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Biomedical subjects

C MacKnight

Publications and source records attributed to C MacKnight.

At least 37 records · Page 2Linked to original sources
PubMed1999

Factors associated with inconsistent diagnosis of dementia between physicians and neuropsychologists.

OBJECTIVE: To explore reasons for discrepancy in the diagnosis of cognitive impairment between physicians and neuropsychologists. DESIGN: Retrospective analysis of national survey data. SETTING: Canadian Study of Health and Aging Phase 1, a national survey of community-dwelling and institutionalized older Canadians. PARTICIPANTS: 1879 subjects who completed all components of a clinical examination. MEASUREMENTS: Data available to both disciplines (demographic data, functional status, Modified Mini-Mental State (3MS), schedule H of the Cambridge Mental Disorders of the Elderly Examination (CAMDEX)), results of the physician's history and physical examination, and results of a psychometric test battery. Subjects were classified as No Cognitive Impairment, Cognitive Impairment Not Dementia (CIND), and Dementia, the latter according to the criteria of the Diagnostic and Statistical Manual, 3rd Ed., Revised. Preliminary diagnoses by physicians and neuropsychologists were compared. RESULTS: In univariate modeling, higher education increased consistency. Lower scores on the 3MS, depression reported in the CAMDEX, focal neurological signs, and all neuropsychological variables decreased agreement. In multivariate modeling, higher education and identification of long-term memory impairment by the neuropsychologist increased agreement; lower scores on the 3MS, depression reported on the CAMDEX, and identification of short-term memory impairment or constructional impairment led to disagreement. When the category of CIND was removed, kappa for agreement increased from 0.51 to 0.92. CONCLUSIONS: Physicians and neuropsychologists have different, complementary approaches to the diagnosis of dementia, and a consensus approach should be used. The category of CIND requires elucidation. Identification of dementia in subjects with depression or low education is difficult, and new strategies are required.

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PubMed1999

Spectrum of disease in vascular cognitive impairment.

The recognition that cognitive impairment of vascular origin is not limited to multi-infarct dementia has led to the development of several sets of new criteria for vascular dementia (VaD). We set out to define the spectrum of disease in patients presenting with vascular cognitive impairment (VCI). Of 412 patients consecutively seen at a memory clinic, 80 had VCI. These patients had vascular cognitive impairment not dementia (n = 19), VaD (n = 48), and mixed Alzheimer's disease-VaD (n = 13). Radiographic patterns were: white matter changes only (40%); multiple infarcts (30%); single strategic stroke (14%), and no identified lesion (16%). Of note, 19 (24%) of these patients meet none of the currently published criteria for VaD. To better understand and treat ischaemic causes of cognitive impairment, the concept of VaD should be expanded to include patients who do not meet traditional dementia criteria.

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PubMed1999

Dementia with Lewy bodies: review and pharmacotherapeutic implications.

Alzheimer's disease accounts for 50-60% of dementia cases in older people. Dementia with Lewy bodies is now recognized as the second most common type of dementia. It is different from Alzheimer's disease and has important pharmacotherapeutic implications. Key features include early-onset, persistent, well-formed, visual hallucinations and motor features of parkinsonism. Pharmacologic management of neurobehavioral symptoms is complicated by an exaggerated response to neuroleptics, which causes excessive morbidity and mortality. Patients with dementia with Lewy bodies may be particularly responsive to cholinesterase inhibitors. When neurobehavioral symptoms are severe enough to require pharmacologic intervention, it is recommended that agents such as trazodone or cholinesterase inhibitors be considered first-line therapy. If these fail, neuroleptics may be prescribed with caution.

Dementia↗
PubMed1998

Retrospective diagnosis of dementia using an informant interview based on the Brief Cognitive Rating Scale.

The accuracy of a dementia diagnosis by specialist physicians, as verified at an autopsy, is greater than 90% in many series. Donations of brains to the Maritime Brain Tissue Bank (MBTB) by individuals who did not have expert dementia diagnoses before death led us to investigate whether clinical features could also be detected retrospectively. Informants for 36 individuals whose brains were in the MBTB (18 women, mean age = 79 years; pathologic diagnoses: 75% Alzheimer's disease [AD]; 8.4% vascular or mixed dementia) were interviewed by specialist physicians using a semistructured retrospective interview based on the Brief Cognitive Rating Scale (BCRS) (range = 1 [no impairment] to 7 [terminal dementia]). The mean duration of dementia was 8.5 +/- 12.8 years based on proxy reports, and most cases suggested severe dementia--(stage 6 [severe] or 7 [terminal])--on the retrospective BCRS (RetroBCRS) before death. A score of 4 or more on the RetroBCRS had 100% sensitivity and specificity in detecting dementia. The RetroBCRS score correlated moderately with duration (.51). In linear and logistic regression models adjusted for age and sex, RetroBCRS staging helped explain 93% of the variation in duration. The accuracy of the retrospective diagnosis of the cause of dementia, compared with autopsy, was 92%. The RetroBCRS used by an expert physician with a reliable informant is a valid method of detecting dementia and determining whether AD was present.

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PubMed1998

Donepezil for treatment of dementia with Lewy bodies: a case series of nine patients.

Dementia with Lewy bodies (DLB) is common. Symptomatic treatment can be difficult. We reviewed nine consecutive patients with DLB (mean age 77.5 [range 67 to 84] years; seven men and two women; mean duration of disease 3.7 [range 1.5 to 8.0] years) who had been treated with donepezil. Each initially received 2.5 to 5 mg per day of donepezil, and was stabilized on 5 mg per day. Donepezil was increased to 10 mg per day in five patients. The mean observation period was 12 (range 8 to 24) weeks. Target symptoms included cognition, hallucinations, parkinsonism, and functional abilities. By both cognitive testing and family reports, cognition improved in seven of nine patients, remained the same in one of nine, and fluctuated in one of nine (mean Mini-Mental State Examination change 4.4 +/- 6.3 points). Function was improved or maintained in six of nine patients and fluctuated in two of nine. Hallucinations initially worsened, then fluctuated in one patient, but improvement in frequency, duration, and content was reported in eight of nine cases. In three of nine patients, treatment with donepezil resulted in worsening of parkinsonism, which in each case responded to levodopa/carbidopa. Treatment of DLB patients with donepezil for 12 weeks most commonly improved hallucinations, and sometimes improved cognition and overall function. Treatment with donepezil was sometimes associated with worse parkinsonism.

Activities of Daily Living↗
PubMed1998

Hip fracture in the elderly. An interdisciplinary team approach to rehabilitation.

The rising incidence of hip fractures in the elderly is a disturbing trend with serious health and socioeconomic consequences, including morbidity, loss of function, long-term institutionalization, and mortality. When preventive measures fail, the interdisciplinary healthcare team works together to provide operative treatment, reduce the risk of postoperative complications, and guide the patient through the recovery process. A team approach that ensures appropriate treatment, careful discharge planning, and coordinated rehabilitation can reduce the impact of the injury, speed recovery, and restore patient independence.

Activities of Daily Living↗
PubMed1996

Bovine spongiform encephalopathy and Creutzfeldt-Jakob disease: implications for physicians.

The appearance of bovine spongiform encephalopathy (BSE) followed by new spongiform encephalopathies and variant Creutzfeldt-Jakob disease (CJD) in the United Kingdom indicates that these diseases may be linked. To give an understanding of this risk, the authors review the literature on the pathogenesis of CJD and BSE and the current findings on how these diseases are transmitted. They also discuss the implications for Canada's food and blood supply and outline previously published recommendations for disease prevention.

Animals↗
PubMed1996

Mobility and balance in the elderly: a guide to bedside assessment.

Elderly patients often have impaired balance and loss of mobility. Regular assessment of mobility status is essential to ensure that appropriate support is provided and to monitor recovery. Functions that should be assessed include mobility in bed, ability to rise to a sitting position, ability to transfer from bed to chair and in and out of a bathtub, balance, ambulation, and gait. Evaluation can be performed quickly at the patient's bedside. For some patients, stretching and strengthening exercises may help restore function.

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