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Biomedical subjects

B Gurland

Publications and source records attributed to B Gurland.

At least 37 records · Page 2Linked to original sources
PubMed1994

Influence of education and occupation on the incidence of Alzheimer's disease.

OBJECTIVE: Several cross-sectional studies have found an association between Alzheimer's disease (AD) and limited educational experience. It has been difficult to establish whether educational experience is a risk factor for AD because educational attainment can influence performance on diagnostic tests. This study was designed to determine whether limited educational level and occupational attainment are risk factors for incident dementia. DESIGN: Cohort incidence study. SETTING: General community. PARTICIPANTS: A total of 593 nondemented individuals aged 60 years or older who were listed in a registry of individuals at risk for dementia in North Manhattan, NY, were identified and followed up. INTERVENTIONS: We reexamined subjects 1 to 4 years later with the identical standardized neurological and neuropsychological measures. MAIN OUTCOME MEASURES: Incident dementia. RESULTS: We used Cox proportional hazards models, adjusting for age and gender, to estimate the relative risk (RR) of incident dementia associated with low educational and occupational attainment. Of the 593 subjects, 106 became demented; all but five of these met research criteria for AD. The risk of dementia was increased in subjects with either low education (RR, 2.02; 95% confidence interval [Cl], 1.33 to 3.06) or low lifetime occupational attainment (RR, 2.25; 95% Cl, 1.32 to 3.84). Risk was greatest for subjects with both low education and low life-time occupational attainment (RR, 2.87; 95% Cl, 1.32 to 3.84). CONCLUSIONS: The data suggest that increased educational and occupational attainment may reduce the risk of incident AD, either by decreasing ease of clinical detection of AD or by imparting a reserve that delays the onset of clinical manifestations.

Aged↗
PubMed1993

Genetic susceptibility and head injury as risk factors for Alzheimer's disease among community-dwelling elderly persons and their first-degree relatives.

We performed a community-based study to investigate the relationship of genetic susceptibility and head injury to Alzheimer's disease (AD) in 138 patients with AD and 193 healthy elderly control subjects. Data concerning presence or absence of dementia and certain exposures were also obtained from 799 first-degree relatives of the patients and 1,238 first-degree relatives of the control subjects. Adjusting for age, gender, and other risk factors, the odds ratio for AD associated with head injury was 3.7 (95% confidence interval [CI], 1.4-9.7). The association was highest for head injuries that occurred after age 70. The risk of AD was higher in first-degree relatives of patients with onset prior to age 70 than in relatives of control subjects (risk ratio [RR] = 2.5; 95% CI, 1.1-5.6). The risk was not increased for relatives of patients with onset of AD at age 70 or older. Compared with relatives without head injury, the risk of AD was increased among both head-injured relatives of patients (RR = 5.9; 95% CI, 2.3-14.8) and head-injured relatives of control subjects (RR = 6.9; 95% CI, 2.5-18.9). Our results are consistent with the hypothesis that severe head injury and genetic susceptibility are associated with AD. Both associations concur with current concepts regarding the role of amyloid in AD. Although we regard head injury, like genetic susceptibility, to be a putative risk factor for AD, the temporal relationship between head injury and AD warrants further investigation.

Age Factors↗
PubMed1992

The impact of depression on quality of life of the elderly.

The individual who suffers the onset of a clinical level of depression is likely to experience a substantial transformation of the quality of his or her whole life. This can be demonstrated by examining the patterns of the course of depression from its onset to the end of life, in particular the impact of depression on morbidity (including symptom distress), functioning, and mortality.

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PubMed1988

Comparison of self-administered and rater-administered methods of assessing levels of severity of depression in elderly patients.

Eighty consecutive attenders (M age = 75 years) in a primary care group practice associated with a teaching hospital in New York were assessed for depression using a self-administered questionnaire, the Zung Self-Rating Depression Scale (SDS), and a rater-administered interview, the Short-CARE. The sample was 75% female and 85% black or Hispanic. The response rate of completed interviews was 65% for the Zung SDS and 100% for the Short-CARE. Among the reasons indicated by subjects for not filling out the Zung SDS were visual problems (n = 13, 28%), illiteracy (n = 4, 9%), and lack of motivation/wanted it read to them (n = 16, 34%). Additionally, using the Primary Care Physicians' Questionnaire (PCPQ), results from the Short-CARE and the Zung SDS were compared to primary care physicians' judgments regarding the presence of depression in these patients. The convergent validity coefficient for the Zung SDS with the PCPQ was .65 (kappa = .29); the comparable coefficients for the PCPQ and the Short-CARE Depression Scale were .73 and .46 respectively.

Aged↗
PubMed1985

Systolic Hypertension in the Elderly Program (SHEP): antihypertensive efficacy of chlorthalidone.

The Systolic Hypertension in the Elderly Program (SHEP) is a randomized, blinded test of the efficacy of antihypertensive drug treatment. In a large feasibility trial, 551 men and women who had isolated systolic hypertension and were at least 60 years old received chlorthalidone (25 to 50 mg/day) or matching placebo as the step I drug. After 1 year, 83% of the chlorthalidone group and 80% of the placebo group were still taking SHEP medications. Of those still taking chlorthalidone, 88% had reached goal blood pressure (BP) without requiring a step II drug, and most had responded to the lower dose (25 mg/day). The BP response was similar in all age, sex and race subgroups, with an overall mean difference between randomized groups of 17 mm Hg for systolic BP (p less than 0.001) and 6 mm Hg for diastolic BP (p less than 0.001). The only common adverse effects were asymptomatic changes in the serum levels of potassium (0.5 mEq/liter lower in the chlorthalidone group, p less than 0.001), uric acid (0.9 mg/dl higher, p less than 0.001) and creatinine (0.08 mg/dl higher, p = 0.02). This study indicates that chlorthalidone is effective for lowering BP in elderly patients with systolic hypertension and sets the stage for a larger trial of the effects of such treatment on the incidence of cardiovascular disease.

Aged↗
PubMed1985

Nursing home care as an alternative to psychiatric hospitalization. A Veterans Administration cooperative study.

Nursing homes have played a major role in deinstitutionalization, and their increased use for the mentally ill has been questioned. We performed a controlled study of nursing homes as an alternative to continued psychiatric hospitalization. Men (N = 403) referred for nursing home placement from eight Veterans Administration medical centers were randomly assigned to community nursing homes (CNHs), Veterans Administration nursing care units, continued care on the same ward, or transfer to another psychiatric ward. Patients met defined criteria for schizophrenia or organic brain disease. Data were collected before random assignment and six and 12 months later, covering physical and mental function, psychopathology, mood, social adjustment, satisfaction with care, as well as drug use, characteristics of settings, and movement in and out of settings. Significant differences between settings were found in self-care, behavioral deterioration, mental confusion, depression, and satisfaction with care. Results were strikingly consistent, showing the group transferred to another ward doing better and the CNH group doing worse. Drug use did not differ from six months before entering the study or later between the settings. Cost showed a marked advantage for the CNH group. Thus, the less costly community nursing home alternative must be viewed in the context of the nonmonetary costs of less favorable patient outcome.

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PubMed1985

Development of a cost-efficient psychogeriatrics service.

Various cost-efficient and space-efficient methods were used to expand outpatient services to the elderly at a teaching hospital's psychiatry clinic over a 2-year period. During this time the active treatment census of elderly patients more than doubled, to 185 patients. Only one enrolled patient required psychiatric hospitalization, and none required nursing home placement in the 2 years. Except for the geriatrics service director, no new paid staff and no extra space were required to form the service. The authors review the methods that seemed most beneficial to the service.

Aged↗
PubMed1984

The SHORT-CARE: an efficient instrument for the assessment of depression, dementia and disability.

The Comprehensive Assessment and Referral Evaluation (CARE) covers a wide range of psychiatric, medical, and social problems. It has been, for certain purposes, reduced to a relatively brief instrument, the SHORT-CARE, that measures three major content areas: depression, dementia, and disability. The SHORT-CARE includes additional items for arriving at operational diagnoses that have public health relevance (pervasive depression, pervasive dementia, and personal time dependency). The reliability and validity of the scales in the SHORT-CARE, as well as their relationship to operational diagnoses, are discussed. The interrater reliability correlations of the SHORT-CARE scales are .94, .76, and .91, respectively for depression, dementia and disability. Internal consistency coefficients for the three scales are .75, .64, and .84. The scales are useful for measurement of severity and change; the operational diagnoses for prediction of service utilization and outcome.

Activities of Daily Living↗
PubMed1984

Wandering and parietal signs in senile dementia of Alzheimer's type.

Among a population of nursing home patients with a diagnosis of senile dementia of Alzheimer's type (SDAT), a subgroup was identified who often became lost and wandered even in familiar surroundings. This subgroup differed from the rest of the SDAT patients on tests of parietal function but not on a generalized test of mental status. Thus, wandering in SDAT patients may be an indication of a specific parietal lobe involvement.

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PubMed1979

A cross-national comparison of the institutionalized elderly in the cities of New York and London.

Two random samples, each constituting 0.5% of the institutionalized elderly (over 65) in the cities of New York and London have been compared. This preliminary report of a collaborative study demonstrates the similarity of the 2 samples. Institutions in the 2 cities are shown to differ in size, type of ownership and the frequency that skilled nursing is provided. Some implications of these 2 findings are raised now, and will be discussed later when the full data for the study are presented.

Aged↗
PubMed1979

Dichotic perception: evidence for right hemisphere dysfunction in affective psychosis.

The association between lateralized hemispheric dysfunction and psychiatric diagnosis was investigated with a measure of summation of dichotic clicks and with a dichotic competing message task. Ear asymmetries of affective psychotic patients were similar to those of right temporal lesioned controls and differed from those of schizophrenic patients and normal controls. In contrast, schizophrenic patients did not display abnormal auditory perceptual asymmetries.

Adult↗
PubMed1976

The geriatric mental status interview (GMS).

The Geriatric Mental Status interview (GMS) is a semi-structured interview technique for assessing psychopathology in elderly patients. It is administered by a trained interviewer in a session of less than one hour. Between 100 and 200 question are asked and almost 500 items are rated. Twenty-one factor scores have been identified and the reliability of the ratings has been established. The interview is acceptable to the patient and is useful for making diagnostic distinctions and evaluation progress

Aged↗
PubMed1976

The usefulness of a psychological test battery.

This paper discusses the usefulness of a battery of psychological tests administered to a group of psychiatric geriatric patients in New York and London, as an assessment of cognitive impairment. Two of the tests, the Paired Associate Learning Test, and the Digit Copying Test, were highly related to the diagnosis of organic brain syndrome or functional disorder made independently by a psychiatrist in a clinical interview. Prognostic predictions in disagreement cases were no better or no worse by psychiatric diagnosis than by psychological tests. Compared to a simple clinical test of disorientation derived from the psychiatric interview, psychological tests were more highly correlated to independent measures of patients' self-care capacity and duration of hospitalization, but equally related to psychiatric diagnosis. The verbal subtest proved to be the more useful of the psychological tests given. The logistics and difficulties of administering psychological tests to this specialized population are discussed, e.g. patients' physical limitations, communication problems; as well as efforts in this study to minimize these problems.

Aged↗
PubMed1976

Distinctions between organic brain syndrome and functional psychiatric disorders: based on the geriatric mental state interview.

Discriminant function analysis was employed to study the ability of the Geriatric Mental Status interview to distinguish between patients diagnosed by the project as having an organic brain syndrome or a functional psychiatric disorder. In both New York and London, patients with organic brain syndrome scored significantly higher (p less than 0.05) than those with functional disorders on the factors of impaired memory, disorientation and incomprehensibility and significantly lower on the factors of depression and somatic concerns. Discriminant functions calculated from data on the New York and London patients separately significantly distinguished not only the patients on whom the functions were based but the patients in the other sample as well.

Affective Symptoms↗