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Biomedical subjects

M F Folstein

Publications and source records attributed to M F Folstein.

At least 91 records · Page 5Linked to original sources
PubMed1986

Structural brain correlates of emotional disorder in multiple sclerosis.

Eighty-seven patients with definite multiple sclerosis (MS) were examined neurologically and administered the Mini-mental State examination (MMS) to assess cognitive disability at the beginning and end of a one-year study. A CT scan was performed in 37. A group of 16 patients with stable spinal cord injuries (SCI) were studied in a similar manner. Of the MS patients, 47% had a mean General Health Questionnaire (GHQ) score in the abnormal range. This was a higher rate than in SCI patients (P = 0.004). Mean depression scores were similar in MS and SCI patients, but MS patients with brain involvement were more depressed than those with cord lesions only (P = 0.05). Depression score was unrelated to functional disability but was correlated with the degree of neurological impairment (P = 0.03). Euphoric patients were more likely to have brain involvement (P = 0.006), to have progressive MS (P less than 0.0001), and to have enlarged ventricles (P = 0.04) and were more impaired cognitively (P = 0.04) than noneuphoric patients. These results suggest that depression in MS patients is partly determined by the presence of brain involvement, but that it is also an emotional reaction to the disorder. Euphoria and cognitive disorder are reflections of brain involvement.

Adult↗
PubMed1986

Prevalence of mental illness in a community nursing home.

A research psychiatrist using a standardized interview found that 94% of a random sample of residents at a large, intermediate-care nursing home had mental disorders according to DSM-III criteria. Primary degenerative dementia and multi-infarct dementia were the most common diagnoses. In addition, the majority of demented patients also had noncognitive symptoms such as delusions and hallucinations, and these residents were significantly more likely to have an associated behavioral disorder than were residents without delusions or hallucinations. Replications of these results would point out the need for major revisions in the funding and delivery of psychiatric care for nursing home residents.

Aged↗
PubMed1986

The diagnosis of Huntington's disease.

We investigated all patients in Maryland reported to have Huntington's disease (HD), and found considerable diagnostic inaccuracy. Fifteen percent of cases reported as HD actually had some other diagnosable condition; 11% of cases that met diagnostic criteria for HD had been given some other diagnosis. Diagnostic errors could be reduced by documentation of the family history by systematic interviewing of relatives and by demonstration of the characteristic disorder of voluntary movement in addition to chorea.

Diagnostic Errors↗
PubMed1985

Screening for delirium on a general medical ward: the tachistoscope and a global accessibility rating.

With a psychiatrist's standardized clinical diagnosis as the criterion, the "Hand-Held Tachistoscope" was 100% sensitive, but only 45% specific in detecting delirium among hospital patients on a general medical ward. For each true positive in this sample of 97 patients, there were almost 5 false positives. The 10 patients with clinically diagnosed delirium could not see the stimulus. This was also true for 24 of the 87 nondelirious patients. Performance on the tachistoscope was related to age and education. This was not true for another method of delirium case detection, the global accessibility rating. This rating was 90% sensitive and 95% specific when compared with the psychiatric diagnosis, and was stable across two days of ratings. The global accessibility rating warrants further evaluation as a simple screening test for delirium.

Adult↗
PubMed1985

Brief report on the clinical reappraisal of the Diagnostic Interview Schedule carried out at the Johns Hopkins site of the Epidemiological Catchment Area Program of the NIMH.

A psychiatric examination was conducted on 810 community dwelling subjects previously given a diagnosis derived from the Diagnostic Interview Schedule (DIS). The agreement in allocating subjects to a particular disorder was never high enough to encourage the confident replacement of a psychiatric diagnosis with a DIS diagnosis.

Alcoholism↗
PubMed1985

Prevalence and significance of cardiovascular disease and hypertension in elderly patients with dementia and depression.

The prevalence and significance of clinical heart disease and hypertension were compared in three groups of elderly patients. One group was diagnosed as dementia of an Alzheimer's type (AD), another as multiinfarct dementia (MID), and the third as major depression. Clinical heart disease and hypertension were uncommon in the AD group with the prevalence being lower than that reported in most epidemiologic studies. Four percent of the AD patients had a history of myocardial infarction, 5% angina, 1% arrhythmias, and 3% heart failure. Electrocardiographic changes of an old myocardial infarction were present in 9%, atrial fibrillation in 1%, and left ventricular hypertrophy in 3%. A history of hypertension was present in 24% of the AD patients. In comparison, a history of myocardial infarction, angina, and heart failure was five times greater, and electrocardiographic abnormalities were twice as prevalent in the MID group. A history of hypertension was three times more common and actual blood pressure readings were higher. In the depression group heart disease was not uncommon and the prevalence, in general, was comparable with the MID group. However, a history of increased blood pressure and actual increased blood pressure readings were statistically less than in the MID group.

Aged↗
PubMed1985

A comparison of the frequency of major affective disorder in Huntington's disease and Alzheimer's disease.

Matched groups of patients suffering from Huntington's disease and Alzheimer's disease were compared for psychiatric morbidity prior to the onset of dementia. The Huntington's disease group showed twice the incidence of major affective disorder. This finding suggests a specific relationship between Huntington's disease and major affective disorder rather than the latter being a non-specific prodromal feature of dementia.

Affective Disorders, Psychotic↗
PubMed1984

Familial Alzheimer Dementia: a prevalent disorder with specific clinical features.

The early literature on Alzheimer Dementia (AD) describes the clinical features aphasia, apraxia and agraphia as characteristic. We investigated the hypothesis that these features would specifically identify the familial form of AD (FAD). Since pedigree studies had suggested that FAD is an autosomal dominant genetic disorder, we hypothesized that the first-degree relatives of language-disordered or apractic AD probands would show at least 50% lifetime risks of dementia. Using standardized methods, we screened 3500 nursing home beds for stringently defined AD cases and controls, tested for agraphia, and obtained probands' clinical and family histories from multiple informants. Language disorder and apraxia were found in 78% of AD cases. They strongly predicted familial aggregation of dementia, with a 90-year lifetime incidence among relatives exceeding 50%, or 7 times the control values. The results suggest that language disorder and apraxia specifically identify a distinct clinical entity, Familial Alzheimer Dementia, that is among the commonest forms of senile dementia.

Aged↗
PubMed1984

Clinical correlates of dementia and disability in Huntington's disease.

The relationship of duration of illness and severity of neurological impairment to psychometric performance and activities of daily living was examined in 57 patients with Huntington's Disease (HD). As earlier studies suggested, a distinct cognitive profile characterized patients early in the disease. Duration of symptoms, however, proved to be a weaker correlate of cognitive decline than was motor impairment at the time of testing. For predicting adaptive functioning, both duration of symptoms and neurological status were important variables. This study underscores the limitations of length of illness as a classificatory variable in studies of dementia in HD. We further suggest that future studies consider the contribution of defects in precise timing and sequential operations to the cognitive and adaptive deficits of these patients.

Adult↗
PubMed1984

Phenotypic heterogeneity in Huntington disease.

Two Huntington disease (HD) pedigrees are presented which differ according to mean and distribution of the age at onset, the effect of paternal transmission on the age at onset, presence of manic-depressive symptoms, and type of presenting symptoms. Together with previous reports, the data suggest clinical heterogeneity between HD kindreds which may imply some kind of genetic heterogeneity, most likely subsequent mutation at a single HD locus. The possibility of genetic heterogeneity has important consequences, both in research, and in the counseling and care of families and patients with differing manifestations of the disease.

Adult↗
PubMed1984

Pedigree study of familial Alzheimer disease.

Twenty-one families with familial Alzheimer disease were ascertained in a dementia clinic and assessed by multiple family interviews. Eight autopsies were reviewed. The age of onset varied from 25 to 85. Seven pedigrees showed evidence of 3 generation transmission. Paternal age of the founders of 4 lines which could be assessed was higher than controls.

Adult↗
PubMed1984

Recognition of dementia among medical patients.

To determine how accurately dementia was diagnosed among medical inpatients, we compared the judgments of medical interns with diagnoses based on standard criteria. Fifty-seven interns rendered opinions regarding the presence of dementia in 380 medical inpatients who were simultaneously examined by physician-investigators applying criteria derived from DSM III. The sensitivity and specificity of diagnosis by interns were 79% and 80%, respectively. Patients who were misdiagnosed as demented were less likely to be high school graduates than their correctly classified nondemented counterparts, and those with unrecognized dementia were more likely to be younger than 65 years than patients whose dementia was recognized by house staff. It is concluded that misdiagnosis is related to age and educational status and that attention to these factors may improve diagnostic accuracy.

Adult↗