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Biomedical subjects

Henry C Weinstein

Publications and source records attributed to Henry C Weinstein.

10 recordsLinked to original sources
PubMed2006

Brain lesions on MRI in elderly patients with type 2 diabetes mellitus.

BACKGROUND AND PURPOSE: Diabetes mellitus (DM) type 2 has been associated with poor cognitive performance and dementia, particularly in elderly patients. The exact mechanisms underlying the cognitive dysfunction in DM remain unclear. Imaging studies of the brain could be helpful to give more insight into possible structural brain lesions underlying these cognitive dysfunctions. Therefore, we performed a study in independently living patients with DM type 2 in order to investigate the association between DM and brain imaging abnormalities. METHODS: The study population consisted of 45 patients with DM type 2 without hypertension (mean age 73.4 +/- 5.1 years, mean duration 16.5 +/- 11.5 years), 45 patients with DM type 2 and hypertension (mean age 73.5 +/- 6.1 years, mean duration 11.9 +/- 9.2 years) and 44 control subjects (mean age 73.1 +/- 5.4 years). All patients and control subjects underwent an MRI of the brain. White matter lesions (WML), cerebral atrophy and medial temporal lobe atrophy were rated by a standardized visual rating scale. Lacunar infarcts were defined as focal hypo-intensities on fluid-attenuated inversion recovery sequences with a hyperintense rim around it. RESULTS: WML occurred more frequently in diabetic patients with hypertension as well as without hypertension. Significantly more deep WML were found in DM patients with and without hypertension when compared to control subjects, whereas no difference was found in the occurrence of periventricular hyperintensities. In all 3 groups, lacunar infarcts occurred sporadically. A trend towards higher atrophy scores was seen in patients with DM compared to control subjects. CONCLUSIONS: The data of this cross-sectional study suggest that type 2 DM is an independent risk factor for deep WML in the independently living elderly patients.

Aged↗
PubMed2006

Cognitive impairment in heart failure: a systematic review of the literature.

BACKGROUND: Heart failure (HF) and cognitive impairment are common medical conditions that are becoming increasingly prevalent in the aging Western population. They are associated with frequent hospitalisation and increased mortality, particularly when they occur simultaneously. Evidence from a number of studies suggests that HF is independently associated with impairment in various cognitive domains. AIMS: This systematic literature review evaluates the relation between cognitive deterioration and heart failure. METHODS: We searched electronic databases from 1966 to May 2006 for studies that investigated cognitive function in HF patients. Twenty-two controlled studies that met the inclusion criteria were selected for analysis. Study characteristics and data on global cognitive performance, memory scores, psychomotor speed and depression scores were extracted and analysed using the Cochrane Review Manager software. RESULTS: Pooled analysis shows diminished neuropsychological performance in HF patients, as compared to control subjects. In a pooled sample of 2937 heart-failure patients and 14,848 control subjects, the odds ratio for cognitive impairment was 1.62 (95% confidence interval:1.48-1.79, p<0.0001) among subjects with HF. CONCLUSION: This review confirms the relationship between HF and cognitive impairment, but it also stresses the need for additional systematic neuropsychological data and adequate neuro-imaging from representative populations of HF patients.

Case-Control Studies↗
PubMed2006

Pain intensity and pain affect in relation to white matter changes.

Since aging is a risk factor for both dementia and the occurrence of painful conditions, with the number of aged people increasing in the next decades, an increase in the number of elderly people suffering from both conditions can be anticipated. Reliable pain assessment in this population is restricted by reduced communicative and cognitive capacity, with serious consequences for effective pain treatment. White matter changes are frequently observed in the various subtypes of dementia as well as in normal aging, and may play a crucial role in pain processing. In healthy elderly people, reliable pain assessment can be accomplished, which enables examining the relationship between pain experience and white matter changes. A normal structure and function of the white matter is extremely important for dorsolateral prefrontal cortex (DLPFC) functioning, which has recently been linked to pain inhibition. The present study focused on the relation between white matter changes and both pain intensity and pain affect in elderly people without dementia. The Coloured Analogue Scale (CAS) and the Number of Words Chosen-Affective (NWC-A) were applied to measure pain intensity and pain affect, respectively. The presence of white matter changes was significantly related to a higher score on the NWC-A but not the CAS score. These results suggest that pain experience may change as a result of aging and that white matter changes might be indicative for these alterations.

Affect↗
PubMed2004

Validation of the HIV Dementia Scale in an elderly cohort of patients with subcortical cognitive impairment caused by subcortical ischaemic vascular disease or a normal pressure hydrocephalus.

INTRODUCTION: Most cognitive screening instruments are tailored to detect symptoms of cortical dysfunction in the elderly. Therefore, subcortical cognitive dysfunction may be missed using these tests. The aim of this study was to validate the Human Immunodeficiency Virus (HIV) Dementia Scale (HDS), a screening test developed to detect subcortical cognitive dysfunction in young HIV-infected patients, in a group of elderly patients with subcortical cognitive impairment (SCI) caused by subcortical ischaemic vascular disease (SIVD) or a normal pressure hydrocephalus (NPH). MATERIALS AND METHODS: 53 patients with SCI caused by SIVD or an NPH and 54 age-matched control subjects without cognitive impairment were included. All subjects underwent the HDS and the Mini-Mental State Examination (MMSE). A neuropsychological examination was used as the best reference test for the diagnosis of SCI. RESULTS: The mean HDS score (maximum 16) was 5.1 +/- 3.5 in the SCI patients and 13.0 +/- 2.4 in the controls (p < 0.0001). The mean MMSE score (maximum 30) was 26.5 +/- 3.1 in the SCI group and 28.6 +/- 1.4 in the controls (p < 0.0001). Among subjects who had an MMSE score of more than 26 points, SCI patients (n = 35) also scored significantly lower on the HDS than controls (n = 50), mean scores being 6.2 +/- 3.4 and 13.0 +/- 2.4, respectively (p < 0.0001). A receiver-operating characteristics curve was used to detect the optimal sensitivity and specificity of the HDS. A cut-off score of 9 yielded 91% sensitivity (95% CI: 79-97) and 96% specificity (95% CI: 87-99). With this cut-off score, the positive predictive value was 96% (95% CI: 86-99) and the negative predictive value was 91% (95% CI: 81-97). CONCLUSIONS: These results suggest that the HDS is able to detect SCI in an elderly population with SIVD or NPH and a normal MMSE score, and warrant its further development as a screening tool for SCI.

AIDS Dementia Complex↗
PubMed2004

Timed executive functions and white matter in aging with and without cardiovascular risk factors.

The present article reviews recent studies of 'healthy aging' with and without cardiovascular risk factors and accompanying white matter changes. Specifically, the relationship between white matter hyperintensities (WMH) and various cognitive functions, in particular executive functions (EF), was subjected to meta-analysis. The results of this analysis indicate that WMH induce a decrease in performance on timed EF tests, while the more basic cognitive abilities (e.g. short-term memory and vocabulary) remained relatively intact. Interestingly, the performance on untimed EF tasks was uniformly unrelated to WMH. This pattern of cognitive dysfunction was observed equally in the 'healthy aged' and the cardiovascular group. These findings suggest that an important distinction exists between untimed and timed EF tests, and that this distinction should be taken into account when interpreting the results of such tests.

Aging↗
PubMed2003

Operational definitions for the NINDS-AIREN criteria for vascular dementia: an interobserver study.

BACKGROUND AND PURPOSE: Vascular dementia (VaD) is thought to be the most common cause of dementia after Alzheimer's disease. The commonly used International Workshop of the National Institute of Neurological Disorders and Stroke (NINDS) and the Association Internationale pour la Recherche et l'Enseignement en Neurosciences (AIREN) criteria for VaD necessitate evidence of vascular disease on CT or MRI of the brain. The purposes of our study were to operationalize the radiological part of the NINDS-AIREN criteria and to assess the effect of this operationalization on interobserver agreement. METHODS: Six experienced and 4 inexperienced observers rated a set of 40 MRI studies of patients with clinically suspected VaD twice using the NINDS-AIREN set of radiological criteria. After the first reading session, operational definitions were conceived, which were subsequently used in the second reading session. Interobserver reproducibility was measured by Cohen's kappa. RESULTS: Overall agreement at the first reading session was poor (kappa=0.29) and improved slightly after application of the additional definitions (kappa=0.38). Raters in the experienced group improved their agreement from almost moderate (kappa=0.39) to good (0.62). The inexperienced group started out with poor agreement (kappa=0.17) and did not improve (kappa=0.18). The experienced group improved in both the large- and small-vessel categories, whereas the inexperienced group improved generally in the extensive white matter hyperintensities categories. CONCLUSIONS: Considerable interobserver variability exists for the assessment of the radiological part of the NINDS-AIREN criteria. Use of operational definitions improves agreement but only for already experienced observers.

Brain↗
PubMed2002

Ethics issues in security hospitals.

The term 'security hospital' is used for a variety of facilities including forensic hospitals and prison hospitals, which, because of their mission, the nature of their work, and the populations they serve-or because of the authority under which they operate-place the staff at considerable risk of ethical violations related to either clinical care or to forensic activities. The problem of divided loyalties is of special concern in security hospitals. Ethics principles particularly at risk are confidentiality and informed consent. Where there are cultural disparities between the staff and the patients, differences in background, socioeconomic class, education, and other types of diversity, cultural awareness is required and must be reflected in appropriate treatment and evaluation. To counteract the risks of ethical violations, a security hospital should create an ethical climate and develop means to anticipate, prevent, and deal with ethical violations. These might include detailed and specific policies and procedures, programs of orientation, education, consultation, and liaison as well as its own ethics committee.

Ethics, Institutional↗