322 research outputs found
Recommended from our members
Heterogeneity and Prognosis in Dementia of the Alzheimer Type
The diagnosis of dementia of the Alzheimer type (DAT) depends on the clinician's ability to document intellectual impairment in the patient and to exclude other causes of dementia. About 50% of all demented patients entering a hospital are ultimately found at postmortem examination to have Alzheimer's disease. However, using the most rigorous criteria the accuracy of correct clinical diagnosis at autopsy approaches only 80-90% and this excludes some unusual patients. Most investigators use the Diagnostic and Statistical Manual of Mental Disorder-third ed. (DSM-III) criteria for dementia, a rating of performance in activities of daily living, and an assessment of personality and intellectual function for diagnosis. Two clinical rating scales: the Blessed Dementia Rating Scale (parts 1 and 2) and the Clinical Dementia Rating Scale, are used frequently and seem to identify patients with DAT with greater accuracy than other scales
Recommended from our members
Comparison of Cognitive Changes in Patients with Alzheimer's and Parkinson's Disease
Objective. —To compare cognitive changes in the dementias of Parkinson's disease (PD) and Alzheimer's disease (AD). Design. —Case series, group comparisons. Setting. —Ambulatory care referral center. Patients. —Consecutive sample of 14 patients with PD dementia and 27 with probable AD matched for overall intellectual function using a mental status test, as well as 1 nondemented PD and 12 mild probable AD patients, similarly matched for overall intellectual function. All demented patients met Diagnostic and Statistical Manual, Revised Third Edition, criteria for dementia. Main Outcome Measures. —Performance on a battery of neuropsychological tests assessing verbal and nonverbal memory, verbal fluency, and constructional ability. Results. —Nondemented and demented patients with PD performed worse than their probable AD comparison groups on verbal fluency and visuospatial tasks. Cognitive changes attributable to dementia were similar in PD and probable AD but were not identical. The patients with probable AD demonstrated more marked change in memory performance with delay. Conclusions. —Our findings suggest that when dementia occurs in PD it is overlaid on cognitive changes that already exist in nondemented patients but that the dementing process in PD involves systems other than those responsible for cognitive change in nondemented PD patients. We hypothesize that in most cases, dementia in PD involves changes in a nondopaminergic neurotransmitter system but is not due to concomitant AD
Recommended from our members
Normative Data for a Brief Neuropsychological Battery Administered to English- and Spanish-Speaking Community-Dwelling Elders
The use of neuropsychological tests in non-English-speaking populations and among those with less education has been limited because most tests have been standardized for English-speaking populations with relatively high levels of education. In effort to establish norms, a battery of neuropsychological tests was administered, in either English or Spanish, to 995 normal elders with a wide range of educational attainment, residing in the community of Washington Heights–Inwood in northern Manhattan. Results indicate that age, education, and language all influence test performance and should be considered when evaluating neuropsychological measures
Recommended from our members
Cumulative Risks of Developing Extrapyramidal Signs, Psychosis, or Myoclonus in the Course of Alzheimer's Disease
Cumulative risks of developing extrapyramidal signs, psychosis, and myoclonus in the course of Alzheimer's disease (AD) were estimated in 72 patients with probable AD by the Kaplan-Meier survival method. The cumulative risk functions were found to increase at different rates for different signs as AD progressed. Comparisons of the cumulative risk functions revealed that in the early stages of AD, extrapyramidal signs and psychosis were more likely to develop than myoclonus. As AD progressed, the risk of developing myoclonus became as great as that of developing the other two signs. This study suggests that extrapyramidal signs, psychosis, and myoclonus represent developmental features that mark the progression of AD, rather than indicators of disease subtypes. The estimated cumulative risk functions set a reasonable expectation for the timing and likelihood of the emergence of the clinical signs. This, in turn, might aid in disease prognosis because the biological bases of these signs have been established and they have been shown to be predictive of other markers of disease course
Recommended from our members
Risk of Dementia in First-Degree Relatives of Patients with Alzheimer's Disease and Related Disorders
First-degree relatives of patients with Alzheimer's disease (AD) are at greater risk for dementia when compared with the relatives of their healthy peers, but not when compared with the relatives of patients with Parkinson's disease. This may indicate that the risk of dementia in these relatives is not specific to AD or that these studies are biased. We obtained a family history and vital status information on each first-degree relative of patients attending a clinic and in a group of recruited healthy elderly subjects. Patients formed two groups: probable AD and other forms of dementia or cognitive disorders without dementia. The odds of dementia in first-degree relatives did not differ between patient groups. The odds of dementia in relatives of patients with probable AD or other forms of dementia was six times that in the relatives of the healthy elderly subjects. The cumulative incidence of dementia increased with age in the first-degree relatives of all subjects. Approximately 50% of the first-degree relatives of patients with AD were demented by age 91 years, but almost the same number of the other patient group's relatives were demented as well. That figure was never reached in the healthy elderly subject's relatives. Because the risk of dementia in first-degree relatives of patients with AD was similar to that for patients with other disorders, we cannot exclude the possibility that this is the result of selection and information biases. Our investigation implies that the increased risk of dementia may not be specific to relatives of patients with AD; the risk may also be increased in first-degree relatives of patients with other neurologic disorders
Recommended from our members
Predictors of Disease Course in Patients with Probable Alzheimer's Disease
The presence of extrapyramidal signs or psychosis may indicate greater disability in patients with probable Alzheimer's disease. We evaluated the ability of these signs, noted at a patient's first visit, to predict one of two specific clinical endpoints: (1) a preselected score on the modified Mini-Mental State examination (cognitive endpoint), and (2) a preselected score on the Blessed Dementia Rating Scale (functional endpoint). Sixty-five patients were followed either until they reached the endpoints or to the end of the study period. Survivorship curves were drawn to predict the distribution of time to onset of an endpoint in patients with and without the clinical signs. Time to reach the cognitive endpoint was shorter for patients with extrapyramidal signs or psychosis compared with those without these signs and symptoms. These clinical signs did not predict the functional endpoint. We conclude that extrapyramidal signs and psychosis may be useful predictors of intellectual decline in Alzheimer's disease
Recommended from our members
The Validity of New Memory Complaints in the Elderly
Objective: To determine the validity of new subjective memory complaints (MCs) from individuals who previously, when without dementia, denied having MCs. Design: Prospective cohort. Setting: Longitudinal, community-based study of aging and dementia. Patients: One hundred thirty-three communitydwelling elderly individuals who were part of a registry for the study of conditions related to aging in North Manhattan, NY. Patients were selected if they were initially without dementia and had completed at least 2 successive annual clinical and neuropsychological evaluations and provided their own medical history. Main Outcome Measures: Performance on memory tests—the Buschke Selective Reminding Test and a visual memory task—and global performance on a neuropsychological test battery and clinical evaluation, by which questionable dementia or dementia was diagnosed according to a well-defined paradigm. Results: Fifty-three subjects with MCs at the initial evaluation performed no worse on the memory test than the 80 subjects who denied MCs initially. There was a weak association between MCs and the diagnosis of questionable dementia at baseline (P=.04), but this was nonsignificant after adjusting for age and education. At 1-year follow-up, 21 of the 80 without baseline MCs now reported MCs. At the follow-up evaluation, these 21 subjects performed significantly worse on the memory tests, were 5 times more likely to have significant cognitive impairment, and had shown significantly greater decline over the preceding year on several of the cognitive measures than the 59 who continued to deny MCs. Conclusion: New MCs from individuals, who when without dementia recently denied MCs, may suggest the presence of significant impairment of memory or cognition
Recommended from our members
Neuropsychological Detection and Characterization of Preclinical Alzheimer's Disease
We attempted to characterize the changes in cognition associated with the earliest, or preclinical, stages of Alzheimer's disease (AD) by administering a comprehensive neuropsychological test battery to a group of initially nondemented older adults participating in a prospective epidemiologic study of dementia. Using Cox regression analyses, we examined the associations between baseline neuropsychological test scores and subsequent development of AD. Results confirmed preliminary findings that baseline scores on the Boston Naming Test, Immediate Recall on the Selective Reminding Test, and the Similarities subtest of the Wechsler Adult Intelligence Scale-Revised were significantly and independently associated with later diagnosis of AD. Analyses controlled for the effects of age, education, sex, and language of test administration. These results lend support to the notion of a preclinical phase of AD and indicate that this very early stage of AD is characterized by poor word-finding ability, abstract reasoning, and memory
Recommended from our members
The Relationship of Serotonin to Depression in Parkinson's Disease
We have previously reported a correlation between depression in patients with idiopathic Parkinson's disease and decreased concentrations of the cerebrospinal fluid content of the serotonin metabolite, 5-HIAA. To further examine this relationship, we repeated the study in a new cohort of patients while they remained on dopaminergic medications, conducted follow-up interviews and examinations in our original cohort, and conducted an open trial of the serotonin precursor, 5-hydroxytryptophan in a group of new patients with depression. We were again able to demonstrate a significant reduction in cerebrospinal 5-HIAA in depressed patients in comparison to controls and patients without depression. Demented patients with Parkinson's disease, particularly those with concurrent depression, had the lowest values of 5-HIAA. No new cases of depression occurred in our orignial cohort after 21/2 years of follow-up, and depression remitted following conventional or experimental treatment in four patients. Depression improved in six of the seven new patients following oral 5-hydroxytryptophan. Three of these patients allowed a repeat lumbar puncture, and the concentration of 5-HIAA increased following 5-hydroxytryptophan. These three studies support our hypothesis that depression in idiopathic Parkinson's disease is associated with a reduction in brain serotonin. However, it also suggests that other factors, biological or environmental, may be causal factors
- …