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Biomedical subjects

S B Rourke

Publications and source records attributed to S B Rourke.

13 recordsLinked to original sources
PubMed2006

Patient support and education for promoting adherence to highly active antiretroviral therapy for HIV/AIDS.

BACKGROUND: Adherence to prescribed regimens is required to derive maximal benefit from many highly active antiretroviral therapy (HAART) regimens in people living with HIV/AIDS. OBJECTIVES: To conduct a systematic review of the research literature on the effectiveness of patient support and education to improve adherence to HAART. SEARCH STRATEGY: A systematic search of electronic databases was performed from January 1996 to May 2005. SELECTION CRITERIA: Randomized controlled trials examining the effectiveness of patient support and education to improve adherence to HAART were considered for inclusion. Only those studies that measured adherence at a minimum of six weeks were included. DATA COLLECTION AND ANALYSIS: Study selection, quality assessments and data abstraction were performed independently by two reviewers. MAIN RESULTS: Nineteen studies involving a total of 2,159 participants met criteria for inclusion. It was not possible to conduct a meta-analysis due to study heterogeneity with respect to populations, interventions, comparison groups, outcomes, and length of follow-up. Sample sizes ranged from 22 to 367. The populations studied ranged from general HIV-positive populations to studies focusing exclusively on children, women, Latinos, or adults with a history of alcohol dependence, to studies focusing almost exclusively on men. Study interventions included cognitive behavioral therapy, motivational interviewing, medication management strategies, and interventions indirectly targeting adherence, such as programs directed to reduce risky sexual behaviours. Ten studies demonstrated a beneficial effect of the intervention on adherence. We found that interventions targeting practical medication management skills, those administered to individuals vs groups, and those interventions delivered over 12 weeks or more were associated with improved adherence outcomes. We also found that interventions targeting marginalized populations such as women, Latinos, or patients with a past history of alcoholism were not successful at improving adherence. We were unable to determine whether effective adherence interventions were associated with improved virological or immunological outcomes. Most studies had several methodological shortcomings leaving them vulnerable to potential biases. AUTHORS' CONCLUSIONS: We found evidence to support the effectiveness of patient support and education interventions intended to improve adherence to antiretroviral therapy. Interventions targeting practical medication management skills, those interventions administered to individuals vs groups, and those interventions delivered over 12 weeks or more were associated with improved adherence outcomes. There is a need for standardization and increased methodological rigour in the conduct of adherence trials.

Acquired Immunodeficiency Syndrome↗
PubMed2006

Neuropsychological functioning and delusions in dementia: a pilot study.

The present pilot study investigated the pattern of neuropsychological functioning associated with the presence of delusions in mild-to-moderate dementia. Participants, all of whom met criteria for dementia, were divided into two groups, delusional (n = 9) and non-delusional (n = 9). Individuals with hallucinations were excluded. Participants completed a neuropsychological test battery. Global cognitive functioning (MMSE) and behavioral disturbance (BEHAVE-AD) were also assessed. Differences between the delusional and non-delusional group were most marked for immediate recall of stories, which was higher in the non-delusional group. Scores on semantic fluency, attention (mental control), and overall cognitive functioning (MMSE) were also lower in the delusional group. Conversely, simple attention span (Digit Span) was within normal limits in both groups. Floor effects were noted on measures of delayed recall and alternating attention. This study supports previous findings of greater neuropsychological impairment in delusional as compared to non-delusional individuals with dementia. However, some areas of cognitive functioning may be relatively preserved. Future research should examine semantic processing in persons with dementia with and without delusions.

Aged↗
PubMed2001

Neurocognitive symptoms and impairment in an HIV community clinic.

BACKGROUND: Neurocognitive impairment is a frequent complication of HIV infection and heralds a poor survival prognosis. With the availability of highly active antiretroviral therapy (HAART), survival times for HIV-infected patients have markedly increased although the effects of HAART on the prevalence of neurocognitive impairment remain uncertain. OBJECTIVE: To determine the relationship between self-reported neurocognitive symptoms and neuropsychological (NP) performance together with the impact of HAART among HIV-infected patients. METHODS: A cross-sectional study was performed in which patients without previously documented neurocognitive impairment attending an HIV community clinic were questioned about neurocognitive symptoms and a NP test battery was administered. RESULTS: Of the eighty-three patients examined, neurocognitive symptoms were reported by 34% of patients and were associated with a shorter duration of HAART and higher viral loads. Patients reporting neurocognitive symptoms were also more likely to exhibit impaired NP performance (p<0.005) with NP impairment being detected in 46% of all patients examined (12% with HIV-associated dementia). Neuropsychological impairment was directly correlated with age (p<0.001), plasma viral load (p<0.005) and inversely correlated with the number of prescribed antiretroviral drugs (p<0.01). CONCLUSIONS: These results suggest that neurocognitive symptoms are predictive of impaired NP performance and that NP impairment remains a frequent finding among older patients with higher viral loads. An increased number of antiretroviral drugs may be neuroprotective.

Adult↗
PubMed1999

The interactive effects of age and length of abstinence on the recovery of neuropsychological functioning in chronic male alcoholics: a 2-year follow-up study.

UNLABELLED: To explore how age and length of abstinence affects neuropsychological (NP) recovery in chronic male alcoholics, we examined 97 recently detoxified alcoholics (RDA) who were abstinent a mean of 29.7 (SD = 9.4) days at their first evaluation, and again 2 years later, at which time 62 had resumed drinking (RES) and 35 had maintained interim abstinence (ITA). To separate practice effects from NP recovery, the NP performance of the RES and ITA groups were compared to age- and education-matched 29 long-term abstinent (LTA) alcoholics, abstinent a mean of 4.3 (SD = 3.5) years at initial testing, and 49 nonalcoholic controls (NAC). Sample mean age and education was 48.7 (SD = 8.8) and 13.9 (SD = 2.7) years, respectively. The RDA and LTA groups were also matched on years of alcoholic drinking [i.e., 17.2 (SD = 9.3) and 15.6 (SD = 8.7) years respectively]. Results of 14 NP tests were reduced to 6 NP abilities (i.e., attention learning, memory (recall), abstraction-cognitive flexibility, complex perceptual-motor integration and simple motor skills) that formed dependent variables in 4 groups x 2 ages (median split at 51.4 years classified participants as young and old) repeated measures MANOVA. RESULTS: (1) the ITA group improved on abstracting ability more than other groups (p = .009) (2) the RES group deteriorated on motor tests (p = .03); (3) all younger alcoholics exceeded practice effects on abstracting ability, while older RES participants deteriorated relative to ITA group (3-way interaction, p = .03); and (4) the LTA group was comparable in NP performance to the NAC group. In conclusion, the extent and features of NP recovery among alcoholics are related to age, length of abstinence, and interim drinking.

Adult↗
PubMed1999

Neurocognitive complaints in HIV-infection and their relationship to depressive symptoms and neuropsychological functioning.

We examined the degree to which depressive symptoms, clinical staging of HIV disease, and neuropsychological (NP) functioning were related to neurocognitive complaints in HIV-infection. One hundred adults with HIV-infection (12 asymptomatic, 41 mildly symptomatic, and 47 with AIDS) were administered NP tests of attention and working memory, language, psychomotor speed, verbal memory, and conceptual problem-solving, the Beck Depression Inventory, and the Patient's Assessment of Own Functioning Inventory (Chelune, Heaton & Lehman, 1986), a subjective neurocognitive complaint questionnaire where patients rated their problems with memory, language and communication, sensory-motor skills, and higher-level cognitive and intellectual functions. Neurocognitive complaints (regardless of specific type) were correlated significantly with depressive symptoms and with NP measures of attention and working memory, psychomotor skills, and learning efficiency. However, multiple regression analyses revealed that depressive symptoms accounted for the majority of variance explained in neurocognitive complaints with psychomotor efficiency generally predicting the remaining variance. Neurocognitive complaints did not differ according to HIV clinical staging.

Acquired Immunodeficiency Syndrome↗
PubMed1999

Neuropsychiatric correlates of memory-metamemory dissociations in HIV-infection.

Ninety-one adults with HIV-infection who varied in the concordance between their subjective memory complaints (or metamemory) on the Patient's Assessment of Own Functioning (Chelune, Heaton, & Lehman, 1986) and their memory performance on the California Verbal Learning Test (CVLT), were compared on the Beck Depression Inventory (BDI), and on neuropsychological (NP) tests of attention, language, psychomotor speed, and conceptual problem-solving. Subjects with low memory complaints and normal CVLT performance (n = 29) had low BDI scores and were normal in all other NP abilities. Subjects with high memory complaints and impaired CVLT performance (n = 20) had elevations on the BDI as well as NP impairments in psychomotor speed and category fluency. Subjects with low memory complaints but impaired CVLT performance (n = 16) had low BDI scores and were selectively impaired in conceptual problem-solving. Subjects with high memory complaints but normal CVLT performance (n = 26) had high BDI scores and normal NP functioning in all other abilities. These results suggest that there are at least two key determinants to metamemory inaccuracy in HIV-infection, namely, frontal executive impairments and mood disturbance.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Predictors of relapse in long-term abstinent alcoholics.

OBJECTIVE: The goals of this study were to examine the hazard of relapse during an average 11 years of follow-up in alcoholics who had achieved long-term abstinence and to determine predictors of later relapse. METHOD: Male alcoholics (N = 77) with at least 18 months of stable abstinence at time of entry were followed for 2 to 17 years (mean follow-up = 10.9 years). During follow-up, detailed information regarding relapse/abstinence and interim drinking behavior was recorded. Potential predictors of relapse collected at enrollment included past drinking history, severity of alcohol-related life problems, degree of neurocognitive impairment based on neuropsychological (NP) tests, psychological distress (MMPI) and past medical health. RESULTS: Twenty-four of 77 (31%) long-term abstainers relapsed during the follow-up period. The average annual hazard rate of relapse was 3.8% in the first 5 years of follow-up and 2.6% over the next 6-11 years. Based on Cox proportional hazard regression analyses, the only significant variables to predict relapse were MMPI Scale 4 (Psychopathic Deviate, relative risk = 3.16, 95% CI = 1.19-8.38) and prior history of alcohol-related life difficulty (i.e., citation for driving while intoxicated, relative risk = 2.64, 95% CI = 1.05-6.64) (chi2 = 14.2, 2 df, p < .001). CONCLUSIONS: There is approximately a 3% annual risk of relapse in alcoholics who have been able to achieve long-term abstinence, even after 5 years of abstinence. Alcoholics who resumed drinking had greater indicators of longer standing psychological trait disturbance, reflected in elevated MMPI Scale 4 and history of more alcohol-related social difficulties. Placing the present study in the context of previous research that focused primarily on predictors or relapse in the shorter term, it appears that, whereas mood disturbance predicts short-term outcome, more enduring personality traits predict long-term success in remaining abstinent.

Adult↗
PubMed1997

Reduction in cortical IMP-SPET tracer uptake with recent cigarette consumption in a young group of healthy males. San Diego HIV Neurobehavioral Research Center.

Functional brain imaging techniques are being used increasingly to infer disturbances in brain function in various neuropsychiatric disorders, but the specificity of such findings is not always clear. We retrospectively examined the effects of one possible confound - cigarette smoking - on cortical uptake of iodine-123 iodoamphetamine (IMP) using single-photon emission tomographic imaging in a young (mean age=35 years) healthy group of male controls divided according to their smoking history. Subjects who had never smoked (n=17), or those with a history of smoking but no recent smoking (n=8), had equivalent and significantly higher mean cortical uptake of IMP than subjects with a history of smoking and who were current smokers (n=8). There were no differences in the cortical distribution of IMP. Our results indicate that cigarette smoking has an acute effect on global cerebral blood flow. This potential confound must be considered before abnormalities in cortical tracer uptake are attributed to some neuropsychiatric disorder of interest.

Adult↗
PubMed1997

Intermanual differences on motor and psychomotor tests in alcoholics: no evidence for selective right-hemisphere dysfunction.

Some previous studies have suggested that alcoholics exhibit selective right-hemisphere dysfunction, based on alcoholics' poor performance on tests believed to subserve the right hemisphere. However, some of these experiments did not account adequately for differences in difficulty or novelty in putative right hemisphere tasks. This experiment was designed to evaluate and compare intermanual differences in grip strength, motor speed, fine-motor dexterity, and nonverbal problem-solving ability in 93 recently detoxified alcoholics, 54 long-term abstinent alcoholics, and 73 nonalcoholic controls. All subjects were right-handed men, matched for age and education, and both alcoholic groups had similar drinking histories. Using percent difference scores to assess intermanual differences, adjusted for demographics where appropriate, we found that, although recently detoxified alcoholics demonstrate some motor and psychomotor impairments, there is no evidence using these tests to suggest the right hemisphere is selectively more vulnerable to the effects of chronic alcohol abuse.

Adult↗
PubMed1996

Single photon emission computed tomography with iodoamphetamine-123 and neuropsychological studies in long-term abstinent alcoholics.

Ten long-term abstinent alcoholics (mean abstinence = 7.7 years) were compared with 13 recently detoxified substance-dependent inpatients (mean abstinence = 25 days) and 8 nonalcoholic control subjects on global end regional measures of cortical cerebral blood flow (CBF), and on neuropsychological measures. CBF was assessed using 123iodoamphetamine (IMP) single photon emission computed tomography (SPECT) under conditions of behavioral challenge (Raven's Progressive Matrices). CBF and neuropsychological test performance were worse in the recently detoxified inpatients. Of greater interest, there was a dissociation in the long-term abstinent group, which, while neuropsychologically indistinguishable from controls, showed significantly decreased mean cortical IMP uptake. We conclude that there may be persistent physiologic abnormalities in long-term abstinent alcoholics who have achieved full behavioral recovery. Smoking on the day of SPECT scanning was also identified to be a significant confound to understanding CBF changes in alcoholism.

Adult↗
PubMed1995

Unique profile of visuo-perceptual skills in a genetic syndrome.

Williams syndrome (WS) and Down syndrome (DS) are genetic disorders with characteristic neuropsychological profiles. Subjects with WS show surface similarities to subjects with right hemisphere damage (RHD) in their relative preservation of linguistic skills, their poor visuo-constructive skills, and their hierarchical processing biases. Ten adolescents and young adults with WS and nine matched subjects with DS were administered a battery of visuospatial perceptual tasks to test whether the profile of performance in WS would resemble that in RHD. It was found instead that the WS subjects showed a distinctive clustering of skills, with particular preservation of facial discrimination, but impairment of other perceptual skills. Subjects with DS showed a more homogeneous profile. The WS profile may map onto the functional dichotomy between ventral and dorsal visual pathways in the cerebral cortex.

Adolescent↗
PubMed1992

Long-term abstinent alcoholics have normal memory.

It is generally believed that many non-Korsakoff alcoholics have subtle defects in memory. To determine whether such defects vary as a function of length of abstinence (LOA), we performed extensive memory testing with: (1) recently detoxified (n = 31; LOA-29 days); (2) intermediate-term abstinent (n = 28; LOA = 1.9 years); (3) long-term abstinent (n = 32; LOA-7.0 years) alcoholics; and (4) nonalcoholic controls (n = 37). All subjects were matched on age and education. Alcoholics were matched on years of alcoholic drinking. Memory measures were divided into the following domains: verbal learning, verbal recall, visual learning, visual recall, and paired associate learning. A series of MANOVAs were conducted that revealed a significant relationship between visual learning and length of abstinence, and a significant interaction between age and length of abstinence on visual recall. Long-term abstinent subjects were not significantly different from controls on any test. We conclude that memory disturbance demonstrable among recently detoxified alcoholics in the early weeks of their abstinence is not evident in demographically matched long-term abstinent alcoholics with similar drinking histories.

Adult↗