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Biomedical subjects

J M Starr

Publications and source records attributed to J M Starr.

At least 55 records · Page 3Linked to original sources
PubMed1997

Survival in early onset dementia: effects of urbanization and socio-economic deprivation.

We estimated survival of patients with early onset Alzheimer's disease (AD) or vascular dementia (VaD) presenting to psychiatric hospitals in Scotland (1974-1988) and related this to age, gender and socio-economic variables. Hospital records of 1794 early onset dementia patients were reviewed. We identified 451 patients with early onset AD and 384 with VaD. Survival to death was calculated from symptom onset and presentation. Small geographical areas (postcode sectors) were classified by urban/rural category and deprivation score. Five-year survival from presentation of early onset AD was 32% for men and 43% for women compared to 22% for men and 36% for women with VaD. We conclude that increased age at presentation was associated with shorter survival in early onset AD and VaD. Socio-economic deprivation was associated with longer survival in VaD. The effects of urban/rural score were accounted for by the major effects of socio-economic deprivation.

Adult↗
PubMed1997

Familial or sporadic clusters of presenile dementia in Scotland: I. Parental causes of death in Alzheimer and vascular presenile dementias.

Between 1974 and 1988, discrete areas within Scotland had unexpectedly high incidences of presenile Alzheimer's disease. To examine whether these clusters might be attributable to 'familial' cases occurring in the same locality, we performed a case-control study of parental cause of death entered on death certificates. Cases comprised (1) 145 presenile Alzheimer's disease patients and (2) 73 vascular dementia patients presenting in Lothian between 1974 and 1988. Two control individuals per case, of the same sex, born in the same registration district, and whose fathers had the same occupation as the case's father, were chosen from birth registration data. Parental death certificates for 131 presenile Alzheimer's disease and 65 vascular dementia cases were located. There was no significant association detected between a diagnosis of presenile Alzheimer's disease and dementia as a parental cause of death (p = 0.25), nor for vascular dementia (p = 0.67). Presenile Alzheimer's disease cases were less likely to have a parent die with cerebrovascular disease (chi 2 = 4.80, p < 0.05) and vascular dementia cases more likely to have a parent die with cerebrovascular disease (chi 2 = 5.28, p < 0.05). There was no increased incidence of other vascular disease or bronchogenic carcinoma in cases' parents compared with control individuals' parents.

Age Factors↗
PubMed1997

Familial or sporadic clusters of presenile Alzheimer's disease in Scotland: II. Case kinship.

Clusters of high incidence areas of presenile Alzheimer's disease were found in Scotland between 1974 and 1988. We present a novel index of case kinship based on the number of observed common ancestors of cases compared with the number expected in order to evaluate whether these cluster are attributable to familial cases. One county with high incidence was Lanarkshire, with 69 of the 451 national presenile Alzheimer's disease cases and 185 of the 1794 any-cause dementia cases. None of the 69 presenile Alzheimer's disease cases shared a common great-grandmother and there was no instance where an individual case's great-grandmother was another case's grandmother. Five pairs of dementia cases shared a great-grandmother; for two pairs, one case's great-grandmother was another's grandmother. We estimated the 'at-risk' ancestral population as 46,000 for the midpoint census of 1861 for the cross-sectional estimate, 155,812 for the cumulative estimate between 1831 and 1891, and 90,282 for the cumulative estimate between 1841 and 1871. Hence, we expected a maximum of 0.29 shared great-grandmothers for presenile Alzheimer's disease cases, and 2.13 shared great-grandmothers for dementia cases. Case-kinship is 2.35 more than expected (estimated range 1.84-3.18). We conclude that familial factors contribute to the incidence of dementia in Lanarkshire.

Adult↗
PubMed1996

Population risk factors for hospitalization for stroke in Scotland.

BACKGROUND: There is considerable heterogeneity of cerebrovascular disease (CVD) incidence throughout Scotland. We sought to relate this geographical variation to differences in population risk factors. METHOD: A computer search of linked national hospital discharge data was performed. Individuals were selected if they had been coded with a diagnosis of CVD (ICD-9 430-438), 1984-1986. Age-sex specific rates were correlated to deprivation score and estimated population risk factors for the 22 local government districts of the Scottish Heart Health Study (1984-1986). RESULTS: Men were more commonly admitted in all districts except one, with an overall male:female ratio of 1.43 (P < 0.0001). Rates for men were significantly higher in populations with elevated mean diastolic blood pressure, greater mean alcohol consumption, and where fewer men ate fruit. The most significant associations of male CVD hospital admissions were with population density and deprivation. A similar pattern was found for women, where CVD was significantly associated with elevated diastolic blood pressure, more smokers and fewer non-smokers, and fewer eating fruit. Again rates were higher in densely populated, deprived districts. Multiple linear regression identified the proportion for men. Sex difference was explained by vitamin C intake. CONCLUSION: Geographical variation in CVD rates in Scotland is related to identifiable population risk factors for atherosclerosis and urban environment.

Adult↗
PubMed1996

The effects of antihypertensive treatment on cognitive function: results from the HOPE study.

OBJECTIVES: Hypertension is associated with impaired cognition, but it is unclear whether this impairment is reversible. We sought to evaluate the effect of blood pressure reduction on cognition. DESIGN: A randomized, double-blind trial. SETTING: A single center, with assessments in subjects' domiciles. PARTICIPANTS: Community-screened subjects more than 69 years of age who had median diastolic pressures > 99 mm Hg and systolic pressures > 159 mm Hg or diastolic > 85 mm Hg and systolic > 179 mm Hg with Mini-Mental State Examination scores of 20 to 28. Subjects had not previously received antihypertensive treatment. INTERVENTION: Captopril 12.5 mg twice daily or bendrofluazide 2.5 mg daily for 24 weeks, preceded by a 2-week placebo phase. MEASUREMENTS: Cognition was evaluated by a psychometric test battery comprising Immediate and Delayed Logical Memory, Paired Associates recall, Raven's Progressive Matrices, Halstead Reitan Trail Making A, and the Anomalous Sentences Repetition Test. RESULTS: Eighty-one subjects (28 male, 53 female) were treated (41 captopril, 40 bendrofluazide). At entry, mean age was 76.1 years (range 70-84), mean blood pressure was 191 (160-230) mm Hg systolic, 101 (88-110) mm Hg diastolic, and mean MMSE score 26.1. A total of 69 subjects completed the trial. The 25th, 50th, and 75th percentiles of the difference between pretreatment and Week 24 blood pressures wer 15 mm Hg, 35 mm Hg, and 50 mm Hg (systolic) and 5 mm Hg, 10 mm Hg, and 19 mm Hg (diastolic). There were no significant differences in any psychometric test between captopril and bendrofluazide. The 19 subjects in the quartile that lowered their diastolic blood pressure most ( > or = 19 mm Hg) had improved scores on Anomalous Sentences (P = .012) and Paired Associates (P = .044) compared to the 19 subjects in the least blood pressure responsive quartile (fall < or = 5 mm Hg)s. CONCLUSION: The treatment of hypertension is not hazardous to cognitive function in older people with pre-existing cognitive impairment. Long-term adequate blood pressure control may reverse cognitive impairment associated with pre-existing hypertension.

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PubMed1995

Understanding circadian rhythms: a holistic approach to nurses and shift work.

When night shift nurses drive home at 7:30 a.m., the daylight resets their circadian pacemakers in the retina. This daylight exposure amplifies desynchronization of the circadian rhythm. It was found that 3:00 a.m. to 3:00 p.m. and 3:00 p.m. to 3:00 a.m. shifts produced less physiological and emotional stresses. Increased awareness of circadian rhythms may help to reduce the multiple risks to nurses' health and enhance quality of life. This article presents the scientific principles of circadian rhythms and their effects on shift workers' health and illnesses. There is a significant decrease in job performance and in satisfaction and quality of patient care. Statistics indicate that errors, injuries, sick days, and accidents are higher for nurses' working rotating shifts. Eleven recommendations provide ideas to support nurses holistically.

Adaptation, Physiological↗
PubMed1995

Epidemiology of presenile Alzheimer's disease in Scotland (1974-88) II. Exposures to possible risk factors.

BACKGROUND AND METHOD: We related geographical variation of 'probable' presenile Alzheimer's disease (AD PSD) to exposures to possible risk factors for AD PSD and vascular dementia (VaD) and to geographical differences in survival times after presentation with AD PSD. RESULTS: We found that an ecological measure of socio-economic deprivation was related to VaD but not to AD PSD. Among men with AD PSD and VaD, specific occupations conveyed no altered risk but having fathers who were coal miners was associated with AD PSD and VaD in offspring. Increased paternal age was associated with AD PSD but only in men. These factors acted independently of one another and did not distinguish between geographical areas of high and low incidence. CONCLUSIONS: The length of survival after presentation with AD PSD distinguished between these areas, and when migration between these areas was taken into account, a plausible multifactorial model of the harmful effects of environment emerged, which acted independently of risk factors acting earlier in life.

Adult↗
PubMed1994

A double-blind trial of captopril or bendrofluazide in newly diagnosed senile hypertension.

Hypertension is a major risk factor for stroke and heart disease in the elderly. Eighty-one hypertensive subjects with mild cognitive impairement, aged over 70 years, were drawn from a community screening programme and randomized to either 12.5 mg captopril twice daily or 2.5 mg bendrofluazide daily in a double-blind trial. Subjects were excluded if they had previously received antihypertensive treatment. The mean blood pressure was reduced from 193/101 mmHg to 154/87 mmHg by captopril and from 188/102 mmHg to 151/89 mmHg by bendrofluazide after 24 weeks; there was no significant difference between the two drugs. Seven subjects withdrew due to adverse events. Adverse events occurred more frequently during the 2-week placebo phase than during active treatment with either drug. The only significant detrimental changes in pre-existing conditions were in 3 subjects (2 captopril, 1 bendrofluazide) who were noted to have worsening of their cataracts. One subject on captopril and 4 subjects on bendrofluazide became hypokalaemic. The trial results support the use of captopril as an alternative to bendrofluazide as a first-line antihypertensive agent in the community for elderly people, but large studies are required to measure accurately effects on significant morbidity and mortality.

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PubMed1994

Drug-induced dementia. Incidence, management and prevention.

Drugs are a frequently cited cause of dementia. There is a paucity of data regarding the incidence of drug-induced dementia, but it has been estimated that over 10% of patients attending memory clinics have iatrogenic disease. Drugs may impair cognition indirectly via metabolic effects, such as hypoglycaemia, by alterations of immunological factors within the CNS, and by actions that interfere with synaptic transmission. Classes of drugs most frequently responsible are the benzodiazepines, antihypertensives and drugs with anticholinergic properties. Each of these classes is likely to produce a different pattern of neuropsychological deficits. Prevention of drug-induced dementia will be aided by: (i) minimising the number of drugs prescribed; (ii) using shorter-acting preparations; (iii) avoiding agents that cross the blood-brain barrier where possible; (iv) evaluating renal and hepatic function regularly; and (v) briefly assessing cognitive function before treatment.

Blood-Brain Barrier↗
PubMed1994

Peace Corps service as a turning point.

This is a longitudinal study of twenty-one U.S. Peace Corps Volunteers, first interviewed in the mid-1960s during their tour of service in the Republic of the Philippines and then twenty years later as middle-aged adults. Life events reported after their service and the high degree of response agreement in the two interviews confirm that their Peace Corps experience constituted a turning point in their life courses. The study reviews the literature on turning points, proposes an appropriate definition for the concept, identifies conditions that promote turning points, especially for youth, and indicates directions for future research.

Adaptation, Psychological↗
PubMed1993

Epidemiology of Alzheimer's presenile dementia in Scotland, 1974-88.

OBJECTIVE: To describe the epidemiology of presenile Alzheimer's disease in Scotland from 1974 to 1988. DESIGN: Retrospective review of hospital records of patients aged less than 73 years admitted to psychiatric hospital with various diagnoses of dementia. Diagnoses were classified by National Institute for Communicative Disorders and Stroke and Alzheimer's Disease and Related Disorders Association Criteria and the Hachinski score. Completeness of the study sample was evaluated by scrutiny of neurology outpatient and general hospital records. SETTING: All general psychiatric hospitals in Scotland. SUBJECTS: All patients with onset of dementia aged 40-64. MAIN OUTCOME MEASURES: Probable and broad Alzheimer's disease, sex of patient, age at onset. RESULTS: 5874 psychiatric hospital records, 129 neurology outpatient records, and 89 records from non-psychiatric hospitals were examined. 317 patients met criteria for probable Alzheimer's disease, 569 met criteria for broad Alzheimer's disease, and 267 met those for multi-infarct dementia. Minimal incidences per 100,000 population aged 40-64 years were 22.6 (95% confidence interval, 20.2 to 25.2) and 40.5 (38.9 to 42.3) per 100,000 for probable and broad Alzheimer's disease. In the 1981 census year the annual incidence of probable Alzheimer's disease was 1.6 (1.0 to 2.6). Women were at greater risk with incidence rates for probable Alzheimer's disease of 28.2 (24.5 to 32.4) per 100,000 compared with 16.5 (13.8 to 19.8) per 100,000 for men. The incidence per 100,000 for multi-infarct dementia was greater in men (25.1, 23.3 to 27.1) than women (13.4, 12.1 to 14.8). CONCLUSION: Female sex seems to be positively associated with development of Alzheimer's disease before age 65 years.

Adult↗
PubMed1993

Hypertensive Old People in Edinburgh (HOPE) Study: electrocardiographic changes after captopril or bendrofluazide treatment.

Hypertension is a major risk factor for stroke and heart disease in elderly people. Eighty hypertensive subjects with mild cognitive impairment, aged over 70 years were drawn from a community screening programme and randomized to either captopril 12.5 mg twice daily or bendrofluazide 2.5 mg daily in a double-blind trial. Subjects were excluded if they had previously received antihypertensive treatment or had significant cardiac disease. Electrocardiograms (ECG) were recorded and scored at baseline and after 12 and 24 weeks of treatment. Mean blood pressure fell significantly and equally in both treatment groups. Most ECG variables remained unchanged throughout the trial but a significant reduction in QRS duration from 0.08 to 0.07 seconds was observed with captopril at 12 weeks (p = 0.004) and 24 weeks (p = 0.002). Subjects on captopril also exhibited a significant improvement in overall ECG classification at 12 weeks (p < 0.05), although this was not sustained at 24 weeks (p = 0.076). Captopril is a suitable alternative to bendrofluazide as an antihypertensive drug for elderly people with regard to ECG detected cardiac complications.

Aged↗
PubMed1993

Blood pressure and cognitive function in healthy old people.

OBJECTIVE: Since hypertension is a major risk factor for multi-infarct dementia, this study aimed to evaluate the effect of blood pressure on cognitive function in elderly subjects on no medication and disease-free. DESIGN: A cross-sectional survey. SETTING: Community. PARTICIPANTS: 598 healthy community-resident subjects aged 70 years and over who were on no treatment. MEASUREMENTS: Blood pressure (BP) and MMSE score, an index of cognitive function. RESULTS: Mean age of the sample was 75.7 years, mean BP 160/86 mmHg, mean MMSE 28.0. Systolic BP correlated negatively with MMSE (P < 0.05), but diastolic BP showed no significant overall correlation. To study possible J-shaped curve effects of BP, the sample was stratified into three groups--low BP, normal BP, and high BP--at levels one standard deviation from the mean for both systolic and diastolic pressures. Mean MMSE scores for low, normal and high systolic BP were 28.3, 28.1, 27.5, respectively; for low, normal, and high diastolic BP scores were 28.0, 28.1, and 27.5 respectively. Multivariate analysis of variance found the differences between normal and high to be significant at P < 0.001 for systolic and P = 0.001 for diastolic BPs. CONCLUSION: High blood pressure is associated with cognitive impairment in healthy, drug-free, older people.

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PubMed1992

Elderly drivers.

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Aged↗