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Biomedical subjects

G T Grossberg

Publications and source records attributed to G T Grossberg.

At least 19 recordsLinked to original sources
PubMed2000

Lack of adverse pharmacodynamic drug interactions with rivastigmine and twenty-two classes of medications.

Alzheimer's disease (AD) is often associated with multiple comorbidities and subsequent polypharmacy. Treatment of AD with acetylcholinesterase (AChE) inhibitors can carry a risk of drug interaction with multiple medications often prescribed for other co-existing illnesses. Rivastigmine is an AChE inhibitor that is enzymatically cleaved by AChE, minimally metabolized by cytochrome P450 enzymes, has low protein binding, has a short plasma half-life, and a relatively short duration of action. Such properties make it ideal for use in this patient population. A pharmacodynamic analysis of rivastigmine administered concomitantly with other medications (22 different therapeutic classes) did not reveal any significant pattern of increase in adverse events that would indicate a drug interaction. In summary, rivastigmine was well tolerated and safely administered to a population receiving multiple medications for 'real-world' comorbidities.

Aged↗
PubMed1998

Advance directives, competency evaluation, and surrogate management in elderly patients.

As patients age, their capacities for memory, judgment, reasoning, planning, and decision-making may erode. Preparing for the time when these losses occur involves three important strategies: advance directives, competency evaluation, and surrogate management. Advance directives allow currently competent patients to record the kind of medical procedures they desire if they become incompetent in the future. Competency evaluations determine the mental competence of a patient and require special training for the physician. The need for surrogate management increases as a patient's cognitive deficits worsen and often requires involvement of the legal system. This paper addresses these important strategies in detail.

Advance Directives↗
PubMed1998

The treatment of psychosis in late life.

The authors emphasize the need for careful differential diagnosis when symptoms of psychosis arise in patients over the age of 65 years. Prevalence of psychotic disorders in the elderly ranges from 0.2%-4.7% in community-based samples to 10% in a nursing home population and as high as 63% in a study of Alzheimer's patients. Risk factors associated with the development of psychotic symptoms and common causes of delirium are reviewed. Because age-related changes affect the pharmacokinetics of neuroleptics, the authors' treatment recommendations, which include the use of traditional and novel antipsychotics, take into account the higher risk of side effects in the elderly.

Age Factors↗
PubMed1998

Epidemiology of psychotherapeutic drug use in older adults.

Those over 65 years of age constitute nearly 13% of the United States population. This age group, however, consumes three times their number of prescribed and over-the-counter remedies. In fact, nearly 30% of all prescriptions and 40% of over-the-counter remedies are consumed by older adults. This is also the population most sensitive to the side effects of drugs and, in particular, to the mood- or mind-altering properties of commonly prescribed and over-the-counter remedies. This article discusses medication usage among older adults with a special focus on various classes of psychotherapeutic agents- their uses, potential abuses, and special hazards.

Age Factors↗
PubMed1998

Estrogen as a psychotherapeutic agent.

This article provides information on the effects of estrogen as a psychotherapeutic agent. Estrogen has a positive effect on several neurotransmitter systems that are assumed to be involved in regulation of affect, behavior, and cognition. Clinical studies suggest that an important cause of nonresponsiveness to antidepressants in postmenopausal women may be inadequate hormone replacement. Potential uses of estrogen as a mood stabilizer or mood enhancer also are described in this article. In the area of behavior, estrogen regulates aggressivity, sexual drive, impulsivity, and hostility. In terms of cognition, evidence suggests the importance of estrogen in the prevention and treatment of Alzheimer's-type dementia. At the end of the article, future research directions are discussed.

Affect↗
PubMed1998

Late-life onset of psychotic symptoms.

The authors retrospectively evaluated the etiology and clinical findings of patients with first manifestations of psychotic symptoms after the age of 65. Nearly 10% of over 1,700 consecutive geriatric patients admitted to an acute inpatient psychogeriatric unit had late-life onset psychotic symptoms. About three-fourths of these were women, usually in their seventies. Dementia of the Alzheimer's type was the most common cause of psychosis arising in late life, followed by major depression, medical/toxic causes, delirium, bipolar disorder, delusional disorder, schizophrenia, and schizoaffective disorder. Clinical manifestations consisted mostly of delusions and hallucinations.

Age of Onset↗
PubMed1998

The role of the psychiatrist in Alzheimer's disease.

Psychiatrists are uniquely qualified to provide a variety of important services to patients with Alzheimer's disease and their families and professional caregivers. This paper highlights the role of the psychiatric physician in the differential diagnosis of dementing illnesses. Psychiatrists are also uniquely trained to evaluate and treat the psychiatric symptoms and problem behaviors in Alzheimer's disease. The psychiatrist may be asked to utilize and monitor antidementia compounds as well as to orchestrate functional and competency evaluations. As the leader of the mental health team, the psychiatrist serves as educator and resource provider to patients and their families. Lately, the psychiatrist works closely with caregivers to monitor for and prevent burnout and depression.

Alzheimer Disease↗
PubMed1997

Issues involved in assessing competency.

A psychiatric competency assessment entails more than merely conducting a few clinical tests to diagnose the cause of a cognitive impairment. The psychiatrist may need to explore other aspects of the patient's life, including his or her interpersonal relationships and functional abilities. To provide a truly useful consult for other physicians, legal professional, family members, and the patient, the psychiatrist must be able to integrate the medical findings along with all relevant personal information and apply this information to the legal standards of the particular jurisdiction. By being able to apply both medical and legal knowledge of proxy decision making, the psychiatrist will be better prepared to make recommendations that will facilitate the proper care and services for the cognitively impaired patient.

Aged↗
PubMed1997

Diagnosis and treatment of psychotic symptoms in elderly patients.

The diagnosis and treatment of psychotic symptoms in elderly patients requires more than extrapolation from studies of similar symptoms in the adult population. In comparison with early-onset psychosis, late-onset psychosis is characterised by differences in both its risk factors and typical signs and symptoms. Diagnosis may include psychotic disorders, mood disorders, delusional disorder, dementia or delirium. Several medications have also been associated with the development of psychotic symptoms in the elderly. There is a paucity of literature concerning psychotic symptoms specifically in elderly patients, and this complicates management. Treatment involves the resolution of any causative general medical condition, and/or symptomatic management with antipsychotic medication. The high-potency antipsychotics are typically better tolerated in the elderly than their low-potency counterparts. In addition, the newer atypical antipsychotics such as clozapine have shown early promise. It is important to consider the higher incidence of adverse effects and tardive dyskinesia in the elderly when choosing a drug and its dosage. Consideration of psychosocial factors completes the appropriate management of psychotic symptoms in older patients.

Adult↗
PubMed1996

The evolution of psychiatric symptoms in Alzheimer's disease: a natural history study.

OBJECTIVE: To characterize the natural history of Alzheimer's Disease (AD); in particular, to determine the prevalence and time of onset of psychiatric symptoms. DESIGN: Retrospective medical records review. SETTING: Regional brain bank operated by a university hospital. PARTICIPANTS: One hundred randomly selected autopsy-confirmed AD patients. MEASUREMENTS: The presence of psychiatric symptoms (e.g., anxiety, wandering, agitation) was documented, and the time of onset relative to diagnosis was measured. RESULTS: Irritability, agitation, and aggression were documented in 81 patients (81%) an average of 10 months after diagnosis. A total of 72% of patients experienced depression, changes in mood, social withdrawal, and suicidal ideation more than 2 years before diagnosis (26.4 months). Hallucinations, paranoia, accusatory behavior, and delusions were documented around the time of diagnosis (0.1 months after diagnosis) in 45% of patients. Patients with early-onset disease, more years of formal education, and male gender experienced psychiatric symptoms later, relative to diagnosis, than their counterparts. CONCLUSIONS: Psychiatric manifestations of depression may herald a diagnosis of AD, as such behaviors occurred more than 2 years before diagnosis, on average, in this cohort. Psychotic symptoms manifested around the time of diagnosis, perhaps even prompting diagnosis, whereas agitative symptoms occurred in the first year after diagnosis. The evolution of psychiatric symptoms in this cohort differed according to age at onset of disease, years of formal education, and gender.

Age Distribution↗
PubMed1996

Treating the agitated Alzheimer patient.

Dementia is a syndrome that consists of cognitive, psychiatric, and behavioral changes. Studies report from 42% to 62% of nursing home residents and at least 50% of outpatients with dementia exhibit behavioral disturbances. Agitation is a frequent behavioral disturbance associated with dementia. The Omnibus Budget Reconciliation Act (OBRA) regulations have made it imperative that physicians review and be familiar with alternative treatment options. We review and present strategies for the evaluation and treatment of agitation in demented patients.

Adrenergic beta-Antagonists↗
PubMed1995

The natural history of Alzheimer's disease: a brain bank study.

OBJECTIVE: To define the natural history of Alzheimer's Disease (AD), from time of clinical (presumptive) diagnosis and/or onset of symptoms to death and to describe demographic and clinical characteristics of patients with AD. DESIGN: Retrospective medical records review. SETTING: Regional brain bank operated by a university hospital. PARTICIPANTS: One-hundred randomly selected, autopsy-confirmed Alzheimer's Disease patients. MEASUREMENTS: All information pertaining to family and clinical history (diagnoses, office visits, hospitalizations), medication use, nutritional status, and clinical testing (laboratory testing, imaging, diagnostics, and psychometric testing) was abstracted. Time of onset for behavioral symptoms (e.g., anxiety, wandering, agitation) and deficits in cognitive function (e.g., recent memory, concentration, language) and activities of daily living (ADL) were also abstracted. Data was collected on-site using a laptop computer and a series of customized data entry spreadsheets. Upon completion of the data abstraction process, data was converted to a database program for query and analysis. RESULTS: A complete natural history timeline was constructed based on the mean values observed in order to demonstrate important clinical endpoints, namely, diagnosis, institutionalization, and death. The mean time between onset of symptoms and clinical diagnosis was 32.1 months (standard deviation = 37.9 months). The interval between symptom onset and AD diagnosis was longer for patients who were less than 65 at time of diagnosis (mean = 37.6 months), female patients (mean = 34.9 months), and patients with a positive family history of dementia (mean = 37.5 months). The mean age at diagnosis was 74.7 years (standard deviation = 8.6 years), with a range of 52 to 89 years. Most patients were diagnosed between the ages of 70 and 79. Males were diagnosed at an earlier age, 72.8 years, on average, than females, 75.4 years. The mean time to institutionalization from time of clinical diagnosis was 23.9 months (standard deviation = 33.6 months). The average age at institutionalization was 77.6 years, with a minimum of 60 years and a maximum of 92.5 years. Institutionalization occurred 56.5 months after symptom onset, on average. This interval was shorter among patients with a negative family history (mean = 53.1 months) and patients diagnosed after age 65 (mean = 51.6 months). Patients diagnosed before age 65 experienced a significantly greater average time to institutionalization, 94 months (P = .01). Disease duration was measured as time from symptom onset until death. Mean disease duration was 101.3 months, or nearly 8.5 years (standard deviation = 59.2 months). Subgroup analysis showed that disease duration was prolonged in younger onset patients (mean = 129.1 months), females (mean = 107.9 months), and patients with a positive family history of dementia (mean = 106.3 months). CONCLUSIONS: These data suggest that the typical AD patient is diagnosed 32 months after symptom onset, at the age of 75 years. This patient is institutionalized 25 months after diagnosis, or approximately 57 months after symptom onset at age 78. The patient remains institutionalized for 44 months or, in actuality, until death. Total disease duration for this typical AD patient is just over 101 months, or approximately 8.5 years.

Activities of Daily Living↗
PubMed1995

The older patient with psychotic symptoms.

Literature of the past ten years is reviewed to examine psychosocial, psychiatric, organic, and general medical causes of psychotic symptoms in persons over age 65. Being bedfast with poor caretaker relationships and being socially isolated are risk factors for psychosis among elderly persons. A thorough history is essential to differential diagnosis. Psychiatric causes to be ruled out include schizophrenia; depression, including mania; dementia and delirium; paranoid state; and late-life delusional disorder. Perhaps the most common etiology is cognitive impairment, generally attributable to Alzheimer's disease or multi-infarct dementia. Organic or toxic etiologies need to be ruled out, especially in persons with visual hallucinations. Drug toxicity, a structural brain lesion, or a subtle seizure disorder should be considered. If symptoms are not alleviated when psychosocial triggers or underlying toxic, organic, or medical causes are addressed, patients may respond to supportive therapy and low doses of high-potency neuroleptics. The clinician should keep in mind that older adults are highly sensitive to the side effects of these agents.

Aged↗
PubMed1995

Safety and efficacy of caffeine-augmented ECT in elderly depressives: a retrospective study.

Prior studies have shown that in younger depressives undergoing ECT whose seizure durations declined despite maximum settings on three different ECT devices, pretreatment with caffeine lengthened seizures and resulted in clinical improvement. Caffeine (half life, 140-270 minutes) was well tolerated even in patients with pre-existing cardiovascular disease. The purpose of this retrospective study was to determine the safety and efficacy of caffeine augmented ECT in elderly depressed patients. The charts of 14 elderly depressives (average age 75.6, range 59-83; 2 males, 12 females) who received caffeine-augmented ECT were reviewed. Patients pre- and post-ECT medications, blood pressure, pulse, and seizure times (cuff and EEG) for each ECT performed were noted. The following conclusions were drawn from our study: (1) Caffeine definitely increases the seizure length and was useful in our setting when the energy settings could not be increased anymore. (2) Caffeine augmentation inconsistently causes an increase in pulse rate, on average, in the elderly. (3) Caffeine inconsistently produces an increase in mean arterial pressure. (4) Caffeine did not consistently produce an increase in the maximum rate-pressure product. We conclude from this study that caffeine-augmented ECT is safe and effective in increasing seizure duration in the elderly. However, more research needs to be done to determine optimal dosing and tolerability.

Aged↗
PubMed1995

Drug-induced seizures in the elderly. Causative agents and optimal management.

We conducted a review of drugs that were most commonly associated with inducing seizures in the elderly population. The method for determining the risk of these agents includes evaluating the utilisation and the percentage of adverse events in previous studies and case reports. Classes of medications, such as anti-psychotics and antidepressants, are extensively reviewed to provide the clinician with treatment options in high risk patients. The risk of seizures secondary to the withdrawal of alcohol (ethanol) and benzodiazepines, and methods employed to minimise the risk are discussed. In addition, the management of patients with drug-induced seizures is delineated. Drug-induced seizures are a potentially serious adverse effect. It is important that clinicians are aware of which classes of medications and individual medications are associated with reducing seizure threshold.

Aging↗