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Biomedical subjects

E B Larson

Publications and source records attributed to E B Larson.

At least 199 records · Page 11Linked to original sources
PubMed1986

Diagnostic tests in the evaluation of dementia. A prospective study of 200 elderly outpatients.

We studied the components of the diagnostic evaluation in 200 patients older than 60 years of age with suspected dementia who received standardized diagnostic evaluation and follow-up. The most common dementia diagnoses were Alzheimer's-type dementia (74.5%) and dementia due to toxic effects of drugs (9.5%). Eleven patients with hypothyroidism, metabolic encephalopathies due to hyponatremia, hyperparathyroidism, and hypoglycemia required laboratory tests for diagnosis, whereas the other dementia diagnoses were made primarily on the basis of data available on the history and physical and neurologic examinations. The complete blood cell count, blood chemistry battery (especially sodium, calcium, and glucose concentrations), and thyroid function tests were of definite value for the diagnosis of unsuspected disease and were useful as routine tests in evaluating patients for dementia. A careful history and physical examination accompanied by complete blood cell count, chemistry battery, and a thyroid function test would have been effective in diagnosing treatable illnesses causing cognitive impairment. Other diagnostic tests could have been used selectively based on results of the examination and screening tests. Estimated diagnostic charges from a selective approach would be 25% to 34% of those for the "routine" evaluation.

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PubMed1986

Features of potentially reversible dementia in elderly outpatients.

A standardized evaluation was carried out in two separate groups of patients with dementia to determine the features that characterize those with potentially reversible or treatable dementia. In both groups, Alzheimer's-type dementia was the most common diagnosis (65% and 70%); the most common cause of potentially reversible cognitive impairment was medication toxicity. In both groups, patients with potentially reversible dementia had a shorter duration of symptoms, less severe dementia and used more prescription drugs. Because of this association, these features may be considered risk factors but are not distinguishing or diagnostic features of patients with potentially reversible dementia. Other, previously undetected, treatable illnesses not often considered in the differential diagnosis of potentially reversible or treatable dementia were also prevalent in these patients.

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PubMed1985

Positive airway pressure for high-altitude pulmonary oedema.

Expiratory positive airway pressure was studied on Mount McKinley, Alaska, at an altitude of 4400 m, in three climbers with high-altitude pulmonary oedema and five climbers without evidence of this disorder. In the subjects with high-altitude pulmonary oedema oxygen saturation improved from 53.3 +/- 10.1% to 72.0 +/- 5.7% with expiratory positive airway pressure of 10 cm water. Oxygen saturation, heart rate, and respiratory rate did not change in healthy climbers. No adverse effects were noted. Improved oxygen saturation did not persist when expiratory positive airway pressure was discontinued. This procedure may be useful as a temporary first-aid measure in high-altitude pulmonary oedema.

Adult↗
PubMed1985

Diagnostic evaluation of 200 elderly outpatients with suspected dementia.

A standardized diagnostic evaluation was performed on 200 consecutive patients over age 60 with suspected dementia. Diagnoses were confirmed by consensus and subsequently by follow up. Over 70% had Alzheimer's type dementia; 31% had more than one illness contributing to the dementia state, with overlap between the two groups. The most common so-called "treatable" illnesses were drug toxicity, hypothyroidism, and other metabolic diseases; 248 other medical diseases were recognized in 124 patients. Improvement occurred in 55 patients (27.5%) and persisted in 28 (14%) for at least a year during follow up, but only 2 patients recovered normal mental function. Our results emphasize the importance of recognizing and treating the multiple illnesses that contribute to dementia in elderly adults. The distribution of illnesses in demented elderly outpatients is different from that reported in younger patients with dementia. Diagnostic strategies and expectations need to be based on data obtained from studies of elderly patients with suspected dementia.

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PubMed1985

A new method of measuring brain atrophy: the effect of aging in its application for diagnosing dementia.

A new method of measuring cerebral atrophy using a ratio of brain parenchyma to ventricular and subarachnoid space is described. It uses digitized brain CT. This ratio was measured prospectively on 117 consecutive elderly patients referred for evaluation of cognitive dysfunction. Diagnosis was determined by preestablished criteria and confirmed by follow-up. Despite the improved accuracy and reproducibility of this method, its ability to differentiate persons with senile dementia of the Alzheimer's type (SDAT) from those suffering from pseudodementia was confounded by age, and was hence of limited utility. We conclude that even with sophisticated measures of cerebral atrophy, CT is unable to discriminate among common causes of cognitive dysfunction in the elderly.

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PubMed1985

Alzheimer's disease and long-term care: the assessment of the patient.

We briefly touched on the excitement, then quickly moved into the trenches. There are models for providing accurate assessments, both for patients with dedicated families and for those who are isolated. The models are imperfect, and await improvement from our colleagues and students. We have also documented the fact that families know what they are talking about (hardly a revelation to experienced clinicians). A refinement in the diagnosis of Alzheimer's disease is that depression and medical illness are more likely to aggravate Alzheimer's than to imitate it. An understanding of this element will help in keeping our evaluation and treatment plans accurate and useful. There is plenty of work for all of us--scientists, clinicians, and caretakers--who are involved with the assessment and long-term care of those with Alzheimer's. We may use different means toward the common goal of reducing suffering, but we all need each other.

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PubMed1984

Hickman catheter infections in patients with malignancies.

The infectious complications associated with implantation of 1,088 Hickman catheters (HCs) in 992 patients reported in 18 published series are presented (including data on 129 previously unreported HCs from our own institution). HCs allow reliable long-term venous access (mean, 92.4 days) with low complication and infection rates (0.30 and 0.14 cases per 100 catheter days, respectively). Exit site infections were the most common form of infection encountered (45.5%), followed by septicemia alone (30.8%), tunnel infections (20.3%), and septic thrombophlebitis (3.5%). Staphylococcus epidermidis (54.1%) and S. aureus (20.0%) were the most common pathogens responsible for catheter infections. HC infections were associated with a low mortality rate (maximum rate of 0.5%). Risk factor analysis of 129 HCs demonstrated that catheter thrombosis was the major risk factor associated with development of catheter infection. Presence of fever, distant infection, neutropenia or antibiotic administration on the day of catheter insertion was not significantly associated with HC infection in this series (although there was a trend suggesting an increased risk of infection of HCs inserted during febrile episodes). Based on observations at our institution and from a review of the literature, tentative recommendations for management of the various types of HC infections are outlined.

Acute Disease↗
PubMed1984

Cognitive performance and functional competence in coexisting dementia and depression.

Assessment was made of the impact of depression on the intelligence, memory, and functional competence of elderly community residents (aged 57-88 years) with senile dementia of the Alzheimer's type. Outpatients with either dementia (n = 21) or dementia coexisting with depression (n = 14) were given the Wechsler Adult Intelligence Scale (WAIS), Wechsler Memory Scale (WMS), and Dementia Rating Scale (DRS). No significant group differences were found for verbal IQ, performance IQ, or WMS memory quotient. Patients with coexisting dementia and depression earned significantly lower full scale IQ scores than patients with only dementia. Analysis of WAIS and WMS subtest scores and profiles revealed no difference between the two groups. Significant associations were found among the various cognitive measures and functional competence in both groups, but the patterns of these relationships differed. Intellectual measures accounted for the greatest proportion of functional competence variance in the patients with dementia, whereas memory measures accounted for the greatest proportion of variance in the patients with coexisting dementia and depression.

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PubMed1984

Quality of ambulatory care of the elderly: an analysis of five conditions.

Twelve hundred twenty-six (1,226) persons representative of the noninstitutionalized United States population aged 65-74 years were interviewed and examined as part of the 1971-1975 Health and Nutrition Examination Survey (HANES). Using information available in the HANES data base, standards for what could be considered minimally acceptable care were developed for five tracer conditions. Rates of "deficient" care were: angina, 46 percent; dyspnea on exertion, 78 per cent; hypertension, 26 per cent; hearing impairment, 61 per cent; depression, 80 per cent. Deficient care was analyzed by gender, race, income, locale, and self-rated health status. Only low income emerged as a consistent risk factor for deficient care, with the relative odds for deficient care for poor patients as compared with non-poor patients ranging from 2.7 to 5.6 (P less than 0.05) for four of five conditions. A subgroup analysis attempted to determine whether deficiencies were caused by limited access to physicians, underreporting of symptoms, or barriers that occurred after presenting complaints to a physician. The analysis revealed that for three of four symptomatic conditions, the poor and non-poor patients were equally likely to report their symptoms, whereas the poor were more likely to receive "deficient" care after presenting complaints to physicians. The ramifications of these findings as they pertain to the present situation are discussed.

Aged↗
PubMed1984

Low sensitivity of sonography and cholescintigraphy in acalculous cholecystitis.

Acalculous cholecystitis is difficult to diagnose by clinical means or contrast radiography. Because sonography and cholescintigraphy have both been shown to do well in the diagnosis of calculous cholecystitis, the sensitivity of these newer imaging methods was assessed retrospectively in 33 proven cases of acalculous cholecystitis. The sensitivities to acalculous cholecystitis for sonography (67%) and for cholescintigraphy (68%) were not as high as has been reported for these tests in calculous cholecystitis. Reasons for the lower sensitivity with each test and the pathogenesis of acalculous cholecystitis are discussed.

Acute Disease↗
PubMed1984

Dementia in elderly outpatients: a prospective study.

We prospectively studied the evaluation of dementia in 107 unselected outpatients; 83 had so-called "irreversible" dementias, including 74 who had an Alzheimer-type dementia. Fifteen patients had potentially reversible dementias, of which hypothyroidism and drug toxicity were the commonest causes. Distinguishing features of reversible dementia were shorter duration, use of more prescription drugs, and less severe dementia. Almost half of the patients had other previously unrecognized treatable medical diseases. Most diagnoses were made from patient history and physical and mental status examination. Patients with reversible dementia improved but rarely reverted to normal. Objective improvement occurred in 25 patients after treating unrecognized coexistent medical and psychiatric diseases, or stopping unnecessary medication. Careful clinical observation is the most useful part of the evaluation and extensive testing may not be required for all patients. Overemphasis on distinguishing reversible from irreversible forms of dementia may detract from recognition of commoner, treatable causes of dysfunction and suffering.

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