Search

Summary Background Few data are available on the effect of social ties on dementia development. This study explored whether single social network components and different degrees of the social connections affect dementia incidence. Methods A community-based cohort of 1203 non-demented people, living at home in the Kungsholmen district of Stockholm, Sweden, and who had good cognition, was followed for an average period of 3 years. On the basis of medical and psychological data, 176 patients were diagnosed with dementia according to the criteria of the third edition revision of the Diagnostic and Statistical Manual of Mental Disorders. Information on social network was obtained by personal interview by trained nurses at baseline. The covariates included in the analysis were age, sex, education, cognitive and functional status, depressive symptoms, and vascular diseases. Findings Those individuals living alone, and those without any close social ties, both had an adjusted relative risk for developing dementia of 1·5 (95% CI 1·0–2·1 and 1·0–2·4, respectively). Compared with married people living with someone, single people and those living alone had an adjusted relative risk of 1·9 (95% CI 1·2–3·1). Infrequent contacts with network resources did not increase the risk of the disease if such contacts were experienced as satisfying. When all components were combined in an index, a poor or limited social network increased the risk of dementia by 60% (95% CI 1·2–2·1), and a significant gradient was found for the four degrees of social connections (p=0·0009). Interpretation An extensive social network seems to protect against dementia. Confirmation of this finding and further investigation to clarify the mechanisms are worthwhile due to the implications for prevention.

The purpose of this research was to assess the frequency and severity of neuropsychiatric and behavioral symptoms and to examine the association between preexisting medical conditions and specific neuropsychiatric symptoms in demented individuals. We studied 211 demented subjects (87.7 percent male) who were participants in epidemiological studies of dementia. Using the Neuropsychiatric Inventory (NPI), we assessed the frequency and severity of neuropsychiatric symptoms. We collected medical history information during a structured telephone interview. Our analyses focused on determining prevalence of neuropsychiatric symptoms by dementia diagnosis and severity. We also examined the association of history of head injury, alcohol abuse, and stroke with development of neuropsychiatric symptoms. We found that neuropsychiatric symptoms were common, with approximately three-fourths of the subjects exhibiting at least one symptom during the preceding month. Apathy (39.3 percent), agitation (31.8 percent), and aberrant motor behavior (31.1 percent) were the most frequent symptoms. Frequency and severity of symptoms were similar for the all-dementia and Alzheimer's disease–only groups. neuropsychiatric symptoms varied by severity of dementia, but generally not in a consistent ordinal pattern. History of alcohol abuse, head injury, or stroke was associated with presence of specific neuropsychiatric symptoms in dementia. While psychiatric symptoms are common in dementia, they also vary by type and severity of dementia. The finding that certain medical conditions may increase risk for specific types of neuropsychiatric symptoms expands our knowledge of the natural history of dementia and should improve management of dementia in medically ill patients. Our results may also shed light on mechanisms that underlie neuropsychiatric symptoms.

It's a rare disease, this Streptococcal Toxic Shock Syndrome, and caused by what the press likes to refer to as the "killer bacteria" (Group A Streptococcus Type M). And yet in the summer of 1998 I got this disease. Out of the blue. At age 47, in perfect health. And thus began my saga of physician as patient, a story of great suffering and great blessings. I am a better physician because of it, and I have developed deeper, more loving connections with the people closest to me. My story is not told from memory. From the onset of the first symptoms until my awakening in an intensive care unit 14 days later I have total memory loss. I have slowly pieced together as much of these 2 weeks as possible. I have spoken with doctors and nurses, with family and friends. I have copies of all of my medical records. Yet there is an emotional gap, which I can't bridge. The powerful drama of those days is lost to me. This loss is a mercy and a sorrow. The memory loss has proved to be almost as dramatic and powerful as the illness and recovery.