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Biomedical subjects

D Masur

Publications and source records attributed to D Masur.

13 recordsLinked to original sources
PubMed2000

The relative frequency of "dementia of unknown etiology" increases with age and is nearly 50% in nonagenarians.

CONTEXT: With the recent change in pathological criteria for Alzheimer disease (AD), a group of patients has emerged who do not meet pathological criteria for any well-characterized degenerative dementias. Whether these unclassified patients have vascular dementia or some other form of dementia is not known. OBJECTIVE: To determine the clinical characteristics, pathological substrate, and relative frequency of dementia not caused by well-characterized degenerative dementias. DESIGN/SETTING: Clinicopathological study of a prospectively observed sample of elderly nondemented and demented subjects recruited from our urban community. METHODS: In our series of 128 subjects with prospective neuropsychological evaluations as well as neuropathology, we identified 35 clinically nondemented subjects and 20 demented patients who did not meet pathological criteria for well-characterized degenerative dementias such as AD or dementia with Lewy bodies. The 20 demented patients were grouped together under the term dementia of unknown etiology (DUE). We compared clinical, genetic, neuropsychological, pathological, and neurochemical characteristics of the nondemented group, patients with DUE, and 28 patients with AD and no other pathological abnormality. RESULTS: Mean age at death for patients with DUE was 89.1 +/- 5.8 years compared with 79.9 +/- 11.4 years for AD (P<.001). Patients with AD and DUE did not differ in sex, risk factors, apolipoprotein E genotype, neuropsychological features, or neurological features. Hippocampal sclerosis (in 11 patients with dementia and no controls) and leukoencephalopathy (in 7 patients with dementia and 1 control) were associated with cognitive impairment; other vascular markers were not. Dementia of unknown etiology accounted for 5% of all cases of dementia among patients dying in their 70s, 21% for patients dying in their 80s, and 48% for patients dying in their 90s. CONCLUSIONS: A significant percentage of demented patients older than 80 years do not meet pathological criteria for AD or dementia with Lewy bodies. Hippocampal sclerosis and leukoencephalopathy are common in these patients but rare in clinically nondemented subjects.

Aged↗
PubMed1997

The effect of dementia risk factors on comparative and diagnostic selective reminding norms.

Robust comparative and diagnostic norms for the elderly are provided for the Selective Reminding Test (Buschke, 1973). Correcting for factors such as age and education level are appropriate for comparative norms, which are intended for ranking individuals with respect to their age and education matched peers. However, because age and education are both risk factors for dementia, correcting for these factors decreases test sensitivity for detecting dementia. Age- and education-corrected Selective Reminding scores have a sensitivity for detecting dementia that is 28% lower than uncorrected scores. Using information about age in combination with memory scores provided optimal discrimination of dementia. It is concluded that statistically removing the contribution of dementia risk factors from memory test scores can severely decrease discriminative validity for detecting dementia in the elderly.

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PubMed1996

Associations of status and change measures of neuropsychological function with pathologic changes in elderly, originally nondemented subjects.

OBJECTIVE: To describe the association between status and change of neuropsychological function and postmortem neuropathologic findings in subjects with Alzheimer's disease, vascular dementia, normal aging, and pathologic aging. DESIGN: Volunteer cohort study. SETTING: Volunteers were interviewed and tested in outpatient-clinical research offices. PARTICIPANTS: Nondemented, healthy, community-residing subjects, initially between 75 and 85 years of age, who participated in the Bronx Aging Study and had at least 2 years of neuropsychological data and quantitative neuropathologic examinations. MAIN OUTCOME MEASURES: Initial summary neuropsychological score, rate of change score. RESULTS: Summary neuropsychological scores at baseline in subjects who subsequently developed pathologically confirmed Alzheimer's disease or vascular dementia were 0.8 z units lower than those of subjects classified in the normal or pathologic aging subgroups (P < .05). Subjects with Alzheimer's disease showed more neuropsychological change over time than subjects in the normal or pathologic aging groups (P < .001). Normal subjects and subjects with pathologic aging did not differ in baseline scores or rate of change. Level of education was strongly associated with initial neuropsychological scores (P < .004), but not with change scores. CONCLUSIONS: Among elderly, initially nondemented subjects who were followed up until death, subjects with pathologically confirmed Alzheimer's disease or vascular dementia had lower neuropsychological scores at initial evaluation than normal subjects or subjects with pathologic aging. Subjects with Alzheimer's disease had a more rapid rate of decline than normal subjects or subjects with pathologic aging.

Aged↗
PubMed1992

Fluent aphasia in children: definition and natural history.

We compared the course of a preschool child we followed for 4 years with published reports of 24 children with fluent aphasia. Our patient spoke fluently within 3 weeks of the injury. She was severely anomic and made many semantic paraphasic errors. Unlike other children with fluent aphasia, her prosody of speech was impaired initially, and her spontaneous language was dominated by stock phrases. Residual deficits include chronic impairment of auditory comprehension, repetition, and word retrieval. She has more disfluencies in spontaneous speech 4 years after her head injury than acutely. School achievement in reading and mathematics remains below age level. Attention to the timing of recovery of fluent speech and to the characteristics of receptive and expressive language over time will permit more accurate description of fluent aphasia in childhood.

Achievement↗
PubMed1991

Dementia. Age-dependent incidence, prevalence, and mortality in the old old.

Age has been reported as a strong risk factor for dementia. Supporting data have been derived mainly from prevalence studies, which had varied criteria and sample compositions that precluded direct comparisons, especially among those aged 85 years and older. Data regarding rates of dementia are presented based on 85 incident cases in the Bronx (NY) Aging Study, a prospective study of 488 initially nondemented, old old persons (mean age on entry, 79 years). Overall, the incidence rate over 8 years of follow-up for all-cause dementia was 3.4 per 100 per year (43% Alzheimer's disease, 30% mixed Alzheimer's and vascular, and 27% other). Incidence rose significantly, irrespective of gender, as subjects were followed up through three age intervals--ages 75 to 79 years (1.3/100 per year), 80 to 84 years (3.5), and 85 years and older (6.0). The comparable age-associated prevalence rates of dementia were 3.7%, 12.2%, and 23.9%, respectively, with an overall period prevalence of 22.8%. Additionally, there was a threefold greater mortality associated with dementia. In conclusion, despite the shortened life expectancy of demented persons, dementia is a highly prevalent condition among those aged 85 years and older. Public policy attention is warranted, since this group is the fastest growing population subgroup.

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PubMed1991

Cognitive functioning in late Lyme borreliosis.

Lyme borreliosis, a tick-borne multisystem disease, may cause a variety of neurologic complications, including meningoencephalitis and encephalopathy. To evaluate neurobehavioral function following treated Lyme borreliosis, 15 patients with Lyme disease and complaints of persistent cognitive difficulty a mean of 6.7 months following antibiotic treatment underwent neuropsychological evaluation and were compared with 10 healthy controls, matched in aggregate for age and education, who underwent the identical neuropsychological assessment. Compared with controls, patients with Lyme disease exhibited marked impairment on memory tests and particularly on selective reminding measures of memory retrieval. The memory impairment did not correlate with serum or cerebrospinal fluid anti-Borrelia burgdorferi antibody titers and was not explained by magnetic resonance imaging findings or depression. The cause of this encephalopathy is currently unknown; however, indirect effects of systemic infection or other toxic-metabolic factors may be partly responsible.

Adult↗
PubMed1990

Women, myocardial infarction, and dementia in the very old.

Dementia is a major public health problem among the very old. Available information on incidence and prevalence is sparse and variable; however, there appears to be a higher prevalence among very old women. We present data from a prospective study of initially nondemented community-residing elderly. There were 75 incident dementia cases (up to 7 years of follow-up) of which at least 47% were probable Alzheimer's disease. Based on a proportional hazards analysis, women were over 3 times more likely to develop dementia than men despite controlling for baseline demographic, psychosocial, and medical history variables. Poor word fluency and a high normal Blessed test score at baseline were also strong predictors of dementia. We did not find age, head trauma, thyroid disease, or family history of dementia to be risk factors. A new finding is that history of myocardial infarction (MI) is associated with dementia, such that women with a history of MI were 5 times more prone to dementia than those without a history. This observation was not true for men.

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PubMed1989

Preservation of musical memory in Alzheimer's disease.

An 82 year old musician with Alzheimer's disease (AD) showed a preserved ability to play previously learned piano compositions from memory while being unable to identify the composer or titles of each work. He also showed a preserved ability to learn the new skill of mirror reading while being unable to recall or recognise new information. Both anterograde and retrograde procedural memory may be relatively spared in AD.

Aged↗
PubMed1989

Neuropsychological characteristics of subjects with and without neocortical Alz-50 immunoreactivity.

We performed quantitative histopathology and Alz-50 staining on 8 non-demented and 16 demented subjects who had received yearly neuropsychological evaluations as part of prospective studies of dementia. Of the 8 non-demented subjects, four had begun to show signs of cognitive decline on serial neuropsychological testing. These subjects showed marked decline on the Fuld Object Memory Evaluation, a test of recent memory. Scores on IQ tests and the Blessed test of orientation, memory, and concentration showed fluctuations but not consistent declines. These old-old, retired subjects were called "cognitively impaired" but not demented because they did not show decline in activities of daily living or social interactions. Five of the non-demented subjects had numerous cortical senile plaques and met standard pathological criteria for Alzheimer's disease (AD), but only one of the five was Alz-50 positive. That subject had shown the most consistent decline on neuropsychological scores. Ten of 11 clinically demented subjects with pathological evidence of AD were Alz-50 positive. All five clinically demented subjects with non-Alzheimer dementias on pathological examination were Alz-50 negative. Alz-50 may stain plaques found in AD, but not stain plaques which accompany aging. The cognitive impairment found in the Alz-50 negative subjects may be age-associated and not indicate early AD.

Aging↗
PubMed1988

Clinico-pathologic studies in dementia: nondemented subjects with pathologically confirmed Alzheimer's disease.

We compared neuropsychological findings in 28 longitudinally evaluated elderly subjects with their postmortem neuropathology, including senile plaque and neurofibrillary tangle counts from standardized sections. Nine of the subjects were not demented when evaluated just prior to their death. Numerous cortical senile plaques and other changes of Alzheimer's disease (AD) occurred in six of nine nondemented old-old subjects. Five of these six subjects had shown decline on yearly neuropsychological tests but their cognitive impairment was too mild to meet clinical criteria for dementia. Whereas cortical senile plaque count did not distinguish well between demented and nondemented subjects, every subject with numerous cortical neurofibrillary tangles was demented. The nondemented subjects with Alzheimer pathology may have had "preclinical" AD, or numerous cortical plaques may occur in some elderly subjects who would never develop clinical dementia.

Aged↗
PubMed1987

Neuropsychological effects of antihypertensive drugs.

Antihypertensive medications are all associated with adverse reactions, and the elderly patient may be particularly sensitive. In a large longitudinal follow up study in an aged population, beta-blockers were shown to have caused no greater impairment of cognitive function or mood when compared to a control population. alpha-Methyldopa did interfere with some measures of neuropsychological functioning.

Affect↗
PubMedDate not supplied

Psychiatric disorders in patients with fibromyalgia. A multicenter investigation.

The authors conducted an investigation in four tertiary-care centers to determine if psychiatric comorbidity and psychological variables were predictive of functional impairment in patients with fibromyalgia syndrome (FMS). Seventy-three individuals were administered the Structured Clinical Interview for DSM-III-R, the Rand 36-item Health Survey (SF-36), and multiple self-report measures. The patients with FMS were found to have a high lifetime and current prevalence of major depression and panic disorder. The most common disorders were major depression (lifetime [L] = 68%, current [C] = 22%); dysthymia (10% [C only]); panic disorder (L = 16%, C = 7%); and simple phobia (L = 16%, C = 12%). The self-report scales revealed significant elevations in depression, anxiety, neuroticism, and hypochondriasis. Functional impairment on all measures of the SF-36 was severe (e.g., physical functioning = 45.5 and role limitations due to physical problems = 20.0). Stepwise multiple-regression analysis revealed that current anxiety was the only variable that predicted a significant proportion of the variance (29%) in SF-36 physical functioning. Thus, in this multicenter study, the persons with FMS exhibited marked functional impairment, high levels of some lifetime and current psychiatric disorders, and significant current psychological distress. Current anxiety level appears to be an important correlate of functional impairment in individuals with FMS.

Adult↗