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Biomedical subjects

L Teri

Publications and source records attributed to L Teri.

85 records · Page 5Linked to original sources
PubMed1989

Impact of mild to moderate hearing loss on mental status testing. Comparability of standard and written Mini-Mental State Examinations.

Mild to moderate hearing loss has been hypothesized to decrease performance on verbally-administered cognitive tests as an artifact of testing. To evaluate this hypothesis, we conducted a randomized trial of a written version of the Mini-Mental State Examination (MMSE), a cognitive screening instrument which, in its standard form, is primarily verbally administered. After baseline standard MMSE testing, 71 outpatients with Alzheimer's type dementia, 39 of whom (55%) had mild to moderate hearing deficits, and 32 of whom (45%) had normal hearing, were randomly assigned to receive either a written or standard MMSE. Hearing-impaired patients exhibited lower standard MMSE scores than hearing-unimpaired patients at baseline (P = .005). Contrary to expectation, however, on experimental administration, written MMSE scores were somewhat lower than standard MMSE scores in hearing-impaired patients (P not significant). Furthermore, written MMSE scores were slightly higher than standard MMSE scores in hearing-unimpaired patients (P not significant). These results suggest that the diminished cognitive performance associated with mild to moderate hearing loss is not necessarily an artifact of cognitive testing. In addition, these results provide preliminary evidence that a written MMSE is comparable to the standard MMSE and, thus, deserves further consideration for cognitive screening of profoundly hearing-impaired individuals.

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PubMed1989

Double-blind trial of imipramine in Alzheimer's disease patients with and without depression.

The authors divided 61 subjects with primary degenerative dementia of the Alzheimer's type into a group who also met DSM-III criteria for depression (N = 28) and a group who did not (N = 33). Both groups were randomly assigned to an 8-week double-blind trial of imipramine or placebo. Scores on the Hamilton Rating Scale for Depression, administered at baseline and weeks 2, 4, 6, and 8, indicated significant improvement in both groups. Two measures of cognitive function yielded differing results. The results suggest that moderate depression is a treatable condition in patients with Alzheimer's disease.

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PubMed1989

On the uses of registries for Alzheimer disease.

Alzheimer disease (AD) is the most common dementing illness of the elderly; more than 2 million persons in the United States may be affected. Although funding levels for research into the causes, prevalence, possible risk factors for, and treatment of AD have increased rapidly in recent years, many basic issues remain unresolved. To address some of these issues, several states have passed legislation to develop registries for AD. This paper discusses the potential uses of such large-scale registries for AD and suggests alternative ways of gathering the information needed by researchers and public health officials. The key issues of purpose, case definition, and ascertainment are discussed in detail, and we note that the primary impediment to implementation of large-scale registries for AD at this time is the lack of a standardized, reliable, and valid diagnostic method. Three types of alternatives to registries are discussed, including use of current data, small-scale registries (such as a local hospital registry), and sampling studies.

Alzheimer Disease↗
PubMed1988

Behavioral disturbance in dementia of the Alzheimer's type.

Behavioral problems are thought to be pervasive and devastating to patients with dementia of the Alzheimer's type and their families. Despite this, little empirical data are available concerning the nature of such impairments, their rate of occurrence or their relationship to the disease process. This study investigated 127 patients with a primary diagnosis of dementia of the Alzheimer's type. Two methods of behavioral assessment were employed: a standardized dementia rating scale and a checklist of behavioral problems. Results indicated a) the overall number of problems significantly increased with increased cognitive impairment, b) the types of problems reported varied with cognitive severity, and c) behavioral problems were not significantly associated with patient's age, gender, duration, or age at onset of dementia. These findings are discussed as they relate to the phenomenology of dementia of the Alzheimer's type and to suggestions for interventions at different stages of the disease process. Problems found associated with level of impairment such as wandering, agitation, incontinence, and poor personal hygiene are thought to be characteristic of the disease and therefore predictable. Problems found not associated with level of impairment such as hallucinations, irrational suspicions, falls, and restlessness are likely to be idiosyncratic. The former should probably be incorporated into education and intervention programs; the latter addressed as needed on an individual basis.

Age Factors↗
PubMed1987

An outpatient geriatric psychiatry assessment and treatment service.

An outpatient evaluation and treatment program for cognitively impaired elderly and their families opened at the University of Washington in 1978. The multidisciplinary approach includes psychiatric, medical, psychological, social, and environmental assessments. The program has been well received by the public and has served as a model for similar programs elsewhere. An important finding from the clinic has been to demonstrate the high frequency of excess disability in patients with dementia of the Alzheimer's type.

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PubMed1986

Dementia of the Alzheimer's type and depression.

This retrospective review of medical records was designed to address three questions: 1) Can the depression seen in some patients with Dementia of the Alzheimer's Type (DAT) be successfully treated? 2) Does this treatment lead to any long-term improvement in the patient's cognitive status? and 3) Do patients with coexisting DAT and depression have a different long-term clinical course than nondepressed DAT patients? In the authors' sample of 131 DAT subjects, 41 (31%) also met DMS-III criteria for a major affective disorder. Of those DAT plus depression patients whose records reflected treatment (usually with a tricyclic antidepressant), 85% (17 of 20) showed clear evidence of improvement in mood, vegetative signs, or activities of daily living (ADLs) based on review of the medical record. An analysis of change in cognitive function (measured by the Folstein Mini-Mental State) and five global measures failed to reveal any differences between the depressed and nondepressed groups after a mean interval of 17 months. The depression that occurs in approximately one-quarter to one-third of DAT patients appears to respond to appropriate therapy. These patients often show improvement in their mood and ADLs but remain demented.

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PubMed1982

The use of the Beck Depression Inventory with adolescents.

Despite numerous theoretical and anecdotal reports of depression in adolescence, and the potential destructiveness of this disorder in this age group, little empirical work has been done. This study presents data on administration of the Beck Depression Inventory (BDI) to an adolescent sample(N = 568). Factor analysis and interitem and item-scale correlations of the BDI suggested that this questionnaire can be used with this population. The mean BDI score for the sample was slightly higher than that obtained in general population studies of younger children or adults. However, only 5% reported depression sufficiently high to be classified as severe, a figure similar to that of younger children but somewhat lower than that for adults. No significant differences across age were obtained, although significantly more females than males reported high depression scores.

Adolescent↗
PubMedDate not supplied

Driving and Alzheimer's disease.

OBJECTIVE: To examine the driving status of Alzheimer's disease (AD) patients presenting to a geriatric clinic, and to investigate the ability of brief cognitive assessment measures to identify those who are no longer able to continue driving safely. DESIGN: Based on caregivers' reports of driving status, AD patients were divided into three groups: those who were still driving with no difficulty, those still driving but having difficulty, and those who had stopped driving due to their cognitive problems. Scores on commonly used cognitive tests were compared across groups. Age, gender, and duration of dementia were also investigated. SETTING: The University of Washington Medical Center (UWMC) outpatient Geriatric and Family Services Clinic. PARTICIPANTS: One hundred consecutive patients who met DSM-III-R criteria for primary degenerative dementia and were either currently driving or had stopped driving due to cognitive deficits. MEASUREMENT AND MAIN RESULTS: Twenty-two subjects were reportedly still driving with no difficulty, 23 were still driving with difficulty, and 55 were no longer driving. Both mental status screening and functional assessments were significantly different between drivers and nondrivers, as were scores on a visual-spatial task. In addition, gender and age distinguished the groups: younger drivers and men drivers were less likely to stop driving despite significant cognitive impairment. CONCLUSIONS: Given the large number of AD patients who continue to drive and who experience problems with driving, this investigation highlights the need for assessment of driving safety as part of a clinical dementia evaluation. In addition, the results suggest a combination of cognitive and functional measures that may be helpful in identifying patients who are at greatest risk for unsafe driving.

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PubMedDate not supplied

A comparison of the Cohen-Mansfield agitation inventory with the CERAD behavioral rating scale for dementia in community-dwelling persons with Alzheimer's disease.

In a group of 242 community-dwelling patients with Alzheimer's disease (AD), a longitudinal comparison was made of two caregiver-administered instruments for assessment of behavioral disturbance; the Cohen-Mansfield Agitation Inventory (CMAI) and the CERAD Behavioral Rating Scale for Dementia (BRSD). We examined records of the 206 patients with baseline and 12-month follow-up data for the CMAI and the BRSD who also had tests of cognitive (Mini-mental State; MMSE) and global function (Clinical Dementia Rating; CDR and Functional Assessment Staging; FAST). Among 114 AD subjects, the correlation between total CMAI at baseline and 1 month readministration was 0.83 (p < 0.0001). In the same subjects, stratified into 5 groups by MMSE scores, the correlations between BRSD baseline and 1-month scores ranged from 0.70-0.89 (p < 0.0001). There was high correlation between total scores of both instruments at baseline and 12 months. In addition, all CMAI subscales except Verbally Aggressive correlated significantly with total BRSD score at both time points. At baseline, BRSD subscales for irritability/aggression, behavioral dysregulation and psychotic symptoms and at 12 months, irritability/aggression and behavioral dysregulation correlated with total CMAI scores. Neither scale changed significantly over 1 year, but there was wide individual variation. CMAI and BRSD scores correlated with 1-year change in the FAST, but not with MMSE or CDR (which weighs cognition heavily), suggesting that behavioral disturbance may be more strongly related to ability to manage activities of daily living (executive function) than to other aspects of cognition. The CMAI and BRSD appear to be interchangeable as measures of agitation, with the CMAI possibly more useful for patients who lack language and the BRSD more sensitive to apathy and depression.

Activities of Daily Living↗
PubMedDate not supplied

Quantifying behavioral disturbance in Alzheimer's disease patients.

In the course of a four-month study of interventions for behavioral disturbances in Alzheimer's disease (AD) patients, the following assessment instruments were examined for validity: the clinical global impression of change (CGIC), Cohen-Mansfield agitation inventory (CMAI); CERAD behavioral rating scale for dementia (BRSD), revised memory and behavioral problems checklist (RMBPC) and the agitated behavior in dementia scale (ABID). The four specific behavioral/agitation scales had excellent cross-sectional and longitudinal correlations with each other, suggesting high validity, but changes as indicated by CGIC scores did not correlate well with change scores on the other instruments. We conclude that specific behavioral instruments are preferable to the more general CGIC for detecting and quantifying behavioral disturbances in AD patients.

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