bluuebunny/crossref_metadata_2025 huggingface dataset:
Time-Dependent Changes in Atherosclerotic Plaque Composition in Patients Undergoing Carotid Surgery
Authors: van Lammeren Guus W. , den Ruijter Hester M. , Vrijenhoek Joyce E. P. , van der Laan Sander W. , Velema Evelyn , de Vries Jean-Paul P. M. , de Kleijn Dominique P. V. , Vink Aryan , de Borst Gert Jan , Moll Frans L. , Bots Michiel L. , Pasterkamp Gerard
Published: March 2014

Background—

Time-dependent trends in the incidence of cardiovascular disease have been reported in high-income countries. Because atherosclerosis underlies the majority of cardiovascular diseases, we investigated temporal changes in the composition of atherosclerotic plaques removed from patients undergoing carotid endarterectomy.

Methods and Results—

The Athero-Express study is an ongoing, longitudinal, vascular biobank study that includes the collection of atherosclerotic plaques of patients undergoing primary carotid endarterectomy in the province of Utrecht from 2002 to 2011. Histopathologic features of plaques of 1583 patients were analyzed in intervals of 2 years. The analysis included quantification of collagen, calcifications, lipid cores, plaque thrombosis, macrophages, smooth muscle cells, and microvessels. Large atheroma, plaque thrombosis, macrophages, and calcifications were less frequently observed over time, with adjusted odds ratios of 0.72 (95% confidence interval, 0.650-0.789), 0.62 (95% confidence interval, 0.569-0.679), 0.87 (95% confidence interval, 0.800-0.940), and 0.75 (95% confidence interval, 0.692-0.816) per 2-year increase in time, respectively. These changes in plaque characteristics were consistently observed in patient subgroups presenting with stroke, transient ischemic attack, ocular symptoms, and asymptomatic patients. Concomitantly, risk factor management and secondary prevention strategies among vascular patients scheduled for carotid endarterectomy significantly improved over the past decade.

Conclusions—

In conclusion, over the past decade, atherosclerotic plaques harvested during carotid endarterectomy show a time-dependent change in plaque composition characterized by a decrease in features currently believed to be causal for plaque instability. This appears to go hand in hand with improvements in risk factor management.
Activation of Cold-Sensing Transient Receptor Potential Melastatin Subtype 8 Antagonizes Vasoconstriction and Hypertension Through Attenuating RhoA/Rho Kinase Pathway
Authors: Sun Jing , Yang Tao , Wang Peijian , Ma Shuangtao , Zhu Zhenyu , Pu Yunfei , Li Li , Zhao Yu , Xiong Shiqiang , Liu Daoyan , Zhu Zhiming
Published: March 2014

Environmental cold is a nonmodifiable hypertension risk factor. Transient receptor potential melastatin subtype 8 (TRPM8) is a cold-sensing cation channel that can be activated by menthol, a compound with a naturally cold sensation in mint. Little is known about the effect of TRPM8 activation on vascular function and blood pressure. Here, we report that TRPM8 is abundantly expressed in the vasculature. TRPM8 activation by menthol attenuated vasoconstriction via RhoA/Rho kinase pathway inhibition in wild-type mice, but the effect was absent in TRPM8
−/−
mice. Chronic dietary menthol blunted mesenteric arterial constriction and lowered blood pressure in genetic hypertensive rats via inhibition of RhoA/Rho kinase expression and activity in the vivo study. TRPM8 effect was associated with inhibition of intracellular calcium release from the sarcoplasmic reticulum, RhoA/Rho kinase activity, and sustained arterial contraction in the vitro study. Importantly, 8-week chronic menthol capsule treatment moderately lowered systolic blood pressure and diastolic blood pressure in prehypertensive individuals compared with the placebo group. Furthermore, chronic menthol capsule administration also improved flow-mediated dilatation in prehypertensive individuals, but not in the placebo group. In conclusion, our study demonstrates that TRPM8 activation by menthol benefits vascular function and blood pressure by inhibiting calcium signaling–mediated RhoA/Rho kinase activation in the vasculature. These findings add to the evidence that long-term dietary menthol treatment had favorable effects on hypertension treatment.
Cardiovascular Risk With and Without Antihypertensive Drug Treatment in the Japanese General Population
Authors: Asayama Kei , Satoh Michihiro , Murakami Yoshitaka , Ohkubo Takayoshi , Nagasawa Sin-ya , Tsuji Ichiro , Nakayama Takeo , Okayama Akira , Miura Katsuyuki , Imai Yutaka , Ueshima Hirotsugu , Okamura Tomonori , Ueshima Hirotsugu , Okamura Tomonori , Imai Yutaka , Ohkubo Takayoshi , Irie Fujiko , Iso Hiroyasu , Kiyohara Yutaka , Miura Katsuyuki , Murakami Yoshitaka , Nakagawa Hideaki , Nakayama Takeo , Okayama Akira , Sairenchi Toshimi , Saitoh Shigeyuki , Sakata Kiyomi , Tamakoshi Akiko , Tsuji Ichiro , Yamada Michiko , Kitamura Akihiko , Miyamoto Yoshihiro
Published: March 2014

To evaluate the cardiovascular mortality risk in association with blood pressure level among people with and without antihypertensive treatment, we performed the participant-level meta-analysis that included 39 705 Japanese from 6 cohorts (58.4% women; mean age, 60.1 years; 20.4% treated). Multivariable-adjusted Cox models were used to analyze the risk of cardiovascular mortality and its subtypes among 6 blood pressure levels according to recent guidelines, optimal to Grade 3 hypertension, and the usage of antihypertensive medication at baseline. During median 10.0 years of follow-up, there were 2032 cardiovascular deaths (5.1 per 1000 person-years), of which 410 deaths were coronary heart disease, 371 were heart failure, and 903 deaths were stroke. Treated participants had significantly higher risk for cardiovascular mortality (hazard ratios, 1.50; 95% confidence intervals, 1.36–1.66), coronary heart disease (hazard ratios, 1.53; confidence intervals, 1.23–1.90), heart failure (hazard ratios, 1.39; confidence intervals, 1.09–1.76), and stroke (hazard ratios, 1.48; confidence intervals, 1.28–1.72) compared with untreated people. Among untreated participants, the risks increased linearly with an increment of blood pressure category (
P
≤0.011). The risk increments per blood pressure category were higher in young participants (<60 years; 22% to 79%) than those in old people (≥60 years; 7% to 15%) with significant interaction for total cardiovascular, heart failure, and stroke mortality (
P
≤0.026). Among treated participants, the significant linear association was also observed for cardiovascular mortality (
P
=0.0003), whereas no stepwise increase in stroke death was observed (
P
=0.19). The risks of cardiovascular mortality were ≈1.5-fold high in participants under antihypertensive medication. More attention should be paid to the residual cardiovascular risks in treated patients.
Detection of predator cues alters mating tactics in male wolf spiders
Authors: Wilgers Dustin J. , Wickwire Daniel , Hebets Eileen A.
Published: March 2014

Males of the wolf spider, Rabidosa punctulata, exhibit condition-dependent alternative mating tactics, whereby small, poor condition males engage in multimodal courtship while large, good condition males adopt a direct mount tactic that forgoes courtship. This study explores the possibility that tactic-specific costs can help explain this unintuitive pattern of mating tactic expression. Specifically, we hypothesize that courtship signaling is costly with respect to eavesdropping by predators and that males can alter their tactic expression based upon the perceived environmental predation risk. We test this by first examining the risk of predation associated with different mating tactics. We use a co-occurring predatory heterospecific, R. rabida as our predator. We found support for the prediction that courting R. punctulata males tended to be attacked more often than non-courting males, and the likelihood of being attacked was best predicted by courtship activity. Given this documented cost, we hypothesized that R. punctulata males would adjust their mating tactic based upon perceived predation risk. In a second experiment, we manipulated perceived predation risk by providing R. punctulata males with different female silk cues (conspecific; predatory heterospecific; conspecific + predatory heterospecific) and examined mating tactic expression. In support of our hypothesis, males were more likely to adopt the direct mount tactic in the presence of predatory heterospecific or mixed silk cues and were more likely to court in the presence of conspecific cues. These results support the hypothesis that the cost of predation from eavesdroppers may influence the evolution and expression of male alternative mating tactics in R. punctulata.
Chronic exposure to 17α-ethinylestradiol reduces behavioral consistency in male Siamese fighting fish
Authors: Dzieweczynski Teresa L. , Hentz Kimberly B. , Logan Brittney , Hebert Olivia L.
Published: March 2014

Both acute and chronic exposure to 17α-ethinylestradiol (EE2), one of the primary active ingredients of birth control pills, decreases courtship and aggression in males of aquatic species. However, how exposure affects behavioral consistency over time is not commonly addressed. To examine the effects of chronic EE2 exposure on behavioral consistency, adult male Siamese fighting fish, Betta splendens, received multiple trials with a dummy male and dummy female presented simultaneously both before and after chronic exposure to a nominal dose (10 ng/l) of EE2. The responses of exposed males were compared before and after exposure and against those of a group of unexposed, control males. Male-directed and female-directed behaviors were reduced after 28 days of EE2 exposure. More importantly, chronic EE2 exposure had dramatic effects on consistent individual differences in female-directed and male-directed behaviors. Repeatability values were markedly lower and level of response was less correlated in the EE2 group, suggesting that exposure disrupts both between-individual variation and behavioral consistency. These results cannot be explained by a temporal effect as they were not found in the control group of unexposed males. This study demonstrates that EE2 exposure may have effects beyond a reduction in overall response. It also demonstrates the importance of studying the effects of chemical exposure on multiple time scales as acute exposure to EE2 affects the consistency of only female-directed behaviors in this species whereas chronic exposure affects consistency of both female-directed and male-directed behavior. Finally, this study suggests that males in this species may differ in their sensitivity, an important area for future research.
Stylistic Accommodation on an Internet Forum as Bonding
Authors: Welbers Kasper , de Nooy Wouter
Published: March 2014

Internet forums are theorized to be important social platforms for peer influence. Current research tends to conceptualize peer influence as adoption processes, investigating whether information received from network contacts stimulate the adoption of a product, service, taste, or attitude. Accordingly, research interest is focused on the first time a product is used. In contrast, the present study investigates mutual and recurrent adaptation between users of an internet forum. This adaptation is theorized to signal engagement in the discussion, which is part of a bonding process. It is essential to internet forum use because this social medium offers no facilities for selecting and evaluating your discussion partners. Using communication accommodation theory, linguistic style matching, and a statistical network model, we analyze style adaptation on an internet forum for the Moroccan minority in the Netherlands. Our results show that posters adapt their style to the style of previous posters within the same thread (discussion) as well as previous posts in other threads within the same section (topic), especially in the case of style elements related to a shared identity. Significant others on the forum—other posters quoted or referenced directly at least two times—also function as style examples provided that they are present in the current discussion. We argue that these effects have wider significance for research into gratifications of online forums for participants and practical relevance for monitoring and moderating discussions on online forums.
Psychopathic traits and ethnicity in female youths
Authors: Pechorro Pedro Santos , Poiares Carlos , Vieira Rui Xavier , Nunes Cristina , Jesus Saul Neves
Published: March 2014

The aim of the present study was to analyze the differences regarding psychopathic traits and related constructs in female youths of diverse ethnic backgrounds. Using a sample of 88 young females from the Juvenile Detention Centers of the Portuguese Ministry of Justice (white Europeans group: n = 44, ethnic minorities group: n = 44), and a sample of 130 young females from the schools of the Lisbon region (white Europeans group: n = 65, ethnic minorities group: n = 65) results showed that almost no differences were found within the forensic group and the school group. Independently of ethnic group membership, psychopathic traits scores were significantly associated with behavioral problems, conduct disorder, self-reported delinquency, crime seriousness, age of crime onset, and age at first trouble with the law.
What are the dynamics of organizational identification in the course of modernization processesAnalysis of a Belgian administration
Authors: Rondeaux Giseline
Published: March 2014

In the course of reform, organizational identity emerges as a prominent issue. While the process of modernizing the administration sets out to redefine this identity, how is this experienced by its members? What are the identity dynamics at work in terms of their perception of changes in their environment?

By analysing the Copernic reform in Belgium, we inductively developed a typology of identity rationales and profiles (Rondeaux, 2006, 2007, 2008, 2010). On this basis, we conducted a questionnaire survey in a regional administration engaged in reform. Our analysis highlights the coexistence of different identity rationales and diverse perceptions of the environment, which are congruent or dissonant with them. The results underline the importance of the environment and of its perception in organizational identification processes and confirms the hypothesis of identity hybridization, providing also an empirical basis for the integrative approach of Ravasi and Schultz (2006).

Points for practitioners

This article proposes an identity interpretive framework for reform processes, considering both the institutionalized organizational identity, at the heart of the modernization project and various alternative rationales contributed by the civil servants. Our analysis highlights the diverse perceptions of the environment in the light of the identities present and underlines the practical implications of such an approach in terms of change management.
The measures adopted to increase the accountability of Belgium's senior civil servants: strategic analysis of the political-administrative system at federal level
Authors: Göransson Marie
Published: March 2014

Over the past decade, Belgium, like many OECD countries, has set out to modernize the management of its public affairs. In April 2000, the Belgian federal government adopted a far-reaching reform of the structures and functioning of the State: the Copernic Plan. One of the ambitions of the changes introduced by the reform is the accountability of senior civil servants. In line with this reform, various measures were developed, the results of which appear to be mixed. This article aims to analyse the outcome of these mechanisms through the behaviour of the stakeholders and their impacts on the regulation and practice of the mechanisms. To do this, the author uses the strategic analysis developed by Crozier and Friedberg (1977). In doing so, the interaction of the stakeholders in response to the measures introduced to increase accountability is highlighted in order to understand certain stand-offs still blocking the processes of modernization.

Points for practitioners

This contribution sets out to analyse the outcome of the measures introduced to increase the accountability of senior civil servants by the Belgian federal reform passed in 2000, the Copernic Plan. To do so, the author uses the strategic analysis developed by Crozier and Friedberg (1977) and therefore considers the political-administrative space in which the accountability measures are rolled out as a concrete action system. Within it, the resistance of the stakeholders involved in the development of the mechanisms and their implementation are studied, shedding light on the destruction of certain measures in the regulation and their hijacking in practice.
New public service performance management tools and public water governance: the main lessons drawn from action research conducted in an urban environment
Authors: Tabi Marie Tsanga , Verdon Dominique
Published: March 2014

At a time when, in France, the central government is placing new hope in the principle of governance of its utilities by means of performance indicators, this article argues that governance through performance measurement and management tools alone, however sophisticated, is not enough to meet the current challenges facing public water governance. However, the debate triggered on the objectives of the performance measurement tools raises substantive issues relating to public water governance. These substantive issues touch as much on the (strategic and organizational) components of the model of governance as on its control system. This is demonstrated by the action research experiment conducted in conjunction with the water utility of Nantes Métropole (Urban Community of Nantes), where the introduction of a new performance measurement tool leads the actors within the system to focus on the question of the values ​​that the public water governance model must carry. These values, which relate to the very ‘public’ and multidimensional component of water, appear in the local governance system under construction as a cornerstone of the model of governance.

Points for practitioners

In the case of the water utilities where the legitimization of the systems of governance is based on a rationale of technical justification, managerial instrumentation and performance evaluation must contend with the strategic and political vacuum resulting from the weakness of expression of political choices. How, then, to take up the challenge of a dynamic and participatory governance? Putting the objectives of the new evaluation tools into the centre of the debate is a relevant approach to question the ultimate meaning of the action, whose content is inevitably associated with the values that should govern water governance.
New public management and the professions within cultural organizations: one hybridization may hide another
Authors: Kletz Frédéric , Hénaut Léonie , Sardas Jean-Claude
Published: March 2014

With the introduction into public organizations of management methods borrowed from the private sector, ‘new public management’ often comes across as a factor that weakens professional autonomy. Cultural industry is no exception to this phenomenon, as demonstrated by the case of the facilitators or interpreters in France ( médiateurs culturels). However, a careful study of the development of this occupation does reveal that, rather than a strict opposition between a professional logic and managerial logic, hybridization is possible. Indeed, professional groups can benefit from the establishment of methods that structure their activity and that take on board the dynamics of knowledge and career pathways.

Points for practitioners

The research presented here raises the question of how to reconcile the streamlining of public activities (new public management approaches) with the challenges of preserving or developing professions. Practitioners can thus see, through a case study and the presentation of a generic grid analysis, the different ways of structuring and managing the professions, with the emphasis on adopting an approach that ensures coherence between the skills necessary for each activity and the skills defined and career paths offered to the players. Far from being at odds, this kind of articulation makes it possible to hybridize the organizational logic of the new public management with the professional logic of the professions .
Place marketing and citizen participation: branding as strategy to address the emotional dimension of policy making?
Authors: Eshuis Jasper , Klijn Erik-Hans , Braun Erik
Published: March 2014

Place marketing is increasingly used by local governments to enhance the image of cities and achieve policy goals related to economic and spatial development. Place marketing has become part of local and regional governance processes. Critics have argued that place marketing is often applied in top-down ways that exclude citizens. Drawing on survey data this article empirically confirms this critique. But the article shows with a case study that citizen involvement in place branding can be used to enhance the quality of the brand and include citizens’ emotions in governance processes.

Points for practitioners

The influence of citizens on place marketing is generally low. Nonetheless, when citizens are given influence the effects of place marketing on spatial plans and other policies increases, according to respondents of this study. Place branding can be carried out interactively with citizens, and then be applied to include citizens’ emotions in governance processes. This may be used to enrich and locally embed governance processes, and prevent citizens’ protest.
Side Effects of Selegiline (Eldepryl)
Authors: Waters Cheryl H.
Published: March 2014

Selegiline (Eldepryl), recently approved as an adjunct to levodopa-carbidopa (Sinemet), was administered to eight patients with Parkinson's disease in an open-label study. Many side effects were seen pertinent in particular to the elderly patient. Urinary retention was precipitated in two gentlemen. We advise that this medication be used with caution in the parkinsonian patient. ( J Geriatr Psychiatry Neurol 1992;5:31–34).
Incontinence and Troublesome Behaviors Predict Institutionalization in Dementia
Authors: O'Donnell Brian F. , Drachman David A. , Barnes Heather J. , Peterson Karen E. , Swearer Joan M. , Lew Robert A.
Published: March 2014

Factors predicting the early institutionalization of demented patients were studied in 143 outpatients using univariate and multivariate life-table methods. Four types of factors were evaluated for prognostic value: severity of functional impairment, behavioral disorders, individual patient characteristics, and type of caregiver. After follow-up of 19 ± 12 months, 51 patients had been institutionalized. Increased global severity of dementia, the presence of troublesome and disruptive behaviors, and incontinence increased the likelihood of institutionalization. The best predictors of institutionalization were paranoia, aggressive behavior, and incontinence. Neither individual patient characteristics (age, education, and gender) nor caregiver relationship to the patient (male spouse, female spouse, and male or female child) influenced institutionalization. Since troublesome behavioral disorders are potentially treatable aspects of dementia leading to institutionalization, their management should be a major focus of therapy in dementia. ( J Geriatr Psychiatry Neurol 1992;5:45–52).
Lithium-Induced Delirium With Therapeutic Serum Lithium Levels: A Case Report
Authors: Brown Alan S. , Rosen Jules
Published: March 2014

Lithium-induced delirium occurring in geriatric patients with serum lithium levels that are within the “therapeutic” range (less than 1.5 mEq/L) has been described in the literature. We present a case that illustrates three major issues regarding this syndrome: (1) differentiating lithium-induced delirium from a recurrence of a chronic psychiatric disorder; (2) the use of the electroencephalogram in supporting this diagnosis; and (3) factors that may increase a patient's vulnerability to delirium while on lithium. A brief review of the most relevant literature is then presented. We conclude that lithium-induced neurotoxicity should be suspected in any patient receiving lithium who develops delirium, regardless of the serum level, and that immediate discontinuation of the medication be considered. ( J Geriatr Psychiatry Neurol 1992;5:53–55).
Entrained Body Temperature Rhythms Are Similar in Mild Alzheimer's Disease, Geriatric Onset Depression, and Normal Aging
Authors: Prinz Patricia N. , Moe Karen E. , Vitiello Michael V. , Marks Alan L. , Larsen Lawrence H.
Published: March 2014

Sleep-wake rhythms are known to be altered in Alzheimer's disease (AD) and in unipolar depression. Other evidence suggests that the circadian rhythm in body temperature may be altered as well. Entrained circadlan temperature rhythms were measured in healthy elderly men and women, as well as in men and women suffering from unipolar depression or mild AD, to examine this possibility. There were no differences in the temperature rhythm characteristics of subjects with depression or AD compared with healthy control subjects. However, gender differences were observed. Female control subjects showed a larger amplitude, higher peak temperature, and earlier acrophase relative to male control subjects. Also, the mesor of female AD subjects was higher than for male AD subjects. These results are discussed in the context of the widely varying subject populations used in other studies. Geriatr Psychiatry Neurol 1992;5:65–71).
Central Anticholinergic Hypersensitivity in Aging
Authors: Ray P.G. , Meador K.J. , Loring D.W. , Zamrini E.W. , Yang X.-H. , Buccafusco J.J.
Published: March 2014

Although neurochemical reductions in cholinergic systems have been found to occur during aging, such changes do not necessarily translate to functional deficits. The cognitive deficits of normal aging have been attributed in part to hypo-cholinergic function, but anticholinergic hypersensitivity in the elderly has not been systematically documented. To test the cholinergic hypothesis of aging, we investigated the effects of scopolamine on memory and attention in healthy young and elderly subjects. Treatments included intramuscular glycopyrrolate (0.0044 mg/kg) and scopolamine (0.002, 0.004, and 0.007 mg/kg) in a randomized double-blind design. The test battery included the Selective Reminding Task (SRT), Digit Span, Paired Associates Learning (PAL), Symbol Digit Modalities Test (SDMT), and the Continuous Performance Task. Elderly controls were more impaired at lower scopolamine doses than were the young on SRT, PAL, and SDMT. These results demonstrate anticholinergic hypersensitivity and are consistent with decremental changes in cholinergic status during normal aging. ( J Geriatr Psychiatry Neurol 1992;5:72–77).
Motor Cortex Involvement in Presenile Dementia: Report of a Case
Authors: Golaz Jean , Bouras Constantin , Hof Patrick R.
Published: March 2014

Alzheimer's disease (AD) is characterized neuropathologically by high densities of neurofibrillary tangles (NFT) and neuritic plaques (NP) in the cerebral cortex, in particular in neocortical association areas and in the hippocampal formation. We report here the case of an AD patient who developed signs of motor dysfunction early in the clinical evolution. A quantitative neuropathologic analysis revealed much higher densities of NFT and NP in the primary motor cortex than is usually observed in AD. This case, together with other reports, points to the existence of neurologically defined subgroups of AD with unusual clinical deficits that are correlated with the regional and laminar distribution of NP and NFT, and further supports the hypothesis that the symptomatology presented by AD patients results from the loss of specific neuronal populations leading to a syndrome of global cortical disconnection. ( J Geriatr Psychiatry Neurol 1992;5:85–92).
Psychiatric Diagnosis and Uncooperative Behavior in Nursing Homes
Authors: Rovner Barry W. , Steele Cynthia D. , German Pearl , Clark Rebecca , Folstein Marshall F.
Published: March 2014

The prevalence of psychiatric disorders and behavioral disturbances in nursing homes is high, but the relationship between the two is unknown. We studied 454 new admissions who were diagnosed by research psychiatrists using DSM-III-R criteria and compared patients who nursing staff designated as cooperative or uncooperative by psychiatric diagnosis and use of restraints and neuroleptics. Uncooperative patients (n = 79; 17.4%) had a variety of psychiatric disorders (total, 87.3%) but particularly had dementia syndromes complicated by delusions, depression, or delirium (44.3%). Uncooperative patients were more frequently restrained and prescribed neuroleptics. Determining the origins of behavior disorders in patients with psychiatric disorders in nursing homes may reduce behavior disturbances. ( J Geriatr Psychiatry Neurol 1992;5:102–105).
Clinical Heterogeneity of Probable Alzheimer's Disease
Authors: Blennow Kaj , Wallin Anders
Published: March 2014

When the symptomatology in probable Alzheimer's disease (AD) was studied, two subgroups emerged: one with predominant cortical symptoms of parietal type (AD type I) and another with general cognitive symptoms but absence of or only mild cortical symptoms (AD type II). In AD type I, the age at onset was significantly lower, confusional symptoms and leukoariosis on computerized tomographic scan were less frequent, and the ganglioside GM1 concentration in cerebrospinal fluid was significantly higher than in AD type II. Although the significance of changes in cerebrospinal fluid gangliosides has not been fully elucidated, it is possible that the increase in cerebrospinal fluid GM1 reflects a more severe degeneration of neurons and synapses in AD type I than in AD type II. The relation between symptomatology and leukoariosis suggests that leukoariosis has clinical significance in AD patients. The total results suggest heterogeneity of probable AD. AD type I appears to constitute a classic AD subgroup with memory disturbances and marked cortical symptoms of parietal type, while age-related changes, vascular changes, and leukoariosis may be responsible for the more generalized symptomatology in AD type II. ( J Geriatr Psychiatry Neurol 1992;5:106–113).
l-Methyl-4–phenylpyridinium (MPP+) but not 1-Methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) Serves as Methyl Donor for Dopamine: A Possible Mechanism of Action
Authors: Charlton Clivel G.
Published: March 2014

1-Methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) and 1-methyl-4-phenylpyridinium (MPP+), the active product of MPTP, caused Parkinson's disease-like symptoms. The mechanism of action of MPP+ is unknown, but analogues of MPTP lacking an N-methyl group were found to be essentially devoid of toxicity, which means that the methyl group of the pyridine ring plays a role in the toxicity. This is of interest because S-adenosylmethionine (SAM), which is the biologic methyl donor and requires a methyl group for its action, also caused MPP+-like motor deficits in rodents. Therefore, the requirement of a methyl group by MPTP and MPP+ for their actions suggests that, like SAM, MPP+ and MPTP may serve as methyl donors. This hypothesis was tested by reacting SAM, MPP+, or MPTP with dopamine in the presence of catechol-O-methyltransferase and measuring the methylated product of dopamine produced. Like SAM, MPP+, but not MPTP, methylated dopamine. The methylated product coeluted from chromatographic columns with standard 3-methox-ytyramine. Concentrations of 15.6, 62.5, 250, and 1000 nmoles/tube increased the 3-methoxytyramine recovered above controls by 0.0, 6.88, 44.55, 129.47 and 5.8, 13.9, 50.58, 121.31 nmoles for SAM and MPP+, respectively. The dopamine that remained unreacted was dose-dependently decreased. MPTP had no significant effect. The ability of MPP+ to serve as a methyl donor may represent a mechanism for the toxicity of MPP+. ( J Geriatr Psychiatry Neurol 1992;5:114–118).
Alzheimer's Disease: A Model From the Quantitative Study of a Large Kindred
Authors: Bruni Amalia C. , Montesi Maria Paola , Salmon Denise , Gei Giorgio , Perre Janine , El Hachimi K. Hamid , Foncin Jean-François
Published: March 2014

In an Italian kindred (family N), early onset Alzheimer's disease has been transmitted in a Mendelian autosomal fashion since the early 18th century. The age at death of affected members of the family varies widely, and was taken as an index of the age of expression, a measure of phenotypic variability. Either a gamma or a log-normal algorithm provides the best fit for the age at death distribution. Subsets of family N widely different as to time and place have the same age at death of patients: Environment appears to play a negligible role in the expression of disease. Pairwise correlation between an affected parent and child is zero: The disease is monogenic (no major expression gene). The same stochastic distribution of age of expression, but with late onset, and after correction for death from other causes, is compatible with the epidemiology of Alzheimer's disease in general. Mendelian genetics is a possible model for Alzheimer's disease etiology. ( J Geriatr Psychiatry Neurol 1992;5:126–131).
New Patterns of Intraneuronal Accumulation of the Microtubular Binding Domain of tau in Granulovacuolar Degeneration
Authors: Mena Raúl , Robitaille Yves , Cuello A. Claudio
Published: March 2014

Sixteen brains from Alzheimer's disease (AD) patients with varying duration of dementia were studied using the monoclonal antibody (mAb) 6.423 raised against the three repeated domains of the tau protein, and named the paired helical filament (PHF) core. In Ammon's horns of the AD cases 6.423 mAb, in addition to immunoreacting with neurofibrillary tangles (NFTs), dystrophic neurites, and plaquelike structures, also recognized a subpopulation of granulovacuolar degeneration elements (GVD). A new immunoreactive structure, a spherical inclusion, was also stained by 6.423. The immunoreactive GVD elements and the spherical inclusion were found in the aged controls (> 65 years of age) and in non-AD dementia cases, as well. The staining of the GVD was markedly decreased when the tissue was preincubated with alkaline phosphatase. In contrast, NFTs and the spherical inclusions resisted dephosphorylation. Neurons containing the spherical inclusion frequently lacked immunoreactive intracellular NFTs. Due to the similar immunohistochemical properties between the spherical bodies and immunoreactive NFTs, we named this new inclusion PHF core body. Our results suggest that the PHF core body may represent a successful attempt by hippocampal neurons to restrict the PHF core expression. Thus, the failure of this mechanism may lead to the NFT formation in a range of dementing processes. Alternatively, the PHF core body may be an early stage in the NFT formation. (J Geriatr Psychiatry Neurol 1992;5:132–141).
ECT-Induced Interictal Delirium in Patients With a History of a CVA
Authors: Martin Michelle , Figiel Gary , Mattingly Gregory , Zorumski Charles F. , Jarvis Michael R.
Published: March 2014

Earlier works have documented a high incidence of affective disorders in patients with a history of a cerebrovascular accident (CVA). In general, electroconvulsive therapy (ECT) has been reported to be effective in treating depressed patients with a history of CVA. Recent works have shown that preexisting structural brain changes may predispose patients to develop interictal ECT-induced delirium. However, the incidence of ECT-induced interictal delirium in patients with a history of CVA has not been directly studied. In this pilot study, the authors examined the incidence of ECT-induced interictal delirium in 14 depressed CVA patients compared with 14 elderly depressed controls (without a history of CVA). Interestingly, the overall incidence of delirium was identical in both groups (28.5%). However, consistent with previous works, some patients who had had a recent CVA involving the caudate nucleus appeared more likely to develop delirium. Thirteen of the 14 depressed CVA patients (92%) showed a moderate to significant improvement in their depressive symptoms from ECT. None of the patients developed significant cardiac complications during ECT. ( J Geriatr Psychiatry Neurol 1992;5:149–155).
Alzheimer's Patients Should Be Included in Phase I Clinical Trials To Evaluate Compounds for Alzheimer's Disease
Authors: Cutler Neal R. , Sramek John J. , Murphy Michael F. , Nash Ralph J.
Published: March 2014

Dosage and tolerance are critical issues in successful drug therapy for patients with Alzheimer's disease (AD). A clear distinction among patient populations and AD patient subpopulations is necessary to ensure a thorough assessment of new central nervous system-active compounds. Phase I inpatient trials, in which tolerance and safety are evaluated under double-blind conditions in the target population, provide valuable information for use in planning multicenter outpatient trials. In similar studies, even those involving the elderly, tolerance and safety outcomes in healthy volunteers are not always predictable. An early trial of the effects of velnacrine in healthy, elderly, male volunteers was followed by a trial in the target population. A group of volunteers, aged 60 to 74 years who did not have AD, received 300 mg of velnacrine each day. This dosage was well tolerated for 28 days. Diarrhea, generally of moderate severity, was the only reported adverse effect. No subjects were required to discontinue taking velnacrine. In contrast, a similar trial showed a dosage of 300 mg of velnacrine each day intolerable among patients with AD. Adverse reactions to dosages greater than 225 mg/day included dizziness, fainting, nausea and/or vomiting, headache, and severe diarrhea. A velnacrine dosage of 225 mg/day appeared to be safe and well tolerated in a small population of healthy patients with AD. Based on the inpatient experience with AD subjects, a maximum dose of 225 mg/day was adopted for outpatient studies. Although factors that may contribute to drug sensitivity in patients with AD vary beyond conclusive parameters, the observed sensitivity within the target AD group may indicate a safety/tolerance study as a worthwhile antecedent to multicenter efficacy trials. ( J Geriatr Psychiatry Neurol 1992;5:192–194).
Antidepressant Treatment of Pathologic Laughing or Crying in Elderly Stroke Patients
Authors: Panzer Michael J. , Mellow Alan M.
Published: March 2014

Pathologic laughing or crying (PLC), a complication of many neurologic disorders, involves behavior that is either inappropriate to the context or to the patient's subjective feeling state. It is due to a dysregulation of the motoric components of emotional experience. PLC is distinct from, but often associated with, major depression. The relatively few reports on treatment of PLC are primarily with tricyclic antidepressants. We report the effective treatment of PLC due to stroke in three patients with nortriptyline or fluoxetine. The cases also illustrate the broad spectrum of depressive symptoms (from none to a major depression) seen in patients with PLC. We discuss treatment implications and directions for future research. ( J Geriatr Psychiatry Neurol 1992;4:195–199).
Successful Treatment With Pimozide of Capgras Syndrome in an Elderly Male
Authors: Tueth Michael J. , Cheong Josepha A.
Published: March 2014

A case of Capgras syndrome in a 67-year-old man who failed to improve on haloperidol, but responded to pimozide, is described. The patient's paranoid delusions abated with 8 mg per day of pimozide. We believe pimozide's established benefit in the treatment of delusional disorders warrants its consideration in alleviating other delusions, including “the delusion of doubles.” ( J Geriatr Psychiatry Neurol 1992;5:217–219).
The Association of Normal-Pressure Hydrocephalus With Obstructive Sleep Apnea
Authors: McNamara M. Eileen , Millman Richard P. , Epstein Mel H. , Fogel Barry S.
Published: March 2014

This report describes a 70-year-old man with obstructive sleep apnea who deteriorated rapidly when nasal continuous positive airway pressure was begun. The patient was found to have normal-pressure hydrocephalus, which was possibly exacerbated by the nasal continuous positive airway pressure. A review of the literature indicates several significant associations between apnea, normal-pressure hydrocephalus, and increased intracranial pressure and suggests that the association of obstructive sleep apnea and hydrocephalus might not be rare. Implications for diagnosis and treatment are discussed. ( J Geriatr Psychiatry Neurol 1992;5:238–240).
Brain Oxidative Energy and Related Metabolism, Neuronal Stress, and Alzheimer's Disease: A Speculative Synthesis
Authors: Hoyer Siegfried
Published: March 2014

A reduction in the cerebral metabolic rate of glucose is one of the most predominant abnormalities generally found in the Alzheimer brain, whereas the cerebral metabolic rate of oxygen is diminished only slightly or not at all at the beginning of this dementive disorder. From the cerebral metabolic rates of oxidized glucose and oxygen, the cerebral adenosine triphosphate (ATP) formation rate was calculated in incipient early-onset, incipient late-onset, and stable advanced dementia of the Alzheimer type (DAT). A reduction in ATP formation by various amounts was found, ranging from at least 7% in incipient early-onset DAT, from around 20% in incipient late-onset DAT, and from 35% up to more than 50% in stable advanced dementia. The cerebral diminution in energy availability, along with a loss of functionally important amino acids, ammonia toxicity, supposed membrane damage, dysregulation of Ca2+ homeostasis, and glycogen accumulation in the incipient stages of DAT are assumed to be stress-related abnormalities capable of inducing the formation of heat shock proteins. These events may lead to an enhanced generation of amyloid precursor protein in earlier states of DAT. If abnormally cleaved, amyloid A4 protein may be produced in increased amounts. From the results discussed in this article it is deduced as a speculative synthesis that perturbations in brain oxidative energy and related metabolism may precede the generation of amyloid precursor protein and the formation of plaques in the brain affected by incipient DAT. ( J Geriatr Psychiatry Neurol 1993;1:3–13).
Presbyophrenia: A Possible Subtype of Dementia
Authors: Zervas Iannis M. , Fliesser Jeffrey Mark , Woznicki Michael , Fricchione Gregory L.
Published: March 2014

Presbyophrenia is characterized by memory impairment, disorientation, confabulation, hypomanic features, and a preserved social facade. These occur in the absence of prior history of alcoholism or affective illness. We present three cases with presbyophrenia and suggest that the syndrome is a recognizable subtype of dementia, possibly related to disruption of aminergic pathways in frontal and subcortical structures. ( J Geriatr Psychiatry Neurol 1993;1:25–28).
Risk Factor and Behavioral Differences Between Vascular and Alzheimer's Dementias: The Pathway to End-Stage Disease
Authors: Cooper James K. , Mungas Dan
Published: March 2014

Differences between vascular dementia and Alzheimer's dementia may be present in both risk factors and in behavioral manifestations. Behavioral distinctions may be apparent only at particular stages of the disease process, but comparisons at different stages require a large number of subjects. The California Alzheimer Disease Diagnostic and Treatment Center Program has collected data on a large number of subjects with dementia. We examined differences in risk factors and in behaviors in 502 subjects with vascular dementia and 810 subjects with probable Alzheimer's dementia. With respect to risk factors, vascular dementia subjects were more likely to have a history of general anesthesia. We found no difference in history of closed head trauma, family history of dementia, or cigarette smoking, suggesting that these factors are less likely to have a disease-specific etiologic role. With respect to behaviors, subjects with vascular dementia were more likely to have depression in all stages of dementia. Subjects with Alzheimer's dementia were more likely to exhibit wandering in the middle or late stages. Subjects were similar in five other behavioral factors in the three stages studied. We conclude that general anesthesia is a risk factor for vascular dementia and that depression is more prevalent in vascular dementia, while wandering is more characteristic of Alzheimer's dementia. ( J Geriatr Psychiatry Neurol 1993;1:29–33).
Militarised Minds: The Lives of Ex-combatants in South Africa
Authors: Maringira Godfrey
Published: March 2014

This article focuses on how ex-combatants in South Africa remain militarised. Identities which were forged through resistance continue to be reproduced in different ways in post-conflict society. Military identity is a source of status and recognition in the everyday lives of ex-combatants, either as ‘defenders of the community’ or for individual gain. While some may argue that there is no such thing as military identity, the group of ex-combatants interviewed remained attached to such an identity and saw themselves as having a particular role in their communities. While studies, particularly in Africa, present ex-combatants as if they can be easily transformed into civilian life, this article considers the difficulties of such a process. The argument is that it is a complex matter to demilitarise ex-combatants’ minds in a highly unequal and militarised community. Sixteen life history interviews were collected, 11 with APLA ex-combatants and five with Zimbabwean army deserters.
Life and Health: Bonhoeffer’s Normative and Divergent Accounts of Private Confession of Sin
Authors: Wilkes Nicola J.
Published: March 2014

This article highlights the critical distinction between Bonhoeffer’s theology of private confession of sin set forth in the collection of working papers from 1940–45, with that found in his other writings. I compare and contrast Bonhoeffer’s “normative account” of private confession with several distinctive aspects of his treatment of the theme in the essay, “The Best Physician,” and other remarks on confession from the same period. In these papers Bonhoeffer restated—albeit in attenuated form—some key points made in his other works on confession of sin and then, departing from his usual christological and ontological depiction, introduced a psychosomatic element not found in his other writings. I argue that the differences do not of necessity constitute a shift in his thinking, but in essence express a common perspective: Christ draws close to the weak. The apparent differences between the texts reflect more the context in which the papers were written than a change in Bonhoeffer’s position. Both the normative and divergent texts emphasize the high priority Bonhoeffer afforded private confession and give insight into the role this concept played in his ecclesiology and theological anthropology.
Bonhoeffer and Reformed Christology: Towards a Trinitarian Supplement
Authors: Holmes Christopher R.J.
Published: March 2014

In this article, I examine Bonhoeffer’s aversion to the Reformed extra Calvinisticum, namely that the extra undermines a real incarnation, the sense in which God is “wholly there.” However, what Bonhoeffer did not supply is an account of what qualifies Jesus Christ to be the “God-human” and the “human-God.” This is where, I argue, a strong trinitarian supplement is necessary. Bonhoeffer’s rather undeveloped trinitarian theology undermined a full articulation of who it is who is said to be wholly there. Without an account of Christ’s origin in relationship to the Father, Bonhoeffer’s christology was hamstrung, unable to fully realize the full power of its immensely salutary efforts to be transparent to Christ’s interpretation of himself to us.