Showing papers on "Cognitive decline published in 1989"

The informant questionnaire on cognitive decline in the elderly (IQCODE): socio-demographic correlates, reliability, validity and some norms

Abstract: The IQCODE is a questionnaire which asks an informant about changes in an elderly person's everyday cognitive function. The questionnaire aims to assess cognitive decline independent of pre-morbid ability. In the present study, the IQCODE was administered to a sample of 613 informants from the general population. In addition, the questionnaire was administered to informants of 309 dementing subjects who had filled it out one year previously. A principal components analysis, using the general population sample, confirmed that the IQCODE measures a general factor of cognitive decline. The questionnaire was found to have high internal reliability in the general population sample (alpha = 0.95) and reasonably high test-retest reliability over one year in the dementing sample (r = 0.75). The total IQCODE score, as well as each of the 26-items, was found to discriminate well between the general population and dementing samples. The correlation with education was quite small (r = -0.13), indicating that contamination by premorbid ability is not a problem.

Neuropsychological Test Findings in Subjects With Leukoaraiosis

Abstract: • Focal periventricular white-matter changes (leukoaraiosis) have been identified incidentally on brain imaging in normal healthy individuals and more commonly in the elderly and in hypertensive individuals. It has been suggested that leukoaraiosis represents the early stages of Binswanger's leukoencephalopathy, a dementing process thought to be related to hypertensive cerebrovascular disease. To test this hypothesis, extensive neuropsychological tests were administered to 50 consecutive normotensive, middleaged, healthy volunteers. Ten subjects (20%) had white-matter changes on magnetic resonance scans; 40 subjects (80%) had normal scans. The differences observed on neuropsychological testing between subjects with and without leukoaraiosis were not significant. While this study argues against a link between leukoaraiosis and dementia, prospective longitudinal studies are needed to determine the value of leukoaraiosis in predicting future cognitive decline.

Speech Understanding in the Elderly

Abstract: Both auditory and cognitive status were determined in 130 elderly persons, in the age range from 51 to 91 years. Data were analyzed from the standpoint of the congruence of auditory and cognitive deficits. The prevalence of central auditory processing disorder was 50%, and the prevalence of cognitive deficit was 41%. Findings in the two areas were congruent, however, in only 63% of the total sample. Central auditory status was abnormal in the presence of normal cognitive function in 23% of subjects. Central auditory status was normal in the presence of cognitive deficit in 14% of subjects. In general, results did not support the hypothesis that decline in speech understanding in the elderly can be explained as the consequence of concomitant cognitive decline.

Structural brain CT changes and cognitive deficits in elderly depressives with and without reversible dementia ('pseudodementia').

Abstract: Twenty-six elderly (greater than 60 yrs) patients with DSM-III major depression were compared to 13 patients with NINCDS/ADRDA probable Alzheimer's disease (AD), and to 31 screened normal controls. Subjects were matched on age and sex. Fifteen of the 26 depressed patients were cognitively impaired on the Mini-Mental State Examination (MMSE) upon admission, but after treatment returned to the normal range. These 15 patients were defined as having the dementia syndrome of depression (DOD). The remaining 11 depressed patients were termed depressed, cognitively normal (DCN). All subjects received standardized cranial CT scans for assessment of ventricular brain ratio (VBR) and CT attenuation numbers. Subjects also received neuropsychological evaluation. CT values for the 26 depressed patients lay between those of AD patients and normal controls. CT values for the DOD subgroup clustered near those of AD patients. Patterns of cognitive deficits and correlations of CT attenuation values with cognitive measures were also similar in AD and DOD. Most patients were reassessed at a mean of two years after initial testing; of the 11 of the 15 DOD re-examined, only one had undergone cognitive decline. By contrast, all AD patients retested had declined significantly. Episodes of DOD and DCN tended to 'breed true'. This study suggests that while patients with DOD may have underlying structural brain abnormalities, obvious short-term progression to AD does not commonly occur.

The Hazards of Cognitive Aging

Abstract: After a review of findings from the Seattle Longitudinal Study of adult cognitive development, this paper discusses the application of event history analysis, a technique pioneered by sociologists, to data involving changes of states in individual behavior related to human aging. The dependent variable of interest for psychologists and other developmentalists should be the age (calendar or functional) at which the event occurs rather than its index in historical time. Using occurrence of significant decline in cognitive abilities as an exemplar, hazard functions are presented that allow the assessment of risk for future decline, as well as the prediction of the calendar age when individuals can expect cognitive decline under alternative assumptions.

Alcoholism, aging, and functional cerebral asymmetries.

Abstract: Reviews research concerning the possible relationship between cognitive decline and abnormal hemispheric asymmetries in alcoholic and aging individuals. Because the deteriorative effects of alcoholism on the central nervous system have suggested greater visuospatial than language-related functional impairments, numerous investigators had hypothesized that right-hemisphere integrity may be selectively disrupted (rather than the left hemisphere). Furthermore, performance on diverse perceptual and cognitive tests used to measure right-hemisphere functions in alcoholics had been observed to decline with normal chronological aging as well, thereby raising the possibility that certain neuropsychological deficits associated with alcoholism (presumably related to right-hemispheric decline) are identical to those associated with aging. However, an extensive review of empirical research findings on cerebral asymmetries both in alcoholics and in aging individuals suggested that their patterns of functional laterality are similar to those of normal controls.

Penetrating head injury in young adulthood exacerbates cognitive decline in later years.

Abstract: Few investigators have studied whether the behavioral effects of brain insult in adulthood are stable after the period of maximum recovery. We addressed this issue in a 30-year longitudinal study of 84 veterans of World War II, 57 with penetrating head injury (HI) and 27 with peripheral nerve injury (PNI), matched with respect to age, premorbid intelligence, and premorbid education. Each subject was examined during the 1950s and during the 1980s; each examination included the largely verbal Army General Classification Test (AGCT) (with Vocabulary, Arithmetic, and Block Counting subscales) and the Hidden Figures Test (which measures figure-ground discrimination). HI exacerbated decline in performance over time, irrespective of lesion site or cognitive test. HI and PNI subjects differed significantly (p less than 0.05) in AGCT Total and Arithmetic change scores, and means were in the same direction for all other measures. In analyses contrasting subjects in each of the eight lesion groups to PNI subjects, those with left parietal lobe injuries showed significantly greater decline from the 1950s to the 1980s on the Vocabulary and Arithmetic subscales of the AGCT, as did those with left temporal lobe injuries on the Arithmetic subscale, whereas subjects with right parietal lobe injuries showed significantly greater decline on the Hidden Figures Test. We hypothesize that the observed reduction of cognitive capacities late in life was due to some combination of HI in young adulthood, secondary effects of the injury occurring with time, effects of stress on remaining brain tissue caused by functioning for decades in a compromised state, and changes in the brain occurring with age. Although the HI subjects were not demented, follow-up studies must assess whether exacerbated decline is a harbinger of dementia.

EEG spectral analysis in delirium.

Abstract: Spectral analysis of EEG was conducted for 51 elderly delirious patients meeting the Diagnostic and Statistical Manual of Mental Disorders III (DSM-III) criteria and for 19 controls. As a whole group, and also when subdivided according to the type of delirium, severity of cognitive decline or the type of central nervous system disease, delirious patients showed significant reductions of alpha percentage, increased theta and delta activity and slowing of the peak and mean frequencies and these changes were also obvious in individual recordings. The alpha percentage and various ratio parameters correlated significantly with Mini Mental State score, and delta percentage and mean frequency with the lengths of delirium and hospitalisation. The results indicate an association between spectral EEG changes and severity of cognitive deterioration in delirium.

Rate of progression of Alzheimer's disease.

Abstract: We determined rate of cognitive decline in 54 patients with a clinical diagnosis of Alzheimer's disease. Cognitive ability was assessed by score on the Blessed test of orientation, memory, and concentration. Rate of progression was defined as the change in score on the Blessed test per year and was computed using a linear regression analysis. Only patients who had been followed for at least one year and who had at least three separate evaluations were included in the study. The overall rate of progression was 4.1 Blessed points per year. Age of onset, duration of illness, and family history of dementia had no significant influence on rate of progression.

Assessment of cognitive decline in dementia by informant questionnaire

Abstract: An informant questionnaire to measure cognitive decline in the elderly (the IQCODE) is described. The IQCODE was found to have high internal consistency reliability and to measure a general factor of cognitive decline. Scores on this questionnaire correlated highly with the Mini-Mental State Examination and with the level of care required by the subject. Furthermore, scores were unrelated to the subject's education or occupational status.

Serial quantitative CT analysis of brain morphometrics in adult Down's syndrome at different ages.

Abstract: Quantitative CT demonstrated increased CSF and 3rd ventricular volumes, and decreased gray matter and white matter volume, in older (greater than 45 years) Down's syndrome (DS) adults with dementia as compared with younger DS adults. Serial CT studies repeated after periods of up to 2 years demonstrated significant progressive cerebral atrophy. Older DS adults without dementia, but with cognitive decline, did not show cerebral atrophy as compared with young DS subjects. These results suggest brain atrophy must be present to accompany dementia in older DS subjects, despite the presence of Alzheimer's disease neuropathology in all older subjects. The Alzheimer's disease process in DS may occur in 2 stages, the 1st with neuropathology and cognitive decline, the 2nd with additional cerebral atrophy and dementia.

Relation of personality and attentional factors to cognitive deficits in human immunodeficiency virus-infected subjects.

Abstract: • In view of the evidence that patients with human immunodeficiency virus infection experience reactive depression and anxiety, it is important to determine whether these factors might account for some of the cognitive deficiencies observed in this group, as is often the case in psychiatric populations. An extensive battery of cognitive, personality, and attention tests was administered to 26 patients who tested positive for the human immunodeficiency virus. In this group were patients who demonstrated no symptoms, patients who had acquired immunodeficiency syndrome—related complex, and patients who had acquired immunodeficiency syndrome. Pearson Product Moment correlations were computed between scores on the three types of measures. The results of this correlational study suggest that cognitive decline in patients infected with human immunodeficiency virus is independent of mood and attentional changes.

Comments on ‘‘Speech understanding and aging’’ [J. Acoust. Soc. Am. 83, 859–895 (1988)]

Abstract: The hypothesis advanced by the CHABA Working Group on Speech Understanding and Aging [J. Acoust. Soc. Am. 83, 859–895 (1986)] that the systematic decline in speech understanding with age might be explained by concommitant decline in extra‐auditory cognitive factors was tested by examining speech audiometric findings in patients with dementia. The fact that performance was consistent with normal central auditory function in 12 of 23 such patients, in spite of deficits in immediate memory for spoken material, tolerance of distraction, mental tracking and sequencing, cognitive flexibility, and set shifting argues against the hypothesis that speech understanding deficits in the elderly can be explained as the simple consequence of cognitive decline.

Therapeutic Results with Nimodipine in Primary Degenerative Dementia and Multi-Infarct Dementia

Abstract: The diagnostic label of dementia is not justified in all elderly patients with cognitive decline. However, an organic factor of unknown aetiology can also be assumed in patients suffering from a milder decline. Therefore, the term “organic brain syndrome” is quite common, especially in German-speaking countries, to characterize these patients as a diagnostic category [6, 8]. This term covers a broad range of dementing and non-dementing processes with different aetiologies [14].

Nonmatching- (oddity) and delayed nonmatching-to-sample performance in aging, alcoholic, and alcoholic Korsakoff individuals

Abstract: Measures of visual processing time, selective attention, and memory were obtained in 59 normal and alcoholic research participants (including 13 with alcoholic Korsakoff’s syndrome) ranging in age from 35 to 71 years. Performance was measured within the context of nonmatching-to-sample and delayed nonmatching-to-sample tasks. The tasks required the participants to identify the “odd” stimulus in a three-stimulus array (i.e., to choose one of two laterally located visual stimuli that did not appear as a central sample display). The sample stimulus varied in complexity, containing one or two stimulus dimensions (color and/or line tilt), and exposure duration of the sample stimulus varied from 20 to 500 msec. The interval between sample offset and response opportunity also was varied, from 0 to 30 sec. The results indicated that for all groups, simple (unidimensional) sample stimuli were easier than compounds (two dimensions), as were stimuli that were available for long durations and with short interstimulus delays. Duration of the sample’s exposure and the delay between sample and response choice were the variables that best differentiated among the groups. With short sample durations and at long delay intervals, the Korsakoff patients were the least accurate. Although older participants—regardless of their drinking history—also were impaired, the age-group differences were exaggerated in the alcoholics. The results emphasize the importance of processing deficits in amnesia of alcohol-related etiology, and in the cognitive decline that may accompany aging and alcoholism.

Coping with the suicidal elderly: a physician's guide.

Abstract: Advancing age is associated with a markedly increased risk of suicide. In the United States, one fourth of all suicides are carried out by citizens age 60 or older. The majority of American elders who commit suicide use a firearm to do so. Most suicidal elders look to their primary care physician for help, although they may not directly express their plan. Therefore, physicians must be alert to clues. By far the principal risk factor for suicide is major depression. The risk is heightened by recent losses, alcohol or drug abuse, psychosis, cognitive decline, and chronic disease. Hopelessness, anhedonia, self-reproach, guilt, and a formed lethal plan are signs of a life-threatening suicidal crisis which requires urgent intervention. Physicians must act decisively in recognition of the fact that suicidality is a transient, treatable condition.

Pharmacological approaches in the treatment of senile dementia.

Abstract: The pathogenesis of primary degenerative dementia is still unknown and current therapeutic approaches can aim only at ameliorating some of the symptoms associated with this brain disease. At present, most approaches, attempt to correct a cholinergic deficit. Although the therapeutic benefits obtained so far with currently available cholinergic drugs are generally modest, it appears that there exists a subgroup of responders. This offers some hope that more potent and more selective cholinergic drugs might be more effective. Recent findings suggest that the neurochemical pathology in degenerative dementia is not restricted to the cholinergic system but also includes pathways using monoamines as transmitters. Alternative strategies should therefore include drugs able to correct disturbances in monoaminergic systems. Hydergine and the novel drug CBM 36-733 are suitable candidates. Hydergine is approved by the FDA as being effective for the treatment of selected symptoms of cognitive decline in the elderly. Preliminary results of a 2-month study indicate that CBM 36-733 has beneficial effects in patients with mild to moderate degrees of degenerative dementia. Interestingly, CBM 36-733 also counteracts age-related decreases in choline acetyltransferase, a marker for cholinergic nerve terminals in experimental animals. It will therefore be of interest to clinically evaluate in long-term studies the potential of this drug to slow down the progression of neurodegenerative processes.

Cerebrospinal fluid somatostatin in delirium.

Abstract: Cerebrospinal fluid somatostatin-like immunoreactivity (CSF SLI) was determined for 67 elderly patients who met the DSM-III criteria for delirium and for 19 age-matched controls. As a group, and also when subdivided according to the type of delirium, severity of cognitive decline or the type of central nervous system disease, the delirious patients showed significant reductions of SLI compared with the controls, together with a declining trend associated with increasing cognitive dysfunction. These findings are in accordance with previous observations that reduced CSF SLI is associated with diseases in which cognitive function is disturbed and they extend this finding to delirium.

Azabicycloalkane oxime & azabicycloalkene oxime muscarinic agents

Abstract: Novel 1-azabicycloalkane- and alkene-oximes (Ia) and 8-azabicyclo[3.2.1]octane- and octene-oximes (Ib) are provided, these compounds being useful as agents for treating pain or for treating the symptoms of senile cognitive decline. Also provided are pharmaceutical compositions containing the compounds and methods of treatment using the compounds in dosage form. ##STR1##

Treatment of mood disorder associated with Binswanger's disease.

Abstract: Binswanger's disease is a cerebrovascular disorder affecting deep white matter and is associated with dementia and affective disturbance. In the case reported, the mood disorder was successfully treated with a combination of lithium and amitriptyline, resulting in an improved quality of life despite continuing cognitive decline. This underlines the importance of treating the affective component of organic dementing conditions on its own merit.

Psychotherapy and the Cognitively Impaired Elderly

Abstract: Cognitive decline is often a devastating event, whatever the cause. It assaults the very core of the individual — his or her capacity for reflection and memory, emotional intimacy, love and warmth, giving and receiving advice and respect, and tolerating or taking pleasure in the daily passage of life. Those who care for the slowly disappearing self of their mother, father, sister, or brother, are left puzzled, helpless and, most importantly, progressively less able to communicate. Relationships that have a past of vital interaction gradually evolve into the isolated and painful solitudes of two people deeply connected by history but irrevocably separated by this disease.

Oxiracetam in the treatment of multi-infarct dementia and primary degenerative dementia.

Abstract: Oxiracetam is a recently synthesized nootropic that was tested as a potential treatment for cognitive decline in patients with multi-infarct dementia (MID) and primary degenerative dementia (PDD). Subjects were 34 MID patients and 39 PDD patients who met entrance criteria for the study. A repeated measures ANOVA showed significant improvement in both patients with MID and patients with PDD for word fluency. The total score on the Relatives' Assessment of Global Symptomatology-Elderly showed significant improvement for patients with PDD. The average score on the Instrumental Activities of Daily Living Scale, however, showed a significant decline for patients with PDD.

Method of treating the symptoms of cognitive decline in an elderly patient employing (S)-3-ethyl-4-[(1-methyl-1H-imidazol-5-yl)-methyl]-2-oxazolidinone

Abstract: (S)-3-Ethyl-4-[(1-methyl-1H-imidazol-5-yl)-methyl]-2-oxazolidinone or a pharmaceutically acceptable salt thereof is useful in the treatment of the symptoms of cognitive decline in an elderly patient suffering therefrom including the treatment of Alzheimer's disease.

Neuropsychological Testing in Normal Pressure Hydrocephalus

Abstract: There have been few systematic behavioral studies in normal pressure hydrocephalus despite the fact that cognitive decline is a characteristic feature. One study suggested that preoperative language deficits predicted a poor outcome with shunt surgery (DeMol 1985). Another indicated that dementia is usually irreversible in idiopathic NPH (Thomsen et al. 1986). We used serial neuropsychological tests to study 23 patients operated for NPH. Our aims were: (1) to look for behavioral predictors of surgical outcome; (2) to analyze the extent of improvement with surgery.

Hypercalcaemia causing declining cognitive function in a head injured patient.

Abstract: Although hypercalcaemia in young children or adolescents immobilized by fractures or spinal cord injury is well recognized, hypercalcaemia in adult immobilized patients is rare without a pre-existing bone disease. To our knowledge, hypercalcaemia in a head-injured, immobilized patient has not been previously reported. We report here a case where a previously normocalcaemic, immobilized, head-injured adult patient developed cognitive decline secondary to hypercalcaemia five months after injury, when transient interruption of enteral feedings led to mild dehydration. Indices of bone turnover were elevated and parathyroid hormone was appropriately suppressed. Possible predisposing factors in our patient included a severe degree of immobilization and a very high level of athletic activity prior to injury. Careful fluid management and specific monitoring of calcium levels, even several months post-injury, should be performed to avoid the added complications of hypercalcaemia in head-injured patients.

Neuropsychological characteristics of subjects with and without neocortical Alz-50 immunoreactivity.

Abstract: We performed quantitative histopathology and Alz-50 staining on 8 non-demented and 16 demented subjects who had received yearly neuropsychological evaluations as part of prospective studies of dementia. Of the 8 non-demented subjects, four had begun to show signs of cognitive decline on serial neuropsychological testing. These subjects showed marked decline on the Fuld Object Memory Evaluation, a test of recent memory. Scores on IQ tests and the Blessed test of orientation, memory, and concentration showed fluctuations but not consistent declines. These old-old, retired subjects were called "cognitively impaired" but not demented because they did not show decline in activities of daily living or social interactions. Five of the non-demented subjects had numerous cortical senile plaques and met standard pathological criteria for Alzheimer's disease (AD), but only one of the five was Alz-50 positive. That subject had shown the most consistent decline on neuropsychological scores. Ten of 11 clinically demented subjects with pathological evidence of AD were Alz-50 positive. All five clinically demented subjects with non-Alzheimer dementias on pathological examination were Alz-50 negative. Alz-50 may stain plaques found in AD, but not stain plaques which accompany aging. The cognitive impairment found in the Alz-50 negative subjects may be age-associated and not indicate early AD.