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Biomedical subjects

Geoffrey Tremont

Publications and source records attributed to Geoffrey Tremont.

11 recordsLinked to original sources
PubMed2006

Unique contribution of family functioning in caregivers of patients with mild to moderate dementia.

The relationship between family functioning and dementia caregiving is complex. The present study examined the interrelationships between family functioning, caregiver burden, and patient characteristics. Participants were 72 live-in, family caregivers of patients with mild (n = 47) or moderate dementia (n = 25). Caregivers completed measures of burden, family functioning, depression, and anxiety. Ratings of patients' memory/behavior problems and patients' activities of daily living were also collected. Results indicated that higher levels of caregiver burden were significantly associated with increased caregiver depression and anxiety, greater frequency of memory and behavior problems in the dementia patient, worse activities of daily living, and poorer family functioning. Even after controlling for caregiver depression, caregiver anxiety, and frequency of memory/behavior problems in dementia patients, poorer family functioning continued to be associated with higher levels of caregiver burden. Caregivers with high levels of burden reported greater family dysfunction in communication and roles, regardless of their relationship to the patient (i.e., spouse or child). These findings suggest that including a family systems component in caregiver interventions may be beneficial in reducing burden in these very distressed individuals.

Activities of Daily Living↗
PubMed2006

Psychosocial predictors of dementia caregiver desire to institutionalize: caregiver, care recipient, and family relationship factors.

Several factors influence dementia caregiver desire to institutionalize; however, little is known about differences in caregivers who desire institutionalization versus those who do not. The current study compares predictors of desire to institutionalize in dementia caregivers. Seventy-two caregivers completed the Desire to Institutionalize Scale (DIS) and several psychosocial measures, including burden, dementia knowledge, self-efficacy, depression, health, care recipient daily functioning and memory/behavior problems, family functioning, and social support. Based on DIS responses, caregivers were divided into No DI versus DI groups. DI caregivers had significantly higher burden, greater dementia knowledge, more family dysfunction, and decreased social support compared with No DI caregivers. Findings emphasize the importance of caregiver and family relationship variables in DIS, suggesting potentially modifiable targets for caregiver interventions. Dementia knowledge was associated with higher DIS, suggesting that educational programs alone may not be helpful to delay institutionalization.

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PubMed2005

Assessing olfaction in the neuropsychological exam: the relationship between odor identification and cognition in older adults.

The relationship between odor identification and cognition has not been previously well characterized. The neuroanatomy of the olfactory system and the frequent finding of olfactory dysfunction in neurodegenerative diseases suggest a likely relationship between odor identification and memory, language, and executive functioning, though previous studies have often failed to demonstrate the expected relationship. The current study examined this relationship in across a continuum of ability levels (N=100). Strongest correlations were found between odor identification and language, most aspects of memory, and a measure of general cognitive functioning. Significant but more modest correlations were seen between odor identification and attention, motor, visuospatial, and executive functions. A regression analysis revealed language as the only significant predictor of olfactory performance. These findings suggest that odor identification is most closely associated with other measures of temporo-limbic functioning. The implications of these findings, particularly in consideration of the assessment of older adults, are discussed.

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PubMed2004

Cognitive reserve and anosognosia in questionable and mild dementia.

Cognitive reserve (CR) theory posits that the clinical presentation of individuals with the same brain disease varies based upon premorbid variables (e.g., education, occupation, reading ability). Anosognosia (decreased insight regarding one's deficits) is common in dementia and has implications for safety, treatment, and caregiver burden. The current study examined the role of CR in anosognosia in individuals with mild dementia. Participants were individuals diagnosed with questionable or mild dementia (Clinical Dementia Rating 0.5 or 1) after neuropsychological evaluation. Anosognosia was measured by informant-patient discrepancy on the Cognitive Difficulties Scale. High and Low CR groups were created based upon reading performance. Low CR showed greater anosognosia than High CR. Anosognosia was associated with reduced reading performance, even after controlling for global cognitive decline. These findings suggest CR is related to anosognosia in questionable and mild dementia, and have clinical implications for the assessment of awareness in dementia.

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PubMed2003

Utility of the neuropsychological evaluation in an acute medical hospital.

Although recent studies have demonstrated the importance of cognitive assessment in medical settings in general, there have been no specific studies addressing the utility of the neuropsychological evaluation in the acute inpatient hospital setting. The current study examined the use of inpatient neuropsychological evaluation by treating physicians in an acute medical hospital for patient care and discharge disposition. Participants were 100 inpatients within an urban medical center who received a neuropsychological evaluation. Results showed 78% of hospital discharge summaries included information regarding the neuropsychological evaluation, 48% referenced specific results, and 68% reported specific recommendations. Further, actual placement outcomes were consistent with the neuropsychological evaluation placement recommendations 80% of the time. The current study supports the utility of neuropsychological evaluations on overall inpatient care, and discusses ways in which the results may be used to communicate the value of neuropsychological services to medical treatment and discharge planning teams, third party payors, and medical center administrators.

Female↗
PubMed2003

Discrimination of dementia with lewy bodies from Alzheimer disease and Parkinson disease using the clock drawing test.

OBJECTIVE: The authors' objective was to examine the ability of the Clock Drawing Test to discriminate Dementia with Lewy bodies from Alzheimer disease and Parkinson disease. BACKGROUND: Recent advances in medical treatments for dementia underscore the importance of differentiating among dementia subtypes. Clinically, Dementia with Lewy bodies can often be difficult to discriminate from Alzheimer disease and Parkinson disease because of similar and overlapping cognitive and motor features. While the Clock Drawing Test has been shown to discriminate dementia from normal aging fairly accurately, less is known about its ability to discriminate between various dementia groups. METHODS: Patients with Alzheimer disease (n = 22), patients with cognitively impaired Parkinson disease (n = 17), and patients with Dementia with Lewy bodies (n = 20), matched for age, education, and dementia severity, were compared on the Clock Drawing Test, scored for overall accuracy as well as the presence of specific error types. RESULTS: There were no significant group differences on a global quantitative measure of Clock Drawing Test performance. With regard to differences on the error types evaluated, the patients with Dementia with Lewy bodies were more likely to make conceptual errors than the patients with Alzheimer disease and Parkinson disease, and the patients with Parkinson disease and Dementia with Lewy bodies made more planning errors than the patients with Alzheimer disease. Classification accuracy was fair, with 69% overall classification for Alzheimer disease versus Dementia with Lewy bodies, and 68% overall classification for Parkinson disease versus Dementia with Lewy bodies. CONCLUSIONS: Although some differences may exist in the qualitative features of clock drawing performance between these patient groups, overall clock drawing performance is relatively similar, and as a single instrument, the Clock Drawing Test provides limited discrimination of Dementia with Lewy bodies from Alzheimer disease and Parkinson disease.

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PubMed2003

Odor identification deficits in diffuse lewy body disease.

OBJECTIVES: To describe odor identification performance in patients with diffuse Lewy body disease and determine the clinical utility of odor identification tests in distinguishing diffuse Lewy body disease from Alzheimer disease. BACKGROUND: The presence of olfactory deficits, especially odor identification deficits, has been well established in both Alzheimer disease and Parkinson disease. The presence of olfactory deficits in diffuse Lewy body disease is also likely given the overlap of clinical symptoms and neuropathology with Alzheimer disease and Parkinson disease. However, odor identification abilities have not been described previously in diffuse Lewy body disease. METHODS: Nine patients from a clinic sample with diffuse Lewy body disease and nine carefully matched patients with Alzheimer disease were administered an odor identification task as part of their neuropsychologic evaluations. RESULTS: Patients with diffuse Lewy body disease performed significantly worse than patients with Alzheimer disease on the odor identification test. CONCLUSIONS: Odor identification deficits may be more prevalent and severe in people with diffuse Lewy body disease than in people with Alzheimer disease, and olfactory testing may be useful in antemortem differential diagnosis of the two disorders.

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PubMed2002

Referring physicians' perceptions of the neuropsychological evaluation: how are we doing?

Clinical neuropsychologists often serve as consultants to physicians. However, little is known about physicians' perceptions of the neuropsychological evaluation. Therefore, the present study examined the opinions of physicians who referred patients for neuropsychological evaluation. Surveys were mailed with the neuropsychological reports to 119 physicians who referred patients to an outpatient hospital-based neuropsychology practice over a 2-year period. Results showed that physicians requesting neuropsychological evaluations most commonly sought assistance with establishing and confirming a diagnosis, and they reported a high level of satisfaction with the evaluation, including strong agreement with diagnosis and recommendations. These findings did not differ based on physician specialty or patient diagnosis.

Attitude of Health Personnel↗
PubMed2000

Minimizing the cognitive effects of lithium therapy and electroconvulsive therapy using thyroid hormone.

Although electroconvulsive therapy (ECT) and lithium are effective treatments for mood disorders, they are both associated with cognitive side-effects that reduce patient compliance and satisfaction. Because both ECT and lithium have significant impact on the hypothalamic-pituitary-thyroid (HPT) axis, at least some of these side-effects may be associated with alterations in HPT activity. There is evidence that cognitive deficits in patients with bipolar disorder taking lithium are related to diminished thyroid status, but not to serum lithium level. A preliminary study showed that adjunctive use of thyroid hormone significantly improves cognitive functioning in patients taking lithium. An animal study and two double-blind, placebo-controlled clinical studies examining the adjunctive use of thyroid hormone (T3) and ECT have confirmed that T3 significantly protects against ECT-related memory impairment compared to placebo. Taken as a whole, this research suggests that adjunctive use of thyroid hormone has the potential to reduce cognitive side-effects of these important psychiatric treatments.

Journal Article↗
PubMedDate not supplied

Assessment of mood state in dementia by use of the visual analog mood scales (VAMS).

OBJECTIVE: The assessment of mood states in individuals with dementia is a challenging yet clinically useful task. The purpose of the present study was to examine the validity of the Visual Analog Mood Scales (VAMS) in individuals with dementia. METHODS: Thirty-one patients who met diagnostic criteria for dementia completed the VAMS and a modified Profile of Mood States. RESULTS: Authors found good convergent validity between all monotrait-heteromethod mood states. Excellent discriminant validity was found for VAMS Happy, Confused, Angry, and Energetic scales. CONCLUSION: These results provide evidence for the validity of the VAMS in patients with dementia.

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