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Biomedical subjects

E H Rubin

Publications and source records attributed to E H Rubin.

At least 19 recordsLinked to original sources
PubMed1992

Mild senile dementia of the Alzheimer type. 4. Evaluation of intervention.

The design of trials of interventions intended to slow or arrest the progression of senile dementia of the Alzheimer type must be based on analysis of the natural history of the disease. Using a random coefficients statistical model, we analyzed the natural history of senile dementia of the Alzheimer type in carefully defined subjects with mild disease (n = 68) for periods of up to 10 years. Subject performance was assessed longitudinally on batteries of clinical and psychometric measures. The characteristics of these measures were analyzed relevant to their utility as outcome measures for long-term trials in patients with senile dementia of the Alzheimer type. Estimates were made of sample sizes required to show arrest, and 50% or 25% slowing in the progression of mild disease. We suggest that a clinically relevant global measure, such as the Sum of Boxes of the Clinical Dementia Rating scale, and a performance-based clinical scale or psychometric measure would be appropriate in a 12- or 24-month trial enrolling subjects with mild senile dementia of the Alzheimer type.

Actuarial Analysis↗
PubMed1992

Risk factors for high-dose cytarabine neurotoxicity: an analysis of a cancer and leukemia group B trial in patients with acute myeloid leukemia.

PURPOSE: We analyzed pretreatment characteristics of patients with postremission acute myeloid leukemia (AML) treated with high-dose cytarabine (HIDAC) during a recent Cancer and Leukemia Group B (CALGB) trial to determine risk factors associated with HIDAC neurotoxicity. PATIENTS AND METHODS: One hundred seventy-six patients received at least one course of HIDAC as part of a CALGB protocol designed to determine the optimal dose of cytarabine (ara-C) for postremission treatment of AML. HIDAC consisted of 3 g/m2 ara-C infused over 3 hours at 12-hour intervals on days 1, 3, and 5. The pretreatment characteristics of 170 patients were available for risk analyses. RESULTS: Eighteen patients (10%) experienced neurotoxicity. Univariate analyses demonstrated associations between the occurrence of neurotoxicity and elevated serum creatinine, age, and alkaline phosphatase (AP). Multivariate analysis showed that these variables were independent risk factors. These findings were used to construct a risk model with the following parameters: creatinine greater than or equal to 1.2 mg/dL, age greater than or equal to 40 years, and AP greater than or equal to 3 x normal. Seventeen of 46 (37%) patients with two or more of these criteria developed neurotoxicity compared with one of 124 (1%) patients with one or none. The sensitivity and specificity of this model were 94% and 81%, respectively. CONCLUSION: We conclude that patients with two or more of the following parameters may be at increased risk for HIDAC neurotoxicity: (creatinine greater than or equal to 1.2 mg/dL, age greater than or equal to 40, and AP greater than or equal to 3 x normal). However, this model should be confirmed by analysis of additional groups of patients treated with HIDAC.

Acute Disease↗
PubMed1991

The influence of major depression on clinical and psychometric assessment of senile dementia of the Alzheimer type.

OBJECTIVE: The performance on standard clinical and psychometric assessments of eight elderly individuals with major unipolar depression alone and seven with depression plus mild senile dementia of the Alzheimer type was compared with that of 41 nondepressed subjects suffering from very mild senile dementia of the Alzheimer type, 66 with mild senile dementia of the Alzheimer type, and 83 age-matched subjects without senile dementia. METHOD: Subjects with depression alone, depression plus mild senile dementia of the Alzheimer type, and very mild and mild senile dementia of the Alzheimer type met strict inclusionary and exclusionary criteria. A 90-minute semistructured interview, including several brief standardized clinical scales, was used to assign a Clinical Dementia Rating to each subject according to published guidelines, and each subject was given a 2-hour psychometric test battery. Data were analyzed by one-way multivariate analysis of variance to ascertain if there was an effect of group on clinical and psychometric test scores. RESULTS: The eight depressed subjects without concurrent dementia performed as well as the 83 nondepressed subjects without dementia on most clinical measures; however, their performance on most psychometric measures closely resembled that of the 41 nondepressed subjects with very mild dementia. The performance of the seven subjects with depression plus mild dementia was comparable to that of the 66 nondepressed subjects with mild dementia on most clinical and psychometric measures. CONCLUSIONS: Although depressed subjects performed as well as subjects without dementia on many clinical assessments, psychometric testing was not able to distinguish depressed subjects from those with very mild senile dementia of the Alzheimer type. This demonstrates the need for careful psychiatric evaluation before interpreting deficits on psychometric tests as indicating the presence of very mild senile dementia of the Alzheimer type.

Aged↗
PubMed1991

Very mild Alzheimer's disease: informant-based clinical, psychometric, and pathologic distinction from normal aging.

We compare clinicopathologic data from 10 subjects identified in the very mild stage of senile dementia of the Alzheimer type with findings from similar studies in four cognitively normal subjects. We based the diagnosis of very mild dementia in the 10 subjects on informant reports and the judgment of experienced clinicians. Deficits of some psychometric measures of memory, language, and speeded psychomotor performance were observed for these subjects. The histologic markers of Alzheimer's disease, including neurofibrillary tangles and both the "diffuse" and classic subtypes of senile plaques, were present in the neocortex in all 10 subjects but essentially were absent in the four controls. These findings indicate that even "questionable" dementia can be diagnostic for Alzheimer's disease. Furthermore, because truly normal aging may be unaccompanied by neocortical senile plaques and neurofibrillary tangles, the presence of these lesions should suggest the possibility of clinically undetected Alzheimer's disease.

Activities of Daily Living↗
PubMed1991

Clinical diagnosis and course of Alzheimer's disease.

Alzheimer's disease can be accurately diagnosed by clinical methods alone in about 90% of cases. The adoption of uniform diagnostic criteria and assessment procedures, such as those developed by the Consortium to Establish a Registry for Alzheimer's Disease (CERAD), will likely improve the characterization of the disease across a variety of clinical settings. In general, Alzheimer's disease is a relentlessly progressive disorder; however, it also is clinically heterogeneous. This is underscored by its diverse cognitive deficits, neurologic features, behavioral pathology, and rates of progression.

Alzheimer Disease↗
PubMed1990

Mild senile dementia of the Alzheimer type: 3. Longitudinal and cross-sectional assessment.

Sixty-six subjects diagnosed by validated criteria as having senile dementia of the Alzheimer type (SDAT) were assessed with clinical measures commonly used to study dementia. The severity of the SDAT was mild in 24, moderate in 24, and severe in 18. The data from these three groups in a cross-sectional study were compared with results in our earlier study of 43 subjects enrolled with mild SDAT and followed longitudinally. We concluded that the cross-sectional method underestimates the severity of progression as indicated by some of the clinical measures. Additionally, the 24 new subjects with mild SDAT were assessed longitudinally. This replication study confirmed our earlier conclusions that four of six clinical measures showed similar patterns over time and were useful throughout the study, global measures being more informative than brief individual measures with ceiling or floor effects.

Aged↗
PubMed1989

Very mild senile dementia of the Alzheimer type. I. Clinical assessment.

We report a longitudinal study of 16 subjects originally enrolled in the Washington University (St Louis, Mo) Memory and Aging Project with Clinical Dementia Rating (CDR) of "questionable" dementia (CDR 0.5). A 0.5 rating was intended to characterize subjects in whom mild cognitive impairment due to senile dementia of the Alzheimer type was suspected but was insufficient in degree to warrant a diagnosis of definite dementia. Over an 84-month follow-up period, 11 of the 16 subjects either had Alzheimer's disease verified post mortem or had clinically progressed to a more advanced CDR stage in which the dementia was clearly evident. These results suggest that the CDR 0.5 stage likely represents the incipient clinical manifestation of Alzheimer's disease and that the majority of subjects with CDR 0.5 have "very mild senile dementia of the Alzheimer type." Performance on several standard clinical scales was significantly different when comparing a larger sample of controls (n = 83), subjects with CDR 0.5 (n = 41), and subjects with mild senile dementia of the Alzheimer type (score of 1; n = 68).

Aged↗
PubMed1989

Psychotic symptoms and the longitudinal course of senile dementia of the Alzheimer type.

Delusions, misidentifications and hallucinations occur frequently throughout the course of senile dementia of the Alzheimer type (SDAT). Rates of psychosis among subjects with moderate to severe SDAT range from 42% to 84% in our study group; at least half of persons with SDAT with no prior psychiatric history will display psychosis at some point during the course of dementia. Furthermore, psychotic symptoms are associated with accelerated cognitive deterioration, but not with increased mortality.

Aged↗
PubMed1989

Psychopathology of very mild dementia of the Alzheimer type.

The authors describe psychiatric abnormalities, including personality and affective changes and psychotic symptoms, associated with very mild senile dementia of the Alzheimer type. The behavioral and affective changes in the subjects with very mild dementia resembled those occurring in subjects with mild dementia, but psychotic symptoms rarely occurred until the dementia had progressed to at least a mild stage.

Aged↗
PubMed1988

Symptoms of "depression" in dementia of the Alzheimer type.

The frequency of symptoms of depression (Feighner criteria) was evaluated in subjects with dementia of the Alzheimer type (DAT) and matched controls enrolled in a longitudinal natural history study of DAT. Despite enrollment criteria which excluded subjects with affective disorders, the collateral sources of subjects with DAT described these subjects as having significantly more "depressive" symptoms than controls without dementia at entry, and at 15- and 34-month follow-up. The collateral sources of the subjects with DAT reported that these demented individuals experienced significantly greater loss of interest, decreased energy, difficulty in thinking and concentrating, and psychomotor agitation or retardation then did the control group. The subjects with DAT reported fewer symptoms than did their collateral sources, but like their collateral sources, they did not report a global elevation of all Feighner symptoms, but rather related significantly greater difficulty in thinking and concentrating than the controls and a tendency toward loss of interest and psychomotor changes. No subject became clinically depressed. The results suggest a significant overlap between the symptoms of dementia and depression. The frequency with which the above symptoms occur in DAT confounds the use of Feighner and, by extension, DSM-III criteria in diagnosing depression in cognitively impaired individuals with DAT.

Alzheimer Disease↗
PubMed1988

Overlapping symptoms of geriatric depression and Alzheimer-type dementia.

The occurrence of geriatric depression and dementia of the Alzheimer type, two of the most common diseases of late life, is certain to increase as the proportion and absolute number of Americans over the age of 65 grow larger. Overlapping symptomatology can sometimes make it difficult to determine whether a patient suffers from geriatric depression with cognitive abnormalities, Alzheimer-type dementia with depressive symptoms, or coexisting depression and dementia. In this review of the course, symptomatology, and pathophysiology of Alzheimer-type dementia and geriatric depression, the authors describe the symptoms often shared by these diseases as well as the characteristics usually associated with one or the other. Factors that complicate diagnosis, such as the presence of other medical illnesses and pharmacokinetic and pharmacodynamic changes associated with aging, are also discussed.

Aged↗
PubMed1988

Electroconvulsive therapy for the elderly: a review.

Treatment of psychiatric disorders among the elderly is complicated by such factors as high incidence of medical illness and changes in drug metabolism; electroconvulsive therapy (ECT) is considered a reasonable treatment alternative for the elderly for several psychiatric syndromes. The authors review indications, complications, and precautions related to ECT for older patients. The primary indication is major depression; about 80 percent of elderly patients respond favorably. ECT appears less effective for depression secondary to dementia or somatization disorder. Although ECT is relatively safe for the elderly, up to one-third may experience a complication that interferes with treatment. Careful pre-ECT medical evaluation is essential, with special attention to cardiovascular factors and to concurrent medications.

Aged↗
PubMed1988

The nature of psychotic symptoms in senile dementia of the Alzheimer type.

The Alzheimer Disease Research Center at Washington University's medical school has gathered a large sample of subjects with senile dementia of the Alzheimer type (SDAT) who are free of other potentially complicating medical, neurologic and psychiatric disorders. Using this homogeneous population, we have characterized psychotic symptoms associated with SDAT. Three groups of symptoms occur commonly: paranoid delusions, misidentification syndromes, and hallucinations. The nature and frequency of these syndromes are discussed.

Aged↗
PubMed1988

Aging and mania.

Geriatric psychiatry involves the study of the interaction of age, medical illnesses, psychopathology, and treatment responsivity. Many of these interactions are demonstrated by reviewing mania in the elderly. Studying geriatric aspects of psychiatric disorders may give clues to understanding the pathophysiology of the same disorder in younger patients. For instance, localization of lesions associated with late onset mania suggests brain areas which may be involved in the early onset form of bipolar affective disorder. Reviewing the use of lithium in the elderly patient with mania provides the opportunity to review general geriatric psychopharmacologic principles.

Aged↗
PubMed1986

Imaging of brain activity and behavioral disorders.

Recent advances in brain imaging permit metabolic variables to be measured in psychiatric patients. These include regional cerebral blood flow, oxygen utilization, oxygen extraction and glucose utilization--all measures which reflect CNS energy utilization. The quantitative relationships between these metabolic parameters, neuronal activity, and higher cortical function are poorly understood. In evaluating the results of imaging studies, it is important to establish whether the reported changes correlate with episodic symptomatology or with a chronic disease process. Affective disorders exemplify conditions which are episodic, progress rapidly and respond to medication, making it difficult to identify consistent patterns of metabolic change. Thus unipolar subgroups have been described with both left and right metabolic predominance. On the other hand, imaging studies in dementia have consistently shown decreased glucose utilization, and more particularly poor verbal performance may go with reduced glucose uptake in the left temporal/parietal area. Although neuro-imaging studies are still at an early stage, the additional capacity to measure regional receptor distribution and kinetics using ligands tagged with positron emitters will open up new dimensions in the study of psycho-pathophysiology.

Alzheimer Disease↗