Does aspirin affect outcome in vascular dementia? A retrospective case-notes analysis.

BACKGROUND: Ischaemic vascular dementia shares risk factors with stroke. There is evidence that control of these risk factors may prevent or alter the course of vascular dementia. OBJECTIVE: To assess the effect of regular low-dose aspirin on outcomes for patients with vascular dementia. DESIGN: Retrospective analysis of hospital case-notes with further outcome information from telephone calls to general practitioners, social services and institutions. Comparison of outcomes for aspirin-treated and untreated patients. SETTING: One North London NHS Trust. PATIENTS: Seventy-eight patients with clinician's diagnosis of ischaemic vascular dementia, discharged from acute inpatient units between 1 January 1995 and 31 December 1997; 38 on aspirin. MAIN OUTCOME MEASURES: Survival times from dementia onset to institutionalization and death. RESULTS: Median survival time to institutionalization was 28 months and to death was 52 months. There was no overall difference between aspirin and non-aspirin groups for these outcomes. When data were stratified for social status, i.e. living alone or with carer when last at home, differences emerged for those living with carer. Aspirin was associated with a trend towards increased time to institutionalization (39 vs 22 months, p < 0.09) and a significant advantage in time to death (71 vs 27 months, p = 0.02). These effects were non-significant after statistical adjustment for confounding variables. CONCLUSIONS: The results support but do not prove a role for regular, low-dose aspirin in improving both life expectancy and survival at home for patients with vascular dementia. Compliance may be better in those living with a carer. Larger, prospective studies should be performed to confirm these findings. Cognitive and behavioural outcomes should also be studied.

Variation in the DCP1 gene, encoding the angiotensin converting enzyme ACE, is not associated with increased susceptibility to Alzheimer's disease.

OBJECTIVES: To attempt to replicate previous reports that polymorphic variation in the DCP1 gene causes increased susceptibility to the development of Alzheimer's disease, either on its own or in interaction with the effects of the gene for apolipoprotein E (APOE). METHOD: Subjects older than 65 years of age consisting of 81 dementia patients diagnosed as having possible or probable Alzheimer's disease and 68 controls were obtained from Camden, Islington and Harlow psychiatric services. Subjects were genotyped for APOE alleles e2, e3 and e4, and the common insertion/deletion polymorphisms for DCP1* I/D were genotyped. RESULTS: There was no statistically significant difference in the frequency of the DCP1* insertion/deletion alleles between the cases and controls (X2 =0.04, 1 degree of freedom, not significant). When subjects were subdivided according to whether they possessed at least one copy of the APOE e4 allele, there were still no differences in DCP1 allele frequencies between cases and controls. CONCLUSIONS: Further research is needed to elucidate any role that the DCP1 polymorphism may play in relation to Alzheimer's disease. Previous studies may be false positive, or inconsistency in replication may be due to heterogeneity.

Aspirin for vascular dementia.

BACKGROUND: For patients with a diagnosis of vascular dementia there is evidence that aspirin is widely prescribed - in one study, completed by geriatricians and psychiatrists in the UK, 80% of patients with cognitive impairment (with vascular risk factors) were prescribed aspirin. However, a number of queries remain unanswered: Is there convincing evidence that aspirin benefits patients with vascular dementia? Does aspirin affect cognition or improve prognosis? In addition, does the risk of cerebral or gastric haemorrhage outweigh any benefit? OBJECTIVES: To assess the evidence of effectiveness of the use of aspirin for vascular dementia. SEARCH STRATEGY: Computerized databases were searched independently by two reviewers. In addition, relevant websites were searched and some journals were handsearched. Specialists in the field were approached for unpublished material and any publications found were searched for additional references. The most recent search for trials was carried out in February 2000. SELECTION CRITERIA: All randomized controlled trials investigating the effect of aspirin for vascular dementia are included. Inclusion/exclusion of studies comprised systematic assessment of the quality of study design and the risk of bias. DATA COLLECTION AND ANALYSIS: Data were extracted independently by both reviewers, using a previously tested data extraction form and, where required, authors were contacted for data not provided in the papers. The aim is to evaluate data recorded via tools assessing cognitive and behavioural changes along with mortality, morbidity and institutionalization data. MAIN RESULTS: No trials are eligible for inclusion in this review. REVIEWER'S CONCLUSIONS: There is no evidence that aspirin is effective in treating patients with a diagnosis of vascular dementia. Further research is needed to assess the effect of aspirin on cognition, and on other outcomes such as behaviour, and quality of life. At present there is no evidence relating to other queries about the use of aspirin for dementia (these are described in the Background section of this review). The most recent search for references to relevant research was carried out in February 2000, but no new evidence was found.

Aspirin for vascular dementia.

BACKGROUND: For patients with a diagnosis of vascular dementia there is evidence that aspirin is widely prescribed - in one study, completed by geriatricians and psychiatrists in the UK, 80% of patients with cognitive impairment (with vascular risk factors) were prescribed aspirin. However, a number of queries remain unanswered: Is there convincing evidence that aspirin benefits patients with vascular dementia? Does aspirin affect cognition or improve prognosis? In addition, does the risk of cerebral or gastric haemorrhage outweigh any benefit? The aim of this review is to assess the evidence of effectiveness of aspirin in those with a diagnosis of vascular dementia. OBJECTIVES: To assess the evidence of effectiveness of the use of aspirin for vascular dementia. SEARCH STRATEGY: Computerised databases were searched independently by two reviewers. In addition, relevant websites were searched and some journals were handsearched. Specialists in the field were approached for unpublished material and also any publications found were searched for additional references. SELECTION CRITERIA: All randomised controlled trials investigating the effect of aspirin for vascular dementia are included. Inclusion/exclusion of studies comprised systematic assessment of the quality of study design and the risk of bias. DATA COLLECTION AND ANALYSIS: Data were extracted independently by both reviewers, using a previously tested data extraction form and, where required, authors were contacted for data not provided in the papers. The aim was to evaluate data recorded via tools assessing cognitive and behavioural changes along with mortality, morbidity and institutionalisation data. MAIN RESULTS: One randomised controlled trial ( approximately approximately Meyer 1989 approximately approximately ) was included, and yielded data for analysis on a total of 70 patients. The only relevant outcome assessed in this trial was cognition. Change in cognitive outcome was towards being in favour of treatment. REVIEWER'S CONCLUSIONS: There is very limited evidence that aspirin is effective in treating patients with a diagnosis of vascular dementia. Further research is needed to assess the effect of aspirin on cognition, and also on additional outcomes such as behaviour, and quality of life. At present it is not possible to provide evidence for other queries regarding the use of aspirin for dementia (these are described in the Background section of this review).

Psychiatric disorders after transurethral resection of the prostate.

Three men in their 70s had long-term changes in mood and personality dating from immediately after transurethral prostatectomy. Focal abnormalities in the brain were not detected. The possibility of psychiatric as well as cardiovascular sequelae from this operation deserves investigation.

Working people who also care for the elderly.

The workforce of a district health authority in south east England was surveyed using two successive postal questionnaires, to determine how many of them had outside work caring commitments to elderly persons. Details of the services and supports received by care receivers and caregivers were further analysed and ways in which worker-carers could be assisted by employers and work colleagues were explored. Fourteen per cent of this workforce had outside work commitments to caring for elderly people (17% of part-time workers and 12% of full-time workers). Worker-carers were usually female, older than non-carers, working part-time and earning low incomes. They tended to be caring for elderly female relatives, living close by, and approximately half were unaided by statutory or voluntary services. Worker-carers' support was mainly from family and friends. At work a supportive and accepting attitude from colleagues and line-managers was valued, as were part-time jobs and flexihours. Seventy-eight per cent of worker-carers wanted to continue with their dual roles. More attention, particularly within the work environment, needs to be paid to ways of supporting working people who also care for the elderly.

Aspects of health care in China.

I work in nurse education mainly running courses concerned with family planning and health screening, so my particular interest was to look at those services, and the training provided to staff. I wished to look both at the urban facilities but particularly the 'barefoot doctor' training and the services they provided in the rural areas. Within the factories I wanted to talk to staff to see if their service equated with our occupational health service.

PIP: China's population is increasing at a rate of 12 million/year and the population doubled from 1949 to 1982. By the end of the century there will be 1 billion 300 million people when the land resources can accommodate only 680 million inhabitants. The policy of 1 child aims only at curtailing this growth by a system of awards and penalties. Contraceptives are free and widely available. As a result there are 32 million single children, and there is concern about the future care of the elderly. Since 1949 health care has improved. The infant mortality rate decreased from 200/1000 in 1949 to 34/1000 in 1982. Average life expectancy rose from 35 to 68 years. There are 2 million hospital beds and over 4 million medical personnel. Contagious and infectious diseases were eliminated in the 1950s, however, 60 million Chinese suffer from endemic disease, especially from snail fever. 40 million women use IUDs. There are 144 medical schools with 144,000 students. 1,200,000 paramedics provide primary care in the communes. There is an acute shortage of nurses because of its lowly status. Dependents pay 50% of health care while it is free for workers. Health education campaigns are widespread (1 child only, stop smoking). The elderly are cared for by their children, but grandparents also take care of grandchildren. Retirement age is 55 or 60 depending on gender and type of work. Professional visits were made to the Beijing Traditional Chinese Medicine Hospital (gallstone treatment with herbs, heat-producing moxibustion for blood circulation), Norman Bethune Hospital, (suction and prostaglandins for abortion), Dongying Commune, Hebei Medical College (25 specialties for postgraduate students), Shandong Psychiatric Hospital in Jinan (treatment of acute psychoses, schizophrenia, or mania), the Provincial Hospital Jinan (cesarean operations are done with acupuncture anesthesia), Jinan School of Health (nursing curriculum demonstration), Shanghai First Social Welfare Home for the Elderly, and to several factories.

Size regulation in the mouse embryo. II. The development of half embryos.

The study describes an analysis of the development of mouse embryos halved at the 2-cell stage by the destruction of one blastomere, in comparison with control embryos of parallel derivation, at 2.5-13.5 days post coitum. The results showed that: (1) half embryos achieve size regulation some time between 7.5 and 10.5 days; (2) there is an indication that by 13.5 days half embryos may have again dropped back significantly in size relative to controls; (3) preregulation half embryos are slightly retarded developmentally, but this does not wholly account for their smaller size: morphogenesis is not size-dependent; (4) early postimplantation half embryos contain a significantly decreased proportion of inner cell mass derivatives and increased proportion of trophectoderm derivatives when compared with controls. A comparison is also made between the up-regulation of half embryos and the down-regulation of aggregate embryos, and it is suggested that size regulation may occur by delaying a change in the normal growth rate.

Size regulation in the mouse embryo. I. The development of quadruple aggregates.

The development of mouse embryos formed by the aggregation of four 8-cell-stage eggs was analysed in comparison with control single embryos. The analysis revealed that: Quadruple aggregates undergo size regulation over several days, starting before implantation and being completed by 6.5 days post coitum. The attainment of recognizable postimplantation morphological stages is independent of size. Regulation is not brought about by disproportionate alterations in the size of the internal cavities. Regulation in both inner cell mass (ICM) and trophectoderm derivatives is completed between 5.5 and 6.5 days post coitum. Despite the abnormal proportions of ICM and trophectoderm in quadruple blastocysts, the proportions of the tissues derived from them are already normal by 5.5 days. The possibility that down regulation in size of aggregate embryos occurs as a consequence of limited nutrient supply is discussed.

Cell allocation in half- and quadruple-sized preimplantation mouse embryos.

The size of preimplantation mouse embryos was experimentally manipulated in order to examine the consequences for the allocation of cells to the two primary tissues, trophectoderm and inner cell mass (ICM). Half embryos were produced by the mechanical lysis of one cell at the two-cell stage and quadruple embryos by the aggregation of four whole eight-cell embryos. Such procedures are shown not only to alter the absolute number of cells that are assigned to the trophectoderm and ICM, but also to disturb significantly the proportions of these two tissues in the blastocyst. The proportion of trophectoderm is directly related to the surface area of the morula, as is predicted by a purely epigenetic scheme for cell allocation.

Behavioural correlates of an experimental hippocampal epileptiform syndrome in rats.

Experiments are reported describing assessment of abnormal behaviour of rats in which a chronic epileptiform syndrome has been induced by the injection of tetanus toxin bilaterally into their hippocampi. The abnormal behaviour included hyper-reactivity to a novel environment, intermittent aggression on handling, and abnormally passive response to a strange rat introduced into their home cage. In animals with unilateral injection of toxin, electrical records from the hippocampi have been obtained. They illustrated bilaterally simultaneous discharges and also some independence between the two hippocampi. The discharges were accompanied by overt signs of complex partial seizures during the first few weeks of the syndrome but later occurred without motor signs. In this later stage the rats were somewhat resistant to the convulsant effects of pentylenetetrazol.