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Biomedical subjects

Joe Verghese

Publications and source records attributed to Joe Verghese.

At least 19 recordsLinked to original sources
PubMed2007

Walking while talking: effect of task prioritization in the elderly.

OBJECTIVE: To examine the effect of 2 instructions on the same walking while talking (WWT) task on task prioritization by nondisabled subjects. DESIGN: Cross-sectional survey with within subject comparisons. SETTING: Community-based sample. PARTICIPANTS: Older adults (N=189; mean age, 80.2+/-4.9y), who did not meet criteria from the Diagnostic and Statistical Manual, Fourth Edition, for dementia and were able to independently perform activities of daily living. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Verbal and gait measures on the same WWT task with 2 different instructions: paying attention to both talking and walking (WWT-C) and paying attention only to talking (WWT-T). RESULTS: Task prioritization effects were seen on walking but not on talking. Compared with their baseline normal walking velocity (without talking), subjects slowed down more on WWT-T (median change, 28.3%) than WWT-C (median change, 26.4%). Comparing the 2 WWT conditions, velocity and cadence was slower during WWT-T compared with WWT-C, with longer stride length. Verbal output was not significantly different on the 2 conditions. CONCLUSIONS: Changing instructions while maintaining the same cognitive and motor tasks on WWT in older adults result in task prioritization effects.

Activities of Daily Living↗
PubMed2006

A comparison of community-residing older adults with frontal and parkinsonian gaits.

Frontal gaits (FG) and parkinsonian gaits (PG) are common neurological gait abnormalities in older adults. It may be difficult to distinguish these gaits as they share common clinical characteristics such as unsteadiness, slowing, and shuffling. Of 488 community-residing subjects in an aging study, 11 were diagnosed with FG and 9 with PG at baseline clinical evaluations. Subjects with FG were older than subjects with PG (84.5 vs. 77.7 years, p<0.001). As expected, parkinsonian signs such as tremor and rigidity were associated with PG and frontal release signs with FG. Subjects with PG had more falls (67% vs. 18%, p=0.02). They performed worse on a panel of executive function tests, although the scores were significantly different only on the verbal fluency test (17.0 vs. 28.3, p=0.009). Advancing age was associated with FG (OR=1.3, 95% CI=1.1-1.4) but not PG (OR=1, 95% CI=0.9-1.1). Medical illnesses were not significantly associated with FG. Diabetes (OR=4.1, 95% CI=1.1-15.5), strokes (OR=4.3, 95% CI=1.1-17.3), and depression (OR=5.1, 95% CI=1.2-20.8) were associated with PG. Despite similar gait characteristics, FG may be distinguished from PG by associated clinical signs, frequency of falls, and the neuropsychological profile. Vascular risk factors and depression were strongly associated with PG, and should be explored further.

Aged↗
PubMed2006

Increased frequency of the LRRK2 G2019S mutation in an elderly Ashkenazi Jewish population is not associated with dementia.

Mutations in leucine-rich repeat kinase 2 gene (LRRK2) have been associated with idiopathic Parkinson's disease (PD), as well as pleomorphic neurodegenerative pathology, including Alzheimer's disease. One specific LRRK2 mutation, G2019S, was reported in 18% of people with PD of Ashkenazi descent, supporting a founder effect in this population. To determine if this mutation is also associated with dementia in the Ashkenazim, we screened 192 elderly Ashkenazi Jewish (AJ) individuals in a longitudinal aging and cognition study, of whom 49 (25.5%) had dementia. Two non-demented individuals harbored the mutation (2/143, 1.4%), but no individuals with dementia. Neither person with the mutation had Parkinson's disease. Therefore, the LRRK2 mutation has a relatively high frequency in the AJ population, is not fully penetrant for parkinsonism in the elderly, and does not appear to be commonly associated with late-onset dementia.

Aged, 80 and over↗
PubMed2006

Carpal tunnel syndrome in older adults.

The clinical and electrophysiologic characteristics of carpal tunnel syndrome (CTS) in elderly adults are not well established. We examined age differences in clinical, functional, and electrophysiologic features in elderly adults referred to a neuromuscular service for evaluation of symptoms suggestive of CTS. Of 415 consecutive subjects referred over an 18-month period, 343 met clinical criteria for CTS. There were 158 young ( or=65 years). There were no age differences in the duration of CTS symptoms, hand function, or presence of autonomic symptoms. The elderly adults had a higher prevalence of thenar weakness and thenar atrophy than younger subjects. Electrophysiologic abnormalities were more common and more severe in the older subjects. Our study shows that although there are no age differences in subjective complaints of CTS, older adults had objective clinical and electrophysiologic evidence of a more severe median nerve entrapment. The findings suggest that greater attention needs to be paid to objective evidence of CTS severity rather than subjective complaints when evaluating elderly adults presenting for clinical evaluation of CTS.

Adult↗
PubMed2006

Gait characteristics in nondisabled community-residing nonagenarians.

OBJECTIVE: To determine gait performance in community-residing nonagenarians. DESIGN: Nested case-control study. SETTING: Community. PARTICIPANTS: Thirty-one nondisabled nonagenarians (17 women) and 170 young-old controls (age range, 70-85y) participating in a longitudinal study. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Systematic clinical and quantitative gait assessments. We also examined the association of gait velocity with death over a 1-year period. RESULTS: Nonagenarian men had better performance on all quantitative gait parameters examined compared with women. Male sex (beta=.58; 95% confidence interval [CI], 9.95-38.89) and depressive symptoms (beta=-.34; 95% CI, -6.73 to -0.04) were independently associated with gait velocity in multivariate linear regression models. The 6 hypertensive nonagenarians on angiotensin-converting enzyme (ACE) inhibitors had faster gait velocity (median, 103.1cm/s) compared with the 8 hypertensive nonagenarians not on ACE inhibitors (median, 77.5cm/s; P=.029). Nonagenarians had worse quantitative gait parameters compared with the young-old controls, although the differences were less marked when subjects with clinically normal gaits in both groups were compared. Gait velocity did not predict survival over 1-year follow-up. CONCLUSIONS: Gait characteristics in nondisabled community-residing nonagenarians are associated with male sex, depressive symptoms, and medications. The quantitative gait measures in this sample of nondisabled nonagenarians provide a yardstick to compare younger-age groups.

Aged↗
PubMed2006

Retention weighted recall improves discrimination of Alzheimer's disease.

Impaired recall for early items (primacy) and late items (recency) on word list recall tests are seen in Alzheimer's disease (AD). We compared conventional scoring on the Telephone Instrument for Cognitive Status (TICS) recall list with scorings based on retention-weighted recall (RWR: each item weighted by its serial position) in older adults participating in a community-based aging study. Subjects with mild AD (N=18) did not differ from those without dementia (N=231) with respect to recency (46% vs. 59%, p = 0.2), but had impaired primacy (2% vs. 39%, p < .001) on word recall on the TICS. RWR scoring improved the effect size (1.52 SD) compared to conventional scoring (1.08 SD). With a fixed sensitivity of 85%, specificity was lower using conventional scoring (56%) than RWR (76%) scoring. Our findings suggest that optimized RWR scoring of word list free recall can improve detection of mild AD compared to conventional scoring.

Aging↗
PubMed2006

Cognitive processes related to gait velocity: results from the Einstein Aging Study.

The authors examined the relationship between cognition and gait velocity, performed with and without interference, in elderly participants. Neuropsychological test scores from 186 cognitively normal elders were submitted to factor analysis that yielded 3 factors: Verbal IQ, Speed/Executive Attention, and Memory. Regression analyses revealed that these factors were significant predictors of variance in gait velocity, but the relationship varied as a function of task condition. All 3 factors predicted gait velocity without interference. However, the Speed/Executive Attention and Memory factors but not Verbal IQ predicted gait velocity in the interference condition. These findings suggest that gait velocity and cognitive function may have both shared and independent brain substrates. Future studies should explore gait velocity and cognitive function as predictors of dementia and falls.

Aged↗
PubMed2006

Epidemiology of gait disorders in community-residing older adults.

OBJECTIVES: To study the epidemiology of gait disorders in community-residing older adults and their association with death and institutionalization. DESIGN: Community-based cohort study. SETTING: Bronx County and the research center at Albert Einstein College of Medicine. PARTICIPANTS: The Einstein Aging study recruited 488 adults aged 70 to 99 between 1999 and 2001. At entry and during annual visits over 5 years, subjects received clinical evaluations to determine presence of neurological or nonneurological gait abnormalities. MEASUREMENTS: Prevalence and incidence of gait disorders based on clinical evaluations and time to institutionalization and death. RESULTS: Of 468 subjects (95.9%) with baseline gait evaluations, 168 had abnormal gaits: 70 neurological, 81 nonneurological, and 17 both. Prevalence of abnormal gait was 35.0% (95% confidence interval (CI) = 28.6-42.1). Incidence of abnormal gait was 168.6 per 1,000 person-years (95% CI = 117.4-242.0) and increased with age. Men had a higher incidence of neurological gait abnormalities, whereas women had a higher incidence of nonneurological gaits. Abnormal gaits were associated with greater risk of institutionalization and death (hazard ratio (HR) = 2.2, 95% CI =1.5-3.2). The risk was strongly related to severity of impairment; subjects with moderate to severe gait abnormalities (HR = 3.2, 95% CI = 1.9-5.2) were at higher risk than those with mild gait abnormalities (HR = 1.8, 95% CI = 1.0-2.8). CONCLUSION: The incidence and prevalence of gait disorders are high in community-residing older adults and are associated with greater risk of institutionalization and death.

Aged↗
PubMed2006

Cognitive and mobility profile of older social dancers.

OBJECTIVES: To define the cognitive and physical attributes of regular social dancing so as to help establish its health benefits and help plan future dance interventions to prevent adverse outcomes in older adults such as falls, slow gait, and dementia. DESIGN: Cross-sectional survey with two-group comparison. SETTING: Bronx County, New York. PARTICIPANTS: Twenty-four cognitively normal older social dancers (OSDs) were compared with 84 age-, sex-, and education-matched older nondancers (ONDs) participating in a community-based study. MEASUREMENTS: Motor and cognitive performance was assessed using validated clinical and quantitative methods. RESULTS: There were no differences in the frequency of participation in other cognitive and physical leisure activities, chronic illnesses, or falls between OSDs and ONDs. Cognitive test performance was not different between OSDs and ONDs. OSDs had better balance but not strength than ONDs. OSDs had a longer mean stride+/-standard deviation than ONDs (117.8+/-10.5 cm vs 103.4+/-20.2 cm, P=.008) on quantitative gait assessment, with a more stable pattern during walking with reduced stance time (63.9% vs 65.9%, P=.01), longer swing time (36.1% vs 34.1%, P=.01), and shorter double support time (27.9% vs 30.9%, P=.03). CONCLUSION: The results of this study suggest that long-term social dancing may be associated with better balance and gait in older adults.

Activities of Daily Living↗
PubMed2005

Decreased neprilysin immunoreactivity in Alzheimer disease, but not in pathological aging.

Although evidence suggests that extensive cortical beta-amyloid (Abeta) deposition is essential in Alzheimer disease (AD), it is also detected in nondemented elderly individuals with pathologic aging (PA). Given evidence that neutral endopeptidase (NEP) or neprilysin, a key enzyme for clearance of Abeta, is decreased in AD, the goal of the present study was to determine if NEP was also decreased in PA. We measured NEP immunoreactivity in frontal cortex of 12 AD and six PA cases and compared this with 10 normal (N) elderly individuals. None had any significant other pathology, and they were similar with respect to age, sex, and postmortem delay. In addition, Abeta1-40 and Abeta1-42 were measured by enzyme-linked immunosorbent assay (ELISA), whereas tau, synaptophysin, and alpha-synuclein were measured on Western blots. The AD cases had more neuritic plaques, neurofibrillary tangles, higher Braak stage, and more tau immunoreactivity in frontal cortex than both PA and N. In contrast, both PA and AD had more senile plaques and Abeta1-42 than N. NEP immunoreactivity was decreased in AD but not in PA. The decrease was unlikely the result of neuronal or synaptic loss because NEP immunoreactivity in frontotemporal degeneration with comparable degrees of synaptic loss as the AD cases was not different from control subjects. Although NEP enzyme activity was decreased in approximately half the AD cases, on average, it was not decreased compared with N or PA. The results add further evidence that PA is distinct from AD and indicate that decreased Abeta degradation by NEP is unlikely to contribute significantly to amyloid deposition in PA or, in many cases, of AD.

Aged↗
PubMed2004

Detecting dementia with the Hopkins Verbal Learning Test and the Mini-Mental State Examination.

The Hopkins Verbal Learning Test (HVLT) and the Mini-Mental State Examination (MMSE) were administered to 323 non-demented elderly and 70 individuals who meet DSM-IV criteria for dementia in order to compare the validity of these two measures for detecting mild dementia and for the two most common dementia subtypes, Alzheimer's disease (AD) and vascular dementia (VaD). The study was conducted in an elderly, ethnically diverse community-dwelling population. Sensitivity, specificity, positive and negative predictive values were calculated over a range of clinically relevant cut scores for each test. We analyzed the influence of age, education, reading ability and sex on test performance using logistic regression models. When sensitivity is held constant at 0.69, the specificity for the HVLT total recall was 0.89 and the MMSE 0.82 for all dementias (P=.10). Age, sex and education did not significantly influence test performance for either test in this sample. Results were similar for AD and VaD. However, while adding a measure of reading ability to the regression models did not affect the overall dementia model, it resulted in improved specificities when combined with the MMSE for AD and combined with the HVLT for VaD. Additional tests such as reading ability can improve discrimination of dementia subtypes. The modest sensitivity of either the HVLT or the MMSE alone suggests that further neuropsychological evaluation is required to confirm dementia diagnosis.

Aged↗
PubMed2003

Leisure activities and the risk of dementia in the elderly.

BACKGROUND: Participation in leisure activities has been associated with a lower risk of dementia. It is unclear whether increased participation in leisure activities lowers the risk of dementia or participation in leisure activities declines during the preclinical phase of dementia. METHODS: We examined the relation between leisure activities and the risk of dementia in a prospective cohort of 469 subjects older than 75 years of age who resided in the community and did not have dementia at base line. We examined the frequency of participation in leisure activities at enrollment and derived cognitive-activity and physical-activity scales in which the units of measure were activity-days per week. Cox proportional-hazards analysis was used to evaluate the risk of dementia according to the base-line level of participation in leisure activities, with adjustment for age, sex, educational level, presence or absence of chronic medical illnesses, and base-line cognitive status. RESULTS: Over a median follow-up period of 5.1 years, dementia developed in 124 subjects (Alzheimer's disease in 61 subjects, vascular dementia in 30, mixed dementia in 25, and other types of dementia in 8). Among leisure activities, reading, playing board games, playing musical instruments, and dancing were associated with a reduced risk of dementia. A one-point increment in the cognitive-activity score was significantly associated with a reduced risk of dementia (hazard ratio, 0.93 [95 percent confidence interval, 0.90 to 0.97]), but a one-point increment in the physical-activity score was not (hazard ratio, 1.00). The association with the cognitive-activity score persisted after the exclusion of the subjects with possible preclinical dementia at base line. Results were similar for Alzheimer's disease and vascular dementia. In linear mixed models, increased participation in cognitive activities at base line was associated with reduced rates of decline in memory. CONCLUSIONS: Participation in leisure activities is associated with a reduced risk of dementia, even after adjustment for base-line cognitive status and after the exclusion of subjects with possible preclinical dementia. Controlled trials are needed to assess the protective effect of cognitive leisure activities on the risk of dementia.

Aged↗
PubMed2003

Screening for dementia by telephone using the memory impairment screen.

OBJECTIVES: : To develop and assess telephone-based screening tests for dementia, especially Alzheimer's disease (AD). DESIGN: : A cross-sectional validation study nested within a longitudinal study of aging and dementia. SETTING: : The Einstein Aging Study of the Albert Einstein College of Medicine, Bronx, New York. PARTICIPANTS: : Three hundred elderly community volunteers living in Bronx County, 27 of whom were diagnosed with dementia based on in-person clinical evaluation. Of the 27 individuals with dementia, 18 had AD. MEASUREMENTS: : A telephone battery was administered that included the Memory Impairment Screen by telephone (MIS-T, a test of semantic memory), the Category Fluency Test (CF-T), and the Telephone Instrument for Cognitive Status (TICS). An in-person evaluation then followed that included a neurological examination, a neuropsychological battery, demographics, and medical history. RESULTS: : The telephone battery was well accepted. The MIS-T required 4 minutes; the CF-T, 3 minutes; and the TICS, 10 minutes. The MIS-T had excellent sensitivity and specificity when compared with the CF-T and the TICS. Using cutscores on all three tests that provide a sensitivity of 78%, specificity was significantly higher for the MIS-T (93%) than for the CF-T (78%, P<.05) or the TICS (80%, P<.05). Combining the MIS-T and CF-T improved discriminative validity but increased screening time and the complexity of scoring. Normative data for the MIS-T, the CF-T, and the TICS for use in settings with different base rates (prevalence) of dementia are presented in this study. CONCLUSION: : The MIS-T outperforms the CF-T and the TICS as a valid and time-efficient telephone screen for dementia. For applications that require optimal efficiency and accuracy, the MIS-T is recommended.

Aged↗