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Biomedical subjects

L S Schneider

Publications and source records attributed to L S Schneider.

At least 19 recordsLinked to original sources
PubMed2001

Treatment of Alzheimer's disease with cholinesterase inhibitors.

The cholinergic system is the most severely affected neurotransmitter system in patients with Alzheimer's disease, and therapeutic strategies have been developed to restore cholinergic function in these patients. This article reviews the present status of cholinesterase inhibitors for the treatment of Alzheimer's disease. It then discusses treatment approaches and current and future issues regarding efficacy and safety.

Alzheimer Disease↗
PubMed2001

Pharmacologic therapy for behavioral symptoms of Alzheimer's disease.

Behavioral signs and symptoms in dementia are common, morbid, classifiable, and treatable. The current state-of-the-art approach is to evaluate carefully for social or environmental causes, intercurrent medical conditions, or other triggers of the behavior and attempt to deal with those directly. When these conservative steps fail, there may be a role for medication. A rational approach typically hinges on matching the most dominant behavioral target symptoms to the most relevant medication class, the key information of which is summarized.

Aged↗
PubMed2001

Assessing outcomes in Alzheimer disease.

To gain a better overview of the effectiveness of treatment of patients with Alzheimer disease (AD), areas such as cognition, activities of daily living (ADL), behavior, caregiver burden, quality of life and economics need to be assessed. A number of instruments are available for assessing these domains, many of which are reviewed in this article. These include the cognitive subscale of the Alzheimer's Disease Assessment Scale (the standard instrument for the measurement of efficacy in dementia trials), scales that assess AD patients' abilities to perform ADL (including the Disability Assessment for Dementia scale and the Alzheimer's Disease Cooperative Study-Activities of Daily Living), scales to assess behavioral symptoms in dementia (including the Neuropsychiatric Inventory and the Behavioral Pathology in Alzheimer's Disease Rating Scale), scales for assessing global clinical change, and methods for assessing caregiver time, quality of life and health economics. Each instrument has its own advantages and disadvantages. However, the instruments used need to be selected carefully to provide credible and informative outcome data.

Activities of Daily Living↗
PubMed2001

National Institute of Mental Health Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE): Alzheimer disease trial methodology.

The authors describe the development of the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) protocol for Alzheimer disease (AD), a trial developed in collaboration with the National Institute of Mental Health (NIMH), assessing the effectiveness of atypical antipsychotics for psychosis and agitation occurring in AD outpatients. They provide an overview of the methodology utilized in the trial as well as the clinical-outcomes and effectiveness measures that were implemented.

Aged↗
PubMed2001

Estrogen replacement therapy and antidepressant response to sertraline in older depressed women.

The influence of the use of estrogen replacement therapy (ERT) on the antidepressant response to sertraline of 127 women over 60 years old was evaluated with data from two multicenter trials. At endpoint, sertraline-treated women taking ERT had significantly greater global improvement and quality of life than those not receiving ERT. Modest improvements were also observed in anxiety symptoms and cognitive functioning. The results provide preliminary evidence that ERT use (without progesterone) in older depressed women may augment the antidepressant response to sertraline in terms of quality of life and general improvement.

Aged↗
PubMed2001

A pilot randomized trial of carbamazepine for behavioral symptoms in treatment-resistant outpatients with Alzheimer disease.

The authors performed a 6-week, randomized, double-blind, placebo-controlled, parallel-group trial of carbamazepine (400 mg/day) with 21 agitated subjects (16 completers) who had been treated unsuccessfully with antipsychotics. There was greater improvement for the carbamazepine group on the Clinical Global Impression of Change (P=0.055) and the Brief Psychiatric Rating Scale (BPRS) Hostility item (P=0.009), with a trend toward worsening on the BPRS Hallucination item (P=0.067). Overall, carbamazepine showed modest clinical benefit in these subjects, who had not responded to antipsychotics, and particular benefit for hostility. The effect on global ratings was similar to those found in an earlier report in nursing home residents.

Aged↗
PubMed2000

Treatment of agitation in AD: a randomized, placebo-controlled clinical trial.

BACKGROUND: Treatment of agitation is a crucial problem in the care of patients with AD. Although antipsychotic and antidepressant medications and behavior management techniques (BMT) have each been used to treat agitation, clinical trials of these treatments have been characterized by small sample sizes and uncontrolled treatment designs. OBJECTIVE: To compare haloperidol, trazodone, and BMT with placebo in the treatment of agitation in AD outpatients. METHODS: A total of 149 patients with AD and their caregivers participated in a randomized, placebo-controlled, multicenter trial. Blind assessment was conducted at baseline and after 16 weeks of treatment. The three active treatments were haloperidol, trazodone, and BMT. The Alzheimer's Disease Cooperative Study Clinical Global Impression of Change was the primary outcome measure. Secondary outcomes included patient agitation, cognition, and function, and caregiver burden. RESULTS: Thirty-four percent of subjects improved relative to baseline. No significant differences on outcome were obtained between haloperidol (mean dose, 1.8 mg/d), trazodone (mean dose, 200 mg/d), BMT, or placebo. Significantly fewer adverse events of bradykinesia and parkinsonian gait were evident in the BMT arm. No other significant difference in adverse events was seen. Symptoms did not respond differentially to the different treatments. CONCLUSIONS: Comparable modest reductions in agitation occurred in patients receiving haloperidol, trazodone, BMT, and placebo. More effective pharmacologic, nonpharmacologic, and combination treatments are needed.

Aged↗
PubMed2000

Qualifying change: a method for defining clinically meaningful outcomes of change score computation.

OBJECTIVES: To identify clinically meaningful change in longitudinal assessment. DESIGN: A novel approach that qualifies item-level change over time by the degree to which it is clinically meaningful. SETTING: The classification method was tested by applying it to changes over 12 months in the frequency ratings of the items of a behavioral assessment instrument that is used commonly in clinical trials with Alzheimer's disease (AD) patients. PARTICIPANTS: Responses from a cohort of 235 well characterized, community-dwelling subjects with AD were analyzed by this method. MEASUREMENTS: The approach allowed us to describe the proportions of items that emerged, ceased, worsened, and improved between the baseline and 12-month visits. RESULTS AND CONCLUSIONS: One-year change in the behavioral symptoms of persons with AD was used to exemplify the methodology. This approach can be used in other populations and with other measurements and was designed for analyses of clinical trial data. This method uses item-level changes to generate global impressions of clinically meaningful change; it also facilitates the definition of change that can be used in the clinical setting.

Aged↗
PubMed1999

"Block the sun, not the fun": evaluation of a skin cancer prevention program for child care centers.

INTRODUCTION: This paper describes the evaluation of a skin cancer prevention program for preschools and daycare centers. The intervention was targeted primarily at staff of child care centers, with the aim of increasing use of sun protection practices for young children while attending these centers. Secondary target groups included parents and the children themselves. The intervention, which adopted the slogan, "Block the Sun, Not the Fun," included workshops for child care center staff, and information/activity packets for parents. METHODS: Twenty-seven preschools and daycare centers were randomly assigned to an intervention or wait-list control group. The intervention group received the intervention during the spring of 1994; the wait-list control group received the intervention during the spring of 1995. Evaluation consisted of interviews with center directors, observations of practices, and review of written policies before the intervention (in summer, 1993) and after the intervention (in summer, 1994). A survey of 201 parents was conducted during late summer 1994. RESULTS: While the intervention did not appear to change the sun protection attitudes or practices of parents, or use of clothing and shade at child care centers, results suggested significant changes in the sun protection knowledge/attitudes of center directors and the use of sunscreen at child care centers. Additionally, parents with children attending centers in the intervention group were more likely to be satisfied with sun protection practices at their centers. CONCLUSION: This low-intensity intervention appears to be effective at changing sun protection attitudes and sunscreen use at child care centers, and can be easily replicated. However, high staff turnover at child care centers would suggest that "boosters" will be necessary to sustain the impact. More intensive efforts directed at social norms are likely to be necessary to change clothing and outdoor play practices.

Adult↗
PubMed1999

Pharmacologic management of psychosis in dementia.

Significant consequences of untreated psychosis in patients with dementia have led clinicians to seek improved therapeutic options. This review presents the scope of the problem, discusses some of the underlying neurobiology, and highlights the evidence for appropriate therapies. A range of potentially effective pharmacologic therapies is available and is discussed.

Aged↗
PubMed1999

Can caregivers independently rate cognitive and behavioral symptoms in Alzheimer's disease patients?: A longitudinal analysis.

To examine whether informant-based assessments of patients with Alzheimer's disease (AD) can be used longitudinally to track patient functioning, the authors followed AD patients (N=153) and their caregivers over 1 year with the Relative's Assessment of Global Symptomatology-Elderly (RAGS-E) and the Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADASc). Factor analysis of the RAGS-E yielded two subscales, Cognitive Functioning and Mood Disturbance. The cognitive subscale and ADASc correlated at all visits, whereas the mood subscale did not. After 12 months (n=62), the cognitive scale worsened at a rate similar to the ADASc, suggesting concurrent validity. Therefore, informant-based measures appear to be reliable and valid methods of identifying cognitive change in AD patients.

Activities of Daily Living↗
PubMed1998

Severity of cognitive impairment in Alzheimer's disease affects list learning using the California Verbal Learning Test (CVLT).

Impairment in list learning is considered a primary symptom of Alzheimer's disease (AD), yet there are no published reports examining the relationship between list learning and severity of cognitive impairment. We gave nine-item and 16-item versions of the California Verbal Learning Test (CVLT; Delis et al., 1987), a standardized shopping list assessment of memory, to 24 AD patients (mean age = 76.2 +/- 8.1; mean years of education = 13.8 +/- 2.4), who were stratified into four groups based on MMSE scores (mean = 16.0 +/- 5.6). ANOVAs revealed severity effects for total list learning (p < 0.001), the first trial (p < 0.001), the last trial (p < 0.001) and short- and long-delay recall measures. Most of these differences seemed due to floor effects. For example, the modal number of words recalled after a delay was 0 by subjects with MMSE scores below 21. Severity of cognitive impairment was associated with the proportion of intrusions such that the most severely demented subjects gave almost entirely intrusion responses. Surprisingly, list length did not significantly affect any of the free recall measures. Our results suggest that list learning and recall seem to be lost relatively early in AD. Measures of list recall like the CVLT may not be useful in tracking severity of cognitive impairment over time.

Aged↗
PubMed1998

Cholinergic deficiency in Alzheimer's disease. Pathogenic model.

Genetic vulnerability factors are becoming more important in AD, yet only a minority of cases are familial, and of these only a portion are genetically determined. Because, early in the course, neurodegeneration is occurring in vulnerable cholinergically innervated regions and not throughout the brain as a whole, AD may be conceptualized as a corticolimbic system neurodegenerative disorder involving the entorhinal cortex, hippocampus, and amygdala. This conceptualization has obvious implications for the development of therapies since future interventions may be designed to prevent or slow neurodegeneration or improve clinical signs by modulating risk factors, beta-amyloid deposition, and phosphorylation of tau proteins; inhibiting inflammatory or oxidative processes; or enhancing cholinergic function in various ways. The recently reported effects of antioxidants, including vitamin E and selegiline, in prolonging time to institutionalization, death, or significant worsening, is one example of the feasibility of this approach, as are the observations that anti-inflammatory use may reduce AD risk and that long-term cholinesterase inhibitor use may delay nursing home placement. At present, approaches that are focused on neurotransmitter systems may prove more immediately accessible targets for therapeutic intervention.

Aged↗
PubMed1998

Normal bone mass in bulimic women.

The aim of this study was to examine the relationship among exercise, menstrual function, and bone mineral density (BMD) in different groups of age-matched patients with eating disorders. Dieting and eating disorder history, physical activity history, and menstrual history were assessed by clinical interview in 43 bulimic and 13 anorectic young women as well as in 17 healthy control subjects (18-29 yr). BMD was assessed by dual x-ray absorptiometry. All the anorectics but only 30% of the bulimics exercised regularly from the onset of their eating disorder (P < 0.01), mainly using aerobic dancing and running. All of the anorectics had been amenorrheic since the start of their symptoms, and 68% of the bulimics had a history of menstrual dysfunction. Within the exercise subgroups of bulimic patients, there was no significant relationship between BMD and current or previous menstrual function. Anorectic patients had lower BMD than bulimics and controls in all skeletal regions studied (P < 0.01). Bulimic patients who had exercised regularly during their illness had higher total body BMD than bulimics classified as sedentary (P < 0.01). Bulimics who had exercised regularly or intermittently since the onset of their eating disorder had higher BMD than sedentary bulimics in the lumbar vertebrae, femoral neck, and legs (P < 0.05). It appears that weight-bearing exercise can prevent or attenuate bone loss at specific skeletal sites in normal weight bulimic patients, but not in anorectics.

Absorptiometry, Photon↗