[The first experiences from a dementia-unit at a geriatric department]

Traditionally, patients suffering from dementia are treated in psychiatric wards. In many geriatric patients, confusion/dementia is one of several problems prohibiting an early return to the previous way of living. To provide the best treatment, one of our geriatric wards was used for these patients. Based on our experiences from the first 58 patients discharged during the period 09.11.89-31.01.91, it was possible to create and secure a stable environment, with suitable activities for the satisfaction of the patients, their families and the staff. A structured procedure, including rating scales, was a great help in disclosing the patients' problems. One quarter of the patients were not demented, but temporarily confused due to other reasons. One third of the demented patients had no public assistance. It was necessary to discharge 60% of the demented and only 10% of the non-demented patients to nursing homes. Sheltered home-like living could be an alternative to the expensive nursing homes.

Submandibular salivary secretion in the cat and associated potassium movements: dependence on temperature and perfusate flow rate

Cat submandibular glands were perfused with Locke solution in a thermostated chamber and intermittently stimulated with 10(-5)M acetylcholine (ACh). In one series of experiments the perfusion pressure was varied within the range 90-60 mm Hg, and secretory flow rate, active K+-reuptake, passive K+-release, and resting and ACh-induced venous flow rates were measured. The ACh-induced secretory flow rate and the maximal K+-fluxes were related to the simultaneous ACh-induced venous flow rates. A proportionality was found between the maximal rate of ACh-induced K+-release and ACh-induced venous flow rates below 8 ml/min, while at higher flow rates the K+-release leveled off. The maximal rate of the post-stimulatory K+-reuptake increased proportionally to the ACh-induced perfusate flow rate throughout the range studied. The secretory flow rate was much less affected by changes in ACh-induced perfusate flow rate. In another series of experiments the gland temperature was varied within the range 12-37 degrees C, and the same parameters were measured. All parameters decreased with cooling being reduced to 50% of their 37 degrees C values at: 24 degrees C for secretion, 19 degrees C for K+-reuptake, and 14 degrees C for K+-release. It is concluded: that the rate of ACh-induced K+-release is limited by the ACh-induced perfusate flow rate (within the physiological range), the capacity of the K+-reuptake mechanism is at least one order of magnitude larger than the maximal rate of K+-reuptake in vivo, the marked temperature sensitivity of the secretory flow rate reflects the high complexity of the mechanisms involved.

Partial dissociation between salivary secretion and active potassium transport in the perfused cat submandibular gland

Isolated cat submandibular glands were perfused with Locke solutions in a thermostated chamber. Passive loss of potassium and uptake of sodium was achieved either by increasing the permeability of the cell membranes by acetylcholine (ACh) or by inhibiting the sodium-potassium pump reversibly by cooling or by removal of extracellular potassium. Irrespective of the way by which the cells were potassium depleted and sodium loaded, re-establishment of normal conditions was sufficient to cause an active net uptake of potassium (probably coupled to net extrusion of sodium). However, while ACh-induced changes in intracellular concentrations of monovalent cations were accompanied by salivary secretion, virtually no secretion was observed when normal conditions were re-established after concentration changes caused by inhibiting the sodium-potassium pump. It is concluded that while the transport mechanisms responsible for the maintenaance of the intracellular concentrations of monovalent cations undoubtedly is a (Na+-K+)-activated ATPase, the transport mechanism responsible for the formation of the primary saliva is probably of a different type, since it apparently is not directly activated by the intracellular sodium concentration.