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G S Alexopoulos

Publications and source records attributed to G S Alexopoulos.

At least 19 recordsLinked to original sources
PubMed1992

Brain computed tomography findings in geriatric depression and primary degenerative dementia.

Brain computed tomography (CT) scans were performed in hospitalized geriatric patients with major depression (n = 45) or primary degenerative dementia (n = 21). Depressed patients with onset of illness at age 60 years or older (n = 32) had greater ventricular size than geriatric depressives with earlier age of illness onset (n = 13). CT parameters of late-onset depressives were comparable to those of patients with primary degenerative dementia. However, early-onset geriatric depressives had significantly smaller ventricles and less sulcal widening than demented patients. The findings suggest that late-onset depression may have a stronger association with neurological dementing disorders than early-onset depression.

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PubMed1992

Outcomes of geriatric depression.

Improvement in the methodology of longitudinal investigations and increasing research interest in depressive disorders led to findings of clinical and heuristic importance. Outcomes, such as chronicity of depression, relapse, recurrence, and development of dementia, appear to be predicted by different clinical and laboratory findings. Chronicity of depression may be predicted by long duration of the current or previous episodes, coexisting medical illness, high severity of depression, nonmelancholic presentation, delusions, and perhaps cognitive impairment and neuroradiologic abnormalities. Predictors of relapse and recurrence of geriatric depression include multiple previous depressive episodes, high severity of illness, "double depression," presence of "exit" events, and intercurrent medical illnesses. Development of dementia may be predicted by a transient dementia syndrome during a depressive episode ("pseudodementia"), onset of the first depressive episode in the senium, and neuroradiologic abnormalities such as cortical atrophy and rapidly evolving ventricular enlargement. Long-term antidepressant treatment, if not controlled by a research protocol, usually is of low intensity and has a questionable effect on the outcome of depression over a long period of time. For this reason, naturalistic treatment studies are useful for identifying subgroups of depressives and time periods of high risk for specific adverse outcomes. This knowledge is particularly important in frail elderly populations who are vulnerable to side effects of antidepressant treatments. The next step is to conduct controlled-treatment studies and examine the capability of antidepressant treatments to prevent adverse outcomes in the high-risk populations identified through naturalistic treatment studies. Controlled-treatment studies can provide findings that clinicians can use to assess the risk-benefit ratio of continuation and maintenance treatments of geriatric depression. The heuristic importance of knowing the outcome of geriatric depression is that it permits identification of clinically and, to some extent, biologically-homogeneous groups. Given the absence of specific and sensitive laboratory tests, outcome is perhaps the "next best thing" to brain autopsy for subclassifying geriatric depression. Biologic measures of structural and functional abnormalities can then be used in homogeneous subgroups for the pursuit of pathophysiologic or etiologic studies.

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PubMed1991

Diagnosing cognitive dysfunction in the elderly: primary screening tests.

The recognition of cognitive disturbances in geriatric patients has important clinical implications for the primary care physician. Commonly seen cognitive dysfunctions include dementia, pseudodementia, delirium, and frontal lobe syndrome; these may be confounded by overlapping depression. The cognitive examination covers such intellectual and behavioral functions as attention, memory, and language. As many psychiatric disorders result from neurologic brain disease, a psychiatric examination is essential. Mental status questionnaires are useful for screening of high-risk populations for dementia and to quantify the degree of cognitive dysfunction for purposes of management planning and surveillance.

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PubMed1991

Verbal memory and plasma drug concentrations in elderly depressives treated with nortriptyline.

Performance on a verbal memory task and affective state were assessed in geriatric major depressives before and during 6 weeks of treatment with nortriptyline (NT) in a fixed-dose design study. Higher plasma NT concentration was associated with poorer free recall but better affective outcome. In contrast, higher plasma Z-10-hydroxynortriptyline (Z-10-OH-NT) concentration was associated with more efficient free recall. Concentration-effect relationships were noted in patients later classified as cognitively unimpaired using the Dementia Rating Scale after optimal treatment, rather than in those with residual cognitive impairment.

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PubMed1991

Depression in Alzheimer's disease.

Alzheimer's disease involves cognitive and noncognitive manifestations including varying degrees of depression. The depressive syndromes of Alzheimer's patients are similar to those of nondemented patients and frequently are identified by patients themselves and their relatives. There is evidence that the depression of Alzheimer's disease is caused by familial and neurobiologic factors. The clinical importance in identifying depression in Alzheimer's disease lies in its responsiveness to antidepressant treatments.

Alzheimer Disease↗
PubMed1989

Chronicity and relapse in geriatric depression.

Recent advances in the methodology of longitudinal investigations have permitted the identification of predictors of chronicity and relapse of depression. However, findings from mixed-age populations may not be directly applicable to geriatric depression. The effects of medical illness, cognitive dysfunction, and neuroradiological abnormalities on the outcome of geriatric depression merit further evaluation. Late-onset depression requires special attention, since medical and neurological disorders may be particularly important factors in these cases.

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PubMed1989

Clonidine challenge of cortisol secretion in dementia and geriatric depression.

The effect of oral clonidine challenge on cortisol secretion was evaluated in seven patients with primary degenerative dementia and in seven patients with major depression. Postclonidine cortisol levels were decreased in all depressed patients and in demented patients with hypercortisolemia at baseline. Demented patients with normal cortisol levels at baseline developed increased post-clonidine cortisol levels. These preliminary findings suggest differences in noradrenergic regulation of cortisol secretion among patients with primary degenerative dementia.

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PubMed1988

Cornell Scale for Depression in Dementia.

The Cornell Scale for Depression in Dementia is introduced. This is a 19-item clinician-administered instrument that uses information from interviews with both the patient and a nursing staff member, a method suitable for demented patients. The scale has high interrater reliability (kw = 0.67), internal consistency (coefficient alpha: 0.84), and sensitivity. Total Cornell Scale scores correlate (0.83) with depressive subtypes of various intensity classified according to Research Diagnostic Criteria.

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PubMed1988

Geriatric depression.

Depression in later life can present unique clinical and therapeutic challenges. Phenomenology is often atypical and the concurrence of physical illness can confound both diagnosis and treatment. A review of current knowledge about epidemiology, pathogenesis, clinical features, and therapeutic issues is presented.

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PubMed1988

Isomers of 10-hydroxynortriptyline in geriatric depression.

In geriatric, depressed inpatients treated with nortriptyline (NT), total unconjugated plasma concentrations of the Z isomer of the 10-hydroxylated metabolite (10-OH-NT) were determined simultaneously with concentrations of the E isomer by high-performance liquid chromatography. Z-10-OH-NT concentrations averaged 14% of E-10-OH-NT concentrations.

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PubMed1988

Use of the Cornell scale in nondemented patients.

The Cornell scale is a 19-item clinician-administered scale of depression that uses information from interviews with both patients and their caregivers. The Cornell scale has been validated in demented patients. In this study, the Cornell scale was psychometically tested in nondemented geriatric subjects by administering it to 15 depressed patients, 15 patients with other psychiatric diagnoses, and 15 normal control subjects. The Cornell scale had high interrater reliability (Cohen's kappa = 0.74), internal consistency (Kuder-Richardson's coefficient = 0.98), and sensitivity, and correlated significantly (Spearman's r = 0.81) with Research Diagnostic Criteria psychiatric diagnoses associated with various intensity of depression. To our knowledge, the Cornell scale is the only depression-rating instrument that has been validated in both demented and nondemented geriatric subjects.

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PubMed1988

Drug-induced dystonia in young and elderly patients.

This retrospective study examined the common notion that neuroleptic-induced dystonia is less frequent in elderly patients. The hospital records of 45 young patients and 45 elderly patients were reviewed. Thirty-one percent of the young patients developed dystonia, compared to 2% of the elderly patients. This significant difference did not appear to be the result of types of neuroleptics used, dose, or concomitant administration of anticholinergic drugs.

Adult↗