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Biomedical subjects

R K Mahurin

Publications and source records attributed to R K Mahurin.

33 records · Page 2Linked to original sources
PubMed1992

Bedside assessment of executive cognitive impairment: the executive interview.

OBJECTIVE: This study is a pilot validation of the Executive Interview (EXIT), a novel instrument designed to assess executive cognitive function (ECF) at the bedside. DESIGN: Inter-rater reliability testing and validation using inter-group comparisons across levels of care and measures of cognition and behavior. PARTICIPANTS: Forty elderly subjects randomly selected across four levels of care. SETTING: Settings ranged from independent living apartments to designated Alzheimer's Special Care units in a single 537-bed retirement community. MEASUREMENTS: The EXIT: a 10-minute, 25-item interview scored from 0-50 (higher scores = greater executive dyscontrol) was administered by a physician. Subjects were also administered the Mini-Mental State Exam (MMSE) and traditional tests of "frontal" executive function by a neuropsychologist, and the Nursing Home Behavior Problem Scale (NHBPS) by Licensed Vocational Nurses. RESULTS: Interrater reliability was high (r = .90). EXIT scores correlated well with other measures of ECF. The interview discriminated among residents at each level of care. In contrast, the MMSE did not discriminate apartment-dwelling from residential care residents, or residential care from nursing home residents. The EXIT was highly correlated with disruptive behaviors as measured by the NHBPS (r = .79). CONCLUSIONS: These preliminary findings suggest that the EXIT is a valid and reliable instrument for the assessment of executive impairment at the bedside. It correlates well with level of care and problem behavior. It discriminates residents at earlier stages of cognitive impairment than the MMSE.

Aged↗
PubMed1992

Mental status testing in elderly Hispanic populations: special concerns.

The rapid growth of the older Hispanic population highlights the importance of accurately assessing the mental status of these individuals. Although several community surveys have reported relatively higher rates of cognitive impairment among older Hispanics, closer analysis has revealed excessive false positives and the underestimation of cognitive functioning. Problems inherent in the mental status testing of this group include the lack of appropriately translated and culturally sensitive instrumentation, the diversity of the population, differences in their educational experiences, and bias in the test-taking situation. Commonly used neuropsychological test batteries have generally been neither translated nor normed for Hispanic subjects. To minimize cultural differences, cross-cultural tests have used nonverbal content; however, nonverbal testing does not, in itself, remove cultural bias. Alternative methods of testing that may reduce bias include performance-based assessment of everyday living skills and measurement of basic psychophysiological responses.

Aged↗
PubMed1991

Structured assessment of independent living skills: preliminary report of a performance measure of functional abilities in dementia.

Assessment of functional abilities is integral to the diagnosis and management of elderly patients with dementia. We present a measure of activities of daily living, the Structured Assessment of Independent Living Skills (SAILS), and report preliminary reliability and validity data for 18 patients with Alzheimer's disease (AD) and 18 age- and education-equivalent controls. The SAILS utilizes behaviorally anchored rating scales to directly assess 10 areas of everyday functioning: Fine Motor Skills, Gross Motor Skills, Dressing, Eating, Expressive Language, Receptive Language, Time and Orientation, Money-Related Skills, Instrumental Activities, and Social Interaction. AD patients scored significantly worse than controls in all 10 areas. High correlations were obtained between the SAILS, visuospatial abilities, attention, and visual memory. In contrast, verbal memory, degree of depression, and praxis were not significantly correlated with the SAILS. The SAILS offers a criterion-based means of quantifying patient functional status for both clinical and research applications.

Activities of Daily Living↗
PubMed1990

Insight for impairment in independent living skills in Alzheimer's disease and multi-infarct dementia.

Dementing diseases cause a deterioration in the capacity for independent living skills (ILS). The present study investigated the level of insight in ILS impairment in 12 Alzheimer's disease (AD) patients, 12 multi-infarct dementia (MID) patients, and 12 normal elderly controls, using two different measurement techniques: informant report and patient self-report. Pairwise comparisons at the .05 level revealed a significantly greater loss of insight for ILS impairment in AD patients as compared to both controls and MID patients. Additional analyses revealed that loss of insight, operationally defined as the discrepancy between informant report and patient self-report, was not significantly related to age, education, mental status, or level of depression, but was significantly related to degree of caregiver burden. These results indicate that intervention strategies are needed that take into consideration the level of patient insight for ILS impairment, as well as the caregiver's perception of the patient's capabilities and the degree of burden experienced by the caregiver.

Activities of Daily Living↗
PubMed1989

Assessment of independent living skills in geriatric populations.

Independent living skills (ILS) assessment techniques, which originally grew out of the tradition of rehabilitation medicine, have been applied to geriatric populations. Over time, various assessment approaches have evolved, each with its own relative merits and drawbacks that the potential user should consider in choosing among instruments. Descriptions of selected ILS instruments are presented, along with a brief discussion of several current issues associated with ILS assessment of the elderly.

Activities of Daily Living↗
PubMed1989

Psychomotor assessment of the older patient.

Psychomotor assessment is a collaborative effort between the neurologic and the neuropsychologic evaluation. Changes associated with normal aging must be differentiated from signs and symptoms that indicate abnormal functioning. Recent developments in computer-based technology should add to the precision and accuracy of differential diagnosis in the psychomotor evaluation of the older patient.

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PubMed1986

Decreased cerebral blood flow precedes multi-infarct dementia, but follows senile dementia of Alzheimer type.

A 7-year prospective study among 181 neurologically normal elderly volunteers (mean age, 70.6 years) revealed an incidence of 3.3%, or 0.47% new cases per year, for Alzheimer's disease (SDAT) and 5.5%, or 0.78% new cases per year, for multi-infarct dementia (MID). The unusually high incidence of MID is considered to reflect preselection of a large percentage of volunteers (48.6%) with risk factors for (but without symptoms of) atherothrombotic stroke. Of 88 volunteers at risk of stroke, 11.4% developed MID within 7 years. In MID patients, cerebral blood flow (CBF) values began to decline around 2 years before onset of symptoms, while in SDAT patients, CBF levels remained normal until symptoms of dementia appeared; thereafter, CBF declined rapidly.

Aged↗
PubMed1986

Neuropsychological performance in dementia of the Alzheimer type and multi-infarct dementia.

Neuropsychological performance was examined in patients with dementia of the Alzheimer type (DAT) and in age- and education-matched patients with multi-infarct dementia (MID). Significant differences were observed for FSIQ, VIQ, and Picture Completion. This contrasts to no difference in verbal memory, visual-spatial skills, and sustained attention/concentration. This report illustrates that neuropsychological testing of elderly patients is unable to aid in the differential diagnosis between clinically similar forms of dementia, and should be employed to establish the level of cognitive function to make inferences regarding the patient's functional independence.

Journal Article↗
PubMed1985

Age-related reductions in cerebral vasomotor reactivity and the law of initial value: a 4-year prospective longitudinal study.

A group of 51 neurologically normal, middle-aged and elderly volunteers (aged 35-86 years; mean age 63.24 years) with and without risk factors for stroke were given annual tests of cerebral vasomotor reactivity to assess any changes in the cerebral vascular capacitance associated with advancing age that might alter cerebral vasomotor reactivity. Cerebral vasomotor reactivity was estimated as the difference in bihemisphere gray matter CBF measured by the 133Xe inhalation method in the steady state breathing room air, followed by a second measurement during inhalation of 100% oxygen. There were significant and progressive reductions in cerebral vasomotor reactivity during the 4-year longitudinal study. Positive linear correlations were apparent between initial steady-state mean bihemisphere gray matter CBF levels and degrees of vasomotor reactivity, suggesting that the Law of Initial Value plays an important role. This should be borne in mind when analyzing scores of cerebral vasomotor reactivity. In the present communication, analysis of covariance was used to correct for influences of initial CBF levels on vasomotor responses tested while breathing pure oxygen.

Aged↗
PubMed1985

Choice reaction time modifiability in dementia and depression.

The effects of cognitive impairment resulting from either dementia of the Alzheimer type (DAT) or major depression (pseudodementia) on choice reaction time were examined in two conditions hypothesized to influence group performance selectively. Elderly controls had shorter reaction times than depressed patients who, in turn, were faster than dementia patients in the standard choice reaction time test. Elderly control and depressed subjects responded more quickly under conditions designed to reduce task demands. However, no effect was detected for DAT patients, presumably due to the neural constraints imposed on cognitive functioning in dementia. These results highlight the different etiologies for the intellectual decline in dementia and pseudodementia.

Aged↗
PubMedDate not supplied

Behavioral effects of low-level exposure to Hg0 among dental professionals: a cross-study evaluation of psychomotor effects.

A Across-study design was used to evaluate the sensitivities of five psychomotor tasks previously used to assess preclinical effects of low-level Hg0 (urinary < or =55 microg/l). Pooling dental professional subject populations from six studies conducted over the last 6 years, a larger study population was obtained with a high degree of uniformity (N = 230). The five psychomotor tests were: Intentional Hand Steadiness Test (IHST); Finger Tapping: The One-Hole Test: NES Simple Reaction Time (SRT); and Hand Tremor. Multivariate analyses were conducted following the hierarchical analysis of multiple responses (HAMR) approach. First, multiple scores of each test were combined into a single-factor (or related summary) variable and its reliability was estimated. Second. multiple regression analyses were conducted including log-transformed [Hg0]U levels, age, gender, and alcohol consumption in each model. Computed were both B and bu, the magnitudes of the log-Hg0 standardized coefficient. respectively uncorrected and corrected for dependent variable attenuation due to unreliability. Results indicated remarkable differences in the effects of relative level of Hg0 on psychomotor performance. Significant associations were found for the IHST factor (B = 0.415, p < 10(-6)), followed by finger tapping, which was relatively meager and insignificant (B 0.141, p = 0.17). The IHST results hold the greatest occupational relevance for dental professionals who rely on manual dexterity in restorative dentistry. Further, this statistical approach is recommended in future studies for condensation of multiple scores into summary scores with enhanced reliabilities useful in correcting for attenuation relationships (B(u)s) with exposure levels.

Adult↗
PubMedDate not supplied

Bedside assessment of frontal degeneration: distinguishing Alzheimer's disease from non-Alzheimer's cortical dementia.

Two instruments, the Executive Interview (EXIT) and the Qualitative Evaluation of Dementia (QED), that are useful in the evaluation of frontal system failure are discussed. The ability of these instruments to discriminate frontal-type dementia (FTD) from Alzheimer's disease (AD) and the dementia of major depression (DMD) was examined in 100 consecutive elderly dementia patients presenting to a multidisciplinary geriatric clinic. All groups showed executive impairment by the EXIT, and 46% of the FTD patients were found to be unimpaired by the Mini-Mental State Examination (MMSE). The AD and FTD groups differed significantly from the DMD group on the QED. The QED alone could not distinguish AD from FTD cases. However, mapping of EXIT scores against MMSE (errors) scores revealed that AD and FTD follow very different regression lines.

Aged↗
PubMedDate not supplied

Chronic neurologic effects of pesticide overexposure.

Pesticide exposure in humans can have persistent effects, even in the absence of acute symptoms of intoxication or after their resolution. Drs. Keifer and Mahurin describe some of the most important examples of established pesticide neurotoxicity.

Central Nervous System Diseases↗