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Biomedical subjects

L Teri

Publications and source records attributed to L Teri.

At least 73 records · Page 4Linked to original sources
PubMed1994

Symptom patterns and comorbidity in the early stages of Alzheimer's disease.

OBJECTIVE: To learn whether patients with early Alzheimer's disease tend to under-report or over-report symptoms and to compare their comorbidity with non-demented patients. DESIGN: Case Control Study in a population-based dementia registry. SETTING AND PATIENTS: Three groups of subjects (mean age 76) were enrolled from an HMO base population: 154 cases had clinically diagnosed probable Alzheimer's disease, 92 subjects were found to be not demented although they had complaints of cognitive impairment, and another 129 cognitively intact controls were enrolled after frequency-matching for age and sex. MEASUREMENTS AND RESULTS: Medical records were examined for the 2 years prior to enrollment. Symptoms suggestive of cognitive impairment were evident 7.8 months prior to enrollment (median 6 months) in 95% of cases, in 77% of the not demented subjects, and in 6% of controls. After corrections for multiple comparisons, only symptoms of cognitive impairment were more frequent in cases, whereas several common symptoms not suggestive of cognitive impairment (eg, gastrointestinal discomfort, joint pain, vision problems) occurred more often in controls and the not demented group, even though comorbidity was similar among all three groups (Charlson Index mean scores: case = 0.7, not demented = 0.7, control = 0.5). CONCLUSIONS: Persons with Alzheimer's disease do complain of symptoms clearly related to cognitive impairment early in the course of illness, but may under-report common symptoms not suggestive of cognitive impairment, even though their comorbidity is similar to patients without dementia.

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PubMed1994

Causes of death associated with Alzheimer disease: variation by level of cognitive impairment before death.

OBJECTIVE: To describe causes of death for patients with Alzheimer disease (AD) and other dementing illnesses enrolled in a population-based Alzheimer disease patient registry (ADPR) and to describe the variation in causes by the level of cognitive impairment before death in probable AD cases. SETTING: The ADPR enrolls and diagnoses newly recognized potential dementia cases occurring in a large, stable health maintenance organization. To date, 654 cases have been enrolled and followed annually to monitor cognitive decline and verify initial diagnosis. DESIGN: Longitudinal descriptive study. PATIENTS: ADPR enrollees who have died. MEASUREMENTS: Death certificates were obtained for all who died (total n = 104, probable AD = 55); reported causes of death were reviewed by a physician to determine the underlying cause. AD patients were categorized according to their Mini-Mental State Exam score (cognitive impairment) within 12 months of death as (a) mildly (21+), (b) moderately (15-20), or (c) severely (0-14) impaired, and underlying cause and all reported causes of death for each group were tabulated. MAIN RESULTS: Among probable AD patients, pneumonia and AD were most often recorded on death certificates when cognitive impairment within the year prior to death had reached the severe level; heart disease, stroke, and other common causes of death predominated in AD patients who were less cognitively impaired. CONCLUSIONS: When AD cases were followed from first diagnosis to death, the causes of death varied by level of cognitive impairment. Illnesses potentially amenable to treatment caused death at all levels of disease, but more so early in the course of AD. Cognitive impairment may make patients less able to recognize and report symptoms of medical problems, thereby complicating efforts to intervene.

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PubMed1994

Behavioral treatment of depression in patients with dementia.

This article provides an overview of the theory, clinical application, and research data on behavioral treatment of depression in dementia patients. Behavioral theory of depression in nondemented adults indicates that decreased positive person-environment interactions initiate and maintain a cycle of depression that may be amenable to treatment. This same cycle is discussed as it appears in demented adults, and treatment is suggested. This treatment focuses on altering the aversive events and interactions that maintain patient depression, by increasing pleasant events and interactions, maximizing cognitive abilities, and teaching caregivers strategies for behavior change and effective problem solving. A 9-week clinical research protocol is provided with specific session-by-session content. Preliminary data are presented from a controlled clinical trial of this approach. Results thus far indicate that behavioral treatment is effective in reducing depression in patients with Alzheimer disease and in reducing the level of depression in their caregivers. The implications of these findings on future clinical care of patients and research directions are discussed.

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PubMed1993

Relationship between cigarette smoking and Alzheimer's disease in a population-based case-control study.

We investigated whether cigarette smoking is negatively associated with Alzheimer's disease (AD) in a population-based, frequency-matched, case-control study of 152 AD patients and 180 controls. Ever having smoked was associated with lower risk of AD (adjusted odds ratio = 0.61; 95% confidence interval: 0.37-0.99). Additional multivariate analyses demonstrated that education and history of hypertension modified this association. The direction of the modification was for higher education level and history of hypertension to further reduce the risk. The "dose-response" pattern showed the greatest risk reduction among those who smoked least and suggests a biologic mechanism of a dose-dependent up-regulation of nicotinic (cholinergic) brain receptors. These data, although consistent with current opinion about pathophysiology of AD, do not suggest smoking should be used as a preventive strategy for AD.

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PubMed1992

Alzheimer's disease and depression.

This article reviews the empirical literature available on the phenomenon of depression in Alzheimer's disease (AD). Although not extensively studied, there is accumulating evidence to suggest that depression affects a large number of patients with AD and can have profound effects on both the long-term functioning of these patients and the well-being of their caregivers. Thus far, the field is dominated by studies of prevalence. Considerably rarer are studies investigating etiology, association with other aspects of disease, impact on patients and caregivers, assessment, and treatment. The conceptual issues, methodological differences, and implications of the studies that exist thus far are discussed.

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PubMed1992

Assessment of behavioral problems in dementia: the revised memory and behavior problems checklist.

The Revised Memory and Behavior Problems Checklist (RMBPC), a 24-item, caregiver-report measure of observable behavioral problems in dementia patients, provides 1 total score and 3 subscale scores for patient problems (memory-related, depression, and disruptive behaviors) and parallel scores for caregiver reaction. Data were obtained from 201 geriatric patients and their caregivers. Factor analysis confirmed 3 first-order factors, consistent with subscales just named, and 1 general factor of behavioral disturbance. Overall scale reliability was good, with alphas of .84 for patient behavior and .90 for caregiver reaction. Subscale alphas ranged from .67 to .89. Validity was confirmed through comparison of RMBPC scores with well-established indexes of depression, cognitive impairment, and caregiver burden. The RMBPC is recommended as a reliable and valid tool for the clinical and empirical assessment of behavior problems in dementia patients.

Adaptation, Psychological↗
PubMed1992

Management of behavior disturbance in Alzheimer disease: current knowledge and future directions.

Assessment and treatment of behavior problems in patients with Alzheimer disease and related disorders is a seriously neglected area of study. Despite the fact that such problems are integral to the disorder, little is known about effective management. This article summarizes the current thinking on five areas of prime importance to patients, care providers, and health care professionals: agitation, assault/aggression, screaming, wandering, and depression/apathy/withdrawal. Methodological guidelines for studying these disorders are provided. Emphasis is on recognizing that behavior problems are important areas of study in their own right as well as in conjunction with studies of cognition.

Activities of Daily Living↗
PubMed1991

Assessment of depression in patients with Alzheimer's disease: concordance among informants.

This study is an investigation of the concordance among different sources of information on ratings of depression in patients with Alzheimer's disease (AD). Informants were 75 outpatients with diagnosed AD (22 with major depressive disorder), their caregivers, and geriatric clinicians. Clinicians rated each patient on the Hamilton Rating Scale for Depression on the basis of (a) the patient's report, (b) the caregiver's report, and (c) the clinician's evaluation. Overall, patients perceived themselves as less depressed than did caregivers or clinicians; for nondepressed patients, caregivers reported patients less depressed than clinicians reported; for depressed patients, no significant differences were obtained between caregiver or clinician. Certain items were more discrepant among informants and significantly differentiated depressed from nondepressed AD patients. Level of patient dementia did not affect ratings. These findings support the need for comprehensive, accurate assessment of depression in AD patients.

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PubMed1991

Predictors of burden in spouse caregivers of individuals with Alzheimer's disease.

This study used the following model of distress: Distress = [Exposure to Stress + Vulnerability]/[Psychological and Social Resources]. The constructs in the model were operationalized as (a) distress in response to caregiver experiences (burden); (b) exposure to stress (care recipient functional impairment in activities of daily living [ADLs]); (c) vulnerability (caregiver health problems, anger, and anxiety); and (d) resources (coping, outlook on life, and social supports). Long-term burden (15-18 months after entry) was predicted by several baseline variables: burden, care recipient ADLs, vulnerability and resource variables, and specific interactions of burden, ADLs, vulnerability, and resource variables. The interactions showed that caregivers with high vulnerability and low resources had higher burden scores than caregivers with other combinations of these variables.

Activities of Daily Living↗
PubMed1991

Imipramine in the treatment of depressed Alzheimer's patients: impact on cognition.

A double-blind study evaluated the impact of imipramine on cognitive function in 61 patients with Alzheimer's disease. Twenty-eight patients had coexistent depression and dementia; 33 had dementia only. All were randomly assigned to an 8-week trial of imipramine or placebo. For both depressed and nondepressed subjects, the effect of imipramine on cognition was minimal. A subtle decrement in general cognitive function was evident in those treated with imipramine, as compared with those treated with placebo. No effects were observed on memory. Clinicians are advised that very low doses of imipramine (25 mg/daily) may be tolerated in depressed Alzheimer patients, but that cognitive changes do occur in some patients and should be carefully monitored.

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PubMed1991

Identifying pleasant activities for Alzheimer's disease patients: the pleasant events schedule-AD.

Identifying pleasant activities for Alzheimer's disease patients is sometimes difficult due to their declining cognitive functioning. Such activities, however, may help to improve the patient's mood, reduce disruptive behaviors, and provide a sense of accomplishment. This paper presents an instrument, the Pleasant Events Schedule-AD, that can help both professional and family care providers identify and monitor activities that are enjoyable to individual patients.

Activities of Daily Living↗
PubMed1991

Cognitive-behavioral interventions for treatment of depression in Alzheimer's patients.

This paper presents two strategies for treating depression in Alzheimer's patients. Cognitive therapy, used with mildly demented adults, challenges the patient's negative cognitions in order to reduce distortions and enable the patient to generate more adaptive ways of viewing specific situations and events. Behavioral intervention, used with more moderately or severely demented adults, attempts to modify person-environment interactions by increasing the level of positive activities and decreasing negative ones (Lewinsohn et al., 1984). Both theories have been used successfully in clinical settings.

Alzheimer Disease↗
PubMed1990

Cognitive deterioration in Alzheimer's disease: behavioral and health factors.

Alzheimer's disease is characterized by progressive cognitive decline. However, little is known about the "typical" rate of decline, the degree of individual heterogeneity evident in decline, or the types of factors that influence such decline. This study investigated these questions in a sample of 106 patients with Alzheimer's disease, assessed at 1-5 points in time, spanning up to three years. At each time point, the Mini-Mental State Exam, a measure of global cognitive function, was administered to all patients. Measures of behavioral disturbance (including the presence/absence of hallucinations, depression, incontinence, wandering, and agitation), health status (including presence/absence of neurological, cardiovascular, and other diseases), and descriptive information (such as gender, age at time of onset, and duration of deficits) were obtained at entry into the study. A two-stage random effects regression model was fit to the data and then used to assess the effect of these behavioral, health, and descriptive measures on the rate of decline. Results indicate that the rate of cognitive decline in Alzheimer's disease is quite variable. Patients with various health and behavioral problems declined at a rate between 1.4 and 5 times faster than patients without such problems. Alcohol abuse, additional neurological disease, and agitation were significantly related to rate of decline. Overall number of problems was not. The association of these problems with accelerated decline may have prognostic and treatment implications.

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PubMed1990

Assessment and management of behavioral disturbances in Alzheimer's disease.

In summary, AD patients and their care givers are confronted with a variety of behavioral problems that may have a devastating impact on both. It is important for physicians and other health-care providers to assess the occurrence and impact of these behaviors, and to assess and treat the broader medical and cognitive problems that are evident. Measurement tools can augment the clinical interview to give the practitioner a thorough assessment of behavioral problems. A systematic six-step approach to intervention, as well as specific recommendations for the most common and troublesome behaviors of depression and agitation, are provided. Care givers vary in their ability to cope with the problems of AD patients. Some seem to adjust naturally and to anticipate and solve problems on their own. Others need considerable guidance and may require assistance from their physician as well as referral to a psychologist or other mental health professional adept in behavioral management. Physicians must play a pivotal role in recognizing problems and providing or arranging for appropriate treatment for their AD patients and care givers.

Alzheimer Disease↗
PubMed1989

The WAIS-R profile: a diagnostic tool for Alzheimer's disease?

A diagnostic index, based on WAIS-R subtests, to identify patients with Dementia of the Alzheimer Type (DAT) and differentiate them from normal or depressed elderly was investigated. In a sample of 82 geriatric outpatient clinic patients who complained of memory loss, 22% of patients with probable DAT and 13% of nondemented patients obtained a positive profile. The occurrence of the profile in the two groups was not significantly different, nor were differences in education or severity of dementia found between subjects who did or did not obtain the profile. In a second sample of 173 elderly research volunteers, the profile occurred in 7% of DAT subjects, 10% of subjects complaining of memory loss who did not meet diagnostic criteria for DAT, 7% of nondemented major depressed subjects, and 7% of normal control subjects. Thus, the current investigation did not find the profile useful in differentiating DAT from other common disorders among elderly subjects. The authors conclude that a more comprehensive test battery remains the diagnostic tool of choice for differentiating DAT from other disorders.

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PubMed1989

Behavioral disturbance, cognitive dysfunction, and functional skill. Prevalence and relationship in Alzheimer's disease.

The nature and severity of behavioral problems, and their relationship to cognitive and functional abilities, was investigated in 56 community-residing patients with Alzheimer's disease. Measures evaluated three domains of function: behavior, cognition and activities of daily living. Problems of cognitive functioning, such as memory loss, confusion, and disorientation were most prevalent, reported to occur in 84%, 82%, and 64% of the sample, respectively. Problems with activity and emotional distress were next, affecting 20 to 43% of the sample. The mean number of problems reported was 10 per patient. Twenty-two percent of caregivers reported a minimum of 15 problems occurring at least twice a week and no caregiver reported an absence of problems. Male patients were reported to have more behavioral difficulties. Level of behavioral disturbance was largely unrelated to cognitive or functional ability. Age was unrelated to cognitive or behavioral disturbance but significantly related to activities of daily living. Results indicated that behavioral problems are prevalent and pervasive in even moderately impaired community-residing Alzheimer disease patients, and that age may be more important than level of cognitive dysfunction in predicting difficulties with activities of daily living.

Activities of Daily Living↗
PubMed1989

Functional status and cognitive impairment in Alzheimer's patients with and without depression.

Cognitive impairment and depression each compromise functional status in the elderly, but it is not known whether their coexistence is associated with additive functional impairment. The effect of the presence or absence of a diagnosis of major depression on functional status was examined in a group of 50 community-residing patients with dementia of the Alzheimer's type (DAT). Patients were diagnosed as depressed (N = 20) or not (N = 30) according to DSM-III criteria. Cognitive status was assessed with the Mini-Mental State Exam (MMSE), and functional status was assessed by family report of Instrumental Activities of Daily Living (IADLs). Consistent with previous reports, patients with a depression diagnosis were less cognitively impaired than their nondepressed counterparts. When cognitive status was controlled for, depression diagnosis was found to have a main effect on functional impairment. Although the direction of effects between depression and functional limitations was not determined here, these results suggest that alleviating depression may decrease functional limitations in DAT patients.

Activities of Daily Living↗