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W C McCormick

Publications and source records attributed to W C McCormick.

At least 37 records · Page 2Linked to original sources
PubMed1998

Provider practice patterns in nursing home-acquired pneumonia.

OBJECTIVE: To describe provider practice patterns in the diagnosis and treatment of Nursing Home-Acquired Pneumonia (NHAP) and to document associations with cure, mortality, and transfer. DESIGN: A retrospective cohort. SETTING: Six nursing homes in Seattle, Washington. PARTICIPANTS: A total of 94 patients, 65 years of age or older (mean 83 +/- SD 9), in whom the diagnosis of pneumonia was documented in the nursing home medical record between July 1, 1994, and June 6, 1995. MEASUREMENTS: Multivariate logistic regression was used to assess the relationship between descriptive, diagnostic, or therapeutic measures and three outcomes, cure, 30-day mortality, and hospital transfer. RESULTS: Ninety-four episodes of pneumonia were identified. Allowing for more than one outcome per patient, there were 71 (75.5%) cures, 16 (17%) deaths, and nine (9.6%) transfers. Eighty-five percent of patients identified as having NHAP by their providers had chest X-rays (CXRs), and 69% had physical examinations. Sputum examination was ordered in 5%, blood cultures in 6%, and white blood cell counts in 33% of patients. In multivariate analysis, patients with functional decline were more likely to die (Odds Ratio (OR) 36.5 (95% CI 6.1, 220)). Cognitive decline was a risk factor for mortality (OR 6.8 l (CI 1.8, 26)) and transfer (OR 7.5 (CI 1.2, 46)). Those patients receiving only oral antibiotics (OR 3.2 (CI 1.1, 9.7)) were more likely to be cured. Length of therapy >1 week was also associated with cure (OR 2.9 (CI 1.0, 8.6)). Providers with Certificate of Added Qualifications (CAQ) in Geriatric Medicine were more likely to achieve cure (OR 3.1 (CI 1.0, 9.0)). CONCLUSIONS: Most patients with NHAP had diagnostic CXRs and physical examinations. In multivariate analysis, death was more likely to occur in patients with cognitive or functional decline. Cure was associated with the use of oral antibiotics alone and with care by providers with CAQ in Geriatric Medicine.

Aged↗
PubMed1998

Accelerated decline in apolipoprotein E-epsilon4 homozygotes with Alzheimer's disease.

BACKGROUND: The apolipoprotein E-epsilon4 (APOE-epsilon4) allele is a powerful genetic risk factor for the development of Alzheimer's disease (AD). AD patients who are APOE-epsilon4 homozygotes have an earlier age at onset, increased amyloid burden, and decreased acetylcholine levels--findings that suggest differences in disease severity or rate of progression. Studies of genotype differences in rate of decline, however, have produced negative results that may be due to methodologic biases. The current study examined rate of decline in the largest sample of APOE-genotyped AD patients for whom longitudinal cognitive data have been reported. METHODS: Newly diagnosed patients with probable AD (n = 201) comprised four genotype groups: epsilon2/3 (n = 14), epsilon3/3 (n = 75), epsilon3/4 (n = 82), and epsilon4/4 (n = 30). The Dementia Rating Scale (DRS) was administered at baseline and then annually for 1 to 6 years (mean, 2.5 years). For each subject, a DRS slope was calculated reflecting annual rate of decline. Rate of decline as measured by DRS slope differed according to genotype, with the effect modified by DRS score (p < 0.014). At the mean DRS score observed in our sample (DRS = 105), the epsilon4/4 group had an increased rate of decline (11.9 points per year) relative to the epsilon2/3 (5.8 points per year; p < 0.003), epsilon3/3 (9.3 points per year; p < 0.076), and epsilon3/4 (9.6 points per year; p < 0.055) groups. At a lower DRS score (DRS = 80), even larger differences were observed among genotypes; the epsilon4/4 group had a increased rate of decline (22.2 points per year) relative to the epsilon2/3 (9.7 points per year; p < 0.0006), epsilon3/4 (15.8 points per year; p < 0.020), and epsilon3/3 (18.2 points per year; p < 0.173) groups. The epsilon2/3 group had a significantly slower rate of decline than all other groups at DRS scores of 80 or 105. CONCLUSIONS: APOE-epsilon4 homozygosity is associated with a faster rate of cognitive decline, whereas the epsilon2 allele slows disease progression. These findings suggest that APOE plays a mechanistic role in the progression of AD, and is not simply related to disease onset.

Age of Onset↗
PubMed1997

Head injury and risk of Alzheimer's disease by apolipoprotein E genotype.

Head injury and apolipoprotein E (APOE)-epsilon 4 (e4) genotype have each been associated with increased risk of Alzheimer's disease. If APOE-e4 affects neuronal viability and branching, and if response to head injury differs in e4 patients, then the association between head injury and Alzheimer's disease may vary with the presence of the e4 allele. The authors examined this association in a case-control study conducted between 1987 and 1995 among enrollees of the Group Health Cooperative of Puget Sound, a health maintenance organization in Seattle, Washington. Proxy informants reported prior head injury with loss of consciousness for 32 of 349 patients with probable Alzheimer's disease and for 16 of 342 control subjects of similar age and sex who had been randomly selected from the same population (odds ratio (OR) = 2.1, 95% confidence interval (CI) 1.1-3.8). Elevated risk was observed among men (OR = 4.2, 95% CI 1.5-11.5) but not among women (OR = 1.1, 95% CI 0.5-2.6). No significant variation in the head injury-Alzheimer's disease risk relation by APOE-e4 genotype was found among 230 cases and 309 controls (OR = 3.1 (95% CI 0.7-14.6) for persons with at least one e4 allele and OR = 2.0 (95% CI 0.8-5.2) for those without e4). Neither age, education, race, type of proxy informant, nor duration of relationship with the proxy confounded the association. Head injury with loss of consciousness, although uncommon in this sample, was associated with increased risk of Alzheimer's disease. APOE-e4 was an independent risk factor which neither modified nor confounded the association. Susceptibility to Alzheimer's disease as conferred by APOE-e4 does not appear to increase the risk associated with head injury.

Aged↗
PubMed1997

Efficacy of total parenteral nutrition in a series of end-stage AIDS patients: a case-control study.

The aims of this study were to document the risks and benefits of total parenteral nutrition (TPN) by comparing two groups of patients with advanced HIV disease. This case-control study took place from June 1992 through June 1994. Medical Records were the primary source of data. Bailey-Boushay House, a 24-h skilled nursing facility in Seattle, Washington was the resident location of participating patients. TPN was commonly used in this long-term care facility for persons with AIDS. Eighty patients with AIDS, 40 of whom were receiving TPN and 40 of whom were not receiving TPN but who had central venous access (control group) were chosen. No significant differences were found between the two groups in the number of positive blood cultures (10% vs. 3%), however, the number of abnormal lab values was higher in the TPN group (6 vs. 4) (p < 0.05). The TPN group also gained an average of 2.2 kg in weight compared to an average loss of 1.4 kg in the control group (p < 0.05); the control group had a higher number of patients with weight loss > 10% of admit weight (28% vs. 8%) (p < 0.05). The length of stay was similar between groups (91 vs. 77 days), as were several quality of life indicators. The conclusions of the investigators was that TPN did not appear to lead to clinically important positive or negative health effects when compared to a group not receiving TPN but with central venous access. Benefits or detriments to certain sub-groups of AIDS patients may well exist that were not apparent in this study.

Acquired Immunodeficiency Syndrome↗
PubMed1997

Alzheimer's disease and history of blood transfusion by apolipoprotein-E genotype.

Some dementias, such as Creutzfeldt-Jakob disease, may result from transmissible agents. To assess the possibility of a blood-borne transmissible agent in Alzheimer's disease (AD), we compared informant-reported history of blood transfusions among 326 newly recognized probable AD cases and 330 control subjects of similar age and sex, randomly selected from the same health maintenance organization population. Since risk of AD is increased in persons with apolipoprotein E epsilon 4 (APOE-e4) alleles, we examined whether the transfusion-AD relationship varies by APOE genotype. Transfusion was more frequent among controls (17.9%) than cases (12.0%) in the overall group (crude odds ratio = 0.62; 95% confidence interval = 0.40, 0.97). Similar risks were seen for transfusions occurring < or = or > 10 years before the reference year. Stratified analysis by APOE-e4 genotype showed no effect modification. Logistic regression adjusting for age, sex, education, and presence of e4 did not change the transfusion-AD association. We conclude that a history of blood transfusion is not associated with increased risk of AD, nor does consideration of APOE-e4 status modify that conclusion.

Aged↗
PubMed1996

Prevalence of dementia and its subtypes in the Japanese American population of King County, Washington state. The Kame Project.

Studies of Asian populations generally have reported prevalence rates for dementia similar to those of predominantly Caucasian populations, but relative prevalence rates of Alzheimer's disease and vascular dementia have differed. Between May 1, 1992 and May 1, 1994, the prevalence rates of dementia, Alzheimer's disease, and vascular dementia were examined in the Japanese American population aged over 65 years in King County, Washington State. A total of 3,045 eligible individuals were identified in a census of persons who were of at least 50% Japanese heritage. Of 1,985 persons who participated in the baseline examination, 382 individuals of 450 sampled from all cognitive performance strata received a diagnostic evaluation. A total of 107 cases with a Clinical Dementia Rating (CDR) of > or = 1 met criteria for dementia according to the Diagnostic and Statistical Manual, 3rd edition, revised (DSM-III-R); 58 of these cases were diagnosed with Alzheimer's disease and 24 with multi-infarct dementia. The estimated prevalence rate for all dementias was 6.3% (95% confidence interval 5.9-6.8). Prevalence rates for dementia increased continuously with age and were 30%, 50%, and 74% for participants aged 85-89, 90-94, and > or = 95 years, respectively; for Alzheimer's disease, prevalence rates were 14%, 36%, and 58% for these three age groups. Rates for Alzheimer's disease were generally higher among women; for multi-infarct dementia, rates for men and women were similar. In the institutional population, the prevalence rate was 66%, and in the community, 2.9%. Persons with lower education had higher overall rates of dementia than those with higher education, but this tendency became weak and inconsistent when rates were age-stratified. The prevalence of dementia in this geographically defined population of Japanese Americans was somewhat higher than prevalence rates reported from Japan, and the distribution of dementia subtypes more closely resembled that found in Caucasian populations in North America and Europe than previously reported in Asian populations.

Age Distribution↗
PubMed1996

The pharmacologic management of pain and discomfort in persons with AIDS near the end of life: use of opioid analgesia in the hospice setting.

To determine the prevalence and management of pain and discomfort during the last 2 weeks of life in persons with acquired immunodeficiency syndrome (AIDS) being cared for in hospice settings, and to find the extent to which opioids are used for relief of pain and discomfort during this period, we conducted a retrospective cohort study of patients treated by AIDS hospice agencies in Seattle, Washington (1987-1992). The medical records for the last 2 weeks of life were reviewed for 185 consecutive adults with AIDS who were receiving hospice care. Most [93% (172/185)] experienced at least one 48-hr period of pain and discomfort during the last 2 weeks of life, with prevalence increasing from over one-half of the cohort early in the 2-week course to two-thirds of the cohort late in the course; 88% (162/185) received some form of opioid analgesia (0-100 mg/hr morphine equivalent), with the majority [62% (100/162)] experiencing some relief thereafter. Ten of the 172 with pain and discomfort did not receive an opioid drug; 4 had relief anyway. Among the 7% (13/185) who did not report pain and discomfort during the last 2 weeks of life, 4% (8) received opioid analgesia. Pain and discomfort in persons with AIDS approaching the end of life is a common experience. Opioids are frequently given in widely varying dosages (and dosing strategies), with variable results. Some patients require high doses yet continue in pain; others are comfortable on no medication. The majority of patients receive opioid medications and experience relief from pain and discomfort.

Acquired Immunodeficiency Syndrome↗
PubMed1996

Apolipoprotein E in Alzheimer's disease risk and case detection: a case-control study.

The objective of this study was to describe the association between the epsilon 4 allele of the apolipoprotein E gene (APOE E4) and Alzheimer's disease (AD) and to evaluate APOE E4 genotyping as a test for AD. The study base of this case-control study included about 23,000 persons 60 year of age or greater (a large health maintenance organization); the demographic characteristics of this group are similar to those of the surrounding area. Analysis focused on 234 Caucasian probable AD patients first identified between 1987 and 1993; and 304 cognitively intact controls of similar age, sex, and race who were randomly selected from the same study base. All cases were examined and diagnosed by study physicians using standard protocols. All subjects participate in continuing annual follow-up testing to verify their cognitive status. APOE genotypes were determined from blood samples using standard laboratory methods. Subject characteristics and diagnoses were obtained from interviews, diagnostic examination, or medical record review. Heterozygous E4 individuals had a crude odds ratio of 3.1 (2.1-4.5) for AD compared to those with no E4, while homozygous E4 subjects had an odds ratio of 34.3 (8.0-146.3) for AD. As an indicator of AD, having one E4 allele showed a sensitivity of 0.52 and a specificity of 0.74. Homozygous E4 genotype had a sensitivity of 0.23 and a specificity of 0.99 (when compared to non-E4 genotypes). Cardiovascular disease differed in cases and controls, but did not confound or modify the APOE E4-AI) association. In this study base, the APOE E4 allele was a significant risk factor. However, considering either homozygous or heterozygous E4 genotype as a screen or diagnostic marker for AD would miss many true cases and could misclassify many normals as AD.

Aged↗
PubMed1996

Attitudes toward use of nursing homes and home care in older Japanese-Americans.

OBJECTIVE: A cohort of 1142 older Japanese Americans was identified to study preferences and attitudes regarding use of long-term care (nursing home or home care). DESIGN: Prospective cohort study. PARTICIPANTS AND SETTING: Older Japanese Americans in King County, Washington. RESULTS: Subjects were asked to consider hypothetical situations in which they were temporarily disabled by hip fracture or permanently disabled by dementing illness. If they fractured a hip, only 12% intended to use a nursing home; 29% intended to recover at home with the help of family or friends; another 54% intended to use paid home health care. If they became demented, the majority (53%) intended to use a nursing home; only 11% intended to rely on family or friends for care, and another 29% intended to use paid home health care. Similar responses were observed when subjects were asked what most members of their family or friends would wish them to do; however, they tended to value the perceived wishes of religious figures or the Japanese American community-at-large less than those of family or friends. Significant correlates with intention to enter nursing homes were lack of social support (unmarried, few or no close relatives or housemates), female gender, and high levels of acculturation into American society (never lived in Japan, English-speaking only). Other factors that were not significantly correlated were health perceptions, satisfaction and life control scales, and health care utilization (hospitalizations and MD visits). In multivariate logistic regression, marital status and level of acculturation were the most powerful independent predictors of intention to enter nursing homes. Age and female gender were predictors of intention to use home care. In the base population of subjects, the prevalence of nursing homes use (5%) was similar to that of the general US older population. CONCLUSIONS: We conclude that older Japanese Americans in the Pacific Northwest often intend to enter nursing homes if they became disabled by dementing illness. Actual use is similar to other older populations. This may be attributable largely to the existence of an ethically appropriate nursing home which is strongly supported by, and familiar to, this close-knit community. Intention to use long-term care services appears to be dependent primarily on the level of social supports and acculturation into American society.

Aged↗
PubMed1996

Head circumference as a measure of cognitive reserve. Association with severity of impairment in Alzheimer's disease.

BACKGROUND: Recent studies suggest that larger brain size may offer some protection against the clinical manifestations of Alzheimer's disease. However, this association has not been investigated in population-based studies. METHOD: The relationship between head circumference, a measure of premorbid brain size, and score on the Cognitive Abilities Screening Instrument (CASI) was studied in a population of 1985 Japanese-Americans aged 65+ living in King County, Washington, USA. RESULTS: After adjusting for age, sex and education, head circumference was positively associated with CASI score (b = 3.8, 95% Cl: 2.2, 5.4; P = 0.0000), but not with diagnosis of probable AD (odds ratio = 0.87, 95% Cl: 0.33, 1.87). When the data were stratified by AD status, no association was seen among controls (b = 1.6, 95% Cl: -1.7, 5.1; P = 0.4), whereas a strong effect was present among cases (b = 35.3, 95% Cl: 12.2, 68.4: P = 0.006). CONCLUSIONS: These results suggest that persons with AD with smaller head circumference either had the disease longer or progressed more rapidly than those with larger head circumference. Improvement in environmental factors in prenatal and early life that partially determine completed brain/head size may have consequences for the late-life expression of Alzheimer's disease in vulnerable individuals.

Aged↗
PubMed1996

Predictors of mortality in patients diagnosed with probable Alzheimer's disease.

OBJECTIVE: We sought to identify factors associated with mortality in persons recently diagnosed with probable Alzheimer's disease (AD). BACKGROUND: Predicting mortality in AD in needed both in patient care and public health planning. Previous studies have identified several factors which contribute to mortality in AD, but few longitudinal studies of population-based cohorts exist. METHODS: In a longitudinal follow-up study 327 patients with newly diagnosed probable AD (mean Mini-Mental State Examination [MMSE] score of 20) from a large, stable health maintenance organization were identified. Demographic characteristics, dementia severity, and comorbid conditions were identified at enrollment. Patients were followed longitudinally (median 3.3 years, total 898 person-years). Baseline characteristics were used to predict survival in univariate and multivariate models. RESULTS: Increased mortality was seen in patients with probable AD (9.0 deaths per 100 person-years) compared with the community population adjusted for age and gender (4.3 deaths per 100 person-years). On univariate analysis we found increased age, male gender, impairment on MMSE or Blessed dementia rating scale (DRS), rate of MMSE decline, wandering or agitation, vascular disease, and sensory impairment affecting the ability to read or hear to be moderately associated with decreased survival. After adjusting for age and gender in a multivariate model, Blessed DRS score and sensory impairment affecting the ability to read were independently associated with decreased survival. CONCLUSIONS: Short-term mortality is increased in patients newly diagnosed with probable AD. Measures of dementia severity, measures of general debility, and vascular disease are associated with increased mortality. Of these, general debility and sensory impairment were more strongly associated with shortened survival.

Aged↗
PubMed1995

Solvent exposure as a risk factor for Alzheimer's disease: a case-control study.

This case-control study investigates whether history of organic solvent exposure is associated with increased risk of Alzheimer's disease. The study base includes about 23,000 persons aged 60 years or more from the local membership of a health maintenance organization in Seattle, Washington, who entered the study between 1987 and 1992. Probable Alzheimer's disease cases (n = 193) who had presented with new dementia symptoms were identified, enrolled, and diagnosed by our Alzheimer's Disease Patient Registry following standardized criteria. Control subjects (n = 243), free of dementia and neurologic disease causing dementia, were selected randomly from the study base and frequency matched to cases for age and sex. Proxy informants provided specific solvent exposure history as well as job descriptions likely to involve solvent use as part of a comprehensive risk factor interview. Kappa statistics indicated substantial agreement for control-control proxy solvent responses. History of exposure to one or more solvent groups (benzene and toluene; phenols and alcohols; ketones; other solvents) yielded an adjusted Alzheimer's disease odds ratio of 2.3 (95 percent confidence interval 1.1-4.7); among males only, it increased to 6.0 (95% confidence interval 2.1-17.2). Thus, past exposure to organic solvents may be associated with onset of Alzheimer's disease.

Age Factors↗
PubMed1995

The effect of diagnosing Alzheimer's disease on frequency of physician visits: a case-control study.

OBJECTIVE: Two groups of elderly subjects were studied to see whether patterns of visits to physicians changed after one group received the diagnosis of Alzheimer's disease. DESIGN: Case-control study. SETTING: Health maintenance organization (HMO). PATIENTS/PARTICIPANTS: Two groups of ambulatory subjects (mean age 77 years) were enrolled from an HMO population for this case-control study: 120 cases had probable Alzheimer's disease diagnosed at enrollment, and another 120 cognitively intact controls with similar comorbidity were enrolled after being frequency-matched for age and gender. Exclusion criteria were nursing home admission and death during the study period. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Medical records were examined for a four-year period: two years prior to and two years following enrollment and diagnosis. Physician visits declined slightly after enrollment for the persons receiving the diagnosis of Alzheimer's disease [17.5/2 years prior vs 16.5/2 years after (NS)], whereas visits increased over time for the controls [13.7/2 vs 16.3/2 (p < 0.05)], hence the rates were similar after enrollment [16.5 vs 16.3 (NS)]. The proportion of subjects with fewer visits during the period after enrollment was higher among the cases than it was among the controls [54% vs 37%; odds ratio = 2.0 (95% confidence interval = 1.6, 3.1)]. Hospitalizations and emergency department use did not change significantly after enrollment. CONCLUSIONS: Physician visit frequency was high before, then decreased after, demented patients received their diagnosis, approaching the frequency in a control population without dementia. This phenomenon cannot be accounted for by nursing home placement, comorbidity, or mortality. Increased hospitalization and emergency department use did not ensue after diagnosis.

Aged↗
PubMed1995

Application of multivariable optimal discriminant analysis in general internal medicine.

OBJECTIVE: To illustrate the use of multivariable optimal discriminant analysis (MultiODA). DESIGN: Data from four previously published studies were reanalyzed using MultiODA. The original analysis was Fisher's linear discriminant analysis (FLDA) for two studies and logistic regression analysis (LRA) for two studies. MEASUREMENTS AND MAIN RESULTS: In Study 1, FLDA achieved an overall percentage accuracy in classification (PAC) for the training sample of 69.9%, compared with 73.5% for MultiODA. In Study 2, the LRA model required three attributes to achieve a 76.1% overall PAC for the training sample and a 79.4% overall PAC for the hold-out sample. Using only two attributes, the MultiODA model achieved similar values. In Study 3, the FLDA model achieved an overall PAC of 82.5%, compared with 87.5% for the MultiODA model. In Study 4, MultiODA identified a two-attribute model that achieved a 93.3% overall training PAC, when an LRA model could not be developed. CONCLUSIONS: MultiODA identified: a superior training model (Study 1); a more parsimonious model that achieved superior overall training and identical hold-out PAC (Study 2); a model that achieved a higher hold-out PAC (Study 3); and a two-attribute model that achieved a relatively high PAC when a multivariable LRA model could not be obtained (Study 4). These findings suggest that MultiODA has the potential to improve the accuracy of predictions made in general internal medicine research.

Acquired Immunodeficiency Syndrome↗
PubMed1995

History of depression as a risk factor for Alzheimer's disease.

Research regarding the possible association between Alzheimer's disease and a history of depression has been inconclusive. Using a case-control design, we assessed the strength of the association between reported history of depression and onset of Alzheimer's disease. We enrolled probable Alzheimer's disease cases (N = 294), who were ascertained and diagnosed by our Alzheimer's Disease Patient Registry, and randomly selected nondemented controls (N = 300) of similar age and gender from the same base population. The mean age (for cases) was 78.5 years. Informants provided data regarding history of depression. "Treated depression" was defined as depression for which a physician/psychologist consultation, medication, or hospitalization had occurred. Restricting treated depression to exclude primary loss or grief reactions, we found a modest association with Alzheimer's disease [odds ratio (OR) = 1.8; 95% confidence interval (CI) = 0.9-3.5] after adjusting for gender, age, education, and type of informant. When these data were stratified by depression onset year, we observed an odds ratio of 2.0 (95% CI = 0.9-4.6) for depression occurring more than 10 years before the onset of dementia symptoms, and an OR of 0.9 (95% CI = 0.2-3.0) for depression onset within 10 years of the onset of dementia symptoms. Thus, depressive episodes occurring well before dementia symptom onset appear to increase the risk of Alzheimer's disease.

Age Distribution↗
PubMed1994

Postmenopausal estrogen replacement therapy and the risk of Alzheimer's disease: a population-based case-control study.

Preliminary animal and human data suggest that estrogens may be protective against Alzheimer's disease in women. In a population-based case-control study at Group Health Cooperative of Puget Sound, Seattle, Washington, the authors compared the exposure of estrogen replacement therapy of 107 female Alzheimer's disease cases with 120 age- and sex-matched controls by using computerized pharmacy data. The cases were obtained from the Alzheimer's Disease Patient Registry of the University of Washington, Seattle, Washington, which is based on the enumerated health plan population from 1987 to 1992. Newly recognized cases of probable Alzheimer's disease according to standardized diagnostic criteria were ascertained, evaluated, and enrolled in the Registry. The controls were selected from the same defined population by stratified random sampling. When the authors applied logistic regression, ever use of estrogens did not show an association with Alzheimer's disease (adjusted odds ratio = 1.1, 95 percent confidence interval 0.6-1.8). Oral and vaginal estrogens yielded similar results. In conclusion, this study provides no evidence that estrogen replacement therapy has an impact on the risk of Alzheimer's disease in women.

Administration, Intravaginal↗