Biomedical subjects

B L Beattie

Publications and source records attributed to B L Beattie.

At least 37 records · Page 2Linked to original sources

PubMed1992

The effect of influenza vaccination on IL2 production in healthy elderly: implications for current vaccination practices.

Age-related senescence of T-cell mediated responses is well recognized. This study was designed to determine how aging affects the T-cell mediated Interleukin 2 (IL2) response to influenza vaccination. A group of healthy elderly individuals were compared to a control group of healthy young adults for their response to the 1990 influenza vaccine. Cultures of peripheral blood mononuclear cells (PBMC) were prepared from venous blood samples taken prevaccination (pre) and 8 and 12 weeks post-vaccination (post). PBMC cultures stimulated with inactivated A/Shanghai/16/89 (contained in the 1990 vaccine) and A/Philippine/2/82 (not contained in the vaccine) were assayed for peak IL2 activity. We find that after influenza vaccination, there was an insignificant increase in IL2 activity when PBMC from the young control group were stimulated with A/Shanghai/16/89 (pre, 5.14 U/mL/10(6) PBMC; post, 6.64 U/mL/10(6) PBMC) but there was a significant increase in IL2 activity when stimulated with A/Phillippine/2/82 (pre, 1.5 U/mL/10(6) PBMC; post, 8.3 U/mL/10(6) PBMC). In similar cultures of PBMC from the elderly group, there was a significant increase in IL2 response to both A/Shanghai/16/89 (pre, 1.6 U/mL/10(6) PBMC; post, 3.5 U/mL/10(6) PBMC) and A/Philippine/2/82 (pre, 0.86 U/mL/10(6) PBMC; post, 8.3 U/mL/10(6) PBMC). Measurements of CD4+/CD8+ populations were not affected by vaccination and were not significantly different in the two groups. Subgroup analysis of the elderly group revealed that previous influenza vaccination in 1989 did not significantly affect IL2 levels measured in the present study. This study shows that in healthy elderly, influenza vaccination effectively restores IL2 activity to normal. There appears to be an age-related decrease in the duration of T-cell memory.(ABSTRACT TRUNCATED AT 250 WORDS)

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PubMed1992

The Clock Test: a sensitive measure to differentiate normal elderly from those with Alzheimer disease.

OBJECTIVE: To examine the clinical utility of the Clock Test for identifying dementia. DESIGN: Group comparisons. SETTING: A hospital-based out-patient diagnostic clinic. PATIENTS: Volunteer sample of elderly individuals (normal elderly, NE, n = 62) and a referred sample of probable Alzheimer Disease (AD, n = 58) patients meeting NINCDS-ADRDA criteria. MAIN OUTCOME MEASURE: The Clock Test is composed of three components: Clock Drawing, Clock Setting, and Clock Reading. A detailed scoring system for qualitative as well as quantitative evaluation of Clock Drawing errors was used. Five time settings, varying in level of complexity, were used to evaluate Clock Setting and Clock Reading. RESULTS: The groups differed significantly on Clock Drawing, Clock Setting, and Clock Reading (P less than 0.001). On Clock Drawing, the AD group made significantly more errors of omission and misplacement of numbers than the NE group (P less than 0.001). Using cut-off scores derived to maximize separation between the groups to define deficits in performance, the sensitivity and specificity for the diagnosis of AD of Clock Drawing, Clock Setting, and Clock Reading were 92% and 86%, 87% and 97%, 92% and 85%, respectively. Using a criterion of deficits on two or more of the three components, sensitivity and specificity increased to 94% and 93%, respectively. CONCLUSIONS: Deficits on clock drawing in AD may be reflective of a generalized disturbance in the conceptualization of time rather than constructional apraxia, per se. The functionally relevant components of Clock Setting and Clock Reading combined with Clock Drawing make the Clock Test particularly useful as a screening and research tool for AD.

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PubMed1992

International comparison in gerontological education--Canada.

The undergraduate programs of geriatric education in medical schools across Canada are variable, and there has not been definition of core content or core clinical experience, although these processes are underway. At UBC in June 1990, the first Canadian Summer Institute took place in Vancouver and medical students representing 16 medical schools in Canada attended the week-long program. Students left the program keen to start student interest groups in their schools. Many students were indicating commitment to careers in geriatrics, both clinical and research. There is a Certificate of Special competence by examination in Canada, administered by the Royal College of Physicians and Surgeons of Canada. The standards for the program have been in place since 1981, and since 1984 candidates for the examination must have a minimum of two years training in Geriatric Medicine after at least three years training in Internal Medicine. To date, there are less than 75 certified Specialists in Geriatric Medicine in the country. The College of Family Physicians of Canada encourages training in care of the elderly during the two-year training program in Family Practice. In some schools (e.g. UBC) at least one month is mandatory. There is a Joint Committee with representatives from the Royal College and the College of Family Physicians making recommendations for geriatric training in Family Practice programs in Canada. The College of Family Practice has elected not to have a program for certification in geriatrics for family physicians. Gerontology and geriatrics are being incorporated into undergraduate and graduate curriculae, driven by the demographic imperative. There remains much to be done.(ABSTRACT TRUNCATED AT 250 WORDS)

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PubMed1991

The role of physical attractiveness in the assessment of elderly patients.

The degree to which patient physical attractiveness affects judgements of professionals and relatives of patients as well as the psychosocial adjustment of elderly was investigated within the context of a longitudinal quasi-experimental design. In contrast to previous analogue and cross-sectional research, no evidence was found to support the contention that physical attractiveness has a potent impact on any of the variables under study.

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PubMed1991

Cued recall and early identification of dementia.

The early detection of dementia carries implications for clinical management for patients and their families and is of utmost concern if an effective pharmacological treatment is to be found. The utility of an enhanced cued recall paradigm for predicting dementia in a group of elderly subjects was examined. Forty-five subjects referred for clinical evaluation who did not meet the criteria for dementia at initial assessment were reassessed 12-18 months later. Eighteen of these subjects were diagnosed as having possible or probable Alzheimer Disease at reassessment and the diagnostic status of 27 remained unchanged. At initial assessment the 'change' group performed more poorly than the 'no change' group on measures of retrieval, acquisition and retention derived from the cued recall procedure. As would be expected, the performance of the 'no change' group remained stable over time whereas the performance of the 'change' group deteriorated, resembling the performance of a group of subjects with mild possible or probable Alzheimer disease. When the sensitivity and specificity of the memory variables were examined, the retrieval measure (i.e., free recall) appeared most useful as an early predictor of dementia. Continued longitudinal evaluations of subjects with questionable dementia are needed to address more fully the natural history of early memory changes associated with dementia.

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PubMed1990

18Fluorodeoxyglucose positron emission tomography studies in presumed Alzheimer cases, including 13 serial scans.

Positron emission tomographic (PET) data on local cerebral metabolic rates for glucose (LCMR) are reported for 32 regions of interest (ROI)s in cross-sectional studies on 57 patients with clinically diagnosed Alzheimer's disease (AD) and 20 neurologically normal controls, and in serial studies on 13 of the AD cases, including a familial, young-onset case where the diagnosis has been confirmed at autopsy. Extensive psychological testing was done on all the AD cases. Almost all cortical regions showed a significant decline in LCMR with age in the control subjects. There were the expected cortical metabolic deficits in AD and the serial studies showed a general increase in such deficits over time in 12 of the 13 cases. The regions showing the greatest declines with time in serial studies are the same as those showing the most severe deficiencies in cross-sectional studies. The young-onset case did not show a greater rate of metabolic decline than many of the older cases studied. Results on individual psychological tests tended to correlate with metabolic rates in multiple, rather than single, cortical regions, suggesting intact neuronal networks are required for good performance. The correlations with cortical metabolic activity found were of a sign indicating that the higher the metabolic rates and the better the left:right asymmetry index, the better was the performance.

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PubMed1990

Age-related decline in interleukin 2 production in response to influenza vaccine.

Articles in the recent literature document an abnormal antibody response in elderly persons to influenza vaccination. Several studies have presented evidence to show that immune dysfunction in aged mice and humans may be due to a defect in the production of interleukin 2 (IL2) by helper T cells (TH). Cultures of peripheral blood mononuclear cells (PBMC) were prepared from blood samples taken at eight weeks after vaccination (0.5 mL of Armand-Frappier, 15 micrograms/0.5 mL each of A/Taiwan/1/86, A/Leningrad/360/86, and B/Ann Arbor/1/86 administered in the fall of 1987) from a group of elderly men and a young control group. Peripheral blood mononuclear cells were frozen in 10% dimethyl sulfoxide (DMSO) until all the cells were cultured. After stimulation with a 1/320 dilution of the same influenza vaccine, cultures of PBMC from young controls showed a significantly greater increase in IL2 production than the cultures of PBMC from the elderly group of patients. This was statistically significant at both day 3 (P less than .01) and day 5 (P less than .05) of culture using the Mann-Whitney U test. Previous experiments that have shown defective IL2 production related to aging have used potent mitogens such as concanavalin A and phytohemagglutinin to stimulate TH. This study provides evidence that defective IL2 production may also occur in response to physiologic antigenic stimulation and may be one explanation for the reduced efficacy of influenza vaccination in elderly persons.

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PubMed1989

A case of adult-onset dementia with argyrophilic grains.

A case of progressive dementia in a 68-year-old woman was characterized by the postmortem finding of widespread argyrophilic grains in the cerebral cortex. The grains consisted of 10- to 13-nm filaments in deposits ranging up to 9 microns in length and 3 microns in diameter. The grains stained positive with Alz-50 monoclonal antibody. Cortical brain tissue levels were minimally elevated for acetylcholinesterase, moderately reduced for choline acetyltransferase, and sharply reduced for glutaminase. Although the case was clinically indistinguishable from Alzheimer's disease, plaque and tangle pathological findings were absent. We confirm cortical changes of the type described by Braak and Braak and provide additional data on subcortical changes in this case.

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PubMed1989

Genetic studies on an Alzheimer clinic population.

All patients attending the Clinic for Alzheimer Disease and Related Disorders have detailed family histories taken by a geneticist. To date, genetic histories are available for 446 consecutive, unrelated individuals. Of these, 151 (33.9%) are diagnosed as having "probable" (N = 141) or "autopsy-confirmed" (N = 10) Alzheimer disease according to recognized criteria. This data base represents a relatively unselected population with respect to more than one person in the family having dementia. Seventy-one of these 151 index cases (47.0%) have a positive family history of dementia, of which 8 (5.3%) may represent the familial (autosomal dominant) form of Alzheimer disease (FAD). Age-corrected empiric recurrence risks for Alzheimer disease/dementia were calculated for first-degree relatives of these 151 index cases using the Kaplan-Meier lifetable method.

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PubMed1989

Severe head injury hastens age of onset of Alzheimer's disease.

Head trauma has been found with greater frequency in the histories of Alzheimer patients than age-matched controls in some studies, but not in others. We hypothesized that events that accelerate neuron loss, such as significant head trauma, hasten the onset of symptoms of Alzheimer's disease in persons vulnerable to the disorder. Retrospective data on 148 probable Alzheimer patients and 33 demented controls were examined. Alzheimer patients with severe head injury before the age of 65 showed onset of symptoms at an earlier age than Alzheimer patients without head trauma.

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PubMed1989

Neuropsychological "systems efficiency" and positron emission tomography.

Positron emission tomography (PET) has dramatically improved our ability to examine the functioning of the living brain. PET studies of neural pathways of the major sensory modalities--auditory, visual, somatosensory--have confirmed many traditional neuropsychological concepts, such as cross-lateral representation and regional functioning to particular primary sensory cortical areas. Other PET studies have used radioisotopes to examine relationships between radiopharmaceutical agents and neurobehavioral functioning in both normal and neuropathological states. In some areas, PET methodology requires further refinement. For example, effort should be made to develop the technology to do multiple scans within a short time frame; statistical procedures to examine relationships between neuropsychological tasks and the activity or presence of radiopharmaceutical agents in multiple sites; adequate controls for experimental error; and activation paradigms controlling the nonspecific effects of simple arousal. PET activation models of cognition suggest that a "systems efficiency" approach to assessing neuropsychological test performance involving both serial and parallel processing would be useful. These developments will improve empirical methodology and our understanding of brain-behavior relationships.

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PubMed1988

Familial Alzheimer's disease.

A family with familial Alzheimer's disease (FAD) inherited as an apparent autosomal dominant trait is presented. Twelve individuals (6 females; 6 males) in 4 generations were affected. The disease had its onset in the late 30's, early 40's with death by age 50. Although FAD which appears to be transmitted as an autosomal dominant trait is relatively rare, such families must be identified and carefully counselled with respect to recurrence risks for subsequent generations. In this family, there are currently 20 members of Generation IV, aged 15-37, and 9 members of Generation V, aged 1-11. The majority of these individuals appear to have a 50% risk for developing this disease.

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PubMed1987

Comparison of one- and two-dose regimens of influenza vaccine for elderly men.

In November and December 1984, 102 male residents of a long-term care facility (mean age 74.6 [extremes 59 and 97] years) received 0.5 ml of trivalent inactivated whole-virion influenza vaccine, containing 15 micrograms of the hemagglutinin of each of A/Philippines/2/82 (H3N2), A/Chile/83 (H1N1) and B/USSR/83. A second dose of the vaccine was administered to a subgroup of 55 randomly chosen subjects 8 weeks later. Serum samples were collected from all the subjects before and 4, 8, 12 and 16 weeks after administration of the first dose and were assayed for hemagglutinin-inhibiting (HAI) antibody to each of the three antigens. At 8 weeks there were significant increases (p less than 0.05) in the geometric mean titre of antibody and in the proportion of subjects with HAI antibody titres of 1:40 or more (except to the B/USSR antigen) in both groups. There were no differences between the groups at 8 weeks or at 16 weeks (8 weeks after administration of the second dose of vaccine) in the frequency of seroconversion, the geometric mean titre or the proportion of subjects with HAI antibody titres of 1:40 or more. Overall, 60%, 32% and 13% of the 102 subjects had titres of 1:40 or more to the A/Philippines, A/Chile and B/USSR antigens respectively at 16 weeks. The results suggest that a second dose of influenza vaccine given 8 weeks after the first does not enhance the immune response in elderly men and that a substantial proportion of this population remains unprotected against infection (having HAI antibody titres of less than 1:40) during the influenza season.

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PubMed1987

Characterization of the immune response to trivalent influenza vaccine in elderly men.

This study characterizes the time course of the immune response to influenza vaccine in elderly men. Sixty-two men aged 58 to 91 years (mean, 74.3 years) were vaccinated with trivalent inactivated influenza vaccine in the fall of 1983. Serum hemagglutinin-inhibiting (HAI) antibody titers were measured at various times up to 24 weeks postvaccination. Seroconversion frequencies determined at single times after vaccination were 28 to 46% of subjects, whereas cumulative seroconversion frequencies were greater than or equal to 70%. Eighteen to 28% of seroconversions occurred later than four weeks, and greater than or equal to 68% of those who seroconverted experienced greater than four-fold declines in peak HAI antibody titers by 24 weeks after vaccination. Consequently, 31 to 73% of subjects had HAI antibody titers greater than 40 throughout the study period. Measurement of HAI antibody titers at only one time after vaccination may not adequately reflect the immune response of this population or the degree of protection maintained through the influenza season.

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PubMed1986

Positron emission tomography in patients with clinically diagnosed Alzheimer's disease.

Fourteen patients who had clinically diagnosed Alzheimer's disease with mild to severe dementia (mean age 69.1 years) were evaluated by calculation of local cerebral metabolic rate for glucose (LCMR-gl) based on uptake of 18F-2-fluoro-2-deoxyglucose (FDG) detected with positron emission tomography (PET). PET scanning showed that the patients had significantly lower LCMR-gl values than 11 age-matched neurologically normal volunteers (mean age 66.3 years). The differences were most marked in the temporal cortex, followed by the frontal, parietal and occipital cortex. In each case the LCMR-gl value was below the lowest control value in at least one cortical area and usually in several; the reduction in LCMR-gl and the number of regions involved in the patients increased with the severity of the dementia. Deficits noted in neuropsychologic testing generally correlated with those predicted from loss of regional cortical metabolism. The patients with Alzheimer's disease were also examined with magnetic resonance imaging, computed tomography or both; the degree of atrophy found showed only a poor correlation with the neuropsychologic deficit. Significant atrophy was also noted in some of the controls. A detailed analysis of LCMR-gl values in selected cerebral regions of various sizes refuted the hypothesis that the reduction in cortical glucose metabolism in Alzheimer's disease is due to the filling by metabolically inert cerebrospinal fluid of space created by tissue atrophy.

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PubMed1984

Food intake of institutionalized women over 80 years of age.

Food intake of 30 women over 80 years of age and residing in a long-term care facility was determined for a five-day period using the weighed intake method. Purposes of the study were to examine the contribution to nutrient intake of foods from eight major food groups; to characterize intake by time of day; and to examine the effect of age on nutrient intake. The results indicated that intakes of calcium, thiamin, vitamin A, zinc, and protein were below recommended levels. Analysis of intake by food group revealed that the grain group was the primary source of energy and many nutrients. Percentage consumption of foods in this group was significantly higher than that of vegetables or meat and alternates. Analysis of intake by time of day indicated that more energy was consumed at breakfast than at dinner. Advanced age was negatively correlated with overall dietary adequacy, although the distribution of energy intake from the eight food groups did not change with age. Implications of the results, for these subjects and similar groups of elderly, are discussed.

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PubMed1983

A randomized placebo-controlled trial of ultraviolet light in the treatment of superficial pressure sores.

Ultraviolet (UV) light treatment of pressure sores enjoyed widespread popularity for many years, but recently its effectiveness has been increasingly questioned. Surprisingly, it appears that this form of treatment has never been tested by a randomized placebo-controlled trial. Eighteen patients residing in the Extended Care Unit of the Health Sciences Centre Hospital at the University of British Columbia and suffering from superficial pressure sores of recent onset were therefore randomly assigned to active and placebo treatment groups. Since treatment procedures appeared identical in both groups, both patients and hospital staff were blind as to individual allocation. Sixteen patients completed the study. Mean time to complete healing was 6.3 weeks in the UV treated group, significantly (P less than .02) less than the mean of 8.4 weeks in the placebo group. This difference persisted unchanged when each patient's age and the initial size of the sore were taken into account by an analysis of covariance. Thus, in spite of growing skepticism about its effectiveness, it appears that UV light may play a useful role in the treatment of pressure sores, and a systematic evaluation of different treatment protocols seems to be justified.

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PubMed1982

Team approach to the problem-oriented record in a long-term care facility.

At the Extended Care Unit of the Health Sciences Centre Hospital at the University of British Columbia, team participation in the care of 300 elderly patients includes the team's ability to facilitate use of the problem-oriented record (POR). The key to making the POR a functional communication tool was the development of a useful Problem List. In establishing this system, many difficulties arose. It was imperative to recognize that many staff members had not been trained in problem-solving techniques, and that they had varying degrees of knowledge about the data base. Active physician involvement was mandatory. Employment of a half-time POR Coordinator working with a supporting interdisciplinary POR Committee was needed to make the system work. Guidelines for defining problems were developed, and Problem Lists gradually acquired significance for the entire health care team. Examples are included. Concurrent continuing education was started in pathophysiology, problem-solving, and use of the POR.

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