31 research outputs found
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Association of subjective memory complaints with subsequent cognitive decline in community-dwelling elderly individuals with baseline cognitive impairment
OBJECTIVE: The validity of subjective memory complaints has been questioned by clinical studies that have shown little relationship between memory complaints and objective memory performance. These studies often have been cross-sectional in design, have excluded individuals with cognitive impairment, or have lacked a comparison group. The authors conducted a study that attempted to avoid these limitations. METHOD: Memory complaints of 364 nondemented, community- dwelling elderly individuals were recorded as present or absent at the baseline evaluation. After 1 year, 169 subjects were reevaluated. Standardized neurologic and neuropsychological evaluations were used at each assessment to classify subjects as normal or cognitively impaired. RESULTS: At baseline, 31% of the normal subjects and 47% of those with cognitive impairment had memory complaints. Subjects with memory complaints had higher Hamilton depression scale scores than subjects without memory complaints but equivalent scores on a measure of total recall. At follow-up, multivariate analyses showed that subjects with baseline memory complaints had significantly greater decline in memory and cognition than subjects without memory complaints. Secondary analyses showed this effect to be confined to subjects with baseline cognitive impairment. CONCLUSIONS: Memory complaints may lack validity in subjects with normal cognition, but in nondemented individuals with cognitive impairment, memory complaints may predict subsequent cognitive decline
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Neurologic consequences of HTLV-II infection in injection-drug users
Several case reports have suggested an association between human T-cell lymphotropic virus type II (HTLV-II) infection and chronic neurologic disease. We performed serial neurologic examinations in injection-drug users (IDU), a group known to be at increased risk for HTLV-II infection. At baseline, those infected with HTLV-II alone, human immunodeficiency virus (HIV) alone, or both were significantly more likely to have neurologic disability than uninfected subjects. Longitudinally, HTLV-II infection was independently associated with the development of global neurologic disability and neuropathy, suggesting that HTLV-II causes neurologic disease
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Serial MRI in HIV Infection With and Without Neurologic Impairment
To assess the relationship of longitudinal brain magnetic resonance imaging (MRI) and infection with human immunodeficiency virus (HIV), a cohort of HIV+ and HIV− gay men and injection drug users (IDU) were evaluated prospectively. Subjects underwent two evaluations including MRI scans, neurologic examinations, neuropsychological assessments and lymphocyte subset determinations one year apart. MRI changes over a one year period were analyzed with respect to serostatus, risk group, CD4 counts, neurological findings and neuropsychological performance. The frequency of MRI changes was no different in subjects with or without HIV infection and no new opportunistic infections or neoplasms were seen. However, among HIV+ subjects with CD4 count < 200 at the time of the initial scan, an increase in white matter hyperintensities was significantly more common. Also among HIV+ subjects, atrophy increased in association with declining CD4 count. Finally, subjects who developed significant neurologic deterioration in one year were much more likely to have increased atrophy. These results suggest that while there are morphological brain changes associated with HIV infection, they are most often seen in association with immunologic or neurologic deterioration
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Gender Differences in HIV-Related Neurological Progression in a Cohort of Injecting Drug Users Followed for 3.5 Years
We evaluated potential gender differences in the development of HIV related neurologic impairment, by matching 38 pairs of HIV positive male and female injecting drug users on their baseline age, education, disease stage and CD4 counts, and following them for 3.5 years. Adjusting for age, education, drug use, history of head injury and baseline CD4 count, more women had sensory abnormalities and symptoms than men at baseline, but the odds of having neurological impairment, particularly extrapyramidal signs and sensory abnormalities were increased over time in men but not in women. Men with ARC or AIDS had more neurological impairment than women in similar stages of illness. This study suggests further investigations of gender differences in HIV disease progression
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A Standardized Technique for Establishing Onset and Duration of Symptoms of Alzheimer's Disease
Objectives: To develop an informant-based semistructured interview to determine the onset and duration of symptoms of Alzheimer's disease, and to use this instrument with informants to characterize a cohort of mildly impaired patients with Alzheimer's disease.
Design: In study 1, interrater and interinformant reliability was examined for the date of onset and the order of appearance for specific symptoms that were elicited by the semistructured onset interview. In study 2, the instrument was used to characterize disease onset in a cohort of patients with Alzheimer's disease who were participating in a large multicenter study.
Subjects: Informants of patients with Alzheimer's disease.
Results: In study 1, interrater reliability for duration of illness was excellent (intraclass correlation coefficient=.99, P<.001), and interinformant reliability was good (intraclass correlation coefficient=.86, P<.001). Agreement for the presence of a given symptom was highest for those that were most commonly reported (eg, memory and performance difficulty). In study 2, 89% of the cohort had memory problems, and 63.9% had performance difficulties as the first or second symptom. Depression and language problems were less commonly reported. Psychosis and behavioral disturbances were rarely reported as the first problem.
Conclusion: This instrument provides a reliable procedure for standardizing the estimation of duration of illness based on retrospective report
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Cognitive function in nondemented older women who took estrogen after menopause
Investigations of the effects of estrogen replacement on cognitive function in healthy older women have yielded disparate results. We evaluated the relationship between a history of estrogen use and cognitive test performance in 727 women participating in a large community-based study. Participants were followed longitudinally for an average of 2.5 years. Estrogen use history was obtained at baseline. Standardized tests of memory, language, and abstract reasoning were administered at baseline and at follow-up. Results indicate that women who had used estrogen replacement scored significantly higher on cognitive testing at baseline than nonusers, and their performance on verbal memory improved slightly over time. The effect of estrogen on cognition was independent of age, education, ethnicity, and APOE genotype. Results suggest that estrogen replacement therapy may help to maintain cognitive function in nondemented postmenopausal women