Biomedical subjects

J Jolles

Publications and source records attributed to J Jolles.

At least 91 records · Page 5Linked to original sources

PubMed1999

Cognition after major surgery in the elderly: test performance and complaints.

There is evidence that older people in particular have a higher risk of cognitive dysfunction after surgery under general anaesthesia. We have investigated the severity and character of postoperative cognitive dysfunction after major non-cardiac surgery in patients older than 65 yr. Also, cognitive complaints were studied. Cognitive function was assessed using cognitive tests measuring memory and attention, such as ability to shift between two sequences, ability to ward off distractions, simple cognitive speed and speed of general information processing. These tests were performed before, 1 week (short-term) and 3 months (long-term) after surgery. Cognitive performance of the patients was compared with that of healthy subjects not undergoing surgery who were also subjected to repeated cognitive measurements. After 1 week, patients had a poorer performance on tests measuring simple cognitive speed and speed of general information processing. Three months after surgery, patients and controls showed improved cognitive performance compared with the first measurement. These results suggest that major non-cardiac surgery in older patients causes short-term but not long-term cognitive dysfunction. However, after 6 months, 14 of 48 patients (29%) reported having experienced a decline in cognitive abilities after discharge from hospital. Eight of these 14 patients (17%) were still experiencing these cognitive complaints and reported 'not being the same since the operation'. These findings emphasize that cognitive complaints after major surgery may not reflect actual changes in cognitive performance but may be caused by other factors such as depression or awareness of age-related changes.

Aged↗

PubMed1999

Neuropsychological correlates of a right unilateral lacunar thalamic infarction.

OBJECTIVES: To report on a patient with a lacunar infarction in the right intralaminar nuclei of the thalamus. The role of the thalamic intralaminar nuclei in cognitive function is as yet insufficiently known. The patient described has shown signs of apathy and loss of initiative, in combination with cognitive deficits, which have persisted essentially unaltered up to the present day since an abrupt onset 17 years ago. METHODS: High resolution MRI was performed to show the extent of the lesion; a combination of published and experimental neuropsychological techniques was administered to show the nature of the cognitive defects; Single photon emission computed tomography (SPECT) was employed to obtain a measure of cortical perfusion. RESULTS: Brain MRI disclosed an isolated lacunar infarction in the dorsal caudal intralaminar nuclei of the thalamus. Neuropsychological evaluation indicated problems with attention and concentration, executive disturbances, and memory deficits both in the visual and verbal domains. The memory deficits could not be attributed to problems in the early stages of information processing, and are hence regarded as resulting from a failure of retrieval rather than encoding or storage. Brain SPECT disclosed a hypoperfusion of the right frontal cortex. CONCLUSION: The data indicate that the cognitive profile is the result of a dysfunction of executive functions. This is corroborated by the finding of decreased blood flow in the right frontal cortex, and by evidence from the neuroanatomical literature. Thus the dysexecutive symptoms are thought to be caused by disconnection of the prefrontal cortex from the brainstem activating nuclei through the strategic localisation of the right thalamic infarction.

Adult↗

PubMed1999

Brain correlates of memory dysfunction in alcoholic Korsakoff's syndrome.

OBJECTIVES: To investigate the relation between anterograde amnesia and atrophy of brain structures involved in memory processing in alcoholic Korsakoff's syndrome. METHODS: The volume of brain structures involved in memory processing was measured with MRI from 13 subjects with Korsakoff's syndrome, 13 subjects with chronic alcoholism without Korsakoff's syndrome, and 13 control subjects. The brain structures analysed were the hippocampus, the parahippocampal gyrus, the mamillary bodies, the third ventricle, and the thalamus. Brain volumes were correlated with the delayed recall of a verbal learning test. RESULTS: Compared with subjects with chronic alcoholism and control subjects, subjects with Korsakoff's syndrome had a reduced volume of the hippocampus, the mamillary bodies, and the thalamus, and enlargement of the third ventricle. The impairment of delayed recall correlated with the volume of the third ventricle (r=-0.55, p=0.05) in the Korsakoff group. CONCLUSIONS: Anterograde amnesia in alcoholic Korsakoff's syndrome is associated with atrophy of the nuclei in the midline of the thalamus, but not with atrophy of the mamillary bodies, the hippocampus, or the parahippocampal gyrus.

Alcoholism↗

PubMed1998

Affected enzyme activities in Alzheimer's disease are sensitive to antemortem hypoxia.

Many enzyme activities in Alzheimer's disease (AD) are changed. Some of these enzyme activities are related to certain neurotransmitter systems. Enzymes in the brain can also be sensitive to antemortem hypoxia. In the present study it was determined if enzyme activities that are altered in AD are also subject to alteration by antemortem hypoxia. As an indicator of antemortem hypoxia brain lactate concentration was used. Enzyme activities measured were those of prolyl endopeptidase (PE), aminopeptidase (AP), phosphatidylinositol (PI) kinase, phosphatidylinositol phosphate kinase, alpha-ketoglutarate dehydrogenase (alpha-KGDH), choline acetyltransferase and beta-glucuronidase. All of these enzyme activities have been measured in AD patients before and several of them have been found to be decreased. In accordance with previous findings, PE, alpha-KGDH and ChAT activities were reduced in AD patients. PI kinase and beta-glucuronidase activities, however, were not reduced, contrary to previous findings. All enzyme activities, except that of beta-glucuronidase, correlated with brain lactate concentration, suggesting that antemortem hypoxia has a major influence on the activity of enzymes in the brain. PE, AP, alpha-KGDH and ChAT activities were still different between AD and control samples when these were matched for lactate concentration. The enzyme activities that were changed in AD were also significantly correlated with lactate concentration, an indicator of antemortem hypoxia, in brain specimens. This suggests that antemortem hypoxia and AD have some factor in common that may be responsible for changes in enzyme activities. Since both PE and alpha-KGDH are known to be sensitive to oxidative stress this factor could be oxidative stress.

Adult↗

PubMed1998

Long-term postoperative cognitive dysfunction in the elderly ISPOCD1 study. ISPOCD investigators. International Study of Post-Operative Cognitive Dysfunction.

BACKGROUND: Long-term postoperative cognitive dysfunction may occur in the elderly. Age may be a risk factor and hypoxaemia and arterial hypotension causative factors. We investigated these hypotheses in an international multicentre study. METHODS: 1218 patients aged at least 60 years completed neuropsychological tests before and 1 week and 3 months after major non-cardiac surgery. We measured oxygen saturation by continuous pulse oximetry before surgery and throughout the day of and the first 3 nights after surgery. We recorded blood pressure every 3 min by oscillometry during the operation and every 15-30 min for the rest of that day and night. We identified postoperative cognitive dysfunction with neuropsychological tests compared with controls recruited from the UK (n=176) and the same countries as study centres (n=145). FINDINGS: Postoperative cognitive dysfunction was present in 266 (25.8% [95% CI 23.1-28.5]) of patients 1 week after surgery and in 94 (9.9% [8.1-12.0]) 3 months after surgery, compared with 3.4% and 2.8%, respectively, of UK controls (p<0.0001 and p=0.0037, respectively). Increasing age and duration of anaesthesia, little education, a second operation, postoperative infections, and respiratory complications were risk factors for early postoperative cognitive dysfunction, but only age was a risk factor for late postoperative cognitive dysfunction. Hypoxaemia and hypotension were not significant risk factors at any time. INTERPRETATION: Our findings have implications for studies of the causes of cognitive decline and, in clinical practice, for the information given to patients before surgery.

Abdomen↗

PubMed1998

Acute effects of acetyl-L-carnitine on sodium cyanide-induced behavioral and biochemical deficits.

In the present study we investigated the effects of acute treatment with acetyl-L-carnitine (50 mg/kg, i.v. 90 min before the sodium cyanide injection) on a sodium cyanide-induced behavioral deficit in the Morris water escape task. In a first experiment the spatial discrimination performance of the rats was found to be dose-dependently impaired after an i.c.v. injection of sodium cyanide (2.5 and 5.0 microg). Acute treatment with acetyl-L-carnitine was found to increase the behavioral deficit after sodium cyanide. These findings were replicated in a second experiment. Based on these results it can be argued that an acute administration of acetyl-L-carnitine appears to potentiate a sodium cyanide-induced behavioral deficit. An additional in vitro experiment with rat brain synaptosomes showed clear effects of administered sodium cyanide on the energy-dependent incorporation of inositol into phosphoinositides and on the ATP concentration. In vitro acetyl-L-carnitine administration had no effect on the sodium cyanide-induced energy depletion. The negative behavioral findings are in contrast with our previously found protective effect of chronic treatment with acetyl-L-carnitine (via drinking water) on the sodium cyanide-induced behavioral deficit. Since chronic acetyl-L-carnitine treatment has no effect on the phosphoinositide metabolism it was suggested that acetyl-L-carnitine may act via the formation of an ATP-independent reservoir of activated acyl groups. Thus, fatty acids as acylated derivatives can be used for reacylation processes during an acute period of energy depletion. However, we have no clear explanation for the discrepancy in behavioral results between the chronic vs acute treatment of acetyl-L-carnitine at present. Further research is needed to characterize the mechanism of action of acetyl-L-carnitine in relation to sodium cyanide.

Acetylcarnitine↗

PubMed1998

Subjective forgetfulness in a normal Dutch population: possibilities for health education and other interventions.

Many, especially elderly people, are worried about their diminishing memory. In order to be able to improve health education activities about forgetfulness and aging processes, nearly 2000 healthy Dutch people, aged 25-85 years, participated in a postal survey into the determinants of subjective forgetfulness. As expected, there was a systematic increase in the prevalence of forgetfulness with age. The relatively high prevalence of forgetfulness in the young (29%) and middle-aged groups (34%) was unexpected. Besides age, the occurrence of dementia in a close relative appeared to be a strong predictor of people's subjective forgetfulness. Furthermore, people who felt more in control of their memory functioning reported less forgetfulness. Younger people ascribed their forgetfulness mostly to external causes (stress, concentration) and older people to internal causes (age, retardation). Eleven percent of all forgetful people were interested in an intervention for their memory complaints. In this group, education (37%), memory training (29%), and medication (12%) were the preferred interventions. No differences were found between older and younger respondents.

Adult↗

PubMed1998

Effects of age on performance in a finger-precuing task.

This study investigated age-related precuing effects in the finger-precuing task (J. Miller, 1982). In this task, a spatial precue provides partial advance information about which fingers to use for responding. Results indicated a substantial age-related deficit in preparing 2 fingers on 2 hands, but not on 1 hand. This disparate set of findings does not provide strong support for A. A. Hartley's (1993) hypothesis that anterior brain attention systems responsible for selection-for-action are compromised with advancing age. Finally, the authors report that advancing age increasingly slows reaction time more to the inner than to the outer stimulus-response positions. A possible mechanism of this age-related bowed stimulus-response position effect is discussed.

Adult↗

PubMed1998

The relation between morbidity and cognitive performance in a normal aging population.

BACKGROUND: Factors related to physical health have been implicated in both normal and pathological aging of cognitive abilities. To substantiate this notion, we studied existing morbidity, as diagnosed by the general practitioner according to well-defined criteria, as a potential predictor of cognitive test performance. METHODS: A sample of 1360 individuals, aged 24-81 years and living in the community, was stratified for age, sex, and general ability. Active and total morbidity in this group were classified according to the International Classification of Primary Care. Neurocognitive tests were used to assess the domains of verbal memory, sensorimotor speed, and cognitive flexibility. RESULTS: Multiple regression analyses with adjustment for age, sex, and educational level showed both insulin-dependent and noninsulin-dependent diabetes to be negatively associated with all cognitive measures. More specific negative associations were found for chronic bronchitis (performance speed) and presbyacusia (memory). Single or aggregated cardiovascular morbidity (including hypertension) was unrelated to test performance. CONCLUSIONS: Existing morbidity as a whole contributes only modestly (up to 3.5%) to total variance in cognitive function. However, some specific, relatively common diseases of the elderly, such as diabetes and chronic bronchitis, may aggravate the age-related decline in cognitive ability.

Adult↗

PubMed1998

Is nondipping in 24 h ambulatory blood pressure related to cognitive dysfunction?

OBJECTIVE: Associations between the outcome of 24 h ambulatory monitoring and cognitive performance were studied in order to evaluate the potential relevance of ambulant blood pressure status to brain function. It was hypothesized that a small daytime-night-time difference in mean blood pressure (nondipping) is associated with reduced cognitive performance, in line with studies in hypertensive subjects that have reported associations between nondipping and target-organ damage. METHODS: The study followed a cross-sectional design and was part of a larger research programme on determinants of cognitive aging (Maastricht Aging Study, MAAS). A group of 115 community residents aged 28-82 years was recruited from a general practice population and screened for cardiovascular events and medication use. All underwent 24 h blood pressure monitoring. Cognitive performance was measured with tests of verbal memory, attention, simple speed and information processing speed. RESULTS: Mean daytime or night-time levels of both systolic and diastolic blood pressure were unrelated to cognitive outcome, when age, sex and educational level were controlled for. Differences between mean daytime and night-time blood pressure (based on both narrow and wide measurement intervals for day and night-time periods) were positively associated with memory function (5-9% of additional variance explained) and one sporadic positive association was found on the sensorimotor speed score (4%). Nondippers (n=15) showed lower levels of both memory and sensorimotor speed scores. CONCLUSIONS: Ambulatory blood pressure status was not associated with cognitive performance. A reduced nocturnal blood pressure drop was associated with quite specific cognitive deficits, but the underlying mechanism remains to be determined.

Adult↗

PubMed1998

An operation under general anesthesia as a risk factor for age-related cognitive decline: results from a large cross-sectional population study.

OBJECTIVE: To evaluate the factor 'operation under general anesthesia' as a possible risk factor for age-related cognitive decline. DESIGN: A retrospective, population-based, cross-sectional study. SETTING: Maastricht Aging Study (MAAS), Maastricht, The Netherlands. PARTICIPANTS: 1257 normal healthy subjects aged 24 to 86 years. Of the 1257 healthy subjects, 946 subjects appeared to have undergone at least one operation under general anesthesia. MEASUREMENTS: The history of an operation under general anesthesia, number of operations, duration of anesthesia, cognitive performance, subjective health, and subjective memory were measured. RESULTS: A history of an operation under general anesthesia, the number of operations, and the total duration of anesthesia significantly contributed to the number of subjective health-related complaints but did not predict cognitive performance or memory complaints. Subjects with a history of an operation under general anesthesia felt less healthy than subjects who had never undergone an operation under general anesthesia. No interactions with age were found. CONCLUSION: The present study found no support for the notion that a history of an operation under general anesthesia is a determinant or risk factor for accelerated age-related cognitive decline.

Adult↗

PubMed1998

[The Maastricht aging study (MAAS). The longitudinal perspective of cognitive aging].

The Maastricht Aging Study (MAAS) was designed to specify the usual and pathological aging of cognitive function. In short, the main questions of MAAS are: who deteriorates when in which aspects of cognitive function, and what biomedical or psychosocial factors can be identified that may act as mediators in this process? The study comprises four independent panel studies in which a group of 1,900 initially healthy individuals are followed for a period of 12 years with respect to health characteristics and neurocognitive status. For this purpose a sample was drawn from a patient register of collaborating general practitioners, stratified by age (range 24 to 81 years), sex and general ability level. Rationale and design of MAAS are discussed and some findings from the cross-sectional baseline measurement are summarized: general aspects of memory and attention in aging, cognitive functioning after brain trauma and general anesthesia, physical condition (fitness, morbidity and vascular risk factors, such as blood pressure) as predictors of cognitive function, and finally cognitive complaints and metamemory.

Adult↗

PubMed1997

Effect of test duration on age-related differences in Stroop interference.

The effect of test duration on age-related differences in Stroop interference was assessed in a large cross-sectional study involving 429 healthy subjects in four age groups (25-35 years, 40-50 years, 55-65 years, 70-80 years). The results show a clear effect of test duration on Stroop interference. The Stroop Color Word Test was run in two parts. The young group performed the first part relatively rapidly but became slower in the second part, whereas the old group showed the reverse effect. The two middle-aged groups did not show differences between the first and second parts of the test. The results are interpreted in terms of a deficit in response inhibition by a controlled processing strategy. A psychological interpretation of the study findings in terms of increased cautiousness appears less probable. The first part of the test, that is, an abridged version of the test, may prove superior to the regular version for both clinical and research purposes.

Adult↗

PubMed1997

Can the blood pressure predict cognitive task performance in a healthy population sample?

OBJECTIVES: To study the relation between the blood pressure and the neurocognitive function within the full adult age range in a large population sample. DESIGN: A cross-sectional study of 936 healthy adults who were recruited from a register of family practices, stratified for age (24-81 years), sex, and occupational level, who took part in a medical and neurocognitive test program. METHODS: The blood pressure status was studied in relation to five measures of cognitive ability, including verbal memory and speed of information processing. Other vascular risk factors were treated as control variables and included smoking, alcohol intake, body mass index, and body fat distribution. The blood pressure was measured five times using an automatic recording technique (with a Dinamap 8100 device). RESULTS: After adjustment for age, sex, and educational level in a hierarchical regression analysis, we found no unequivocal association between the mean systolic and diastolic blood pressures (or any other studied vascular risk factor) and cognitive test performance both for the whole group and for the subgroup of subjects who were not being administered antihypertensive medication and whose medical history did not include cardiovascular events. Stratified analysis within four age levels revealed no age-specific associations between the blood pressure and the cognitive function. Subjects whose blood pressure was within the hypertensive range performed worse than did matched controls at letter digit copying, but not according to other cognitive measures. CONCLUSIONS: With a population-based sample unselected for blood pressure status we found no linear relationship between the actual blood pressure level and various aspects of cognitive performance. Prospective studies are needed to investigate the possibility that the systemic blood pressure load over time is associated with a decline in specific cognitive abilities.

Adult↗

PubMed1997

Aerobic capacity and cognitive performance in a cross-sectional aging study.

In a population unselected for aerobic fitness status, aerobic fitness (VO2max) and its interaction with age were used to predict performance on several cognitive measures known to be affected by chronological age. It was hypothesized that, in particular, cognitively demanding tasks would be sensitive to aerobic capacity. Healthy subjects between 24 and 76 yr of age (N = 132) were recruited from a larger study into determinants of cognitive aging (Maastricht Aging Study-MAAS). All participants took part in a submaximal bicycle ergometer protocol and an extensive neurocognitive examination, including tests of intelligence, verbal memory, and simple and complex cognitive speed. Participants engaged more hours a week in aerobic sports and felt healthier than the nonparticipants of the same age did. No group differences were found in the basic anthropometric characteristics height, weight, and BMI. Two of four subtasks that reflect complex cognitive speed (Stroop color/word interference and Concept Shifting Test) showed main and interaction effects with age of aerobic capacity in a hierarchical regression analysis, accounting for up to 5% of variance in parameter score after correction for age, sex, and intelligence main effects. These findings fit well within a moderator model of aerobic fitness in cognitive aging. They add to the notion that aerobic fitness may selectively and age-dependently act on cognitive processes, in particular those that require relatively large attentional resources.

Adult↗

PubMed1997

Prevalence and covariates of subjective forgetfulness in a normal population in The Netherlands.

In this study we examined the prevalence and covariates of forgetfulness in a large sample of almost 2,000 subjects in the age range twenty-four to eighty-six years. Nearly 40 percent of the participants considered themselves to be forgetful. There was a systematic increase in the prevalence of forgetfulness with age, from 29 percent in the young age group to 52 percent in the oldest age group. Forgetfulness was not considered to be a serious problem in terms of perceived hindrance and worry by most subjects, independent of their age. Age, depression, and subjective health (especially complaints about vitality) acted as covariates of forgetfulness. Gender and education had no effect on the prevalence of forgetfulness. The younger adults ascribed their forgetfulness more to potentially reversible and manageable memory-extrinsic causes such as tension and emotional problems, whereas the older adults mentioned less manageable and more or less irreversible memory-intrinsic causes such as aging more often.

Adult↗

PubMed1996

Effects of age and gender on discrete and reciprocal aiming movements.

Using a cross-sectional design, this study determined the time course of aging effects on rapid discrete and reciprocal aiming movements in men and women. A total of 80 men and 61 women in good health were classified into six age groups (25, 35, 45, 55, 65, and 75 years). The discrete task required participants to make one discrete aiming movement, whereas the reciprocal task required a series of back-and-forth movements. Results indicated for both aiming tasks that greater age was strongly associated with slower movement times. The significant interaction between age and task indicated that the discrete task showed much larger aging effects (54%) than the reciprocal task (25%). This finding is tentatively interpreted in terms of a reduced efficiency of "on-line" control processes.

Adult↗

PubMed1996

The Abridged Dutch Metamemory in Adulthood (MIA) Questionnaire: structure and effects of age, sex, and education.

This study presents data on the factor structure, reliability, and discriminant validity of the Metamemory in Adulthood (MIA) questionnaire in a Dutch sample of 1,899 normal and healthy participants aged 24 to 86 years. The factor structure of the Dutch MIA corresponded with that of the original MIA. The Strategy scale could be divided into two subscales: External and Internal Memory Strategies. The number of items on the MIA could be reduced by 34% without loss of the factor structure or lowering of the internal consistency of the subscales. Data on the relation of the abridged MIA with age, sex, education, depression, anxiety, and subjective health are presented. The study supports the cross-national use of the MIA as a research and clinical instrument for the evaluation of subjective memory functioning.

Adult↗