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Biomedical subjects

B S Fogel

Publications and source records attributed to B S Fogel.

At least 19 recordsLinked to original sources
PubMed1998

Occurrence and predictors of short-term mental and functional changes in older adults undergoing elective surgery under general anesthesia.

The authors studies the cognitive, affective, and functional status of 172 mentally healthy patients, age 55 and older, who were undergoing elective surgery under general anesthesia. Patients were interviewed before and after surgery; this report focuses on changes 1 month postoperatively. Authors compared the mental status and function of 190 nonsurgical patients of comparable age. Surgical patients showed a temporary functional decline. Linear regression predictors of affective, cognitive, and functional change at follow-up included demographics, baseline measures of mental status and function, surgery type, and intraoperative measures. Longer duration of anesthesia--but not type of surgery--predicted short-term decline in activities of daily living but not cognition or affect. Authors discuss results in the context of previous findings in which surgery had no impact on mental status or function at 10-month follow-up.

Activities of Daily Living↗
PubMed1996

Effect of elective surgery under general anesthesia on mental status variables in elderly women and men: 10-month follow-up.

Mental status changes were assessed and compared in 172 general surgical and orthopedic patients and 190 nonsurgical patients, all aged 55 and over, during a 10-month period. Assessments included a structured psychosocial questionnaire and standardized tests of cognition, affect, and function. The relationship of surgery, type of surgery, age, gender, and postoperative delirium to long-term postoperative decline was evaluated. Analyses of variance directly tested main effects pertaining to each of the five hypotheses and interactions of surgery with background variables. Hierarchical multiple regression analyses assessed the unique contributions of demographic and surgical variables to cognitive, affective, and functional change. None of the independent variables tested made a significant contribution to changes from baseline to long-term follow-up. The findings may be due to the physical and psychological health of this sample, and replication of this work in more impaired populations may be productive.

Activities of Daily Living↗
PubMed1996

Impaired awareness of deficits in Alzheimer disease.

This study examined the relation between awareness of memory and functional decline and cognitive function in patients with Alzheimer disease (AD). Twenty-six patients with early AD and 16 nondemented elderly controls were studied. Awareness of deficits was determined by using (a) a discrepancy score between subject's and caregiver's ratings on a memory questionnaire, (b) a discrepancy score between subject's and caregiver's ratings on an activities-of-daily-living scale, and (c) a clinical rating of dementia awareness for patients. Whereas self-ratings of memory and activities of daily living were not significantly different between AD patients and controls, these two measures differed significantly when AD patients' ratings were compared with those of their caregivers. Measures of awareness of deficits correlated with one another and were primarily associated with performance on tests of executive and visuospatial functions but not with depression. Early AD is characterized by a failure of self-monitoring. Deficits in self-monitoring have been proposed to occur after damage to the frontal lobes and other cerebral areas. Impaired awareness of memory and functional deficits in AD is related to cognitive impairments, which may involve frontal and right hemisphere connections.

Aged↗
PubMed1996

Apathy and loss of insight in Alzheimer's disease: a SPECT imaging study.

Apathy and loss of insight as correlates of behavior in Alzheimer's disease (AD) were studied in 40 patients by using clinical scales and cerebral blood flow measurements from SPECT imaging. Apathy was significantly correlated with decreased right temporoparietal perfusion and problem behaviors. Loss of insight was significantly correlated with decreased right temporo-occipital perfusion and impairment in daily functioning. Dementia severity as measured by the Mini-Mental State Examination (MMSE) was a poor predictor of behavioral problems or daily functioning. These data suggest that global measures of cognitive ability, which are weighted toward measuring left hemisphere function, are less important as indicators of management problems in AD than are measures of right hemisphere function such as motivation and insight.

Activities of Daily Living↗
PubMed1995

Apathy: a treatable syndrome.

Apathy occurs frequently in neuropsychiatric disorders both as a symptom of other syndromes and as a syndrome per se. Histories are presented of patients with a syndrome of apathy who showed clinically significant, sustained benefit from pharmacological treatment. Etiologies included non-Alzheimer's frontal lobe dementia, cerebral infarction, intracranial hemorrhage, alcoholism, and traumatic brain injury. Agents included amantadine, amphetamine, bromocriptine, bupropion, methylphenidate, and selegiline. These histories support the suggestion that apathy is a discriminable dimension of behavior having its own pathophysiology and implications for psychiatric care. They raise the possibility of treatment for many patients previously thought untreatable. Studying the treatment of apathy may contribute to the clinical care and scientific understanding of neuropsychiatric disorders throughout the life span.

Adult↗
PubMed1994

The significance of frontal system disorders for medical practice and health policy.

In major chronic diseases, apathy or impaired executive cognitive function (ECF) can reduce the patient's ability to cope with the disease and its treatment and to maintain personal safety, dignity, and goal-directed activity. Psychometric and imaging studies support a causal role for frontal system dysfunction. The view that frontal system dysfunction mediates or aggravates disability in a wide range of psychiatric and nonpsychiatric disorders 1) motivates further research on how ECF deficits interact with specific physical impairments to produce disability; 2) supports policies that base entitlements to care on ECF impairments; and 3) suggests the need for a vigorous search for drugs that prevent or palliate prefrontal dysfunction, especially the syndromes of apathy and impaired ECF.

Activities of Daily Living↗
PubMed1993

Depressed mood and care preferences in patients with AIDS.

Eight hundred ninety-seven patients with AIDS seen in ambulatory settings were questioned about whether they would accept a nursing home or a respirator if necessary to prolong their lives. Two hundred ninety-one (32.9%) said they would accept a nursing home; 102 (11.5%) said they would accept a respirator. Acceptability of these life-sustaining interventions was significantly lower in those patients who showed evidence of clinical depression on a structural screening instrument (nursing home: 29.4% vs 39.5%, p = 0.002; respirator: 9.4% vs 14.3%, p = 0.032). Depression remained significant in multivariate models of care preferences that controlled for demographics and symptom severity. Based upon follow-up interviews conducted an average of 11 months later, subjects who were initially depressed and found nursing home care unacceptable were significantly more likely to have changed their minds at follow-up if their depression was no longer present (45.7% vs 28.4%; p = 0.0005). Findings for respirator preferences were similar, but did not attain significance. We conclude that assessment for depression is essential when advance directives for care are elicited from patients with AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Cognitive function and spirometry performance in the elderly.

A total of 65 ambulatory subjects over the age of 65 yr were studied to determine if mild impairment in cognitive function precludes reliable spirometric measures in the aged. Standardized questionnaires were used to obtain information on demographics, cigarette smoking, respiratory symptoms, and physician-diagnosed lung disease. Each subject performed several simple standardized tasks of cognitive function and underwent spirometric testing. A total of 36 women and 29 men participated. The mean age for the group was 74.9 +/- 5.6 yr; most were nonsmokers (never smokers, n = 28; former smokers, n = 29; and current smokers, n = 8). Of the 65 participants, 8 (12.3%) individuals were unable to perform at least three ATS-acceptable FVC maneuvers after suitable demonstration. These subjects were similar to the 57 subjects able to perform three acceptable maneuvers, except for worse scores on both the symbol-digit modalities test (23.3 +/- 3.6 versus 31.6 +/- 10.5, p < 0.001) and the trail-making test, Part B (244.3 +/- 87.1 versus 160.4 +/- 71.8, p < 0.01). Of the 57 subjects able to perform spirometry, 18 (31.6%) failed to meet ATS reproducibility criteria for FEV1, FVC, or both. Cognitive impairment was not associated with the ability to achieve reproducible measures. These results suggest that the vast majority of older subjects can perform reliable spirometry; those elderly unable to perform spirometry may have impairment in cognitive function requiring further evaluation.

Aged↗
PubMed1991

Psychotropic drug use in the medically ill. Part II.

Underlying medical illness and drug interactions may make the use of psychotropic agents problematic in some physically ill patients. This overview, published in two parts, discusses six major classes of psychotropic medications (cyclic antidepressants, monoamine oxidase inhibitors, benzodiazepines, neuroleptics, lithium, psychostimulants, and carbamazepine) and examines their use in the setting of specific types of medical illnesses (e.g., cardiovascular, pulmonary, hepatic, and renal disease). Practical considerations in using psychotropic medications in medical-surgical patients--particularly those who are elderly or medically debilitated--will receive special emphasis.

Drug Interactions↗
PubMed1991

The high sensitivity cognitive screen.

Ceiling effects limit the utility of many established brief cognitive screening tests for detecting and measuring mild delirious states and prodromal disorders. The High Sensitivity Cognitive Screen (HSCS) (Faust & Fogel, 1989), a bedside test taking approximately 25 minutes to administer, may overcome this limitation. The test consists of a selection of moderately difficult items testing six major domains of neuropsychological performance: memory, language, attention/concentration, visual/motor, spatial, and self-regulation and planning. Reliability is adequate, and two separate concurrent validity studies show accuracy rates of 93% and 87% in classifying the overall result of comprehensive neuropsychological testing. HSCS performance is highly correlated with EEG results in medical psychiatric inpatients, and with functional status in HIV-infected community-dwelling subjects. The brevity and convenience of the HSCS and related instruments make them particularly useful in studies of elderly and chronically ill subjects.

AIDS Dementia Complex↗
PubMed1990

Psychotropic drug use in the medically ill: Part I.

Underlying medical illness and drug interactions may make the use of psychotropic agents in some physically ill patients problematic. This overview, published in two parts, discusses six major classes of psychotropic medications (cyclic antidepressants, monoamine oxidase inhibitors, benzodiazepines, neuroleptics, lithium, psychostimulants, and carbamazepine) and examines their use in the setting of specific types of medical illnesses (e.g., cardiovascular, pulmonary, hepatic, and renal disease). Practical considerations in using psychotropic medications in medical-surgical patients, particularly those who are elderly or medically debilitated, receive special emphasis. In part I, the use of cyclic antidepressants, monoamine oxidase inhibitors, benzodiazepines, and buspirone are discussed.

Drug Interactions↗
PubMed1990

Anticonvulsant-responsive panic attacks with temporal lobe EEG abnormalities.

The phenomenology of panic attacks and of complex partial seizures overlap, and at times distinguishing between the two entities is difficult. The authors report five patients with recurrent panic attacks and temporal lobe EEG abnormalities whose symptoms did not warrant a clinical diagnosis of partial seizures but who responded well to anticonvulsant therapy. The cases suggest that focal cortical discharges may trigger panic attacks in some patients in whom an unequivocal diagnosis of epilepsy cannot be made. Electroencephalography and anticonvulsant trials may be appropriate in patients with panic attacks refractory to conventional treatment.

Adolescent↗