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Biomedical subjects

D Coakley

Publications and source records attributed to D Coakley.

At least 91 records · Page 5Linked to original sources
PubMed1993

Parkinson's dementia and Alzheimer's dementia: an evoked potential comparison.

Auditory endogenous event-related potentials (ERPs) and flash visual evoked potentials (VEPs) were recorded in 26 elderly patients with idiopathic Parkinson's disease (PD), 14 with dementia and 12 non-demented, 16 elderly patients with Alzheimer dementia (AD) and 15 cognitively intact controls. ERP P3 and flash-VEP N2, P2 and delta (P2-P1) latency measures were significantly increased in the demented PD group compared with controls. The ERP P3 latency was also significantly delayed in the AD group compared with controls, but the differences in the flash-VEP measures from controls were not significant. No significant differences were noted between the PD groups, except for a significantly shorter flash-VEP N1 latency in the demented PD group; this was also the only significant evoked potential difference between the AD and PD dementia groups, which were otherwise electrophysiologically similar.

Aged↗
PubMed1993

Suitable screening tests for cognitive impairment and depression in the terminally ill--a prospective prevalence study.

Although confusional states and depression are common accompaniments of advanced cancer, few objective data are available concerning the prevalence of these clinical states or what methods are most suitable for their accurate detection. We decided that a 10-question Abbreviated Mental Test Score (AMTS) and a semistructured application of modified DSMIII-R (Diagnostic and Statistical Manual of Mental Disorder, third edition-revised) criteria for a major depressive illness were the most suitable screening tests for a terminally ill population. Thirty of 87 patients (34%) displayed significant cognitive impairment. The AMTS rating declined with approaching death and also correlated negatively with age. Of 81 patients, 21 (26%) were depressed when screened using DSMIII-R criteria for depression. One-third of patients with impaired AMTS scores also satisfied DSMIII-R criteria for depression. Of cognitively impaired patients, 90% had at least two possible causes for their confused state. We have found that both the AMTS and semistructured interview using DSMIII-R criteria for depression are useful routine screening tests in the terminally ill.

Adult↗
PubMed1992

High frequency eye tremor: reliability of measurement.

Recent reports suggest that high frequency eye tremor or ocular microtremor (OMT) may be a useful indicator of brainstem function. The method of record analysis, and in particular the amount of record subjected to such analysis, has varied widely. We have recorded OMT from 10 normal subjects. Using these records we have performed 42 distinct replication reliability studies. We suggest seven parameters of OMT (including overall frequency of tremor) which may be of value in comparing abnormal with normal records. For each parameter we have determined the optimal duration of the record to analyse and the reliability of such analysis. Our results suggest that at least 5 s of OMT should be analysed to yield an acceptable estimate of all seven parameters.

Adult↗
PubMed1992

'Pseudo-Alzheimer's' and primary brain tumour.

Primary brain tumour may present in the elderly purely as a dementing illness before the onset or detection of sensorimotor neurological symptoms or signs. Although neurological examination may indicate no definite signs, close attention to accepted DSM-IIIR and NINCDS-ADRDA diagnostic criteria for primary degenerative dementia and 'probable' Alzheimer's disease respectively will suggest a process other than a degenerative one. This was the case in two patients with primary brain tumour presenting clinically with dementing illness similar to but distinct from Alzheimer's disease.

Aged↗
PubMed1992

Vitamin-D-fortified liquid milk--a highly effective method of vitamin D administration for house-bound and institutionalised elderly.

The aim of the study was to assess the efficacy and acceptability of vitamin-D-fortified liquid milk in the management of hypovitaminosis D in an elderly institutionalised population. The design was a single-blind randomised controlled study. In phase I, patients were encouraged to drink an increased quantity of either fortified or unsupplemented milk for 3 months. In phase II, patients were continued on either fortified or on unsupplemented milk which was given as part of the everyday diet for a further 6 months with no extra encouragement of any patient to take additional amounts. Ninety-eight patients (mean age 84 years) from extended care wards at the Department of Medicine for the Elderly, St. James's Hospital, Dublin, Ireland, participated in the study. Seventy-eight patients completed phase I, and 62 completed phase II. A general biochemical screen and 25-hydroxy vitamin D measurements were performed at entry and repeated 3 and 9 months later. The average milk intake per patient in phase I was 454 ml/day in the unsupplemented group and 359 ml/day in the fortified milk group. In phase II, the average daily milk intake per patient was 235 ml in the unsupplemented milk group and 140 ml in the fortified milk group. Seventy-four patients (94%) of the total who completed phase I had serum vitamin D baseline levels below the normal range. In the fortified milk group, mean vitamin D levels rose from 2.4 to 14.80 ng/ml (p < 0.001) at the end of phase I and remained significantly elevated at 10.2 ng/ml (p < 0.001) at the end of phase II.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1991

Prospective hospital study of community acquired lower respiratory tract infection in the elderly.

A prospective study of community acquired lower respiratory tract infection in the elderly was carried out over a 15-month period. During this time 127 consecutive admissions to two acute geriatric medical wards were studied. An aetiology was established in 77 (61%) of cases. Streptococcus pneumoniae was identified in 37% of patients. Haemophilus influenzae in 18% and Branhamella catarrhalis in 10%. Infection with Mycoplasma pneumoniae was found in only one episode and no cases of Legionella pneumophilia were diagnosed. A significant number of patients had multiple bacterial pathogens isolated: 18% of all bacterial pathogens isolated were ampicillin resistant. Fourteen patients died (11%). Lower respiratory tract infection is a frequent cause of hospital admission for those aged over 65 and is often regarded as a preterminal event. Adequately treated however, mortality is no higher than in the general population. Knowledge of the likely pathogens allows early and appropriate antibiotic therapy for these patients whether at home or on admission to hospital.

Aged↗
PubMed1991

The fast flush test: evaluation in radial artery catheter-manometer systems.

The 'fast flush test' is commonly used to determine the dynamic response of catheter-manometer systems in vivo. We compared the fast flush test with an established bench top test in vitro. The results of the two tests were compared in fifteen underdamped radical artery catheter-manometer systems. There were significant differences between the results, (P less than 0.001 for both resonant frequency and damping factor), and the variance of estimates within measurement systems was significantly greater in the case of the fast flush test (P less than 0.05 and P less than 0.005 for resonant frequency and damping factor respectively). Nevertheless, the differences between the tests were small by comparison with the errors associated with either test; in addition there was a significant linear correlation between the results of the two tests (r = 0.91, P less than 0.001 and r = 0.85, P less than 0.001 for resonant frequency and damping factor respectively). In the in vitro situation, therefore, the fast flush test provides a crude estimate of the dynamic parameters of underdamped catheter-manometer systems.

Arteries↗
PubMed1991

Caring for dementia sufferers in the community: the caregivers problems.

Twenty-four carers of dementia sufferers were screened for psychological well being and compared with 19 carers of non-demented elderly. Carers of demented relatives showed significantly raised levels of stress on the Relatives' Stress Scale (RSS), and also increased psychiatric morbidity on the 30 item General Health Questionnaire (GHQ-30), when compared with the carers on non-demented relatives. Scores in the behaviour and mood disturbance scale (BMD) were significantly raised in the dementia group of patients, when compared with the non-demented group. However, high scores on the behaviour and mood disturbance Scale for the dementia sufferer were not correlated with increased stress and psychiatric morbidity scores found in the relatives of the patients with dementia. The implications of these findings are discussed.

Aged↗
PubMed1990

Elder abuse.

Elder abuse is an under-recognised cause of morbidity in the elderly. The frail elderly with multiple physical and psychiatric problems living with a relative who may also have a physical or psychiatric problem are particularly at risk. Although increased awareness of the problem and a high index of suspicion are necessary factors to diagnose the condition, clinical pointers towards diagnosis are available. Treatment for both victim and "carer" should be on the basis of multi-disciplinary assessment, and may result in admission of the elderly patient to an extended-care facility.

Aged↗
PubMed1990

The effect of mild to moderate dementia on the Geriatric Depression Scale and on the General Health Questionnaire.

The Geriatric Depression Scale (GDS) and two versions of the General Health Questionnaire (GHQ 28 and corrected GHQ 28) were administered to 111 patients admitted to an acute geriatric medical unit. Depression and dementia were diagnosed by semi-structured interview using DSM III criteria. There was no statistically significant difference in the three scales between cognitively normal depressed patients and demented depressed patients. The three scales were sensitive indicators of depressive illness (greater than 90%), but the GHQ 28 and CGHQ 28 needed adjustment of their community-based threshold values.

Aged↗
PubMed1990

Altered pharmacodynamics in the elderly.

The importance of age-related changes in drug sensitivity is increasingly appreciated. More conclusive evidence is now being presented in combined kinetic and dynamic studies. The type, intensity, and duration of drug action may be affected, ranging from therapeutic failure to major drug toxicity. Alterations in physiologic and homeostatic systems, including the autonomic system, baroreceptors, thermoregulation, and balance, have been described. These may explain the propensity to postural hypotension, falls, hypothermia, and confusion, particularly following drug-induced decrements in these systems. Studies on the sensitivity to individual drugs produce a varied picture emphasizing the danger of generalizations. An increased sensitivity to many agents affecting the central nervous system, including benzodiazepines, halothane, metoclopramide, and narcotic analgesics, is becoming apparent. For the latter this may also be accompanied by an age-associated qualitative difference in toxicity. Whereas there is conclusive evidence of a reduced responsiveness to propranolol, the data are conflicting for calcium antagonists. The increased hypotensive response to ACE inhibitors is more likely due to kinetic factors. The anticoagulant response to warfarin is enhanced. Evidence is also emerging of a wide divergence in the sensitivity of different systems to the same drug--with aging the inotropic effect of theophylline is increased, but the bronchodilator response is decreased. It is becoming clear also that there is a need to separately study certain subgroups of the elderly population.

Aged↗
PubMed1989

Do subjects with stiff arteries have high blood pressure?

It has been argued that age-related increases in arterial stiffness could lead to spuriously high indirect blood pressure measurements, with consequent overdiagnosis of hypertension in older patients. To study the relationship between arterial stiffness and blood pressure, we identified patients with 'arterial stiffness', using Osler's manoeuvre, and compared their blood pressure levels with patients of a similar age. A total of 250 hospital inpatients were assessed independently by two doctors. In the 198 patients (79%) where both observers agreed on Osler's manoeuvre status, positive Osler's manoeuvre was uncommon under the age of 50 years but became more common thereafter, rising to 58% of patients aged over 75 years. However, blood pressure levels were similar in each age group, irrespective of Osler's manoeuvre status. We conclude that increased arterial stiffness as measured by Osler's manoeuvre is not necessarily associated with raised blood pressure levels in the elderly.

Adolescent↗