Search PubMed⌕ Search

Biomedical subjects

E Kokmen

Publications and source records attributed to E Kokmen.

At least 91 records · Page 5Linked to original sources
PubMed1991

Head trauma as a risk factor for Alzheimer's disease: a collaborative re-analysis of case-control studies. EURODEM Risk Factors Research Group.

A re-analysis of the data from 11 case-control studies was performed to investigate the association between head trauma and Alzheimer's disease (AD). To increase comparability of studies, exposures were limited to head trauma with loss of consciousness (hereafter referred to as 'head trauma') and comparisons were restricted to community (versus hospital) controls. Test for heterogeneity across studies was negative; consequently, data were pooled in subsequent analyses. The pooled relative risk for head trauma was 1.82 (95% confidence interval: 1.26-2.67). Stratified analyses showed stronger associations in cases without a positive family history of dementia and in males (versus females). Adjustment of the pooled relative risk for family history of dementia, education and alcohol consumption did not alter significantly the association between head trauma and AD. There was no interaction effect between head trauma and family history of dementia, suggesting that these risk factors operate independently. Mean age of onset was not significantly different in cases with a history of head trauma compared to cases without such a history. The findings of the pooled analysis support an association between reported head trauma and AD.

Alzheimer Disease↗
PubMed1991

Medical history and the risk of Alzheimer's disease: a collaborative re-analysis of case-control studies. EURODEM Risk Factors Research Group.

In a re-analysis of eight case-control studies on Alzheimer's disease we explored several medical conditions that had previously been suggested as possible risk factors for Alzheimer's disease. History of hypothyroidism was increased in cases as compared to controls (relative risk 2.3; 95% confidence interval 1.0-5.4). Severe headaches and migraine were inversely related to Alzheimer's disease (relative risk 0.7; 95% confidence interval 0.5-1.0). More cases than controls reported epilepsy before onset of Alzheimer's disease (relative risk 1.6; 95% confidence interval 0.7-3.5), especially for epilepsy with an onset within 10 years of onset of dementia. Neurotropic viruses, allergic conditions, general anaesthesia and blood transfusions were not associated with Alzheimer's disease.

Alzheimer Disease↗
PubMed1991

Psychiatric history and related exposures as risk factors for Alzheimer's disease: a collaborative re-analysis of case-control studies. EURODEM Risk Factors Research Group.

Data from case-control studies of Alzheimer's disease (AD) were pooled to examine the possible roles of history of depression, anti-depressant treatment and adverse life events as risk factors. History of depression was found to be associated with AD, although the effect was confined to late onset cases. The association held for episodes of depression more than 10 years before AD onset, as well as for episodes occurring within a decade of onset. No association was found with anti-depressant treatment. However, data were only available from two studies, limiting the power of the analysis. Also, no association was found with the three major life events considered in the pooled analysis: death of spouse, death of a child and divorce.

Alzheimer Disease↗
PubMed1991

Alcohol and tobacco consumption as risk factors for Alzheimer's disease: a collaborative re-analysis of case-control studies. EURODEM Risk Factors Research Group.

A meta-analysis, involving the secondary analysis of original data from 11 case-control studies of Alzheimer's disease, is presented for alcohol consumption and cigarette smoking. Five studies included in the meta-analysis of alcohol consumption. Alcohol consumption was computed in terms of average weekly intake, measured in ounces of 'pure alcohol'. This variable was categorized into tertiles to represent low, medium and high intake. Analyses showed no excess estimated risk of Alzheimer's disease for any level of alcohol intake. Smoking was analysed in three different manners: (1) lifetime prevalence of smoking (ever/never)--this included eight studies; (2) amount smoked (less than or equal to one pack per day versus more than one pack per day)--this included seven studies; and (3) pack-years--including four studies. A statistically significant inverse association between smoking and Alzheimer's disease was observed at all levels of analysis, with a trend towards decreasing risk with increasing consumption (p(trend) = 0.0003). A propensity towards a stronger inverse relation was observed among patients with a positive family history of dementia, but the difference between this group and the group with no such history was not statistically significant. Although the observed disturbance in nicotinic receptor function in Alzheimer's disease may provide an explanation for these findings, possible biases related to the selection or survival of study subjects cannot be fully ruled out at this time. Prospective, community-based studies of incident cases of Alzheimer's disease are needed to document in detail the smoking history, age of onset of disease and survival of patients and cognitively intact people by smoking status.

Alcohol Drinking↗
PubMed1991

Occupational exposures to solvents and lead as risk factors for Alzheimer's disease: a collaborative re-analysis of case-control studies. EURODEM Risk Factors Research Group.

A meta-analysis, involving the secondary analysis of original data from 11 case-control studies of Alzheimer's disease, is presented for occupational exposures to solvents and lead. Three studies had data on occupational exposure to solvents. Among cases, 21.3% were reported to have been exposed; among controls, this figure was comparable (20.9%). This yielded a pooled matched relative risk of 0.76 (95% CI: 0.47-1.23). Four studies had data on exposure to lead. Exposure frequencies were 6.1% in cases and 8.3% in controls. This resulted in a pooled matched relative risk of 0.71 (95% CI: 0.36-1.41). The meta-analysis was particularly useful in validating negative results from individual studies and in increasing the statistical power for the analysis of lead exposure, where stratum-specific cell sizes were frequently smaller than five in individual studies. However, since exposure in the various studies was ascertained in a rather broad manner, prospective studies are recommended which focus on high-risk occupational populations and which determine the incidence of Alzheimer's disease in these and comparable unexposed populations.

Alzheimer Disease↗
PubMed1991

The EURODEM collaborative re-analysis of case-control studies of Alzheimer's disease: implications for clinical research and practice.

The EURODEM re-analyses of 11 case-control studies of Alzheimer's disease imply that familial aggregation of dementia, Down's syndrome, and parkinsonism occurs more frequently in Alzheimer's disease than in matched controls. Prior history of head trauma, hypothyroidism, and depression also occurs in higher frequency among patients with Alzheimer's disease. Exposure to a series of other medical conditions and environmental toxins was not significant. The association between Alzheimer's disease and maternal age remains unclear.

Alzheimer Disease↗
PubMed1991

Brain injury and neurologic sequelae: a cohort study of dementia, parkinsonism, and amyotrophic lateral sclerosis.

We reviewed the medical records of 821 Olmsted County residents who had suffered head trauma with presumed brain injury between 1935 and 1974 and were more than 40 years old at the time of their last medical assessment. These patients were followed over 15,000 person-years for dementia and other degenerative neurologic diseases. The standardized morbidity ratio (SMR) for dementia was 1.06, and the SMR for dementia of the Alzheimer type was 1.00. These values are not significantly elevated and are inconsistent with studies that suggest that head trauma is a risk factor for Alzheimer's disease. In addition, the SMRs for parkinsonism (1.04), Parkinson's disease (0.94), and amyotrophic lateral sclerosis (1.05) were not significantly elevated, providing no evidence that head trauma is a risk factor for these disorders. However, these latter results are based on smaller total case numbers.

Alzheimer Disease↗
PubMed1991

The association between Alzheimer's disease and thyroid disease in Rochester, Minnesota.

To determine whether an association exists between Alzheimer's disease (AD) and thyroid disease, we carried out two studies in the population of Rochester, Minnesota. We reviewed medical records of a cohort of 198 women with histologically confirmed Hashimoto's thyroiditis (1935 to 1974) for evidence of subsequent dementia, applying the criteria used for dementia in a previous determination of incidence and prevalence rates in this population. From a total of 4,197 person-years of follow-up, eight cases of AD were diagnosed, whereas the expected number was 5.8. The standardized morbidity ratio was 1.37, which failed to reach statistical significance. The second study was a retrospective case-control comparison that sought any relationship between AD and all thyroid disorders, using a previously identified (1960 to 1979) AD cohort (N = 646) and their age- and sex-matched controls. For myxedema there was a positive association for AD without significance, whereas in Graves' disease there was a significant negative association for AD.

Adolescent↗
PubMed1991

Is the prevalence of dementia changing?

We compared the point prevalence rates of dementing illnesses in the population of Rochester, Minnesota, on January 1, 1980, with the previously published rates of January 1, 1975, by using extensive health care records available from all sources of care in the community, in order to identify and classify cases with standard diagnostic criteria derived from DSM-III. The overall age- and sex-adjusted prevalence rate per 100,000 population for dementia on January 1, 1980, was 402.5 compared with 388.4 on January 1, 1975; for Alzheimer's disease it was 259.8 in 1980 and 259.5 in 1975. The stability of the rates suggests no change in the incidence and mortality associated with these conditions. The prevalence rates for Rochester, Minnesota, are similar to many other rates estimated in other North American communities, but they differ from two other population-based estimates from East Boston and California. Case definitions and methods of assessment probably account for the differences in estimated prevalence.

Adult↗
PubMed1991

Clinical risk factors for Alzheimer's disease: a population-based case-control study.

Using information on clinical risk factors provided through the medical record linkage system of the Rochester Epidemiology Project, we conducted a population-based case-control study of Alzheimer's disease (AD). During the period 1960 to 1974, we identified 415 newly diagnosed cases of AD among residents of Rochester, Minnesota, and matched one community control to each case based on age, sex, and duration of community medical record. We estimated odds ratios using conditional logistic regression for several potential clinical risk factors of AD. Among more than 20 clinical risk factors that were evaluated, the only statistically significant findings were for episodic depression, personality disorder, and hypertension.

Alzheimer Disease↗
PubMed1990

Alzheimer's disease and prior therapeutic radiation exposure: a case-control study.

Few risk factors have been identified for dementing illness to date. To evaluate prior therapeutic radiation exposure as a potential risk factor for Alzheimer's disease, we carried out a retrospective case-control study using the Rochester Epidemiology Resource. Cases were all incident cases of AD from 1960 through 1974 (N = 392) identified in an ongoing study of the condition in this community. One age- and sex-matched control for each case was selected from all registrations for care during the year of onset in the case. There were 86 cases and 89 controls with prior radiation exposure, and the variable used to describe exposure was absorbed dose. Most of the exposure was small doses: 11 individuals received greater than 1,000 centigray (3 cases, 8 controls). Using the logistic regression methods of Breslow and Day, the estimated odds ratio for any prior therapeutic radiation exposure was 0.95 (95% CI, 0.66 to 1.37). When the exposure variable was limited to head exposure only, the odds ratio was 0.65 (95% CI, 0.32 to 1.31). It is unlikely that the risk associated with therapeutic radiation in the development of Alzheimer's disease is greater than 1.4.

Aged↗
PubMed1989

An anatomy of the autopsy, Olmsted County, 1935 through 1985.

In this study, we examined in detail the patterns of autopsy rates for a half century (1935 through 1985) among residents of Olmsted County, Minnesota. The time trend of the autopsy in this community represents, in many respects, a microcosm of national trends. In the process of this analysis, we identified several medical and socioeconomic variables that may influence the rate of autopsy, including the age at death, physical location of death, gender, surgical procedures preceding death, immediate cause of death, and direct and indirect costs of the autopsy. In particular, the advancing mean age at death and the increase of the nursing home as a social phenomenon seem to have had a profound effect on autopsy rates both in Olmsted County and throughout the United States.

Adult↗
PubMed1989

Resurrecting the autopsy: benefits and recommendations.

Maintenance of high autopsy rates is associated with specific benefits, especially for clinical practice and for clinical and epidemiologic research. We have compiled and evaluated (on the basis of related costs and benefits) a comprehensive list of recommendations to resurrect the autopsy and reestablish it as a central contributor to medical practice, teaching, and research.

Autopsy↗
PubMed1989

Cognitive and psychiatric abnormalities in multiple sclerosis.

In multiple sclerosis, behavioral changes, including alterations in cognitive functions and psychiatric abnormalities, have been recognized with increasing frequency in recent years. Multiple sclerosis formerly was thought to be primarily a disorder of the brain stem and spinal cord; however, functional changes that can be attributed, at least in part, to cerebral dysfunction are being recognized. Certain cognitive functions such as memory and conceptual processes seem to be preferentially impaired. The degrees of impairment of other functions such as attention and visuospatial skills are now being evaluated. Psychiatrically, affective disorders seem to be the most common diagnoses, and debate exists about whether these abnormalities are a function of the demyelinating process itself or are a reaction to the disability produced by the disorder.

Dementia↗
PubMed1989

Deficiencies of polyunsaturated fatty acids and replacement by nonessential fatty acids in plasma lipids in multiple sclerosis.

Fatty acid compositions of plasma phospholipids, cholesteryl esters, triacylglycerols, and nonesterified fatty acids of 14 clinically proven and graded cases of multiple sclerosis were determined by capillary gas chromatography and compared with the values obtained for 100 normal, healthy subjects. In phospholipids, linoleic acid (18:2 omega 6; 18 carbon atoms, 2 double bonds, 6 carbon atoms beyond last double bond) was normal and 18:3 omega 6 was increased, but all subsequent omega 6 acids were subnormal (P less than 0.001), indicating impairment of chain elongation. All omega 3 acids were subnormal. The paucity of polyunsaturated fatty acids was compensated mass-wise by an increase in saturated acids. Disproportionate increases in short-chain, saturated, and monounsaturated acids, decreases in long-chain homologs, and increases of branched and odd-chain acids were observed. Loss of polyunsaturated fatty acids and replacement by nonessential acids lowered mean chain length and raised mean melting point significantly, suggesting that lowered membrane fluidity was only partially compensated by endogenous synthesis of lower-melting, nonessential acids. This phenomenon was not observed in cholesteryl esters or triacylglycerols. Nonesterified fatty acids showed significant changes in pattern of possible autacoid precursors. The abnormal profile of fatty acids in multiple sclerosis has features in common with profiles of other syndromes involving viral infections.

Adult↗