Biomedical subjects

S Freels

Publications and source records attributed to S Freels.

48 records · Page 3Linked to original sources

PubMed1993

Psychopathology associated with Alzheimer's disease and related disorders.

BACKGROUND: This study compared the occurrence of psychiatric symptoms in a large group of community-residing participants enrolled in an Alzheimer's disease patient registry who met clinical diagnostic criteria for Alzheimer's disease or multi-infarct dementia, as well as mixed Alzheimer's disease and multi-infarct dementia. METHODS: Psychiatric morbidity observed from a psychiatric examination of 514 patients with Alzheimer's disease, 135 patients with multi-infarct dementia, and 86 cases with mixed dementia was analyzed using analysis of variance comparing symptoms across groups and chi-square test for differences in frequency of occurrence. Associations between pairs of symptoms were also reported. RESULTS: The frequency of occurrence and patterns of psychiatric problems were similar in patients with Alzheimer's disease and multi-infarct dementia. Agitation was the most frequent symptom, followed by depression, apathy, and behavioral disorders. Patients with mixed dementia had significantly more psychopathology. CONCLUSION: This study demonstrated that significant psychopathology occurs in individuals with Alzheimer's disease or multi-infarct dementia. The high levels of symptoms in mixed dementia suggest that the two conditions have a synergistic effect on behavioral problems. The prevalence of multiple symptoms is higher than previously reported.

Aged↗

PubMed1993

Sex differences in the psychiatric manifestations of Alzheimer's disease.

OBJECTIVE: To test the null hypothesis, ie, that there are no gender differences in psychiatric problems manifest in patients with Alzheimer's disease. DESIGN: Survey. SETTING: Patients living in the community and evaluated at Alzheimer's disease and geriatric outpatient programs. PATIENTS: Three hundred twenty-eight women and 186 men clinically diagnosed with Alzheimer's disease using NINCDS/ADRDA or DSM-III-R criteria. MEASUREMENTS: Psychiatric signs and symptoms recorded following a psychiatric interview, including the Hamilton Depression Rating Scale. RESULTS: Approximately two-thirds of both men and women had psychiatric problems, but women had significantly more multiple symptoms. When pairs of symptoms were analyzed for independence, agitation was only significantly associated with paranoia in men, whereas in women agitation was significantly associated with most other psychiatric problems. CONCLUSION: The higher prevalence of multiple psychiatric problems in women may be due to many factors, including sociodemographic influences, physician bias, and/or other differences between men and women. The finding of a different pattern of association of symptoms with agitation in men and women deserves replication.

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PubMed1993

Drug use patterns of persons with Alzheimer's disease and related disorders living in the community.

OBJECTIVE: To describe drug use patterns by persons with Alzheimer's disease, multi-infarct dementia, and mixed Alzheimer's disease and multi-infarct dementia. DESIGN: Multicenter, patient registry. SETTING: Community-living persons evaluated in primary care, geriatric, and Alzheimer ambulatory settings. PARTICIPANTS: Of the 930 persons in three diagnostic categories, there were 671 with probable or possible Alzheimer's disease by NINCDS/ADRDA criteria or Alzheimer's disease by DSM-III-R criteria, 162 multi-infarct cases by DSM-III-R criteria, and 97 mixed cases by DSM-III-R criteria. In each diagnostic category, 65% were women, and the majority were 70 years or older. MEASUREMENTS: The average number of all prescription and non-prescription drugs and selected therapeutic categories by age, sex, diagnosis, and mini-mental status score at the time of diagnosis or evaluation. RESULTS: Alzheimer patients average 2.3 drugs compared with multi-infarct (4.3; P < 0.0001) and mixed (3.7; P = 0.002) patients, and their pattern of drug use was different when stratified by therapeutic categories and drug classes. Drug use increased with age, and women used significantly more drugs than men in all three diagnostic categories. Women with Alzheimer's disease used significantly more cardiovascular drugs than men with Alzheimer's disease (P < 0.05). The lower the mini-mental status score in patients with any dementia, the greater the mean number of central nervous system agents used. The higher the mini-mental status score in a patient with multi-infarct or mixed dementia, the greater the use of cardiovascular drugs. CONCLUSION: Drug use by Alzheimer patients was lower than in multi-infarct and mixed patients, primarily due to a lower prevalence of cardiovascular drugs.

Age Factors↗

PubMed1992

Personality changes in Alzheimer's disease.

We profiled personality changes that were measured cross-sectionally on the Blessed Dementia Scale in 80 patients with Alzheimer's disease who were examined at a dementia clinic. The most common personality changes were diminished initiative/growing apathy (61.3%), relinquishment of hobbies (55.0%), and increased rigidity (41.3%). The least frequent personality change was sexual misdemeanor (3.8%). Discriminant function analysis showed that the Global Deterioration Scale, the Clinical Rating Scale for Symptoms of Psychosis in Alzheimer's Disease, and the duration of dementia symptoms were the best predictors to classify personality change in an overall score of personality. However, cognitive impairment, as measured by the Blessed Memory-Information-Concentration Test and Mini-Mental State Examination, was not a good predictor of overall personality change. Personality and behavioral changes are common in Alzheimer's disease and may not be attributed entirely to intellectual impairment.

Activities of Daily Living↗

PubMed1992

Functional status and clinical findings in patients with Alzheimer's disease.

We analyzed the association of clinical findings with impaired functional status, i.e., activities of daily living (ADLs), in a sample of 240 patients diagnosed with Alzheimer's disease by NINCDS/ADRDA or DSM-III-R criteria. Logistic regression models were used to determine independent predictors of both the number of ADL impairments and number of ADL impairments characterized as moderate to severe. Two psychiatric problems, behavioral disorders and apathy, as well as a history of hypertension were significantly associated with ADL impairment independent of age, sex, race, and cognitive impairment. Behavioral disorders and apathy were also significantly associated with moderate to severe ADL impairment, but hypertension was not significant at this level.

Activities of Daily Living↗

PubMed1992

Severe family violence and Alzheimer's disease: prevalence and risk factors.

This study describes the prevalence of violence and the putative risk factors for violence in 184 Alzheimer patients and their primary caregivers living in the community. Analysis of the severe violence subscale of the Conflict Tactics Scale indicated that 15.8% of patients had been violent in the year since diagnosis. A total of 5.4% of caregivers reported being violent toward the patient. The overall prevalence of violence was 17.4%. The variables most associated with violence were caregiver depression and living arrangement.

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PubMed1992

Are there clinical differences between familial and nonfamilial Alzheimer's disease?

OBJECTIVE: The purpose of the study was to determine whether there are differences in clinical characteristics in two groups of patients with Alzheimer's disease, those reported to have a family history of dementia and those without a family history of dementia. METHOD: Using a data set from an Alzheimer's disease patient registry, funded as part of a National Institute on Aging cooperative agreement, the authors made comparisons of sociodemographic and clinical variables in a group of 462 patients with Alzheimer's disease, 172 reported to have at least one first-degree relative with dementia and 290 classified with no family history. RESULTS: Patients with a presumptive family history differed from those without a family history in two ways: the course of dementia was described as having a fast rather than a slow progression from onset of symptoms to diagnosis, and caregivers reported a higher prevalence of family history of psychiatric disorders. There were no significant differences in age at onset, duration, female gender, aphasia and apraxia, handedness, family history of Down's syndrome, or number of children, brothers, and sisters. CONCLUSIONS: The association of faster course and family history of psychiatric disorders in the patients with a family history of dementia is consistent with the hypothesis of heterogeneity, but the overall results could also be explained by a genetic-environmental model of Alzheimer's disease.

Age Factors↗

PubMed1991

Long-term survival of patients with AIDS, Pneumocystis carinii pneumonia, and respiratory failure.

OBJECTIVE: --To evaluate the long-term survival of patients admitted to the medical intensive care unit, Cook County Hospital, Chicago, Ill, with Pneumocystis carinii pneumonia and acute respiratory failure. DESIGN: --Cohort study over a 4-year period. SETTING: --Municipal teaching hospital. PATIENTS: --Seventy-three consecutive patients who had 75 episodes of P carinii pneumonia and acute respiratory failure were followed up from the time of hospital admission until their deaths or the termination of the study. OUTCOME MEASURES: --Duration of survival from the time of initial hospital admission with diagnoses of P carinii pneumonia and acute respiratory failure. RESULTS: --Consistent with recent reports of improved short-term outcome, the immediate hospital survival was 47% (35/75). The 1-year survival was 37% (95% confidence interval, 26% to 49%). Two patients have survived for 40 months. Almost three quarters of the patients who survived hospitalization lived for at least 1 year. CONCLUSIONS: --The long-term prognosis for patients with the acquired immunodeficiency syndrome, P carinii pneumonia, and acute respiratory failure is now substantially better than anticipated. Respiratory failure due to P carinii pneumonia does not necessarily signify the terminal phase of human immunodeficiency virus infection. Accordingly, patients with the acquired immunodeficiency syndrome, P carinii pneumonia, and acute respiratory failure can be appropriate candidates for life support in medical intensive care units.

Acquired Immunodeficiency Syndrome↗

PubMedDate not supplied

Prescribe for health. Improving cancer screening in physician practices serving low-income and minority populations.

OBJECTIVE: To evaluate a health maintenance organization (HMO)-sponsored intervention to improve cancer screening in private physician practices serving low-income, minority populations. DESIGN: A randomized controlled trial with preintervention and postintervention measurements. Measurements were obtained by abstracting information from independent random samples of medical charts (N = 2316 at preintervention and 2238 at postintervention). SETTING: Forty-seven primary care physician practices located in low-income and minority urban neighborhoods in Chicago, Ill. INTERVENTION: Practices were encouraged to adopt an office chart reminder system and to use a patient health maintenance card. Activities to facilitate the adoption of these items and for compliance with cancer screening guidelines included on-site training and start-up assistance visits, a physician continuing medical education seminar, and quality assurance visits with feedback to physicians. MAIN OUTCOME MEASURES: The proportions of patients with a chart-documented mammogram, clinical breast examination, Papanicolaou smear, or fecal occult blood slide test in the 2 years before preintervention and postintervention chart abstractions. RESULTS: Between baseline and postintervention, there was a net increase in the proportion of HMO members in the intervention, compared with the control practices, who received in the preceding 2 years a Papanicolaou smear (11.9%) and a fecal occult blood slide test (14.1%). There was a net increase in the proportion of non-HMO patients in the intervention compared with the control practices who received a clinical breast examination (15.3%) and a fecal occult blood slide test (20.2%). CONCLUSIONS: Implementation of an HMO-mediated, multicomponent intervention to improve cancer screening was feasible and effective for the Papanicolaou smear, fecal occult blood slide test, and the clinical breast examination, but not for mammography.

Adult↗

PubMedDate not supplied

Psychotropic drug use in relation to psychiatric symptoms in community-living persons with Alzheimer's disease.

We attempted to determine the relationship between psychiatric symptoms and psychotropic drug use in persons with Alzheimer's disease based on a multicenter patient registry of 671 community-living persons diagnosed with the disease by published criteria. Logistic regression was performed to determine which symptoms were associated psychotropic use after controlling for age, sex, and Mini-Mental Status Examination (MMSE) score. At least one psychotropic drug was reported by 31% of patients, and 66% had at least one psychiatric symptom. Antipsychotics were associated with a lower MMSE score (odds ratio = 0.92, 95% confidence interval 0.88-0.97), emotional lability (OR = 4.52, 95% CI 1.69-11.94), and hallucinations (OR = 6.54, 95% CI 2.99-14.26). Antidepressants were associated with depressive symptoms (OR = 5.8, 95% CI 2.61-13.46), and benzodiazepines with a lower MMSE score (OR = 0.93, 95% CI 0.90-0.97). Community-living persons with Alzheimer's disease are frequently prescribed psychotropic drugs; however, more than 50% of patients with a psychiatric symptom did not report taking one of these agents. This suggests that alternative therapies and no treatment are also prevalent.

Aged↗

PubMedDate not supplied

Clinical features, site of involvement, bacteriologic findings, and outcome of infective endocarditis in intravenous drug users.

BACKGROUND: Intravenous drug use is an increasingly common condition predisposing to infective endocarditis. Data on infective endocarditis in intravenous drug users are limited. OBJECTIVE: To determine the clinical features, bacteriologic findings, site of involvement, complications, and mortality associated with infective endocarditis in intravenous drug users. METHODS: Cohort study of intravenous drug users with native valve infective endocarditis. RESULTS: A total of 125 cases of infective endocarditis occurred in 114 patients (84 cases [67%] in men and 41 cases [32%] in women) with a mean (+/- SD) age of 37 +/- 7 years. The tricuspid valve was involved in 58 cases (46%), the mitral valve in 40 cases (32%), and the aortic valve in 24 cases (19%). The microorganisms identified included Staphylococcus in 82 cases (65.6%) and Streptococcus in 32 cases (25.6%). Twenty-three patients (18%) underwent surgery, and two (9%) of them died. One hundred two patients (82%) were treated medically, and nine (9%) of them died. Fifteen patients (63%) with aortic valve involvement vs 17 patients (17%) without aortic valve involvement underwent surgery or died without surgery (odds ratio, 8.24; 95% confidence interval, 3.1 to 21.8). Among the survivors, at least one major cardiovascular complication occurred in 79 cases (69.3%). CONCLUSIONS: Infective endocarditis in intravenous drug users affects the right and left sides of the heart with approximately equal frequency. At present, more than 90% of cases of infective endocarditis in intravenous drug users in Chicago are caused by staphylococci or streptococci. Involvement of the aortic valve is predictive of increased morbidity and mortality in intravenous drug users with infective endocarditis. With medical treatment, and surgery when medical treatment fails, intravenous drug users with infective endocarditis have an in-hospital survival rate of 91%.

Adult↗

PubMedDate not supplied

Timing of single lung transplantation for primary pulmonary hypertension.

Single lung transplantation has been advocated as a definitive treatment for primary pulmonary hypertension. Because of reports of improved survival in some patients with vasodilators and anticoagulants, the timing of referral for single lung transplantation needs to be examined. Survival in primary pulmonary hypertension was estimated, with the use of a proportional hazards model, from data obtained from the National Institutes of Health registry on primary pulmonary hypertension. Waiting times for single lung transplantation, obtained from the United Network for Organ Sharing, were found to follow an exponential distribution. Under the assumption that waiting time and survival are independent, a model was developed to estimate the probability of surviving to single lung transplantation, depending on the waiting time for a single lung transplantation, and the delay in transplant referral. Examples were computed with hemodynamic data from the National Institutes of Health registry on primary pulmonary hypertension: waiting times of 6, 12, 18, and 24 months and delays in single lung transplantation referral of 0, 1, 2, and 3 years. For a waiting time of 6 months, the chance of surviving to single lung transplantation with a 3-year delay varies from 19% for a patient with a mean pulmonary artery pressure of 80 mm Hg to 72% for a patient with a mean pulmonary artery pressure of 41 mm Hg. For a waiting time of 24 months and a 3-year delay in single lung transplantation referral, this probability varies from 14% (mean pulmonary artery pressure 80 mm Hg) to 59% (mean pulmonary artery pressure 41 mm Hg).(ABSTRACT TRUNCATED AT 250 WORDS)

Hemodynamics↗