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Biomedical subjects

R Jacoby

Publications and source records attributed to R Jacoby.

At least 55 records · Page 3Linked to original sources
PubMed1991

Factors affecting survival in Alzheimer's disease.

Factors affecting survival of 178 patients diagnosed using NINCDS/ADRDA criteria for Alzheimer's disease were studied. All patients were drawn from the Camberwell Health Authority Area and so were a representative sample of subjects from a clinical old age psychiatry service. The mortality rate of the sample was 3.5 times that expected after adjustment for age. Younger subjects had a higher standardized mortality ratio than older subjects. The cumulative three-year mortality of the sample was 47%. Factors shown to be associated with a reduced survival included: increasing age, longer duration of illness, male sex, presence of physical illness, poor cognitive function, observed depression and absence of misidentification syndromes. Apraxia was a stronger predictor of early death than aphasia or dysmnesia.

Aged↗
PubMed1991

Neurological signs in Alzheimer's disease.

Neurological signs were assessed in 178 patients satisfying NINCDS/ADRDA criteria for Alzheimer's disease. A snout reflex was present in 41%, extrapyramidal signs in 12%, drug-induced extrapyramidal signs in 3%, myoclonus in 5%, and a history of epileptic fits in 3%. A grasp reflex, extrapyramidal signs and symptoms were associated with severe cognitive impairment. On CT scanning, extrapyramidal signs were associated with increased 3rd ventricular size and basal ganglia calcification, a grasp reflex with frontal lobe atrophy and a history of epilepsy with left temporal lobe atrophy. Lateral ventricular size was greater in patients developing a grasp reflex during a 12 month follow-up. Extrapyramidal signs and primitive reflexes were associated with a higher mortality.

Aged↗
PubMed1991

Progression of cognitive impairment in Alzheimer's disease.

Change in cognitive function was assessed over 12 months in 110 patients over the age of 65 satisfying National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association (NINCDS/ADRDA) criteria for "probable" Alzheimer's Disease. A highly significant deterioration in cognitive function was observed. Decline in cognitive scores was relatively normally distributed. Patients who died during the follow-up had more apraxia at entry to the study than survivors. A greater rate of decline was seen in patients whose parents suffered from dementia (but not in those where a sibling or other relative was affected), in subjects who had moderate dementia, and those who had been ill for less than 24 months. Age, age of onset, and the presence or absence of aphasia or apraxia had no influence on rate of progression. A cluster analysis revealed three patterns of decline.

Age Factors↗
PubMed1991

Computerised tomography in Alzheimer's disease. Methods of scan analysis, comparison with normal controls, and clinical/radiological associations.

One hundred and thirty-eight patients satisfying NINCDS/ADRDA criteria for Alzheimer's disease (AD) and 36 normal controls underwent cranial CT. A comparison of methods of scan analysis showed good agreement between computer-assisted methods and visual ratings and planimetry. The CT scans of controls differed significantly from patients and a discriminant analysis, based on all CT measures, predicted group membership (control or patient) in 81% of cases. Within the AD group, cortical atrophy correlated with age and duration of illness. Global tests of cognitive function correlated significantly with both cortical atrophy and ventricular size. Subjects who died in a three-year follow-up had more atrophy and larger third ventricles than survivors, but this effect was due entirely to increased age.

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PubMed1991

Neuroanatomical correlates of clinical misidentification and misperception in senile dementia of the Alzheimer type.

BACKGROUND: Impaired frontal lobe and/or nondominant hemisphere lesions have been described in patients with typical misidentification syndromes (e.g., Capgras' syndrome or reduplicative paramnesia) who had various underlying psychiatric or neurologic disorders. In a prospective long-term study, the authors examined computed tomography measurements of patients with senile dementia of the Alzheimer type (DAT) to determine whether the forms of misidentification they suffered might correlate with organic factors. METHOD: One hundred twenty-eight consecutive DAT patients were examined by means of standardized clinical instruments (Mini-Mental State score, CAMCOG, the Benton facial recognition test, the Kendrick object learning test, CAMDEX, and the Geriatric Mental State Schedule) and computed tomography. RESULTS: Of the 128 patients, 40 showed symptoms of misidentification; 25 of them misidentified other people in their homes, 7 misidentified their own mirror images, and 7 misidentified television images as being real. Computer-assisted planimetric computed tomography measurements showed that patients with misidentification syndromes had significantly larger right anterior horn areas of the lateral ventricle and significantly larger left anterior brain areas than did patients without such symptoms. CONCLUSIONS: The authors conclude that an accentuated degeneration of the right frontal lobe (and a relative preservation of the left frontal lobe) may be associated with delusional misidentification symptoms in DAT.

Aged↗
PubMed1990

Behavioral abnormalities and psychiatric symptoms in Alzheimer's disease: preliminary findings.

Behavioral abnormalities and psychiatric symptoms were assessed in 178 patients diagnosed as having Alzheimer's disease by NINCDS/ADRDA criteria. The subjects were selected from a defined catchment area and therefore were representative of a group of patients with Alzheimer's disease of varying severity. Auditory hallucinations were found in 10%, visual hallucinations in 13%, and delusions in 16%. Symptoms suggestive of depression were reported by 39% of the patients and features of depression observed in 25%. Twenty percent were aggressive, and 7% were sexually disinhibited. Nineteen percent exhibited excessive walking behavior and 10% binge eating. Nearly 50% of the sample were incontinent. Patients in the hospital were more often aggressive, incontinent, and seemingly less depressed. Patients with severe dementia displayed excessive walking behavior, were more likely to be incontinent, and reported less depressive symptoms than those with moderate or mild dementia.

Activities of Daily Living↗
PubMed1990

Transcendence and psychological health: studies with long-term participants of the transcendental meditation and TM-Sidhi program.

We investigated the nature of the relationship between experiences of transcendental consciousness and psychological health. In Study 1, three groups with different levels of experience in transcendental meditation (TM) and in the TM-Sidhi program (techniques that have been shown to produce experiences of transcendental consciousness) were studied, using the self-investigation method of Hermans (1976). We employed blind interviewers and raters with various attitudes toward TM to minimize the possible impact of a variety of artifacts. Cross-sectionally, experience with TM and the TM-Sidhi program was positively related to a general measure of psychological health (p = .002); longitudinally, the meditating groups improved more than the control group on the psychological health measure (p less than .03). In Study 2, two contrast groups of long-term participants were similar on several confounding variables but differed on physiological indicators of experiences of transcendental consciousness. The groups with the positive physiological indicators showed a trend toward higher scores on the psychological health factor (p = .092), indicating that psychological health may be developed through the systematic cultivation of transcendental meditation and the TM-Sidhi program.

Adaptation, Psychological↗
PubMed1990

Cause of death in Alzheimer's disease.

Bronchopneumonia was the commonest cause of death in 84 elderly patients suffering from Alzheimer's disease. The cause of death as stated on the death certificate agreed with the pathological diagnosis in 77% of cases. In 30%, no mention of the presence of a dementia syndrome was recorded on the death certificate. An increased willingness to record the presence of a dementia syndrome and a higher autopsy rate would increase the accuracy of death certification in Alzheimer's disease.

Aged↗
PubMed1990

Psychiatric phenomena in Alzheimer's disease. I: Disorders of thought content.

In a sample of 178 subjects with Alzheimer's disease, diagnosed by clinical criteria (NINCDS/ADRDA), delusions had occurred in 16% of the sample since the onset of the illness and been present within the last 12 months in 11%. Simple delusions of theft and suspicion were the most common types and a greater proportion of men suffered delusions of theft. Subjects with other types of delusion had relatively well preserved lateral ventricular size and basal ganglia calcification. Twenty per cent of the group had experienced persecutory ideation short of delusions since the onset of the illness. Cognitive function at entry to the study and cognitive deterioration over the succeeding 12 months was not influenced by the presence of disorders of thought content.

Aged↗
PubMed1990

Psychiatric phenomena in Alzheimer's disease. II: Disorders of perception.

In a sample of 178 patients with AD, visual hallucinations had been experienced by 13% and auditory hallucinations by 10%. Thirty per cent had misidentification syndromes; these were associated with a younger age and younger age at onset of illness, and proportionally more men than women were affected. There was a reduced 30-month mortality rate in this group. Subjects with hallucinations had a greater deterioration in cognitive function at 12-month follow-up, which could not be accounted for by neuroleptic medication.

Aged↗
PubMed1990

Psychiatric phenomena in Alzheimer's disease. III: Disorders of mood.

Of 178 patients with AD, at least one depressive symptom was reported by 63%, 24% were rated as being depressed by a trained observer, and 43% were considered depressed by their relatives. Ten per cent had a previous history of depression. Elevated mood was rare, occurring in only six patients (3.5%). Subjects with depressive symptoms had less cognitive impairment and less ventricular enlargement on CT compared with those without symptoms. Widening of the interhemispheric fissure was associated with symptoms of mania but was inversely related to presence of depressive symptoms.

Aged↗
PubMed1990

Psychiatric phenomena in Alzheimer's disease. IV: Disorders of behaviour.

Out of a sample of 178 patients with AD, aggression was present in 20%, wandering in 19%, binge-eating in 10%, hyperorality in 6%, urinary incontinence in 48%, and sexual disinhibition in 7%. Behavioural abnormalities were greater in those with more severe dementia. Temporallobe atrophy correlated with aggression, and widening of the third ventricle with hyperorality. Features of the Kluver-Bucy syndrome were commonly seen, but the full syndrome occurred in only one subject. Patients with at least one feature of the Kluver-Bucy syndrome had greater temporal-lobe atropy than those without any of the features.

Adult↗
PubMed1989

Laser abrasion for cosmetic and medical treatment of facial actinic damage.

Previous studies have shown the carbon dioxide (CO2) laser to be effective in the treatment of actinic cheilitis. After CO2 laser abrasion, normal skin and marked cosmetic improvement of the lip were noted. In our study, twenty-three patients were treated with CO2 laser abrasions for cosmetic improvement of facial lines and actinic changes. Pre- and postoperative histopathologic examinations were made on two patients. Preoperative examination of specimens from actinically damaged skin showed atypical keratinocytes in the basal layer of the epidermis, with overlying dense compact orthokeratosis and parakeratosis. Abundant solar elastosis was seen in the papillary dermis. Postoperative histologic specimens showed a normal-appearing epidermis with fibrosis in the papillary dermis and minimal solar elastosis (about four weeks after laser treatment). At present, various modalities are available for the regeneration of the aged skin, including chemical peels and dermabrasion. Significantly fewer complications were noted with CO2 laser abrasion than with these methods. Thus, CO2 laser abrasion can be useful in the cosmetic and medical treatment of the aged skin. Marked clinical and histologic improvement has been demonstrated.

Adult↗
PubMed1986

A pilot study of erythrocyte choline flux and content in affective disorders.

Choline influx and choline content were measured in healthy volunteers (N = 36), patients with unipolar affective disorder (N = 28), and bipolar patients before and during treatment with lithium (N = 14, N = 13 respectively). Erythrocyte choline content was not found to be significantly elevated in any of the groups studied, except in patients taking lithium. Choline influx into the erythrocytes of healthy controls was found to decrease with increasing age, while choline influx into lithiated erythrocytes increased with increasing age in patients. An inverse relationship between erythrocyte choline influx and content was found to exist only in the erythrocytes of elderly healthy volunteers (greater than or equal to 60 years old).

Adult↗
PubMed1986

Extended haplotypes in rheumatoid arthritis and preliminary evidence for an interaction with immunoglobulin genes.

The incidence of extended haplotypes of the Major Histocompatibility Complex was compared between 20 probands with RA, their unaffected family members, and 42 controls. One haplotype only, HLA-Bw62 BfS C4A*3 C4B*3 DR4 GLO2, was significantly increased in the patient group, whereas HLA-B7 BfS C4A*3 C4B*1 DR2 GLO1, which was the most common haplotype in the control groups, was absent. The immunoglobulin allotype Glm(2) was significantly increased in frequency in the RA patients, and analysis showed that of the seven patients carrying Bw62-DR4, five were G1m(2) positive. Further, the increase in frequency of the phenotype Gm(1,2,17,21,3,5,23) was also significant and was carried by two of four probands with the extended haplotype HLA-Bw62 BfS C4A*3 C4B*3 DR4 GLO2 and by one proband also bearing this haplotype but with a null allele at the C4A locus. The striking association of G1m(2) and Bw62 with DR4 in our patients suggests that in interaction of immunoglobulin genes with DR4 is stronger when DR4 is associated with particular haplotypes rather than with DR4 in general.

Arthritis, Rheumatoid↗