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• W3026401275 abstract "Journal of the American Geriatrics SocietyVolume 51, Issue 5 p. 721-721 Free Access DEATH FROM PNEUMONIA IN PATIENTS WITH PROGRESSIVE DEMENTIA First published: 29 April 2003 https://doi.org/10.1034/j.1600-0579.2003.00221.xCitations: 2AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat To the Editor: Pneumonia is the major cause of death in demented patients. Recently, van der Steen et al. reported that short-time mortality after pneumonia was increased in patients with the most-severe dementia,1 and that it would be important to define confounding variables. Certainly, immune system capacity to respond to infection will be an important determinant for outcome. In the blood of otherwise healthy patients with various types of dementia, increased formation of neopterin and enhanced degradation of tryptophan were reported, both indicating cellular (Thelper1-type) immune system activation.2, 3 Expression of immune activation markers correlated with the severity of dementia,2, 3 and, in patients with Huntington's disease, higher neopterin levels and lower tryptophan levels were associated with earlier death.3 It has been demonstrated that indoleamine (2,3)-dioxygenase (IDO)2, 3 critically influences T-cell responsiveness.4 IDO is preferentially inducible by cytokine interferon-γ, and IDO is rate-limiting for the conversion of tryptophan to kynurenine outside the liver. Therefore, enhanced degradation of tryptophan accompanies T-cell activation, and tryptophan deficiency may develop. Diminished availability of tryptophan prevents T-cell response to infectious agents.4 Pneumonia is associated with immune activation,5 which may further diminish tryptophan availability in patients with dementia and thus prevent successful immune response against the infectious agent. Thus, the data of van der Steen et al. may support the view that tryptophan availability in patients with dementia is crucial for the outcome of pneumonia. If this is true, increased blood levels of neopterin and decreased tryptophan concentrations might predict the outcome of demented patients suffering from pneumonia. Gabriele Neurauter Dietmar Fuchs Institute of Medical Chemistry and Biochemistry University of Innsbruck Ludwig Boltzmann Institute of AIDS Research Innsbruck, Austria Barbara Wirleitner Institute of Medical Chemistry and Biochemistry University of Innsbruck Innsbruck, Austria REFERENCES 1 Van Der Steen JT, Ooms ME, Mehr DR et al. Severe dementia and adverse outcomes of nursing home-acquired pneumonia: Evidence for mediation by functional and pathophysiological decline. J Am Geriatr Soc 2002; 50: 439– 448. Wiley Online LibraryPubMedWeb of Science®Google Scholar 2 Widner B, Leblhuber F, Walli J et al. Tryptophan degradation and immune activation in Alzheimer's disease. J Neural Transm 2000; 107: 343– 353. CrossrefCASPubMedWeb of Science®Google Scholar 3 Leblhuber F, Walli J, Jellinger K et al. Activated immune system in patients with Huntington's disease. Clin Chem Lab Med 1998; 36: 747– 750. CrossrefCASPubMedWeb of Science®Google Scholar 4 Mellor AL, Munn DH. Tryptophan catabolism and T-cell tolerance: Immunosuppression by starvation? Immunol Today 1999; 20: 469– 473. CrossrefCASPubMedWeb of Science®Google Scholar 5 Denz H, Fuchs D, Hausen A et al. Value of urinary neopterin in the differential diagnosis of bacterial and viral infections. Klin Wochenschr 1990; 68: 218– 222. CrossrefCASPubMedWeb of Science®Google Scholar Citing Literature Volume51, Issue5May 2003Pages 721-721 ReferencesRelatedInformation" @default.
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• W3026401275 title "DEATH FROM PNEUMONIA IN PATIENTS WITH PROGRESSIVE DEMENTIA" @default.
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