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S Borson

Publications and source records attributed to S Borson.

At least 37 records · Page 2Linked to original sources
PubMed1996

Basic Mechanisms in Neurodegenerative Disease: Implications for Behavioral Pathogenesis and Treatment.

Current therapies for neurodegenerative diseases focus primarily on the use of psychotropic drugs to influence their non-cognitive manifestations. In this article, we take a conceptual approach to understanding behavioral syndromes in dementing disorders, with a heuristic emphasis on Alsheimer's disease. We draw upon recent developments in research to explore the fundamental mechanisms implicated in the pathophysiology of neuropsychiatric impairments, and consider endocrine, vascular, genetic, and interpersonal factors that may modulate their expression. Emerging evidence points to dysfunction of particular neural systems within the diseased brain as the basis for neuropsychiatric syndromes, but the specificity of postulated clincal-pathologic correlations remains to be verified by research designed to test critical hypotheses. We highlight advances in clinical and experimental psychopharmacology that extend conventional concepts of the actions of psychotropic drugs, and prompt a broad approach to investigating and treating behavioral pathology in dementia.

Journal Article↗
PubMed1996

Objective sleep quality of healthy older men and women is differentially disrupted by nighttime periodic blood sampling via indwelling catheter.

Elucidation of sleep-endocrine relationships requires frequent blood sampling during sleep recording. Unfortunately, such sampling can itself affect sleep and indirectly, hormonal patterns. We examined the effect of catheterization and frequent nighttime blood sampling on the sleep of a large sample of healthy older men and women. A total of 113 healthy older [69.1 +/- 0.6 years, mean +/- standard error of the mean (SEM) adults (68 women and 45 men) were studied. Following an adaptation night sleep was recorded during an undisturbed night and a night of periodic blood sampling via i.v. catheter. Lights out and lights on were significantly delayed and advanced, respectively, on the catheterization night, resulting in a significantly shorter time in bed (TIB). Total sleep time and sleep efficiency were significantly reduced, and sleep latency, total wake time and the number of awakenings from sleep of > or = 1 minute were significantly increased. Rapid eye movement (REM) sleep percentage of TIB was significantly reduced. Stages 3/4 sleep [slow wave sleep (SWS)] percentage of TIB was significantly reduced, as was total delta energy during SWS. With the exception of total sleep time and sleep latency, all sleep-wake and delta variables were significantly correlated between nights. This was particularly the case for SWS and the delta energy variables. When examined separately by gender, both men and women showed significant catheter-based sleep disturbance. However, SWS and delta energy measures in men were unaffected by catheterization. The data clearly demonstrate that both the sleep maintenance and sleep architecture of healthy older men and women are significantly impacted by nighttime blood sampling procedures. Of the various measures examined here, SWS measures appear to be the least disrupted, particularly in men. These findings need to be taken into account in any study examining sleep-endocrine relationships utilizing older subjects.

Aged↗
PubMed1995

Geographically overlapping Alzheimer's disease registries: comparisons and implications.

In the medical and epidemiologic literature, a registry denotes a data base in which registrants share some common characteristic such as disease category. One criticism of registries is that they frequently collect subjects in a haphazard fashion and, hence, are "nonrepresentative of the population purportedly being represented." In this report, we compare two registries: an incident-based Alzheimer's Disease Patient Registry (ADPR) recruiting subjects for epidemiologic studies from a large health maintenance organization; and an Alzheimer's Disease Research Center (ADRC) registry recruiting subjects for phenomenologic, biologic, and pharmacologic studies. While these registries share personnel, overlap geographically, and use similar diagnostic procedures, they differ substantially in their missions and resulting recruitment strategies. We compared these registries with respect to demographic characteristics and cognitive features at subject entry. Subjects enrolled in the incident-based registry are older and report shorter time between symptom onset and recruitment. They are less demented and mirror the general population demographically more closely than do subjects in the other registry. The ADRC registry contains a much greater proportion of subjects with higher educational attainment.

Age Factors↗
PubMed1994

Physical and functional health assessment in normal aging and in Alzheimer's disease: self-reports vs family reports.

This longitudinal 2-year study compared self and family members' reports of physical and functional health among 40 patients with Alzheimer's disease and 53 age-matched nondemented healthy older persons. Functional health was consistently rated as more impaired by family caregivers of demented patients than by the patients themselves, a discrepancy not observed in the cognitively intact comparison group. Caregiver reports correlated significantly with declines in patients' cognitive abilities as measured by formal testing, but self-reports did not. Patients did recognize deterioration in ADLs over time, despite progressively worsening cognitive ability. These data indicate that the capacity for self-observation is partially preserved in Alzheimer's patients in mild to moderate stages. Patient self-reports can provide valuable data for clinicians, but should be supplemented by detailed information from caregivers.

Activities of Daily Living↗
PubMed1994

Neurotrophins in the developing and adult primate adenohypophysis: a new pituitary hormone system?

Expression of neurotrophins and of the low-affinity neurotrophin receptor p75 was examined immunocytochemically in pituitary glands of twelve developing and adult macaques, ranging in age from fetal day 100 through age 5 years. Neurotrophins were identified by labeling with a rabbit polyclonal antiserum raised against purified mouse nerve growth factor, which recognizes brain-derived neurotropic factor and neurotrophin-3 as well. During pituitary morphogenesis, neurotrophins were present in epithelial cells distributed throughout all divisions of the anterior pituitary (pars distalis, pars intermedia, and pars tuberalis). Near term and in the adult, neurotrophin-immunoreactive cells were fewer in number and their distribution was limited to the pars distalis and pars tuberalis. A monoclonal antibody against the human neurotrophin receptor p75 heavily labeled mesenchymal boundary structures and blood vessels in the developing gland, and several populations of glial-like cells with a presumed paracrine function (folliculostellate cells in the pars distalis, and pituicytes and tanycytes in the neural lobe and infundibulum, respectively) as well as axons innervating the portal vasculature in postnatal specimens. These complementary patterns of neurotrophin and receptor expression suggest a possible inductive role for neurotrophins in pituitary morphogenesis and in the establishment of hypothalamic neural and hormonal control of pituitary function. In the adult anterior pituitary, examined using double-label immunocytochemistry for neurotrophins and conventional anterior-pituitary hormones, neurotrophins did not colocalize with human prolactin, human adrenocorticotropic hormone, recombinant human growth hormone, or the beta subunits of human luteinizing hormone, human follicle-stimulating hormone, or human thyrotropin. Neurotrophin-containing cells therefore appear to be a distinct population, suggesting novel paracrine or endocrine functions for this family of neuropeptides.

Aging↗
PubMed1992

Improvement in mood, physical symptoms, and function with nortriptyline for depression in patients with chronic obstructive pulmonary disease.

Although recent epidemiologic studies have established that patients with chronic medical illness and depressed mood are more disabled than euthymic patients, detailed data on the benefits and risks of antidepressant treatment in medically high-risk patients have been slow to accumulate. The authors have examined multiple outcome indicators in patients with disabling chronic obstructive pulmonary disease and comorbid depression. Thirty patients completed a 12-week, randomized controlled trial of nortriptyline. Nortriptyline was clearly superior to placebo for treatment of depression. Nortriptyline treatment was accompanied by marked improvements in anxiety, certain respiratory symptoms, overall physical comfort, and day-to-day function; placebo effects were negligible. Physiological measures reflecting pulmonary insufficiency were generally unaffected by treatment. These data provide impetus for renewed efforts to improve recognition and treatment of mood disorders in even severely disabled medical patients.

Activities of Daily Living↗
PubMed1991

Relationships between requests for psychiatric consultations and psychiatric diagnoses in long-term-care facilities.

OBJECTIVE: The authors' objective was to investigate reasons for referral of elderly nursing home residents for psychiatric consultation and the relationship of these reasons for referral to psychiatric diagnoses. METHOD: They examined 197 nursing home residents consecutively referred to a consulting team in a university-affiliated mental health center. These patients represented all patients evaluated by the consulting team at six nursing homes over a 2-year period (Sept. 1, 1984, through Aug. 30, 1986). RESULTS: Reasons for referral were diverse but fell into seven broad clusters: behavioral problems; mood-related problems; consultations requested by involuntary treatment services, patients, physicians, or other referring agencies; psychotic features; physical signs; impaired activities of daily living; and other. Behavioral problems were most commonly cited and tended to be associated with dementia diagnoses. Mood-related reasons for referral were most strongly associated with diagnoses of affective disorders, and diagnoses of schizophrenia and adjustment disorder were each associated with two or more reasons for referral. However, reasons for referral were distributed widely across diagnostic groups and were relatively weak predictors of diagnoses. CONCLUSIONS: The results illustrate the variety of problems for which nursing home staff are willing to seek psychiatric consultation but emphasize the need for professional psychiatric evaluation to establish a diagnostic base on which treatment interventions can be built.

Adjustment Disorders↗
PubMed1989

Neuroendocrine responses to physostigmine in Alzheimer's disease.

To assess central nervous system cholinergic neuroendocrine regulation in Alzheimer's disease (AD), we measured plasma arginine vasopressin, beta-endorphin, and epinephrine responses to a cholinergic challenge elicited by intravenous administration of the acetylcholinesterase inhibitor physostigmine (0.0125 mg/kg) in male patients with AD (n = 12) and compared their responses with those of age-matched normal control subjects (n = 12). Physostigmine promptly increased plasma arginine vasopressin (tenfold), beta-endorphin (twofold to threefold) and epinephrine (threefold) levels in elderly control subjects. In contrast, patients with AD showed attenuated responses to physostigmine. When controls and patients with AD who experienced nausea (n = 2 and n = 6, respectively) were excluded, the arginine vasopressin, beta-endorphin, and epinephrine responses of patients with AD were significantly less than those of control subjects. These data suggest that the central nervous system cholinergic deterioration of AD results in decreased responsiveness of neuroendocrine systems that are regulated by central cholinergic mechanisms.

Aged↗
PubMed1989

Impaired sympathetic nervous system response to cognitive effort in early Alzheimer's disease.

Sympathetic nervous system responses to a cognitive challenge and a physiologic stimulus (upright posture) were compared in 10 patients with early Alzheimer's Disease and a group of healthy older adults. Plasma catecholamine and cardiovascular responses to upright posture were similar in the two groups. However, sympathetic activation during mental effort was impaired in the patient group; this difference did not appear to be attributable to motivational factors. Alzheimer's Disease is associated with a defect in sympathetic nervous system function that is specifically linked to cognitive effort and appears early in the course of the disease.

Aged↗
PubMed1989

Behavioral disturbance, cognitive dysfunction, and functional skill. Prevalence and relationship in Alzheimer's disease.

The nature and severity of behavioral problems, and their relationship to cognitive and functional abilities, was investigated in 56 community-residing patients with Alzheimer's disease. Measures evaluated three domains of function: behavior, cognition and activities of daily living. Problems of cognitive functioning, such as memory loss, confusion, and disorientation were most prevalent, reported to occur in 84%, 82%, and 64% of the sample, respectively. Problems with activity and emotional distress were next, affecting 20 to 43% of the sample. The mean number of problems reported was 10 per patient. Twenty-two percent of caregivers reported a minimum of 15 problems occurring at least twice a week and no caregiver reported an absence of problems. Male patients were reported to have more behavioral difficulties. Level of behavioral disturbance was largely unrelated to cognitive or functional ability. Age was unrelated to cognitive or behavioral disturbance but significantly related to activities of daily living. Results indicated that behavioral problems are prevalent and pervasive in even moderately impaired community-residing Alzheimer disease patients, and that age may be more important than level of cognitive dysfunction in predicting difficulties with activities of daily living.

Activities of Daily Living↗
PubMed1987

Psychiatry and the nursing home.

In the last two decades, nursing homes have become major providers of health services for the frail elderly. Despite ample evidence of need for specialized psychiatric services in the nursing home setting, the majority of patients who could benefit from such care do not receive it. The authors propose a fourfold role for the psychiatrist, encompassing clinical care, consultation, teaching, and research. Features of this role can be adapted to fee-for-service, community mental health center, and academic models of psychiatric practice.

Aged↗
PubMed1986

Symptomatic depression in elderly medical outpatients. I. Prevalence, demography, and health service utilization.

The authors assessed the prevalence and demography of depressive symptoms, their association with specific chronic diseases, and their influence on health service use in a large sample of elderly men seen in a primary care setting. Twenty-four percent of respondents reported clinically significant depressive symptoms; the prevalence of major depressive disorders was estimated at 10%, but only 1% reported receiving mental health treatment by a specialist. Self-reported marital separation or divorce and physical disability affecting employment were strongly associated with high depression scores, whereas the normative stresses of aging (widowhood, retirement, social isolation) were not. Only chronic lung disease was differentially associated with high depression scores, and this effect was weak. The authors discuss the implications of these findings for the design of comprehensive health services for the elderly with chronic disease.

Aged↗
PubMed1982

Behçet's disease as psychiatric disorder: a case report.

The author describes a man in whom a progressive psychiatric syndrome was the predominant manifestation of Behçet's disease. Incorrect labelling of his illness as functional may have contributed to the evolution of a permanently disabling dementia from a potentially treatable brain disease.

Adult↗
PubMed1981

Chronic anorexia nervosa: medical mimic.

While anorexia nervosa is typically construed as an acute, dramatic disorder of younger women, long-term follow-up studies indicate that morbidity is chronic or relapsing in 30 percent to 50 percent of cases and sometimes leads to death. In older patients or those with atypical clinical features or obscure complications, chronic starvation may mimic other diseases, and rigid adherence to current diagnostic criteria may impede recognition and appropriate treatment. Anorexia nervosa should be viewed as a spectrum of disorders, with varying courses and presentations, in order that clinicians in nonpsychiatric settings may be equipped to provide adequate care of patients with this complex psychosomatic disease.

Adult↗
PubMedDate not supplied

Depression and physical illness among elderly general medical clinic patients.

In this study we conducted a resurvey at 33 months of elderly general medical clinic outpatients previously classified as depressed or not using the Zung Self-Rating Depression Scale. Resurvey results and review of medical records permitted characterization of the point prevalences of depression at the time of the initial and follow-up surveys, and identification of physical illness factors associated with depression. The point prevalences of depression were approximately equal (20%), although only about 10% were depressed at both occasions. Among the initially nondepressed, the number of new physical diagnoses during follow-up was the best predictor of depression at retest. Other factors associated with depression at one or both occasions were: alcohol abuse, obstructive pulmonary disease, and a relatively greater number of medical diagnoses. Thus, among elderly outpatients, depression appears common with roughly equal rates of remission and incidence; also, new medical illness may precipitate depression.

Adjustment Disorders↗