to be as high as 30 per cent, while those with other forms of mental dysfunction, serious enough to require help in ADL, account for a similar proportion. The annual incidence of dementia is 7.5 per mill (10.6 per mill including those in early stages). The risk of institutionalisation and death was much higher among the dementia victims, most of whom had had little support from the social services, and some none at all, before being institutionalised. Dementia victims came into contact with the medical services much earlier than did mentally healthy patients with other, often vague and more varied symptoms. It is argued in the article that current concern with dementia should not be allowed to divert our attention from the needs, diagnosis and care of the many elderly patients with other mental problems.
Dementia and geriatric cognitive disorders extra, 2012
Serum N-terminal pro-brain natriuretic peptide (NT-proBNP) is regarded as a sensitive marker of c... more Serum N-terminal pro-brain natriuretic peptide (NT-proBNP) is regarded as a sensitive marker of cardiovascular disease. Vascular disease plays an important role in cognitive impairment. In 447 elderly patients with mental illness, serum NT-proBNP level and the presence or absence of vascular disease according to the medical record were used to categorize patients in different subgroups of vascular disease. Patients with vascular disease and elevated serum NT-proBNP level had a lower cognition level, shorter survival time, lower renal function and a higher percentage of pathological brain imaging than patients with vascular disease and normal NT-proBNP level. Thus, elevated serum NT-proBNP level might be helpful to detect patients who have a more severe cardiovascular disease.
Läkartidningen, Jan 22, 2001
Classification and registration of diseases is necessary in order to monitor the proliferation of... more Classification and registration of diseases is necessary in order to monitor the proliferation of diseases in a population. Despite the presence of an international framework for classification of diseases (ICD 10) which has been approved by the Swedish authorities, the guidelines provided are not observed in the area of dementia diseases. Different diagnoses can be used to describe the same condition, and "dementia unspecified" is sometimes employed when a specified diagnosis could have been used. In order to refine consensus regarding the use of different diagnoses in the dementia field, representatives for the Swedish University hospitals and medical faculties propose a unified description of a limited number of dementia diagnoses.
Clinical chemistry, 2000
Cobalamin/folate deficiency in elderly subjects may lead to psychiatric symptoms, but more often ... more Cobalamin/folate deficiency in elderly subjects may lead to psychiatric symptoms, but more often it increases the severity of various organic and nonorganic mental diseases. A major clinical problem, however, is the uncertainty and controversy concerning biochemical markers of cobalamin/folate deficiency to be used in the diagnostic evaluation of suspected cobalamin/folate deficiency. We measured plasma homocysteine (tHcy), blood folate, serum methylmalonic acid, and serum cobalamin in 80 psychogeriatric patients (age, 77.3 +/- 8.6 years) and 50 controls (age, 76.1 +/- 8. 0 years). We assessed associations of these tests with measures of cognitive and behavior performance by use of regression analyses. Plasma tHcy was increased in 45% of the psychogeriatric population (mean, 20.5 +/- 9.2 micromol/L vs 15.3 +/- 4.7 micromol/L for controls; P <0.01). Plasma tHcy correlated with severity of dementia (r = 0.36; P <0.01), the Katz ADL index (r = 0.29; P <0.05), the Berger scale ...
Dementia and Geriatric Cognitive Disorders, 1993
Twenty-five out of 26 cases of autopsy-verified frontal lobe degeneration of non-Alzheimer type (... more Twenty-five out of 26 cases of autopsy-verified frontal lobe degeneration of non-Alzheimer type (FLD) were found to have focal frontal or frontotemporal blood flow reductions involving both hemispheres. The deviant case had an asymmetric frontal pathology only apparent on the right side. Focal reduction of blood flow in the frontal lobes is, however, a common and unspecific flow abnormality found in e.g. Pick's disease. Creutzfeldt-Jakob's disease, and in some cases of Alzheimer's disease. Low frontal flow has also been reported in schizophrenia and in toxic encephalopathy. Since a characteristic feature of FLD is a steady progress of the pathology, serial flow measurements extending over several years are especially informative.
Acta Psychiatrica Scandinavica, May 1, 1977
Fifteen chronic alcoholics and 15 presenile patients were matched in pairs with regard to their m... more Fifteen chronic alcoholics and 15 presenile patients were matched in pairs with regard to their mean hemisphere cerebral blood parametersan index of brain metabolism. The distribution of the regional cerebral blood flow was similar in the two groups. The alcoholics performed significantly better in all psychometric tests than the presenile patients and more alcoholics than presenile patients were still employed and working. Nine presenile patients and one alcoholic showed symptoms indicating brain stem dysfunction.
Dementia and Geriatric Cognitive Disorders, Feb 1, 2002
Several studies have shown that plasma total homocysteine (tHcy) concentration is elevated in Alz... more Several studies have shown that plasma total homocysteine (tHcy) concentration is elevated in Alzheimer&amp;amp;amp;amp;amp;amp;amp;#39;s disease (AD). However, it is not clear whether elevated plasma tHcy is a primary cause or a consequence of AD. To elucidate this question, we have analysed plasma homocysteine and its determinants in patients with early (EOAD)- and late-onset AD (LOAD) and compared the findings with those in vascular dementia (VaD) and age- and sex-matched control subjects. One of the main findings in the present study is that in EOAD there is no change in the levels of either plasma tHcy or its determinants compared with an age- and sex-matched control group. The fact that plasma tHcy concentration is normal in EOAD thus indicates that elevated plasma tHcy is not the primary cause of the disease. Another main finding is that patients with mixed dementia (AD and VaD) and patients with VaD showed significantly increased plasma tHcy concentration compared with controls and that plasma tHCy concentration in patients with LOAD and a history of additional cardiovascular disease was elevated compared both with AD patients without such a history and with the controls. Thus, there is an association between elevated plasma tHcy and vascular disease. A third main finding is that patients with AD who were followed up for several years showed a clinical deterioration of dementia and an elevation of plasma tHcy concentration. This finding likewise supports the notion that elevated plasma tHcy is not the primary cause of the disease. The findings suggest that elevated plasma tHcy is not the primary cause of the disease. Furthermore, the findings indicate that elevated plasma tHcy might be a reflection of concomitant vascular disease in AD patients.
Clinical Chemistry and Laboratory Medicine, Jan 7, 2004
Early diagnosis of cobalamin deficiency is crucial, owing to the latent nature of this disorder a... more Early diagnosis of cobalamin deficiency is crucial, owing to the latent nature of this disorder and the resulting possible irreversible neurological damage. A normal serum cobalamin concentration does not reliably rule out a functional cobalamin deficiency and there does not at present seem to be any single diagnostic approach to achieve this diagnosis. A new marker for cobalamin status is the serum concentration of cobalamin bound to transcobalamin II (holoTC). Because methods suitable for routine use have been unavailable until recently, the clinical value of low holoTC is still uncertain. Furthermore, there is at the moment no gold standard or true reference method to diagnose subtle cobalamin deficiency, which makes evaluation of the clinical usefulness of holoTC and the estimation of sensitivity and specificity problematic. In this study, we aimed to assess whether low holoTC concentrations are congruent with other biochemical signs of cobalamin deficiency in a group of psychogeriatric patients. The findings in the present study show that holoTC is strongly related to serum cobalamin (0.68; p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001 in both patients and controls). Distribution of the different markers for cobalamin/folate status in the 33 patients with low levels of serum holoTC (below 40 pmol/l) showed that 17 patients had normal levels of the other markers for cobalamin status. This may indicate poor specificity of low holoTC for cobalamin deficiency. In 23 out of 176 patients with normal levels of holoTC we observed pathological levels of other markers for cobalamin deficiency. The use of holoTC in the present study group did not give significant additional information other than that given by serum cobalamin and therefore cannot be recommended in this clinical setting.
International Journal of Geriatric Psychiatry, Jul 1, 2003
To retrospectively evaluate pre-diagnostic clinical features (predictors) of mortality in frontot... more To retrospectively evaluate pre-diagnostic clinical features (predictors) of mortality in frontotemporal dementia (FTD). The main aim was to investigate if there were indications against interpreting missing data as signs of absence. 96 cases with FTD, here defined as Dementia in Pick&amp;#39;s disease according to ICD-10. The predictors were behavioural/psychiatric features, language impairment and neurological deficits up to the date of diagnosis. Each predictor was rated as present (Yes), absent (No) or not recorded (Missing), and evaluated according to its distribution and mortality pattern: if a feature was not recorded because it was absent, the mortality of the Missing and the No-category should hypothetically be close. Statistical methods included Kaplan-Meier survival curves and Cox regression analyses. Neurological deficits and language impairments were frequently recorded as present or absent, while non-recordings were more prevalent among the behavioural/psychiatric features. Some features were excluded as predictors because they showed too little variation. Analyses of the survival pattern indicated that in some features, the observations of the Missing-category could be interpreted as absence of the symptoms. In other features these observations had to be regarded as truly missing. In the retrospective evaluation of predictors of mortality a method for treating missing data was applied. The interpretation of non-recordings as signs of absence was supported by the analyses of the survival patterns in some of the studied features. However, the study underscores the importance of systematic estimations of pre-diagnostic clinical features in dementia.
American Journal of Neurodegenerative Disease, 2013
Background: In 2011 the C9ORF72 repeat expansion was identified as the most frequent genetic muta... more Background: In 2011 the C9ORF72 repeat expansion was identified as the most frequent genetic mutation underlying FTD and ALS. The main aim of this study was to investigate clinical characteristics in a large C9ORF72-positive FTD family, and to compare these with the neuropathological findings. Methods: The clinical records of 12 related FTD patients were thoroughly evaluated. The five neuropathologically examined cases were revised using additional TDP-43 immuno-stainings. Four cases were screened for the C9ORF72 expansion. Results: All 12 patients fulfilled the criteria for bvFTD. Restlessness and social neglect were often among the first reported symptoms. Psychotic symptoms were reported in 8 patients. Somatic complaints were seen in 7 cases. All the neuropathologically examined cases were TDP-43 positive. Conclusions: The phenotype of this C9ORF72 hexanucleotide expansion carrier family was bvFTD. The clinical symptom profile was strikingly homogenous. Psychotic symptoms and somatic complaints were observed in most of the cases.
American Journal of Neurodegenerative Disease, 2014
Frontotemporal dementia (FTD) is associated with a broad spectrum of clinical characteristics. Th... more Frontotemporal dementia (FTD) is associated with a broad spectrum of clinical characteristics. The objec-FTD. We also examined whether the somatic presentations correlated with protein pathology or regional brain pathology and if the patients with these somatic features showed more depressive traits. Ninety-seven consecutively all medical records were systematically reviewed. The somatic complaints focused on were headache, musculoskeletal, gastro/urogenital and abnormal pain response. Symptoms of somatic character (either somatic complaints and/or abnormal pain response) were found in 40.2%. These patients did not differ from the total group with regard to gender, age at onset or duration. Six patients showed exaggerated reactions to sensory stimuli, whereas three patients showed reduced response to pain. Depressive traits were present in 38% and did not correlate with somatic complaints. Suicidal behavior was present in 17 patients, in 10 of these suicidal behavior was concurrent with somatic complaints. No clear correlation between somatic complaints and brain protein pathology, regional pathology or asymmetric hemispherical atrophy was found. Our results show that many FTD patients suffer from unexplained somatic complaints before and/or during dementia where no clear correlation can be found with protein pathology or regional degeneration. Somatic complaints are not covered by current diagnostic criteria for FTD, but need to be considered in diagnostics and care. The need for prospective studies with neuropathological follow up must be stressed as these phenomena remain unexplained, misinterpreted, bizarre and, in many cases, excruciating.
Clinical Chemistry and Laboratory Medicine, May 1, 2003
Homocysteine (Hcy) is the demethylated derivate of methionine and can be metabolized by two pathw... more Homocysteine (Hcy) is the demethylated derivate of methionine and can be metabolized by two pathways. It is either catabolized by the transulfuration pathway to cysteine or remethylated to methionine mainly by the folate- and cobalamin-dependent enzyme methionine synthase. Previous findings suggest that folate is the most important vitamin determinant of plasma total homocysteine (tHcy) concentration but also that the relation between plasma tHcy levels and levels of cobalamin and folate in the circulation might differ in different populations. In the present study, we have analyzed these parameters in different age groups of healthy subjects and psychogeriatric patients, who are known to have increased plasma tHcy. The present study shows that serum cobalamin concentration is a more important determinant of plasma tHcy concentration than blood folate concentration in the age groups &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;65 years in both psychogeriatric patients and control subjects, whereas with increasing age blood folate concentration becomes the most important vitamin determinant. The findings of increased plasma tHcy with folate being the main vitamin determinant in the oldest age groups of patients and controls, suggest that tissue levels of folate in elderly subjects are too low and that vitamin supplementation should be given.
Alz Dis Assoc Disorder, 1996
The Journal of Ect, 2005
Our aim was to study the long-term effects of electroconvulsive therapy (ECT) in depression. A to... more Our aim was to study the long-term effects of electroconvulsive therapy (ECT) in depression. A total of 55 patients were followed-up 20 to 24 years after an ECT series; 13 patients were still alive, and 10 agreed to participate in the study. All 55 patients had been investigated with clinical and neuropsychological assessment and with neurophysiological measurements and with regional cerebral blood flow (rCBF) and EEG before the first ECT, 6 months later, and after approximately 1 year. These investigations were repeated in the 10 patients. Before the original ECT series, all patients had suffered from severe mood disorder. At follow-up, the 10 patients showed no clear signs of mood disorder or cognitive impairment. There was a slightly subnormal performance in working memory and in verbal as well as visual episodic memory on all 3 occasions after the ECT series. The rCBF measurement showed a significant average CBF decrease from the first to the last measurement. There was, moreover, a significant rCBF decrease in frontal areas at the last measurement compared with the 3 previous assessments. All ten patients followed-up 20 to 24 years after an ECT series were mentally healthy and thus besides a moderate visual memory dysfunction, no severe side effects were observed with clinical and neuroimaging techniques.
Http Dx Doi Org 10 1207 S15324826an1301_5, Jun 7, 2010
Patients suffering from spider phobia were studied with measurement of regional cerebral blood fl... more Patients suffering from spider phobia were studied with measurement of regional cerebral blood flow (rCBF) when they were looking at a video recording of living spiders. Six patients were studied before and after cognitive psychotherapy with successful outcome in all cases. On each occasion rCBF was measured under 3 conditions: during rest, during exposure to a video recording of neutral nature scenery, and finally while the patient watched a recording of living spiders. The patients who managed to control their emotional reactions without panicking during spider exposure before treatment showed an rCBF increase in prefrontal cortex, more pronounced in the right hemisphere. Following successful treatment, these patients showed an rCBF decrease in this region. In contrast, patients who reported panic during the initial spider exposure showed hypoactivity in the frontal cortex at that time, and then showed an increase in prefrontal rCBF in the spider challenge after cognitive therapy. The psychological improvement from cognitive therapy thus appears to be associated with activation of prefrontal cortex that varies closely with the demands for self-regulation of emotional reactivity.
Dementia (Basel, Switzerland)
ABSTRACT
Acta neurologica Scandinavica. Supplementum
Human Genetics
A novel mutation, a C to T transition at base pair 2124 in exon 17 of the amyloid beta-protein pr... more A novel mutation, a C to T transition at base pair 2124 in exon 17 of the amyloid beta-protein precursor (APP) gene, has been identified by direct sequencing of amplified DNA from two Alzheimer&amp;#39;s disease (AD) patients. A simple oligonucleotide-hybridization procedure was developed to allow population studies of this DNA variation. The mutation, which is silent at the protein level, was present in 2 out of 12 investigated AD patients, in 1 out of 60 non-AD patients and in 1 out of 30 healthy individuals. The mutation can be used as a new marker for linkage studies involving the APP gene, although more comprehensive population studies are required to determine the status of the mutation as a possible risk factor for the development of AD.
Lakartidningen
The entire 1902 and 1903 birthyear cohorts in the catchment area of Dalby Community Health Centre... more The entire 1902 and 1903 birthyear cohorts in the catchment area of Dalby Community Health Centre in southern Sweden have been followed with health examinations and interviews every second year since 1969-70. Of the total of 192 subjects, complete data are available for 153. Of 65 subjects surviving at the age of 83, 6 per cent were advanced dementia cases, 11 per cent were in the early stages of dementia, and a further 17 per cent were afflicted with other mental problems requiring help and care. Of those who died before the age of 83, 11 per cent were afflicted with dementia, with a further 4 per cent in the early stages, and 17 per cent had other mental problems. Thus, the overall risk of dementia is at least 16 per cent, but may eventually turn out to be as high as 30 per cent, while those with other forms of mental dysfunction, serious enough to require help in ADL, account for a similar proportion. The annual incidence of dementia is 7.5 per mill (10.6 per mill including those in early stages). The risk of institutionalisation and death was much higher among the dementia victims, most of whom had had little support from the social services, and some none at all, before being institutionalised. Dementia victims came into contact with the medical services much earlier than did mentally healthy patients with other, often vague and more varied symptoms. It is argued in the article that current concern with dementia should not be allowed to divert our attention from the needs, diagnosis and care of the many elderly patients with other mental problems.
Dementia and geriatric cognitive disorders extra, 2012
Serum N-terminal pro-brain natriuretic peptide (NT-proBNP) is regarded as a sensitive marker of c... more Serum N-terminal pro-brain natriuretic peptide (NT-proBNP) is regarded as a sensitive marker of cardiovascular disease. Vascular disease plays an important role in cognitive impairment. In 447 elderly patients with mental illness, serum NT-proBNP level and the presence or absence of vascular disease according to the medical record were used to categorize patients in different subgroups of vascular disease. Patients with vascular disease and elevated serum NT-proBNP level had a lower cognition level, shorter survival time, lower renal function and a higher percentage of pathological brain imaging than patients with vascular disease and normal NT-proBNP level. Thus, elevated serum NT-proBNP level might be helpful to detect patients who have a more severe cardiovascular disease.
Läkartidningen, Jan 22, 2001
Classification and registration of diseases is necessary in order to monitor the proliferation of... more Classification and registration of diseases is necessary in order to monitor the proliferation of diseases in a population. Despite the presence of an international framework for classification of diseases (ICD 10) which has been approved by the Swedish authorities, the guidelines provided are not observed in the area of dementia diseases. Different diagnoses can be used to describe the same condition, and "dementia unspecified" is sometimes employed when a specified diagnosis could have been used. In order to refine consensus regarding the use of different diagnoses in the dementia field, representatives for the Swedish University hospitals and medical faculties propose a unified description of a limited number of dementia diagnoses.
Clinical chemistry, 2000
Cobalamin/folate deficiency in elderly subjects may lead to psychiatric symptoms, but more often ... more Cobalamin/folate deficiency in elderly subjects may lead to psychiatric symptoms, but more often it increases the severity of various organic and nonorganic mental diseases. A major clinical problem, however, is the uncertainty and controversy concerning biochemical markers of cobalamin/folate deficiency to be used in the diagnostic evaluation of suspected cobalamin/folate deficiency. We measured plasma homocysteine (tHcy), blood folate, serum methylmalonic acid, and serum cobalamin in 80 psychogeriatric patients (age, 77.3 +/- 8.6 years) and 50 controls (age, 76.1 +/- 8. 0 years). We assessed associations of these tests with measures of cognitive and behavior performance by use of regression analyses. Plasma tHcy was increased in 45% of the psychogeriatric population (mean, 20.5 +/- 9.2 micromol/L vs 15.3 +/- 4.7 micromol/L for controls; P <0.01). Plasma tHcy correlated with severity of dementia (r = 0.36; P <0.01), the Katz ADL index (r = 0.29; P <0.05), the Berger scale ...