Biomedical subjects

Brent J Small

Publications and source records attributed to Brent J Small.

At least 19 recordsLinked to original sources

PubMed2005

Cognitive functioning after adjuvant chemotherapy and/or radiotherapy for early-stage breast carcinoma.

BACKGROUND: Evidence suggests that women diagnosed with early-stage breast carcinoma may experience cognitive problems as a consequence of adjuvant chemotherapy treatment. The present study was conducted to examine whether there are differences in cognitive performance and cognitive complaints between women treated with and without chemotherapy for TNM Stage 0 to II breast carcinoma. METHODS: As part of a larger study on quality of life, women were recruited with newly diagnosed Stage 0 to II breast carcinoma scheduled to be treated with chemotherapy plus radiotherapy (n = 60) or radiotherapy only (n = 83). Six months after the completion of treatment, participants were administered a standard neuropsychologic battery to assess cognitive performance and a self-report measure to assess perceived cognitive problems. RESULTS: There were no statistically significant differences between women who received chemotherapy and those who did not with regard to their average performance on tests of episodic memory, attention, complex cognition, motor performance, or language. Likewise, there were no significant differences between the treatment groups in the prevalence of impairment in each of these cognitive domains. Women who underwent chemotherapy also did not report significantly more problems with cognitive functioning than women treated without chemotherapy. CONCLUSIONS: The findings failed to confirm previous reports suggesting adjuvant chemotherapy is associated with problems in cognitive functioning among women who receive treatment for Stage 0 to II breast carcinoma. Future research should use prospective longitudinal research designs incorporating appropriate comparison groups to further explore this issue.

Analysis of Variance↗

PubMed2005

Corpus callosum in neurodegenerative diseases: findings in Parkinson's disease.

Corpus callosum area has been examined in neurodegenerative diseases as a marker for cortical pathology and for differential diagnosis; however, it has not been examined in Parkinson's disease (PD). We compared callosal area in patients with PD and PD with dementia (PDD) to healthy controls and patients with Alzheimer's disease (AD). We subsequently compared our results to a meta-analysis of studies examining callosal area in AD, frontotemporal dementia (FTD), progressive supranuclear palsy (PSP), and corticobasal degeneration (CBD). For the imaging study, midsagittal T1-weighted MRIs were analyzed and the callosal area was determined in patients with PD (n = 24), PDD (n = 25), AD (n = 16) and controls (n = 27). The meta-analysis combined results from all publications (Medline or PubMed) representing unique samples and measuring callosal area in AD, FTD, PSP, and CBD. We found that PD and PDD patients did not show statistically significant callosal atrophy compared to controls (effect size d, 95% CI, d = 0.13, -0.26 to 0.52, and d = 0.05, -0.44 to 0.33, respectively) or AD. The AD patients had a significant loss of callosal area compared to controls (d = -0.58, -1.01 to -0.15). Dementia severity was correlated with total callosal atrophy in AD (R = 0.66, p < 0.01) but not in PDD patients (R = 0.18, p > 0.1). The meta-analysis revealed significant combined effect sizes for callosal atrophy of: AD (d = -1.03, -1.13 to -0.93), FTD (d = -1.21, -1.56 to -0.86), PSP (d = -1.09, -1.38 to -0.81), and CBD (d = -1.80, -2.18 to -1.43). We conclude that PD and PDD patients do not have callosal atrophy in contrast to other neurodegenerative diseases, including AD. Callosal atrophy was correlated with dementia severity in patients with AD but not PDD.

Aged↗

PubMed2005

Training pain resource nurses: changes in their knowledge and attitudes.

PURPOSE/OBJECTIVES: To determine the changes in knowledge and attitudes of pain resource nurses (PRNs) as a result of an intensive pain management course. DESIGN: Pre- and post-test design. SETTING: A Veterans Administration hospital in the southeastern United States. SAMPLE: 18 RNs from multiple units where care is provided for veterans with cancer. METHODS: The PRNs were tested before and after a 32-hour intensive pain management course. MAIN RESEARCH VARIABLES: Knowledge about pain management, attitudes toward pain management, and attitudes toward patients in pain. FINDINGS: Significant improvements were found in pain knowledge and attitudes toward patients in pain. Improvements in attitudes toward pain management approached significance. CONCLUSIONS: The improvements in scores not only supported the effectiveness of the course but also provided additional evidence of the validity of the assessment instruments. IMPLICATIONS FOR NURSING: Courses such as this should be offered in other settings to encourage practicing nurses to provide better care to patients in pain and to serve as role models for their peers.

Adult↗

PubMed2005

Cognitive impairment in preclinical Alzheimer's disease: a meta-analysis.

To determine the size of the impairment across different cognitive domains in preclinical Alzheimer's disease (AD), a meta-analysis based on 47 studies involving 9,097 controls and 1,207 preclinical AD cases was conducted. There were marked preclinical deficits in global cognitive ability, episodic memory, perceptual speed, and executive functioning; somewhat smaller deficits in verbal ability, visuospatial skill, and attention; and no preclinical impairment in primary memory. Younger age (< 75 years) and shorter follow-up intervals (< 3 years) were associated with larger effect sizes for both global cognitive ability and episodic memory. For global cognitive ability, studies that used population-based sampling yielded larger effect sizes; for episodic memory, larger differences were seen in studies that preidentified groups in terms of baseline cognitive impairment. Within episodic memory, delayed testing and recall-based assessment resulted in the largest effect sizes. The authors conclude that deficits in multiple cognitive domains are characteristic of AD several years before clinical diagnosis. The generalized nature of the deficit is consistent with recent observations that multiple brain structures and functions are affected long before the AD diagnosis.

Adult↗

PubMed2004

A preclinical phase in vascular dementia: cognitive impairment three years before diagnosis.

Alzheimer's disease (AD) and vascular dementia (VaD) patients exhibit similar patterns of deficits in many cognitive tasks in the early clinical stages. Considering that preclinical cognitive deficits are well documented in AD, the purpose of the present study was to investigate if such deficits are also present in VaD. The cognitive outcome measure was the Mini-Mental State Examination (MMSE). The sample was taken from a population-based study and consisted of 699 persons who were nondemented at baseline, but out of whom 35 persons were diagnosed with VaD and 170 with AD at a 3-year follow-up. Both the incident VaD and AD cases exhibited baseline deficits on the total score of the MMSE and three of the subscales: orientation to time, orientation to place, and delayed memory. Further, both dementia groups exhibited precipitous decline on most MMSE subscales during the 3-year follow-up period. Logistic regression analyses showed that all subscales that revealed deficits at baseline predicted dementia status at follow-up. Delayed memory was the best predictor in both preclinical VaD and preclinical AD. Thus, these results demonstrate preclinical cognitive deficits in VaD in a measure of global cognitive functioning, which closely resemble those observed in AD. This observation suggests that circulatory disturbance is associated with cognitive problems several years before the actual VaD diagnosis.

Aged↗

PubMed2004

Similar patterns of cognitive deficits in the preclinical phases of vascular dementia and Alzheimer's disease.

We investigated whether (1) cognitive deficits are present among persons who will be diagnosed with vascular dementia (VaD) 3 years later, and (2) the pattern of such deficits is similar to that observed in preclinical Alzheimer's disease (AD). The VaD diagnosis was a diagnosis of post-stroke dementia. Population-based samples of 15 incident VaD cases, 43 incident AD cases, and 149 normal controls were compared on tests of episodic and short-term memory, verbal fluency, and visuospatial skill. Both dementia groups showed preclinical impairment relative controls on tasks assessing episodic memory 3 years before diagnosis, and there were no differences between these groups on any cognitive measure. The existence of a preclinical phase in the present VaD cases suggests that circulatory disturbance may affect cognitive performance before the occurrence of stroke that leads to clinical VaD. These results extend previous findings of similar patterns of cognitive deficits in the early clinical phases of AD and VaD to the preclinical phases of these diseases.

Aged↗

PubMed2004

Apolipoprotein E and cognitive performance: a meta-analysis.

The epsilon4 allele of the apolipoprotein E (APOE) gene is a known risk factor for Alzheimer's disease and may also affect cognitive performance in normal aging. Evidence of the presence and magnitude of epsilon4-related cognitive deficits was examined with a meta-analysis of the available literature. Thirty-eight studies were included, and cognitive performance was collapsed into 8 domains. Results indicated significant APOE-epsilon4 group differences for global cognitive functioning, episodic memory, and executive functioning, in favor of non-epsilon4 carriers. In addition, older age and APOE-epsilon4 heterozygosity was associated with smaller epsilon4-related impairments. The meta-analysis results suggest that APOE-epsilon4 genotype does affect cognitive performance in healthy aging, although the influence is relatively small and specific to certain domains of cognitive performance.

Adult↗

PubMed2003

Cognitive deficits in preclinical Alzheimer's disease.

We review the literature on cognitive functioning during the transition from normal aging to clinical Alzheimer's disease (AD). There is ample empirical evidence that deficits across multiple cognitive domains are apparent years to decades before the AD diagnosis, with impairments in episodic memory representing a common cognitive manifestation of the preclinical phase of the disease. Interestingly, the magnitude of the preclinical cognitive deficits appears to be relatively stable until a few years before clinical diagnosis. The behavioural deficits associated with preclinical AD are consistent with the neural changes that appear many years before eventual diagnosis. In addition to increasing our theoretical understanding of AD development, research on cognition in preclinical AD contributes to the identification of persons at risk of developing AD for purposes of intervention.

Aging↗

PubMed2003

Terminal decline and cognitive performance in very old age: does cause of death matter?

Cross-sectional differences and longitudinal changes in cognitive functioning in relation to mortality across a 7-year follow-up period, with 3 times of measurement, were examined in a population-based sample of very old adults. The authors also sought to determine whether cause of death (cerebro/cardiovascular disease [CVD]; non-CVD) modified the magnitude of mortality-related cognitive deficits. Cognitive performance was indexed by tests of general cognitive ability, episodic memory, primary memory, verbal fluency, and visuospatial ability. Results indicated cross-sectional differences on all domains of functioning, with persons who would die within 3 years after baseline testing performing more poorly. Longitudinally, greater decrements were observed on all domains for persons who would die after the first follow-up period, as compared with survivors. Cause of death failed to modify the magnitude of the cross-sectional and longitudinal deficits. The pattern of results point to the general nature of this phenomenon.

Aged↗

PubMed2003

Stability and change in adult personality over 6 years: findings from the Victoria Longitudinal Study.

Data from the Victoria Longitudinal Study were used to examine the 6-year longitudinal stability of personality in older adults. Personality was measured with the NEO Personality Inventory. The longitudinal sample consisted of 223 adults initially ranging from 55 to 85 years of age. Longitudinal confirmatory factor analyses were used to examine the stability of individual differences in change over time, and the stability of the longitudinal factor structure. The results indicated both substantial stability at the level of individual differences in change, as well as significant individual differences in change that were related to age and gender. Finally, the factor structure of personality was invariant over time but did not approximate simple structure for the five dimensions of personality. Our study of 6-year personality development provided both (a). a confirmation of early significant stability findings and (b). unique evidence for significant individual differences in late adulthood.

Aged↗

PubMed2003

Rate of cognitive decline in preclinical Alzheimer's disease: the role of comorbidity.

We investigated the influence of individual-difference variables implicated as risk factors for Alzheimer's disease (AD) or known to be related to cognitive performance in normal aging (e.g., age, sex, years of education, previous and recent diseases, apolipoprotein E status, social network, and substance use) on rate of cognitive change from preclinical to clinical AD. With the use of data from a population-based study, 230 persons who were nondemented at baseline and diagnosed with AD at a 3-year follow-up were examined with the Mini-Mental State Examination (MMSE). Of all predictor variables examined, only number of diseases resulting in hospital admission during the follow-up period made an independent contribution to rate of MMSE change. These results suggest that many variables affecting the onset of the degenerative process as well as cognitive functioning in normal aging exert little influence on rate of cognitive change in preclinical AD. This may reflect the fact that the emerging dementia disease overshadows the role of these variables for cognitive functioning. A possible exception to this pattern is that an increasing number of concomitant health conditions may exacerbate the rate of cognitive decline during the final portion of the preclinical phase in AD.

Aged↗

PubMed2003

Determinants of a sense of mastery in African American and White older adults.

OBJECTIVES: This study compares determinants of a sense of mastery in African American and White older adults. METHODS: The association between predictor variables (sociodemographic variables, health conditions, social resources, and religiosity) and feelings of mastery was assessed by using representative community-dwelling samples of 250 African American (mean age = 71.6) and 452 White (mean age = 73.0) older adults. RESULTS: African American older adults had a lower sense of mastery than White older adults. Significant modification by race was found in the associations of age, self-rated health, and religiosity with feelings of mastery. The negative effects of old age and poor health on feelings of mastery were stronger in the White sample, whereas the positive effect of religiosity on feelings of mastery was observed only in the African American sample. DISCUSSION: Although African American older adults had a lower sense of mastery than Whites, their feelings of mastery were less likely to be diminished by old age and poor health and more likely to be enhanced by religiosity. Possible explanations for cross-racial differences are discussed, as are implications.

Black or African American↗

PubMed2002

Efficacy and costs of two forms of stress management training for cancer patients undergoing chemotherapy.

PURPOSE: Professionally administered psychosocial interventions have been shown to improve the quality of life of cancer patients undergoing chemotherapy. The present study sought to improve access to psychosocial interventions during chemotherapy treatment by evaluating the efficacy and costs of a patient self-administered form of stress management training that requires limited professional time or experience to deliver. PATIENTS AND METHODS: Four hundred eleven patients about to start chemotherapy were randomly assigned to receive usual psychosocial care only, a professionally administered form of stress management training, or a patient self-administered form of stress management training. Quality-of-life assessments were conducted before randomization and before the second, third, and fourth treatment cycles. Intervention costs were estimated from both payer and societal perspectives. RESULTS: Compared with patients who received usual care only, patients receiving the self-administered intervention reported significantly (P < or = .05) better physical functioning, greater vitality, fewer role limitations because of emotional problems, and better mental health. In contrast, patients who received the professionally administered intervention fared no better in terms of quality of life than patients receiving usual care only. Costs of the self-administered intervention were estimated to be 66% (from a payer perspective) to 68% (from a societal perspective) less than the average costs of professionally administered psychosocial interventions for patients starting chemotherapy. CONCLUSION: Evidence regarding the efficacy and favorable costs of self-administered stress management training suggests that this intervention has the potential to greatly improve patient access to psychosocial intervention during chemotherapy treatment.

Adult↗

PubMed2002

Influences of preclinical dementia and impending death on the magnitude of age-related cognitive deficits.

The authors examined the influence of preclinical dementia and impending death on the cross-sectional relationship between age and performance in tasks assessing episodic memory, visuospatial skill, and verbal fluency. Increasing age was associated with a general decrease in cognitive performance. In addition, those who were to be diagnosed with dementia or had died by a 3-year follow-up, were older, and performed at a lower level than the remaining sample across all cognitive tasks at baseline. Nevertheless, removal of the preclinical dementia and impending death groups from the original sample affected the cross-sectional age-cognition relations relatively little. This pattern of findings suggests that the biological aging process exerts negative influences on cognitive functioning beyond those resulting from disease and mortality.

Age Factors↗

PubMed2002

Pain reports by older hospice cancer patients and family caregivers: the role of cognitive functioning.

PURPOSE: Prior research in nursing homes has shown that cognitive impairment may reduce self-reported pain, but this relation has not been systematically explored among hospice patients. The assessment and treatment of pain is a primary goal of hospice care, and both disease processes and the use of opioid analgesics may lead to cognitive impairment among hospice patients. However, little is known about how cognitive functioning may impact the self-report of pain or the report of care recipient pain by family caregivers. DESIGN AND METHODS: We explored the associations between pain, cognitive functioning, and gender among cancer patients and their family caregivers (N = 176 dyads) during in-home hospice care. This was a cross-sectional, correlational study. RESULTS: Contrary to expectation, care recipients with cognitive impairment reported more intense pain than care recipients with intact cognitive functioning. However, cognitive impairment among care recipients had no impact on the pain report of family caregivers. Care recipient cognitive impairment was related to greater discrepancy in the pain reports of caregivers and care recipients. No gender differences in pain intensity report were found. IMPLICATIONS: Measurement issues and implications for assessing self-reported pain among hospice cancer patients with impaired cognitive functioning and the report of care recipient pain by family caregivers are discussed. Specifically, hospice staff must educate family caregivers regarding the potential impact of care recipient cognitive impairment on pain reports in order to facilitate accurate pain assessment and management.

Adult↗

PubMed2002

The role of mastery and social resources in the associations between disability and depression in later life.

PURPOSE: Although disability is widely acknowledged as a risk factor for late-life depression, few studies have studied the potential of psychosocial factors to alter the association between disability and depression. The present study assessed the impacts of mastery and social resources (social network, social support, and satisfaction with support) on depression and, in particular, whether they modify the link between disability and depression. DESIGN AND METHODS: The direct and moderating effects of mastery and social resources were empirically tested using a sample of 406 community-dwelling older adults who were cognitively intact (mean age = 72.3). RESULTS: Higher level of mastery and greater satisfaction with support had significant direct effects on depression and also buffered the adverse impact of disability on depression. IMPLICATIONS: The findings support the importance of psychosocial factors in modifying the association between disability and depression and suggest that efforts to enhance positive psychosocial attributes should be emphasized in interventions for older adults.

Activities of Daily Living↗

PubMed2002

Elderly norms for the Spot-the-Word test.

This study provides population-based normative data for healthy, community-dwelling American elderly on the Spot-the-Word test (STW). The effects of age, education, and gender on STW performance are also investigated. Given previously limited normative data for the elderly, the current norms expand the clinical utility of STW as an estimate of premorbid intelligence. Significant but small effects were found for age on STW performance. Significant and moderate effects were found for education. Therefore, normative adjustments are provided for education. Consistent with previous research, no effect was found for gender.

Journal Article↗

PubMed2002

3MS normative data for the elderly.

The Modified Mini-Mental State Examination (3MS) was developed to overcome shortcomings of the Mini-Mental Status Exam (MMSE), specifically its narrow range of possible scores and ceiling effects. Several studies have examined the psychometric characteristics of the 3MS, showing an improvement in reliability and increased sensitivity in detecting dementia in comparison to the MMSE. Despite research supporting the favorable psychometric features of the 3MS, the clinical value of the instrument is restricted by limited normative data, especially for the elderly population. In this study, we examine the influence of demographic characteristics on 3MS scores and present descriptive data for a sample of 393 community-dwelling older adults. Normative data, based on age and with adjustments for education, are provided for clinical use.

Journal Article↗