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Biomedical subjects

Brian A Lawlor

Publications and source records attributed to Brian A Lawlor.

18 recordsLinked to original sources
PubMed2006

A review of screening tests for cognitive impairment.

The merit of screening for dementia and cognitive impairment has been the subject of recent debate. One of the main limitations in this regard is the lack of robust evidence to support the many screening tests available. Although plentiful in number, few such instruments have been well validated in the populations for which they are intended to be used. In addition, it is likely that "one size does not fit all" in cognitive screening, leading to the development of many specialised tests for particular types of impairment. In this review, we sought to ascertain the number of screening tools currently available, and to examine the evidence for their validity in detecting different diagnoses in a variety of populations. A further consideration was whether each screen elicited indices of a range of cognitive, affective and functional domains or abilities, as such information is a valuable adjunct to simple cut-off scores. Thirty-nine screens were identified and discussed with reference to three purposes: brief assessment in the doctor's office; large scale community screening programmes; and identifying profiles of impairment across different cognitive, psychiatric and functional domains/abilities, to guide differential diagnosis and further assessment. A small number of screens rated highly for both validity and content. This review is intended to serve as an evaluative resource, to guide clinicians and researchers in choosing among the wide range of screens which are currently available.

Cognition Disorders↗
PubMed2006

Electrophysiological and information processing variability predicts memory decrements associated with normal age-related cognitive decline and Alzheimer's disease (AD).

Recent theoretical models of cognitive aging have implicated increased intra-individual variability as a critical marker of decline. The current study examined electrophysiological and information processing variability and memory performance in normal younger and older controls, and older adults with Alzheimer's disease (AD). It was hypothesized that higher levels of variability would be indicative of age-related and disease-related memory deficits. Results indicated both implicit and explicit memory deficits associated with AD. Consistent with previous research, behavioral speed and variability emerged as sensitive to age- and disease-related change. Amplitude variability of P3 event-related potentials was a unique component of electrophysiological activity and accounted for significant variance in reaction time (RT) mean and RT standard deviation, which in turn accounted for significant variance in memory function. Results are discussed in light of theoretical and applied issues in the field of cognitive aging.

Adult↗
PubMed2006

Investigating the enhancing effect of music on autobiographical memory in mild Alzheimer's disease.

The enhancing effect of music on autobiographical memory recall in mild Alzheimer's disease individuals (n = 10; Mini-Mental State Examination score >17/30) and healthy elderly matched individuals (n = 10; Mini-Mental State Examination score 25-30) was investigated. Using a repeated-measures design, each participant was seen on two occasions: once in music condition (Vivaldi's 'Spring' movement from 'The Four Seasons') and once in silence condition, with order counterbalanced. Considerable improvement was found for Alzheimer individuals' recall on the Autobiographical Memory Interview in the music condition, with an interaction for condition by group (p < 0.005). There were no differences in terms of overall arousal using galvanic skin response recordings or attentional errors during the Sustained Attention to Response Task. A significant reduction in state anxiety was found on the State Trait Anxiety Inventory in the music condition (p < 0.001), suggesting anxiety reduction as a potential mechanism underlying the enhancing effect of music on autobiographical memory recall.

Acoustic Stimulation↗
PubMed2006

Co-morbid and socio-demographic factors associated with cognitive performance in an elderly community dwelling Irish population.

BACKGROUND: Epidemiological studies suggest an association between health factors and dementia. The impact of these factors on the cognitive performance of the elderly population is unclear. Possible correlates of poor cognitive performance in a community dwelling elderly Irish population were examined. METHODS: Subjects were from a sample of individuals over 65 years agreeable to interview using the Geriatric Mental State (GMS)-Automated Geriatric Examination for Computed Assisted Taxonomy (AGECAT) package conducted at the subject's home. Associations between patient profiles and Mini Mental State Examination (MMSE) score were investigated in a multivariate model. RESULTS: There were 793 subjects, 528 (66.6%) female with mean (s.d.) age 74.8 (6.7) yrs. Mean MMSE score was 26.5 (3.3). 169 (21.3%) were current smokers, 198 (25%) ex-smokers. Two hundred and twenty-four (28.3%) had a history of hypertension, 85 (10.7%) case level anxiety or depression, 51 (6.4%) stroke, ten0 (1.3%) epilepsy, nine (1.1%) Parkinson's disease and 29 (3.7%) dementia. Two hundred and fifty-five (32.2%) subjects were on psychotropic medications. Factors associated with MMSE score included age (p < or = 0.0001), diagnosis of dementia (p < or = 0.0001), socioeconomic group (p < or = 0.0001), education (p < or = 0.0001), previous stroke (p = 0.0013) and use of psychotropic medication (p = 0.03). Case level anxiety or depression (p = 0.99), Parkinson's disease (p = 0.52), epilepsy (p = 0.26), smoking status (p = 0.99) and hypertension (p = 0.34) were not found to be associated with cognitive performance. CONCLUSION: Factors associated with cognitive performance included age, socioeconomic group, education, previous stroke and use of psychotropic medication. These factors should be adjusted for in studies assessing cognition in this population. Stroke prevention strategies and avoidance of psychotropic medication may benefit cognitive performance.

Age Factors↗
PubMed2005

Driving cessation in patients attending a memory clinic.

BACKGROUND: Driving is an increasingly important form of transport for older people. Dementia is common in later life and will eventually lead to driving cessation, which reduces the public health risk of impaired driving but also impairs access to services. The factors associated with driving cessation in dementia are uncertain. OBJECTIVE: To examine the demographic, psychometric and personal factors associated with driving cessation in patients attending a memory clinic in a European setting. DESIGN, SUBJECTS AND SETTING: A retrospective study of 430 consecutive patients referred over a 21 month period to the memory clinic at a university teaching hospital. METHODS: The data collected included a questionnaire administered to their carers regarding demographic and personal factors as well as driving practices. All subjects had standardised neuropsychological and functional assessments. Dementia diagnosis was recorded using DSM IV criteria. RESULTS: Driving cessation in this population was associated with poorer cognitive and functional status, older age, and living in the city. Of those studied, 22% continued to drive: 63% of these were driving daily, 71% were driving unaccompanied and 31% reported an accident. There was no difference in the neuropsychological testing between those who reported an accident and those who did not report an accident. CONCLUSIONS: Driving cessation was affected not only by psychometric performance but also by demographic and personal factors.

Aged↗
PubMed2005

Screening for dementia in an Irish community sample using MMSE: a comparison of norm-adjusted versus fixed cut-points.

BACKGROUND: The MMSE is a widely-used instrument in screening for dementia in the community. The traditional cut-point of <24/30 may be unsuitable for use in some settings, due to biases in age and education. OBJECTIVES: This study aimed to investigate whether cut-points derived from age- and education-specific norms would improve the performance of the MMSE as a screening tool for dementia and cognitive impairment in an Irish community setting, potentially reducing the number of onward referrals. A secondary aim was to obtain score norms in an Irish sample. METHODS: One thousand one hundred and fifteen people aged over 65 (mean age 74.8+/-6.8 years; 68% female) were assessed in their own homes, using MMSE (world) and the AGECAT computerised diagnostic system for mental illness in the elderly. The performance of the MMSE in identifying case- and sub-case-level dementia was investigated using cut-points of <24 and <23, as well as adjusted cut-points based on published norms and norms derived from the Irish sample. RESULTS: Published norms did not prove useful in improving screening accuracy. Cut-points based on 10th percentile Irish norms and the <23 cut-point performed comparably well, both yielding 93% specificity, with overall accuracy of 90% and 91% respectively (as sensitivity was higher for the <23 cut-point). CONCLUSIONS: Locally-derived norms yielded better screening accuracy than did published norms or the traditional <24 cut-point. The importance of selecting an appropriate percentile cut-off when using norms is discussed. The best results were obtained with a simple <23 cut-point, and this may be optimal when screening for dementia in an Irish community setting.

Aged↗
PubMed2005

Repetitive behaviour in Alzheimer's disease: description, correlates and functions.

BACKGROUND: Repetitive behaviour is among the most common and burdensome of the behavioural and psychological symptoms of Alzheimer's disease (AD), yet little research has been done to investigate its nature or correlates. Memory impairment may account for repetitive questioning, but its possible role in other repetitive behaviours is unclear. Attention and executive dysfunction may account for both repetitive speech and actions. The role of mood also merits investigation. OBJECTIVES: To investigate cognitive and affective differences between patients with and without repetitive behaviours, and to identify themes and carer attributions for the function of such behaviours. METHODS: Fifty-four participants aged > or = 65, meeting NINCDS-ADRDA criteria for probable AD, were assessed using the MMSE, WMS-III word list, Trailmaking test, Stroop, Modified WCST, Cornell Scale for Depression, DEX and a repetitive behaviour questionnaire. Regression analyses were used to identify significant predictors of repetitive behaviour. RESULTS: Repetitive behaviours were manifest in 87% of the sample, with questions (68.5%) and statements/stories (61.1%) the most common types. Repetitive questions were predicted by high MMSE score (p = 0.013), low immediate list recall score (p = 0.013) and female gender (p = 0.004). Repetitive statements/stories were predicted by dysexecutiveness (p = 0.003) and younger age (p = 0.016). Repetitive actions were predicted by longer illness duration (p = 0.041), depressive symptoms (p = 0.035) and dysexecutiveness (p < 0.001). Themes and patterns were evident in repetitive behaviour. CONCLUSIONS: Repetitive behaviours were common in a sample of patients with AD referred to hospital clinics. Vocal and motor repetitive behaviours were predicted by different cognitive, demographic and mood variables.

Affect↗
PubMed2004

A systematic review of the utility of self-report alcohol screening instruments in the elderly.

BACKGROUND: Effective screening instruments are needed for the detection of alcohol use disorders (AUDs) in the elderly, in view of the significant physical, psychological and social problems associated with this phenomenon. METHODS: This paper provides details on the different self-report alcohol screening instruments that have been studied in the elderly, describing both the instruments themselves and their effectiveness as screening instruments for AUDs in different elderly populations. RESULTS: The vast majority of studies reviewed were carried out in the US, and a high proportion of these were carried out in Veterans Administrations institutions, thus limiting the generalizability of results. The CAGE was the most widely studied screening instrument, followed by the MAST or variations of the MAST, the AUDIT and variations of the AUDIT, and other screening instruments. Sensitivity and specificity of these instruments varied widely, depending on the prevalence of AUDs in the population being studied, the clinical characteristics of the population and the type of AUD being detected. The CAGE performed poorly in psychiatric populations but a newer instrument, the AUDIT-5, has had promising results to date. No studies focussed on elderly people with cognitive impairment, and there is a need for research in this area. CONCLUSIONS: Ease of use, patient acceptability, sensitivity and specificity must all be considered when selecting a self-report alcohol screening instrument for use in the elderly. Furthermore, the prevalence of AUDs in the population and the clinical characteristics of that population must also be taken into account.

Aged↗
PubMed2004

The effect of the menstrual cycle on electrophysiological and behavioral measures of memory and mood.

Event-related potentials (ERPs) were compared between the menses and ovulatory phase of the menstrual cycle in response to visually presented words, some of which were repeated as part of direct and indirect memory tasks. Twelve spontaneously cycling women were tested during the menses and ovulatory phases. For the direct task, participants had to discriminate between new words and those repeated after a mean of six trials. In the indirect task, subjects were required to discriminate between target and nontarget words. Some of the nontarget words were repeated after a mean of six trials. The ERP repetition effect mean amplitude was significantly greater in response to repeated words at both cycle phases but did not differ across the cycle. P300 amplitude was significantly greater during menses than the ovulatory phase. We conclude that context updating mechanisms as indexed by the P300 are sensitive to cyclic hormonal fluctuations.

Adolescent↗
PubMed2004

Behavioral and psychological symptoms in dementia: the role of atypical antipsychotics.

Although cognitive dysfunction is the hallmark of dementia, behavioral and psychological symptoms of dementia (BPSD), such as psychosis, aggression, sleep disturbance, agitation, and mood disorders, develop in most elderly patients at some stage. These symptoms pose major difficulties in the day-to-day care of patients and are likely to impair the quality of life of both patient and caregiver. Patients exhibiting BPSD should be assessed in a detailed clinical interview to establish symptoms causing distress to the patient and/or caregiver. Several mood and behavior scales with good psychometric properties are available for patient evaluation. Initial intervention should focus on nonpharmacologic measures, and the quality of patient care should be optimized with potential physical, environmental, social, and psychiatric triggers being addressed where possible. Caregiver education, support, and behavioral training can also be effective in alleviating BPSD. However, pharmacologic intervention is necessary in many cases and includes use of antidepressants for mood disorders, anticonvulsants for nonpsychotic agitation, and antipsychotics for aggression, agitation, and psychotic symptoms. Conventional antipsychotics have shown modest benefit over placebo in the treatment of psychosis and agitation in dementia patients; however, they are associated with treatment-emergent side effects, particularly extrapyramidal symptoms (EPS). Atypical antipsychotics such as risperidone, olanzapine, and quetiapine are at least as effective as conventional antipsychotics, are better tolerated, and have a lower propensity for EPS. There are, however, significant differences between atypical agents with regard to receptor affinities and, therefore, side effect profiles. Patients' vulnerability to these side effects should be considered when making individual treatment decisions.

Aged↗
PubMed2004

Depression among older people in Europe: the EURODEP studies.

The data from nine centres in Europe which had used the Geriatric Mental Scale (GMS) AGECAT were analysed to compare prevalence of diagnoses in subjects aged 65 years and over living in the community. Levels of depressive illness were: Iceland 8.8%, Liverpool 10.0%; Zaragoza 10.7%; Dublin 11.9%; Amsterdam 12.0%; Berlin 16.5%; London 17.3%; Verona 18.3% and Munich 23.6%. Taking all levels of depression, five high (Amsterdam, Berlin, Munich, London and Verona) and four low (Dublin, Iceland, Liverpool, Zaragoza) scoring centres were identified. Meta-analysis of all 13,808 subjects yielded a mean level of depression of 12.3% (95% CI 11.8-12.9), 14.1% for women (95% CI 13.5-14.8) and 8.6% for men (95% CI 7.9-9.3). Symptom levels varied between centres: 40% of the total study population in Amsterdam reported depressive mood against only 26% in Zaragoza. To incorporate studies from other centres using other methods for depression identification, the EURO-D scale was developed from 12 items of the GMS and validated against other scales and expert diagnosis. A two factor solution emerged, an 'affective suffering factor' and a 'motivation factor'. The EURO-D scale was applied to 14 population based surveys. Depression score tended to increase with age unlike levels of prevalence of depression. Large between centre differences were evident in levels of depression unexplained by age, gender or marital status. These data show that depressive illness defined as suitable for intervention is common among older people in Europe. Opportunities for effective treatment are almost certainly being lost. Levels of depressive symptoms vary significantly between high and low scoring centres, prompting the next phase of this study, an examination of risk factors in Europe.

Journal Article↗
PubMed2002

Symptom domains in autism and related conditions: evidence for familiality.

Heterogeneity in autism impairs efforts to localize and identify the genes underlying this disorder. As autism comprises severe but variable deficits and traits in three symptom domains (social interaction, communication, and repetitive behaviors) and shows variability in the presence and emergence of useful phrase speech, different genetic factors may be associated with each. The affected cases (n=457) in multiply affected siblingships (n=212), including a proband with autism and one or more siblings with either autism or marked deficits in autism symptom domains, were assessed using the Autism Diagnostic Interview, Revised. Symptom domain scores and language features were examined to determine their similarity within siblingships. The variance within siblingships was reduced for the repetitive behavior domain and for delays in and the presence of useful phrase speech. These features and the nonverbal communication subdomain provided evidence of familiality when we considered only the diagnosis of autism to define multiply affected siblingships (cases: n=289; siblingships: n=136). In addition, the same familial features identified also appeared familial for those with autism-related conditions. Finally, the level of severity of almost all of the familial features varied within multiplex siblingships independently. The features identified as familial replicate the combined set suggested in earlier, smaller studies. Furthermore, the familiality of these features extend to related conditions of milder severity than autism and appear to be independent. Making distinctions among families by the severity of these features may be useful for identifying more genetically homogeneous subgroups in studies targeted at genes for specific autism-related symptom domains.

Autistic Disorder↗
PubMed2002

Individual quality of life factors distinguishing low-burden and high-burden caregivers of dementia patients.

Dementia patient (n = 72) and caregiver characteristics and individual quality of life (IQoL) factors distinguishing low- and high-burden caregivers were evaluated. Measures included patient cognitive, functional and behavioural status, and caregiver burden, well-being, social support appraisal and IQoL. The caregivers were divided by median split into low- and high-burden groups. In the high-burden group daughters were over-represented, psychological morbidity was higher, QoL was lower, the patients were more behaviourally disturbed, and there was a trend towards more negative appraisal of informal social support. Of the many QoL factors elicited from caregivers, only 'time for self' and 'finances' differed significantly between the groups. A need for more time away from the patient is a major QoL concern for highly burdened caregivers, and a perceived lack of adequate informal support and/or financial constraints are contributory factors.

Adult↗
PubMed1989

Single doses of the serotonin agonists buspirone and m-chlorophenylpiperazine do not relieve neuropathic pain.

A large body of evidence links serotonin with analgesia in animal models, but the lack of serotonin agonists suitable for clinical use has delayed study of serotonin's relevance to pain relief in humans. In a randomized, double-blind crossover study, we compared single doses of two 5-HT1 agonists, buspirone and m-chlorophenylpiperazine, to placebo in 20 patients with post-herpetic neuralgia or painful neuropathy. No analgesia was observed after either drug, at doses high enough to produce frequent central nervous system side effects. These results suggest that acute stimulation of 5-HT1 receptors is not sufficient to produce analgesia in patients with these neuropathic pain syndromes.

Adult↗