W.H.L. Hoefnagels

Simultaneous measurements of cerebral oxygenation changes during brain activation by near‐infrared spectroscopy and functional magnetic resonance imaging in healthy young and elderly subjects

Near infrared spectroscopy (NIRS) and functional magnetic resonance imaging (fMRI) both allow non‐invasive monitoring of cerebral cortical oxygenation responses to various stimuli. To compare these methods in elderly subjects and to determine the effect of age on cortical oxygenation responses, we determined motor‐task‐related changes in deoxyhemoglobin concentration ([HHb]) over the left motor cortex in six healthy young subjects (age 35 ± 9 years, mean ± SD) and five healthy elderly subjects (age 73 ± 3 years) by NIRS and blood‐oxygen‐level‐dependent (BOLD) fMRI simultaneously. The motor‐task consisted of seven cycles of 20‐sec periods of contralateral finger‐tapping at a rate as fast as possible alternated with 40‐sec periods of rest. Time‐locked averages over the seven cycles were used for further analysis. Task‐related decreases in [HHb] over the motor cortex were measured by NIRS, with maximum changes of −0.83 ± 0.38 μmol/L (P < 0.01) for the young and −0.32 ± 0.17 μmol/L (P < 0.05) for the elderly subjects. The BOLD‐fMRI signal increased over the cortex volume under investigation with NIRS, with maximum changes of 2.11 ± 0.72% (P < 0.01) for the young and 1.75 ± 0.71% (P < 0.01) for the elderly subjects. NIRS and BOLD‐fMRI measurements showed good correlation in the young (r = −0.70, r2 = 0.48, P < 0.001) and elderly subjects (r = −0.82, r2 = 0.67, P < 0.001). Additionally, NIRS measurements demonstrated age‐dependent decreases in task‐related cerebral oxygenation responses (P < 0.05), whereas fMRI measurements demonstrated smaller areas of cortical activation in the elderly subjects (P < 0.05). These findings demonstrate that NIRS and fMRI similarly assess cortical oxygenation changes in young subjects and also in elderly subjects. In addition, cortical oxygenation responses to brain activation alter with aging. Hum. Brain Mapping 16:14–23, 2002.

Community occupational therapy for older patients with dementia and their care givers: cost effectiveness study.

Objective To assess the cost effectiveness of community based occupational therapy compared with usual care in older patients with dementia and their care givers from a societal viewpoint. Design Cost effectiveness study alongside a single blind randomised controlled trial. Setting Memory clinic, day clinic of a geriatrics department, and participants’ homes. Patients 135 patients aged ≥65 with mild to moderate dementia living in the community and their primary care givers. Intervention 10 sessions of occupational therapy over five weeks, including cognitive and behavioural interventions, to train patients in the use of aids to compensate for cognitive decline and care givers in coping behaviours and supervision. Main outcome measures Incremental cost effectiveness ratio expressed as the difference in mean total care costs per successful treatment (that is, a combined patient and care giver outcome measure of clinically relevant improvement on process, performance, and competence scales) at three months after randomisation. Bootstrap methods used to determine confidence intervals for these measures. Results The intervention cost €1183 (£848,

No effect of one-year treatment with indomethacin on Alzheimer's disease progression: a randomized controlled trial.

1738) (95% confidence interval €1128 (£808,

Blood pressure reduction after oral glucose loading and its relation to age, blood pressure and insulin

1657) to €1239 (£888,

How can occupational therapy improve the daily performance and communication of an older patient with dementia and his primary caregiver? A case study

1820)) per patient and primary care giver unit at three months. Visits to general practitioners and hospital doctors cost the same in both groups but total mean costs were €1748 (£1279,

Validation of Multi-Frequency Bioelectrical Impedance Analysis in Detecting Changes in Fluid Balance of Geriatric Patients

2621) lower in the intervention group, with the main cost savings in informal care. There was a significant difference in proportions of successful treatments of 36% at three months. The number needed to treat for successful treatment at three months was 2.8 (2.7 to 2.9). Conclusions Community occupational therapy intervention for patients with dementia and their care givers is successful and cost effective, especially in terms of informal care giving.

Clinical significance of low cobalamin levels in older hospital patients

Background The objective of this study was to determine whether treatment with the nonselective nonsteroidal anti-inflammatory drug (NSAID) indomethacin slows cognitive decline in patients with Alzheimers disease (AD). Methodology/Principal Findings This double-blind, randomized, placebo-controlled trial was conducted between May 2000 and September 2005 in two hospitals in the Netherlands. 51 patients with mild to moderate AD were enrolled into the study. Patients received 100 mg indomethacin or placebo daily for 12 months. Additionally, all patients received omeprazole. The primary outcome measure was the change from baseline after one year of treatment on the cognitive subscale of the AD Assessment Scale (ADAS-cog). Secondary outcome measures included the Mini-Mental State Examination, the Clinicians Interview Based Impression of Change with caregiver input, the noncognitive subscale of the ADAS, the Neuropsychiatric Inventory, and the Interview for Deterioration in Daily life in Dementia. Considerable recruitment problems of participants were encountered, leading to an underpowered study. In the placebo group, 19 out of 25 patients completed the study, and 19 out of 26 patients in the indomethacin group. The deterioration on the ADAS-cog was less in the indomethacin group (7.8±7.6), than in the placebo group (9.3±10.0). This difference (1.5 points; CI −4.5–7.5) was not statistically significant, and neither were any of the secondary outcome measures. Conclusions/Significance The results of this study are inconclusive with respect to the hypothesis that indomethacin slows the progression of AD. Trial Registration ClinicalTrials.gov NCT00432081

Social and psychological characteristics of elderly visually handicapped patients with the Charles Bonnet Syndrome

Recently it was shown that blood pressure (BP) in the elderly may decrease after a meal. The pathophysiologic mechanism of this phenomenon is unknown. It has been suggested that a failure of insulin-mediated sympathetic nervous system activation plays a role. To evaluate the role of endogenous insulin, the effects of oral glucose and oral fructose loading on BP, heart rate and norepinephrine levels were studied in 10 young normotensive volunteers (YN), 10 young hypertensive patients (YH), 10 elderly normotensive volunteers (EN) and 10 elderly hypertensive patients (EH). Fructose, 75 g/300 ml of water, elicited--in contrast to the same amount of glucose--only a small increase in insulin and glucose levels. After glucose loading, mean arterial BP decreased by 17 mm Hg in the EH group (p less than 0.001), 6 mm Hg in the EN group (p less than 0.01) and 7 mm Hg in the YH group (p less than 0.001), and did not change in the YN group. After oral fructose loading, BP did not change in any group. In all groups except the YN group, the increases in norepinephrine level and heart rate after both tests were not significantly different. These findings suggest that the BP reduction after glucose loading is related to glucose-mediated factors. A failure of insulin-mediated sympathetic nervous system activation does not appear to play a major role.

The Influence of Age and Blood Pressure on the Hemodynamic and Humoral Response to Head-Up Tilt

Objective: To enhance insight into the process of occupational therapy (OT) and the changes after OT, in an older patient with mild dementia and his primary caregiver. Design and setting: Case study: content analysis of an OT patient record. Intervention: System-based OT at home using a guideline focusing on both patients performance in daily activities and caregivers cognition on patient behaviour and caregiver role and focusing on adaptation of the physical environment. Measures: Triangulation of results of qualitative content analysis and quantitative description using the following measures: Brief Cognitive Rating Scale (BCRS), Assessment of Motor and Process Skills (AMPS), Interview of Deterioration in Daily Activities in Dementia (IDDD), Canadian Occupational Performance Measurement (COPM), Dementia Quality of Life Instrument (DQOL), Sense of Competence Scale (SCQ) and the Mastery Scale. Results: The global categories derived from content analysis were: daily performance and communication. The specific categories were the patient with dementia, his or her caregiver and the occupational therapist. Important themes derived from content analysis were: patients capacity for pleasure, autonomy and appreciation in performing daily activities and caregivers competence. Patients changes reported after OT: more initiative, autonomy and pleasure in performing daily activities, increase of quality of life; caregivers changes reported after OT: improved communication and supervision skills, changed cognition on patient behaviour and caregiver role, improved sense of competence. The quantitative results showed an improved daily performance (e.g. initiative, motor and process skills, need for assistance) and quality of life of the patient and improved sense of competence, quality of life and mastery of the situation of the caregiver after OT intervention. Thus the results of the qualitative content analysis were supported by the quantitative results. Additionally, based on the results of the content analysis an exploratory and system-based model has been developed connecting OT diagnosis and OT treatment at home for patients with dementia and their primary caregivers. Conclusion: This case study provides information on how occupational therapy can improve the daily performance, communication, sense of competence and quality of life of an older patient with dementia and his or her primary caregiver. A combination of education, setting feasible goals, using adaptations in physical environment, training compensatory skills, training supervision skills, and changing dysfunctional cognitions on patient behaviour and caregiver role seemed to be successful. A randomized controlled trial must provide information on the effects of OT at home for older patients with dementia and their primary caregivers.

The Influence of Food Temperature on Postprandial Blood Pressure Reduction and Its Relation to Substance-P in Healthy Elderly Subjects

OBJECTIVES: Multi‐Frequency Bioelectrical Impedance Analysis (MFBIA) is a quick, simple, and inexpensive method to assess body fluid compartments. This study aimed at determining the validity of MFBIA in detecting clinically relevant changes of fluid balance in geriatric patients.