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R B Lipton

Publications and source records attributed to R B Lipton.

At least 145 records · Page 8Linked to original sources
PubMed1996

Associations of status and change measures of neuropsychological function with pathologic changes in elderly, originally nondemented subjects.

OBJECTIVE: To describe the association between status and change of neuropsychological function and postmortem neuropathologic findings in subjects with Alzheimer's disease, vascular dementia, normal aging, and pathologic aging. DESIGN: Volunteer cohort study. SETTING: Volunteers were interviewed and tested in outpatient-clinical research offices. PARTICIPANTS: Nondemented, healthy, community-residing subjects, initially between 75 and 85 years of age, who participated in the Bronx Aging Study and had at least 2 years of neuropsychological data and quantitative neuropathologic examinations. MAIN OUTCOME MEASURES: Initial summary neuropsychological score, rate of change score. RESULTS: Summary neuropsychological scores at baseline in subjects who subsequently developed pathologically confirmed Alzheimer's disease or vascular dementia were 0.8 z units lower than those of subjects classified in the normal or pathologic aging subgroups (P < .05). Subjects with Alzheimer's disease showed more neuropsychological change over time than subjects in the normal or pathologic aging groups (P < .001). Normal subjects and subjects with pathologic aging did not differ in baseline scores or rate of change. Level of education was strongly associated with initial neuropsychological scores (P < .004), but not with change scores. CONCLUSIONS: Among elderly, initially nondemented subjects who were followed up until death, subjects with pathologically confirmed Alzheimer's disease or vascular dementia had lower neuropsychological scores at initial evaluation than normal subjects or subjects with pathologic aging. Subjects with Alzheimer's disease had a more rapid rate of decline than normal subjects or subjects with pathologic aging.

Aged↗
PubMed1996

Patterns of hospital use, family history and co-existing conditions among urban African-American and Hispanic-American children with insulin-dependent diabetes mellitus.

Little information is available about insulin-dependent diabetes mellitus (IDDM) when it occurs among US minorities. The incidence of IDDM among African-American and Hispanic children < 18 years of age was determined in the city of Chicago. Hospital records were used as the primary source of cases, and a small amount of additional data was collected from the medical charts. Cases were drawn from records at 37 hospitals in Cook County, IL. African-American and Hispanic patients using insulin, residing in the city of Chicago, and < 18-years-old at onset were registered. Three secondary sources were used and overall ascertainment was estimated at 86%. There were 413 new cases during the 6-year interval 1985 through 1990. The age-standardized incidence of IDDM was 13.2/100,000 (95% confidence interval (C.I.) 11.8-14.8) among African-Americans and 10.8/100,000 (95% C.I. 9.5-12.3) among Hispanics. Hospital use differed between African-Americans and Hispanics, presumably based on geographic, cultural and financial factors. Diabetes among the first degree relatives of children from both ethnic groups was common, and the most frequently listed co-morbid conditions were asthma and obesity. The risk for IDDM in Chicago is among the highest for both African-origin and Hispanic children worldwide. The prevalence of asthma and obesity parallels the high prevalence of these conditions among non-diabetic children in Chicago. The ongoing epidemic of non-insulin-dependent diabetes mellitus (NIDDM) among African-Americans and US Hispanics is likely to be the reason for the large number of minority IDDM patients who have a first-degree relative with diabetes.

Adolescent↗
PubMed1996

Headache epidemiology. Emphasis on migraine.

Through the use of IHS criteria, large population-based epidemiologic studies in Denmark, the United States, France, Canada, and elsewhere have shed light on the descriptive epidemiology of migraine. Although migraine is a remarkably common cause of temporary disability, many migraineurs, even those with disabling headache, have never consulted a physician for the problem. Prevalence is highest in women, in persons between the ages of 25 and 55, and, at least in the United States, in individuals from low income households. Nonetheless, it occurs with high prevalence outside these groups at highest risk. The prevalence of migraine may be increasing in the United States, but this is uncertain. Longitudinal studies are required to better determine the incidence and natural history of migraine, as well as the life course of comorbid conditions.

Adolescent↗
PubMed1996

Work-related disability: results from the American migraine study.

Migraine headache is a highly prevalent, often severely painful and frequently disabling disorder. The indirect costs related to disability greatly exceed the direct cost of medical care. The objective of this paper is to describe work-related disability associated with migraine headache and predictors of disability. In a two-stage survey of the US population, we estimate missed workdays and impairment at work in a sample of 1663 migraine suffers, age 18 years and older. Lost workday equivalents (LWDE) was derived as the sum of actual missed workdays and the product of percentage effectiveness at work and days at work with the most severe headache. Overall, reported actual lost workdays and reduced effectiveness at work contributed approximately equally to total LWDE. A total of 51.1% of females and 38.1% of male migraineurs experienced six or more LWDE per year. This subgroup of migraine sufferers accounted for about 90% of the total LWDE experienced by all respondents. Among women, headache duration was the strongest predictor of LWDE followed by less significant associations with number of symptoms and pain level. Among men, only pain level was significantly associated with LWDE. Among sociodemographic factors, disability was more likely among older (40+) subjects and less likely among individuals with higher education and higher income (females only), even after adjusting for headache features. Health-care interventions may yield the greatest individual benefit (by reducing pain and disability) and the greatest societal benefit (by reducing indirect costs) if they are directed to those who account for the greatest proportion of disability.

Adolescent↗
PubMed1996

The effects of preclinical dementia on estimates of normal cognitive functioning in aging.

Individuals with preclinical dementia have begun to decline cognitively, but still perform within normal limits on cognitive testing. As a group, subjects with preclinical dementia have lower scores on neuropsychological tests than their dementia-free counterparts. This study examines the effects of preclinical dementia on estimates of normal cognitive function in the aged using data from a longitudinal study. Individuals with preclinical dementia at baseline were retrospectively identified based on subsequent development of dementia. Age-adjusted norms were computed using baseline data for the Selective Reminding Test and the WAIS verbal and performance scores, both including (conventional norms) and then excluding (robust norms) preclinical cases. The results indicate that by failing to exclude preclinical dementia, conventional normative studies underestimate the mean, overestimate the variance, and overestimate the effect of age on cognitive measures. Methods are discussed for selecting robust elderly samples that are relatively free of contamination by preclinical dementia.

Age Factors↗
PubMed1996

Variation in migraine prevalence by race.

PURPOSE: Estimates of migraine prevalence from African and Asian populations are lower than those observed in European and North American populations. To determine if these international differences reflect differences in cultural, environmental, or genetic factors, we compared the prevalence of migraine among Caucasians, African Americans, and Asian Americans in the United States. If genetic factors predominate, racial differences should persist in the United States. METHODS: In Baltimore County, Maryland, 12,328 individuals 18 to 65 years of age were selected by random-digit dialing and interviewed by telephone about their headaches. Migraine diagnoses were assigned using International Headache Society criteria. RESULTS: In women, migraine prevalence was significantly higher in Caucasians (20.4%) than in African (16.2%) or Asian (9.2%) Americans. A similar pattern was observed among men (8.6%, 7.2%, and 4.2%). African Americans were less likely to report nausea or vomiting with their attacks, but more likely to report higher levels of headache pain. In contrast, African Americans tended to be less disabled by their attacks than Caucasians. There were no statistically significant differences in associated features between Asian American and Caucasian migraineurs. CONCLUSIONS: In the United States, migraine prevalence is highest in Caucasians, followed by African Americans and Asian Americans. While differences in socioeconomic status, diet, and symptom reporting may contribute to differences in estimated prevalence, we suggest that race-related differences in genetic vulnerability to migraine are more likely to predominate as an explanatory factor.

Adolescent↗
PubMed1996

Classification of daily and near-daily headaches: field trial of revised IHS criteria.

Primary chronic daily headache can be subdivided into transformed migraine, chronic tension-type headache, hemicrania continua, and new daily persistent headache. We proposed and tested criteria in 150 consecutive outpatients with chronic daily headache. Based on preliminary analysis, we revised the criteria for transformed migraine. Using the International Headache Society criteria, 43% of the patients could not be classified; using our old criteria, 25% could not be classified; however, using our new criteria, we were able to classify 100%. Seventy-eight percent had transformed migraine, 15.3% had chronic tension-type headache, and 6.7% had other headache disorders.

Adult↗
PubMed1996

Is the comorbidity of epilepsy and migraine due to a shared genetic susceptibility?

We tested the hypothesis that the comorbidity of migraine and epilepsy results from a shared genetic susceptibility to the two disorders. We used semistructured telephone interviews to collect information on migraine and epilepsy in the families (parents, siblings, and offspring) of 1,967 adult probands with epilepsy. Epilepsy was defined as a lifetime history of two or more unprovoked seizures, and migraine as self-reported severe headaches with two or more of the following symptoms: unilateral pain, throbbing pain, visual aura, or nausea. As a first test of the hypothesis of shared susceptibility, we assessed risk of migraine in relatives of probands with genetic versus nongenetic forms of epilepsy, using two proxy measures of genetic susceptibility-a first-degree family history of epilepsy and idiopathic/cryptogenic (versus postnatal symptomatic) etiology. Neither of these two measures was associated with risk of migraine in relatives. As a second test, we assessed risk of epilepsy in the relatives of probands with versus without migraine. With the exception of one subgroup (sons of female probands), risk of epilepsy in relatives was not associated with the proband's history of migraine. This pattern of results is inconsistent with the hypothesis of a shared genetic susceptibility to migraine and epilepsy.

Adolescent↗
PubMed1995

Population variation in migraine prevalence: a meta-analysis.

A meta-analysis of published studies was conducted to identify factors which explained variation in estimates of migraine prevalence. Twenty-four population based studies contributed a total of 168 gender and age specific estimates of migraine prevalence. In linear regression analysis, 70.6% of the variation in these prevalence estimates was explained by gender, age (AGE+AGE2), a binary variable for case definition, and an interaction term between age and the case definition. Initially, we identified five groups of case definitions among the 24 studies. Only the definition of Waters (any 2 of warning, nausea, or unilateral pain) was associated with statistically significant differences in prevalence estimates among studies; accordingly the other 4 groups were combined. Several other factors were examined as predictors of migraine prevalence including the method of selecting the study population, the source of the population, the response rate and whether diagnoses were confirmed by a clinical assessment. None of these factors substantially increased explained variance. We conclude that after taking sociodemographic factors and case definition into account, estimates of migraine prevalence are remarkably stable among studies.

Age Distribution↗
PubMed1995

Aging, encoding specificity, and memory change in the Double Memory Test.

Aged and young adults were tested by category cued recall after learning with category cues (CCR) or with item cues (ICR). CCR was about twice ICR for both aged and young adults. The aged recalled less than the young and did not benefit as much from greater encoding specificity and deeper processing in CCR. ICR and CCR were correlated, so that expected CCR can be predicted from ICR. The regression of CCR on ICR was linear for young adults, but was piecewise linear for the aged, showing that the relationship between ICR and CCR was not uniform for the aged adults. Lower than expected CCR by a subset of aged without clinical dementia may be a sign of preclinical dementia.

Adult↗
PubMed1995

The neuroendocrine challenge paradigm in headache research.

The neuroendocrine challenge paradigm provides a "window" on central neurotransmitter function in vivo. This strategy is based on the premise that the sensitivity of certain central receptors can be inferred from the magnitude of the hormonal response to specific pharmacologic probes. For example, the serotonin (5HT) receptor agonist m-chlorophenylpiperazine (m-CPP) stimulates the release of cortisol and prolactin and induces migraine-like headaches. We have previously reported that the headache and cortisol responses to m-CPP are highly correlated, which may implicate a disturbance in central serotonergic neurotransmission in the pathogenesis of migraine. As pharmacologic probes with greater specificity for 5HT receptor subtypes become available, we may be able to elucidate these mechanisms with greater precision. The neuroendocrine challenge methodology is also applicable to the study of other neurotransmitter systems and other headache disorders.

Headache↗
PubMed1995

Migraine: association with personality characteristics and psychopathology.

The relationship between migraine and psychopathology has been discussed far more often than it has been systematically studied. Twentieth-century investigators have frequently described the obsessional rigid, angry personality postulated to characterize migraine sufferers. More recent population-based studies have demonstrated associations between migraine and depression and migraine and panic disorder. This article discusses the relationship of migraine and personality and migraine and psychopathology.

Controlled Clinical Trials as Topic↗
PubMed1995

Migraine impact and functional disability.

This article reviews the substantial impact of migraine on individual headache sufferers and on society. While the individual impact of migraine is determined by pain and role dysfunction, the societal impact is primarily determined by work loss and disability in the work place and at home. Epidemiologic studies demonstrate that migraine is very common, substantially under diagnosed and often inadequately treated. Improving health care delivery to persons with migraine could substantially reduce the individual and societal impact of the illness. Migraine ranges in severity, with mild headache and no disability on one extreme and excruciating pain and complete disability on the other. Because of this spectrum of severity, diagnosis alone does not provide enough information to permit the selection of optimal therapy. A headache grading system might help headache sufferers and clinicians match the therapy not only to the diagnosis but to the overall severity of illness; such a system provides the best hope for cost effective health care interventions.

Absenteeism↗
PubMed1995

Headache characteristics in hospitalized patients with Lyme disease.

We reviewed 49 patients consecutively hospitalized for neurologic Lyme disease to determine the frequency and characteristics of recent onset headaches in this group. All patients had positive serum Lyme ELISAs and other neurologic illness excluded. Recent-onset headache occurred in 26 of 49 patients (53%). Patients with headaches more commonly had central nervous system involvement (54% vs 19%, P < .05) and flu-like illness (58% vs 19%, P < .0005). Eight of 26 (31%) met criteria for meningitis or encephalitis with abnormal CSF examinations. All 8 had focal findings (6), cognitive dysfunction (1), or both (1). The remaining 18 patients had recent-onset headaches resembling migraine (9), tension-type headache (5), or neither (4). Antibiotic treatment resulted in complete headache resolution in 11 of 14 patients with available follow-up data. Based on these findings, we conclude that recent-onset headaches are common in patients hospitalized with Lyme disease. Of those with meningitis or encephalitis requiring intravenous antibiotics, all had focal neurologic findings or cognitive abnormalities, not just headaches.

Adult↗
PubMed1995

Seronegative chronic relapsing neuroborreliosis.

We report an unusual patient with evidence of Borrelia burgdorferi infection who experienced repeated neurologic relapses despite aggressive antibiotic therapy. Each course of therapy was associated with a Jarisch-Herxheimer-like reaction. Although the patient never had detectable free antibodies to B. burgdorferi in serum or spinal fluid, the CSF was positive on multiple occasions for complexed anti-B. burgdorferi antibodies, B. burgdorferi nucleic acids and free antigen.

Anti-Bacterial Agents↗