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Biomedical subjects

C E Coffey

Publications and source records attributed to C E Coffey.

At least 19 recordsLinked to original sources
PubMed1992

Neuropsychological importance of subcortical white matter hyperintensity.

Subcortical hyperintensity on magnetic resonance imaging is a common incidental finding in healthy elderly subjects. The relationship of such changes to cognitive functioning remains unclear, however, because only a small number of studies have examined this issue with conflicting results. We therefore assessed 66 healthy adult volunteers (mean [+/- SD] age, 61.8 +/- 15.8 years) with magnetic resonance imaging scans rated for subcortical hyperintensity, and with two neuropsychological instruments selected a priori on the basis of previous reports in the literature. Findings were highly significant for both the Benton Facial Recognition Test and the Wechsler Adult Intelligence Scale-Revised Digit Symbol. However, in both cases, the majority of variance was accounted for by age and educational level. Effects of subcortical hyperintensity were not significant. We conclude that subcortical hyperintensity in healthy adults does not relate to cognitive functioning, at least with these two instruments.

Aged↗
PubMed1992

Quantitative cerebral anatomy of the aging human brain: a cross-sectional study using magnetic resonance imaging.

Seventy-six healthy adults underwent magnetic resonance imaging (1.5 T) to investigate the effects of age on regional cerebral volumes and on the frequency and severity of cortical atrophy, lateral ventricular enlargement, and subcortical hyperintensity. Increasing age was associated with (1) decreasing volumes of the cerebral hemispheres (0.23% per year), the frontal lobes (0.55% per year), the temporal lobes (0.28% per year), and the amygdala-hippocampal complex (0.30% per year); (2) increasing volumes of the third ventricle (2.8% per year) and the lateral ventricles (3.2% per year); and (3) increasing odds of cortical atrophy (8.9% per year), lateral ventricular enlargement (7.7% per year), and subcortical hyperintensity in the deep white matter (6.3% per year) and the pons (8.1% per year). Many elderly subjects did not exhibit cortical atrophy or lateral ventricular enlargement, however, indicating that such changes are not inevitable consequences of advancing age. These data should provide a useful clinical context within which to interpret changes in regional brain size associated with "abnormal" aging.

Adult↗
PubMed1991

Brain anatomic effects of electroconvulsive therapy. A prospective magnetic resonance imaging study.

To determine prospectively whether electroconvulsive therapy (ECT) produces structural brain changes, 35 inpatients with depression underwent magnetic resonance imaging before and twice after (at 2 to 3 days and at 6 months) completion of a course of brief-pulse, bilateral ECT. The magnetic resonance images were analyzed blindly for evidence of changes in brain structure using two approaches: measurement of regional brain volumes and a pairwise global comparison. Structural brain abnormalities were present in many patients before ECT. The course of ECT produced no acute or delayed (6-month) change in brain structure as measured by alterations of the total volumes of the lateral ventricles, the third ventricle, the frontal lobes, the temporal lobes, or the amygdala-hippocampal complex. In five subjects, the pairwise global comparisons revealed an apparent increase in subcortical hyperintensity, most likely secondary to progression of ongoing cerebrovascular disease during follow-up. Our results confirm and extend previous imaging studies that also found no relationship between ECT and brain damage.

Amygdala↗
PubMed1991

The monitoring and management of electrically induced seizures.

Because induced seizures have such a fundamental influence on both beneficial and adverse effects associated with ECT, it is crucial that they be monitored as effectively as possible. In practice this process involves a combination of both motor and EEG monitoring. The technology for such monitoring, although not overly sophisticated, is also not trivial, and a certain amount of training is required before a practitioner can meaningfully interpret this type of information. Efforts to standardize monitoring practices, at least within a particular ECT program, are also indicated. Our knowledge of what constitutes an adequate seizure is limited, with duration still the primary focus. Future studies of ictal electrophysiology may well provide better answers in this regard. One area where already accomplished work has proved productive involves the delineation of many of the factors which influence seizure threshold and duration. On the basis of these data, practitioners now can exert considerably greater control over such measures, and thereby make more optimal use of this treatment modality.

Electroconvulsive Therapy↗
PubMed1991

Electroconvulsive therapy in the United States.

In 1990, electroconvulsive therapy (ECT) celebrated 50 years of continuous use in the United States. After many trials and tribulations, this treatment modality has experienced a resurgence of interest in recent years. Contemporary research has helped to both maximize benefits and minimize risks, as ECT has grown technologically into a sophisticated procedure administered by highly trained practitioners. Given the substantial growth in knowledge about ECT, the American Psychiatric Association has recently developed comprehensive clinical guidelines for its practice. The present paper provides an overview of the history of ECT in the United States, the manner in which it is used at present, and areas of active research interest.

Animals↗
PubMed1991

Practical issues in the use of electroconvulsive therapy (ECT).

ECT is a safe and effective treatment for affective disorders and certain types of schizophrenia. It is also useful as a form of continuation/maintenance therapy in otherwise resistant cases. The referral of a patient for ECT is based on a careful risk-benefit analysis of all viable treatment options. The administration of ECT in the present era is a refined, technically sophisticated procedure which should be performed only by practitioners with established competency to do so. With proper understanding of risk factors and treatment technique, modifications of the ECT procedure can now frequently be made to minimize adverse effects and to maximize therapeutic response.

Electroconvulsive Therapy↗
PubMed1990

Cardiovascular response to unilateral electroconvulsive therapy.

Few studies have examined the cardiovascular response to pulse unilateral electroconvulsive therapy (ECT) performed using modern techniques. In this study of 30 patients (mean age 62 years) with major depression, we determined the effects of pulse unilateral ECT on cardiac work load using the rate-pressure product (RPP), a product of pulse and systolic blood pressure. The mean RPP across all ECT treatments increased by an average of 96% from pre-ECT baseline, with the maximal RPP occurring typically during the seizure. The amount of increase in RPP did not differ significantly over the course of treatments. The increase in RPP was significantly and inversely related to baseline RPP, such that subjects with the highest baseline RPPs actually had smaller increases in RPP during the ECT treatments. The mean percent change in RPP was not associated with age, sex, presence of cardiovascular disease, ECT stimulus charge, EEG seizure duration, or amnestic side effects. There was a trend (p = 0.06), however, for the mean increase in RPP to be greater in responders (100% increase, n = 25) than in nonresponders (76% increase, n = 5). The potential relationship of clinical outcome to the increase in RPP suggests that both factors may be manifestations of the physiological intensity of the ECT-induced seizure.

Adult↗
PubMed1990

Caffeine augmentation of ECT.

In a randomized, double-blind, placebo-controlled pilot study of 40 depressed inpatients, the authors compared two techniques for maintaining seizure duration during pulse unilateral ECT: pretreatment with intravenous caffeine versus electrical stimulus intensity dosing. Both techniques effectively maintained seizure duration, but with caffeine this was accomplished without any increase in mean stimulus intensity over the course of ECT. There were no differences between the two techniques in therapeutic outcome or cognitive side effects from ECT, and caffeine pretreatment was well tolerated. The authors discuss the clinical and research implications of these findings with respect to strategies for maintaining seizure duration during ECT.

Adult↗
PubMed1990

Brain magnetic resonance imaging findings in ECT-induced delirium.

A prolonged (interictal) but reversible delirium was induced by electroconvulsive therapy (ECT) in 10 of 87 (11%) elderly depressed patients. Brain magnetic resonance imaging (MRI) revealed several structural abnormalities, particularly basal ganglia and moderate to severe subcortical white-matter lesions, in the patients who developed delirium. These findings are consistent with several lines of data that have implicated the basal ganglia and subcortical white matter in the development of delirium from other causes and suggest that lesions in these areas may predispose one to developing an interictal delirium during a course of ECT.

Aged↗
PubMed1990

Electroconvulsive therapy: an update.

Electroconvulsive therapy (ECT) is a safe, rapidly acting, and very effective form of treatment for severe affective illness. In recent years the limitations of available psychopharmacotherapies and the pressures of cost containment appear to be encouraging the increasing use of ECT. The authors provide an overview of electroconvulsive therapy as a treatment modality, focusing on indications, contraindications, adverse effects, and contemporary ECT technique, including recent modifications in electrode placement, stimulus wave form, and dosage intensity. They urge that adequate training be provided for medical and nursing personnel who administer ECT and that facilities monitor practitioners' competence by specific privileging.

Bipolar Disorder↗
PubMed1990

Caffeine-modified electroconvulsive therapy in depressed patients with medical illness.

Although pretreatment with intravenous caffeine is an effective technique for increasing seizure duration during a course of electroconvulsive therapy (ECT), little has been published regarding the use of this technique in patients with severe medical illness. The authors describe nine depressed inpatients with major cardiovascular or other medical disease or both whose ECT seizure durations declined despite maximal settings on the ECT device. In all cases, caffeine pretreatment lengthened seizures, and clinical improvement followed. The caffeine-modified ECT treatments were well tolerated and were associated with no clinically significant adverse cardiovascular effects.

Aged↗
PubMed1989

Regional cerebral blood flow correlates of a dichotic listening task.

This investigation was designed to test the hypothesis that ear advantage on a dichotic listening (DL) task of pitch discrimination reflects asymmetries in the metabolic activities of the temporal lobes. Fourteen normal subjects, with either a left-ear advantage (LEA) (n = 9) or a right-ear advantage (REA) (n = 5) on the DL task, underwent measurements of regional cerebral blood flow (rCBF) during a resting baseline condition and during performance on the DL task. For both groups, the DL task was associated with selective and significant increases in rCBF to the contralateral posterior temporal lobe. Our finding of selective rCBF activation with dichotic stimulation may have potential implications for an understanding of the functional organization of the cerebral hemispheres.

Acoustic Stimulation↗
PubMed1989

White matter hyperintensity on magnetic resonance imaging: clinical and neuroanatomic correlates in the depressed elderly.

In a prospective study of depressed elderly patients referred for electroconvulsive therapy (ECT), subcortical white matter hyperintensity (WMH) was seen in all 51 patients 60 years or older who received magnetic resonance imaging (MRI) prior to treatment. In over half of the patients the WMH was formally rated as at least moderately severe, and it was commonly associated with other structural brain changes. The majority (80%) of patients had late-age-onset depression, suggesting that structural brain changes may interact with aging to facilitate the emergency of depression in late life.

Aged↗
PubMed1989

Brain iron in progressive supranuclear palsy: clinical, magnetic resonance imaging, and neuropathological findings.

A patient with progressive supranuclear palsy demonstrated a region-specific decrease in T2 signal during high-field-strength brain magnetic resonance imaging. At autopsy the T2-signal hypointensity was found to correspond topographically to increased deposition of ferric iron. The potential clinical, radiologic, and pathophysiologic implications of these findings are discussed.

Brain↗