Biomedical subjects

Marta S Mendiondo

Publications and source records attributed to Marta S Mendiondo.

4 recordsLinked to original sources

PubMed2006

Long-term cognitive impact of anticholinergic medications in older adults.

OBJECTIVE: The objective of this study was to determine whether chronic use of medications with anticholinergic (AC) properties impact older adults' cognitive functioning. METHODS: Six years of cognitive test data from two groups of older adults (AC and control) were examined retrospectively (N = 592). RESULTS: Declines over time were found for the AC group on parts A and B of the Trail Making Test. CONCLUSION: Physicians prescribing ACs to older adult patients should be aware of their potential effects on psychomotor speed and executive functioning. These cognitive effects may lead to impairments in daily functioning resulting in the need to reevaluate patient medications.

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PubMed2006

Alzheimer's disease and head circumference.

OBJECTIVE: Larger brains may contain more neurons and synaptic connections, providing a greater reserve against cognitive decline in Alzheimer's disease (AD). Larger head circumference (HC) may therefore be associated with later detection and diagnosis of AD. We investigated HC in nondemented individuals and AD patients using cross-sectional and prospective analyses. METHODS: The cross sectional analysis compared mean HC between 592 AD patients and 459 nondemented controls. Prospective analysis was based on the same initially normal controls who were followed longitudinally for conversion to dementia. Diagnosis of AD was made by neurologists using NINDS-ADRDA criteria. RESULTS: When compared to AD patients, controls had a significantly larger mean HC by 0.58 cm in men and by 0.31 cm in women, but these differences were no longer significant after adjustment for age and years of education. HC varied inversely with age and directly with years of education but did not vary with presence/absence of dementia in first-degree relatives or with apolipoprotein-E (ApoE) genotype. In the prospective analysis, the hazard ratio for time to conversion to AD was not significant for HC when adjusted for age at entry, ApoE allele status, family history of dementia, gender, and years of education. ApoE allele status, first degree relative with dementia, and baseline age conferred an increased risk for conversion to AD, consistent with other studies. CONCLUSIONS: We observed a smaller HC in AD patients compared to nondemented individuals, but AD per se accounted for little of this difference. HC was not a statistically significant predictor for conversion to AD in our longitudinal group.

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PubMed2004

Designing a large prevention trial: statistical issues.

Recent research in Alzheimer's disease (AD) is centred about the early detection and prevention of this disease. Several recent moderate size clinical trials targeted at high risk cohorts have been designed along this theme. There have been few attempts to design a large trial to prevent this disease in elderly individuals at low risk for the disease. The purpose of this paper is to suggest a framework for designing a simple, large AD prevention trial. This framework uses a discrete time hazard model for decreasing the incidence of AD when participants are randomly assigned to one or more active prevention agents or placebo. This design allows for differential incidence among participants due to age, family history, genetic disposition, and ethnicity. It takes into account the length of the follow-up period, participant mortality, drop-outs, drop-ins, and loss to follow-up. This framework is illustrated by PREADVISE, a recently initiated large add-on prevention trial investigating the use of anti-oxidants for preventing AD among men enrolled in a even larger prostate cancer prevention study, SELECT.

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PubMed2003

Designing a Brief Alzheimer Screen (BAS).

CONTEXT: With advances in the treatment of Alzheimer's disease (AD), clinical focus has shifted to early patient identification. Memory recall tests and category fluency distinguish normal individuals from early AD patients. OBJECTIVE: Develop a brief test for general practitioners to screen for AD. Design. Examination of items from the MMSE and category fluency. SETTING AND PARTICIPANTS: A Brief Alzheimer Screen (BAS) was developed from cognitive assessments on 406 normal subjects and 342 mild AD patients in the CERAD (Consortium to Establish a Registry for AD) dataset. The derived measure was then applied to a second validation sample. MAIN OUTCOME MEASURE: Logistic regression was used to derive a predictive equation, which was then applied to two validation samples to estimate sensitivity and specificity. RESULTS: The resulting logistic model for discriminating between mild AD and controls included: recall of 3 words, number of animals named in 30 seconds, date, and spelling of WORLD backwards, (p < 0.001 for each) accounting for 77% of the variance. When applied to the validation samples, sensitivity and specificity were over 99% and 87%, respectively. CONCLUSIONS: These data support the use of the BAS as a potential screen of patients over 60 years of age.

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