Showing papers on "Cognitive decline published in 1992"

A prospective longitudinal study of depression, cognitive decline, and physical impairments in patients with Parkinson's disease.

Abstract: A consecutive series of 105 patients with Parkinson's disease were examined for the presence of affective disorders, cognitive deficits, and impairments in activities of daily living (ADLs); 92 received the same evaluation 12 months after the initial examination. On the basis of the initial psychiatric findings, patients were divided into major, minor, and non-depressed groups. Patients with major depression showed a significantly greater cognitive decline, deterioration in ADLs, and further advance through the Hoehn and Yahr stages than patients with either minor depression or no depression.

Prognosis after hospital discharge of older medical patients with delirium.

Abstract: Objective To determine survival, functional independence, and cognitive performance of older patients 2 years after an episode of delirium. Design Descriptive cohort study. Setting General medical wards of a teaching hospital. Patients Two hundred twenty-nine consecutive patients aged 70 years or older who had been community-dwelling prior to admission. Fifty patients met criteria for delirium (cases); these were compared to patients without delirium (controls). Two-hundred twenty-three patients survived hospitalization (46 cases, 177 controls) Of these, 92% were followed greater than or equal to 2 years. Main outcome measures Vital status, place of residence, activities of daily living (ADL), and cognitive performance were determined by telephone interview of patients or care-givers 2 years after discharge. Independent community living was defined as survivorship outside of an institution and without dependence in any of four basic ADL (bathing, dressing, transfers, eating). Results Two-year mortality in the entire population was 39% for cases and 23% for controls (relative risk 1.82, 95% confidence interval 1.04-3.19). Delirium identified those patients at risk for loss of independent community living, even after adjustment for potential confounding variables (adjusted odds ratio 2.56, 95% confidence interval 1.10-5.91). Follow-up cognitive testing in a subset of patients with high baseline performance revealed a greater decline in performance among cases of delirium than controls (P = 0.023). Conclusions Delirium identifies older patients at risk for mortality or loss of independence. Delirium may also identify patients at risk for future cognitive decline.

Intellectual Deficits in First-Episode Schizophrenia: Evidence for Progressive Deterioration

Abstract: The developmental processes leading to neuropsychological deficits in schizophrenia are poorly understood. Both early developmental defects and subsequent deterioration may occur. Intelligence test profiles are often used to estimate premorbid ability and deterioration from prior levels of functioning. These characteristics were assessed in samples of firstepisode (« = 51) and chronic (« = 50) schizophrenic patients. Although the groups showed few differences on tests to estimate premorbid intellectual ability, the chronic group performed worse on measures considered sensitive to deterioration. Dextral (right-handed) patients tended to have better performance; this effect was marked in the firstepisode sample, especially on verbal tests. Male patients showed more evidence of deterioration than female patients. Subgroups differing in the time course of premorbid social dysfunction also differed in intelligence test profiles, suggesting that estimates of social and cognitive deterioration may have concurrent validity. The results support the hypothesis that patients differ in the course of cognitive decline and suggest that deterioration of function may follow the onset of overt psychosis in some patients. Prospective longitudinal studies of first-episode schizophrenic patients could directly test this hypothesis.

A New Systematic Method of Measurement and Diagnosis of “Mild Cognitive Impairment” and Dementia According to ICD-10 and DSM-III-R Criteria

Abstract: Normative data were collected in a study population of 150 randomly selected elderly subjects. Using the SIDAM (Structured Interview for the Diagnosis of Dementia of the Alzheimer Type, multi-infarct dementia, and dementias of other etiology according to DSM-III-R and ICD-10), both the dimensional and the categorical aspects of dementia and "mild cognitive impairment" are considered. With the SIDAM score (SISCO) [range 0 (minimum)-55 (maximum, no cognitive impairment)] and the SIDAM Mini-Mental State Examination (MMSE) (range 0-30), appropriate cutoffs for the category of DSM-III-R and ICD-10 dementia and "mild cognitive impairment" were defined. MMSE scores of 0-22 were found to be indicative of DSM-III-R and ICD-10 dementia. For "mild cognitive impairment," MMSE scores ranged from 23-27 according to a DSM-III-R definition (ICD-10: 23-28). An MMSE score of 22 or less was found to differentiate between DSM-III-R/ICD-10 dementia and "mild cognitive impairment," with a specificity of 92% (ICD-10: 95.6) and a sensitivity of 96% (ICD-10: 96%). With the SIDAM-based DSM-III-R/ICD-10 diagnoses of dementia as the criterion, the SISCO was 97.3% specific (ICD-10: 99%) and 94% sensitive (ICD-10: 94%) in detecting dementia. A SISCO of 0-33 was highly indicative of DSM-III-R and ICD-10 dementia. For "mild cognitive impairment," a SISCO between 34-47 (ICD-10: 34-51) was found. The SISCO covers a broader range of cognitive functions than the MMSE and is more useful in detecting even very mild cognitive decline. Furthermore, the newly defined category of "mild cognitive impairment" could be validated successfully by means of GDS Stages 2-3 and CDR Stage 0.5. These findings confirm the value of the SIDAM as a short diagnostic instrument for measurement and diagnosis of dementia and "mild cognitive impairment."

The relations among caregiver stress, "sundowning" symptoms, and cognitive decline in Alzheimer's disease.

Abstract: Objective To investigate the relations among the initial perceived stress of Alzheimer patients' caregivers, the rate of change of perceived stress, patients' sundowning behaviors, and patients' rate of cognitive decline. Design A longitudinal cohort study in which Alzheimer patients and their caregivers were assessed at 6-month intervals. Setting Hospital out-patient clinic. Patients and caregivers lived at home. Subjects Subjects were 35 patients (50–79 years) with Alzheimer's disease and their primary caregivers (24 males and 11 females); all caregivers were spouses. Methods At time of entry into the study, caregivers indicated which of seven behaviors indicative of sundowning were exhibited by the patient. Patients were evaluated successively using the Mini-Mental State Examination, whereas caregivers completed the Perceived Stress Scale, provided an index of social support utilization, and completed the Beck Depression Inventory. Main Outcome Measures Caregivers' initial perceived stress and the rate of change of perceived stress, patients' sundowning behavior, and rate of cognitive decline. Results The pattern of correlations indicated that both rate of cognitive decline and initial sundowning behavior were significantly correlated with initial perceived caregiver stress. The average rate of increase of caregivers' perceived stress was positively correlated with the initial incidence of sundowning behaviors, even when controlling for the effects of caregiver depression and social support utilization. Conclusion Sundowning behavior of Alzheimer patients is associated with an increased rate of change of caregivers' perceived stress. This association may be specific to sundowning behavior because there was no relation between the rate of change of perceived stress and morning agitation. The findings suggest that future caregiver intervention programs could profitably focus on sundowning behavior rather than general agitation.

Age associated memory impairment.

Abstract: The clinical significance and neurobiological basis of normal age-related cognitive decline remains controversiaL Terms such as ‘benign senescent forgetfulness’, ‘age-associated memory impairment’ (AAMI) and, more recently, ‘age-associated cognitive decline’ have been proposed to describe memory loss in non-demented individuals as they age. This editorial considers to what extent such terms, particularly AAMI, should be accepted as clinically meaningfuL It is concluded that, in the current state of knowledge about the natural history of AAMI and similar entities, widespread treatment with pharmacotherapy is premature.

Evidence for Early Vulnerability of the Medial and Inferior Aspects of the Temporal Lobe in an 82-Year-Old Patient With Preclinical Signs of Dementia: Regional and Laminar Distribution of Neurofibrillary Tangles and Senile Plaques

Abstract: • Detailed neuropathologic studies of neurofibrillary tangle and senile plaque distribution have shown that key elements of certain neocortical and hippocampal circuits are either compromised or lost in Alzheimer's disease. It has been suggested that a global corticocortical disconnection underlies dementia and leads to the dramatic disruption of integrated functions exhibited by patients with Alzheimer's disease. To investigate the distribution of lesions associated with the earliest indications of incipient dementia, we performed a quantitative neuropathologic evaluation of a nondemented 82-year-old patient demonstrating globally intact intellectual function but initial signs of impairment of specific cognitive functions before death. We observed densities of senile plaques comparable to those found in Alzheimer's disease throughout the cerebral cortex, whereas extensive neurofibrillary tangle formation was restricted to selective areas of the temporal lobe. The results of this systematic quantitative and comparative analysis of medial and inferior temporal lobe structures suggest a functional relationship between the degree of cognitive decline evidenced in the earliest stages of Alzheimer's disease and the anatomic progression of Alzheimer's disease-related pathologic changes along specific elements of the cortical circuitry.

Individual trajectories of cognitive decline in patients with dementia of the Alzheimer type.

Abstract: The course of decline was studied in 16 patients with probable or definite dementia of the Alzheimer type (DAT) over 2.7 to 6.8 years from first to last evaluation. Overall severity of dementia was measured with the Wechsler Adult Intelligence Scale (WAIS), the Dementia Rating Scale (DRS), and the Mini-Mental State Examination (MMSE), at approximately annual intervals. An initial plateau phase, during which language and cognitive functions did not change for periods of 9 to 35 months, was observed in 5 patients who initially had an isolated memory impairment without significant impairment of nonmemory language or visuospatial function. Once nonmemory functions began to decline, the rate of decline was remarkably steady in most individual patients but varied markedly among patients. The initial rate of decline after the plateau phase, as measured with the WAIS and DRS, was a significant predictor of subsequent rate in individual patients (r = .66, p < .01, and r = .67, p < .01, for the WAIS and DR...

Neurophysiological basis of cognitive deficits in long-term survivors of childhood cancer.

Abstract: • Thirty-three survivors of childhood cancer were tested with event-related potentials (P300), motor reaction time tests, and neuropsychological tests to assess the underlying physiological basis of treatment-related cognitive sequelae. Thirteen patients had received intrathecal chemotherapy, 11 had received intrathecal chemotherapy plus cranial radiotherapy, and nine had been treated without any form of central nervous system therapy. Neuropsychological performance of the groups treated without cranial radiotherapy was normal, but the group given cranial radiotherapy was significantly impaired. Mean reaction time and P300 latency were somewhat slower in the group given intrathecal chemotherapy relative to the group given no central nervous system treatment, but were significantly delayed in the group given cranial radiotherapy. Correlations of reaction time and P300 latency with neuropsychological test scores were also obtained. Results suggest that slowing of cortical activity secondary to white-matter damage may underlie cognitive decline in children treated with intensive central nervous system therapies, especially cranial radiotherapy.

Cognitive function and regional cerebral blood flow in parkinson's disease

Abstract: In order to investigate relationships between cognition and regional brain function, we studied 20 non-demented patients with idiopathic Parkinson's disease (PD), 21 mildly demented patients with Alzheimer's disease (AD) and 24 control subjects using cognitive testing and single photon emission computerized tomographic (SPECT) measurements of relative regional cerebral blood flow (rCBF). Neuropsychological tests were grouped into clusters reflecting frontal lobe executive abilities, perseveration, memory and visuospatial ability, with a summary score summarizing performance in all four of these spheres. SPECT imaging utilized the tracer [123I]N-isopropyl-p-iodoamphetamine with a relative measure of regional tracer uptake normalized to occipital radiotracer uptake (rCBF ratios). Patients with PD performed more poorly than controls in all cognitive domains, and were intermediate to AD patients and controls in tests of memory and overall cognitive functioning. Those PD patients who performed most poorly on neuropsychological testing showed lowest rCBF ratios in left and right temporal lobes. Using a stepwise multiple regression procedure, we examined patterns of correlations between cognitive clusters and predictor variables, including rCBF ratios, in the PD patients. We found that while patient age was a strong determinant of performance on the memory cluster and the summary score, dorsolateral frontal lobe perfusion and scores on a depression inventory accounted for a greater proportion of the variance of the frontal lobe and perseveration clusters than did age. These results imply that different neural mechanisms are responsible for the different aspects of cognitive decline seen in PD patients, with overall cognitive function closely related to age and temporal perfusion, while frontal lobe abilities are more linked to frontal perfusion and the presence of depression.

Evidence of presymptomatic cognitive decline in Huntington's disease

Abstract: Asymptomatic persons at risk for Huntington's disease (HD) (N = 28) were assessed with neuropsychological, psychiatric, and neurologic tests while undergoing genetic linkage studies to determine their probability of carrying the HD gene. Those participants who were subsequently identified as probable gene carriers did not differ on neurologic or psychiatric examination from those subsequently identified as probable noncarriers. Neuropsychological data are presented for a subset of participants free of other conditions (such as alcoholism) putting them at risk for cognitive deficits. Among these subjects, probable gene carriers were inferior to probable noncarriers on the neuropsychological battery as a whole and on several individual tests involving learning and memory. The results suggest the presence of cognitive decline prior to identifiable motor impairments in HD.

Physical restraint use and cognitive decline among nursing home residents.

Abstract: Objective This study investigated the association between physical restraint use and decline in cognition. Design Cohort analytic study describing changes in resident characteristics. Setting Eight nursing homes, both urban and suburban, operated by a proprietary corporation in a large metropolitan area. Participants 437 nursing home admissions, with 201 remaining at 1 year. Main Outcome Measures Cognitive status was measured by geropsychiatrists, using the Folstein Mini-Mental State Exam, during a psychiatric evaluation of the resident. Daily restraint use was documented from nursing orders. Observations were made at 2 weeks, 10 weeks, and 1 year. Results Restraint use alone and in combination with neuroleptic use was associated with poor cognition. Other variables associated with poor cognitive scores were: ADL impairment, poor adaptive behavior, and longer time in the nursing home. The use of neuroleptics alone was not significant. Variables which were associated with good cognitive status were: being non-ambulatory but without dementia and having strong social support. Conclusions These findings raise the possibility that restraint use may contribute to cognitive impairment, specifically among residents who have moderate to no cognitive impairment at admission; however, the findings do not exclude an alternative explanation that residents undergoing cognitive decline are more likely to be put in restraints. Further research is needed to understand whether factors which can be manipulated contribute to cognitive decline.

Effects of group interventions on cognition and depression in nursing home residents.

Abstract: The effects of cognitive-behavioral group therapy, focused visual imagery group therapy, and education-discussion groups on cognition, depression, hopelessness, and dissatisfaction with life were studied among depressed nursing home residents. Seventy-six depressed subjects with mild to moderate cognitive decline participated in nurse-led 24-week protocols. Data were collected 4 weeks before the interventions, 8 and 20 weeks after treatment initiation, and 4 weeks after treatment termination. There were no significant changes in depression, hopelessness, or life satisfaction scores for any of the three conditions. Participants in the cognitive-behavioral and focused visual imagery groups showed a significant improvement beginning 8 weeks after treatment initiation on cognitive scores. These findings are encouraging indications that cognitive-behavioral and focused visual imagery group therapies may reduce cognitive impairment in depressed nursing home residents with mild to moderate cognitive decline.

Self-recognition in Alzheimer's Disease: A Mirror and Video Study

Abstract: Twenty-nine subjects with Senile Dementia of the Alzheimer Type (SDAT) were tested for self-recognition when confronted with their reflection in a mirror and with a noncontingent video image. All subjects at stage 5 (moderately severe cognitive decline) on the Global Deterioration Scale (GDS) showed self-recognition in the mirror condition, whereas 25% of GDS stage 6 subjects (severe cognitive decline) did not self-recognize. Only seven subjects showed signs of self-recognition on video (six at GDS 5, one at GDS 6). The results confirm two hypotheses: the first, based on studies with infants, is that contingency cues in the mirror condition facilitate self-recognition; the second is that SDAT patients may show "regression" of at least some cognitive functions.

Can age-related decline in speech understanding be explained by peripheral hearing loss?

Abstract: Speech audiometric scores were compared across the age range from 50 to 90 years in 137 subjects selected in such a way that average audiometric thresholds were matched across four age groups. Thus any age-related changes in speech audiometric scores could not be attributed to age-related differences in peripheral hearing sensitivity . Four speech audiometric measures were studied; phonemically-balanced words (PB), Speech Perception in Noise (SPIN) test for both high- and low-predictability sentences, and the Synthetic Sentence Identification (SSI) test. There was an age trend for all four speech measures but only the change in SSI (30%) was statistically significant . The argument that the change in SSI can be explained by subtle changes in the auditory periphery, not reflected in audiometric thresholds, is weakened by the fact that the change in SSI was greater than the change in either of the two monosyllabic word tests (PB and SPIN-low). The argument that the change in SSI can be explained by concommitant cognitive decline is not supported by correlations among SSI performance and any of several neuropsychological measures of cognitive function in the same subjects. Finally, the lack of a significant interactive effect between hearing sensitivity level and cognitive status does not support a model in which a peripherally degraded speech signal interacts with a deficit in cognitive function to produce the decline in speech audiometric scores. We conclude that the observed age-related decline in SSI performance cannot be satisfactorily explained by peripheral hearing sensitivity loss.

[Validation of the S-IQCODE: the Spanish version of the informant questionnaire on cognitive decline in the elderly].

Abstract: Although in the last decade the screening test of dementia have improved, is still being of interest the study of simple methods with a most sensitivity and specificity in the detection of the cognitive decline. Jorm et al have used recently a questionnaire (IQCODE) by which a subject's relative informs of the decline suffered by this in his cognitive capacity. In this work is showed a spanish adaptation of this test, the spanish-IQCODE, analysing it's usefulness for the detection of mild dementia. The S-IQCODE shows a diagnostic validity (sensitivity of 86%, specificity of 92%, positive predictive value of 54% and negative predictive value of 98%) greater than Mini-Mental State Examination (MMSE); it also shows a correlation with the diagnostic of dementia greater (r = 0.70 vs r = 0.37); and, different from MMSE, it doesn't show significative correlations with the age, the schooling and the premorbid intelligence. The results in this study show the S-IQCODE as a good test for the detection of the mild dementia, of greater diagnostic power than the MMSE and less contaminated than this by strange variables to the cognitive decline.

Sensitivity of the mini‐mental state examination to frontal lobe dysfunction in normal aging

Abstract: The present study examined the sensitivity of the Mini-Mental State Examination (MMSE) in detecting the frontal lobe dysfunction that occurs with normal aging. Eighty normal, independently living older adults in four age groupings from 50 to 89 were administered the MMSE along with three neurocognitive measures sensitive to frontal lobe functioning. Results revealed age-related cognitive decline on frontal lobe tasks that also was detected by the MMSE. These findings are noteworthy because the MMSE was intended as a measure of gross cognitive status rather than of frontal lobe functioning.

The MRC Multicentre Study of Cognitive Function and Ageing: A EURODEM Incidence Study in Progress

Abstract: The purpose of this paper is to describe the design and methodology of this multicentre study of cognitive function and ageing, which is currently funded by the Medical Research Council (MRC) and the Department of Health for a period of 5 years. The study is designed to estimate and compare the prevalence and incidence of dementia in five centres in the United Kingdom, to examine the natural history of cognitive decline and dementia in the population and to evaluate the degree of disability associated with any decline. This will be achieved by the examination, twice, of the cognitive function of individuals aged 65 and over, with an interval of 2 years between the examinations. A 20% subsample, taken across the full range of cognitive function will be reviewed annually in more detail to chart the level of cognitive function and to ascertain a diagnosis of dementia. This represents the first systematic examination of different populations using a common methodology in the United Kingdom.

Aluminium and Alzheimer's disease.

Abstract: The hypothesis that aluminium (Al) is a cause of (or a risk factor in) the development of beta-amyloid plaques and neurofibrillary tangles (NFT) and dementia in Alzheimer's disease (AD) is based on studies by Wisniewski et al, Klatzo et al and Terry & Pena in 1965 that showed that injection of experimental animals with Al compounds induces the formation of NFT Other publications revealed that Al affects cognitive functions in experimental animals and humans undergoing dialysis for renal failure Electron probe and laser microprobe mass analysis (LAMMA) studies have demonstrated the presence of Al in NFT and cores of amyloid stars and nuclei of neurons in AD patients Other studies have indicated the association between amyotrophic lateral sclerosis/Guam parkinsonism-dementia complex and Al in the environment A recent report suggests that the chelating agent desferrioxamine slows the rate of cognitive decline in AD patients Extensive studies of the pathology of AD and Al-induced encephalopathy by our group and others indicate that Al does not cause Alzheimer's disease neuropathology However, under certain conditions, cognition can be affected when Al enters the brain Therefore, for individuals with renal failure or undergoing dialysis or individuals with a damaged blood-brain barrier, the intake of Al should be controlled

Lack of association of nonsteroidal anti-inflammatory drug use and cognitive decline in the elderly.

Abstract: Folstein Mini-Mental State Examination (MMSE) scores obtained in an ambulatory elderly population were used to examine the effect of nonsteroidal anti-inflammatory drug (NSAID) use on cognitive performance. There were 1,310 participants who met the inclusion criteria for the study, of whom 873 (66.6%) were women and 437 (33.3%) were men. There were no differences in mean MMSE scores or in the five dimensions of cognitive function measured by the MMSE for subjects reporting NSAIDs or aspirin use.

Neurosarcoidosis presenting as schizophreniform disorder.

Abstract: A patient whose clinical presentation met criteria for schizophreniform disorder was ultimately found to have neurosarcoidosis, and the psychiatric symptoms responded to steroid treatment. The ongoing search for organic etiology was prompted by the presence of cognitive decline, perseveration and rare bizarre automatisms. This is virtually the first reported association between schizophreniform disorder and sarcoidosis. We reviewed the literature on neurologic involvement and psychiatric manifestations in sarcoidosis as well as the concurrence between organicity and schizophrenic psychosis. The importance of attending to all elements of the mental status examination in a patient with complex atypical findings is underscored.

The evaluation of long‐term care for the dementing elderly: A comparative study of hospital and collective non‐medical care in France

Abstract: Despite growing interest in the nature and mechanisms of senile dementia, there has been surprisingly little research on long-term care provision for persons with irreversible cognitive decline. The present study describes a model for the evaluation of long-term care facilities for the dementing elderly and its application in France to a comparative study of traditional long-stay hospitals and non-medical communal care. Results suggest that persons in communal care are less dependent, report less depressive symptomatology, are more mobile, engage in verbal communication more frequently and have fewer language difficulties than persons in hospital care, although no differences are found between the two groups in terms of dementia severity. Both family and professional caregivers were found to be more satisfied with communal care. A follow-up study suggests that some of these differences might, however, be due to differences in the populations at admission. The results are discussed in terms of appropriate care allocation for persons with senile dementia.