Biomedical subjects

A La Rue

Publications and source records attributed to A La Rue.

At least 19 recordsLinked to original sources

PubMed1995

Cognition and depression in a cohort of aging men: results from the Western Collaborative Group Study.

Relationships between cognitive performance and self-ratings of depression on the Center for Epidemiologic Studies Depression scale (CES-D; L.S. Radloff, 1977) were examined for 1,217 older men. After controlling for demographic variables and both objective and subjective measures of health, significant associations were observed between several CES-D variables and measures of cognitive mental status, memory, and psychomotor speed. The Well-Being factor of the CES-D was the most robust predictor of cognitive scores. Therefore, for older adults with generally favorable health and socioeconomic resources, there may be a link between positive affect and maintenance of cognitive effectiveness.

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PubMed1995

Cognitive changes in young-old adults: effect of family history of dementia.

Cognitive performance of 40 first-degree relatives of patients with probable Alzheimer disease was compared to that of 24 matched controls without a family history of dementia. Across a test-retest interval ranging from 1 to 6 years, relatives more often showed evidence of cognitive decline, and in multivariate analyses of memory and intelligence measures, relatives of patients with early-onset dementia (< 67 years) showed greater decline than controls or relatives of patients with late-onset dementia. All changes observed to date are in the subclinical range, and further follow-up will be needed to determine the reliability of change trajectories. However, the findings suggest that family history of dementia may be worthy of monitoring in research on normal cognitive aging.

Age Factors↗

PubMed1995

Predictors of cognitive change in middle-aged and older adults with memory loss.

OBJECTIVE: Previous longitudinal studies of age-related memory loss have focused on objective neuropsychological measures that predict subsequent cognitive change, yet brain metabolic function, self-perception of memory loss, and other measures may also be sensitive indicators of cognitive change. To determine such baseline predictors of change, the authors made longitudinal assessments of middle-aged and older adults with memory loss. METHOD: Forty-two persons (mean age = 60 years, range = 43-81) with memory complaints received comprehensive baseline assessments, including subjective neuropsychological measures, objective measures of visual-spatial memory (the Benton Visual Retention Test) and verbal memory (the Buschke-Fuld Selective Reminding Test), and positron emission tomography scans to determine neocortical glucose metabolism. At an average follow-up of 3 years, the objective neuropsychological measures were again used to quantify the degree of cognitive change. RESULTS: Multiple regression analyses indicated that parietal asymmetry, sex of the subject, and baseline visual-spatial memory score were significant predictors of change in visual-spatial memory; level of education and baseline verbal memory score predicted change in verbal memory. Other neocortical asymmetry scores, age, family history of Alzheimer's disease, cerebral atrophy, and self-ratings of use of mnemonics were not significant predictors of change. CONCLUSIONS: Measures of cerebral metabolism, objective memory performance, sex, and education may predict subsequent cognitive change in middle-aged and older persons with memory loss. Also, the parietal asymmetry found in persons with questionable dementia that progresses to probable Alzheimer's disease may be present very early in the course of age-related cognitive decline.

Adult↗

PubMed1994

Commingling analysis of memory performance in elderly men.

Smalley et al. [(1992) Genet Epidemiol 9:333-345] found evidence of a mixture of two distributions in memory performance among offspring of patients with dementia of the Alzheimer type (DAT), suggesting that these groups reflect genotypic subgroups of carriers and non-carriers of a putative DAT gene. One prediction of this hypothesis is that, in the general population, two distributions of memory performance are present, with a smaller proportion of subjects in the low-scoring cluster than that found among the offspring sample, but similar to the prevalence of DAT in the elderly community-at-large. Memory performance was investigated in a large sample of normal elderly males (N = 1,149; mean age = 71.4 +/- 4.7 years) to test this hypothesis. Commingling analyses of performance on the Benton visual retention test demonstrated significant negative skewness in the distribution of memory performance, requiring a transformation to fit a single normal distribution. In the absence of a transformation, two distributions fit better than one, with 6% of subjects falling into a "low"-scoring cluster. These findings are consistent with the hypothesis that memory performance may represent a premorbid or morbid difference in those who go on to develop, or currently have, DAT, possibly allowing identification of at-risk carriers of a putative single major gene for DAT.

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PubMed1994

Age-associated memory loss: initial neuropsychological and cerebral metabolic findings of a longitudinal study.

To determine the relationships between clinical and brain function in persons with a familial risk for Alzheimer's disease, the authors assessed subjective and objective cognitive abilities, mood state, and cerebral glucose metabolism (using positron emission tomography) in 43 persons with age-associated memory impairment, with and without first-degree relatives with a clinical diagnosis of Alzheimer's disease. Subjective complaints of memory loss, mood state ratings, and objective memory measures were similar in persons with a family history of Alzheimer's disease (n = 29) compared to those without such a history (n = 14). Metabolic ratios in the frontal regions correlated with a decrease in a specific type of subjective memory complaint (mnemonics usage; p < .001) and some mood state ratings. These results indicate that parietal and temporal hypometabolism is not evident in persons with mild age-related memory complaints, even when such subjects have a familial risk for Alzheimer's disease. Moreover, self-reports of mnemonics usage may be sensitive indicators of decreased frontal lobe function. Longitudinal study will determine whether such clinical and metabolic measures will predict eventual disease progression.

Adult↗

PubMed1993

Clinical, neuroimaging, and environmental risk differences in monozygotic female twins appearing discordant for dementia of the Alzheimer type.

OBJECTIVE: The study of monozygotic twins can elucidate possible environmental causes for a disease in genetically identical subjects. To this end, we studied a pair of monozygotic female twins appearing discordant for dementia of the Alzheimer type (DAT). DESIGN: Clinical and neuroimaging findings were compared in terms of potential environmental risk factors. SETTING: University referral center. PARTICIPANTS: An 81-year-old female monozygotic twin pair. OUTCOME MEASURES: Clinical assessments, standardized rating scales, and brain imaging studies, including magnetic resonance imaging, positron emission tomography, and electroencephalography, were performed. Neuropsychological tests were performed initially and after 1 year. RESULTS: Although DAT was confirmed clinically in only one twin, neuropsychological and brain imaging studies suggested that the unaffected twin may be developing the prodrome of DAT. The twins' varied life histories suggest that environmental risk factors may contribute to apparent discordance for DAT and possible delay in disease onset for the currently nondemented twin. CONCLUSIONS: These results suggest that both genetic and nongenetic factors influence disease onset and expression. Moreover, review of previous reports of monozygotic twin pairs concordant or discordant for Alzheimer's disease, with adequate family history data, suggest a pattern indicating interactions among age at dementia onset, sex, and familiarity. Such patterns point to hypotheses regarding neurobiologically meaningful Alzheimer's disease subgroups.

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PubMed1992

Cognitive performance in relatives of patients with probable Alzheimer disease: an age at onset effect?

Cognitive performance of 32 siblings and children of patients with probable Alzheimer disease was assessed longitudinally over an interval averaging 4 years. Mean scores were within normal limits for age on all measures at both test times. However, relatives of patients with early-onset dementia (less than or equal to 67 years) were more likely to show a decline in performance from the first to second testing than relatives of patients with late-onset dementia. Additional follow-up will be needed to determine the reliability of performance trajectories and to assess whether mild cognitive changes are related to future dementia. However, findings suggest that it may be important to consider family history of dementia in studies of normal cognitive aging.

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PubMed1992

Retrospective accounts of dementia symptoms: are they reliable?

Relatives of patients with dementia completed questionnaires about caregiver stress and patients' functional and psychiatric problems during an initial evaluation, at follow-up 4 to 17 months later, and retrospectively (i.e., based on recall of symptoms and behaviors at the initial assessment). Retrospective accounts correlated well with initial reports, particularly with larger scales including a wider range of alternative responses, but psychiatric symptoms were underreported in the retrospective accounts. Spouses tended to report lower levels of psychiatric symptoms than did younger relatives.

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PubMed1989

Recombinant human erythropoietin treatment may improve quality of life and cognitive function in chronic hemodialysis patients.

Medical, psychological, and social adaptation (quality of life) as well as cognitive function were studied in 15 chronic stable hemodialysis patients before the onset of treatment with recombinant human erythropoietin (r-HuEPO), 1 month after stabilization of normal hematocrit levels, and 10 to 15 months after treatment onset. After r-HuEPO treatment, subjects had significantly higher hematocrits, markedly improved energy levels, and marginally improved global health. r-HuEPO treatment was also associated with progressively decreased levels of subject mood disturbance and dialysis-related stresses. Subjects had no increased participation in paid employment and only minimally increased participation in social and leisure activities at posttreatment data points. There was no significant improvement in cognitive function after treatment. r-HuEPO treatment appears to be associated with higher energy levels, significant psychological benefits, and minimal improvements in social adaptation. The effects on cognitive function merit further study.

Adaptation, Psychological↗

PubMed1989

Patterns of performance on the Fuld Object Memory Evaluation in elderly inpatients with depression or dementia.

The Fuld Object Memory Evaluation (Fuld, 1981) was administered to 80 elderly adults (aged 60 to 90 years) who were hospitalized for evaluation and treatment of primary degenerative dementia (PDD), other organic disorders (e.g., Parkinson's disease or multi-infarct dementia), or major depression. Although mean performance in each of the diagnostic groups was below normative levels reported by Fuld (1981), PDD patients performed significantly more poorly than those with depression or other organic disorders. Analysis of subscore patterns failed to support the hypothesis of a selective memory deficit in depression, and substantial overlap in scores was observed between the depressed group and patients with organic disorders other than PDD. Object Memory Evaluation performance was influenced by global mental status and secondary psychiatric diagnoses, but not by education, age, or physical health.

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PubMed1987

Relatives' descriptions of changes in symptoms of dementia of the Alzheimer type: a comparison of retrospective and concurrent ratings.

Although relatives' retrospective reports are often used in characterizing the onset and progression of symptoms in dementia of the Alzheimer type (DAT), little is known about the accuracy of these accounts. The primary purpose of this paper is to summarize preliminary data obtained from relatives in an ongoing family study of DAT. Preliminary findings suggest there is rough reliability to relatives' recall of the progression of symptoms over time. This observation is discussed in relation to literature from other areas (e.g. child development, psychopathology) where the reliability of relatives' retrospection has been more thoroughly examined.

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PubMed1987

Methodological concerns: longitudinal studies of dementia.

Common methodological problems in longitudinal research on dementia are discussed, applying terms and constructs from the literature on normal aging. Critique of prevailing methods suggests that longitudinal studies of dementia could be improved by more extensive pilot examination of dependent measures and by more stringent control of instrumentation bias. The impact of attrition also needs to be more thoroughly evaluated before generalizations are stated about rates and patterns of decline in dementing illness.

Alzheimer Disease↗

PubMed1987

Cognitive function and prediction of dementia in old age.

Longitudinal changes in cognitive functioning were examined for a sample of aging twins, some of whom developed dementia while others did not. Individuals who were judged to be demented at a mean age of eighty-five years had achieved lower scores on most tests twenty years prior to diagnosis, and experienced greater declines in vocabulary and forward digit span over time, than those surviving to a comparable age without dementia. These trends were observed for individuals with mild, as well as moderate-to-severe, dementia and were unrelated to physical health status or premorbid activity patterns. It is suggested that dementing illness may develop very slowly, and that the likelihood of exhibiting clinically significant dementia may vary with premorbid intellectual level.

Activities of Daily Living↗

PubMed1986

Clinical tests of memory in dementia, depression, and healthy aging.

In Study 1, carefully screened elderly adults with primary degenerative dementia or major depression were compared to healthy aged control subjects on three tests of learning and memory: the Benton Visual Retention Test, Inglis Paired-Associate Learning Test, and the Fuld Object-Memory Evaluation (OME). The sharpest distinction in performance among the groups was observed on the OME, and discriminant equations based on this test correctly classified a high percentage (greater than or equal to 90%) of participants. Study 2 applied the classification rules derived in the first investigation to an unselected series of geropsychiatry inpatients referred for neuropsychological evaluation. There was agreement between memory test classification and general categories of clinical discharge diagnosis (organic vs. functional) for 21 of 25 patients, and with status at follow-up approximately 18 months later. Predictive value computations suggested that the OME is more accurate in confirming true dementia than in detecting dementia syndromes associated with functional disorders.

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PubMed1985

Acute response to methylphenidate as a predictor of outcome of treatment with TCAs in the elderly.

Acute response to a single-dose, nonblind administration of methylphenidate 20 mg predicted outcome of treatment with desipramine in 42 elderly depressed inpatients. Treatment outcome was not predicted by the methylphenidate challenge in 29 patients who received amitriptyline. These findings are consistent with Maas' biogenic amine hypothesis and are encouraging with respect to the clinical utility of the methylphenidate challenge in geriatric depression.

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PubMed1983

Major depression in the elderly: DSM-III criteria and the dexamethasone suppression test as predictors of treatment response.

Twenty-seven elderly individuals with DSM-III diagnoses of major depression who demonstrated a nonsuppressor response to the dexamethasone suppression test had higher pretreatment levels of mood disturbance, required higher dosages of antidepressant medication, and had poorer responses to treatment than 17 clinically similar individuals with a suppressor response. However, when data on the outcomes of suppressors and nonsuppressors were combined, over half of the entire group sustained significant improvement, which supports the practical value of DSM-III criteria for depression in the elderly.

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PubMed1983

Clinical differentiation of primary degenerative and multi-infarct dementia: a critical review of the evidence. Part I: Clinical studies.

For patient care and for research purposes there is an obvious need for a valid and reliable set of clinical criteria to distinguish antemortem between primary degenerative dementia (PDD) and multi-infarct dementia (MID). To this end, specific diagnostic criteria for each have been promulgated in the official nomenclature, and a rating scale devised to differentiate these disorders is in wide use. These efforts suggest a diagnostic capability that is not, however, well supported by the literature. This critical analysis of representative clinical studies and articles published over the past two decades reveals important drawbacks in methodologic approaches and interpretation of data which seriously undermine confidence in making the clinical distinction between PDD and MID.

Alzheimer Disease↗

PubMed1983

Clinical differentiation of primary degenerative and multi-infarct dementia: a critical review of the evidence. Part II: Pathological studies.

A critical examination of representative pathological studies published over the past four decades reveals that this literature fails to provide sufficient support for the antemortem differentiation of primary degenerative dementia (PDD) from multi-infarct dementia (MID) on the basis of clinical criteria. Similar conclusions with respect to clinical studies and articles are presented in Part I of this overview. Among the difficulties commonly encountered in the literature are sampling bias, retrospective design, nonblind assessments, inadequate sample size, failure to consider overlap (i.e., mixed cases), absence of pathological verification in the clinical studies and post hoc reasoning. The necessity to assure that one is dealing with a case of PDD as opposed to some other dementing process is self-evident. However, these reviews show that this capability has not been adequately established with respect to the differential diagnosis of PDD and MID; the evidence to date indicates that the clinical diagnosis of MID, in particular, should be made with caution until more conclusive methods become available.

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