Biomedical subjects

R A Lasser

Publications and source records attributed to R A Lasser.

5 recordsLinked to original sources

PubMed1998

Apolipoprotein E epsilon 4 allele in association with global cognitive performance and CSF markers in Alzheimer's disease.

To better define the influence of apolipoprotein E (ApoE) epsilon 4 genotype on the cognitive and biochemical features of Alzheimer's disease (AD), cross-sectional analysis of global cognitive measures and cerebrospinal fluid studies gathered on AD subjects at a tertiary care facility between 1986 and 1997 was carried out. The 112 AD patients examined included 62 women and 50 men with a mean (SD) age of 64.2 (9.2) years. Patient demographics; illness onset age and duration, education level and global cognitive measures were recorded systematically. Genetic analysis for ApoE allele type and biochemical characterization of CSF, including total tau concentration, was performed. Descriptive statistics of demographics, cognitive and CSF measures were performed by chi-square, ANOVA and Tukey's tests. Overrepresentation of the epsilon 4 allele was found, with 45.5% of AD patients heterozygous and 20.5% homozygous for ApoE epsilon 4. Overall, ApoE epsilon 4 status had no effect on mean onset age of AD (F = 1.56; p = 0.214), but an earlier mean onset age of AD (F = 4.10; p = 0.02) was seen in the late-onset subjects. No differences were found with regard to ApoE epsilon 4 status and measures of disease, duration of illness or global cognitive performance. Although CSF tau was elevated in our sample (575.4 +/- 290.3 pg/ml), ApoE epsilon 4 status did not influence total CSF tau or neurotransmitter metabolite levels. ApoE epsilon 4 genotype had no impact on a variety of illness severity, cognitive and CSF examinations in the largest cross-sectional analysis of AD subjects yet reported.

Aged↗

PubMed1998

Newer psychotropic medication use in nursing home residents.

OBJECTIVE: To evaluate the use of newer psychotropic agents in nursing home residents in the era of new Health Care Financing Administration (HCFA) guidelines. DESIGN: Retrospective chart review of referrals to an on-site geriatric psychiatry service in seven Eastern Massachusetts facilities during 1995-1996. SUBJECTS: The 298 patients examined included 226 women and 72 men with a mean (SD) age of 81.9 (9.4) years. MEASUREMENTS: Patient demographics, psychiatric history and medical diagnoses, prescribed medication information, and mental status examination results were recorded systematically. Descriptive statistics of demographics, medication use, and dosing were generated, and comparative analyses were performed by chi-square, ANOVA, and Tukey's tests. RESULTS: Overall, 69% of subjects were taking at least one psychotropic medication. Although benzodiazepines (32%) and antipsychotics (42%) were used by a large portion of subjects, antidepressants (61%) were the most commonly prescribed psychotropic, with 53% taking serotonin reuptake inhibitors. The atypical antipsychotic, risperidone, accounted for more than 30% of antipsychotic prescriptions. Low rates of anticholinergic use and low doses and rates of tricyclic antidepressant use were found in Alzheimer's disease patients. Mean dosing of the psychotropic agents fell within HCFA guidelines. CONCLUSIONS: Newer-generation psychotropics have had a significant impact on the prescribing practices of primary physicians in treating nursing home residents. Of clinical importance is the high rate of antidepressant use in a population that has traditionally received inadequate pharmacotherapy for depression. More studies are needed to examine a shift to the use of other psychotropic drugs in this population in the post-HCFA area.

Aged↗

PubMed1997

Depression in the elderly: biologic considerations.

Although support for the biologic basis and effective somatic therapy of geriatric depression is increasing, both patients and clinicians are reluctant to identify and treat the symptoms associated with late-life depression, a broad-based problem in the geriatric population. There is much clinical and biologic overlap between depression and other organic brain disorders such as dementia, with evidence that late-onset depression may sometimes be a prodrome for other organic disorders. These and other issues surrounding geriatric depression are reviewed with a focus on future research questions.

Age Factors↗

PubMed1997

Combining serotonin reuptake inhibitors and bupropion in partial responders to antidepressant monotherapy.

BACKGROUND: Many patients with affective illness show partial or otherwise unsatisfactory responses to standard treatments, encouraging trials of combinations of pharmacologically dissimilar antidepressants. METHOD: Records of consecutive outpatients with affective disorders only partially responsive to treatment with a serotonin reuptake inhibitor (SRI) or bupropion, alone, were reviewed for changes in specific symptoms and risks of adverse events when an SRI and bupropion were combined. RESULTS: Greater symptomatic improvement was found in 19 (70%) of 27 subjects during a mean +/- SD of 11 +/- 14 months of combined daily use of bupropion (243 +/- 99 mg) with an SRI (31 +/- 16 mg fluoxetine-equivalents) than with either agent alone. Adverse effect risks were similar to those associated with each monotherapy, with a > 10% incidence of sexual dysfunction (N = 11, 41%), insomnia (N = 6, 22%), anergy (N = 4, 15%), and tremor (N = 3, 11%) during combined therapy; there were no seizures. CONCLUSION: With conservative dosing and close monitoring, combinations of SRIs with bupropion in this uncontrolled clinical series appeared to be safe and often more effective than monotherapy.

1-Naphthylamine↗

PubMedDate not supplied

Thyroid hormones in depressive disorders: a reappraisal of clinical utility.

Centuries of clinical observation suggest a connection between thyroid function and behavior. Advances in neuroendocrinology of the hypothalamic-pituitary-thyroid (HPT) axis provide many techniques for examining the role of thyroid function in psychiatric disorders. HPT hypofunctioning may be especially relevant to the pathophysiology of major mood disorders, although the diagnostic specificity and prognostic value of its assessment remain tentative. Evidence that synthesis and actions of thyroid hormones in the brain may not parallel those in the periphery further complicates such assessments. Nevertheless, measures of HPT function show some promise of contributing to the clinical evaluation and treatment of depression. Research findings include an association of subclinical hypothyroidism with unsatisfactory responses to antidepressant treatment, evidence that triiodothyronine and thyroid-stimulating hormone may speed recovery in acute depression, and limited and inconsistent support for the effectiveness of exogenous thyroid hormones to augment antidepressants. Additional systematic and controlled studies comparing various types and doses of thyroid hormones are needed to establish their efficacy and safety. Of special interest would be studies that use contemporary diagnostic methods, assess thyroid function, and employ the newer, safer antidepressants.

Depressive Disorder↗