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Biomedical subjects

J A Stack

Publications and source records attributed to J A Stack.

33 records · Page 2Linked to original sources
PubMed1992

Nortriptyline and weight change in depressed patients over 60.

Weight change in pounds and body mass index was documented in 29 geriatric patients with recurrent depression successfully treated with nortriptyline over a 30-week period of acute and continuation therapy (925 patient-weeks of nortriptyline treatment). Weight before index episode as documented by physician records, and weight at three points (beginning of treatment, end of acute therapy, and end of continuation therapy) were recorded. Weight changes over the interval between these times and net weight change over the entire interval were then calculated. Only five patients (17.2%) gained a clinically significant (greater than 10 lb) amount of weight during treatment, ranging from 10 to 43 lb above premorbid weights. Seven of 29 patients (24.1%) showed a net weight loss below premorbid levels (maximum loss 12.5 lb), and 6 patients (20.7%) showed no weight change. The pattern of weight gain was variable; no correlations were found between initially high body mass index and weight gain over the entire interval. These data suggest that nortriptyline is apparently not a potent weight promoter in this group.

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PubMed1988

Reliable discrimination of elderly depressed and demented patients by electroencephalographic sleep data.

Using electroencephalographic sleep data from a sample of 235 elderly subjects, discriminant function analyses of sleep alterations in depression and dementia were performed. Overall, 80% of patients were correctly classified using a backward discriminant function analysis, and 81% with a general stepwise discriminant function analysis. Four measures contributed to the separation of depressed and demented patients: rapid eye movement (REM) sleep latency (lower in depressives); REM sleep percent (higher in depressives); indeterminate non-REM sleep percent (higher in demented patients, reflecting greater loss of spindles and K complexes); and early morning awakening (more marked in depressives). When both discriminant functions were subjected to cross-validation in independent subsamples, both procedures correctly identified 78% of patients. The classification functions derived from nondemented depressed and nondepressed demented patients were applied to a mixed-symptom group (n = 42). Overall, 27 patients (64%) with either depressive pseudodementia or dementia with depressive features were correctly classified using the same four predictor variables. These findings suggest that sleep physiological alterations of depression and dementia reflect between-group differences in sleep continuity, sleep architecture, and REM sleep temporal distribution, and that the differences are statistically reliable, in both diagnostically pure and mixed clinical presentations. These findings are discussed in the context of current hypotheses of sleep regulation and its mechanisms.

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PubMed1988

Electroencephalographic sleep in depressive pseudodementia.

Twenty-six patients with mixed symptoms of depression and cognitive impairment were studied with serial clinical ratings and sleep electroencephalograms during a one-night sleep-deprivation procedure. A subgroup of these patients with depressive pseudodementia (n = 8) had less severe symptoms of dementia at baseline and showed significant improvements in both Hamilton Depression Rating Scale scores and Profile of Mood States tension scores following sleep deprivation, while another subgroup of patients having primary degenerative dementia with depression (n = 18) showed no change or worsening in Hamilton depression and Profile of Mood States tension ratings. Baseline sleep measures demonstrated significantly higher rapid eye movement (REM) percent and phasic REM activity/intensity in pseudodemented compared with demented patients. While both groups had increases in sleep efficiency, sleep maintenance, and slow-wave sleep following sleep deprivation, recovery night 2 was characterized by greater first REM period duration in depressive pseudodementia than in dementia. These differences in REM sleep rebound (using an REM period 1 cutoff of greater than or equal to 25 minutes) permitted correct identification of 88.5% of patients. Implications of these data for current theories regarding sleep, aging, and psychopathology are discussed.

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PubMed1988

Bedside differentiation of depressive pseudodementia from dementia.

The authors analyzed the pretreatment clinical presentations of 14 patients with depressive pseudodementia and 28 patients with primary degenerative dementia as measured by the Mini-Mental State, the Blessed Dementia Rating Scale, and the Hamilton Rating Scale for Depression. They found that patients with pseudodementia showed significantly greater pretreatment early morning awakening, higher ratings of psychological anxiety, and more severe impairment of libido. Patients with dementia, however, showed significantly more disorientation to time, greater difficulty finding their way about familiar streets or indoors, and more impairment with dressing. The authors suggest that these findings be considered preliminary.

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PubMed1988

Pretreatment systolic orthostatic blood pressure (PSOP) and treatment response in elderly depressed inpatients.

This study evaluated the utility of morning pretreatment systolic orthostatic blood pressure (PSOP) in predicting clinical response to treatment with nortriptyline (N = 11) or electroconvulsive therapy (N = 6) in 17 depressed geriatric inpatients (mean age, 70.4 +/- 5.1). Morning PSOP showed a significant inverse correlation with percent change in Hamilton depression ratings (rho = -0.59, p less than 0.01; r = -0.52, p less than 0.02). In nortriptyline-treated patients (N = 10, excluding one outlier), PSOP was significantly correlated with percent change in Hamilton ratings (rho = -0.55, p less than 0.05); a similar association was also found in the subsample of electroconvulsive therapy-treated patients (N = 6, rho = -0.77, p less than 0.05). Patients with PSOP less than or equal to 10 mm Hg averaged 83% improvement in Hamilton depression ratings versus 64% improvement in patients with PSOP less than or equal to 10 mm Hg (p less than 0.05). In an age-equated contrast group of 15 inpatients with mixed clinical pictures of depression and cognitive impairment (11 with primary degenerative dementia with depressive features and four with major depressive disorder with cognitive impairment), no relation between PSOP and treatment response (as measured by Hamilton ratings) was found. The current findings extend earlier work in medically healthy, nonsuicidal geriatric depressed outpatients and suggest that PSOP may also be useful in predicting treatment response in older, cognitively intact depressed inpatients (many with concurrent medical illness and/or suicidal) but not in mixed depression-dementia.

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PubMed1987

Sleep deprivation as a probe in the elderly.

Decreased slow-wave sleep (SWS) and sleep continuity are major effects of healthy aging and of associated psychopathological states. Using sleep deprivation, we studied the extent to which age- and psychopathology-related sleep "decay" is reversible in aged normal, depressed, and demented subjects. Depression or probable Alzheimer's dementia compromised the augmentation of sleep continuity and SWS seen in healthy elderly following sleep deprivation. Rapid eye movement (REM) latency decreased during recovery sleep in the controls but increased in both patient groups. Compared with demented patients, depressed elderly had greater severity of sleep continuity disturbance both before and after sleep deprivation, a more protracted course of recovery sleep, and increased slow-wave density in the second non-REM (NREM) sleep period (during recovery). The REM sleep time was diminished in dementia compared with depression both at baseline and during recovery sleep. These differential effects of age, health, and neuropsychiatric disease on recovery from sleep loss are relevant to recovery or reversal theories of sleep and have implications for daytime well-being in the elderly.

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PubMed1987

Sleep deprivation effects in older endogenous depressed patients.

In a drug-free group of 15 older endogenous depressed inpatients, all-night sleep deprivation (SD) was associated with a significant decrease in Hamilton depression scores and in Profile of Mood States self-ratings of depression. Six of 15 patients (40%) were responders to SD, as evidenced by greater than or equal to 30% improvement in Hamilton ratings. While symptomatic improvement was short-lived (8 of 15 patients worsened after 1 night of recovery sleep), five patients showed further improvement after 1 night of recovery sleep. The final two patients had an increase in Hamilton ratings after sleep deprivation, with a return to baseline values after 1 night of recovery sleep. Responders (but not nonresponders) showed significant improvement in sleep latency, sleep efficiency, and slow wave sleep during recovery sleep (as did controls). The SD Hamilton depression rating (at 9 a.m. after all-night sleep deprivation) showed a significant inverse correlation with the increase in slow wave sleep (SWS) minutes and in SWS % from baseline to first recovery night. Responders also had significantly larger increases in SWS minutes than did nonresponders (53.8 vs. 7 minutes). Similarly, the % change in Hamilton depression ratings was predicted by baseline Stage 4 sleep. These findings suggest that there is a mutual interaction between the process of sleep regulation and the symptoms of depression. They also confirm a prediction from the two-process model of sleep regulation--namely, that improved sleep initiation and maintenance and increased SWS, attained by SD, are associated with clinical improvement.

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PubMed1987

Open-trial response to antidepressant treatment in elderly patients with mixed depression and cognitive impairment.

We report open-trial antidepressant response in 16 inpatients with mixed symptoms of depression and cognitive impairment, compared to 16 elderly depressives without cognitive impairment. Criteria for adequate treatment specified a steady-state plasma nortriptyline level of 50-150 ng/ml for 4 consecutive weeks or a minimum of six treatments with electroconvulsive therapy. Ten of 16 mixed-symptom patients showed a drop in Hamilton depression ratings greater than or equal to 50% during treatment. Similarly, Blessed dementia ratings declined significantly; the % change in Blessed dementia ratings was significantly correlated with improvement in Hamilton depression ratings. By contrast, Folstein mini-mental state scores did not change significantly during treatment. Six of 16 (37.5%) patients showed resolution of cognitive impairment with adequate treatment of depression. Mixed-symptom patients diagnosed as suffering from major depression (with cognitive impairment) showed more robust pre-post treatment differences, particularly in Hamilton, Folstein, and Blessed dementia scores, than did mixed patients diagnosed as having primary degenerative dementia (with depression). In cognitively intact elderly depressives, the mean % change in Hamilton ratings was 72% (4.3), not significantly different from mean % change in mixed-symptom patients (57.4 +/- 29.9). The proportion of intact depressives showing a reduction greater than or equal to 50% in Hamilton depression ratings was significantly greater (93.8%) than in the mixed group (62.5%). In both groups, 81.3% of patients (13 of 16 in each cell) had a final Hamilton rating less than or equal to 10. These data suggest that elderly patients with mixed depression and cognitive impairment respond to treatment similar to that used in cognitively intact elderly depressives. A controlled study of antidepressant treatment in mixed-symptom patients is warranted.

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PubMed1987

The superior sleep of healthy elderly nuns.

The nocturnal sleep structure of ten healthy elderly nuns was compared to that of ten healthy age-matched female controls. The nuns fell asleep more quickly and had less early morning awakening, as well as greater REM sleep time. These differences may reflect the more highly entrained life style of the nuns, including modest habitual sleep restriction (and thus accumulated sleep debt) of about one hour each night. The current findings, reviewed in relation to the sleep and aging literature, tend to support the concept that some of the effects of aging on sleep can be offset by attention to good "sleep hygiene," including careful entrainment of sleep schedule and modest habitual sleep restriction. However, age-related decrements in slow-wave sleep and sleep maintenance were not significantly better in the nuns.

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PubMed1986

Sleep deprivation in healthy elderly men and women: effects on mood and on sleep during recovery.

Elderly women had better recovery sleep than elderly men following 36-h sleep deprivation, as evidenced by higher sleep maintenance/efficiency and more slow wave sleep (particularly in the amount of stage 4 sleep). During recovery sleep, both groups showed REM latency reduction (two men and three women had seven sleep-onset REM periods out of a total of 40 recovery nights), decrease in percentage of early REM sleep and increase in whole-night REM sleep time. Total Mood Disturbance scores on the Profile of Mood States increased in both men and women following sleep deprivation (reflecting a decrease in vigor and increase in fatigue and tension). While the increase tended to be greater in women, in both groups self-ratings of mood returned to baseline after 1 night of recovery sleep. These observations underscore the importance of gender in determining late-life sleep structure and suggest that the ability of older women to achieve slow wave sleep and to have long uninterrupted sleep in greater than that of men.

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PubMed1986

Two-year follow-up of elderly patients with mixed depression and dementia. Clinical and electroencephalographic sleep findings.

In a two-year follow-up of 16 patients with mixed symptoms of depression and dementia, eight showed clinical improvement and eight showed deterioration. Improvement at two-year follow-up was associated with several baseline measures: a Folstein Mini-Mental State score of 21 or greater, a Hamilton Depression score of 21 or greater, and a sleep efficiency of less than 75%. These findings suggest that in the elderly with mixed symptoms of depression and dementia, a more favorable outcome is associated with initially greater depressive symptomatology, higher cognitive function, and moderate sleep continuity disturbance ("early morning awakening").

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PubMed1986

Sleep-disordered breathing in normal and pathologic aging.

In a study of sleep-disordered breathing among 139 elderly individuals, sleep apnea (defined as 5 or more apneas per hour) occurred in 34 (41.7%) Alzheimer's subjects compared with 56 (5.4%) healthy controls, 35 (11.4%) depressive subjects, and 24 (16.7%) patients with mixed symptoms of both cognitive impairment and depression (p less than .001). Alzheimer's patients had a significantly higher proportion of NREM-related than REM-related apnea. Moreover, a significant (p less than .01) positive correlation between the apnea index and severity of dementia, as measured by the Blessed Dementia Rating Scale, was found in apnea-positive Alzheimer's patients, as well as in the entire sample of Alzheimer's patients (p less than .05). No such correlation was found in the mixed-symptoms group. Possible clinical and neuropathologic implications are discussed.

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PubMedDate not supplied

Longitudinal analysis of nortriptyline side effects in elderly depressed patients.

Forty-five depressed elderly patients were closely monitored in a research setting during treatment with nortriptyline and interpersonal psychotherapy for 7 consecutive months of acute and continuation treatment. Overall, nortriptyline was efficacious and well tolerated in this group. The frequency of somatic complaints measured by the Rating Scale for Side Effects declined by 50% during the acute phase of treatment, suggesting that many somatic complaints that may be attributed to side effects of nortriptyline are actually somatic symptoms of depression. The authors discuss the implications of these findings and offer practical advice for the treating clinician.

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