Tyrosine hydroxylase and norepinephrine transporter mRNA expression in the locus coeruleus in Alzheimer's disease.

Despite the loss of locus coeruleus (LC) noradrenergic neurons in Alzheimer's disease (AD), cerebrospinal fluid norepinephrine (NE) levels are normal or increased in AD. This paradox suggests compensatory upregulation of NE synthetic capacity or downregulation of the NE transporter (NET) in the remaining LC neurons. LC tyrosine hydroxylase (TH) mRNA expression in the LC was measured in AD subjects (n=5) and in age and gender comparable non-demented subjects (n=6). When AD subjects were divided into those still ambulatory prior to death (CDR 3/4) and those in a prolonged 'vegetative' state prior to death (CDR 5), differences among groups became apparent at specific levels of the LC. In CDR 3/4 AD subjects there was increased TH mRNA expression per neuron compared to non-demented subjects in the caudal half of the LC. However, expression of NET mRNA in the same subjects was not significantly different at any level of the LC. These preliminary results suggest an upregulation of NE biosynthetic capacity in at least some LC neurons in AD prior to the very late stage of the disease.

Advance directive preferences among subpopulations of Asian nursing home residents in the Pacific Northwest.

OBJECTIVE: To study advance directives (code status) among subgroups of Asian nursing home residents. DESIGN: Cross-sectional design. PARTICIPANTS AND SETTING: A total of 423 residents of Asian descent (aged >55) from two ethnic nursing homes in Seattle, Washington. METHODS: Chart review was conducted on 423 residents (199 discharged between 1995 and 1998 and 244 current residents) to ascertain code status, age, gender, ethnicity, comorbidity (using the Charlson Index), and religion. RESULTS: Seventy percent of the residents were women, median age was 83 +/- 9, 43% were Chinese, 40% Japanese, and 17% other Asian (Korean, Filipino, Southeast Asian). The majority of the patients in any subgroup (72% overall) were 'no code'. In bivariate analysis, ethnicity, increased age, and comorbidity were correlated with no code status. In multivariable logistic regression, Japanese residents were more likely to be no code (OR 4.1 (95% CI, 3.1- 5.4)) controlling for age, comorbidity, gender, and religion. Chinese were more likely to be full code (OR 3.3 (95% CI, 2.6-4.2)). CONCLUSIONS: Code status differs significantly among Asian subgroups in these ethnic nursing homes. Whereas the majority of residents are no code, Japanese residents are more likely than Chinese or others to be no code. Higher age and comorbidity are also correlated with no code status.

The Memorial Symptom Assessment Scale: an instrument for the evaluation of symptom prevalence, characteristics and distress.

The Memorial Symptom Assessment Scale (MSAS) is a new patient-rated instrument that was developed to provide multidimensional information about a diverse group of common symptoms. This study evaluated the reliability and validity of the MSAS in the cancer population. Randomly selected inpatients and outpatients (n = 246) with prostate, colon, breast or ovarian cancer were assessed using the MSAS and a battery of measures that independently evaluate phenomena related to quality of life. Symptom prevalence in the 218 evaluable patients ranged from 73.9% for lack of energy to 10.6% for difficulty swallowing. Based on a content analysis, three symptoms were deleted and two were added; the revised scale evaluates 32 physical and psychological symptoms. A factor analysis of variance yielded two factors that distinguished three major symptom groups and several subgroups. The major groups comprised psychological symptoms (PSYCH), high prevalence physical symptoms (PHYS H), and low prevalence physical symptoms (PHYS L). Internal consistency was high in the PHYS H and PSYCH groups (Cronback alpha coefficients of 0.88 and 0.83, respectively), and moderate in the PHYS L group (alpha = 0.58). Although the severity, frequency and distress dimensions were highly intercorrelated, canonical correlations and other analyses demonstrated that multidimensional assessment (frequency and distress) augments information about the impact of symptoms. High correlations with clinical status and quality of life measures support the validity of the MSAS and indicate the utility of several subscale scores, including PSYCH, PHYS, and a brief Global Distress Index. The MSAS is a reliable and valid instrument for the assessment of symptom prevalence, characteristics and distress. It provides a method for comprehensive symptom assessment that may be useful when information about symptoms is desirable, such as clinical trials that incorporate quality of life measures or studies of symptom epidemiology.

Nicotinic and muscarinic agonists stimulate rapid protein kinase C translocation in PC12 cells.

Phosphoinositide hydrolysis, a major mechanism for signal transduction in neural cells, generates diacylglycerol, which can in turn activate protein kinase C (PKC). Although cholinergic agonists elicit phosphoinositide hydrolysis in neural tissues, little is known about activation of PKC by cholinergic agonists. PKC requires phosphatidylserine for activation, and in intact cells this lipid requirement is satisfied by binding of the enzyme to cell membranes. Therefore, in intact cells, activation of PKC is often associated with a decrease in cytosolic PKC activity accompanied by an increase in membrane-associated activity. We studied cholinergic-induced activation of PKC by examining changes in the subcellular distribution of the enzyme in PC12 cells treated with cholinergic drugs. Carbachol (1 mM) induced large and rapid increases in membrane-associated PKC activity; a maximal increase of 460% occurred after 5 sec of incubation. Carbachol-induced PKC translocation was concentration-dependent, with a biphasic dose-response curve yielding approximate EC50 values of 10(-6) M and 10(-4) M for the high- and low-affinity components, respectively. Experiments with selective cholinergic agents demonstrated that both muscarinic and nicotinic receptors are involved in carbachol-induced PKC translocation, but the response is predominantly mediated by nicotinic receptor stimulation. Muscarinic-induced association of PKC with cell membrane fractions was resistant to extraction by chelators, whereas nicotinic-mediated membrane binding was partially reduced by homogenization of cells in the presence of EGTA. Omission of calcium from the incubation medium or chelation of calcium with EGTA completely blocked muscarinic- and nicotinic-induced translocation. In addition, the calcium channel blocker nifedipine reduced the nicotinic response by 60%. (ABSTRACT TRUNCATED AT 250 WORDS)