Biomedical subjects

E Kokmen

Publications and source records attributed to E Kokmen.

At least 73 records · Page 4Linked to original sources

PubMed1994

Patterns and predictors of institutionalization in community-based dementia patients.

OBJECTIVE: To investigate patterns and predictors of institutionalization in a community-based sample of dementia patients. SETTING: The Mayo Clinic Alzheimer's Disease Patient Registry (ADPR), a community-based prospective registry. PATIENTS: Two hundred seventy-five participants, including 145 dementia patients and 130 controls on whom longitudinal follow-up data was available. The mean ages were 79.9 and 78.8 years, and the mean Mini-Mental State Examination (MMSE) scores at enrollment were 22.1 and 28.1 points for the demented cases and controls, respectively. MEASURES: Place of residence, marital status, number of direct support providers, global cognitive status, activities of daily living and instrumental activities of daily living were used in hazards modeling of institutionalization. RESULTS: The results from our community-based sample suggest a high rate of institutionalization for dementia patients. One-half of the sample of dementia patients were institutionalized within 2.5 years of enrollment in our patient registry. Identified assistance providers were absent in a significant proportion (36%) of our dementia sample. Marital status, global cognitive function, and functional status were significant terms in hazards models of institutionalization. Age, gender, number of direct caregivers, and dementia etiology were not associated with significant risk. Seventy-two percent of the dementia patients who died over the course of this study had been placed in nursing home care prior to death (with a mean length of stay of 2.8 years). CONCLUSIONS: Social (marital status) and disease-related variables (cognitive and functional status) are related to risk for institutionalization. These variables may be useful in estimating time to institutionalization in various clinical and research populations.

Aged↗

PubMed1994

Alzheimer's disease and cumulative exposure to anesthesia: a case-control study.

OBJECTIVE: To evaluate prior exposure to general anesthesia as a potential risk factor for Alzheimer's disease (AD). DESIGN: A retrospective, population-based, case-control study. SETTING: The Rochester Epidemiology Resource. PATIENTS: Cases were all incident cases of AD from 1975 to 1984 who resided for 40 years or more in Olmsted County prior to the onset of their dementia (n = 252). One age- and gender-matched control for each case was selected from all registrations for care at Mayo Clinic during the year of onset in the incident case. The case and control groups each had 252 individuals. Of these, 208 cases and 199 controls had at least one exposure to general anesthesia prior to the year of onset of dementia in the matched AD patient. MEASUREMENTS: The cumulative duration of anesthesia and the total number of general anesthetic exposures prior to the age of onset of dementia and the corresponding year in each matched control were ascertained. RESULTS: There was no significant difference in mean cumulative exposure (in minutes) to general anesthesia (patients vs controls: 188.4 vs 170.5 minutes, ns). Neither exposure to six or more episodes of general anesthesia (OR = 1.44; 95% CI: 0.77-2.71) nor cumulative exposure to 600 minutes or more of general anesthesia (OR = 1.63; 95% CI: 0.53-5.04) were associated with a significantly increased risk of AD. CONCLUSION: It is unlikely that multiple exposures to general anesthesia increase the risk of AD.

Aged↗

PubMed1994

Fracture risk in patients with Alzheimer's disease.

OBJECTIVE: To assess the risk of fracture following onset of Alzheimer's disease. DESIGN: Retrospective (historical) cohort study. SETTING: Population-based in Rochester, Minnesota. PARTICIPANTS: All 543 Rochester residents with onset of Alzheimer's disease during the 10-year period, 1975-84, and an equal number of age- and sex-matched controls from the community. MEASUREMENTS: Fractures were assessed through review of each subject's complete (inpatient and outpatient) medical records in the community. MAIN RESULTS: Rochester residents with Alzheimer's disease were no more likely to have a history of fracture prior to onset than were matched controls from the same population. During the year of onset, there was a 2-fold excess of fractures at various sites among those with Alzheimer's disease. The risk ratio for any fracture subsequently was 1.1 (95% CI 0.9, 1.3), and this slight increase was accounted for entirely by a 2.7-fold increase in the risk of hip fracture (95% CI 1.8, 4.2). CONCLUSIONS: Fracture risk was not increased before the onset of Alzheimer's disease, although there was an excess of fractures around the time that Alzheimer's disease came to clinical attention. Fracture risk was not elevated thereafter except for a substantial increase in the risk of hip fracture. This suggests a link with certain falls rather than generalized disuse osteoporosis.

Adult↗

PubMed1994

Psychometric Properties of the Mattis Dementia Rating Scale

This study investigated the psychometric properties of the Mattis Dementia Rating Scale (DRS), including its internal consistency, sensitivity to age and education effects, pattern of change scores, convergent validity and predictive utility. Age and education effects and stability were assessed in a sample of 280 cognitively normal persons over age 55. All other features were assessed in a sample of 274 persons with cognitive impairment, including 221 newly diagnosed dementia patients and 53 patients with mild cognitive impairment. Both samples were drawn from the Mayo Clinic Alzheimer's Disease Patient Registry. Within the normal sample, Pearson correlation coefficients for DRS Total score with age, education and intelligence were all significant, p < .0001; MAYO Full Scale IQ (FSIQ) shared approximately 20% variance with DRS Total score. Internal consistency was greater than .7 for Construction, Conceptualization, Memory, and Total score, greater than .65 for Attention and less than .5 for Initiation and Perseveration. DRS subscale scores for Memory, Attention, and Conceptualization were significantly correlated with appropriate indices from the WAIS-R or Wechsler Memory Scale-Revised, as assessed in the Mayo Older Americans Normative Studies, providing convergent validity for these DRS scales. Importantly, proportional hazards modeling revealed initial DRS Total score to be a significant predictor of longitudinal institutionalization and mortality outcomes.

Journal Article↗

PubMed1994

Are patients with Alzheimer's disease surviving longer in recent years?

We report the survival experience of the incidence cohort of Alzheimer's disease (AD) patients in Rochester, Minnesota, whose onset occurred during the years 1960 to 1984. Survival was evaluated relative to year of onset, age at onset, and gender. Survival was better among women than men and improved for those with AD with more recent onset. The relative hazard decreased by a factor of 0.82 for each decade. The effect of age at onset was nonlinear, indicating that the hazard of death does not change at a constant rate with age.

Age of Onset↗

PubMed1994

Memory function in very early Alzheimer's disease.

The detection of very early Alzheimer's disease (AD) can be important for both theoretical and practical reasons. Typically, a memory impairment is the first sign of incipient disease, but the early clinical diagnosis can be challenging. We investigated several aspects of memory function in AD and normal aging to determine which indices of performance were most sensitive at detecting early impairments. We evaluated 106 pairs of patients with probable AD and matched controls from the Mayo Clinic Alzheimer's Disease Patient Registry using a logistic regression model that included measures of memory function, verbal and nonverbal intelligence, attention, and language. Results indicated that an index of learning, especially with semantic cuing, was most sensitive at separating the two groups. We then matched subsets of individuals from the larger groups of AD and control subjects on the Mini-Mental State Examination (range of scores, 24 to 26). A logistic regression analysis on these matched groups yielded the same results. A measure of learning with facilitation of performance using cues appears to be the best discriminator at detecting very mild AD. These measures can be useful in selecting patients for interventional strategies.

Aged↗

PubMed1994

Prior blood transfusions and Alzheimer's disease.

We performed a population-based, case-control study to evaluate prior blood transfusion as a potential risk factor for Alzheimer's disease (AD). All cases were incident cases of AD from 1975 to 1984 with residence for 40 years or more in Olmsted County, Minnesota, prior to their onset of dementia (N = 252). There was one age- and gender-matched control for each case. We ascertained the number of blood transfusions prior to the age of onset of dementia and the corresponding year in each control. Sixty-five cases and 55 controls had at least one prior blood transfusion. We did not find a significantly increased risk of AD for the events of at least one, three, or six blood transfusions.

Adult↗

PubMed1994

Early and midlife exposure to anesthesia and age of onset of Alzheimer's disease.

Patients with Alzheimer's disease (AD) who have a late onset of dementia may represent a subgroup of AD that has a unique multifactorial/genetic profile. It was hypothesized in the present study that if external factors interact with a biological or genetic susceptibility in at least some subsets of patients with AD, these factors may accelerate the manifestation of the disease. The cumulative exposure to different types of general and major regional anesthetics prior to the onset of dementia was calculated in a population-based study of incident cases of AD residing in Rochester, MN, for more than 40 years preceding the onset of dementia (N = 252). Correlational analysis revealed that age of onset was inversely related to cumulative exposure to general and spinal anesthesia before the age of 50, whereas there was no, or an expected positive, correlation for anesthetic exposure after 50 years. These findings may suggest that the manifestation of dementia in AD patients may be related to exposure to external factors at an earlier age.

Age Factors↗

PubMed1994

Apolipoprotein E: risk factor for Alzheimer disease.

The apolipoprotein E gene (APOE) has three common alleles (epsilon 2, epsilon 3, and epsilon 4) that determine six genotypes in the general population. In this study, we examined 77 patients with late-onset Alzheimer disease (AD), along with an equal number of age- and sex-matched controls, for an association with the APOE-epsilon 4 allele. We show that the frequency of this allele among AD patients was significantly higher than that among the control population (.351 vs. .130, P = .000006). The genotype frequencies also differed between the two groups (P = .0002), with the APOE-epsilon 4/epsilon 3 genotype being the most common in the AD group and the APOE-epsilon 3/epsilon 3 being the most common in the control group. In the AD group, homozygosity for epsilon 4 was found in nine individuals, whereas none was found in the control group. The odds ratio for AD, when associated with one or two epsilon 4 alleles, was 4.6 (95% confidence interval [CI] 1.9-12.3), while the odds ratio for AD, when associated with heterozygosity for APOE-epsilon 4, was 3.6 (95% CI 1.5-9.8). Finally, the median age at onset among the AD patients decreased from 83 to 78 to 74 years as the number of APOE-epsilon 4 alleles increased from 0 to 1 to 2, respectively (test for trend, P = .001). Our data, which are in agreement with recent reports, suggest that the APOE-epsilon 4 allele is associated with AD and that this allelic variant may be an important risk factor for susceptibility to AD in the general population.

Age of Onset↗

PubMed1993

Rapidly progressive aphasic dementia and motor neuron disease.

Articulatory and language impairment heralded rapidly progressive motor neuron disease in 7 patients aged 54 to 77 years. One patient had a family history of a similar disorder. Severe nonfluent aphasia developed in all 7 patients and 4 were anarthric within a year. Other cognitive domains were impaired, yet 2 patients lived alone until 1 month before their deaths. Four died within 2 years. Abnormalities were found on electromyography, computed tomography, magnetic resonance imaging, single-photon emission computed tomography, and electroencephalography. Neuropathological examination in 3 patients showed bilateral hemispheric atrophy with neuronal loss and gliosis predominantly of superficial cortical layers. Pigmented and hypoglossal nuclei were relatively preserved. At all spinal levels there was degeneration of corticospinal tracts and loss of anterior horn cells with gliosis. Rapidly progressive aphasic dementia and motor neuron disease are a distinctive clinical entity whose nosology is poorly understood.

Aphasia↗

PubMed1993

Is the incidence of dementing illness changing? A 25-year time trend study in Rochester, Minnesota (1960-1984)

We performed a time trend study of incidence of dementing illness in Rochester, Minnesota. We ascertained age- and sex-specific incidence rates for the five quinquennia, 1960 through 1984. The incidence rates sharply increased with advancing age, reaching a high of 2,922/100,000 person years in the group 85 years and older. For dementia caused either solely or predominantly by Alzheimer's disease, this figure was 2,600/100,000 person years for the oldest age group. There were no significant differences in the incidence of dementing illness between men and women. In the oldest age groups in the last two quinquennia of study, there appears to be a trend toward increasing incidence rates. Over the years, the proportion of cases attributed to dementia due to unknown causes has decreased while the proportion of cases attributed to Alzheimer's disease has increased.

Adult↗

PubMed1992

Post-lumbar puncture headaches: experience in 501 consecutive procedures.

To ascertain the frequency and risk factors for post-lumbar puncture headache, we studied all adults who had an ambulatory lumbar puncture (LP) in a 1-year period. Patients filled out a questionnaire detailing their headache experience on the day of, and the 6 days following, LP. Those who did not return the questionnaire were telephoned. We systematically collected and analyzed many items, including the lumbar puncturist's experience, the degree of difficulty of the LP, CSF findings, final diagnosis, and the patient's demographic characteristics. Patients reporting headache before LP were more likely to report post-LP headaches. In addition to this, younger female patients with a lower body mass index have the highest risk of developing post-LP headaches. CSF opening pressure, cells, and protein, patient's position during LP, the duration of recumbency following LP, and the amount of CSF removed at the time of LP did not influence the occurrence of headache.

Adolescent↗

PubMed1992

Lack of association between Alzheimer's disease and education, occupation, marital status, or living arrangement.

Using the resources of the Rochester Epidemiology Project, we conducted a case-control study of sociodemographic characteristics using the incidence cohort of patients with Alzheimer's disease (AD). During the conduct of ongoing studies of AD in Rochester, we identified new cases of AD as they occurred during 1975-1979 (N = 241). We selected one age- and sex-matched control from among all registrations for care in this community during the year of onset for each case. There was little difference between cases and controls for educational attainment, marital status, type of dwelling, living arrangement, or occupation. We were unable to confirm low educational level as a risk factor for AD in this population. Future attempts to identify etiologic risk factors for dementing illness should probably move toward other areas of research.

Aged↗

PubMed1992

Memory function in normal aging.

We evaluated memory function in a group of 161 community-dwelling, cognitively normal individuals aged 62 to 100 years recruited as part of the Mayo Clinic Alzheimer's Disease Patient Registry. We used the Free and Cued Selective Reminding Test and the Rey Auditory Verbal Learning Test to evaluate two aspects of memory function thought to be sensitive to the effects of aging: learning (acquisition) and delayed recall (forgetting). The results were quite consistent and demonstrated that learning or acquisition performance declines uniformly with increasing age but is not related to education. Delayed recall or forgetting, however, remained relatively stable across age when adjusted for the amount of material initially learned. These findings are relevant for assessing normal memory function relative to the early impairments found in dementia and form a baseline against which memory performance can be assessed by the clinician. In particular, suspicion regarding a disorder of brain function affecting memory processes should be raised if learning performance declines more rapidly than expected or if delayed recall is impaired to any significant extent.

Aged↗

PubMed1991

The short test of mental status. Correlations with standardized psychometric testing.

The Short Test of Mental Status can be administered to patients in inpatient and outpatient settings in approximately 5 minutes, and it contains items that test orientation, attention, immediate recall, arithmetic, abstraction, construction, information, and delayed (approximately 3 minutes) recall. The test was administered to a group of demented community patients and their age- and sex-matched control subjects. Using an age-adjusted approach, sensitivity of the test to identifying dementia is 86.4, with a specificity of 93.5. The test was compared with standardized tests of cognitive function such as the Wechsler Adult Intelligence Scale, Mattis Dementia Scale, and the Auditory Verbal Learning Test, and showed a high degree of correlation. Group means and standard deviations for subtest items and total score are presented for control subjects (n = 138), demented patients (n = 130), and patients with memory impairment only (n = 20). Percentile scores for subtest items in control subjects are also provided.

Aged↗

PubMed1991

Age-associated memory impairment diagnoses: problems of reliability and concerns for terminology.

Objective memory criteria for diagnosing age-associated memory impairment (AAMI), age-consistent memory impairment, and late-life forgetfulness (LLF) were applied to 523 cognitively normal older persons divided into 2 groups on the basis of the clinical memory assessment battery they received. Seventy-seven percent of Group 2 and 98% of Group 1 met the Crook et al. (1986) cognitive criteria for AAMI on at least 1 test. Rates based on individual tests varied from 7% to 96%. Objective-cognitive criteria for LLF were met by no members of Group 1 but by 31% of Group 2. Results suggest that, as proposed, the criteria for age-related diagnoses lack reliability. Concerns regarding the diagnosis of normal memory in older populations are considered.

Aged↗

PubMed1991

Familial aggregation of Alzheimer's disease and related disorders: a collaborative re-analysis of case-control studies.

Case-control studies of Alzheimer's disease were re-analysed to examine the association of Alzheimer's disease with family history in first degree relatives of dementia, Down's syndrome and Parkinson's disease. Overall, the relative risk of Alzheimer's disease for those with at least one first degree relative with dementia was 3.5 (95% confidence interval 2.6-4.6). Stratification according to age of onset of Alzheimer's disease showed that the relative risk decreased with increasing onset age. However, among patients with an onset of disease after 80 years, there were still significantly more subjects with one or more first degree relatives with dementia as compared to controls (relative risk 2.6; 95% confidence interval 1.3-5.2). The relative risk of Alzheimer's disease was significantly lower in patients who had one first degree relative with dementia (relative risk 2.6; 95% confidence interval 2.0-3.5) as compared to those who had two or more affected relatives (relative risk 7.5; 95% confidence interval 3.3-16.7). Furthermore, the re-analysis showed a significant association between Alzheimer's disease and family history of Down's syndrome (relative risk 2.7; 95% confidence interval 1.2-5.7), which was strongest in those patients who had a positive family history of dementia. The relative risk of Alzheimer's disease for those with a positive family history of Parkinson's disease was 2.4 (95% confidence interval 1.0-5.8).

Age Factors↗

PubMed1991

Maternal age and Alzheimer's disease: a collaborative re-analysis of case-control studies. EURODEM Risk Factors Research Group.

To investigate the possible association between Alzheimer's disease and late maternal age at index birth, we conducted a collaborative re-analysis of existing case-control data sets. Of the 11 studies participating in the EURODEM project, four were included in the analyses regarding maternal age. In all four studies, cases were matched to controls by age and gender, and only population controls were considered. Analyses were conducted on the individual data sets, on the pooled sample, and on subgroups defined by gender, age at onset, and familial aggregation of dementia. Maternal age of 40 years and over was found to be suggestively associated with a higher risk of Alzheimer's disease (overall relative risk = 1.7; 95% confidence intervals: 1.0-2.9). In subgroup analyses, the association was statistically significant for women and for sporadic cases. Adjustments for education or analyses restricted to case-control pairs matched by type of respondent did not modify these results noticeably. The association was confirmed by a test of consistency with the Down's syndrome risk model; results of this test were again more definite for sporadic Alzheimer's disease. In addition, three of the four studies also suggested an increased risk for maternal age at index birth between 15 and 19 years (overall relative risk = 1.5; 95% confidence intervals: 0.8-3.0). Although consistency across studies was not always complete, only some of the increased relative risks reached statistical significance, and information regarding maternal age obtained through a next-of-kin interview may have limitations, our study suggests that both early and late maternal age should be further investigated as possible risk factors for Alzheimer's disease.

Adolescent↗