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D Coakley

Publications and source records attributed to D Coakley.

116 records · Page 7Linked to original sources
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Letter and category fluency in Alzheimer's disease: a prognostic indicator of progression?

This study investigated differential patterns of performance by 40 Alzheimer's disease (AD) patients on standardised letter and category fluency tests. The performance of 24 age and education matched controls was used to classify patients as relatively more letter fluency impaired (L < C, n = 15) or more category fluency impaired (C < L, n = 25), and clinical features distinguishing these patient subgroups were investigated. Category performance was equally impaired in both patient subgroups, whereas the L < C subgroups were particularly impaired on letter fluency. The subgroups differed significantly in duration of illness (24 months for L < C group, 47 months for C < L group; t = 2.69, p = 0.01) but did not differ in global dementia severity, age, education, general language ability, or functional status. Data on annual rate of change (ARC) on the Mini-Mental State Examination were available for 26 patients. While not statistically significant, subgroup ARC differences were suggestive of more rapid decline in the L < C patients, consistent with the finding of shorter duration of illness in this group. Word fluency tests may have potential as early predictors of rate of progression in AD.

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Bone aluminium content in Alzheimer's disease.

The possible association between aluminium and Alzheimer's disease is still contentious. If aluminium neurotoxicity is implicated in the pathophysiology of Alzheimer's disease, it may result either from excessive aluminium exposure or increased brain aluminium uptake. In a pilot study to test the former hypothesis, trabecular bone aluminium content, which reflects long-term aluminium exposure, was evaluated in 7 patients with a clinical diagnosis of senile dementia of the Alzheimer type (SDAT; mean age 80.8 +/- 3.35 years) and 19 non-demented age-matched controls (mean age 79.6 +/- 6.09 years). Trabecular bone was obtained from post-traumatic femoral neck fracture specimens taken from patients during femoral head prosthesis surgery. Bone aluminium content was expressed quantitatively by atomic absorption spectrometry and qualitatively by the acid solochrome azurine histological staining technique. Quantitative analysis showed a lower aluminium content in the SDAT (11.9 +/- 4.04 micrograms/g dry bone) versus the non-demented group (18.2 +/- 7.37 micrograms/g), which was significant at the 95% but not at the 99% confidence limit. Aluminium deposition from qualitative histological analysis was not detectable in either group. These results do not support a hypothesis of excessive aluminium absorption and tissue accumulation in Alzheimer's disease.

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Hypovitaminosis D in the healthy elderly.

Hypovitaminosis D is a common finding in the healthy elderly population and has significant sequelae. No clear dietary or sunlight-related risk factors were identified by dietary assessment and modified outdoor score. Fortified liquid milk and vitamin supplements were associated with significantly higher serum 25-hydroxyvitamin D levels. These results emphasise the need for foodstuff fortification and supplement use in the healthy elderly, as well as the 'high-risk' housebound and institutionalised elderly.

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A memory clinic for the assessment of mild dementia.

The aims and experience of work in a specialist memory clinic' are described with reference to the first 200 patients attending the service. 93.5% of attenders were found to suffer from dementia. 67.9% of these fulfilled criteria for probable/possible Alzheimer's disease or other primary degenerative dementias and 8.6% fulfilled criteria for vascular dementia. In the remaining cases the aetiology of the dementia was considered to be multifactorial. The memory clinic proved to be an important resource for demented patients, their carers, and for research projects.

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Knowledge and attitudes to prescribed drugs in young and elderly patients.

Increasing patient knowledge of drug therapy is said to improve compliance and may reduce adverse drug reactions. We assessed patient knowledge of prescribed drugs in fifty patients attending a hypertension clinic [outpatients] and in elderly patients on admission to (n = 129) and on discharge from (n = 100) an acute geriatric assessment unit. We found that 88% of outpatients, 40% of elderly admissions, and 41% of elderly discharges knew the indications for their therapy; only 40% of outpatients, 8% of elderly admissions and 12% of elderly discharges could name their medications. Patients said that their information came principally from the prescribing doctor. In a further study we assessed doctor, nurse, young and elderly patients' ability to discriminate between commonly prescribed white tablets. Errors were made by the doctors on 25% occasions, nurses on 40% occasions and patients on 61% occasions. Young patients made errors 67% of the time and elderly patients 55% of the time. These studies indicate that both inpatients and outpatients, both young and elderly have poor knowledge of their medications. In addition, many commonly prescribed drugs are not easily distinguishable by patient, prescriber or drug administrator. We conclude that there is a need to improve knowledge both in patients and in prescribers. We suggest that prescribers should consider the colour and shape of medications prescribed concurrently as many "little white tablets" are difficult to tell apart.

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PubMedDate not supplied

Eye screening in the elderly.

Poor vision is considered to be a common unreported illness in the elderly population. To determine its prevalence we carried out an eye screen on 150 randomly selected co-operative elderly subjects attending St James's Hospital. A database [mean age 78.2 years (range 65 to 97)], medical history, mini-mental test score [mean score 9.1 (range 2 to 10)], mobility assessment and history of eye problems was gathered. A visual test of both eyes together (standard N6 and N8), inspection of the eyes, tonometry (Perkin's handheld tonometer) and fundoscopy were performed on each subject and the need and reason for referral to an optician or an ophthalmologist was documented. Results show that 64% of subjects could read N6 or N8. Tonometry revealed no subject with raised intraocular pressure, including 4 subjects who were currently on treatment for glaucoma. Fundoscopy showed that 57.3% of subjects had some evidence of cataracts, 16.6% moderate and 3% severe. The retina appeared normal in 58.6% of subjects, 20.6% of the population had hypertensive changes, 4.6% had diabetic changes, 3% had optic atrophy, 1.3% had macular degeneration and a further 10% could not be clearly visualised due to cataracts. 90% of subjects wore glasses and the average duration since the glasses were last changed was 3.7 years (range 2 weeks to 20 years). No glasses examined were in need of cleaning or repair. 36% of subjects could not read N8 (28 of these had forgotten their glasses and were advised to visit their optician if they could not read newsprint). 7.3% of subjects were referred to an optician for new glasses, 1.3% were referred to an ophthalmologist for newly diagnosed cataracts and 6.6% were regular attenders to an ophthalmologist. We conclude that the rate of new referrals for the occurrence of correctable undetected visual acuity deficit was lower than expected at 8.6% of subjects screened.

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