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At the present time several techniques are available for studying
quantitatively global and regional blood flow and metabolism of the
human brain. How ever, many scientists working in the clinical and
research field who would like to use these tools for their
investigations may be less familiar with the indi cations and
limitations of the individual methods. The rapid development of
both modern imaging techniques and new tracers may have led to some
con fusion in answering the question as to which method is
appropriate to solve the diagnostic problem of an individuum with
brain disease. Scepticism and ignorance as to the methods to be
used as tools in differential diagnosis of brain disorders may have
prevented their widespread introduction into clinical practice.
Thus, the significance of circulatory and metabolic parameters
involved in the majority of diseases of the central nervous system
may have been overlooked. The contributions compiled in this book
describe in detail the individual techniques, outline their
indications and limitations and deal in particular with newer
methods such as the atraumatic 133Xe technique, stable xenon
tomogra phy, three-dimensional techniques such as 133Xe single
photon emission tomog raphy and N-isopropyl-P23-iodoamphetamine.
Positron emission tomography studies provide information on
function and metabolism, particularly that of oxygen and glucose,
in regional brain areas of interest. Nuclear magnetic reso nance
may be a promising method for studying metabolic parameters;
however, accurate circulation measurements can not be performed at
present."
Significant progress has doubtlessly been made in the field of cere
bral protection compared to earlier centuries, as recently reviewed
by Elisabeth Frost (6). She cites the recommendations for treat
ment of brain trauma by Areteus, a Greek physician of the second
century A. D. He expressed quite modem views with regard to the
need for prompt action considering complications that follow even
minor symptoms. He advised burr holes for evacuation of hema toma
in seizures, the use of diuretics and, most interestingly, also
hypothermia. German surgeons of the 17th century had little more to
offer than prescriptions of which the most effective constituent
was alcohol (10). Thus, Sir Astley Cooper was probably the next
surgeon to make noteworthy contributions when advising the use of
leeches to the temporal artery and other means of bleeding in stead
of surgical intervention in cases of raised intracranial pressure
(loc. cit. 6). Although our knowledge has greatly expanded during
the last two decades, extensive discussions have led to only few
conclusions. Promising results from animal studies were translated
to clinical sit uations only to yield controversial and sometimes
confusing results. Since the observations of Brierly (5) on
ischemic cell damage, im proved information on structural aspects,
probably even related to concomitant biochemical studies, should
allow the validity of thera peutic concepts to be verified.
Investigations on cerebral ischemia have led to the differentiation
of synaptic transmission failure and membrane failure."
Infirmity, that decays the wise, doth ever make the better fool
William.Shakespeare, Twelfth Night 1,5 Since antiquity, it has been
a dream of mankind to live in eternal youth and thus to attain
longevity. Gods and heroes of the myths of many European cultures
were always repre sented as young. Their youth was one of their
most remark able attributes, and eternal youth given to a human
being from a god was the greatest act of grace. This age old dream
of mankind is demonstrated very graphically in one of the most
impressive paintings of the Middle Ages, the famous "Jungbrunnen"
(Fountain of Youth) by Lucas Cranach. During recent decades,
progress in medical and social areas has increased life expectancy
at least in the highly developed countries. Although this longevity
does not mean eternal youth, it obviously fulfills the ancient
desire of mankind. However, to live longer and longer and thus to
become older and older also means to live in infirmity over a
longer period of life. If progress in medical science continues at
the present rate, longevity will as seems inevitable, increase
further. At least at this stage, problems of aging might become as
important as problems of development."
"Inhaltliche Information" Der internationale Geriatrie-Kongre 1990
in Berlin hatte das Problem der Demenz zum Gegenstand. Demenz wurde
hier als jene Herausforderung gesehen, die sie f}r Medizin,
Forschung und Gesellschaft darstellt. Dabei bestand das Bem}hen,
jener Vielschichtigkeit, in der sich das Problem der Demenz
darstellt, auch durch die einzelnen Beitr{ge Rechnung zu tragen.
Dieses Buch, das nun in }berarbeiteter Form die wesentlichen
Inhalte aus diesem Kongre wiedergibt, gibt nicht nur neueste
Forschungsergebnisse wieder, etwa }ber pathogenetische Mechanismen
und Ans{tze der Forschung auf dem Gebiet der Nootropika, ebenso zu
deren Pharmakologie, sondern berichtet ebenso }ber klinische
Pr}fmodelle und Beurteilungskriterien von Me methoden f}r die
Evaluation der Wirksamkeit von Nootropika. In anderen Beitr{gen
wird weit }ber diesen ersten Ansatz hinausgegangen,
epidemiologische und sozial-medizinische Fragen werden dargestellt
wie auch psychopathologische und diagnostische Probleme. Fragen der
Versorgung von Demenzkranken und die Kriterien daf}r, des Umgangs
mit dem dementen Patienten und die F-rderung von Selbst{ndigkeit in
verschiedenen Institutionen werden ebenso ber}hrtwie die
anthropologischen Aspekte des Alters und der Demenz.
Dementsprechendwerden auch ehtische Fragen im Zusammenhang mit den
Rechten {lterer Menschenund psychotherapeutische Zugangswege zu
ihnen angesprochen. Gerade wegendieser inhaltlichen Breite d}rfte
das Buch f}r alle die Bedeutung gewinnen, die den alten und
dementen alten Menschen }ber Therapie und Versorgung hinaus Hilfe
anbieten wollen.
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