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Biomedical subjects

E Kokmen

Publications and source records attributed to E Kokmen.

At least 37 records · Page 2Linked to original sources
PubMed1999

Testing normal older people three or four times at 1- to 2-year intervals: defining normal variance.

Normative data were presented that defined the upper and lower standards for deciding if cognitive abilities show reliable change over 2 or more testing occasions when retesting occurs at 1- to 2-year intervals. The Mayo Cognitive Factor Scores (MCFS; G. E. Smith et al., 1994) were analyzed because they permit the quantitation of overall functioning in 5 clinically important cognitive domains: established verbal knowledge, nonverbal reasoning, attention and concentration, new learning, and delayed memory. To the authors' knowledge, this is the first report of both group-level and individual-level data analyses derived from a respectably sized sample of normal persons who have been tested 3 or more times at clinically common test-retest intervals.

Aged↗
PubMed1999

Use of physician and acute care services by persons with and without Alzheimer's disease: a population-based comparison.

OBJECTIVE: To estimate differences in use of acute care services between persons with and without Alzheimer's disease (AD). STUDY DESIGN: Population-based historical cohort study. SETTING/SUBJECTS: All Rochester, Minnesota, residents with AD onset between January 1, 1980, and December 31, 1984 (n = 301), plus one age- and sex-matched nondemented control per case, were identified with a retrospective review of community-based medical records. MEASUREMENTS: Cases and controls were followed in their medical records for number of acute care encounters in the year before January 1 of the index year (year of onset for AD case and their matched control) and in the 4 years following December 31 of the index year. Encounters included clinician visits (office or nursing home), emergency room (ER) visits, hospitalizations (inpatient and outpatient), and inpatient days. Multivariate regression analyses were adjusted for age, sex, pre-index level of illness, and follow-up time. RESULTS: In the pre-index period, cases and controls were similar with respect to level of illness, number of office visits, ER visits, and hospitalizations. In the year before AD onset, 17 cases (7%) had a clinician visit in the nursing home compared with no controls. In the 4 years after the index year, mean length of follow-up was 3.4 years for both cases and controls. The numbers of ER visits, hospitalizations, and inpatient days were similar for cases and controls. Sixty-four percent of AD cases had a clinician visit in a nursing home versus 1% of controls. Controls experienced more office visits than cases (median = 16 vs 10, P < .001). CONCLUSIONS: The onset of AD is not associated with greater use of acute care services. However, neither is the high use of nursing home care offset by fewer ER or hospital encounters.

Acute Disease↗
PubMed1999

Gradually progressive dementia without discrete cerebrovascular events in a patient with Sneddon's syndrome.

A 37-year-old man sought medical advice because of an 8-year history of a slowly progressive dementing illness with no clinically apparent discrete strokelike episodes. Cognitive functioning was markedly, globally impaired without lateralizing or localizing features. Widespread livedo reticularis led to a diagnosis of Sneddon's syndrome. Antiphospholipid antibodies and lupus anticoagulant were negative. Magnetic resonance imaging showed widespread cerebral atrophy, cortical and subcortical cerebral infarcts, and extensive periventricular white matter abnormalities. Cerebral angiography revealed diffuse medium- and small-vessel occlusive disease, with numerous collaterals in the mid and distal circulation but no evidence of atherosclerosis or vasculitis. No other cause of a dementing illness was found. We postulate that our patient's dementia was due to the cumulative effects of multiple cerebral infarcts.

Adult↗
PubMed1999

Delirium episodes during the course of clinically diagnosed Alzheimer's disease.

A retrospective review was conducted of 122 charts of patients with clinically diagnosed Alzheimer's disease (CDAD) who had participated in a longitudinal dementia study at the Mayo Clinic from 1965 to 1970. DSM-III-R diagnoses were assigned based on the longitudinal description of symptoms detailed in the Mayo Clinic medical records of the hospitalizations; clinic, home, and nursing home visits; and state hospital admissions. Thirty patients (25%) were found to have a delirium episode during their course of CDAD that occurred during inpatient admissions; 50% (15 of 30) of the delirium episode occurred in patients ages 80 to 89. Among patients with a delirium episode, 50% died within one year of the delirium episode and 64% died within two years. Of 13 patients, 10 (77%) had multiple delirium episodes within two years. Admitting diagnoses were mainly primary degenerative dementia of the Alzheimer's type (PDDAT) or PDDAT with delirium. Only 3 (10%) demented patients experienced delirium episodes during a medical admission. No deaths occurred during hospitalization for the years covered by this study. A psychiatric consultation was requested in only 17 (14%) patients; 88% of these patients received diagnoses involving PDDAT, late onset. An additional diagnosis included depressive disorders. Psychopharmacology was the major management strategy (82% of patients with a delirium episode received medication) with a resolution of symptoms within 48 hours. At discharge, only 2 (7%) patients failed to clear the increased degree of confusion.

Aged↗
PubMed1998

Incidence of dementia and Alzheimer's disease: a reanalysis of data from Rochester, Minnesota, 1975-1984.

For both dementia and Alzheimer's disease (AD), data regarding incidence rates in the oldest old and time trends in incidence are limited. The authors reanalyzed previously reported data on the incidence of dementia and AD in Rochester, Minnesota, from 1975 through 1984, using three new strategies. First, incidence rates were corrected by removing age-, sex-, and calendar year-specific prevalent cases from the census-derived denominator figures. Second, incidence figures for persons above age 84 years were disaggregated. Third, time trends were investigated graphically using age-specific curves and birth cohort curves. Dementia diagnosis and AD diagnosis followed defined ad hoc criteria. Analyses were conducted for men, women, and both sexes combined, and for dementia and AD separately. The age-specific incidence rates were similar in men and women, continued to increase after age 84 years, and remained stable over time for both dementia and AD. No birth cohort effect was present for either dementia or AD. The similar risks seen in men and women, the continuing increase in incidence after age 84 years, and the stability of incidence over time have important implications for etiologic research on AD.

Age Distribution↗
PubMed1998

Hippocampal atrophy and apolipoprotein E genotype are independently associated with Alzheimer's disease.

A variety of anatomic and functional neuroimaging findings are associated with Alzheimer's disease (AD). One of the strongest imaging associations identified is between AD and hippocampal atrophy. The epsilon4 allele of the apolipoprotein E (ApoE) gene increases the risk of developing AD and lowers the mean age of onset of the disease. The purpose of this study was to assess the association between hippocampal volume and ApoE polymorphisms in elderly control subjects and in patients with probable AD. We performed magnetic resonance imaging-based volume measurements of the hippocampus in 125 cognitively normal elderly controls and 62 patients with probable AD. ApoE genotyping was performed by using standard methods. Hippocampal volumes were significantly smaller in AD cases than in control subjects. Hippocampal volumes did not differ significantly within either clinical group on the basis of ApoE genotype. Both the epsilon4 allele of ApoE and hippocampal atrophy were significantly but independently associated with AD.

Aged↗
PubMed1998

Testing for apraxia in neurological patients: a descriptive study in two diverse cultures.

We constructed a detailed apraxia testing battery consisting of 55 items arranged in seven subparts and applied it to a convenience series of patients with a variety of neurological diseases and asymptomatic control subjects. A total of 173 subjects were evaluated in two culturally diverse settings: Rochester, MN, USA and in Istanbul, Turkey. There was little difference between performance scores in the two sites. The test could be completed within a reasonable time (5-10 min) in cases and in controls in both sites. Patients with Parkinson's disease performed just as well as controls but patients with Alzheimer's disease or other neurodegenerative disorders did less well than control subjects. Copyright Rapid Science Ltd

Journal Article↗
PubMed1998

Normative data for the Mattis Dementia Rating Scale.

Age-adjusted normative data are presented for persons over age 55 on the Mattis Dementia Rating Scale. Additional adjustment for the effect of education on test performance is also provided. These data were collected as part of Mayo's Older Americans Normative Studies (MOANS) in a continuing effort to develop age-appropriate norms for older persons on commonly used neuropsychological tests. The normative data presented here should prove more useful in characterizing the presence and severity of general cognitive dysfunction than currently available norms. Limitations and unique features of MOANS normative data are also discussed.

Aged↗
PubMed1998

Evidence of posterior fossa hypoplasia in the familial variant of adult Chiari I malformation: case report.

OBJECTIVE AND IMPORTANCE: A case of familial Chiari I malformation and a review of the literature are presented. Recent posterior fossa morphological studies suggest that the sporadic variant of adult Chiari I malformation may be caused by occipital dysplasia and overcrowding of posterior fossa contents. This analysis was applied retrospectively for two of the three members of this familial variant. CLINICAL PRESENTATION: A family is described in which symptomatic Chiari I malformation occurred in two generations: monozygotic twin sisters and the daughter of one sister. The monozygotic twins developed symptoms within 1 year of each other, and both had associated syringomyelia. The daughter of one of the twins presented with symptomatic tonsillar herniation alone at a young age. INTERVENTION: All three family members underwent surgical decompression of the craniovertebral junction, with or without syringosubarachnoid shunting, with good results. CONCLUSION: Cases of familial Chiari I malformation are rare, although they are probably under-reported. An evaluation of posterior fossa morphology in these patients suggests that occipital dysplasia and overcrowding of posterior fossa contents may be the substrate for both familial and sporadic cases of Chiari I malformation and suggests a unifying concept of origin.

Adolescent↗
PubMed1998

Measurement of impaired consciousness in the neurological intensive care unit: a new test.

Neurological deterioration in alert patients with an acute CNS disorder can be subtle, but current coma scales may not clearly capture changes in level of alertness. Many coma scales include components such as eye opening and content of speech, features that are difficult to assess in intubated patients and patients with facial trauma. Two new tools have been devised by the authors. The components are a continuous performance test (patient is asked to raise his hand every time he hears a certain letter in a standardised sentence) and the three consecutive hand position test ("thumbs up-fist-victory sign"). Variation within and between observers was assessed with three neurologists, two junior neurology residents, and two neuroscience nurses, and compared with the Glasgow coma score. The average agreements had comparable ranges for both scores, 65% to 89% for both tests and 60% to 88% for the Glasgow coma score. On the first visit 49% of all tests with a maximum Glasgow coma score had a negative continuous performance test as opposed to 13% of tests with a less than maximum Glasgow coma score. For the consecutive hand position test, these numbers were respectively 25% and 2%. These tests may be a reasonable alternative to the Glasgow coma score to monitor patients, in particular when the verbal and eye response cannot be reliably tested.

Analysis of Variance↗
PubMed1998

Apolipoprotein E genotype influences cognitive 'phenotype' in patients with Alzheimer's disease but not in healthy control subjects.

We examined the association of apolipoprotein E (apo E) genotype with cognitive performance in Alzheimer's disease (AD) and Mild Cognitive Impairment (MCI) patients and in normal subjects. One hundred fifty-seven AD patients, 35 MCI patients who developed AD during longitudinal follow-up, and 341 normal control subjects from the Mayo Clinic Alzheimer's Disease Patient Registry were studied. All participants were typed for apo E using polymerase chain reaction-based assay, epsilon 4+ and epsilon 4- groups were compared on cognitive factor scores of Verbal Comprehension, Perceptual Organization, Attention/Concentration, Learning, and Retention. Raw delayed verbal recall and visual confrontation naming scores supplemented these scores. Multivariate ANOVA was completed for cognitive scores. As expected, a main effect for diagnostic group was present across all scores. Multivariate main effects for age group and apo E genotype were also statistically significant. Subsequent within-group comparisons revealed no genotype differences for control subjects across all cognitive scores except raw delayed recall where an interaction indicated that older epsilon 4+ control subjects actually scored better than younger epsilon 4+ patients. Genotype differences were present for the Retention factor in the MCI sample and for Verbal Comprehension and Learning in the AD sample. In a combined cognitive impairment sample (AD + MCI), genotype differences were present for Verbal Comprehension, Learning, and Retention. Possession of an apo E epsilon 4 allele did not appear to be associated with poorer cognitive performance among normal control subjects. In the AD and MCI samples, epsilon 4+ status was associated with greater memory impairment in analyses including duration of illness as a covariate. In combined AD + MCI analyses, epsilon 4 homozygosity was associated with poorer retention, learning, and verbal comprehension at a given disease duration. Possession of the epsilon 4 genotype may influence cognition in a dose-response relationship.

Aged↗
PubMed1998

REM sleep behavior disorder and degenerative dementia: an association likely reflecting Lewy body disease.

BACKGROUND: REM sleep behavior disorder (RBD) has been reported with various neurodegenerative disorders, most frequently in disorders with Lewy body pathology. RBD often precedes the onset of PD, and a recent prospective study showed that 38% of patients with RBD eventually developed PD. METHODS: We identified 37 patients with degenerative dementia and a history of bursts of vigorous movement of the arms and legs with vocalization during sleep and associated with dream recall. Patients with and without two or more signs of parkinsonism were compared. Clinical, laboratory, and neuropsychometric features were analyzed, and criteria for the clinical diagnosis of dementia with Lewy bodies (DLB) were applied to all patients. RESULTS: Thirty-four of the 37 patients were male with mean age at onset of 61.5 years for RBD and 68.1 years for cognitive decline. RBD commenced before or concurrently with dementia in all patients but two. Parkinsonism (two or more signs) occurred in 54% of the sample (20/37), with a mean age at onset of 69.1 years. Polysomnography (PSG) confirmed RBD in all patients studied. Neuropsychological testing demonstrated impaired perceptual-organizational skills, verbal fluency, and marked constructional dyspraxia in more than one-half the patients. There were no statistically significant differences in the frequency of clinical features or in neuropsychological performance between patients with and without parkinsonism. Thirty-four patients (92%) met criteria for clinically possible or probable DLB. Three patients were autopsied; all had limbic with or without neocortical Lewy bodies. CONCLUSIONS: We report a group of predominantly male patients with a characteristic association of RBD and degenerative dementia. The clinical and neuropsychometric features of the groups of patients with and without parkinsonism are similar. We hypothesize that the underlying pathology in these patients is DLB.

Aged↗
PubMed1998

Rate of medial temporal lobe atrophy in typical aging and Alzheimer's disease.

OBJECTIVES: To determine the annual rates of volumetric change of the hippocampus and temporal horn in cognitively normal elderly control subjects and individually matched patients with AD, and to test the hypothesis that these rates were different. BACKGROUND: Cross-sectional studies consistently reveal cerebral atrophy in elderly nondemented subjects compared with healthy young adults, and greater atrophy in patients with AD relative to elderly control subjects. However, rates of atrophy are estimated most accurately by performing serial measurements in the same individuals. METHODS: MRI-based volumetric measurements of the hippocampi and temporal horns were performed in 24 cognitively normal subjects aged 70 to 89 years who were individually matched with respect to gender and age with 24 patients with AD. Each subject underwent an MRI protocol twice, separated by 12 months or more. RESULTS: The mean annual rate of hippocampal volume loss among control subjects was -1.55+/-1.38% and the temporal horns increased in volume by 6.15+/-7.69% per year. These rates were significantly greater among AD patients: hippocampus, -3.98+/-1.92% per year, p < 0.001; temporal horn, 14.16+/-8.47% per year, p = 0.002. CONCLUSION: A statistically significant yearly decline in hippocampal volume and an increase in temporal horn volume was identified in elderly control subjects who represent typical aging individuals. These rates were approximately 2.5 times greater in patients with AD than in individually age- and gender-matched control subjects.

Aged↗
PubMed1998

Nonsteroidal anti-inflammatory drug use and Alzheimer's disease: a case-control study in Rochester, Minnesota, 1980 through 1984.

OBJECTIVE: To compare the frequency of use of nonsteroidal anti-inflammatory drugs (NSAIDs) among 302 incident cases of Alzheimer's disease (AD) and age- and sex-matched control subjects. DESIGN: We undertook a retrospective case-control study, using the resources of the Rochester Epidemiology Project. MATERIAL AND METHODS: In ongoing studies of dementia in Rochester, Minnesota, we identified all incident cases of AD with onset between 1980 and 1984. From among all Rochester residents who received care at Mayo Clinic Rochester during those years, we selected one age- (within 3 years) and sex-matched control subject. For this study, exposure to a prescription NSAID was defined as prescribed use for 7 or more days during the 2-year window of time encompassing the year of onset and the year before onset among cases and the corresponding index year and the year prior for control subjects. RESULTS: The odds ratio (OR) for exposure, as described, to a prescription NSAID versus no exposure to any NSAID was 0.79 (95% confidence interval [CI], 0.45 to 1.38); the OR was 1.00 (95% CI, 0.52 to 1.92) for women and 0.40 (95% CI, 0.13 to 1.29) for men. Similarly, the overall OR for aspirin exposure versus no NSAID exposure was 0.90 (95% CI, 0.54 to 1.50). CONCLUSION: These data are suggestive but not confirmatory of a protective effect of NSAIDs for AD.

Aged↗
PubMed1997

Risk of dementia among persons with diabetes mellitus: a population-based cohort study.

It is unclear whether persons with diabetes are at increased risk for dementia, including Alzheimer's disease. Existing studies are limited by small sample size, selection bias, and case-control designs. This population-based historical cohort study provides estimates of the risk of dementia and Alzheimer's disease associated with adult onset diabetes mellitus (AODM). The sample included all persons with AODM residing in Rochester, Minnesota, on January 1, 1970, plus all persons diagnosed in Rochester or who moved to Rochester with the diagnosis between January 1, 1970, and December 31, 1984. Individuals were followed through review of their complete medical records from AODM diagnosis until dementia onset, emigration, death, or January 1, 1985. Standardized morbidity ratios for dementia and Alzheimer's disease were calculated, using an expected incidence based on age- and sex-specific rates for the Rochester population. Poisson regression was used to estimate risks for persons with AODM relative to those without. Of the 1,455 cases of AODM followed for 9,981 person-years, 101 developed dementia, including 77 who met criteria for Alzheimer's disease. Persons with AODM exhibited significantly increased risk of all dementia (Poisson regression relative risk (RR) = 1.66, 95% confidence interval (CI) 1.34-2.05). Risk of Alzheimer's disease was also elevated (for men, R = 2.27, 95% CI 1.55-3.31; for women, RR = 1.37, 95% CI 0.94-2.01). These findings emphasize the importance of AODM prevention and prompt additional investigation of the relation between AODM and dementia.

Age Distribution↗
PubMed1997

Response of the pupil to tropicamide is not a reliable test for Alzheimer disease.

OBJECTIVE: To confirm the putative hypersensitivity of the pupil to a weak mydriatic in persons with Alzheimer dementia. DESIGN: Twenty patients with Alzheimer dementia and 20 control subjects were examined. Automated binocular infrared pupillography was performed in the dark after instillation of 0.01% tropicamide or placebo. Ocular penetration of eye drops was assessed simultaneously using 2% fluorescein sodium as a tracer. SETTING: Rochester, Minn. SUBJECTS: Twenty patients and 20 cognitively normal control subjects from the Alzheimer's Disease Patient Registry of the Mayo Clinic, Rochester, Minn. MAIN OUTCOME MEASURE: Percent change in the diameter of the pupil following topical ocular instillation of a diluted concentration of the mydriatic drug tropicamide and penetration of topically applied fluorescein into the aqueous humor. RESULTS: No statistically significant difference was found between patients with Alzheimer disease and control subjects in either the mydriatic response of the pupil or in the rate of penetration of topically applied fluorescein. CONCLUSION: No evidence of pupillary hypersensitivity to an anticholinergic mydriatic drug was found in patients with Alzheimer disease or any evidence that this putative hypersensitivity could be used as an early, simple diagnostic test for Alzheimer disease.

Aged↗