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Biomedical subjects

P B Gorelick

Publications and source records attributed to P B Gorelick.

At least 19 recordsLinked to original sources
PubMed1995

Stroke prevention.

Stroke is ideally suited for prevention. It has a high prevalence, burden of illness, and economic cost, and safe and effective prevention measures. The estimated $30 billion that is being spent for stroke each year in the United States should not come as a surprise given the approximately 3 million stroke survivors and 400,000 to 500,000 new or recurrent stroke cases annually. Stroke remains the third leading cause of death among adults and has been targeted for cost containment by managed care health systems and other insurers. The US Public Health Service in conjunction with the National Health Promotion and Disease Prevention Objectives has set a goal to reduce stroke deaths to 20 per 100,000 by the year 2000. This goal could be attained as the estimate of "preventable" strokes could be as high as 80%. In this article, I will review the status of stroke risk factors, prevention approaches to reduce stroke, clinical trial data from primary and secondary stroke prevention studies, and future directions in stroke prevention.

Alcohol Drinking↗
PubMed1995

Early onset Alzheimer's disease in a South American pedigree from Argentina.

We report the clinical, SPET, immunohistochemical and DNA features of an early-onset familial Alzheimer's disease (FAD) in an Argentine pedigree of South American indian ethnic background. Pedigree spans 5 generations comprising more than 110 biological relatives. Clinical data supported the diagnosis of early onset FAD (mean age at onset 38.9 years) in 10 family members, including 3 with pathological confirmation (mean age at death 48.5). The pattern of transmission suggested autosomal dominant inheritance. Prominent features were mood changes, early language impairment, myoclonus, seizures and cerebellar signs. SPET displayed bilateral frontal, temporo-parietal and cerebellar hypoperfusion in early stages and in an asymptomatic member at risk, suggesting that SPET may have predictive value in this family. Immunohistochemistry showed beta amyloid deposits within neuritic plaques and vessel walls and no anti-PrP immunoreactivity. DNA analysis showed no abnormalities in the beta amyloid precursor protein gene. The identification of additional genetic defects in well characterized independent FAD pedigrees will contribute to the understanding of the pathogenesis of Alzheimer's disease.

Adult↗
PubMed1995

CT and MRI findings among African-Americans with Alzheimer's disease, vascular dementia, and stroke without dementia.

We compared CT and MRI findings among 78 Alzheimer's disease (AD), 66 vascular dementia (VaD), and 41 stroke without dementia (SWD) African-American patients to identify possible neuroimaging indicators of dementia. The patients with AD and VaD were generally older and less educated than those with SWD. VaD and SWD patients had a higher frequency of cardiovascular disease risk factors than those with AD. In multivariate analysis, the CT data showed that the presence of white matter lesions, nonlacunar infarcts, and left subcortical infarcts were predictors of VaD when compared with AD, whereas atrophy of the third ventricle and equal distribution of white matter lesions distinguished VaD from SWD. On MRI, atrophy of the temporal sulci, temporal horns, and the third ventricle, and right hemisphere infarcts, distinguished AD from VaD, while atrophy of the third ventricle differentiated VaD from SWD. These data suggest that atrophy, especially at the level of the third ventricle, presence of infarcts, and white matter lesions may be useful predictors of dementia subtype. Furthermore, the qualitative CT and MRI findings among our African-American patients were similar to those reported in other dementia studies.

Black or African American↗
PubMed1995

Neuroepidemiology of vascular and Alzheimer's dementia among African-American women.

To better understand risk factors for Alzheimer's disease and vascular dementia, demographic, medical, and other epidemiological factors were compared for 83 African-American women with Alzheimer's disease and 46 with vascular dementia. Overall, the risk-factor profiles for Alzheimer's disease and vascular dementia were similar to those in other studies. However, Alzheimer's patients had a high frequency of hypertension and a relatively high frequency of diabetes mellitus. The presence of such risk factors raises the possibility that there is a vascular component to the dementia in these African-American women with Alzheimer's disease. Neuropathological studies are needed to help answer this question.

Aged↗
PubMed1994

Epidemiology of vascular and Alzheimer's dementia among African Americans in Chicago, IL: baseline frequency and comparison of risk factors.

We compared demographic, medical, and other epidemiologic factors among 113 African-American Alzheimer's disease (AD) patients and 79 African-American vascular dementia (VaD) patients. The typical background profile of our AD and VaD patients who entered into the study was that of women who were born and raised on farms in the southeastern United States, currently lived in an apartment or home in Chicago with other family members, and were retired, widowed, and had some form of medical insurance. The following distinct patient profiles emerged: (1) African-American AD patients were generally older than their VaD counterparts, more likely to have a family history of AD, Parkinson's disease and dementia, a history of head injury with loss of consciousness and hip fracture, and more severe cognitive impairment and difficulty with instrumental activities of daily living. (2) African-American VaD patients had a higher frequency of cardiovascular disease risk factors and focal neurologic findings, more difficulty with activities of daily living, and a higher frequency of medication use. Differences in risk-factor profile may help explain differential susceptibility by dementia subtype. Since ethnic minorities will constitute a higher proportion of the United States population in the future, targeted epidemiologic research to better understand etiology and risk factors for the dementias of middle and later life among minorities is needed.

Black or African American↗
PubMed1994

Psychiatric symptoms in dementia associated with stroke: a case-control analysis among predominantly African-American patients.

As part of a case-control study, the psychiatric symptoms and behavioral problems of 61 multi-infarct dementia (MID) cases and 86 multi-infarct controls without dementia were compared to determine the prevalence of psychiatric symptoms and to clarify psychiatric predictors of dementia associated with cerebral infarcts. Ninety-two percent of the cases and 85% of the controls were African American. Cases were generally older, less well educated, and had a greater number of strokes and more neurologic deficits than controls. The most frequent psychiatric symptoms as reported by caregivers of patients with MID were irritability (57.3%), apathy (44.4%), insomnia (43.6%), agitation (40.7%), impatience (37%), and emotional lability (28.3%). In multivariate analysis, apathy and irritability were independent predictors of dementia associated with cerebral infarcts unless tests of cognitive function were added to the model. Our findings suggest that psychiatric symptoms are common in African-American vascular dementia patients, and cognitive impairment may be associated with psychiatric symptoms, behavioral problems, and personality changes. As there is a paucity of information about the prevalence of psychiatric symptoms in African Americans with vascular dementia, additional studies are needed to validate these findings. A better understanding of psychiatric symptoms in vascular dementia could lead to improved diagnosis and treatment of this disorder.

Black or African American↗
PubMed1992

Personality changes in Alzheimer's disease.

We profiled personality changes that were measured cross-sectionally on the Blessed Dementia Scale in 80 patients with Alzheimer's disease who were examined at a dementia clinic. The most common personality changes were diminished initiative/growing apathy (61.3%), relinquishment of hobbies (55.0%), and increased rigidity (41.3%). The least frequent personality change was sexual misdemeanor (3.8%). Discriminant function analysis showed that the Global Deterioration Scale, the Clinical Rating Scale for Symptoms of Psychosis in Alzheimer's Disease, and the duration of dementia symptoms were the best predictors to classify personality change in an overall score of personality. However, cognitive impairment, as measured by the Blessed Memory-Information-Concentration Test and Mini-Mental State Examination, was not a good predictor of overall personality change. Personality and behavioral changes are common in Alzheimer's disease and may not be attributed entirely to intellectual impairment.

Activities of Daily Living↗
PubMed1992

The role of drugs in the etiology of stroke.

Drugs of many classes have been implicated in hemorrhagic and ischemic stroke. Alcohol in moderation may have a protective effect although in greater doses may predispose to stroke. Drugs such as cocaine, amphetamines and heroin have been associated with stroke by a number of mechanisms. Antiplatelet, anticoagulant and thrombolytic therapy carry risk of hemorrhagic complications. Oral contraceptives appear to slightly increase stroke risk whereas estrogen replacement therapy may decrease it. Anabolic steroid use in athletes has been linked to stroke. The antineoplastic agent L-asparaginase has been associated with cerebral hemorrhage, ischemic infarction and venous sinus thrombosis. Infarction has been reported in association with cisplatin-based combination chemotherapy. Stroke is an infrequent but recognized complication of some forms of drug therapy and drug abuse.

Animals↗
PubMed1992

Vascular dementia: a clinical and death certificate study.

We compared the extent of documentation of the diagnoses, vascular dementia and stroke, on inpatient (hospital) medical records and death certificates among 23 multi-infarct dementia index cases and 14 multi-infarct controls without cognitive dysfunction who were enrolled in a hospital-based case-control study and were followed longitudinally. Both the inpatient medical records and the death certificates markedly under-diagnosed vascular dementia when compared to the case-control study diagnosis. Furthermore, the diagnosis of stroke was grossly underdiagnosed on the death certificates. In lieu of the lack of medical record and death certificate documentation of vascular dementia, studies that utilize such information may be in considerable error. Clarification of the criteria for the diagnosis of vascular dementia and greater physician and public awareness of vascular dementia are needed.

Activities of Daily Living↗
PubMed1992

Cranial computed tomographic observations in multi-infarct dementia. A controlled study.

BACKGROUND AND PURPOSE: We compared cranial computed tomography findings among 58 multi-infarct dementia index cases and 74 multi-infarct control subjects without cognitive impairment to identify potential determinants of multi-infarct dementia. METHODS: The cranial computed tomography records of acute ischemic stroke patients with a history of multiple cerebral infarcts were compared to determine the number, location, and size of cerebral infarcts; the pattern of infarction; brain volume loss; and the degree of white matter lucency, sulcal enlargement, and ventricular enlargement. Multi-infarct patients were divided into two groups: 1) index cases were defined as those with multi-infarct dementia as defined by the Diagnostic and Statistical Manual of Mental Disorders, edition 3 (DSM-III) criteria; and 2) control subjects were defined as those multi-infarct patients without dementia or multi-infarct dementia according to DSM-III criteria. RESULTS: Overall, multi-infarct index cases had more cerebral infarcts, more cortical and subcortical left hemisphere infarcts, higher mean ventricular volume to brain volume ratio, more extensive enlargement of the body of the lateral ventricles and cortical sulci, and a higher prevalence of white matter lucencies. Among multi-infarct cases and control subjects the most frequent site of infarction was the subcortical region, and the most frequent pattern of infarction was lacunar. Stepwise logistic regression analysis examined cranial computed tomography as well as other factors and showed that level of education, stroke severity, left cortical infarction, and diffuse enlargement of the left lateral ventricle were the best overall predictors of multi-infarct dementia. CONCLUSIONS: Level of education, stroke severity, and left hemisphere infarction may be predictors of multi-infarct dementia.

Brain↗
PubMed1992

An empirical evaluation of the Global Deterioration Scale for staging Alzheimer's disease.

OBJECTIVE: Although the Global Deterioration Scale has been widely used since its publication in 1982, its stages are based on implicit assumptions about the linearity, temporality, and interdependence of cognitive, functional, and behavioral impairment in Alzheimer's disease. The authors evaluated the validity of these assumptions and tested the hypothesis that psychopathology and functional impairment would occur in earlier stages than the Global Deterioration Scale predicts. METHOD: The analyses were based on data on 324 patients with Alzheimer's disease who were selected from a registry of such patients. Data analyses included 1) descriptive statistics on the frequency of psychiatric symptoms and difficulties with activities of daily living and 2) logistic regression, with symptoms and functional impairment as independent variables, to test for significant changes in patients' status between stages of the Global Deterioration Scale. RESULTS: More than 50% of the patients at stage 2 displayed psychopathology, and 32% had two or more symptoms. The significant increase in psychiatric symptoms occurred between stages 3 and 4, not between stages 5 and 6 as predicted by the Global Deterioration Scale. Impairment in functional status was observed at all stages, and significant increases occurred between stages 3 and 4 as well as between stages 5 and 6. CONCLUSIONS: Psychiatric symptoms and functional impairment occur earlier than predicted by the Global Deterioration Scale, and the rate of change is also different from that specified in the scale. Separate scales to describe cognitive, clinical, and functional status may be the best way to describe the illness until better multidimensional instruments are developed.

Activities of Daily Living↗
PubMed1992

Antiphospholipid antibodies and stroke: an epidemiological perspective.

Antiphospholipid antibodies have been reported to occur in ischemic stroke patients. We review the major epidemiological study designs and measures of risk and discuss these concepts in relation to the assessment of antiphospholipid antibodies as a risk factor for ischemic stroke. While there have been few rigorously designed epidemiological studies, available data suggest that the stroke risk associated with antiphospholipid antibodies may be substantial, especially in young adults. Additional epidemiological studies are needed to establish the consistency of this relation. A well-designed clinical trial could answer important questions about the efficacy and safety of proposed treatments.

Antibodies↗
PubMed1991

Alzheimer's disease. Clues to the cause.

Although Alzheimer's disease was described at the turn of the century, it has gained notoriety only in the past several decades. Interest in the disease has been catapulted forward by the dramatic increase in the number of elderly persons, the most rapidly expanding segment of the population. As the proportion of the aged population grows, so too will the medical and social consequences of the disease. Thus far, the most substantial leads in the search for a cause of Alzheimer's disease have been in the areas of genetic, biochemical, and epidemiologic research. While certain environmental factors such as aluminum have provoked interest, their role remains controversial.

Alzheimer Disease↗
PubMed1991

Stroke recurrence within 2 years after ischemic infarction.

We prospectively studied stroke recurrence in 1,273 patients with ischemic stroke who were entered into the Stroke Data Bank. Median follow-up was 13 months. The 2-year cumulative recurrence rate among these patients was 14.1%. Age, sex, race, history of hypertension, atrial fibrillation, or transient ischemic attacks, and stroke location were not associated with a higher risk of stroke recurrence. Patients with an elevated blood pressure, an abnormal initial computed tomogram, or a history of diabetes mellitus were at a higher risk of stroke recurrence. In contrast, patients with an infarct of unknown cause were at a lower risk of stroke recurrence than patients with a defined stroke mechanism, such as lacune, embolism, or atherosclerosis. A multivariate model suggests that patients at the lowest risk for stroke recurrence have a low diastolic blood pressure, no history of stroke, no history of diabetes mellitus, and an infarct of unknown cause.

Cerebral Infarction↗
PubMed1991

Quantitative measurement of delta activity in Alzheimer's disease.

Quantitative measurements of delta activity were made in 10 healthy elderly controls and 31 subjects with Alzheimer's disease. Delta activity did not discriminate between the healthy elderly controls and the early mild Alzheimer's disease subjects. However, delta activity was a significantly greater percentage of total EEG power in the moderate-to-advanced Alzheimer's subjects when compared to either the healthy controls or mild Alzheimer subjects. In the T3 and T4 electrodes, delta activity in the moderate-to-advanced Alzheimer subjects was 78.3% and 47.6% higher, respectively, than in control subjects. Furthermore, delta activity was an excellent predictor of dementia severity within the 31 subjects with Alzheimer's disease.

Aged↗