PubMed Health⌕ Search

Biomedical subjects

Justin Sauer

Publications and source records attributed to Justin Sauer.

9 recordsLinked to original sources
PubMed2006

Differences between Alzheimer's disease and dementia with Lewy bodies: an fMRI study of task-related brain activity.

We investigated whether previously reported differences between Alzheimer's disease and dementia with Lewy bodies (DLB) in resting occipital activity lead to activation differences within functionally specialized visual cortical areas and deactivation differences in the default network. Patients with Alzheimer's disease (n = 10; 5 male), DLB (n = 9; 4 male) and controls (n = 13; 5 male) performed three functional MRI (fMRI) scanning experiments involving visual colour, face or motion stimuli. Reaction time or accuracy in DLB and Alzheimer's disease differed significantly from controls but not between patient groups, with the exception of accuracy in the face task (DLB < Alzheimer's disease; P = 0.038). The most significant fMRI activations in the pooled data set were in left V4alpha for the colour task (Talairach coordinate: -30, -52, -24; P = 0.002 corrected), the right fusiform face area (FFA) for the face task (34, -48, -22; P = 0.005 corrected) and right intra-parietal sulcus (30, -66, 42; P = 0.003 corrected) for the motion task, with additional activity in right V5 (48, -64, 0; P = 0.015 corrected). Each task was associated with decreases in activity within the default network with prominent deactivation foci bilaterally in the posterior cingulate gyrus (+/-8, -48, 26; left P < 0.001; right P < 0.001 corrected) and medial frontal cortex (+/-18, 42, 32; left P < 0.001; right P < 0.001 corrected). Comparing patterns of task-related activity across groups, DLB patients showed more activation than Alzheimer patients within the superior temporal sulcus (STS) for the motion task (right STS: 44, 0, -20; P = 0.004 corrected; left STS: -40, -4, -26; P = 0.07 corrected). This difference could not be attributed to task performance, cognitive score or age [analysis of covariance (ANCOVA)F (2, 18) = 8.44, P = 0.003]. Within regions of interest, group activation differences were found for the face task (Alzheimer's disease > DLB P = 0.05; Alzheimer's disease > controls P = 0.14) and the motion task (DLB < Alzheimer's disease P = 0.031 and DLB < control P = 0.048). However, these differences could be explained by behavioural performance, failing to reach significance in the ANCOVA analysis. In the default network, group deactivation differences between controls and both patient groups were found for the colour and motion task (colour: control < Alzheimer's disease P = 0.02; control < DLB P = 0.019; motion: control < Alzheimer's disease P = 0.118; control < DLB P = 0.118) but could be accounted for by behavioural performance. The results suggest that cognitive fMRI can be used to detect both performance-dependent and performance-independent differences between Alzheimer's disease and DLB, reflecting the distribution of functional pathology in the two conditions.

Aged↗
PubMed2006

Male gender influences response to an educational package for delirium prevention among older people: a stratified analysis.

BACKGROUND: Increasing evidence is pointing towards the efficacy of intervention programmes in decreasing the incidence of delirium among older people admitted to hospital. We have previously shown that an educational package directed at doctors and nurses significantly decreased the point prevalence of delirium among older people on a general medical ward. It is not yet established whether specific and 'fixed' patients' characteristics influence the rate of response to such an intervention. METHODS: A secondary, exploratory stratified analysis was carried out to determine whether age, sex and presence of dementia might influence the effect of the intervention through a delirium educational package. This information is important in order to increase the effectiveness of preventive measures across various patients' subgroups. RESULTS: Male gender (OR 0.17, 0.05-0.65) significantly (p = 0.030) and positively influence the response to the educational package compared to female gender (OR 1.04, 0.38-2.81). Neither age nor the presence of underlying dementia was associated with a significant influence on the rate of response to the delirium prevention package. CONCLUSION: Staff may be more likely to implement an earlier and more effective intervention for males who are perceived as presenting a higher risk to themselves and others. The results reported highlight the need to increase staff's vigilance to female patients whose prodromal symptoms of delirium may be underemphasised. Understanding different sub-group responses to preventive educational packages for delirium is an important consideration if these are to be applied widely.

Age Factors↗
PubMed2005

An educational intervention can prevent delirium on acute medical wards.

BACKGROUND: Delirium is a common disorder in hospitalised older people and established cases may have a poor outcome that is not readily improved by intervention. Prevention of cases through education of medical and nursing staff has not been fully studied. OBJECTIVES: To test the hypothesis that an educational package for medical and nursing staff would both reduce the number of incident cases of delirium and increase recognition of cases of delirium within an acute medical admissions ward. DESIGN: Single-blind case-control study. SETTING: Two acute admissions wards in a busy inner-city teaching hospital. SUBJECTS: 250 acute admissions over the age of 70 years. METHODS: An educational package for staff on one ward consisting of a 1 hour formal presentation and group discussion, written management guidelines and follow-up sessions. The follow-up sessions, which were based on one-to-one and group discussions, aimed at providing continuous support of staff through emphasising learning and testing knowledge. Diagnosis and management of some discharged delirium patients were also discussed to allow staff to learn from previous experience. The main outcome measures are point prevalence of delirium established by researchers, and recognition and case-note documentation of delirium by clinical staff. RESULTS: The point prevalence of delirium was significantly reduced on the intervention compared to the control ward (9.8% versus 19.5%, P < 0.05) and clinical staff recognised significantly more delirium cases that had been detected by research staff on the ward where the educational package had been delivered. CONCLUSION: A focused and inexpensive educational programme can decrease the prevalence of delirium among older inpatients.

Acute Disease↗
PubMed2004

Assessing the prevalence of depression in Punjabi and English primary care attenders: the role of culture, physical illness and somatic symptoms.

Previous studies exploring the prevalence of depression among South Asians reported inconsistent findings. Research artefacts due to sampling bias, measurements errors and a failure to include ethnographic methods may all explain this. We estimated the prevalence of depression, and variations of prevalence with culture, cultural adaptation, somatic symptoms and physical disability in a cross-sectional primary care survey of Punjabi and English attendees. We included a culture specific screening instrument, culturally adapted the instruments and offered bilingual interviews. We found that, compared with their English counterparts, depressive diagnoses were more common among Punjabis, Punjabi women, Punjabis with physical complaints and, contrary to expectation, even Punjabis with low scores for somatic symptoms.

Acculturation↗
PubMed2002

Psychiatric emergencies and the millennium: an international study.

BACKGROUND: The millennium posed an unknown challenge to mental health services worldwide. In anticipation, contingencies were implemented in preparation for the unexpected impact on psychiatric morbidity. RESULTS: This study evaluates the impact of the millennium on psychiatric emergency service utilization in the Northern and Southern hemispheres--the UK, Nigeria and Australia. Findings did not demonstrate a notable "millennium effect" on mental health services. A number of patients presented psychopathology incorporating millennium themes. A post-Christmas and post-New Year increase in presentation was observed. CONCLUSION: There was no change in service needs.

Emergency Services, Psychiatric↗
PubMedDate not supplied

Are Black Caribbean patients more likely to receive an incorrect diagnosis of very-late-onset schizophrenia-like psychosis than their white British counterparts?

OBJECTIVE: Increased rates of schizophrenia and schizophrenia-like psychoses are repeatedly reported within migrant populations. The authors investigated whether some or all of an observed increase in service contact rates for very-late-onset schizophrenia-like psychosis in older black people of Caribbean origin could be explained by underdiagnosis of affective psychosis. METHODS: The case-notes of 47 patients with very-late-onset schizophrenia-like psychosis were rated with a 44-point psychopathology checklist. RESULTS: Black Caribbean patients with very-late-onset schizophrenia-like psychosis were younger and more likely to be male than their white British counterparts. Although there were some differences in symptoms between the groups, these did not reach levels of statistical significance. CONCLUSION: Further studies will be required to establish the diagnostic stability and outcome of very-late-onset schizophrenia-like psychosis in older black Caribbean migrants.

Adult↗
PubMedDate not supplied

The OSCE has landed: One small step for British psychiatry?

OBJECTIVE: In the United Kingdom (UK), an objective structured clinical examination (OSCE) has replaced the individual patient assessment (IPA) for part 1 of the membership examination of the Royal College of Psychiatrists (MRCPsych). The authors' assessment of the OSCE was conducted. METHOD: Residents completed and evaluated an OSCE designed according to guidelines set by the Royal College of Psychiatrists. RESULTS: These residents considered the OSCE fair (86%) and appropriate (89%) in assessing clinical ability. They believed that the OSCE reflected the skills required in clinical practice and found it preferable to the IPA. CONCLUSION: The OSCE received positive evaluation from residents.

Education↗