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  • 1
    Electronic Resource
    Electronic Resource
    Visual assessment of medial temporal lobe atrophy on magnetic resonance imaging: Interobserver reliability (1995)
    Springer
    Journal of neurology 242 (1995), S. 557-560 
    Details
    ISSN: 1432-1459
    Keywords: Magnetic resonance imaging ; Interobserver agreement ; Medial temporal lobe atrophy ; Alzheimer's disease
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We conducted an interobserver study to assess agreement on visual rating of medial temporal lobe atrophy on coronal T1-weighted MRI. A total of 100 studies of elderly individuals, using two different MRI techniques (spin echo and inversion recovery sequences), were analysed by four raters (three neurologists and one neuroradiologist) using a five-point rating scale. Complete agreement was found in 37% of the total sample. Interobserver agreement as expressed by kappa values was 0.44 (95% CIl0.34–0.54) and 0.51 (95% Cl=0.41–0.61) for the two techniques. After dichotomizing medial temporal lobe atrophy into present or absent, a post hoc analysis revealed higher complete agreeement (70%), with kappa values of 0.59 (95% Cl=0.51–0.67) and 0.62 (95% Cl=0.48–0.075), for the two techniques (all four raters). From this study we conclude that visual rating of medial temporal lobe atrophy on MRI in the coronal plane yields fair to good agreement among observers. We recommend this type of visual rating for use in clinical settings when a quick judgement on the presence of medial temporal lobe atrophy is needed.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00868807
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    Paper (German National Licenses)
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  • 2
    Electronic Resource
    Electronic Resource
    Tetrahydroaminoacridine and lecithin in the treatment of Alzheimer's disease (1991)
    Springer
    Journal of neurology 238 (1991), S. 34-38 
    Details
    ISSN: 1432-1459
    Keywords: Alzheimer's disease ; Tetrahydroaminocridine ; Cognition
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary In 12 ambulant patients with a clinical diagnosis of probable Alzheimer's disease, a 12-week, double-blind, placebo-controlled study with 100 mg/day tetrahydroaminoacridine (THA) and 10 g/day lecithin is reported. The aim of the study was to find whether treatment would result in an improvement of cognition, of functioning in daily life, decrease of behavioural disturbances, and decrease in burden experienced by the carers. Two of the six THA-treated patients demonstrated an increase on cognitive test scores with a moderate increase in the other outcome measurements. There was, however, no difference between the two groups in any outcome measurement after treatment. In addition, we found a reversible rise of liver transaminases in 4 of 6 patients in the treated group. This pilot study is too small to draw definite conclusions on the use of THA alone or in combination with lecithin. Our results suggest, however, that semi-structured interviews with the carers may be of value in the evaluation of treatment effects in patients with Alzheimer's disease.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00319708
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    Paper (German National Licenses)
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  • 3
    Electronic Resource
    Electronic Resource
    Diagnosing Alzheimer's disease in elderly, mildly demented patients: the impact of routine single photon emission computed tomography (1995)
    Springer
    Journal of neurology 242 (1995), S. 401-405 
    Details
    ISSN: 1432-1459
    Keywords: Dementia ; Alzheimer's disease ; Single photon emission computed tomography
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Based on the observation of bilateral temporoparietal hypoperfusion in Alzheimer's disease (AD), single photon emission computed tomography (SPECT) is advocated by some as a powerful diagnostic tool in the evaluation of demented patients. We studied whether routine brain SPECT in elderly, mildly demented outpatients increases the a priori diagnostic sensitivity and specificity of a careful clinical examination.99mTc-HMPAO SPECT imaging was performed in 110 patients for a first evaluation for dementia. A semiquantitative measure of temporoparietal (TP) perfusion was calculated as the ratio of the activity in the temporoparietal cortex to activity in the cerebellum. A diagnosis of probable AD according to the McKhann criteria was made in 68 patients (mean age of 79.3 years) based on the results of a clinical examination, ancillary investigations and a 6-month follow-up. TP perfusion was significantly lower in AD patients than in 18 age-matched, non-demented controls. However, at a specificity of 89%, sensitivity was only 43% for detecting probable AD. The clinicians judged that SPECT had contributed to the final diagnosis in only 8% of the demented patients investigated. Routine brain SPECT in elderly, mildly demented outpatients does not contribute substantially to diagnostic accuracy after a careful clinical examination using current diagnostic criteria. Clinical guidelines have to be developed for the use of SPECT in patients with (suspected) dementia.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00868397
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    Paper (German National Licenses)
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  • 4
    Electronic Resource
    Electronic Resource
    Dementia and subnormal levels of vitamin B12: Effects of replacement therapy on dementia (1996)
    Springer
    Journal of neurology 243 (1996), S. 522-529 
    Details
    ISSN: 1432-1459
    Keywords: Dementia ; Vitamin B12 ; Reversibility ; Outcome assessment
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Routine determination of serum vitamin B12 levels is generally recommended as part of the screening of demented patients, based on the notion that vitamin B12 deficiency is one of the causes of reversible dementia. We studied the effects of vitamin B12 replacement therapy in a prospective longitudinal study at a memory clinic, with special emphasis on assessment of severity of dementia: not only cognitive deterioration, but also disability in the activities of daily life, behavioural problems, and the burden experienced by the caregiver were examined using instruments of proven validity. In a series of 170 consecutive patients with dementia, subnormal serum vitamin B12 levels were found in 26 cases (15%); all but one fulfilled diagnostic criteria for possible Alzheimer's disease. Cobalamin supplementation was given to all patients and the effect was evaluated after 6 months. When the size and pattern of individual change scores, and the mean change scores on all instruments were taken into account, functioning after replacement therapy was not improved. When change scores of treated patients were compared with those of patients with Alzheimer's disease (n = 69), vitamin B12 replacement did not result in slowing of the progression of dementia. Contrary to widely accepted beliefs, subnormal serum vitamin B12 levels are not a (quantitatively) important cause of reversible dementia.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00886874
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    Paper (German National Licenses)
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