RESUMEN
The Behavioral Pathology in Alzheimer's Disease Rating Scale (BEHAVE-AD) is a well-established instrument, designed to assess potentially remediable behavioral symptoms in Alzheimer's disease (AD) patients as well as to evaluate treatment outcome. It consists of 25 symptoms grouped into seven categories. Each symptom is scored on the basis of severity on a four-point scale. A knowledgeable caregiver is queried and items are scored on the basis of symptoms noted in the preceding two weeks. Reliability, construct validity and criterion validity data for the BEHAVE-AD have previously been published. Because of the significance of psychopathology in dementia, it is necessary to optimally describe and define the nature, magnitude and prevalence of behavioral symptomatology. Accordingly, a frequency component was added to each of the 25 items of the BEHAVE-AD scale. The objective of the present report is to describe this new Behavioral Pathology in Alzheimer's Disease Frequency-Weighted Severity Scale (BEHAVE-AD-FW) and to establish its inter-rater reliability. In this investigation the BEHAVE-AD-FW scale was administered to caregivers of 28 patients with either mildly impaired cognitive function or a dementia diagnosis. Two clinicians separately and independently rated the responses. Analyses determined that the intraclass correlation coefficients (ICCs) for the frequency component varied between 0.86 and 0.97 for each of the seven BEHAVE-AD categories (p(s) < 0.001). ICCs for the frequency-weighted scores (item severity score x item frequency score) ranged from 0.69 to 0.98 for the seven symptom categories (p(s) < 0.001). For the BEHAVE-AD-FW total scores, the ICC was 0.91 (P < 0.001). These results indicate that the frequency-weighted component is a reliable addition to the BEHAVE-AD scale.
Asunto(s)
Enfermedad de Alzheimer/psicología , Trastornos Mentales/etiología , Encuestas y Cuestionarios , Anciano , Enfermedad de Alzheimer/diagnóstico , Atrofia/patología , Femenino , Humanos , Masculino , Trastornos Mentales/diagnóstico , Pruebas Neuropsicológicas , Reproducibilidad de los Resultados , Índice de Severidad de la Enfermedad , Lóbulo Temporal/patologíaRESUMEN
BACKGROUND: Intestinal fructose transport rates or GLUT5 mRNA levels typically show a two- to threefold increase after weaning in rats allowed to wean normally but can be enhanced precociously by high-fructose diets during early weaning. Developmental increases in serum thyroxine levels coincide with the onset of weaning and have been linked to changes in intestinal sucrase and lactase activities. METHODS: Rat pups were made hypothyroid by giving the dam 0.01% propylthiouracil as drinking water from day 18 of gestation. The hypothyroid pups and age-matched euthyroid control pups were then fed high-fructose or high-glucose solutions by gavage, twice a day starting at 17 days of age for 3 days, and then killed at 20 days of age. RESULTS: Serum thyroxine levels were five times lower in the hypothyroid pups. Rates of intestinal fructose uptake in the proximal and middle small intestine were 2.0 to 2.5 times higher in the hypothyroid and euthyroid pups fed high-fructose solution than in littermates fed high-glucose solution or those allowed to wean normally with the dam. Intestinal glucose uptake also increased in hypothyroid but not in euthyroid pups fed high-fructose or high-glucose solutions. GLUT5 mRNA levels increased in euthyroid and hypothyroid pups fed high fructose and paralleled the increase in fructose uptake. CONCLUSION: During weaning, dietary fructose can precociously enhance intestinal fructose uptake and GLUT5 mRNA expression, independent of developmental increases in serum thyroxine levels. Modest changes in glucose transport rates indicate that nonspecific mechanisms may provide a minor contribution to diet-induced changes in nutrient absorption in hypothyroid pups.
Asunto(s)
Dieta , Fructosa/metabolismo , Hipotiroidismo/metabolismo , Mucosa Intestinal/metabolismo , Proteínas de Transporte de Monosacáridos/genética , ARN Mensajero/metabolismo , Animales , Transporte Biológico , Northern Blotting , Peso Corporal , Femenino , Fructosa/administración & dosificación , Glucosa/administración & dosificación , Glucosa/metabolismo , Transportador de Glucosa de Tipo 5 , Hipotiroidismo/inducido químicamente , Intestinos/anatomía & histología , Tamaño de los Órganos , Propiltiouracilo , Ratas , Ratas Sprague-Dawley , Soluciones , Tiroxina/sangreRESUMEN
BACKGROUND: In order to evaluate the puberal development of girls treated by Acute Lymphocytic Leukaemia (ALL) a retrospective study was done at Campinas-SP, Brazil. MATERIAL AND METHODS: Forty two girls were treated by ALL with either 18 or 24 Grays of cranial irradiation. All patients were treated with chemotherapy including intrathecal methotrexate in similar dose regimens in either groups. RESULTS: The results showed lower mean ages at telarche, pubarche and menarche in the treated group, mainly in the group treated before five years old. No differences were observed in the 18 Grays or 24 Grays group. CONCLUSIONS: Our data suggest that girls treated by ALL have a precocious puberal development.
Asunto(s)
Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamiento farmacológico , Leucemia-Linfoma Linfoblástico de Células Precursoras/radioterapia , Pubertad/efectos de los fármacos , Pubertad/efectos de la radiación , Adolescente , Factores de Edad , Niño , Preescolar , Femenino , Humanos , Modelos Lineales , Estudios RetrospectivosRESUMEN
Objetivo. Com o objetivo de avaliar o desenvolvimento puberal após o tratamento de leucemia linfóide aguda (LLA) na infância, foi realizado um estudo retrospectivo, em meninas tratadas de janeiro de 1980 a janeiro de 1991, no Centro de Investigaçoes Hematológicas "Dr. Domingos A. Boldrini", em Campinas-SP. Casuística e Método. Foram selecionadas 42 meninas, tratadas antes da puberdade com quimioterapia sistêmica e intratecal e radioterapia cranial, utilizando doses de 18 a 24 Grays (Gy). Resultados. As idades médias da telarca, pubarca e menarca foram inferiores às do grupo-controle, embora com significância estatística apenas para a idade da telarca. Nao houve diferenças entre os grupos tratados com 18 ou 24Gy. As meninas tratadas antes dos cinco anos de idade apresentaram idade média da menarca estatisticamente inferior àquelas tratadas após cinco anos e em relaçao ao grupo-controle. Conclusao. Os resultados mostraram que o desenvolvimento puberbal em meninas tratadas de LLA na infância foi mais precoce que o de mininas saudáveis.
Asunto(s)
Preescolar , Niño , Femenino , Humanos , Adolescente , Pubertad/efectos de los fármacos , Pubertad/efectos de la radiación , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamiento farmacológico , Leucemia-Linfoma Linfoblástico de Células Precursoras/radioterapia , Modelos Lineales , Estudios Retrospectivos , Factores de EdadRESUMEN
We investigated the reliability, using a telephone interview procedure, of cognitive, functional, and behavioral scales in an elderly population with normal aging and dementia. Two clinicians performed the assessments: one performed the assessments in a telephone interview format and the other conducted the assessments at the clinic. The telephone interview always preceded the clinic evaluation (2-30 days apart), and both clinicians were blind to any previous evaluations of the patient. The intraclass correlation coefficients between the telephone interview and the ratings obtained by a different clinician on the clinic evaluation varied between 0.92 and 0.98 (P's < or = .001) for comprehensive test scores. These results indicate that a telephone interview format, although not a substitute for a face-to-face diagnostic evaluation, is a reliable procedure for obtaining the assessment modalities studied. These findings are particularly important in aged and dementia research populations where personal contact may not always be feasible.
Asunto(s)
Enfermedad de Alzheimer/diagnóstico , Trastornos del Conocimiento/diagnóstico , Evaluación Geriátrica , Entrevista Psicológica/normas , Consulta Remota/normas , Anciano , Métodos Epidemiológicos , Femenino , Humanos , Entrevista Psicológica/métodos , Masculino , Pruebas Neuropsicológicas/normas , Variaciones Dependientes del Observador , Escalas de Valoración Psiquiátrica/normas , Reproducibilidad de los Resultados , Índice de Severidad de la EnfermedadRESUMEN
BACKGROUND: The treatment of the acute lymphocytic leukaemia can determine impaired growth. SUBJECTS AND METHOD: All the patients had length measurements at the time of the beginning of the treatment and, at least, one year after the end of it. CONCLUSIONS: There was impaired growth after the treatment according to the dose regimens (18 or 24 Grays). No relation was observed related to the age at the diagnosis.
Asunto(s)
Irradiación Craneana/efectos adversos , Crecimiento/efectos de la radiación , Leucemia-Linfoma Linfoblástico de Células Precursoras/radioterapia , Factores de Edad , Estatura/efectos de la radiación , Niño , Preescolar , Femenino , Humanos , Lactante , Estudios RetrospectivosRESUMEN
Objetivo. Determinar alteraçoes no crescimento após o tratamento de leucemia linfóide aguda em meninas. Pacientes e Métodos. Realizou-se estudo restrospectivo com 59 meninas que apresentavam medidas de estatura antes e com no mínimo um ano do tratamento, subdivididas de acordo com a dose de radioterapia cranial utilizada [18 ou 24 Grays Gy] e com a idade no início do tratamento (antes e após os cinco anos de idade). Resultados. Observou-se deficiência do crescimento com um, dois e mais de dois anos do tratamento. O crescimento foi mais afetado no grupo tratado com 24Gy, quando comparado com 18Gy. Nao houve diferenças com relaçao à idade no início do tratamento. Conclusoes. Houve retardo no crescimento após o tratamento, independentemente da idade em que foi realizado, mas dependente da dose de radioterapia cranial utilizada.
Asunto(s)
Niño , Preescolar , Lactante , Femenino , Humanos , Irradiación Craneana/efectos adversos , Leucemia-Linfoma Linfoblástico de Células Precursoras/radioterapia , Crecimiento/efectos de la radiación , Estatura/efectos de la radiación , Estudios Retrospectivos , Factores de EdadRESUMEN
Intestinal fructose transport typically increases 3-fold after completion of weaning (> 28 d of age) in rats allowed to wean normally. Precocious enhancement of fructose transport has been demonstrated in rats fed high fructose diets during early weaning. To determine the role of corticosterone in the enhancement of fructose uptake by diet, we fed 17-d-old rat pups, previously adrenalectomized or sham-operated at 10 d of age, high (65%) fructose or fructose-free diets for 3 d. Corticosterone levels in 20-d-old sham-operated and unoperated controls were 2.2-3.3-fold higher than those in adrenalectomized littermates and in unoperated 10-d-old pups. Fructose uptake per mg and per cm were each 2.0-2.5-fold higher in adrenalectomized and sham-operated pups fed high fructose diets compared with those in adrenalectomized and sham-operated littermates fed fructose-free diets or to those in unoperated littermates allowed to wean normally with the dam. An increase in levels of GLUT5 mRNA in pups fed high fructose diets paralleled the increase in rates of fructose uptake. Intestinal glucose uptake was independent of corticosterone levels and of diet. Thus, the corticosterone surge is not necessary for the precocious enhancement of intestinal fructose transport and of GLUT5 mRNA expression by dietary fructose during weaning.
Asunto(s)
Glándulas Suprarrenales/fisiología , Carbohidratos de la Dieta/farmacocinética , Fructosa/farmacocinética , Mucosa Intestinal/metabolismo , Adrenalectomía , Animales , Transporte Biológico , Corticosterona/metabolismo , Carbohidratos de la Dieta/administración & dosificación , Fructosa/administración & dosificación , Glucosa/metabolismo , Transportador de Glucosa de Tipo 5 , Proteínas de Transporte de Monosacáridos/genética , ARN Mensajero/biosíntesis , Ratas , Ratas Sprague-Dawley , Tasa de Secreción , Factores de Tiempo , DesteteAsunto(s)
Enfermedad de Alzheimer/diagnóstico , Pruebas Neuropsicológicas/estadística & datos numéricos , Determinación de la Personalidad/estadística & datos numéricos , Trastorno de la Conducta Social/diagnóstico , Anciano , Enfermedad de Alzheimer/clasificación , Enfermedad de Alzheimer/psicología , Humanos , Psicometría , Reproducibilidad de los Resultados , Trastorno de la Conducta Social/clasificación , Trastorno de la Conducta Social/psicologíaAsunto(s)
Enfermedad de Alzheimer/tratamiento farmacológico , Antipsicóticos/uso terapéutico , Demencia/tratamiento farmacológico , Trastornos Neurocognitivos/tratamiento farmacológico , Inhibidores Selectivos de la Recaptación de Serotonina/uso terapéutico , Trastorno de la Conducta Social/tratamiento farmacológico , Anciano , Enfermedad de Alzheimer/diagnóstico , Enfermedad de Alzheimer/psicología , Atención Ambulatoria , Antipsicóticos/efectos adversos , Demencia/diagnóstico , Demencia/psicología , Método Doble Ciego , Femenino , Fluoxetina/efectos adversos , Fluoxetina/uso terapéutico , Estudios de Seguimiento , Evaluación Geriátrica , Haloperidol/efectos adversos , Haloperidol/uso terapéutico , Humanos , Masculino , Trastornos Neurocognitivos/diagnóstico , Trastornos Neurocognitivos/psicología , Escalas de Valoración Psiquiátrica , Inhibidores Selectivos de la Recaptación de Serotonina/efectos adversos , Trastorno de la Conducta Social/diagnóstico , Trastorno de la Conducta Social/psicología , Tioridazina/efectos adversos , Tioridazina/uso terapéuticoRESUMEN
A clinician should not rely entirely upon a caregiver's report regarding behavioral pathology when planning a treatment strategy. Direct observational evaluation instruments as well as caregiver-based assessments are necessary. A new scale for the empirical (observational) evaluation of behavioral symptoms in Alzheimer's disease (AD) and related dementias, the Empirical Behavioral Pathology in Alzheimer's Disease Rating Scale (E-BEHAVE-AD) was developed. Interrater reliability of this new assessment instrument was examined. Additionally, the relationship between the observed occurrence of behavioral symptomatology on this new rating instrument was compared with the occurrence using a similarly designed, caregiver-based instrument. The interrater reliability study consisted of two raters who simultaneously evaluated 20 dementia patients. The comparative study employed a cross-sectional design (N = 49). Individuals were evaluated in an outpatient clinic setting. The study population consisted of cognitively normal individuals and dementia patients. Evaluations included the new, observationally based behavioral assessment (the E-BEHAVE-AD), a caregiver-based behavioral assessment (the Behavioral Pathology in Alzheimer's Disease Rating Scale; BEHAVE-AD), a clinical global measure (the Global Deterioration Scale), and a mental status assessment (the Mini-Mental State Examination). The interrater reliability study revealed an intraclass correlation coefficient of .97 (p < .01) for total scores on the new E-BEHAVE-AD rating scale. The correlation coefficient for the amount of agreement on the presence of symptoms in six symptomatic categories between caregiver-based information about the patient's behavioral pathology assessed on the BEHAVE-AD and the clinician's observations assessed with the new E-BEHAVE-AD rating instrument was .51 (p < .01). The new E-BEHAVE-AD rating instrument showed excellent interrater reliability. Furthermore, there was a statistically significant relationship between clinician observation of the occurrence of behavioral pathology assessed using the E-BEHAVE-AD and caregiver-reported pathology assessed with the BEHAVE-AD. However, the magnitude of the correlation between these measures indicated that the majority of variance was independent and nonoverlapping. Consequently, these data support theoretical models suggesting that the assessment of behavioral pathology in dementia might ideally encompass both direct observational and caregiver-report approaches, using measures such as the E-BEHAVE-AD as well as measures such as the BEHAVE-AD.