Background: It is not understood why some patients with Alzheimer disease (AD) display aggression and others do not. Objective: To examine the relation betwee n regional brain perfusion and aggression in AD. Design: S...Background: It is not understood why some patients with Alzheimer disease (AD) display aggression and others do not. Objective: To examine the relation betwee n regional brain perfusion and aggression in AD. Design: Single photon emission computed tomographic scans were coregistered to a standardized template in Tala irach space, generating mean ratios of up take referenced to the cerebellum. Pa rticipants: Forty nine outpatients (25 men and 24 women; mean±SD age, 74±11 y ears) with probable AD (Mini Mental State Examination score, 17.7±5.0; 30 aggr essive and 19 nonaggressive), comparable in age, sex, and severity of cognitive impairment. Main Outcome Measures: Regional perfusion ratios were determined for 5 bilateral regions of interest: orbitofrontal, middle medial temporal, inferio r medial temporal, hypothalamus/thalamus, and anterior cingulate. Results: Compa red with nonaggressive patients, aggressive ones displayed hypoperfusion in the right and left middle medial temporal regions of interest (P=.02 for both), but not the others (all t tests, unpaired, 2 tailed). On regression analyses, right middle temporal hypoper fusion (P=.001), younger age (P=.002), greater activit y disturbances (P=.004), and higher Mini Mental State Examination scores (P=.04 ) independently predicted aggression, accounting for 44%of the total variance ( F=8.7; P<.001). Statistical parametric mapping analyses supported right middle m edial temporal hypoperfusion in the aggressive group (P=.008). Conclusion: In th is sample of patients with AD, the right middle medial temporal region emerged a s an important neural correlate of aggression.展开更多
Objectives: To quantify and compare potential benefits (subjective reports of sleep variables) and risks (adverse events and morning-after psychomotor impairment) of short term treatment with sedative hypnotics in old...Objectives: To quantify and compare potential benefits (subjective reports of sleep variables) and risks (adverse events and morning-after psychomotor impairment) of short term treatment with sedative hypnotics in older people with insomnia. Data sources: Medline, Embase, the Cochrane clinical trials database, PubMed, and PsychLit, 1966 to 2003; bibliographies of published reviews and meta-analy- ses; manufacturers of newer sedative hypnotics (zaleplon, zolpidem, zopiclone) regarding unpublished studies. Selection criteria: Randomised controlled trials of any pharmacological treatment for insomnia for at least five consecutive nights in people aged 60 or over with insomnia and otherwise free of psychiatric or psychological disorders. Results: 24 studies (involving 2417 participants) with extractable data met inclusion and exclusion criteria. Sleep quality improved (effect size 0.14, P < 0.05), total sleep time increased (mean 25.2 minutes, P < 0.001), and the number of night time awakenings decreased (0.63, P < 0.001) with sedative use compared with placebo. Adverse events were more common with sedatives than with placebo: adverse cognitive events were 4.78 times more common (95%confidence interval 1.47 to 15.47, P < 0.01); adverse psychomotor events were 2.61 times more common (1.12 to 6.09, P >0.05), and reports of daytime fatigue were 3.82 times more common (1.88 to 7.80, P < 0.001) in people using any sedative compared with placebo. Conclusions: Improvements in sleep with sedative use are statistically significant, but the magnitude of effect is small. The increased risk of adverse events is statistically significant and potentially clinically relevant in older people at risk of falls and cognitive impairment. In people over 60, the benefits of these drugs may not justify the increased risk, particularly if the patient has additional risk factors for cognitive or psychomotor adverse events.展开更多
文摘Background: It is not understood why some patients with Alzheimer disease (AD) display aggression and others do not. Objective: To examine the relation betwee n regional brain perfusion and aggression in AD. Design: Single photon emission computed tomographic scans were coregistered to a standardized template in Tala irach space, generating mean ratios of up take referenced to the cerebellum. Pa rticipants: Forty nine outpatients (25 men and 24 women; mean±SD age, 74±11 y ears) with probable AD (Mini Mental State Examination score, 17.7±5.0; 30 aggr essive and 19 nonaggressive), comparable in age, sex, and severity of cognitive impairment. Main Outcome Measures: Regional perfusion ratios were determined for 5 bilateral regions of interest: orbitofrontal, middle medial temporal, inferio r medial temporal, hypothalamus/thalamus, and anterior cingulate. Results: Compa red with nonaggressive patients, aggressive ones displayed hypoperfusion in the right and left middle medial temporal regions of interest (P=.02 for both), but not the others (all t tests, unpaired, 2 tailed). On regression analyses, right middle temporal hypoper fusion (P=.001), younger age (P=.002), greater activit y disturbances (P=.004), and higher Mini Mental State Examination scores (P=.04 ) independently predicted aggression, accounting for 44%of the total variance ( F=8.7; P<.001). Statistical parametric mapping analyses supported right middle m edial temporal hypoperfusion in the aggressive group (P=.008). Conclusion: In th is sample of patients with AD, the right middle medial temporal region emerged a s an important neural correlate of aggression.
文摘Objectives: To quantify and compare potential benefits (subjective reports of sleep variables) and risks (adverse events and morning-after psychomotor impairment) of short term treatment with sedative hypnotics in older people with insomnia. Data sources: Medline, Embase, the Cochrane clinical trials database, PubMed, and PsychLit, 1966 to 2003; bibliographies of published reviews and meta-analy- ses; manufacturers of newer sedative hypnotics (zaleplon, zolpidem, zopiclone) regarding unpublished studies. Selection criteria: Randomised controlled trials of any pharmacological treatment for insomnia for at least five consecutive nights in people aged 60 or over with insomnia and otherwise free of psychiatric or psychological disorders. Results: 24 studies (involving 2417 participants) with extractable data met inclusion and exclusion criteria. Sleep quality improved (effect size 0.14, P < 0.05), total sleep time increased (mean 25.2 minutes, P < 0.001), and the number of night time awakenings decreased (0.63, P < 0.001) with sedative use compared with placebo. Adverse events were more common with sedatives than with placebo: adverse cognitive events were 4.78 times more common (95%confidence interval 1.47 to 15.47, P < 0.01); adverse psychomotor events were 2.61 times more common (1.12 to 6.09, P >0.05), and reports of daytime fatigue were 3.82 times more common (1.88 to 7.80, P < 0.001) in people using any sedative compared with placebo. Conclusions: Improvements in sleep with sedative use are statistically significant, but the magnitude of effect is small. The increased risk of adverse events is statistically significant and potentially clinically relevant in older people at risk of falls and cognitive impairment. In people over 60, the benefits of these drugs may not justify the increased risk, particularly if the patient has additional risk factors for cognitive or psychomotor adverse events.
