Biomedical subjects

Julie A Fields

Publications and source records attributed to Julie A Fields.

10 recordsLinked to original sources

PubMed2025

Caregiver experiences after the death of a person with dementia with Lewy bodies: A mixed-methods analysis.

BackgroundDementia with Lewy bodies (DLB) is a common degenerative dementia, but no studies investigate bereaved caregiver experiences.ObjectiveTo investigate the experiences of caregivers three months after the death of persons with DLB using a mixed-methods approach.MethodsDyads of individuals with moderate-advanced DLB and their primary informal caregivers were followed prospectively every 6 months until the person with DLB died. Caregivers completed a study visit with questionnaires and a semi-structured interview ∼3 months later. Spearman correlation coefficients and Wilcoxon rank-sum tests evaluated the relationships of post-death measures with pre-death patient and caregiver variables. Thematic analysis was used to analyze the interviews.ResultsSeventy-three caregivers completed visits (mean 3.5 months post-death). Most of the caregivers were women (82.2%) and spouses (76.7%) or adult children (17.8%). Over 40% had scores indicating risk for clinical depression. Post-death caregiver experiences (depression, quality of life, grief, resilience) correlated with pre-death caregiver experiences. Post-death experiences did not associate with patient characteristics, disease-related symptoms, or healthcare services used in the last 6 months of life. Trajectories for caregiver measures from pre- to post-death visits varied widely. Interview themes included grief and sadness, anger, guilt and regret, relief, appreciation/gratitude, and adjusting to a new normal.ConclusionsThe finding that pre-death caregiving experiences have the strongest association with post-death experiences emphasizes the critical importance of accessible and evidence-based caregiver support before and after the death of a person with DLB. Research is needed to develop interventions for current and bereaved caregivers of individuals with DLB.Trial registration informationNCT04829656 (submitted 2021-03-22).

Caregivers↗

PubMed2006

Absence of the apolipoprotein E epsilon4 allele is associated with working memory impairment in Parkinson's disease.

The apolipoprotein E (APOE) epsilon4 allele has been associated with an increased risk of Alzheimer's disease (AD) and weaker episodic memory among elderly. Although this APOE allele has been linked to earlier onset of Parkinson's disease (PD), an association with dementia in PD has been only inconsistently demonstrated. Given the heterogeneity of cognitive impairment patterns in PD, this study sought to determine whether an association exists between APOE genotype and specific cognitive deficits in PD. The neuropsychological test performance of 42 PD patients without an epsilon4 allele (PD-Non4) and of 20 with at least one epsilon4 allele (PD-epsilon4) was compared to that of 146 elderly control subjects (NC). The PD groups were comparable in overall severity of cognitive impairment and disease duration, but the PD-epsilon4 group was younger, had an earlier disease onset, and contained a higher proportion of persons with dementia. Both PD groups showed wide-ranging cognitive impairments relative to NC. Once age differences between groups were controlled for, the PD groups generally did not differ from each other in cognitive performance. However, only the PD-Non4 group demonstrated working memory/attention impairments (digit span, visual span, Trailmaking test) relative to the NC group. Results suggest that the APOE genotype may influence the cognitive phenotype of PD, and specifically that absence of the epsilon4 allele is associated with working memory impairment. Additionally, results are consistent with prior findings showing an association between the epsilon4 allele and earlier onset of PD and presence of dementia.

Aged↗

PubMed2005

Quality of life in Essential Tremor Questionnaire (QUEST): development and initial validation.

BACKGROUND/OBJECTIVE: Essential tremor (ET) can diminish functioning and quality of life (QOL) but generic QOL measures may be relatively insensitive to ET and its therapies. We sought to develop an ET-specific measure that might be more sensitive, acceptable to patients, relatively brief, and easily used. DESIGN/METHODS: A sample of 200 patients (average age 70 years, range 30-91; average disease duration 15 years) rated the extent to which tremor impacts a function or state, tremor severity in various body parts, perceived health, and overall QOL. Responses to this initial questionnaire were subjected to principal components analysis (PCA). Inspection of factor coordinates, Eigenvalues, variance accounted for, and correlation matrices were used to select items for confirmatory PCA. Final scale reliability was assessed using Cronbach's alpha. Validity was evaluated by correlations between QOL scales and self-rated tremor severity. RESULTS: PCA of 65 initial items yielded 11 factors accounting for 71% of variance. Six factors were discarded. Two items were eliminated for not loading on a factor and 33 for perceived redundancy. Confirmatory PCA of the retained 30 items yielded an almost identical factor structure (six factors, 70% of variance accounted for, and similar item loadings). Because two factors had very few items loading on them, these two factors were combined into one scale. The final measure has five scales: Physical, Psychosocial, Communication, Hobbies/Leisure, and Work/Finance. Reliability was excellent for the whole instrument and four scales (> or =0.89), and good for the Work/Finance scale (0.79). Severity of voice and head tremor were the best correlates of Communication (0.70 and 0.35), while the Physical scale was related to right and left upper extremity tremor (0.59 and 0.56). Scales correlated more highly with patients' rating of their overall QOL than their health perception. CONCLUSIONS: A brief, 30-item, ET-specific QOL scale with excellent reliability was developed. Preliminary validity data are encouraging. The Quality of Life in Essential Tremor Questionnaire (QUEST) promises to facilitate QOL measurement in ET.

Adult↗

PubMed2004

Action verbal fluency normative data for the elderly.

An emerging body of literature points to the prominent role of the frontal lobes in the retrieval of verbs, whereas production of common and proper nouns arguably is mediated primarily by posterior and anterior temporal regions, respectively. Although the majority of studies examining the neuroanatomic distinctions between verb and noun retrieval have relied on action naming tasks (naming depicted activities, e.g., running) as indicators of verb retrieval abilities, recent studies have utilized an action (verb) verbal fluency measure, the Action Fluency Test (AFT), to assess verb retrieval. Findings from these studies suggest that action fluency is sensitive to the integrity of fronto-subcortical neural circuitry and that it is a valid measure of executive and language functions. The AFT is an easily administered executive function measure, but no normative data for the AFT or other action fluency tasks has been published. This study was undertaken to provide initial AFT normative data for a sample of 145 healthy elderly subjects. As education is significantly correlated with AFT scores, the normative data are stratified by educational level.

Aged↗

PubMed2003

Pulse width is associated with cognitive decline after thalamic stimulation for essential tremor.

The present study sought to identify predictors of cognitive decline after thalamic deep brain stimulation (DBS) for essential tremor (ET). Twenty-seven patients (55%) with ET demonstrated mild cognitive decrements relative to pre-surgical baseline (ET-D), whereas 22 patients (45%) were classified as neuropsychologically stable (ET-S). The ET-D and ET-S groups were comparable in terms of baseline demographic, disease, and neuropsychological characteristics, as well as post-surgical motor outcomes. However, the ET-D group had significantly higher pulse width (PW) stimulator settings, and a greater proportion of ET-D than ET-S patients underwent left in comparison to right thalamic stimulation. A subsequent step-wise discriminant function analysis revealed that disease onset after age 37 years and higher PW settings (>or=120 micros) were the strongest predictors of post-surgical cognitive decline in this sample. Findings indicate that although relatively higher PW settings might afford optimal tremor control in some patients, the corresponding risk of mild, probably often subclinical, cognitive morbidity must be weighed accordingly.

Aged↗

PubMed2003

Effect of motor improvement on quality of life following subthalamic stimulation is mediated by changes in depressive symptomatology.

BACKGROUND/AIMS: Subthalamic deep brain stimulation (STN-DBS) for Parkinson's disease (PD) improves motor symptoms and quality of life (QOL). Because depression is a potent correlate of QOL, and STN-DBS may be associated with changes in mood, this study sought to determine whether QOL improvement is a direct or indirect consequence of motor improvement. METHODS: 26 patients with PD, free of dementia and major depression, who consecutively underwent bilateral, microelectrode-guided STN-DBS, underwent preoperative and 3-month postoperative neuropsychological evaluation, including measures of QOL (PD Questionnaire -39) and depressive symptoms (Beck Depression Inventory). RESULTS: Motor score in the Unified Parkinson's Disease Rating Scale (UPDRS Part III) improved significantly with STN-DBS relative to preoperative 'on' and 'off' scores, as did QOL and depressive symptoms. Extent of QOL improvement tended to be associated with improvement in motor score from presurgical on to postsurgical on stimulation and on medication state. QOL improvement was significantly related to amelioration of depressive symptoms. Partial correlations revealed that the association between QOL improvement and depression remained significant when influence of motor improvement on QOL and depression was controlled for. The motor-QOL association was no longer significant when effects of depression were controlled for. CONCLUSIONS: Significant QOL improvements after STN-DBS are associated with improved motor 'on' state and depressive symptoms. The influence of motor improvement on QOL may be largely indirect by reducing depression.

Aged↗

PubMed2003

Verbal fluency declines after pallidotomy: an interaction between task and lesion laterality.

Verbal fluency declines are commonly reported after pallidotomy in patients with Parkinson's disease. However, it is not clear whether there is an interaction between side of surgery and task format (lexical vs. semantic) or whether error rates (perseverations, intrusions, rule violations) increase after surgery. This study examined verbal fluency before and approximately 4 months after unilateral pallidotomy. The left and right pallidotomy groups were matched on key demographic, cognitive, and disease variables. Pallidotomy resulted in a decline in lexical but not semantic verbal fluency, and this decline was most evident in the left-sided surgery group. Error rates (perseverations, intrusions, and rule violations) were not affected by pallidotomy. Findings support the role of left frontal-basal ganglionic circuits in word retrieval processes and/or lexical search and access.

Aged↗

PubMed2002

Declines in switching underlie verbal fluency changes after unilateral pallidal surgery in Parkinson's disease.

Declines in verbal fluency are consistently reported in patients with Parkinson's disease (PD) after pallidal surgery. In the present study, the clustering and switching components of semantic or category fluency (oral naming of items obtainable in supermarkets) were examined at baseline and four months after unilateral deep brain stimulation or pallidotomy in 45 patients with PD (30 left, 15 right pallidal surgery). Post-operative declines were observed for supermarket fluency total score and switching, but not for average cluster size. These findings support the proposal that semantic fluency decrements after pallidal surgery reflect a disruption of frontal-basal ganglia circuits mediating efficient shifting between semantic categories, or perhaps efficient access to categories, rather than a degradation of semantic stores.

Basal Ganglia↗

PubMed2002

Neuropsychological sequelae of subthalamic nucleus deep brain stimulation in Parkinson's disease: a critical review.

Neuropsychologists are increasingly involved in surgical candidacy evaluations and postoperative neurobehavioral assessments of patients with movement disorders, most notably those with Parkinson's disease (PD). We review here the initial studies regarding neuropsychological outcomes of deep brain stimulation (DBS) within the subthalamic nucleus (STN) for treatment of PD. Overall, these initial investigations provide preliminary support for the cognitive and neurobehavioral safety of STN DBS. Improvements in self-reported symptoms of depression and diminished verbal fluency were the most common findings, whereas changes in global cognitive abilities, memory, attention, and frontal/executive functions were inconsistent and most often described as nominal and/or transient. The generalizability of this literature is hindered by several methodological limitations, including small samples and the absence of appropriate control participants. The clinical and theoretical implications of these initial studies are highlighted and recommendations are offered to guide future research.

Cognition Disorders↗

PubMed2002

Effects of depression and Parkinson's disease on cognitive functioning.

This study compared the performance of Parkinson's disease (PD) patients with and without depression, patients with depression alone, and normal control subjects on a cognitive screening instrument, the Mattis Dementia Rating Scale (DRS) to evaluate the influences of depression and Parkinson's disease on cognition. PD affects overall level of cognitive functioning and, to a lesser extent, DRS Initiation/Perseveration, Construction, and Attention. Diminished memory was primarily related to depression. Treatment of depression may ameliorate aspects of cognitive dysfunction in the PD patient with depression.

Aged↗