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L F Jarvik

Publications and source records attributed to L F Jarvik.

At least 19 recordsLinked to original sources

Commingling analysis of memory performance in offspring of Alzheimer patients.

Dementia of the Alzheimer type (DAT) is a neurodegenerative disorder which afflicts approximately 3% of the population. Genetic influences are indicated from twin and family studies although genetic heterogeneity has been suggested from both pedigree analyses and linkage investigations. Autosomal dominant inheritance with age-dependent penetrance has been suggested in at least some families with DAT. In the present investigation, we examine memory and nonmemory task performance in 106 asymptomatic offspring (mean age 40.6 years) of 54 DAT probands. Intraclass sibling correlations revealed little evidence of sibling similarity for performance on three memory tasks which have been reported to be relatively sensitive to the memory losses accompanying DAT. Subsequent investigations of the distributions of the cognitive task scores in the offspring revealed evidence for a commingling of two distributions for the three memory tasks but not for the nonmemory measures. These findings are consistent with a hypothesis that these distributions reflect genotypic subgroups, carriers, and noncarriers, of a presumed DAT gene.

Adult

Cognitive performance in relatives of patients with probable Alzheimer disease: an age at onset effect?

Cognitive performance of 32 siblings and children of patients with probable Alzheimer disease was assessed longitudinally over an interval averaging 4 years. Mean scores were within normal limits for age on all measures at both test times. However, relatives of patients with early-onset dementia (less than or equal to 67 years) were more likely to show a decline in performance from the first to second testing than relatives of patients with late-onset dementia. Additional follow-up will be needed to determine the reliability of performance trajectories and to assess whether mild cognitive changes are related to future dementia. However, findings suggest that it may be important to consider family history of dementia in studies of normal cognitive aging.

Aged

A group of potassium-channel blockers-acetylcholine releasers: new potentials for Alzheimer disease? A review.

This review of the literature examines systematically the data currently available for potassium-channel blockers to reassess their clinical potential in Alzheimer disease. The conclusion is that potassium-channel blockers may have been dismissed prematurely for the treatment of Alzheimer disease, an impression supported by data indicating intimate relationships between potassium-channel blockade and cholinergic transmission.

Acetylcholine

Potassium channel blockers: could they work in Alzheimer disease?

Many of the actions of potassium channel blockers, such as 4-aminopyridine, appear to complement the deficits in Alzheimer disease. The two clinical studies in the literature are contradictory, so potassium channel blockers may still merit trial in Alzheimer disease.

4-Aminopyridine

A checklist for managing the dementia patient.

Primary care physicians seeing a growing number of elderly demented patients must consider a number of problem areas when treating such patients. This article offers the mnemonic FICS'M (Family, Intellectual status, Continence, Sleep, and Mobility) to help physicians address treatable problems associated with dementing illnesses. Strategies are offered to minimize morbidity from the particular problem and from the treatment, such as trying "low toxicity" therapies and medications with few side effects. Other medical, ethical, and legal issues are discussed, including handling dangerous behaviors and abuse, nursing home placement and autopsy, and specific treatment of both the dementia itself and associated disorders--agitation, depression, and delirium.

Aged

Clinical drug trials in Alzheimer disease. What are some of the issues?

Clinical drug trials in Alzheimer disease are underway in many locations throughout the world. That experience has uncovered a number of unique difficulties. In response, members of the Alzheimer's Association Medical and Scientific Advisory Board organized meetings with experts from the government, academia, private practice and the pharmaceutical industry. The issues are presented here along with some suggestions to facilitate planning and to avoid problems in future drug trials.

Age Factors

Hypothesis: microtubules, a key to Alzheimer disease.

Alzheimer disease (AD) is a clinicopathologic syndrome of unknown etiology with numerous abnormalities in neuronal and nonneuronal cells. A review of the literature suggests that a common basic intracellular defect may underlie many of the reported abnormalities. We hypothesize impairment of the microtubule (MT) system as one explanation for the pathogenesis of AD. Evidence in support of the hypothesis includes the following: MTs are ubiquitous and vital cell components, unequally distributed, with the highest concentration in the brain; various abnormalities, including the key neuropathologic lesions, can be explained by impairments of the MT system; and experiments utilizing pharmacologic agents known to disrupt MTs have reproduced certain abnormalities observed in AD. The hypothesis provides a framework for systematic investigations of MTs at the cellular and molecular levels as well as the basis for in vivo diagnostic tests for AD.

Alzheimer Disease

Antidepressant drug studies, 1964 to 1986: empirical evidence for aging patients.

This review is based on 25 double-blind anti-depressant drug studies reported between 1964 and 1986 that focused on patients over 55 years of age. The number of studies located in the literature is appallingly small, particularly when we consider that we included experimental drugs as well as drugs not recommended for use with the elderly. In general, the results of our survey support clinical experience: the drugs are clearly superior to placebo; they show comparable therapeutic efficacy--about 50% improvement in Hamilton Psychiatric Rating Scale for Depression scores versus 20% to 25% on placebo; and all of them have undesirable side effects. Thus, the choice of drug is based on side effects profiles and potential drug-drug interactions rather than on degree of therapeutic efficacy. The review makes apparent the need for more substantial data on treatment outcome in patients over the age of 60 years. Beyond that, additional information is unlikely to change the 50% response rate or the potential for serious side effects with most of the currently available drugs. We clearly need better drugs.

Aged

The dental management of the patient with dementia.

There has been a dramatic increase in the incidence of dementia as the percentage of aging Americans has increased. Approximately half of these persons are living at home with their spouses or in the homes of their children. This increasing group of patients will be seeking care from community-based dentists. An understanding of the diagnosis, the treatment, the course, and the prognosis of the disease process will better prepare dentists to meet the unique needs of this group of patients.

Aged

Anxiety, aging and the third emergency reaction.

Severe anxiety, unlike severe depression, is not common among the aged. In view of the multitude of stresses accompanying later life and considering the fact that lack of success in mastering stress typically produces anxiety, one should expect a high frequency of anxiety among the aged. To explain the deficit, it is proposed that those who survive into old age have developed strategies to successfully deal with stress, that among these strategies is a passive stance, termed "freeze," and that "freeze" is a third emergency reaction, one which was omitted from the fight-flight paradigm of emergency reactions.

Adaptation, Psychological

Chromosomes in patients receiving methadone and methadyl acetate.

Chromosomes of peripheral leukocytes were examined in 28 addicts participating in a Veterans Administration-Special Action Office for Drug Abuse Prevention (SAODAP) cooperative study of methadyl acetate vs methadone. Blood samples for 72-hour leukocyte cultures were drawn after nearly 40 weeks of maintenance therapy while subjects were receiving active medication. For comparison, ten nondrug users were also studied. The frequency of chromosome damage was not greater in subjects maintained on methadyl acetate or methadone than in nondrug users.

Adult

Hypodiploidy and serum immunoglobulin concentrations in the elderly.

Chromosome analyses and Ig level determinations were carried out on seventeen aged men and women, 83--100 years of age. In men, significant correlations were found between hypodiploidy and IgA (gamma = 0.95) and between monosomy C and IgG (gamma = 0.79) while in women, monosomy G and IgG were significantly correlated (gamma = 0.73). The emergence of significant correlations between chromosome loss and Ig levels in this study provides support for a relationship between age-associated chromosomal changes in T cells and the immunologic response of B cells.

Aged