Loading…

The Progression of Alzheimer’s Disease from Limbic Regions to the Neocortex: Clinical, Radiological and Pathological Relationships

Alzheimer’s disease (AD) is characterised by the gradual accumulation of neurofibrillary pathology in selected regions of the brain. Earlier studies indicate that the accumulation of neurofibrillary tangles is associated both with decline in patient’s cognitive performance as well as with medial tem...

Full description

Saved in:
Bibliographic Details
Published in:Dementia and geriatric cognitive disorders 1999-03, Vol.10 (2), p.115-120
Main Authors: Nagy, Zs, Hindley, N.J., Braak, H., Braak, E., Yilmazer-Hanke, D.M., Schultz, C., Barnetson, L., King, E.M.-F., Jobst, K.A., Smith, A.D.
Format: Article
Language:English
Subjects:
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
cited_by cdi_FETCH-LOGICAL-c415t-3624101d0b37004802f9970169be9656eb2ee15f4e17e7ce2dd23a2e0e01b59d3
cites cdi_FETCH-LOGICAL-c415t-3624101d0b37004802f9970169be9656eb2ee15f4e17e7ce2dd23a2e0e01b59d3
container_end_page 120
container_issue 2
container_start_page 115
container_title Dementia and geriatric cognitive disorders
container_volume 10
creator Nagy, Zs
Hindley, N.J.
Braak, H.
Braak, E.
Yilmazer-Hanke, D.M.
Schultz, C.
Barnetson, L.
King, E.M.-F.
Jobst, K.A.
Smith, A.D.
description Alzheimer’s disease (AD) is characterised by the gradual accumulation of neurofibrillary pathology in selected regions of the brain. Earlier studies indicate that the accumulation of neurofibrillary tangles is associated both with decline in patient’s cognitive performance as well as with medial temporal lobe atrophy on CT scans. There are also indications that progression through the pathological stages of AD is associated with decline in cognitive functions. The results of this study indicate that progression of disease, especially beyond the boundaries of the limbic regions, is associated with marked decline in the cognitive performance of patients suffering from AD. However the clinical manifestations of early pathological stages are not so well defined. We also found that the atrophy of the medial temporal lobe on CT scans is related to the progression of pathology. Atrophy is most apparent when the disease reaches its isocortical stages and is not marked in the limbic stages of the disease. The additive effect of pathologies co-existing with AD is apparent in reduced cognitive scores, while the atrophy of limbic structures, as measured on CT scans, seems to be mainly attributable to AD-related pathology.
doi_str_mv 10.1159/000017111
format article
fullrecord <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_crossref_primary_10_1159_000017111</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>69592219</sourcerecordid><originalsourceid>FETCH-LOGICAL-c415t-3624101d0b37004802f9970169be9656eb2ee15f4e17e7ce2dd23a2e0e01b59d3</originalsourceid><addsrcrecordid>eNqF0c1u1DAQAGALgegPHDgjIQshJCQCM07sxNyqbSlIC1Srco6cZLLrksSLnZUKJw59ib4eT1Jvd7VFCAlf_Pd5PPYw9gThDaLUbyE2zBHxHtvHTGCiC5Hdvx1DUgAUe-wghIuocqn0Q7aHAEKlhdxnV-cL4mfezT2FYN3AXcuPup8Lsj3537-uAz-2gUwg3nrX86ntK1vzGc2jDXx0fIznP5OrnR_p8h2fdHawtele85lprOvcfD3jZmj4mRkXu4UZdWZcx1jYZXjEHrSmC_R42x-yr-9PzicfkumX04-To2lSZyjHJFUiQ8AGqjQHyAoQrdY5oNIVaSUVVYIIZZsR5pTXJJpGpEYQEGAldZMespebuEvvvq8ojGVvQ01dZwZyq1AqLbUQqP8LBWgBQqcRPv8LXriVH-IjSpEKGf87w4hebVDtXQie2nLpbW_8jxKhXBew3BUw2mfbgKuqp-YPualYBC-2wIT4ka03Q23DnVOFgkzdJfbN-Dn53f7xyafbi8pl00b09J9ok8oN9Zi2xQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>232507541</pqid></control><display><type>article</type><title>The Progression of Alzheimer’s Disease from Limbic Regions to the Neocortex: Clinical, Radiological and Pathological Relationships</title><source>Social Science Premium Collection</source><creator>Nagy, Zs ; Hindley, N.J. ; Braak, H. ; Braak, E. ; Yilmazer-Hanke, D.M. ; Schultz, C. ; Barnetson, L. ; King, E.M.-F. ; Jobst, K.A. ; Smith, A.D.</creator><creatorcontrib>Nagy, Zs ; Hindley, N.J. ; Braak, H. ; Braak, E. ; Yilmazer-Hanke, D.M. ; Schultz, C. ; Barnetson, L. ; King, E.M.-F. ; Jobst, K.A. ; Smith, A.D.</creatorcontrib><description>Alzheimer’s disease (AD) is characterised by the gradual accumulation of neurofibrillary pathology in selected regions of the brain. Earlier studies indicate that the accumulation of neurofibrillary tangles is associated both with decline in patient’s cognitive performance as well as with medial temporal lobe atrophy on CT scans. There are also indications that progression through the pathological stages of AD is associated with decline in cognitive functions. The results of this study indicate that progression of disease, especially beyond the boundaries of the limbic regions, is associated with marked decline in the cognitive performance of patients suffering from AD. However the clinical manifestations of early pathological stages are not so well defined. We also found that the atrophy of the medial temporal lobe on CT scans is related to the progression of pathology. Atrophy is most apparent when the disease reaches its isocortical stages and is not marked in the limbic stages of the disease. The additive effect of pathologies co-existing with AD is apparent in reduced cognitive scores, while the atrophy of limbic structures, as measured on CT scans, seems to be mainly attributable to AD-related pathology.</description><identifier>ISSN: 1420-8008</identifier><identifier>EISSN: 1421-9824</identifier><identifier>DOI: 10.1159/000017111</identifier><identifier>PMID: 10026385</identifier><identifier>CODEN: DGCDFX</identifier><language>eng</language><publisher>Basel, Switzerland: Karger</publisher><subject>Aged ; Alzheimer Disease - diagnostic imaging ; Alzheimer Disease - pathology ; Alzheimer Disease - psychology ; Biological and medical sciences ; Cognition ; Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases ; Disease Progression ; Female ; Humans ; Limbic System - diagnostic imaging ; Limbic System - pathology ; Male ; Medical sciences ; Memory ; Neocortex - diagnostic imaging ; Neocortex - pathology ; Neurofibrillary Tangles - pathology ; Neurology ; Neuropsychological Tests ; Original Research Article ; Prospective Studies ; Severity of Illness Index ; Temporal Lobe - pathology ; Tomography, X-Ray Computed</subject><ispartof>Dementia and geriatric cognitive disorders, 1999-03, Vol.10 (2), p.115-120</ispartof><rights>1999 S. Karger AG, Basel</rights><rights>1999 INIST-CNRS</rights><rights>Copyright S. Karger AG Mar/Apr 1999</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c415t-3624101d0b37004802f9970169be9656eb2ee15f4e17e7ce2dd23a2e0e01b59d3</citedby><cites>FETCH-LOGICAL-c415t-3624101d0b37004802f9970169be9656eb2ee15f4e17e7ce2dd23a2e0e01b59d3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.proquest.com/docview/232507541/fulltextPDF?pq-origsite=primo$$EPDF$$P50$$Gproquest$$H</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/232507541?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>315,786,790,21422,27957,27958,33646,33647,43768,74578</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&amp;idt=1686046$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/10026385$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Nagy, Zs</creatorcontrib><creatorcontrib>Hindley, N.J.</creatorcontrib><creatorcontrib>Braak, H.</creatorcontrib><creatorcontrib>Braak, E.</creatorcontrib><creatorcontrib>Yilmazer-Hanke, D.M.</creatorcontrib><creatorcontrib>Schultz, C.</creatorcontrib><creatorcontrib>Barnetson, L.</creatorcontrib><creatorcontrib>King, E.M.-F.</creatorcontrib><creatorcontrib>Jobst, K.A.</creatorcontrib><creatorcontrib>Smith, A.D.</creatorcontrib><title>The Progression of Alzheimer’s Disease from Limbic Regions to the Neocortex: Clinical, Radiological and Pathological Relationships</title><title>Dementia and geriatric cognitive disorders</title><addtitle>Dement Geriatr Cogn Disord</addtitle><description>Alzheimer’s disease (AD) is characterised by the gradual accumulation of neurofibrillary pathology in selected regions of the brain. Earlier studies indicate that the accumulation of neurofibrillary tangles is associated both with decline in patient’s cognitive performance as well as with medial temporal lobe atrophy on CT scans. There are also indications that progression through the pathological stages of AD is associated with decline in cognitive functions. The results of this study indicate that progression of disease, especially beyond the boundaries of the limbic regions, is associated with marked decline in the cognitive performance of patients suffering from AD. However the clinical manifestations of early pathological stages are not so well defined. We also found that the atrophy of the medial temporal lobe on CT scans is related to the progression of pathology. Atrophy is most apparent when the disease reaches its isocortical stages and is not marked in the limbic stages of the disease. The additive effect of pathologies co-existing with AD is apparent in reduced cognitive scores, while the atrophy of limbic structures, as measured on CT scans, seems to be mainly attributable to AD-related pathology.</description><subject>Aged</subject><subject>Alzheimer Disease - diagnostic imaging</subject><subject>Alzheimer Disease - pathology</subject><subject>Alzheimer Disease - psychology</subject><subject>Biological and medical sciences</subject><subject>Cognition</subject><subject>Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases</subject><subject>Disease Progression</subject><subject>Female</subject><subject>Humans</subject><subject>Limbic System - diagnostic imaging</subject><subject>Limbic System - pathology</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Memory</subject><subject>Neocortex - diagnostic imaging</subject><subject>Neocortex - pathology</subject><subject>Neurofibrillary Tangles - pathology</subject><subject>Neurology</subject><subject>Neuropsychological Tests</subject><subject>Original Research Article</subject><subject>Prospective Studies</subject><subject>Severity of Illness Index</subject><subject>Temporal Lobe - pathology</subject><subject>Tomography, X-Ray Computed</subject><issn>1420-8008</issn><issn>1421-9824</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1999</creationdate><recordtype>article</recordtype><sourceid>ALSLI</sourceid><sourceid>M2R</sourceid><recordid>eNqF0c1u1DAQAGALgegPHDgjIQshJCQCM07sxNyqbSlIC1Srco6cZLLrksSLnZUKJw59ib4eT1Jvd7VFCAlf_Pd5PPYw9gThDaLUbyE2zBHxHtvHTGCiC5Hdvx1DUgAUe-wghIuocqn0Q7aHAEKlhdxnV-cL4mfezT2FYN3AXcuPup8Lsj3537-uAz-2gUwg3nrX86ntK1vzGc2jDXx0fIznP5OrnR_p8h2fdHawtele85lprOvcfD3jZmj4mRkXu4UZdWZcx1jYZXjEHrSmC_R42x-yr-9PzicfkumX04-To2lSZyjHJFUiQ8AGqjQHyAoQrdY5oNIVaSUVVYIIZZsR5pTXJJpGpEYQEGAldZMespebuEvvvq8ojGVvQ01dZwZyq1AqLbUQqP8LBWgBQqcRPv8LXriVH-IjSpEKGf87w4hebVDtXQie2nLpbW_8jxKhXBew3BUw2mfbgKuqp-YPualYBC-2wIT4ka03Q23DnVOFgkzdJfbN-Dn53f7xyafbi8pl00b09J9ok8oN9Zi2xQ</recordid><startdate>19990301</startdate><enddate>19990301</enddate><creator>Nagy, Zs</creator><creator>Hindley, N.J.</creator><creator>Braak, H.</creator><creator>Braak, E.</creator><creator>Yilmazer-Hanke, D.M.</creator><creator>Schultz, C.</creator><creator>Barnetson, L.</creator><creator>King, E.M.-F.</creator><creator>Jobst, K.A.</creator><creator>Smith, A.D.</creator><general>Karger</general><general>S. Karger AG</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>0-V</scope><scope>3V.</scope><scope>7RV</scope><scope>7TK</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88G</scope><scope>88I</scope><scope>88J</scope><scope>8AF</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ALSLI</scope><scope>AN0</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M2M</scope><scope>M2P</scope><scope>M2R</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PSYQQ</scope><scope>Q9U</scope><scope>S0X</scope><scope>7X8</scope></search><sort><creationdate>19990301</creationdate><title>The Progression of Alzheimer’s Disease from Limbic Regions to the Neocortex: Clinical, Radiological and Pathological Relationships</title><author>Nagy, Zs ; Hindley, N.J. ; Braak, H. ; Braak, E. ; Yilmazer-Hanke, D.M. ; Schultz, C. ; Barnetson, L. ; King, E.M.-F. ; Jobst, K.A. ; Smith, A.D.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c415t-3624101d0b37004802f9970169be9656eb2ee15f4e17e7ce2dd23a2e0e01b59d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1999</creationdate><topic>Aged</topic><topic>Alzheimer Disease - diagnostic imaging</topic><topic>Alzheimer Disease - pathology</topic><topic>Alzheimer Disease - psychology</topic><topic>Biological and medical sciences</topic><topic>Cognition</topic><topic>Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases</topic><topic>Disease Progression</topic><topic>Female</topic><topic>Humans</topic><topic>Limbic System - diagnostic imaging</topic><topic>Limbic System - pathology</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Memory</topic><topic>Neocortex - diagnostic imaging</topic><topic>Neocortex - pathology</topic><topic>Neurofibrillary Tangles - pathology</topic><topic>Neurology</topic><topic>Neuropsychological Tests</topic><topic>Original Research Article</topic><topic>Prospective Studies</topic><topic>Severity of Illness Index</topic><topic>Temporal Lobe - pathology</topic><topic>Tomography, X-Ray Computed</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Nagy, Zs</creatorcontrib><creatorcontrib>Hindley, N.J.</creatorcontrib><creatorcontrib>Braak, H.</creatorcontrib><creatorcontrib>Braak, E.</creatorcontrib><creatorcontrib>Yilmazer-Hanke, D.M.</creatorcontrib><creatorcontrib>Schultz, C.</creatorcontrib><creatorcontrib>Barnetson, L.</creatorcontrib><creatorcontrib>King, E.M.-F.</creatorcontrib><creatorcontrib>Jobst, K.A.</creatorcontrib><creatorcontrib>Smith, A.D.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Social Sciences Premium Collection【Remote access available】</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing &amp; Allied Health Database</collection><collection>Neurosciences Abstracts</collection><collection>Health &amp; Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Psychology Database (Alumni)</collection><collection>Science Database (Alumni Edition)</collection><collection>Social Science Database (Alumni Edition)</collection><collection>STEM Database</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>Social Science Premium Collection</collection><collection>British Nursing Database</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>Health &amp; Medical Collection (Alumni Edition)</collection><collection>PML(ProQuest Medical Library)</collection><collection>Psychology Database</collection><collection>Science Database</collection><collection>Social Science Database</collection><collection>Nursing &amp; Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest One Psychology</collection><collection>ProQuest Central Basic</collection><collection>SIRS Editorial</collection><collection>MEDLINE - Academic</collection><jtitle>Dementia and geriatric cognitive disorders</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Nagy, Zs</au><au>Hindley, N.J.</au><au>Braak, H.</au><au>Braak, E.</au><au>Yilmazer-Hanke, D.M.</au><au>Schultz, C.</au><au>Barnetson, L.</au><au>King, E.M.-F.</au><au>Jobst, K.A.</au><au>Smith, A.D.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The Progression of Alzheimer’s Disease from Limbic Regions to the Neocortex: Clinical, Radiological and Pathological Relationships</atitle><jtitle>Dementia and geriatric cognitive disorders</jtitle><addtitle>Dement Geriatr Cogn Disord</addtitle><date>1999-03-01</date><risdate>1999</risdate><volume>10</volume><issue>2</issue><spage>115</spage><epage>120</epage><pages>115-120</pages><issn>1420-8008</issn><eissn>1421-9824</eissn><coden>DGCDFX</coden><notes>ObjectType-Article-2</notes><notes>SourceType-Scholarly Journals-1</notes><notes>ObjectType-Feature-1</notes><notes>content type line 23</notes><notes>ObjectType-Article-1</notes><notes>ObjectType-Feature-2</notes><abstract>Alzheimer’s disease (AD) is characterised by the gradual accumulation of neurofibrillary pathology in selected regions of the brain. Earlier studies indicate that the accumulation of neurofibrillary tangles is associated both with decline in patient’s cognitive performance as well as with medial temporal lobe atrophy on CT scans. There are also indications that progression through the pathological stages of AD is associated with decline in cognitive functions. The results of this study indicate that progression of disease, especially beyond the boundaries of the limbic regions, is associated with marked decline in the cognitive performance of patients suffering from AD. However the clinical manifestations of early pathological stages are not so well defined. We also found that the atrophy of the medial temporal lobe on CT scans is related to the progression of pathology. Atrophy is most apparent when the disease reaches its isocortical stages and is not marked in the limbic stages of the disease. The additive effect of pathologies co-existing with AD is apparent in reduced cognitive scores, while the atrophy of limbic structures, as measured on CT scans, seems to be mainly attributable to AD-related pathology.</abstract><cop>Basel, Switzerland</cop><pub>Karger</pub><pmid>10026385</pmid><doi>10.1159/000017111</doi><tpages>6</tpages></addata></record>
fulltext fulltext
identifier ISSN: 1420-8008
ispartof Dementia and geriatric cognitive disorders, 1999-03, Vol.10 (2), p.115-120
issn 1420-8008
1421-9824
language eng
recordid cdi_crossref_primary_10_1159_000017111
source Social Science Premium Collection
subjects Aged
Alzheimer Disease - diagnostic imaging
Alzheimer Disease - pathology
Alzheimer Disease - psychology
Biological and medical sciences
Cognition
Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases
Disease Progression
Female
Humans
Limbic System - diagnostic imaging
Limbic System - pathology
Male
Medical sciences
Memory
Neocortex - diagnostic imaging
Neocortex - pathology
Neurofibrillary Tangles - pathology
Neurology
Neuropsychological Tests
Original Research Article
Prospective Studies
Severity of Illness Index
Temporal Lobe - pathology
Tomography, X-Ray Computed
title The Progression of Alzheimer’s Disease from Limbic Regions to the Neocortex: Clinical, Radiological and Pathological Relationships
url http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-09-21T10%3A59%3A32IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=The%20Progression%20of%20Alzheimer%E2%80%99s%20Disease%20from%20Limbic%20Regions%20to%20the%20Neocortex:%20Clinical,%20Radiological%20and%20Pathological%20Relationships&rft.jtitle=Dementia%20and%20geriatric%20cognitive%20disorders&rft.au=Nagy,%20Zs&rft.date=1999-03-01&rft.volume=10&rft.issue=2&rft.spage=115&rft.epage=120&rft.pages=115-120&rft.issn=1420-8008&rft.eissn=1421-9824&rft.coden=DGCDFX&rft_id=info:doi/10.1159/000017111&rft_dat=%3Cproquest_cross%3E69592219%3C/proquest_cross%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-c415t-3624101d0b37004802f9970169be9656eb2ee15f4e17e7ce2dd23a2e0e01b59d3%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_pqid=232507541&rft_id=info:pmid/10026385&rfr_iscdi=true