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Symptoms of dizziness and imbalance are common sequelae following concussion and blast exposures that result in mild traumatic brain injury (mTBI), and these symptoms often last six months or longer. Most studies examining the effect of vestibular dysfunction on postural stability have used symptom scales or tests of vestibulo-ocular reflex (VOR) that measure horizontal semicircular canal (hSCC) function only. Vestibular loss, however, can occur in one or both labyrinths, in one or both branches of the vestibular nerve, and in one or more vestibular sensory end-organs. A prospective case-controlled design was used to determine the effect of mTBI and blast exposure on peripheral vestibular system function, postural stability, and gait. MANOVAs revealed significant differences between the control and mTBI and blast groups for cervical vestibular evoked myogenic potentials, sensory organization test, and dynamic gait index. These findings suggest that mTBI and blast affect the otolith organs, postural stability, and gait. The frequency of test abnormalities ranged from 22 to 71% with the most frequent abnormalities occurring on tests of balance and gait function. Vestibular test abnormalities occurred in 48% of individuals with mTBI and/or blast exposure. Specifically, abnormalities occurred more often in tests of otolith organ function than hSCC function.

The primary, descriptive aim of this dissertation was to describe the nighttime sleep quality of previously mechanically ventilated older adult patients within 24-48 hours of transfer out of the intensive care unit (ICU) to a medical-surgical floor. The secondary, exploratory aim was to examine the relationships between post-ICU sleep efficiency (SE) and wake after sleep onset (WASO) with grip strength in previously mechanically ventilated older adult patients within 24-48 hours of transfer out of the ICU. The study included 30 adults ages 65 and older (11 women, 19 men; age 71.37 ± 5.35, range 65-86 years), who were functionally independent at home prior to hospitalization, mechanically ventilated during their ICU stay, and were within 24-48 hours of transfer out of ICU to a medical-surgical floor at Tampa General Hospital, a level 1 trauma center. Subjects wore an actigraph monitor on the dominant wrist (Actiwatch Spectrum) to monitor sleep over two consecutive nights. Parameters of post-ICU sleep quality included total sleep time (TST), sleep efficiency (SE), wake after sleep onset (WASO), sleep latency (SL), and number of awakenings (NA). The outcome measure of motor function was dominant hand grip strength, assessed by the National Institutes of Health Toolbox Motor Battery Grip Strength Test. Sleep data collected between nighttime hours (9:00 PM to 9:00 AM) on both nights were analyzed. For the descriptive aim, means for each sleep parameter and clinical characteristics were reported. For the exploratory aims, multiple regression analyses examined the individual associations between mean sleep parameters (SE and WASO) and grip strength. Study subjects had a mean SE of 63.24 ± 3.88% and spent 135.39 ± 9.94 minutes awake after sleep onset. The mean TST among subjects was 7.55 ± 2.52 hours, ranging from 2.02 to 10.84 hours of sleep, out of the 12 hours of total time in bed. A total of 6 (20%) subjects slept less than 5 hours each night, and a total of 6 (20%) subjects slept greater than 10 hours each night. The mean SL among study subjects was 42.57 minutes, and ranged from 0.0 to 237.75 minutes. Overall, subjects’ average NA was 78.28 ± 26.39, ranging from 35 to 136 awakenings. In multiple regression analysis, SE was significantly and negatively associated with grip strength, after adjusting for potential confounding factors. The model predictors explained 80.8% of the variance in grip strength, [R2 = .808, F(10, 15) = 6.324, p = .001]. Higher SE independently predicted worse grip strength (β = -0.326, p = .036). Further, among the tertiles of subjects with moderate or high TST (sleep duration ≥ 6 hours, n = 23), there remained a significant, negative association between SE and grip strength. The predictors explained 73.7% of the variance in grip strength, [R2 = .737, F(5, 15) = 8.416, p = .001]. Higher SE independently predicted worse grip strength among the subset of subjects with moderate or high sleep duration (β = -0.296, p = .046). Among the two quartiles of subjects with moderate-high or high WASO (≥ 120 minutes spent awake after sleep onset, n = 16), there was a significant, negative association between WASO and grip strength, after adjusting for covariates. The model indicated that the predictors explained 91.4% of the variance in grip strength [R2 = .914, F(6, 8) = 14.134, p = .001]. Greater WASO independently predicted worse grip strength (β = -0.276, p = .04). Finally, the effects of sex and preexisting obstructive sleep apnea (OSA) on grip strength were individually examined. Higher SE independently predicted worse grip strength among male subjects (β = -0.353, p = .039), as did preexisting OSA (β = -0.493, p = .033). In summary, objectively measured sleep quality was disturbed among previously mechanically ventilated, hospitalized older adults, even after transfer out of ICU to a medical-surgical floor. Longer TST and greater SE predicted worse grip strength among these frail patients who were previously independent, community dwelling older adults. Among the subjects with more severely fragmented sleep, WASO also independently predicted weaker grip strength. As poor grip strength is an indicator of ICU-acquired weakness, optimal sleep duration and less sleep disturbances may be crucial in prevention of worse functional outcomes and new institutionalization. Additional research is needed to discern the temporality of associations between sleep quality and motor function among older adult survivors of critical illness.

Patients with Alzheimer's disease (AD) often have a family history of the disease, implicating genetics as a major risk factor. Three genes are currently known to cause familial early-onset AD (<65 years): the amyloid precursor protein (APP) and the presenilins (PSEN1 and PSEN2). For the much more common late-onset disease (>65 years), only the APOE gene has repeatedly been associated to AD, where the ε4 allele increases disease risk and decreases age at onset. As APOE ε4 only explains part of the total estimated disease risk, more genes are expected to contribute to AD. This thesis has focused on the study of genetic risk factors involved in AD. In the first study, we conducted a linkage analysis of six chromosomes previously implicated in AD in a collection of affected relative pairs from Sweden, the UK and the USA. An earlier described linkage peak on chromosome 10q21 could not be replicated in the current sample, while significant linkage was demonstrated to chromosome 19q13 where the APOE gene is located. The linkage to 19q13 was further analyzed in the second study, demonstrating no significant evidence of genes other than APOE contributing to this peak. In the third study, the prevalence of APP duplications, a recently reported cause of early-onset AD, was investigated. No APP duplications were identified in 141 Swedish and Finnish early-onset AD patients, implying that this is not a common disease mechanism in the Scandinavian population. In the fourth study, genes with altered mRNA levels in the brain of a transgenic AD mouse model (tgAPP-ArcSwe) were identified using microarray analysis. Differentially expressed genes were further analyzed in AD brain. Two genes from the Wnt signaling pathway, TCF7L2 and MYC, had significantly increased mRNA levels in both transgenic mice and in AD brains, implicating cell differentiation and possibly neurogenesis in AD.

It is suggested that Alzheimer’s disease (AD) is caused by an imbalance between production, degradation and clearance of the amyloid-β (Aβ) protein. This imbalance leads to aggregation of Aβ and tau proteins and neurodegeneration in the brain. Today there is increasing evidence that the balance between the protease cathepsin B and the protease inhibitor cystatin C affects the tendency for Aβ to aggregate. The primary aim of this thesis was to investigate Aβ, cystatin C and cathepsin B levels in blood and cerebro-spinal fluid (CSF) in relation to the risk of AD. Studies I & II were based on the re-examinations of participants, at ages 70 and 77, in the Uppsala Longitudinal Study of Adult Men (ULSAM), a community-based prospective study initiated in 1970 (participants then being 50 years of age). In ULSAM, low plasma Aβ1-40 (Study I) and low serum cystatin C levels (Study II) were associated with a higher risk of AD. Studies III & IV were based on a cross-sectional sample of people with AD, mild cognitive impairment and healthy controls, recruited at three Swedish Memory Disorder units: Uppsala University Hospital, Uppsala, Skåne University Hospital, Malmö, and Karolinska University Hospital, Huddinge, Stockholm. In Study III, CSF cystatin C levels were positively correlated with both Aβ1-42 and tau levels. In Study IV, individuals with AD had higher mean plasma cathepsin B levels than healthy controls. In conclusion, low plasma Aβ1-40 and low serum cystatin C levels may precede clinically manifest AD in elderly men, cystatin C levels are positively correlated with Aβ1-42 and tau levels in CSF, and mean plasma cathepsin B levels are higher in people with AD compared to healthy controls. In addition to Aβ1-42 and tau levels in CSF, Aβ1-40, cystatin C and cathepsin B levels in blood may reflect the risk of AD.

This is a cross section study of the White elderly patients who attended Addington Hospital, Durban, Out-patient Department during a two week period in July 1985. Screening was by means of systematic sampling, a standard questionnaire was administered to 321 of them and their characteristics and needs were identified. In order to determine the attitudes of the medical and nursing staff who work in Addington Out-Patient Department, a further questionnaire was used. It was found that 88,37% of health professionals did not have a particular leaning towards looking after the elderly, but 88% agreed that the needs of the elderly were different in comparison with other age groups. 92,8% considered that geriatrics is a speciality in its own right. Recommendations are made for a 24 hour community geriatric service, the establishment of day centres to serve the needs of the greater Durban area, and for the establishment of a Chair of Geriatrics at the University of Natal. / Thesis (M.Med.)-University of Natal, 1987.

The purpose of this study was to explore the referrals that were generated from one hospital emergency room to a community outreach team. This study used a specific geriatric program assessment team in Winnipeg, Manitoba, Canada as the community outreach team. Malcolm Payne’s description of Task Centered Casework and Crisis Intervention and Irene Pollin’s Medical Crisis Counseling served as the theoretical structure and design to gain an understanding of the reasons geriatric patients were referred to the GPAT on discharge. This study aimed to answer three research questions: 1) What is the emergency room medical team’s main reason for referral to a geriatric outreach team? 2) Are the referrals received from the emergency room medical team clearly identifying psychosocial issues as areas for examination by an outreach team? 3) Are psychosocial issues identified only after an outreach team clinician completed a comprehensive assessment? This study revealed that out of the 209 referrals to geriatric program assessment team, the highest number of times referred was for functional decline. It revealed that the emergency room medical team saw functional decline as a valid reason to have the geriatric program assessment team assess the individual in their home settings to ensure that any functional issue be addressed and possible adaptations made in a timely manner to avoid the reverberation that one ailment can set off. The second most common reason for referring to the geriatric program assessment team was for social issues. Forty percent of the referrals identified that there were concerns in relation to social issues which clearly identifies that the emergency room medical team identified psychosocial issues as an area for further examination. And finally, the findings show psychosocial issues were not identified only after an outreach team clinician completed a comprehensive assessment, but that both appear cognizant of the interplay between medical issues and social issues.

During the past decades there has been an increase in longevity. These aging trends have an enormous economic impact and present challenges to policymakers, families, and health care providers to meet the needs of aging individuals. Aging is accompanied with various physiological changes that can limit the elderly’s functional status and their independency. Some of the most noticeable changes occur within the musculoskeletal system, however cardiorespiratory changes, as well as changes in the body composition limits the elderly’s aerobic capacity and therefore increases the risk for cardiovascular and hypokinetic diseases. Moderate physical activity reduces the risk, or prolong the onset of physiological changes and various diseases. Physical activity can also enhance functional fitness amongst the elderly. Functional fitness is having the physiologic capacity to perform normal everyday activities safely and independently without undue fatigue. The aim of this study was to determine the functional fitness as well as static balance and dynamic balance status of senior citizens. Secondly, to determine the association between: physical activity, aerobic endurance and functional fitness and status amongst senior citizens. Thirdly, to determine the association between physical activity status, aerobic endurance and static– and dynamic balance amongst elderly. A once off subject availability study was performed, and 58 senior citizens (32 females and 26 males) between the ages of 65 years and 96 years participated. The physical activity index was determined with the Sharkey and Gaskill Physical activity index questionnaire. Functional fitness was measured using the Rikli and Jones Fullerton’s functional fitness test protocol. The static balance and dynamic balance was tested with the one leg balance eyes closed and functional reach test respectively. Descriptive statistics were used to describe the status of the participants. Two way summary tables were used to categorize the amount of weak test results. Partial correlations were used to determine the association between physical activity, functional fitness and static and dynamic balance. The male participants’ functional fitness status compared well with USA normal ranges, however the functional fitness test scores of the female participants were even lower than the older age group (75 to 79 years) of the USA normal ranges. The results of the frequency distribution indicated that 80.77% and 68.75% of the male and female participants respectively, tested poorly in more than four of the functional fitness tests. Neither the male nor the female participants’ static balance score were adequate, although it does not indicate a fall risk. Aerobic endurance showed to have medium (r = 0.3–0.49) to high (r 0.5) partial correlation with all functional fitness tests for the total group, as well as in the female participants. In the male participants aerobic endurance only showed high correlation (r 0.5) with lower body strength and dynamic balance and agility. Dynamic balance correlated well (r 0.5) with all functional fitness tests as well as aerobic endurance and physical activity index in the female participants, and only showed a medium correlation with agility in the male participants. This study showed alarming percentages of poor test results for both male and female senior citizens and highlights the need for physical activity interventions in old age homes. The correlations between aerobic endurance, as well as dynamic balance and functional fitness tests indicates that even simple interventions such as walking programs could enhance the functional fitness of senior citizens and thereby increase their independency. / Thesis (M.A. (Biokinetics))--North-West University, Potchefstroom Campus, 2011.

The purpose of this study was to explore the referrals that were generated from one hospital emergency room to a community outreach team. This study used a specific geriatric program assessment team in Winnipeg, Manitoba, Canada as the community outreach team. Malcolm Payne’s description of Task Centered Casework and Crisis Intervention and Irene Pollin’s Medical Crisis Counseling served as the theoretical structure and design to gain an understanding of the reasons geriatric patients were referred to the GPAT on discharge. This study aimed to answer three research questions: 1) What is the emergency room medical team’s main reason for referral to a geriatric outreach team? 2) Are the referrals received from the emergency room medical team clearly identifying psychosocial issues as areas for examination by an outreach team? 3) Are psychosocial issues identified only after an outreach team clinician completed a comprehensive assessment? This study revealed that out of the 209 referrals to geriatric program assessment team, the highest number of times referred was for functional decline. It revealed that the emergency room medical team saw functional decline as a valid reason to have the geriatric program assessment team assess the individual in their home settings to ensure that any functional issue be addressed and possible adaptations made in a timely manner to avoid the reverberation that one ailment can set off. The second most common reason for referring to the geriatric program assessment team was for social issues. Forty percent of the referrals identified that there were concerns in relation to social issues which clearly identifies that the emergency room medical team identified psychosocial issues as an area for further examination. And finally, the findings show psychosocial issues were not identified only after an outreach team clinician completed a comprehensive assessment, but that both appear cognizant of the interplay between medical issues and social issues.

During the past decades there has been an increase in longevity. These aging trends have an enormous economic impact and present challenges to policymakers, families, and health care providers to meet the needs of aging individuals. Aging is accompanied with various physiological changes that can limit the elderly’s functional status and their independency. Some of the most noticeable changes occur within the musculoskeletal system, however cardiorespiratory changes, as well as changes in the body composition limits the elderly’s aerobic capacity and therefore increases the risk for cardiovascular and hypokinetic diseases. Moderate physical activity reduces the risk, or prolong the onset of physiological changes and various diseases. Physical activity can also enhance functional fitness amongst the elderly. Functional fitness is having the physiologic capacity to perform normal everyday activities safely and independently without undue fatigue. The aim of this study was to determine the functional fitness as well as static balance and dynamic balance status of senior citizens. Secondly, to determine the association between: physical activity, aerobic endurance and functional fitness and status amongst senior citizens. Thirdly, to determine the association between physical activity status, aerobic endurance and static– and dynamic balance amongst elderly. A once off subject availability study was performed, and 58 senior citizens (32 females and 26 males) between the ages of 65 years and 96 years participated. The physical activity index was determined with the Sharkey and Gaskill Physical activity index questionnaire. Functional fitness was measured using the Rikli and Jones Fullerton’s functional fitness test protocol. The static balance and dynamic balance was tested with the one leg balance eyes closed and functional reach test respectively. Descriptive statistics were used to describe the status of the participants. Two way summary tables were used to categorize the amount of weak test results. Partial correlations were used to determine the association between physical activity, functional fitness and static and dynamic balance. The male participants’ functional fitness status compared well with USA normal ranges, however the functional fitness test scores of the female participants were even lower than the older age group (75 to 79 years) of the USA normal ranges. The results of the frequency distribution indicated that 80.77% and 68.75% of the male and female participants respectively, tested poorly in more than four of the functional fitness tests. Neither the male nor the female participants’ static balance score were adequate, although it does not indicate a fall risk. Aerobic endurance showed to have medium (r = 0.3–0.49) to high (r 0.5) partial correlation with all functional fitness tests for the total group, as well as in the female participants. In the male participants aerobic endurance only showed high correlation (r 0.5) with lower body strength and dynamic balance and agility. Dynamic balance correlated well (r 0.5) with all functional fitness tests as well as aerobic endurance and physical activity index in the female participants, and only showed a medium correlation with agility in the male participants. This study showed alarming percentages of poor test results for both male and female senior citizens and highlights the need for physical activity interventions in old age homes. The correlations between aerobic endurance, as well as dynamic balance and functional fitness tests indicates that even simple interventions such as walking programs could enhance the functional fitness of senior citizens and thereby increase their independency. / Thesis (M.A. (Biokinetics))--North-West University, Potchefstroom Campus, 2011.