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M J Lichtenstein

Publications and source records attributed to M J Lichtenstein.

At least 19 recordsLinked to original sources
PubMed1996

The relationship between Piaget and cognitive levels in persons with Alzheimer's disease and related disorders.

Clinical observations and research studies have documented that people with Alzheimer's disease and related disorders (ADRD) appear to regress developmentally during the course of the disease. The purpose of this study was to prospectively determine the association between changes in Piaget levels of cognitive development and cognitive decline in nursing home residents in various stages of ADRD. Fifty-seven people were tested three times at yearly intervals, using the Folstein Mini-Mental State Exam to determine cognitive levels and a set of 14 Piaget tasks to determine cognitive developmental levels: 1) Formal Operations; 2) Concrete Operations; 3) Preoperational; and 4) Sensorimotor. Mean MMSE scores declined from 12.7 to 9.4, and there was a downward trend in Piaget levels over the study period. ANOVA showed significant differences (p < 0.0005, Years 1, 2, 3) in MMSE scores among all Piaget levels, and Spearman rho analysis showed significant correlations between Piaget levels and MMSE for each year (p < 0.0005, Years 1, 2, 3). The results suggest that there is a concurrent decline in cognitive developmental levels and cognition in people in various stages of Alzheimer's disease and related disorders.

Aged↗
PubMed1996

Measuring chronic rheumatic pain in Mexican Americans: cross-cultural adaptation of the McGill Pain Questionnaire.

We performed a cross-cultural adaptation of the McGill Pain Questionnaire (MPQ) from English to Spanish for studying Mexican Americans in South Texas. Each of the 78 single-word pain descriptors in the original MPQ was translated into Spanish by a panel of nine bilingual health researchers, preserving the original structure of the questionnaire. The pain-intensity content (PIC) of the words in each language was then rated on a 100 mm visual analog scale by 8 bilingual health care providers and 10 bilingual health-care consumers. The correlation between Spanish and English average PIC ratings was strong (r = 0.85 for providers, r = 0.80 for consumers). The translated Spanish version was compared to the original English in a group of 50 bilingual Mexican-American patients with musculoskeletal pain, who completed the MPQ in both languages. There was no difference in Average Pain Rating Index between the Spanish and English versions (29.8 +/- 14.7 vs 29.1 +/- 15.8, p = 0.55), and agreement between the two language versions was almost perfect (ri = 0.85). Test-retest reliability was measured in two groups of hospitalized patients (25 per group), one composed of monolingual Spanish speakers and the other of monolingual English speakers. Each subject completed the MPQ, the McGill Pain Map, two 10-cm visual analog scales measuring pain now and within the past week, the bodily pain items of the MOS-SF36 survey, and the Modified Health Assessment Questionnaire, on two occasions one day apart. Test-retest reliability of the Spanish and English components of the MPQ was not significantly different and was comparable to that of the other pain and health status instruments. We conclude that the Spanish MPQ is cross-culturally equivalent to the original English and has similar concurrent validity and reliability. This questionnaire is suitable for cross-cultural studies of pain comparing Spanish-speaking Mexican Americans with English-speaking members of the same and other ethnic groups.

Adult↗
PubMed1996

SES and ethnic differences in perceived caregiver availability among young-old Mexican Americans and non-Hispanic whites.

Differences in perceived caregiver availability were examined among a random sample of Mexican American (MA) and non-Hispanic white (NHW) young-old residents (58-74 years old) in three socioeconomically distinct neighborhoods in San Antonio, Texas. For MAs across all three socioeconomic status (SES) groups, being female, widowed, and having more chronic illnesses were associated with a lesser likelihood of perceived caregiver availability. SES and number of children were not associated with perceived caregiver availability. Among MAs and NHWs of middle- and upper-SES, being male, married, and of upper-SES were associated with a greater likelihood of perceived caregiver availability. The number of children modified the associations of both SES and ethnic group with perceived caregiver availability.

Aged↗
PubMed1996

Increased baseline sway contributes to increased losses of balance in older people following triazolam.

OBJECTIVE: Although it has been stated frequently that older people are more sensitive to benzodiazepines, the relative roles of impaired baseline performance, impaired elimination, and altered responsiveness have not been defined. We evaluated postural sway and plasma triazolam concentrations after administration of placebo and triazolam 0.375 mg in both young and older healthy subjects. DESIGN: Double-blind placebo-controlled trial. PARTICIPANTS: Nine young and nine older healthy men. INTERVENTION: All subjects received triazolam 0.375 mg or placebo on different study days, which were separated by at least 48 hours. MEASUREMENTS: Postural sway, visual analog scale of drowsiness, and plasma triazolam levels. RESULTS: The older subjects swayed more during triazolam than did the younger subjects, and this resulted in an increased number of losses of balance. This difference appeared to be caused by greater baseline sway in the older subjects rather than higher concentrations or increased responsiveness. A subset of older people had a much greater number of losses of balance during triazolam than did the rest of the subjects, and these individuals could be identified from their baseline sway. CONCLUSIONS: In this study, the increase in drug effect seen in the older subjects was of similar magnitude to that of the young, but it resulted in greater postural sway after drug administration than was seen in the young. The higher postural sway and the corresponding increased instability seen in the older subjects may put these older persons at increased risk of drug-related falls. This study also suggests that it should be possible to develop techniques that will identify individuals at particular risk of drug-induced postural instability.

Adult↗
PubMed1996

Where does it hurt? Stability of recordings of pain location using the McGill Pain Map.

OBJECTIVE: To evaluate the validity and reliability of recordings of pain location among patients with pain from 2 different sources, using the McGill Pain Map (MPM). METHODS: Consecutive outpatients from a rheumatology clinic and inpatients recovering from surgical interventions participated in a structured interview during which the McGill Pain Questionnaire and the MPM were administered. After an interval of 3 to 6 weeks for the rheumatology patients and 1 to 2 days for the postoperative patients, a 2nd identical interview was administered. Criterion related validity was examined by testing whether the extent [total number of painful areas (NPA)] and distribution (individual body areas affected) of pain differed significantly between the 2 patient groups and whether, among postoperative patients, the distribution of pain was consistent with the site of surgical incision. Test-retest reliability of the recordings on the MPM was measured by calculating a kappa coefficient for each individual body area on the MPM, and an intraclass correlation coefficient for the NPA. RESULTS: 51 rheumatology and 47 postoperative patients were interviewed. Significant differences in the total NPA (4.1 +/- 3.0 vs 11.5 +/- 6.2; p < 0.001) and in the distribution of the painful areas were observed between the 2 groups. Among postoperative patients, there was no significant difference in the NPA between the 2 interviews (4.1 +/- 3.0 vs 4.3 +/- 3.5; p = 0.53), while among rheumatology patients, there was a reduction in the NPA at the second interview (11.5 +/- 6.2 vs 9.8 +/- 5.3; p = 0.007). Reliability of the recordings of pain location by individual areas averaged 0.50 (range 0.04 to 0.76). The reliability of the NPA was 0.82 for the combined group of patients (0.71 and 0.84, respectively). CONCLUSION: Recordings of pain location using the MPM are valid and reliable. The MPM is a valuable instrument for studies of the distribution of pain in populations.

Adult↗
PubMed1995

A method for scoring the pain map of the McGill Pain Questionnaire for use in epidemiologic studies.

Identifying and quantifying the location of pain may be important for understanding specific functional impairments in elderly populations. The purpose of the present analysis was two-fold: first, to describe the reliability of a scoring method for the McGill Pain Map (MPM), and second, to validate the method of scoring the MPM as a tool for assessing areas of body pain in an epidemiologic study. In interviews performed at the subjects' homes, 411 community dwelling Mexican-American and non-Hispanic white subjects aged 65-74 from the San Antonio Longitudinal Study of Aging (SALSA) were asked to describe the location of their pain on the map of the human body included in the McGill Pain Questionnaire. The location of pain was scored by overlaying the survey figures with a MPM template divided into 36 anatomical areas. Inter- and intra-rater agreement among three raters was measured by calculating a kappa statistic for each of the body areas, and an intraclass correlation coefficient for the total number of painful areas (NPA). Internal validity was measured by Spearman's rho between the NPA and the Present Pain Index (PPI) and Pain Rating Index (PRI) of the McGill Pain Questionnaire, and external validity by correlation between NPA and the Perceived Health (PH), Amount of Bodily Pain (APB), and Pain Interference with Work (PIW) items of the Medical Outcomes Study, and the Perceived Physical Health (PPH) question of the San Antonio Heart Study. Average inter-rater agreement for individual MPM areas was 0.92 +/- 0.01, and average agreement for NPA was 0.96 +/- 0.01. Intra-rater agreement for individual areas averaged 0.94 +/- 0.01, and for NPA = 0.99 +/- 0.001. Pain in one or more areas was present in 47.7% of the subjects. For the whole sample, correlations between NPA and the validation indices were: PPI (0.91), PRI (0.89), PH (0.25), ABP (0.64), PIW (0.49), and PPH (0.20). Among the 196 subjects with pain, correlations were: PPI (0.34), PRI (0.34), PH (0.19), ABP (0.21), PIW (0.38), and PPH (0.19)-p < 0.01 for all correlations. In conclusion, we have developed a reliable method of scoring the MPM and have shown evidence of its validity in a community-based sample of elderly subjects. Patterns of painful body areas may be associated with specific diseases and functional impairments.

Aged↗
PubMed1994

Risk factors for hip fractures occurring in the hospital.

Risk factors for in-hospital hip fractures among patients aged > or = 65 years were evaluated in a population-based case-control study conducted in the Canadian province of Saskatchewan from 1983 through 1985. There were 129 cases with confirmed in-hospital hip fractures and 234 controls, who were those controls from a previous study in this setting hospitalized on their assigned index date. Study variables were abstracted from the hospital chart. Six factors were independently associated with a significantly increased risk of in-hospital hip fracture: impaired vision (odds ratio = 1.97, 95% confidence interval (CI) 1.18-3.30), assisted ambulation (odds ratio = 2.12, 95% CI 1.25-3.59), confusion (odds ratio = 2.48, 95% CI 1.37-4.48), psychotropic drug use (odds ratio = 2.02, 95% CI 1.22-3.33), lowest weight tertile (odds ratio = 2.86, 95% CI 1.38-5.92), and prior in-hospital fall (odds ratio = 2.71, 95% CI 1.52-4.82). The risk increased substantially with the number of factors present, from an odds ratio of 4.08 (95% CI 1.56-10.67) for one factor (reference group, no factors) to 82.84 (95% CI 18.6-368.7) for four or more factors (p < 0.001, test for trend). These data underscore the multifactorial etiology of in-hospital hip fracture and suggest that prevention programs need to target multiple risk factors.

Aged↗
PubMed1994

Clinical validation of the Welch-Allyn Pneumocheck hand held spirometer.

Pulmonary function is predictive of morbidity and mortality. Therefore, in epidemiologic studies, researchers seek to measure pulmonary function with portable spirometers feasible for use in clinics or participants' homes. The purpose of this study was to validate a hand held spirometer, the Welch-Allyn Pneumocheck, against standard pulmonary function tests. The authors used a convenience sample of 66 subjects. All subjects were asked to perform three vital capacity maneuvers with the Welch-Allyn Pneumocheck and then either a water seal spirometer or heated pneumotach in a hospital pulmonary function laboratory. The mean forced vital capacity (FVC) obtained with the Pneumocheck was 3.50 liters (standard deviation (SD) = 1.28) compared with 3.31 liters (SD = 1.24) for the pulmonary function laboratory. The correlation between the two measures was 0.98; the mean difference was 0.19 L (95% confidence interval = 0.12 to 0.26). The mean forced expiratory volume at one second (FEV1) was 2.31 L (SD = 1.07) for the Pneumocheck compared with 2.32 L (SD = 1.06) for the pulmonary function laboratory values. The correlation between the two measures was 0.99; the mean difference was 0.01 L (95% confidence interval = -0.03 to 0.04). Of the 46 subjects originally classified by the Pneumocheck as having FEV1/FVC ratios of less than 0.75, 10 (22%) had ratios greater than or equal to 0.75 after correcting for the FVC difference between methods. Therefore, there was an excellent correlation between the Welch-Allyn Pneumocheck and pulmonary function laboratory values for FVC and FEV1. Small systematic differences in FVC measures can lead to substantial misclassification rates when evaluating FEV1/FVC ratios.

Female↗
PubMed1993

Reducing antipsychotic drug use in nursing homes. A controlled trial of provider education.

OBJECTIVE: In the United States, 20% or more of nursing home residents receive antipsychotic drugs, primarily for the behavioral manifestations of dementia. This high level of use of drugs with substantial toxicity has engendered a strong and persistent controversy and recently has led to explicit regulatory measures to curtail use (Omnibus Budget Reconciliation Act of 1987). We developed and tested a comprehensive program to reduce antipsychotic use through education of physicians, nurses, and other nursing home staff. The primary elements of the program were instruction in use of behavioral techniques to manage behavior problems and encouragement of a trial of gradual antipsychotic withdrawal. DESIGN: In a nonrandomized controlled trial, the program was implemented (beginning in August 1990) in two rural Tennessee community nursing homes with elevated antipsychotic use; two other comparable homes were selected as concurrent controls. PATIENTS: Throughout the study 194 residents were in the education homes and 184 were in the control homes. Residents in both groups of homes had comparable demographic characteristics and functional status, and each group had a baseline rate of 29 days of antipsychotic use per 100 days of nursing home residence. MAIN OUTCOME MEASURES: The primary end points were postintervention changes in administration of antipsychotics and other psychotropic drugs, use of physical restraints, and frequency of behavior problems. RESULTS: Days of antipsychotic use decreased by 72% in the education homes vs 13% in the control homes (P < .001). No significant changes were noted in the use of other psychotropic drugs in either group. Days of physical restraint use decreased 36% in the education homes vs 5% in the control homes (P < .001). Behavior problem frequency did not increase in either group, even among the 48% of baseline antipsychotic users in the education homes who had antipsychotic drug regimens discontinued for 3 or more months. CONCLUSIONS: The educational program led to a substantial reduction in antipsychotic use with no increase in the frequency of behavior problems. This suggests that for many antipsychotic drug users benefits may be marginal and that programs to reduce such drug use among the 250,000 US nursing home residents receiving these drugs should have high priority.

Aged↗
PubMed1993

Development and validation of a physical performance instrument for the functionally impaired elderly: the Physical Disability Index (PDI).

Article describes development of the Physical Disability Index (PDI), an observer-administered, performance-based instrument measuring physical disability in frail-elderly persons without severe cognitive impairment. Sixty-five items in four subscales encompassing Range of Motion (ROM), Strength (STR), Balance (BAL), and Mobility (MOB) were measured. Subjects were randomly selected frail nursing home residents (N = 103) with a Folstein Mini-Mental State Exam (MMSE) score of > or = 11. Using correlation matrices, cluster analysis, and regression techniques, the scale was reduced to 54 items. All individual item values were standardized and aggregated into subscale and summary PDI scores, each with a range of 0-100. Test-retest and interrater reliability were evaluated. Discriminant and convergent validity were established using MMSE, Physical Self-Maintenance Scale (PSMS), and Sickness Impact Profile-Physical Dimension (SIP-PD). PDI is a performance-based instrument that appears to discriminate among frail individuals with differing levels of physical function. Further testing is warranted in other populations of frail-elderly persons to ascertain its applicability and generalizability.

Activities of Daily Living↗
PubMed1993

Falls: an examination of three reporting methods in nursing homes.

OBJECTIVE: To examine the concordance of various fall reporting methods and to use the results to recommend a preferred method of ascertaining fall frequency for residents of nursing homes, both for research and in the collection of federally mandated nursing home data. DESIGN: A cohort study followed for 858 patient months, with a mean individual follow-up of 6.6 months. MEASUREMENTS: Falls were independently ascertained monthly by three methods: review of administrative incident reports, nursing home chart abstraction, and structured interview of subjects. Concordance of events was assessed using measures of simple agreement and Kendall's Tau-b. Simple correlation and multiple regression were used to evaluate the relation of age, sex, gender, depression, mental status, and functional status with degree of concordance between self-reported falls and chart-recorded falls. SETTING: One academic and six community nursing homes in San Antonio, Texas. PARTICIPANTS: 131 long-stay nursing home residents, greater than 60 years of age, dependent in at least two activities of daily living, and mildly cognitively impaired. RESULTS: Falls were ascertained in 74 of the 131 individuals; 53 subjects fell 124 times by incident report, 58 had 140 falls according to chart review, and 66 subjects self-reported 232 falls. Greatest agreement between reporting methods was shown for incident report and chart review, with a Kendall's Tau-b of 0.88; self-report and chart-review agreement was 0.56; and self-report and incident agreement was 0.53. Estimated total fall events were more often (P = 0.001) identified by chart review (92%) than incident report (82%). Although concordance was higher for non-fallers, no significant relationships were observed between concordance and age, sex, race, depression, mental status, and functional status. Also, there was no systematic relationship between length of follow-up and degree of concordance. CONCLUSIONS: Fall frequency varies by ascertainment method, with chart review reflecting a greater number of fall events than the traditionally counted incident reports.

Accidental Falls↗
PubMed1992

The Nursing Home Behavior Problem Scale.

Nursing home patients frequently have serious disturbances of behavior that can lead to use of chemical or physical restraints. To support research into better management of these problems, we developed the Nursing Home Behavior Problem Scale (NHBPS), a 29-item inventory of serious behavior problems designed to be completed by nurses and nursing assistants. NHBPS scores were obtained for two samples of nursing home residents: 431 in Tennessee and 122 in Texas. The interrater correlation was .754 in the Tennessee sample and .827 in the Texas sample. The NHBPS had a correlation of -.747 with the NOSIE scale and .911 with the CMAI. There was a pronounced association of increased NHBPS scores with mental impairment and use of sedative drugs or restraints. These data suggest the NHBPS is a useful research instrument for measuring serious behavior problems in nursing home residents.

Behavior↗
PubMed1992

Hearing and visual impairments.

Hearing impairments, with their resultant difficulties in communication function, represent a common chronic condition affecting one third of aged individuals. Loss of hearing ability pervades multiple domains of function in aged individuals, decreasing activity, increasing depressive symptoms, and confounding assessment of cognitive ability. Although they are not curable, hearing impairments are often remediable with appropriate audiologic evaluation and the prescription of amplification devices. The role of the geriatrician in managing hearing impairment is to recognize its presence, provide appropriate audiologic referral, and overcome its effects in the clinical setting by providing optimal listening environments and using ALDs appropriately. Visual loss, too, is a common age-associated disability that has effects in multiple domains of function. Visual loss especially increases the risk of falls and hip fractures and may limit the ability of an older individual to safely operate a car. The ability to remediate visual disability depends on the cause of the underlying impairments and the relative effectiveness of treatment for each. Sight restoration can be dramatic for selected patients with cataracts. Sight preservation is also excellent for persons with diabetic retinopathy. For those with macular degeneration, the data are hopeful but less compelling. Although persons with glaucoma should receive medications to lower their intraocular pressure, experimental evidence that this, in fact, preserves vision is currently lacking. The geriatrician's role in visual rehabilitation consists of the identification of the impairments, determination of the impact of visual loss on other functional domains, and appropriate referral to an ophthalmologist for full assessment and treatment. If severely limited by permanent visual losses, the patient should be referred for appropriate support services.

Aged↗
PubMed1991

Dose-related effect of triazolam on postural sway.

Measurement of clinically relevant benzodiazepine drug effects at hypnotic and anxiolytic doses has been difficult because most measures are subjective, difficult to interpret, or relate to anesthetic doses. A potentially useful measure of drug effect is postural sway, which is a manifestation of the corrective mechanisms associated with the maintenance of upright posture. Postural sway was measured over 8 hours, with a biomechanics force platform, in six healthy male volunteers who received triazolam, 0.125, 0.250, or 0.375 mg, or placebo in a randomized double-blind study. Our results show a dose-dependent increase in postural sway measured as the elliptical area or the 95% confidence ellipse for the area covered by the subjects' sway. After triazolam, 0.250 and 0.375 mg, the area under the sway-time curve and peak effect increased significantly compared with placebo (p less than 0.05). The number of losses of balance when subjects stood on one foot also showed a significant increase with increased dose (p less than 0.05). The rate of loss of balance was positively correlated with the extent of postural sway (r = 0.802; p less than 0.001). The extent of sway when the subjects were drug free predicted this increase in a subject's postural sway with triazolam. Thus at hypnotic or anxiolytic doses of triazolam, computer-assisted force platform measures of sway provide a clinically relevant measure of drug effect. Measurement of drug-induced postural sway may be useful in persons at risk for falls, such as the elderly.

Adult↗
PubMed1991

Rheumatoid arthritis identified in population based cross sectional studies: low prevalence of rheumatoid factor.

All 5 cross sectional population based studies which included evaluation of all subjects for both rheumatoid factor (RF) and rheumatoid arthritis (RA) were reviewed. RF was found in only 19-33% of individuals who met the 1958 ARA criteria for RA. Many individuals identified in these studies met criteria for only "probable" or "possible" RA according to the 1958 criteria, and might not meet the 1987 criteria. However, RF was found in only 26-60% of subjects who met criteria for "definite" RA in the studies that included this information. Population based studies of RA often have been interpreted as applicable to clinical RA patients, which may explain in part different views of RA as both a mild and a progressive disease.

Arthritis, Rheumatoid↗
PubMed1990

Effect of loss of balance on biomechanics platform measures of sway: influence of stance and a method for adjustment.

This paper describes a method for adjusting biomechanics platform measures of sway for loss of balance. Area and velocity measures of sway were determined in forty-seven elderly women, in double and single leg stance, first with their eyes open, then closed. Subjects were rarely able to complete 10 s trials during single leg stances. Therefore, a method was developed for eliminating data associated with loss of balance. Monitoring changes in vertical force and velocity by computer, those points exceeding trial specific thresholds associated with loss of balance were truncated. In double leg stances, loss of balance increased area measures by 0.3%, but did not effect velocity measures. In contrast, the loss of balance increased area measures by 0-3%, but did not effect velocity measures. In contrast, the loss of balance experienced by most subjects in single leg stance exaggerated area measures by 16-38%, and velocity measures by up to 10%. In double leg stances the correlations between unadjusted area measures and area measures adjusted for loss of balance ranged from 0.98 to 1.00. In single leg stances, the correlations for the area measures ranged from 0.69 to 0.89. The correlations between adjusted and unadjusted velocity measures were 1.00 and 0.93 for the double and single leg stances respectively. Although the question of which sway measure is best remains unanswered, this study provides useful data for future research. First, it demonstrates a method for modifying area representations of the center of pressure excursions for the effects of loss of balance.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1990

Comparison of biomechanics platform measures of balance and videotaped measures of gait with a clinical mobility scale in elderly women.

Performance on the clinical mobility index developed by Tinetti (9) was compared with biomechanics platform measures of sway and videotaped measures of gait in a sample of 43 community-dwelling aged women. Area measures of sway, but not velocity, were associated with performance on the mobility index. When standing on one leg with eyes open, the correlation coefficients for radial area per second with the mobility indices ranged from -0.59 to -0.64 (p less than .001). Knee range of motion and stride length correlated with performance on the mobility index. Knee range of motion correlation coefficients ranged from 0.47 to 0.54 (p less than .001), whereas the range was 0.62 to 0.68 (p less than .001) for stride length. These data demonstrate that biomechanics platform measures of sway and videotaped measures of gait are associated with subject performance on a clinical mobility index and may themselves also be predictive of persons susceptible to falling.

Aged↗