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Biomedical subjects

D Coakley

Publications and source records attributed to D Coakley.

At least 19 recordsLinked to original sources
PubMed2003

Low serum cholesteryl ester-docosahexaenoic acid levels in Alzheimer's disease: a case-control study.

Low n-3 polyunsaturated fatty acid (PUFA) status may be associated with neuro-degenerative disorders, in particular Alzheimer's disease, which has been associated with poor dietary fish or n-3 PUFA intake, and low docosahexaenoic acid (DHA) status. The present case-control study used an established biomarker of n-3 PUFA intake (serum cholesteryl ester-fatty acid composition) to determine n-3 PUFA status in patients with Alzheimer's disease, who were free-living in the community. All cases fulfilled the National Institute of Neurological and Communicative Disorders and Stroke and Alzheimer's Disease and Related Disorders Association criteria for Alzheimer's disease. Detailed neuropsychological testing and neuroimaging established the diagnosis in all cases. The subjects (119 females and twenty-nine males) aged 76.5 (SD 6.6) years had a clinical dementia rating (CDR) of 1 (SD 0.62) and a mini mental state examination (MMSE) score of 19.5 (SD 4.8). The control subjects (thirty-six females and nine males) aged 70 (SD 6.0) years were not cognitively impaired (defined as MMSE score <24): they had a mean MMSE score of 28.9 (SD 1.1). Serum cholesteryl ester-eicosapentaenoic acid and DHA levels were significantly lower (P<0.05 and P<0.001 respectively) in all MMSE score quartiles of patients with Alzheimer's disease compared with control values. Serum cholesteryl ester-DHA levels were progressively reduced with severity of clinical dementia. DHA levels did not differ in patients with Alzheimer's disease across age quartiles: all were consistently lower than in control subjects. Step-wise multiple regression analysis showed that cholesteryl ester-DHA and total saturated fatty acid levels were the important determinants of MMSE score and CDR. It remains to be determined whether low DHA status in Alzheimer's disease is a casual factor in the pathogenesis and progression of Alzheimer's disease.

Age Factors↗
PubMed2002

A longitudinal evaluation of behavioural and psychological symptoms of probable Alzheimer's disease.

BACKGROUND: Non-cognitive symptoms are a frequent feature of Alzheimer's disease (AD). Much of the literature that has accumulated pertains to cross-sectional prevalence of these symptoms. There has been relatively little attention paid to the longitudinal course of Behavioural and Psychological Symptoms of Dementia (BPSD). AIMS: The purpose of this study is to examine the longitudinal course of BPSD in a group of patients with mild AD. METHODS: A retrospective review of a database was performed to identify patients with NINCDS/ADRDA criteria for probable AD and who had been evaluated three times at yearly interval over a two-year period. Fifty-two subjects were identified with probable AD that had completed follow-up for 24 months. The BEHAVE-AD was used to evaluate BPSD and data was analysed using a Markov analysis. RESULTS: Activity disturbance is a common and relatively persistent symptom in the mild stages of AD. Anxiety, paranoid ideation, and aggression were moderately persistent. Affective symptoms were not persistent with less than half the patients having the symptoms a year later. CONCLUSIONS: Activity disturbance is common and persistent in early AD. Paranoid and delusional ideation shows moderate persistence and depressive symptoms infrequently last longer than a year. These findings may have clinical relevance for the pharmacological and non-pharmacological management of BPSD.

Aged↗
PubMed2001

Verbal aggression in Alzheimer's disease. Clinical, functional and neuropsychological correlates.

OBJECTIVES: To determine the clinical, functional and neuropsychological correlates of verbal aggression in Alzheimer's disease in a group of consecutive first attendees to a memory clinic. METHODS: 150 people were evaluated and diagnosed as suffering with probable Alzheimer's disease. These people were tested using the Behave-AD for the presence of verbal aggression, delusions, depression and agitation. They were also assessed with cognitive, functional and neuropsychological scales. RESULTS: Twenty-eight per cent of this group of Alzheimer patients had exhibited some verbal aggression in the preceding month. Male gender (p = 0.022), the presence of paranoid and delusional ideation (p = 0.003) and agitation (p = 0.042) were significantly associated with verbal aggression in a stepwise backward logistic regression analysis. CONCLUSION: The presence of verbal aggression should prompt the clinician to search for delusional ideation, which may respond to pharmacotherapy.

Aged↗
PubMed2001

The clock drawing test in primary care: sensitivity in dementia detection and specificity against normal and depressed elderly.

OBJECTIVES: The aim of this study was to examine the sensitivities and specificities of the clock drawing test (CDT) in the detection of dementia among older people in primary care, with particular emphasis on the effect of depression on CDT specificity. Most previous studies have been sited in specialist settings and few have addressed the issue of specificity against depression. METHODS: Comparison of cohorts identified from community-based screening with GMS-AGECAT. The CDT and the Mini-Mental State Examination (MMSE) were administered to 41 elderly subjects with organic disorder (dementia), 84 elderly subjects with case level depression and 523 normal elderly subjects. Sensitivities and specificities of the CDT were calculated. RESULTS: The sensitivity of the CDT in the detection of dementia in the general community was 76%. The specificities of the CDT against normal elderly and depressed elderly was 81% and 77% respectively. Higher sensitivity and specificity were achieved by the MMSE. CONCLUSIONS: The use of the CDT in the detection of dementia syndromes is likely to be more relevant in the primary care context than in specialist settings. The CDT provides good sensitivity and specificity but may not be as sensitive or specific in the general community as previous studies have suggested, particularly in mild dementia. Community-based late life depression does not appear to alter the specificity of the CDT.

Aged↗
PubMed2001

Depression in the community dwelling elderly: do clinical and sociodemographic factors influence referral to psychiatry?

BACKGROUND: Little is known about the reasons why depressed elderly patients are referred to the old age psychiatric services. Reasons for referral of depressed younger patients have been clarified however they may not be generalisable to an older population. OBJECTIVES: The purpose of this study is to examine which clinical and sociodemographic factors influence referral of patients with late life depression from primary care. METHODS: Twenty-eight people were identified with depression in a day hospital referred by their general practitioner. These were compared with fifty-two people with depression in the community who had not been referred to the psychiatric services. RESULTS: Having a more severe depression (p = 0.0016) and having co-morbid anxiety (p = 0.0017) meant you were more likely to be referred to the day hospital. Gender did not appear to influence referral from general practitioners. CONCLUSIONS: It appears that severity of depression and having higher levels of anxiety make it more likely that you will be referred by your general practitioner to the old age psychiatry services.

Aged↗
PubMed2001

Effect of age on ocular microtremor activity.

BACKGROUND: Ocular microtremor (OMT) is a high-frequency tremor of the eyes. It is present in all individuals and is related to brainstem activity. The OMT signal appears as an irregular oscillatory movement with intermittent burst-like components. The clinical interest in OMT has centered on its use in the assessment of the comatose patient, with broad agreement among authors of its prognostic value. The purpose of this study was to examine the changes in OMT activity related to aging. METHODS: OMT was recorded from 72 normal healthy subjects using the piezoelectric strain gauge technique. The subjects ranged in age from 21 to 88 years (54.22 +/- 20.43 years, mean +/- SD). RESULTS: Our results show that the overall frequency and frequency content of the bursts falls with age (p < .002 and p < .001, respectively). There is a highly significant drop in all three frequency parameters of OMT (p < .0001) in subjects older than 60 years of age. CONCLUSIONS: These results suggest that different values of normality should operate for subjects over 60 years of age when considering the clinical application of OMT.

Adult↗
PubMed2001

Endogenous sex hormone levels in postmenopausal women with Alzheimer's disease.

A cross-sectional study examined whether there was a difference in endogenous serum sex hormone levels between community-dwelling postmenopausal women with Alzheimer's disease (AD) and healthy controls. Total morning levels of serum estrone, estradiol, androstenedione, testosterone, and cortisol were measured in 52 nondepressed women with AD and 60 postmenopausal women who were neither depressed nor cognitively impaired. Estradiol was undetectable in 35.7% of cases, but detectable hormone was found in 96-100% of cases otherwise. After adjustment for potential confounds, serum levels were significantly higher for estrone (P = 0.0057) and androstenedione (P = 0.02), but not testosterone (P = 0.086) or estradiol (P = 0.59), in subjects with AD. Sex hormone levels did not correlate with cognitive scores in either group. Although the failure to detect estradiol in a third of cases limits the conclusions that can be drawn for this hormone, the possibility that AD is associated with abnormalities in certain serum sex hormone levels should be considered and warrants further research.

Aged↗
PubMed2001

The effects of age on accident severity and outcome in Irish road traffic accident patients.

Road traffic accidents (RTA's) are the leading cause of fatal trauma in Ireland. Although older drivers are the safest group of drivers in the population, once involved in a crash they are more likely to sustain a severe injury or death. The experiences of Irish elderly RTA victims has not been previously documented. We studied older RTA patients admitted to two Irish trauma centres in 1995. Of 525 patients, 39 (7%) were aged over 65. We compared 38 patients aged 16-64 years for comparison and reviewed the notes in detail. Elderly patients were mostly pedestrians (23/38 - 61%) though 21% (8/38) were drivers with 8% (3/38) on public transport. Younger patients were mostly drivers (14/37 - 38%), cyclists (9/37 - 24%) or motorcyclists (7/37 - 19%). Older patients had a higher median Injury Severity Score, p < 0.05, were more likely to be female (p<0.01), involved in RTA's between 9am-5pm (p<0.05) and have pre-existing medical conditions (p<0.01). The following were significantly increased in older patients (p values): surgical (<0.01), medical (<0.01) and therapist workload (p<0.05), complications (<0.0001), length of stay (<0.01). Less elderly were discharged directly to home (p<0.001). Strategies to reduce the mortality and morbidity associated with RTA in the elderly should emphasise a) older pedestrians during daytime hours, b) attention to safety in public transport. Treatment must ensure adequate medical and therapist input to anticipate higher complication rates.

Accidents, Traffic↗
PubMed2000

CT measurement of medial temporal lobe atrophy in Alzheimer's disease, vascular dementia, depression and paraphrenia.

OBJECTIVE: Measurement of medial temporal lobe atrophy (MTL) by computerised tomography (CT) may be a useful adjunct to the diagnosis of AD. The aim of this study was to assess the sensitivity, specificity, predictive values and diagnostic accuracy of CT measurement of MTL thickness for patients with probable AD, compared with a 'diseased' control group, and to correlate the measure with neuropsychological test scores. DESIGN: Cross-sectional. METHODS: One hundred subjects were prospectively recruited: 60 with probable AD (mean age 73.7 years, mean Mini-Mental State Examination [MMSE] 19.6), 17 with probable vascular dementia (VaD) (mean age 77.9 years, mean MMSE 20.9), 14 with depression (mean age 73.2 years, mean MMSE 25.7) and nine with paraphrenia (mean age 74 years, mean MMSE 25.4). Axial and temporal lobe-oriented CT brain was performed and the minimum MTL thickness was measured electronically. RESULTS: The mean minimum MTL thickness was significantly smaller in AD subjects compared to VaD (p<0.0001) and psychiatric subjects (p<0.0001). For the clinical diagnosis of probable AD, the sensitivity of the measure was 0.75, specificity 0.9, and diagnostic accuracy 0.81. For the mildest cases of AD (CDR 0.5), the sensitivity of the measure was 0.61, specificity 0.91, and diagnostic accuracy 0.81. No significant correlations with neuropsychological test scores were found. CONCLUSIONS: Temporal lobe-oriented CT imaging is a non-invasive test with good discrimination for AD. Potential uses of this technique include as an aid to diagnosis and possibly as a means of monitoring disease progression.

Aged↗
PubMed2000

Do patient age and medical condition influence medical advice to stop smoking?

OBJECTIVE: to determine whether the age and medical condition of a patient influences hospital-based doctors' decision making when advising patients to stop smoking cigarettes. METHODS: we presented 142 doctors from four grades (consultant, registrar, senior house officer and house officer) and four specialities (medicine, surgery, psychiatry and anaesthetics), based in a Dublin teaching hospital, with 20 clinical vignettes. Each vignette described a patient from one of five age groups with one of four levels of health. The vignettes were randomly mixed. We asked doctors to say whether they would advise the patient in each case to quit smoking. RESULTS: hospital-based doctors are significantly less likely to advise patients aged over 65 years than younger patients of the hazards of cigarette smoking, irrespective of the person's physical or mental health (P < 0.001). CONCLUSION: the advice given to patients about their cigarette smoking habits by hospital doctors is strongly influenced not only by the patient's health, but also by the patient's chronological age.

Age Factors↗
PubMed2000

Ocular microtremor (OMT): a new neurophysiological approach to multiple sclerosis.

Using a piezoelectric transducer, the frequency and pattern of ocular microtremor (OMT) between 50 normal subjects and 50 patients with multiple sclerosis were compared. Controls were age matched. All records were analysed blindly. The frequency of OMT in the normal group was 86 (SD 6) Hz, which was significantly different from that of the multiple sclerosis group (71 (SD) 10 Hz, p<0.001). Those in the multiple sclerosis group with clinical evidence of brain stem or cerebellar disease (n=36) had an average OMT frequency of 67 (SD 9) Hz (p<0.001) compared with normal (n=86), whereas those with no evidence of brain stem or cerebellar involvement (n=14) had a frequency of 81.2 (SD 6) Hz (p<0.05, n=64). The differences between the two multiple sclerosis groups were also significant (p<0. 001, n=50). At least one abnormality (frequency and pattern) of OMT activity was seen in 78% of patients with multiple sclerosis. In the presence of brain stem or cerebellar disease 89% had abnormal records whereas in the absence of such disease 50% had abnormal records. This is the first report of the application of this technique to patients with multiple sclerosis. The results suggest that OMT activity may be of value in the assessment of multiple sclerosis.

Adult↗
PubMed2000

Three-year prognosis of depression in the community-dwelling elderly.

BACKGROUND: Depression is the most common mental disorder in the community-dwelling elderly. AIMS: To determine the three-year prognosis of depression in a cohort of 127 community-dwelling elderly subjects and identify factors relevant to outcome. METHOD: The subjects, diagnosed depressed at year 0 using the GMS-AGECAT package, were followed up three years later. A number of factors were investigated for an association with recovery from, or persistence of, depression. RESULTS: At follow-up, 30.2% of the depressed subjects had died, 34.9% had persistent or relapsed case-level depression, 24.5% had other case- or sub-case-level mental illness and 10.4% had recovered completely. Physical ill-health, bereavement and positive family history of depression were associated with poor outcome, whereas treatment with antidepressant medication significantly improved prognosis. CONCLUSIONS: Late-life depression in community-dwelling subjects is a chronic condition. However, the positive response to antidepressant medication suggests that it should be vigorously treated.

Aged↗
PubMed1999

Dysthymia among the community-dwelling elderly.

There are few data on the clinical features of dysthymia among the community-dwelling elderly. Forty elderly individuals with dysthymic disorder were identified following screening in the community with GMS-AGECAT. A detailed clinical history was obtained and DSM-IV checklists and standardized scales were used, at a second interview. Comparisons were made with a group of 630 non-depressed elderly from the same community. Dysthymia was predominately of late onset (93%) and associated with a major stressor in 65% of cases. Comorbid axis 1 disorders were present in 15% of dysthymics and an axis 2 disorder in 10%. The dysthymic group had significantly higher degrees of physical impairment than the non-depressed elderly. The symptom profile demonstrated prominent anxiety and functional features. Eighty-three per cent of the elderly with dysthymia had presented to their GP with anxiety/depressive symptoms at some stage during the dysthymic disorder. The presentation of dysthymia in older people differs from that in earlier life. Late life dysthymia is less associated with axes 1 and 2 comorbidity but is associated with significant degrees of physical impairment. Dysthymia in older people presents to primary care, rather than specialist services, and interventions must be delivered at this level.

Age of Onset↗
PubMed1999

Dominant frequency content of ocular microtremor from normal subjects.

Ocular microtremor (OMT) is a high frequency tremor of the eyes present during fixation and probably related to brainstem activity (Coakley, D. (1983). Minute eye movement and brain stem function. CRC Press, FL.). Published observations on the frequency of OMT have varied widely. Ocular microtremor was recorded in 105 normal healthy subjects using the Piezoelectric strain gauge technique. The dominant frequency content of a signal was determined using the peak counting method. Values recorded ranged from 70 to 103 Hz, the mean frequency being 83.68 Hz (S.D. +/- 5.78 Hz).

Adult↗
PubMed1999

The association between demographic factors, disease severity and the duration of symptoms at clinical presentation in elderly people with dementia.

OBJECTIVE: To determine the association between factors unrelated to the disease process, the duration of symptoms and the degree of cognitive or functional impairment in elderly patients presenting with dementia. METHOD: The living situation, educational level, age, gender and diagnosis based on standardized criteria were recorded for 209 elderly patients presenting to a memory clinic with dementia. Cognitive and functional deficits were measured with the cognitive section of the Cambridge Mental Disorders of the Elderly Examination combined with the Mini-Mental State Examination and the abbreviated version of the Blessed dementia scale, respectively. RESULTS: 129 patients had a diagnosis of probable Alzheimer's disease, 19 had probable ischaemic vascular dementia and 61 had mixed dementia. There was no effect of diagnosis on duration of symptoms or dementia severity at the time of presentation. Patients living with a son or daughter were more functionally impaired than those living alone or with a spouse. Males had higher cognitive scores but did not have milder functional deficits. Patients with only a primary-school education had a trend towards lower cognitive scores at presentation but did not have more functional deficits. CONCLUSIONS: The gender of the patient and the relationship to the carer are associated with cognitive and functional scores at the time of presentation in patients with dementia.

Age Factors↗
PubMed1999

Tissue culture adherence and haemagglutination characteristics of Moraxella (Branhamella) catarrhalis.

The haemagglutination and tissue culture adherence properties of 20 isolates of Moraxella catarrhalis obtained from the sputum of elderly patients with lower respiratory tract infections were compared with those of 20 isolates of M. catarrhalis obtained from the nasopharynx of elderly persons colonised by the organism. Eighty percent of isolates from the infected group as opposed to 5% of isolates from the colonised group haemagglutinated human erythrocytes (P < 0.001), indicating that the haemagglutinin might be a marker of pathogenicity for M. catarrhalis. There was a significant difference in the adherence to HEp-2 cells of isolates from the infected group in comparison to isolates from the colonised group (P = 0.03). Haemagglutination and tissue culture adherence properties were unrelated, indicating that separate adhesin systems are involved. The adherence of M. catarrhalis to HEp-2 cells was unaffected following pronase and trypsin treatment, however, sodium periodate pre-treatment of the bacteria significantly reduced the tissue culture adherence index, indicating that the adhesin by which the bacteria bind to HEp-2 cells may have a carbohydrate moiety. Transmission electron microscopy studies revealed that adherence of M. catarrhalis to HEp-2 cells was mediated by trypsin-resistant 'tack-/spicule-like' structures protruding from the surface of the bacteria.

Aged↗
PubMed1999

Transmission electron microscopy studies of Moraxella (Branhamella) catarrhalis.

A trypsin-sensitive 200-kDa protein has been reported to be exclusively associated with haemagglutinating isolates of Moraxella (Branhamella) catarrhalis. Transmission electron microscopy studies revealed that haemagglutination by M. catarrhalis to both human and rabbit erythrocytes was mediated by a trypsin-sensitive outer fibrillar coat. This fibrillar layer was absent on non-haemagglutinating isolates examined. Immuno-electron microscopy, using a polyclonal antiserum containing antibodies to the 200-kDa protein as a probe, showed that the 200-kDa protein is present on the outer fibrillar layer of the bacterium. These findings suggest that the haemagglutinin of M. catarrhalis is a 200-kDa protein present on the outer fibrillar coat.

Animals↗