Showing papers by "Jerome A. Yesavage published in 1997"

Cognitive Function and the Costs of Alzheimer Disease: An Exploratory Study

Abstract: Objective: To estimate the dollar savings in costs attainable from drug or other treatments for Alzheimer disease (AD) that stabilize or reverse patients' cognitive decline. Methods: Medical and other disease-related utilization data were collected from the caregivers of 64 patients diagnosed as having probable AD. The quantities of utilization were priced at national levels to generate measures of illness costs. Costs per patient were then estimated as regression functions of scores on the Mini-Mental State Examination (MMSE), which was used as an index of patient cognitive function. Potential savings in illness costs were estimated by comparing predicted costs at various baseline and intervention-level values of the patient's MMSE score. Results: The potential savings in illness costs attainable from treatment are small for mildly and very severely demented patients with AD. However, for moderately to severely demented home-dwelling patients having, say, an MMSE score of 7 at baseline, prevention of a 2-point decline in the score would save about $3700 annually, and a 2-point increase in an MMSE score rather than a 2-point decline would save about $7100. Conclusion: Large savings in the costs of caring for moderately to severely demented home-dwelling patients with AD may be achievable from disease interventions that have minor effects on patients' cognitive status.

No association between apolipoprotein E epsilon 4 allele and rate of decline in Alzheimer's disease.

Abstract: Objective The relationship between number of apolipoprotein E epsilon 4 (APOE epsilon 4) alleles and the rate of cognitive decline in patients with Alzheimer's disease was examined. Method Rate of decline in score on the Mini-Mental State was measured during the active phase of the decline curve between Mini-Mental State scores of 23 and 0. To characterize onset, the authors also estimated for each subject the age at which the Mini-Mental State score fell below 23 and obtained a retrospective report of age at onset from the caregiver. The number of APOE epsilon 4 alleles carried by each subject was determined from genomic DNA samples. The study included 86 subjects with probable Alzheimer's disease who had had at least two cognitive evaluations (a mean of 5.6 evaluations per subject over an average period of 3.6 years). Results The results did not support an association between APOE epsilon 4 dosage and rate of cognitive decline. Age at onset and age at which the Mini-Mental State score fell below 23 were also not related to APOE epsilon 4 dosage. The APOE allele frequencies were similar to those in other studies of subjects with Alzheimer's disease, showing an enrichment of the epsilon 4 allele. Conclusions Although the APOE epsilon 4 allele is a risk factor for Alzheimer's disease, there is no support of a strong association between APOE epsilon 4 dosage and rate of cognitive decline. The epsilon 4 allele did not predict age at onset. Methodological inconsistencies may account for discrepancies between these results and previous findings.

Selective Cortical and Hippocampal Volume Correlates of Mattis Dementia Rating Scale in Alzheimer Disease

Abstract: Objective: To examine whether each of the 5 Mattis Dementia Rating Scale (DRS) scores related to magnetic resonance imaging—derived volumes of specific cortical or limbic brain regions in patients with Alzheimer disease (AD). Design: Relations between DRS measures and regional brain volume measures were tested with bivariate and multivariate regression analyses. Setting: The Aging Clinical Research Center of the Stanford (Calif) University Department of Psychiatry and Behavioral Science and the Geriatric Psychiatry Rehabilitation Unit of the Veterans Affairs Palo Alto Health Care System, Palo Alto, Calif. Patients and Other Participants: Fifty patients with possible or probable AD. Magnetic resonance imaging data from 136 healthy control participants, age 20 to 84 years, were used to correct brain volumes for normal variation arising from intracranial volume and age. Main Outcome Measures: The DRS scores and volumes of regional cortical gray matter and of the hippocampus. Results: Memory scores of the patients with AD were selectively related to hippocampal volumes. Attention and construction scores were related to several anterior brain volume measures, with attention showing a significantly greater association to right than left hemisphere measures. Initiation/perseveration scores were not significantly correlated with any measure of regional gray matter volume, but performance was related to prefrontal sulcal widening, with a greater association with the left than right sulcal volume. Conclusions: Certain DRS subtests are predictably correlated with selective regional brain volumes in AD. The specific relation between memory and hippocampal volumes and the nonsignificant relations between memory and regional cortical volumes suggest a dissociation between cortical and hippocampal contributions to explicit memory performance.

No association between the alpha 1‐antichymotrypsin A allele and Alzheimer's disease

Abstract: The alpha 1-antichymotrypsin (ACT) A allele was recently associated with Alzheimer9s disease (AD), and the ACT AA genotype was reported to be more frequent in AD subjects with the apolipoprotein E (APOE) ϵ4 allele. We examined ACT and APOE genotypes in a sample of 160 subjects with probable AD and in 102 elderly control subjects. ACT A allele frequencies were similar in AD subjects (0.503) and elderly controls (0.519). In addition, we found no evidence that in AD the AA genotype is more frequent in subjects with the APOE ϵ4 allele than in those without it. Our results do not support an association between the ACT A allele and AD.

Assessment and Management of "Sundowning" Phenomena.

Abstract: Approximately one quarter of patients with AD-type dementia reportedly exhibit disruptive, restless, and/or confused behavior that tends to be more apparent in late afternoon or early evening. Research has yet to document the phenomenon in a definitive manner to facilitate standardized assessment and clinical trials. Recent work attempting to define precisely the prevalence of abnormal behaviors during different periods of time of day in AD patients is reviewed. Caregiver reports of confusion and aggressive, disruptive behavior have been associated with going to bed early, increased use of sedative-hypnotics, and more severe cognitive impairment. Because there is evidence that the sleep of many AD patients is of poor quality, one might try to treat such patients with behavioral approaches useful in insomnia in other populations. Futhermore, as psychotropic medications can adversely affect sleep and/or have "hangover" effects on daytime cognition, one should carefully manage these medications to optimize care. Advances in assessment of sundowning, combined with longitudinal studies of sleep and circadian rhythm changes associated with dementia progression, should enhance efforts to treat behavioral and sleep disturbances.

Disruptive behavior and actigraphic measures in home-dwelling patients with Alzheimer's disease: preliminary report.

Abstract: The purpose of this preliminary report was to explore overall level and diurnal patterning of caregiver reports of abnormal behavior and to explore relationships with actigraphic measures of sleep/wake activity in Alzheimer's disease (AD) patients. Our primary behavioral measure was the Time-based Behavioral Disturbance Questionnaire (TBDQ). The overall score on this measure was shown to have adequate test-retest reliability and convergent validity with another behavioral measure. Significant correlations were obtained between the TBDQ overall score and actigraphically scored sleep efficiency (r = -.35, P < .05) and wake after sleep onset (r = .43, P < .01) in 41 subjects. The data suggest a moderate relationship between actigraphic measures of sleep/wake and disturbed behavior in home-dwelling AD patients.