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Biomedical subjects

J L Cummings

Publications and source records attributed to J L Cummings.

At least 55 records · Page 3Linked to original sources
PubMed2000

Olanzapine treatment of psychotic and behavioral symptoms in patients with Alzheimer disease in nursing care facilities: a double-blind, randomized, placebo-controlled trial. The HGEU Study Group.

BACKGROUND: Patients with Alzheimer disease (AD) commonly exhibit psychosis and behavioral disturbances that impair patient functioning, create caregiver distress, and lead to institutionalization. This study was conducted to assess the efficacy and safety of olanzapine in treating psychosis and/or agitation/aggression in patients with AD. METHODS: A multicenter, double-blind, placebo-controlled, 6-week study was conducted in 206 elderly US nursing home residents with AD who exhibited psychotic and/or behavioral symptoms. Patients were randomly assigned to placebo or a fixed dose of 5, 10, or 15 mg/d of olanzapine. The primary efficacy measure was the sum of the Agitation/Aggression, Hallucinations, and Delusions items (Core Total) of the Neuropsychiatric Inventory-Nursing Home version. RESULTS: Low-dose olanzapine (5 and 10 mg/d) produced significant improvement compared with placebo on the Core Total (-7.6 vs -3.7 [P<.001] and -6.1 vs -3. 7 [P =.006], respectively). Core Total improvement with olanzapine, 15 mg/d, was not significantly greater than placebo. The Occupational Disruptiveness score, reflecting the impact of patients' psychosis and behavioral disturbances on the caregiver, was significantly reduced in the 5-mg/d olanzapine group compared with placebo (-2.7 vs -1.5; P =.008). Somnolence was significantly more common among patients receiving olanzapine (25.0%-35.8%), and gait disturbance occurred in those receiving 5 or 15 mg/d (19.6% and 17.0%, respectively). No significant cognitive impairment, increase in extrapyramidal symptoms, or central anticholinergic effects were found at any olanzapine dose relative to placebo. CONCLUSION: Low-dose olanzapine (5 and 10 mg/d) was significantly superior to placebo and well tolerated in treating agitation/aggression and psychosis in this population of patients with AD.

Aged↗
PubMed2000

Utilization of Alzheimer's disease community resources by Asian-Americans in California.

Alzheimer's disease is as prevalent among Asian ethnic minority groups as among Caucasians. We explored Asian groups' utilization of available Alzheimer's disease services in California, using a uniquely large sample of Asian-Americans. The Minimum Uniform Dataset includes data from nine California Alzheimer's Disease Diagnostic and Treatment Centers. Of the 9,451 cases included in the Minimum Utilizable Dataset, 4.2% were Asian (primarily Chinese), 0.8% Filipino, 0.3% Pacific Islander, and 75.9% Caucasian. In comparison to their numbers within the nine California countries served, Asian ethnic elders were underrepresented in enrollment by approximately 50%, except at one center where all staff were bilingual. The centers referred a significantly greater proportion of Asian than Caucasian patients for financial help (47.8 vs. 7.4%, P < 0.001), case management (47.8 vs. 22.3%, P < 0.001), and to Alzheimer's disease day care (41.3 vs. 28.4%, P < 0.05). A significantly greater proportion of Asian caregivers received referrals to caregiver resource centers (32.6 vs. 61.3%, P < 0.001) and financial help (29.6 vs. 4.7%, P < 0.001). A smaller proportion of Asian patients received referrals to home health services than Caucasians (4.3 vs. 14.9%, P < 0.05). Filipino patients were also referred more frequently to financial assistance than Caucasians (P < 0.05). Asians and Pacific Islanders under-enroll at centers specializing in AD care. Bilingual staff at centers specializing in dementia care, training for community physicians who treat these patients, and establishment of caregiver support groups within Asian and Pacific Islander communities may enhance the enrollment of these elders. AD care centers in areas supporting Asian and Filipino families may need to concentrate resources on providing financial assistance in case management.

Aged↗
PubMed2000

Neurobehavioral and neuropsychiatric symptoms in Alzheimer's disease: characteristics and treatment.

Neuropsychiatric symptoms are common in Alzheimer's disease. Personality changes, mood disturbance, and psychosis are frequently seen and may coexist in the same patient. Neuropsychiatric symptoms may signal the onset of disease and often fluctuate and recur. These symptoms are associated with a more rapid cognitive and functional decline that can lead to institutionalization. Cholinergic therapy, disease-modifying therapy, and psychotropic medications can improve these symptoms.

Aged↗
PubMed2000

The use of the neuropsychiatric inventory in nursing home residents. Characterization and measurement.

The authors assessed the validity of the nursing home version of the Neuropsychiatric Inventory-Nursing Home Version (NPI-NH), comparing the responses of certified nurses' aides (CNAs) and licensed vocational nurses (LVNs) with research observations. Correlations were significant but moderate for all of the domains of the NPI-NH (delusions, hallucinations, agitation/aggression, depression, apathy, disinhibition, euphoria, irritability/lability, and aberrant motor disturbances) except anxiety and appetite disturbance. The LVNs' ratings showed consistently higher correlations with the researchers' behavioral observations than did the CNAs', but were moderate and generally better for residents with high levels of neuropsychiatric symptoms, thus, caution should be used with any untrained rater in the nursing home setting. The NPI-NH used by non-research staff can be useful in identifying residents with significant neuropsychiatric disturbances, but may be limited as an instrument for tracking behavioral changes.

Adult↗
PubMed2000

Cerebral correlates of psychotic symptoms in Alzheimer's disease.

BACKGROUND: Psychotic symptoms are produced by distributed neuronal dysfunction. Abnormalities of reality testing and false inference implicate frontal lobe abnormalities. OBJECTIVES: To identify the functional imaging profile of patients with Alzheimer's disease manifesting psychotic symptoms as measured by single photon emission computed tomography (SPECT). METHODS: Twenty patients with Alzheimer's disease who had SPECT and clinical evaluations were divided into two equal groups with similar mini mental status examination (MMSE), age, sex, and the range of behaviours documented by the neuropsychiatric inventory (NPI), except delusions and hallucinations. SPECT studies, registered to a probabilistic anatomical atlas, were normalised across the combined group mean intensity level, and subjected to a voxel by voxel subtraction of the non-psychotic minus psychotic groups. Subvolume thresholding (SVT) corrected random lobar noise to produce a three dimensional functional significance map. RESULTS: The significance map showed lower regional perfusion in the right and left dorsolateral frontal, left anterior cingulate, and left ventral striatal regions along with the left pulvinar and dorsolateral parietal cortex, in the psychotic versus non-psychotic group. CONCLUSION: Patients with Alzheimer's disease who manifest psychosis may have disproportionate dysfunction of frontal lobes and related subcortical and parietal structures.

Alzheimer Disease↗
PubMed2000

Cholinesterase inhibitors: A new class of psychotropic compounds.

OBJECTIVE: This article reviews evidence indicating that acetylcholinesterase inhibitors have psychotropic properties. METHOD: The author reviewed the English-language literature pertinent to the response of neuropsychiatric symptoms in Alzheimer's disease and related conditions to cholinergic agents. RESULTS: The cholinergic system originates in the basal forebrain and projects diffusely to the cerebral cortex; the limbic and paralimbic regions receive the most abundant cholinergic projections. The basal forebrain nuclei are positioned at the interface of the limbic system and cerebral cortex, where they play a role in mediating emotional responses. The basal forebrain nuclei are atrophic in Alzheimer's disease, leading to a widespread cholinergic deficit. The cholinergic disturbance may contribute to neuropsychiatric manifestations of the disease. The treatment of patients with Alzheimer's disease with acetylcholinesterase inhibitors reduces neuropsychiatric symptoms, particularly apathy and visual hallucinations. In some studies, a variety of other neuropsychiatric symptoms have been reported to respond to treatment with acetylcholinesterase inhibitors. Response profiles vary among acetylcholinesterase inhibitors. CONCLUSIONS: Acetylcholinesterase inhibitors have psychotropic effects and may play an important role in controlling neuropsychiatric and behavioral disturbances in patients with Alzheimer's disease. These agents also may contribute to the management of other disorders with cholinergic system abnormalities and neuropsychiatric symptoms. The beneficial response is most likely mediated through limbic cholinergic structures.

Alzheimer Disease↗
PubMed2000

Orbital and dorsolateral frontal perfusion defect associated with behavioral response to cholinesterase inhibitor therapy in Alzheimer's disease.

The authors retrospectively explored the behavioral and functional imaging profile of Alzheimer's disease (AD) patients who respond to cholinesterase inhibitor therapy by using the Neuropsychiatric Inventory (NPI) and baseline [99mTc]HMPAO SPECT. Thirty AD patients were divided into three groups (Responders, Nonresponders, and Unchanged) based on their behavioral response to donepezil. Responders had significantly (P < or = 0.01) more pretreatment irritability, disinhibition (P < or = 0.05), and euphoria (P = 0.05) than Nonresponders and significantly lower lateral orbital frontal (P < 0.00001) and dorsolateral frontal (P < or = 0.0005) perfusion bilaterally. A pretreatment orbitofrontal syndrome may predict behavioral response to cholinesterase inhibitor therapy in AD.

Aged↗
PubMed2000

Validation of the NPI-Q, a brief clinical form of the Neuropsychiatric Inventory.

The Neuropsychiatric Inventory (NPI) is a validated clinical instrument for evaluating psychopathology in dementia. The authors developed a brief questionnaire form of the NPI (NPI-Q), intended for use in routine clinical practice, and cross-validated it with the NPI in 60 Alzheimer's patients. Test-retest reliability of the NPI-Q was acceptable. The prevalence of analogous symptoms reported on the NPI and NPI-Q differed on average by 5%; moderate or severe symptom ratings differed by less than 2%. The NPI-Q provides a brief, reliable, informant-based assessment of neuropsychiatric symptoms and associated caregiver distress that may be suitable for use in general clinical practice.

Aged↗
PubMed2000

Functional correlates of musical and visual ability in frontotemporal dementia.

BACKGROUND: The emergence of new skills in the setting of dementia suggests that loss of function in one brain area can release new functions elsewhere. AIMS: To characterise 12 patients with frontotemporal dementia (FTD) who acquired, or sustained, new musical or visual abilities despite progression of their dementia. METHOD: Twelve patients with FTD who acquired or maintained musical or artistic ability were compared with 46 patients with FTD in whom new or sustained ability was absent. RESULTS: The group with musical or visual ability performed better on visual, but worse on verbal tasks than did the other patients with FTD. Nine had asymmetrical left anterior dysfunction. Nine showed the temporal lobe variant of FTD. CONCLUSION: Loss of function in the left anterior temporal lobe may lead to facilitation of artistic or musical skills. Patients with the left-sided temporal lobe variant of FTD offer an unexpected window into the neurological mediation of visual and musical talents.

Aged↗
PubMed2000

The Clinician Assessment of Fluctuation and the One Day Fluctuation Assessment Scale. Two methods to assess fluctuating confusion in dementia.

BACKGROUND: The identification of fluctuating confusion is central to improving the differential diagnosis of the common dementias. AIMS: To determine the value of two rating scales to measure fluctuating confusion. METHOD: The agreement between the clinician-rated scale and the scale completed by a non-clinician was determined. Correlations between the two scales were calculated; variability in attention was calculated on a computerised cognitive assessment and variability in delta rhythm on an electroencephalogram (EEG). RESULTS: The Clinician Assessment of Fluctuation and the computerised cognitive assessment were completed for 155 patients (61 Alzheimer's disease, 37 dementia with Lewy bodies, 22 vascular dementia, 35 elderly controls). A subgroup (n = 40) received a further evaluation using the One Day Fluctuation Assessment Scale and an EEG. The two scales correlated significantly with each other, and with the neuropsychological and electrophysiological measures of fluctuation. CONCLUSIONS: Both scales are useful instruments for the clinical assessment of fluctuation in dementia.

Aged↗
PubMed2000

Neuropsychiatric aspects of corticobasal degeneration.

Neuropsychiatric symptoms are present in the majority of patients with CBD. Depression is common in this group of patients and contributes to the morbidity of the disease. Depression is more severe in CBD than in many other neurologic disorders. Neuropsychiatric symptoms should be assessed in all patients with CBD to enhance symptom detection and improve management.

Basal Ganglia Diseases↗
PubMed2000

Autistic savants. [correction of artistic].

OBJECTIVE: The objectives of this study were to examine common patterns in the lives and artwork of five artistic savants previously described and to report on the clinical, neuropsychological, and neuroimaging findings from one newly diagnosed artistic savant. BACKGROUND: The artistic savant syndrome has been recognized for centuries, although its neuroanatomic basis remains a mystery. METHODS: The cardinal features, strengths, and weaknesses of the work of these six savants were analyzed and compared with those of children with autism in whom artistic talent was absent. An anatomic substrate for these behaviors was considered in the context of newly emerging theories related to paradoxical functional facilitation, visual thinking, and multiple intelligences. RESULTS: The artists had features of "pervasive developmental disorder," including impairment in social interaction and communication as well as restricted repetitive and stereotyped patterns of behavior, interest, and activities. All six demonstrated a strong preference for a single art medium and showed a restricted variation in artistic themes. None understood art theory. Some autistic features contributed to their success, including attention to visual detail, a tendency toward ritualistic compulsive repetition, the ability to focus on one topic at the expense of other interests, and intact memory and visuospatial skills. CONCLUSIONS: The artistic savant syndrome remains rare and mysterious in origin. Savants exhibit extraordinary visual talents along with profound linguistic and social impairment. The intense focus on and ability to remember visual detail contributes to the artistic product of the savant. The anatomic substrate for the savant syndrome may involve loss of function in the left temporal lobe with enhanced function of the posterior neocortex.

Adolescent↗
PubMed2000

The relationship between donepezil and behavioral disturbances in patients with Alzheimer's disease.

The authors tested the hypothesis that behavioral disturbances are reported at significantly lower rates by caregivers of Alzheimer's disease (AD) patients receiving the antidementia drug donepezil, compared with a group of patients receiving no antidementia drug treatment. Patients administered donepezilfor 6 months (n=84) were compared with patients not on donepezil (n=248). Patients taking donepezil had significantly lower levels of behavioral disturbances than patients not receiving this agent (P< or =0.011). Specifically, donepezil patients were described as significantly (P< or =0.05) less likely to be threatening, destroy property, and talk loudly. Also, significantly fewer patients receiving donepezil were treated with sedatives (P< or =0.005). These findings support the growing body of evidence that cholinesterase inhibitors have psychotropic properties and reduce behavioral disturbances in patients with AD.

Aged↗
PubMed2000

Quantitative electroencephalographic correlates of psychosis in Alzheimer disease.

OBJECTIVE: We hypothesized that the distinctive neurobiology of Alzheimer disease (AD) with psychosis would be reflected in more severe abnormalities in frontal and temporal regions on quantitative electroencephalography (QEEG). BACKGROUND: Patients with AD and psychosis have more rapid cognitive decline and greater pathologic involvement of frontal and temporal cortex than AD patients without psychotic features. METHOD: We evaluated brain function using QEEG in a group of 44 patients who had a diagnosis of probable or possible AD. All patients were administered the Mini-Mental State Examination and the Neuropsychiatric Inventory to assess psychiatric symptoms, including the presence of hallucinations and delusions. Absolute and relative power in patients with and without psychosis were compared to determine if there were regional or global QEEG differences in these two groups. RESULTS: Patients with psychosis showed greater overall absolute and relative delta power but no regional predominance of slowing compared with those without psychosis. Those with psychosis had a concomitant decrease in relative alpha power. These differences remained after adjustment for different dementia severity in the two groups. CONCLUSIONS: This finding suggests more severe brain dysfunction in patients with psychosis than in those with similar levels of cognitive impairment but without psychosis. The QEEG abnormalities were not regionally specific and involved all areas assessed.

Aged↗