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Biomedical subjects

S M Albert

Publications and source records attributed to S M Albert.

At least 37 records · Page 2Linked to original sources
PubMed2000

Validity and test-retest reliability of a disability questionnaire for essential tremor.

BACKGROUND: One important outcome in clinical trials is patients' own opinions about whether the medication alleviates their symptoms and improves their ability to function. A valid and reliable method with which to assess this subjective information is important. OBJECTIVE: To determine the validity and test-retest reliability of the Columbia University Disability Questionnaire for Essential Tremor (ET). METHODS: Patients with ET underwent a 2.5-hour evaluation, including a 36-item tremor disability questionnaire, to assess the functional impact of tremor, a 26-item videotaped tremor examination rated by a neurologist, a 15-item performance-based test, and quantitative computerized tremor analysis. We determined the validity and test-retest reliability of the tremor disability questionnaire. Correlations between variables were assessed using Pearson's correlation coefficients and test-retest reliability with the weighted kappa statistic. RESULTS: Ninety-five patients with ET participated. The score on tremor disability questionnaire correlated with the neurologist's clinical ratings (r = 0.57, p <0.001) and the total score on the performance-based test (r = 0.69, p < 0.001). Correlations with quantitative computerized tremor analysis results were less robust, but each remained significant, including mean amplitude of dominant arm tremor while arms were extended (r = 0.56, p <0.001), while drawing a spiral (r = 0.42, p = 0.01), and while pouring (r = 0.34, p = 0.04). The questionnaire was readministered to 32 subjects, and the test-retest reliability was substantial (weighted kappa = 0.67). CONCLUSIONS: This Tremor Disability Questionnaire demonstrated substantial reliability, and it correlated with multiple measures of tremor severity, including a neurologist's clinical ratings, a performance-based test of function, and quantitative computerized tremor analysis results. The questionnaire would be useful in clinical trials in which it could be used as a reliable and valid tool to assess disability in ET.

Activities of Daily Living↗
PubMed1999

Prospective study of palliative care in ALS: choice, timing, outcomes.

To understand palliative care choices among people with ALS, it is important to follow a group of recently diagnosed patients and record when patients reach well-defined palliative care milestones. We began following such a cohort prospectively in 1996, when 121 ALS patients were enrolled from a tertiary care clinic. These patients are assessed every 4 months to determine their experience with ameliorative and palliative care. Domains include adjuvant therapies (e.g. speech therapy), adaptive aids (e.g. wheelchair use, augmentative communication), home health care, PEG placement, pulmonary support, health care directives, psychosocial care (e.g. participation in support group, pastoral counseling), and hospitalization. The median follow-up time for the cohort, to date, was 12 months. In the group that entered the cohort within 1 year of their diagnosis (n=93), 53.8% have died, 22.6% have had PEG, 19.4% have used Bi-PaP, and 4.3% have had a tracheostomy. Many patients did not take advantage of palliative care options before death; for example, 36.6% used hospice, 48% had signed a power of attorney form, and 18% had 'do not resuscitate' orders in their medical charts. Examining time to such endpoints captures important features of patient and family experience with the disease.

Amyotrophic Lateral Sclerosis↗
PubMed1999

A prospective study of preferences and actual treatment choices in ALS.

OBJECTIVE: To determine whether ALS patients' preferences for ameliorative or life-extending technologies elicited early in the disease were related to later treatment choices. METHODS: In this prospective cohort study, 121 patients were seen at a tertiary ALS care center and followed for a median of 12 months. At baseline, patient preferences for use of tracheostomy and percutaneous endoscopic gastrostomy (PEG) placement were elicited. All patients received the same educational information before being interviewed about treatment preferences. Patients were then followed to determine if patients who viewed the interventions favorably at baseline were significantly more likely to use the interventions over follow-up. RESULTS: Six to twelve percent of patients were certain they wanted tracheostomy and 28.2% wanted PEG. Preferences were related to later treatment choices: 20% of patients who found tracheostomy acceptable had one in the follow-up period, compared with 3.4% of those not in favor (p < 0.001). For PEG, similar findings were obtained: 48.5% who initially found it acceptable had PEG, versus 8.1% of those not in favor of this treatment (p < 0.001). Patients who found the interventions acceptable were more likely to be recently diagnosed, expressed greater attachment to life, and showed greater declines in pulmonary function over follow-up. CONCLUSIONS: Patients with ALS were able to express their preferences for life-extending or ameliorative technologies and made choices consistent with these preferences. However, patient preferences may change over time, and clinical education efforts are required throughout the course of disease.

Adult↗
PubMed1999

Assessment of cognition in advanced AD: the test for severe impairment.

The Test for Severe Impairment (TSI) was compared with the Mini-Mental State Examination (MMSE) and a modified MMSE (mMMSE) in a multisite, longitudinal study of AD. The TSI correlated highly with the MMSE (r = 0.83) and the mMMSE (r = 0.82), but was not redundant. There was a wide range of scores on the TSI among those scoring in the severely impaired range on the MMSE and mMMSE. The slope of cognitive change over time detected by the TSI was greater than that revealed by the MMSE or the mMMSE. Performance on the TSI was a significant predictor of survival. The TSI is a valid measure that is sensitive to cognitive change over time in severely demented patients with AD.

Aged↗
PubMed1999

Validity of a performance-based test of function in essential tremor.

BACKGROUND: The central factor influencing therapeutic decisions in essential tremor (ET) is the functional impact of the tremor. Neither the neurological examination nor computerized tremor analysis measures function. Questionnaires may assess function, but data are highly subjective. Performance-based tests of functional impairment provide an alternative means with which to assess the functional impact of ET. OBJECTIVE: To determine the internal consistency and validity of a performance-based measure of functional impairment in ET. METHODS: Subjects with ET from a community in northern Manhattan, NY, and from a clinic and control subjects each underwent a 2 1/2-hour evaluation including 12 screening questions for ET, a 31-item Tremor Disability Questionnaire to assess the functional impact of tremor, a 26-item Videotaped Tremor Examination that was rated by a neurologist, a 15-item, 10-minute Performance-Based Test, and Quantitative Computerized Tremor Analysis. Internal consistency was assessed with Cronbach alpha. The correlation between the Performance-Based Test and these other measures of tremor was assessed by means of correlation coefficients (r). RESULTS: There were 50 ET cases and 51 normal control subjects. The Performance-Based Test was internally consistent (Cronbach alpha = .92). It also demonstrated validity among cases; the total score correlated with the total number of screening questions answered yes (r = 0.44; P = .001), the total score on the Tremor Disability Questionnaire (r=0.55; P<.001), the total score on the Videotaped Tremor Examination (r=0.71; P<.001), and multiple physiological measures recorded during Quantitative Computerized Tremor Analysis. CONCLUSIONS: A valid performance-based test was developed to objectively assess functional capacity in patients with ET. This test would be useful in therapeutic trials, where it would provide an objective means to quantify the functional impact of tremor.

Aged↗
PubMed1999

Hospitalization and Alzheimer's disease: results from a community-based study.

BACKGROUND: Prior studies offer conflicting findings on whether Alzheimer's disease (AD) is associated with an increased risk of hospitalization. METHODS: We investigated AD and hospitalization in the Washington Heights-Inwood Columbia Aging Project (WHICAP), a community-based study of 2,334 elders in New York City. In 1996, an electronic medical records system was established that allows an e-mail alert to be sent to the research team whenever WHICAP subjects are admitted to Columbia-Presbyterian Medical Center (CPMC), the site of hospital care for the majority of subjects. RESULTS: Of the WHICAP cohort, 13.1% was admitted to CPMC in 21 months of follow-up; 17.5% of AD patients and 11.9% of unaffected subjects were admitted (p<.01). Multivariate logistic regression models showed that more advanced AD (Clinical Dementia Rating scale 3+) was a significant risk factor for hospitalization independently of age, gender, education, comorbid medical conditions, and death in the follow-up period (OR 2.3; 95% CI: 1.1, 4.6); subjects with mild or moderate AD did not show a significantly elevated risk. The prevalence of psychiatric symptoms did not differ between AD subjects who were hospitalized in the reporting period and AD subjects who were not hospitalized. Infectious disease was a more common discharge diagnosis for subjects with AD (p<.05). CONCLUSIONS: In this community-based cohort, subjects with severe AD were more likely to be hospitalized than unaffected subjects. The increased use of hospital care by these AD patients appears to be specific to AD but is not a result of psychiatric morbidity or end-of-life care. Rather, a greater risk of medical complications that require hospital care, especially infections, appears to be characteristic of severe AD.

Age Factors↗
PubMed1999

Functional significance of mild cognitive impairment in elderly patients without a dementia diagnosis.

The authors investigated differences in functional ability among three groups of subjects who were not diagnosed with dementia: normal control (NC) subjects (n=35); Clinical Dementia Rating Scale (CDRS) score of 0 (minimal impairment; n=26); and CDRS 0. 5 (questionable dementia; n=42). CDRS 0 and 0. 5 patients reported significantly poorer functioning than NCs in household and other activities, but CDRS 0 and CDRS 0. 5 groups did not differ in self-reported functioning. It is likely that CDRS 0. 5 patients overestimated their functional abilities. Correlations between self- and informant reports of functional status were significantly lower in the CDRS 0. 5 group than in the CDRS 0 group, an important finding for clinical management because patients with questionable dementia may actually be more impaired than they admit. Informants' reports or standardized performance-based assessment should be considered in the clinical evaluation of such patients.

Activities of Daily Living↗
PubMed1999

Use of latent class analyses for the estimation of prevalence of cognitive impairment, and signs of stroke and Parkinson's disease among African-American elderly of central Harlem: results of the Harlem Aging Project.

A probability sample (response rate of 79.4%) of 164 African-American elderly residing in central Harlem was assessed using several standard cognitive screening measures and scales measuring stroke and Parkinson's symptoms, respectively. Both traditional cutting scores and the methods of latent class analysis were used to estimate point prevalence. The latent class prevalence ratio estimates range from 10 to 14%. The confidence intervals for cognitive impairment ranged from 5 to 18% with an average estimate of 12%. The latent class estimate for stroke effects was 11% and for two measures of neurological signs associated with Parkinson's disease 7 and 12%. About 2-3% of the sample were communication disordered, and 5% had significant ambulation disorder. These results indicate that a relatively large proportion of elderly community residents of central Harlem evidenced or reported health problems, any or all of which may constitute a public health challenge.

Black or African American↗
PubMed1999

Reading ability, education, and cognitive status assessment among older adults in Harlem, New York City.

OBJECTIVES: This study examined reported level of education and current reading ability as predictors of cognitive status among older African Americans in central Harlem, New York City. METHODS: A probability sample of 164 noninstitutionalized older African Americans was assessed. Mini-Mental State Examination (MMSE) scores were regressed on education and reading ability measures. RESULTS: Reading ability and educational attainment were significant, independent predictors of MMSE performance. Within any level of education, subjects whose grade-equivalent reading ability exceeded reported level of education scored significantly higher on the MMSE. CONCLUSIONS: Reading ability may be useful in interpreting the results of cognitive screening among low-educated and minority groups.

Black or African American↗
PubMed1998

Hourly care received by people with Alzheimer's disease: results from an urban, community survey.

People with Alzheimer's disease living in a defined community in New York City were identified and assessed on two occasions to determine the number of hours of activities of daily living (ADL) care they received. Nearly half received all care hours from informal sources; however, a quarter received all ADL care hours from formal sources. The mean number of daily ADL hours in the sample was 9.7, of which 4.2 came from formal sources. This reflects the extensive use of Medicaid-based home care services in New York City. As dementia worsened, substitution of formal for informal care was rare, but formal care assumed a greater proportion of total care hours.

Activities of Daily Living↗
PubMed1997

Predicting time to nursing home care and death in individuals with Alzheimer disease.

OBJECTIVE: To develop and validate an approach that uses clinical features that can be determined in a standard patient visit to estimate the length of time before an individual patient with Alzheimer disease (AD) requires care equivalent to nursing home placement or dies. DESIGN: Prospective cohort study of 236 patients, followed up semiannually for up to 7 years. A second validation cohort of 105 patients was also followed. SETTING: Three AD research centers. PATIENTS: All patients met National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association (NINCDS-ADRDA) criteria for probable AD and had mild dementia at the initial visit. INTERVENTION: Predictive features, ascertained at the initial visit, were sex, duration of illness, age at onset, modified Mini-Mental State Examination (mMMS) score, and the presence or absence of extrapyramidal signs or psychotic features. MAIN OUTCOME MEASURES: (1) Requiring the equivalent of nursing home placement and (2) death. RESULTS: Prediction algorithms were constructed for the 2 outcomes based on Cox proportional hazard models. For each algorithm, a predictor index is calculated based on the status of each predictive feature at the initial visit. A table that specifies the number of months in which 25%, 50%, and 75% of patients with any specific predictor index value are likely to reach the end point is then consulted. Survival curves for time to need for care equivalent to nursing home placement and for time to death derived from the algorithms for selected predictor indexes fell within the 95% confidence bands of actual survival curves for patients. When the predictor variables from the initial visit for the validation cohort patients were entered into the algorithm, the predicted survival curves for time to death fell within the 95% confidence bands of actual survival curves for the patients. CONCLUSIONS: The prediction algorithms are a first but promising step toward providing specific prognoses to patients, families, and practitioners. This approach also has clear implications for the design and interpretation of clinical trials in patients with AD.

Age of Onset↗
PubMed1997

Participation in clinical trials and long-term outcomes in Alzheimer's disease.

The objective of this study was to determine whether participation in clinical trials affects long-term outcomes in Alzheimer's disease (AD). Participation in clinical trials for persons with dementia is often justified on the grounds that patients benefit from the medical oversight typical of trials, even when experimental agents do not demonstrate short-term benefits. This claim has not been rigorously assessed. Of 215 community-resident subjects enrolled in a prospective study of outcomes in AD, 101 participated in randomized clinical trials (RCTs) during the first 2 years of follow-up. These subjects were compared with subjects who met eligibility requirements for RCTs but did not participate (N = 57) and with subjects who were ineligible (N = 57), over a total of 3.5 years of follow-up. Survival analyses assessed risk of death, nursing home placement, and incident functional deficit end points, adjusting for baseline differences. Subjects who participated in RCTs were younger and more highly educated. Mortality, risk of hospitalization, number of medical examinations conducted by study physicians, and onset of severe functional deficit did not differ between the groups, but risk of nursing home admission was significantly lower among RCT participants compared with eligible nonparticipants and ineligible subjects (16.8% versus 36.8% and 31.6%, respectively [p = 0.01]). The difference in risk of nursing home placement may represent a long-term, drug-related benefit to patients, a selection effect (caregivers of patients who participate in RCTs differ from caregivers of patients who do not), or a positive effect on caregivers (greater contact with a medical service may be associated with better care-giving outcomes). Further research is required to assess these effects.

Aged↗
PubMed1996

The nucleotide sequence of the coat protein gene and 3' untranslated region of azuki bean mosaic potyvirus, a member of the bean common mosaic virus subgroup.

The relationship of azuki bean mosaic potyvirus (AzMV) to members of the bean common mosaic virus (BCMV) subgroup has been unclear. Degenerate oligonucleotide primers and the polymerase chain reaction were used to amplify and clone the coat protein (CP) gene and 3' untranslated region (UTR) of AzMV. The deduced amino acid sequence of the CP is 94% identical to that of dendrobium mosaic virus, establishing the two as strains of the same virus. While the CP amino acid identities between AzMV and potyviruses of the BCMV species are at or below 90%, the 91 to 94% identity between their UTRs suggests that AzMV could be considered a strain of BCMV. Interestingly, the grouping of potyviruses within the greater BCMV subgroup on a coat protein amino acid tree correlates with a grouping based on the response elicited on bean containing the I gene for resistance to BCMV.

Amino Acid Sequence↗
PubMed1996

Quality of life in patients with Alzheimer's disease as reported by patient proxies.

OBJECTIVE: To measure behaviors indicative of quality of life (QOL) in patients with Alzheimer's disease and to examine correlates of patient QOL. DESIGN: Cross-sectional investigation. SETTING: Multi-center study. PARTICIPANTS: Sample of 130 diagnosed patients. PRINCIPAL OUTCOME MEASURES: Proxy ratings of (1) the frequency, opportunity, and enjoyment of 15 non-ADL activities potentially within the capacity of a demented person, and (2) the frequency of a series of positive and negative affects, evident in clearly demarcated facial and bodily expressions. RESULTS: QOL ratings were reliably elicited. Family and institutional caregivers differed only in reports of opportunity for patient activity. Frequency of activities declined with increasing severity of dementia. The frequency of negative affects increased and positive affects declined with increasing severity of dementia, but correlations were weak. High QOL, defined by frequent activity and positive affect, was evident in a quarter of the sample. In multivariate models, functional and cognitive status independently predicted QOL among community-resident older adults; only absence of antipsychotics was related to QOL among older people in nursing homes. Patient education, a marker of premorbid state, independently predicted some activity patterns. CONCLUSIONS: Although the subjective world of the demented patient is not directly accessible, readily observable behaviors offer a basis for assessing QOL.

Affect↗
PubMed1995

APOE genotype influences functional status among elderly without dementia.

The presence of apolipoprotein-epsilon 4 (APOE-epsilon 4) significantly increases the risk of Alzheimer's disease (AD). The association between APOE-epsilon 4 status and functional abilities was explored further in a multicultural sample of community-dwelling, non-demented elders. The sample was limited to cognitively-intact, community-dwelling elders, who were free of stroke or other neurologic disability. In 218 elders who met research criteria, the presence of APO-epsilon 4 was associated with poorer functional status, apart from the effects of neuropsychological performance, gender, age, and education (OR = 2.5, 95% CI: 1.3, 4.9). In 158 subjects without an APOE-epsilon 4 allele, 50% reported no functional limitation; in the 60 subjects with an epsilon 4 allele, only 28% reported no functional limitation (P < .01). The relationship was not explained by the distribution of co-morbidities. The association between poorer function and the presence of an APOE-epsilon 4 allele was evident in each ethnic group. In path analyses, the presence of an APOE-epsilon 4 allele was associated with decreased functional ability in non-demented elders not simply through an association with poorer cognitive status, but also independently. These results suggest that the APOE-epsilon 4 genotype is associated with functional deficit in people with normal neuropsychological profiles.

Aged↗
PubMed1995

Neuropsychologic impairment in early HIV infection. A risk factor for work disability.

OBJECTIVE: To explore the functional significance of incident neuropsychologic impairment among initially asymptomatic subjects infected with human immunodeficiency virus. DESIGN: Prospective, observational cohort study of homosexual and bisexual men to examine the incidence of work disability related to the onset of neuropsychologic impairment. SETTING: A university clinical and behavioral research site in New York City. PARTICIPANTS: Sample of 207 homosexual and bisexual men; 123 were seropositive and 84 were seronegative. PRINCIPAL OUTCOME MEASURES: Incident work disability in the course of 4.5 years of follow-up, with disability defined as a persistent (> or = 24 months) change in work hours (from 20 or more to less than 20 h/wk). RESULTS: Compared with seronegative control subjects (n = 72), the relative risk of work disability among initially asymptomatic seropositive men (n = 44) was 2.76 (95% confidence interval, 1.2 to 6.5), nearly a threefold increase. Proportional hazards models show that this increased risk is attributable to the development of major neuropsychologic impairment in a subset (eight of 44) of the initially asymptomatic men, which is significantly associated with incident work disability (6/8 [75%]). Adjusting for symptom status and CD4+ cell count at the time of disability did not eliminate the increased risk associated with neuropsychologic impairment. CONCLUSIONS: In this cohort, the increased risk of work disability among initially asymptomatic human immunodeficiency virus-positive men was related to incident neuropsychologic impairment; such impairment predicted work disability independently of symptom status and CD4+ cell count over the follow-up period. Neuropsychologic impairment in the course of human immunodeficiency virus infection may indicate increased risk for poor outcomes over and above that associated with systemic disease.

Cohort Studies↗
PubMed1994

Marital status of daughters and patterns of parent care.

Patterns of help to disabled elderly parents from family and paid sources are examined as they vary among five groups of parent-caring daughters: married (n = 234), remarried (n = 56), separated/divorced (n = 91), widowed (n = 52), and never married (n = 59). Parents of all groups received similar total amounts of care from all sources combined, with daughters providing at least half of the care themselves. Never-married daughters, followed by the widowed, provided larger proportions of the total hours of care (77% and 62%) than the other three groups (p < .001). Married daughters had the most informal helpers (p < .001), and never marrieds more often were their parents' sole informal helpers (p < .01). Separated/divorced women who shared households used the highest proportions of paid care.

Adult↗