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Biomedical subjects

Brian R Ott

Publications and source records attributed to Brian R Ott.

At least 19 recordsLinked to original sources

Considering phasic alerting in Alzheimer's disease: comment on Tales et al. (2006).

A. Tales, R. J. Snowden, M. Brown, and G. Wilcock (2006) have questioned the authors' view of a possible interdependence between attentional systems mediating exogenous spatial orienting and phasic alerting as well as the authors' suggestion that phasic alerting deficits in patients with Alzheimer's disease (AD) may be influencing their performance on tests of spatial orienting. Consistent with this possibility, both laboratories have previously demonstrated increased spatial orienting and decreased phasic alerting in patients with AD. In Tales et al.'s current study, however, they have instead suggested that their results provide evidence for functional independence between these attentional systems in AD. In this commentary, the authors address the misinterpretations of their study and evaluate the degree to which Tales et al.'s study addresses the issues that they raise. Given Tales et al.'s difficulty performing analyses on response time data because of variance issues, the presence of a reduced (although not significant) alerting effect in Tales et al.'s AD group (consistent with the authors' previous findings), and a potential floor effect in their measure of alerting, the authors question the validity of Tales et al.'s conclusions and reaffirm their position that not considering interactions among attentional systems can lead to inaccurate characterizations of the mechanisms by which they operate.

Aged↗

Memantine treatment in mild to moderate Alzheimer disease: a 24-week randomized, controlled trial.

OBJECTIVE: The objective of this study was to compare the efficacy and safety of the moderate-affinity, uncompetitive N-methyl-d-aspartate receptor antagonist, memantine, versus placebo in patients with mild to moderate Alzheimer disease (AD). METHOD: This was a randomized, double-blind, placebo-controlled clinical trial conducted at 42 U.S. sites. Participants were 403 outpatients with mild to moderate AD and Mini-Mental State Examination scores of 10-22 randomized to memantine (20 mg/day; N=201) or placebo (N=202) for 24 weeks. Primary outcomes were change from baseline at 24 weeks on the Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-cog), a measure of cognition, and on the Clinician's Interview-Based Impression of Change Plus Caregiver Input (CIBIC-Plus), a global measure. Secondary outcomes included change on the Neuropsychiatric Inventory (NPI) and the Alzheimer's Disease Cooperative Study Activities of Daily Living Inventory (ADCS-ADL(23)), measures of behavior and function, respectively. RESULTS: Most (82.4%) participants completed the trial. Memantine resulted in significantly better outcomes than placebo on measures of cognition, global status, and behavior when based on the protocol-specified primary last observation carried forward imputation as well as a mixed-models repeated-measures approach applied to the continuous outcomes. Treatment discontinuations because of adverse events for memantine versus placebo were 19 (9.5%) and 10 (5.0%), respectively. CONCLUSIONS: These results support the safety and efficacy of memantine for the treatment of mild to moderate AD.

Aged↗

Driving scenes test of the Neuropsychological Assessment Battery (NAB) and on-road driving performance in aging and very mild dementia.

The Driving Scenes test of the new Neuropsychological Assessment Battery (NAB; [Stern, R.A., & White, T. (2003a). Neuropsychological Assessment Battery. Lutz, FL: Psychological Assessment Resources, Inc.]) measures several aspects of visual attention thought to be important for driving ability. The current study examined the relationship between scores on the Driving Scenes test and on-road driving performance on a standardized driving test. Healthy participants performed significantly better on the Driving Scenes test than did very mildly demented participants. A correlation of 0.55 was found between the brief, office-based Driving Scenes test and the 108-point on-road driving score. Furthermore, the Driving Scenes test scores differed significantly across the driving instructor's three global ratings (safe, marginal, and unsafe), and results of a discriminant function analysis indicated that the Driving Scenes test correctly classified 66% of participants into these groups. Thus, the new NAB Driving Scenes test appears to have good ecological validity for real-world driving ability in normal and very mildly demented older adults.

Aged↗

Progressive morphometric and cognitive changes in vascular dementia.

Evidence for progressive cognitive decline in vascular dementia (VaD) is mixed, with some studies showing little or no decline over time. One possible explanation for these inconsistent findings is the heterogeneity of pathology encompassed by the VaD diagnosis. It is possible that subtypes of VaD (i.e. those resulting from different lesion distributions) show different patterns of cognitive decline. In the present study, a heterogeneous VaD group demonstrated cognitive decline from baseline to 12-month follow-up. Although this decline was coincident to morphometric changes (i.e. increased subcortical hyperintensities (SH), decreased whole brain volume (WBV)), no relationship emerged between cognitive decline and morphometric changes. Preliminary examination of VaD subtypes revealed patients with subcortical infarct or SH-only exhibited greater decline than VaD patients with cortical lesions. Further research is needed to determine whether this observed decline is attributable to differential lesion distribution or statistical artifact.

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Is donepezil therapy associated with reduced mortality in nursing home residents with dementia?

BACKGROUND: Since cholinesterase inhibitors (CEIs) were approved for use in mild to moderate Alzheimer's disease, the therapeutic efficacy of this class of medications has largely centered on demonstration of short-term improvement in cognition and global function. Later evidence suggested that the beneficial effects of CEIs might be sustainable for at least 3 years and that CEIs may have a disease-modifying effect on Alzheimer's disease. These broad-ranging, long-term effects may explain the recent finding that the use of a CEI among nursing home residents with dementia was associated with lower mortality. OBJECTIVE: The goal of this study was to investigate whether donepezil treatment is associated with reduced mortality in nursing home residents who have dementia. METHODS: We performed a retrospective matched cohort study using the Systematic Assessment of Geriatric Drug Use via Epidemiology database, which contains data collected with the Minimum Data Set on a cross section of 915,469 nursing home residents aged > 65 years between 1998 and 2000 in 6 US states. We identified users of donepezil (5 and 10 mg) and an equal number of matched nonusers in the same facility, date of donepezil use, level of cognitive function, and dementia diagnosis. Comparisons of the 2 groups were made for sociodemographic variables, dementia severity, number of medications, and major comorbid illnesses (heart disease, cancer, diabetes mellitus, chronic obstructive pulmonary disease, and malnutrition), as well as survival over the 2-year study period. RESULTS: A total of 5423 users and 5423 nonusers of donepezil were identified. Based on Cox proportional hazards models, donepezil users showed a lower mortality rate than nonusers. The hazard rate ratio was 0.89 (95% CI, 0.83-0.95). After adjusting for the confounding variables, sociodemographic factors, other psychotropic drugs, and comorbid conditions, this survival advantage remained (hazard rate ratio, 0.90; 95% CI, 0.84-0.96). CONCLUSIONS: A relationship was observed between treatment of nursing home residents with donepezil and lower mortality. If the relationship was due to a direct effect of donepezil use, then this observation has implications for the socioeconomic impact of CEI therapy in those with advanced dementia in the nursing home. These implications deserve future investigation.

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Neuropsychological deficits associated with driving performance in Parkinson's and Alzheimer's disease.

Neuropsychological and motor deficits in Parkinson's disease that may contribute to driving impairment were examined in a cohort study comparing patients with Parkinson's disease (PD) to patients with Alzheimer's disease (AD) and to healthy elderly controls. Nondemented individuals with Parkinson's disease [Hoehn & Yahr (H&Y) stage I-III], patients with Alzheimer's disease [Clinical Demetia Rating scale (CDR) range 0-1], and elderly controls, who were actively driving, completed a neuropsychological battery and a standardized road test administered by a professional driving instructor. On-road driving ability was rated on number of driving errors and a global rating of safe, marginal, or unsafe. Overall, Alzheimer's patients were more impaired drivers than Parkinson's patients. Parkinson's patients distinguished themselves from other drivers by a head-turning deficiency. Drivers with neuropsychological impairment were more likely to be unsafe drivers in both disease groups compared to controls. Compared to controls, unsafe drivers with Alzheimer's disease were impaired across all neuropsychological measures except finger tapping. Driving performance in Parkinson's patients was related to disease severity (H&Y), neuropsychological measures [Rey Osterreith Complex Figure (ROCF), Trails B, Hopkins Verbal List Learning Test (HVLT)-delay], and specific motor symptoms (axial rigidity, postural instability), but not to the Unified Parkinson Disease Rating Scale (UPDRS) motor score. Multifactorial measures (ROCF, Trails B) were useful in distinguishing safe from unsafe drivers in both patient groups.

Accidents, Traffic↗

Prediction of on-road driving performance in patients with early Alzheimer's disease.

OBJECTIVES: Physicians and family members frequently are asked to provide information about driving ability in patients with Alzheimer's disease (AD), yet there has been little research on the validity of their assessments of driving performance. DESIGN: Cross-sectional. SETTING: Participants were recruited from the neurology department of a community hospital affiliated with Brown Medical School. PARTICIPANTS: Participants included 75 older adults (17 with mild AD, 33 with very mild AD, and 25 elderly controls). MEASUREMENTS: The participant him/herself, an informant, and an experienced neurologist rated each participant's driving ability on a 3-point rating scale (safe, marginal, unsafe). A professional driving instructor also completed a standardized 108-point on-road driving assessment of each participant and then rated driving ability on the 3-point scale. Ratings were compared with the on-road driving score and with each other. RESULTS: Only the neurologist's rating of the participants' driving abilities was significantly related to on-road driving score. When related to the instructor's safety rating, the neurologist's ratings were the most sensitive and specific. Mini-Mental State Examination score was a borderline covariate for the neurologist's rating. Overall, the instructor was the most stringent rater of participant driving ability, followed by the neurologist, the informant, and the participant. CONCLUSION: An experienced neurologist's assessment of driving competence may be a valid predictor of driving performance of patients with early AD.

Adult↗

Clinician assessment of the driving competence of patients with dementia.

OBJECTIVES: To determine the validity and reliability of clinician ratings of the driving competence of patients with mild dementia. DESIGN: Observational study of a cross-section of drivers with mild dementia based on chart review by clinicians with varying types of expertise and experience. SETTING: Outpatient dementia clinic. PARTICIPANTS: Fifty dementia subjects from a longitudinal study of driving and dementia. MEASUREMENTS: Each clinician reviewed information from the clinic charts and the first study visit. The clinician then rated the drivers as safe, marginal, or unsafe. A professional driving instructor compared these ratings with total driving scores on a standardized road test and categorical ratings of driving competence. Clinicians also completed a visual analog scale assessment of variables that led to their determinations of driving competence. RESULTS: Accuracy of clinician ratings ranged from 62% to 78% for the instructor's global rating of safe versus marginal or unsafe. In general, there was moderate accuracy and interrater reliability. Accuracy could have been improved in the least-accurate raters by greater attention to dementia duration and severity ratings, as well as less reliance on the history and physical examination. The most accurate predictors were clinicians specially trained in dementia assessment, who were not necessarily the most experienced in their years of clinical experience. CONCLUSION: Although a clinician may be able to identify many potentially hazardous drivers, accuracy is insufficient to suggest that a clinician's assessment alone is adequate to determine driving competence in those with mild dementia.

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Patient versus informant perspectives of Quality of Life in Mild Cognitive Impairment and Alzheimer's disease.

BACKGROUND: Prior studies on Quality of Life (QOL) in Alzheimer's disease (AD) have rarely included control participants, or participants with very mild levels of cognitive impairment. Furthermore, there is little data to indicate whether or not mildly impaired patients can provide self-report QOL data or if informant reports are needed. OBJECTIVES: This study compared QOL ratings from informants and patients with mild AD (n = 26), Mild Cognitive Impairment (MCI, n = 30), and elderly controls (n = 23). METHODS: Participants (aged 60-91 years) were recruited from an outpatient memory disorder clinic. Elderly controls were recruited from the community. Measures about patients were the Dementia Quality of Life scale, the Neuropsychiatric Inventory-Questionnaire, Instrumental of Activities of Daily Living, and Mini-mental State Exam. Informant depression was assessed with the Geriatric Depression Scale. RESULTS: Results indicated that overall patient-informant agreement for MCI (M=0.24), AD (M=0.48), and controls (M=0.49) did not differ significantly. Self-reported QOL did not differ significantly across the 3 groups. For caregiver-reports, QOL in MCI again did not differ from controls but was significantly greater than QOL in AD for 2 of 6 scales, and QOL in controls was greater than AD for 4 of 6 scales. Regression analyses indicated that neuropsychiatric symptoms were the most consistent predictors of QOL. CONCLUSIONS: In summary, informant- and self-perceptions of QOL differed substantially. Results suggest that future investigators should carefully consider gathering QOL information from both informants and patients because they provide unique information regarding patient QOL and, to date, neither source of information has been established to be superior.

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The neuropsychological profile of vascular cognitive impairment--no dementia: comparisons to patients at risk for cerebrovascular disease and vascular dementia.

Hachinski and co-workers have used the term vascular cognitive impairment-no dementia (VaCIND) to represent the earliest stages of cognitive decline associated with vascular changes [Neurology 57 (4) (2001) 714]. However, the neuropsychological profile of vascular CIND remains unclear. Twenty-five healthy elders, 29 individuals at risk for cerebrovascular disease (R-CVD), 18 individuals with VaCIND, and 26 individuals with vascular dementia (VaD) were examined to determine whether patterns of neuropsychological assessment performance can assist in the differentiation of patients at varying levels of risk and severity for cerebrovascular disease and VaD. The R-CVD group performed within normal expectations on most cognitive measures as compared to the elderly control sample and published clinical norms. Relative to elderly controls, the VaCIND group demonstrated significant difficulties on measures of cognitive flexibility, verbal retrieval, and verbal recognition memory, but not on measures of confrontational naming or verbal fluency. The VaD group was impaired on all cognitive measures assessed. The current findings suggest that poor cognitive flexibility and verbal retrieval in the context of preserved function in other domains may characterize the prodromal stage of VaD.

Aged↗

Interactions between phasic alerting and spatial orienting: effects of normal aging and Alzheimer's disease.

The effects of aging and Alzheimer's disease (AD) on phasic alerting and exogenous spatial orienting were examined within a single precuing task. Phasic alerting decreased with normal aging and was completely eliminated with AD. AD patients also demonstrated an increased spatial orienting effect, attributable to an increased benefit from spatial orienting that was associated with a decreased benefit from nonselective alerting. These results suggest that performance within the precuing paradigm reflects the product of an interaction between nonselective alerting processes and spatially selective orienting processes. The results also highlight the importance of simultaneously assessing alerting and orienting within the same task, because changes attributable to alerting may otherwise be attributed incorrectly to changes in 1 or more processes associated with spatial orienting.

Adolescent↗

Driving and dementia: a review of the literature.

The purpose of this article is to review the literature on the ability of individuals with dementia to drive an automobile. Based on a review of the literature, several factors were identified that may be useful in differentiating between people with dementia who presently remain safe drivers from those who have progressed to impaired driving. These factors include disease duration and severity, sex, patient self-assessment, family assessment, neuropsychological measures, findings on road evaluations, and driving simulator testing. The approach of the physician to driving and dementia is addressed, including in-office screening, referral for on-road driving assessments, and the potential for physician reporting to state agencies.

Aged↗

Preliminary study of the relationship between thyroid status and cognitive and neuropsychiatric functioning in euthyroid patients with Alzheimer dementia.

OBJECTIVE: To investigate whether variations within normal ranges of thyroid functioning are related to cognitive and neuropsychiatric functioning in Alzheimer disease (AD). BACKGROUND: Mild alterations of thyroid hormone levels, even in the normal range, are associated with changes in mood and cognitive functioning in older, nondemented adults, and lower concentrations of thyroid hormones have been shown to be associated with an increased risk for cognitive decline. Less is known about the relationship between thyroid hormone levels and cognitive and neuropsychiatric dysfunction in AD. METHOD: Twenty-eight euthyroid patients with AD on donepezil underwent evaluation of thyroid status, including measures of thyroid-stimulating hormone (TSH) and free thyroxine (FT4), and cognitive and neuropsychiatric assessment with the Alzheimer's Disease Assessment Scale, Neuropsychiatric Inventory, and Visual Analog Mood Scales. RESULTS: Correlational analyses indicated statistically significant associations between FT4 concentrations and self-reported feelings of fear and fatigue. Fear and fatigue were negatively correlated with FT4. There were no significant relationships between thyroid hormones and cognition and other depressive and anxiety symptoms. CONCLUSIONS: Results of this preliminary study support a relationship between thyroid status and neuropsychiatric symptoms in euthyroid individuals with AD, with lower concentrations of FT4 associated with fear and fatigue.

Affective Symptoms↗

A survey of voter participation by cognitively impaired elderly patients.

The authors surveyed 100 outpatients with dementia during the 2 months following the November 2000 US presidential election. A majority (60%) of respondents voted. Increasing severity of dementia was associated with reduced knowledge about the election as well as reduced voting participation by patients and caregivers. Actively voting persons had general knowledge about the election as evidenced by matching candidate photographs with name and party labels.

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Quality of Life measures for dementia.

Over the past 10 years, several instruments developed specifically for the assessment of Quality of Life (QOL) in dementia have been introduced. The goal of the current review is to present, compare, and critique existing QOL measures for dementia populations to assist investigators and clinicians in selecting the optimal inventory for their specific needs. Nine measures are reviewed with a focus on conceptualizations of QOL, psychometric data, targeted patient population, and administration and scoring procedures. Critical discussion and comparison of the instruments is presented after the scales are described individually. Differences in definitions of QOL, assessment procedures, and methods that were used to establish the validity of instruments are highlighted. An important direction for future research on QOL scales for dementia is to establish their responsiveness to change over time. It will also be important to identify factors that affect reports of QOL, determine the how perceived QOL affects decisions regarding the care of dementia patients, and evaluate interventions to increase patient QOL.

Activities of Daily Living↗

Amnestic behavior in dementia: symptoms to assist in early detection and diagnosis.

OBJECTIVES: This study evaluated two amnestic behavior changes (repetitive questioning and repetitive actions) to determine their utility in screening for early dementia. DESIGN: Patient data were collected through a retrospective chart review. Comparison data from nondemented older people were collected prospectively from acquaintances of clinic patients. SETTING: The setting was a hospital-based outpatient memory disorder clinic. PARTICIPANTS: Participants were older individuals with no cognitive impairment (n = 25), undetermined dementia (n = 50), and definite dementia (n = 25). The undetermined cases were followed for at least 1 year to assess for conversion to dementia. MEASUREMENTS: Amnestic behaviors were assessed using informant-report for all participants. The behaviors were examined for their ability to distinguish between definite dementia cases and noncases. They were further evaluated for the ability to differentiate undetermined cases that eventually converted to definite dementia from cases that did not convert. RESULTS: Results indicated that repetitive behaviors were common in early and more-severe dementia cases. Repetitive behaviors were relatively uncommon in cognitively intact older participants. In analyses of the full study sample, engagement in repetitive behaviors had high sensitivity (0.97) in identifying dementia cases. CONCLUSIONS: Assessing repetitive behaviors in patients may be a useful means for family members and primary care physicians to screen for early cognitive impairment. The assessment can help to identify individuals that should be evaluated further for dementia.

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Clinical correlates of cognitive decline in vascular dementia.

OBJECTIVE: To determine whether demographic data, dementia severity, functional status, whole brain volume (WBV), or subcortical hyperintensity volume (SH) predict subsequent cognitive decline in vascular dementia (VaD). BACKGROUND: The identification of variables that accurately predict progressive cognitive decline in dementia has important clinical implications. METHODS: A cohort of 30 patients with VaD completed neurologic and neuropsychologic examinations and magnetic resonance imaging of the brain at baseline and again after 12 months. All participants met clinical and research criteria for VaD according to standard guidelines. Change scores were computed for measures of verbal fluency, verbal learning, and visual learning. Potential correlates of cognitive change included age, education, score on the Hachinski scale, WBV, SH, and functional ability. RESULTS: As a group, lower WBV and lower Hachinski score correlated with decline in verbal fluency and visual learning, whereas lower Hachinski score correlated with decline in verbal learning. However, when subdivided by disease type, this pattern held only for individuals with evidence of a cortical stroke at baseline. No clinical variables correlated with cognitive decline among individuals without a cortical infarction. CONCLUSIONS: Assessment of cognitive decline in VaD should be guided by dementia subtype, with particular attention directed at severity of cerebral atrophy rather than classic symptoms of infarction.

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