Showing papers on "Cognitive decline published in 1993"

Clinical trial of indomethacin in Alzheimer's disease

Abstract: In a 6-month, double-blind, placebo-controlled study, 100 to 150 mg/d indomethacin appeared to protect mild to moderately impaired Alzheimer's disease patients from the degree of cognitive decline exhibited by a well-matched, placebo-treated group. Over a battery of cognitive tests, indomethacin patients improved 1.3% (+/- 1.8%), whereas placebo patients declined 8.4% (+/- 2.3%)--a significant difference (p < 0.003). Caveats include adverse reactions to indomethacin and the limited scale of the trial.

Speed and intelligence in old age.

Abstract: Past research suggests that age differences in measures of cognitive speed contribute to differences in intellectual functioning between young and old adults. To investigate whether speed also predicts age-related differences in intellectual performance beyond age 70 years, tests indicating 5 intellectual abilities--speed, reasoning, memory, knowledge, and fluency--were administered to a close-to-representative, age-stratified sample of old and very old adults. Age trends of all 5 abilities were well described by a negative linear function. The speed-mediated effect of age fully explained the relationship between age and both the common and the specific variance of the other 4 abilities. Results offer strong support for the speed hypothesis of old age cognitive decline but need to be qualified by further research on the reasons underlying age differences in measures of speed.

Adult information processing : limits on loss

Abstract: Introduction: A.T. Welford, The Gerontological Balance Sheet. Neurophysiological Sparing: D.S. Woodruff-Pak, Neural Plasticity as a Substrate for Cognitive Adaptation in Adulthood and Aging. T.R. Bashore, Differential Effects of Aging on the Neurocognitive Functions Subserving Speeded Mental Processing. R. Parasuraman and P.G. Nestor, Preserved Cognitive Operations in Earl Alzheimers Disease. Information Processing Rate: J. Myersonand S. Hale, General Slowing and Age-Invariance in Cognitive Processing: The Other Side of the Coin. S.H. Johnson and J.M. Rybash, A Cognitive Neuroscience Perspective on Age-Related Slowing: Developmental Changes in the Functional Architecture. A. Baron and J. Cerella, Laboratory Tests of the Disuse Account of Cognitive Decline. T.R. Bashore and P.H. Goddard, Preservative and Restorative Effects of Aerobic Fitness on the Age-Related Slowing of Mental Processing Speed. AttentionalCapacity: B. Molander and L. Backman, Performance of a Complex Motor Skill Across the Life-Span: General Trends and Qualifications. L.M. Giambra, Sustained Attention in Older Adults: Performance and Processes. D.J. Madden and D.J. Plude, Selective Preservation of Selective Attention. Perception of Objects: N.L. Bowles, Semantic Processes that Serve Picture Naming. D.L. Schacter, J.F. Kihlstrom, A.W. Kaszniak, and M. Valdiserri, Preserved and Impaired Memory Functionsin Elderly Adults. J.C. Bartlett, Limits on Losses in Face Recognition. Word Perception: J.M. Duchek and D.A. Balota, Sparing Activation Processes in Older Adults. R. McGinchey-Berroth and W. Milberg, Preserved Semantic Memory Structure in Alzheimers Disease. Language Comprehension: P.A. Tun and A. Wingfield, Is Speech Special? Perception and Recall of Spoken Language in Complex Environments. L.L. Light, S.A. Owens, P.G. Mahoney, and D. LaVoie, Comprehension of Metaphors by Young and Older Adults. S. Kemper and C. Anagnopoulos, Adult Use of Discourse Constraints on Syntactic Processing. Learning, Memory, and Problem Solving: D.V. Howard and C.L. Wiggs, Aging and Learning: Insights from Implicitand Explicit Tests. E.A. Maylor, Minimized Prospective Memory Loss in Old Age. D.A. Walsh and D.A. Hershey, Mental Models and the Maintenance of Complex Problem-Solving Skills in Old Age. Conclusion: E. Hunt, What Do We Need to Know about Aging? Subject Index.

Course of Schizophrenia: Neuropsychological Evidence for a Static Encephalopathy

Abstract: The course of cognitive function in schizophrenia has often been debated. In one view, it is thought to be akin to that of a progressive dementia with relentless cognitive decline. In another view, the deficits are thought to remain relatively stable, analogous to those of a static encephalopathy. Review of longitudinal and cross-sectional studies strongly supports the latter interpretation. In particular, we present data from a recent cross-sectional study in which cohorts of patients in their third, fourth, fifth, sixth, and seventh decades of life were administered a battery of tests known to be sensitive to progressive dementing diseases. All patients were carefully screened to exclude those with neurologic, systemic, or psychiatric comorbid conditions, and cohorts were matched on estimated premorbid intellectual capacity. Although scores on most tests were impaired, no evidence of decline across groups was observed. These results are also consistent with neuroimaging and neuropathological studies in that no evidence for an active degenerative process has been discovered.

Chronic Obstructive Pulmonary Disease: An Original Model of Cognitive Decline

Abstract: In order to characterize the neuropsychologic profile of patients with hypoxic-hypercapnic chronic obstructive pulmonary disease (COPD), the performance of 36 patients with COPD 69 +/- 10 yr of age (mean +/- SD) on 19 tests exploring eight cognitive domains was compared with those of 29 normal adults (69 +/- 7 yr of age), 20 normal elderly adults (78 +/- 2 yr of age), 26 patients with Alzheimer-type dementia (72 +/- 6 yr of age), and 28 with multi-infarct dementia (MID) (70 +/- 8 yr of age). The discriminant analysis of cognitive test scores showed that 48.5% of patients with COPD had a specific pattern of cognitive deterioration characterized by a dramatic impairment in verbal and verbal memory tasks, well-preserved visual attention, and diffuse worsening of the other functions. The remaining patients with COPD were functionally classified as normal adults (12.1%), normal elderly adults (15.2%), those with MID (12.1%), and those with Alzheimer-type dementia (12.1%) according to discriminant analysis. Cognitive impairment was significantly and positively correlated with age (p < 0.05) and duration of hypoxic-hypercapnic chronic respiratory failure (p < 0.05). Because patients with COPD were receiving oxygen therapy from the beginning of oxyhemoglobin desaturation, results suggest that continuous oxygen therapy does not prevent or only partly prevents cognitive decline in COPD. Although some analogies between age-related and COPD-related cognitive decline are evident, a distinct cognitive profile was found in a large fraction of patients with COPD and it differs in several aspects from those of both normal and demented subjects.

The Prevalence of Dementia, Depression and Neurosis in Later Life: The Liverpool MRC-ALPHA Study

Abstract: Prevalence rates for psychiatric disorders in the elderly are presented from the initial cross-sectional stage of a longitudinal community study of the incidence of dementia in the city of Liverpool. Together with five other centres in the UK the MRC-ALPHA project forms part of the MRC multicentre incidence study of dementia and cognitive decline. An age- and sex-stratified random sample of 5222 subjects aged > or = 65 was interviewed at home using the Geriatric Mental State-AGECAT package to provide computer diagnoses. The overall age-standardized prevalence rates for organic disorder (4.7%) depressive illness (10.0%) and the neuroses (2.5%) are consistent with levels found in previous smaller studies that have used GMS-AGECAT. Each of these diagnoses is more common in females than males. A rise in organic disorder with age is confirmed as continuing into the oldest age groups for both sexes. An apparent decline with age observed for depression and neurosis diagnoses disappears when organic cases are excluded from the analysis.

Predictors of nursing home placement in patients with alzheimer's disease

Abstract: Sixty-six outpatients with mild to moderate dementia in Alzheimer's disease at baseline were examined twice with an interval of 12 months. Twenty-two of these patients who were admitted to a nursing home within this period were compared to a group of 44 patients who remained living at home with respect to demographic data, cognitive and physical dysfunction, behavioural changes in daily living and the burden of caregivers. Stepwise discriminant function analysis revealed that older age, global cognitive decline, incontinence, aggression, depression, and the caregiver's wish to leave the care to someone else were predictors for nursing home placement ithin 1-year follow-up and correctly classified 82% of the cases. The study indicates that factors predicting nursing home placement in Alzheimer patients are complex, including demographic characteristics, level of cognitive and physical functioning, behavioural abnormalities in daily living, as well as burden of the caregiver, and are consistent with predictors of institutionalization found in healthy elderly individuals.

Cognitive decline in the elderly: A double- blind, placebo- controlled multicenter study on efficacy of phosphatidylserine administration

Abstract: This double-blind study assesses the therapeutic efficacy and the safety of oral treatment with phosphatidylserine (BC-PS) vs placebo (300 mg/day for 6 months) in a group of geriatric patients with cognitive impairment. A total of 494 elderly patients (age between 65 and 93 years), with moderate to severe cognitive decline, according to the Mini Mental State Examination and Global Deterioration Scale, were recruited in 23 Geriatric or General Medicine Units in Northeastern Italy. Sixty-nine patients dropped out within the 6-month trial period. Patients were examined just before starting therapy, and 3 and 6 months thereafter. The efficacy of treatment compared to placebo was measured on the basis of changes occurring in behavior and cognitive performance using the Plutchik Geriatric Rating Scale and the Buschke Selective Reminding Test. Statistically significant improvements in the phosphatidylserine-treated group compared to placebo were observed both in terms of behavioral and cognitive parameters. In addition, clinical evaluation and laboratory tests demonstrated that BC-PS was well tolerated. These results are clinically important since the patients were representative of the geriatric population commonly met in clinical practice.

Side of onset of motor symptoms influences cognition in Parkinson's disease

Abstract: Studies attempting to relate cognitive impairment to asymmetry of motor symptoms in Parkinson's disease (PD) have found contradictory results. We examined 88 patients with unilateral onset of idiopathic PD who underwent a comprehensive neuropsychological assessment, including language, visuospatial abilities, abstraction and reasoning, attention and mental tracking, set shifting, and memory. Patients whose motor signs began on the left side of the body consistently performed more poorly on the battery of cognitive measures than did patients with right-side onset. Significant differences were found on immediate and delayed verbal recall, word retrieval, semantic verbal fluency, visuospatial analysis, abstract reasoning, attention span, and mental tracking. These differences could not be attributed to differences in the overall severity of motor symptoms at the time of cognitive assessment, or the current pattern of motor asymmetry. This finding suggests that damage to right-hemisphere dopamine systems plays a disproportionately greater role in PD-related cognitive decline than a presumably comparable left-hemisphere dopamine depletion.

Down's syndrome and Alzheimer's disease.

Abstract: Individuals with Down's syndrome (DS) who live to be 40 years of age will demonstrate neuropathological changes that are consistent with Alzheimer's disease (AD). Due to modern medical intervention, we are now observing an aging DS population. Middle-aged Down's syndrome adults are actually considered to be "very old," and it is not uncommon to observe a progressive loss of cognitive function and a decline in the ability to perform daily tasks consistent with that seen in Alzheimer's disease. At this stage, the DS individual will not be able to perform daily preventive dental care and may be unable to cooperate for professional dental care. Clinicians who care for DS adults must be aware of this problem when preparing their dental treatment plans, which must emphasize preventive care prior to the onset of dementia and the maintenance of that program during their patients' cognitive decline. In the latter stages of AD, it may be necessary to extract all the remaining teeth due to the inability of the individual or care giver to provide adequate oral hygiene to prevent dental caries or periodontal disease.

A two-year longitudinal study of cognitive function in normal aging and Alzheimer's disease.

Abstract: A group of 136 elderly subjects were administered a comprehensive neuropsychological test battery, which was readministered 2 years later. Among the 136 elderly subjects, 86 were assigned a diagnosis of probable Alzheimer's disease. An additional 33 young subjects were administered the assessment battery at baseline only. The normal elderly group exhibited no decline in cognitive test performance over the 2-year follow-up interval. Subjects with mild cognitive impairment, however, were as likely to deteriorate between baseline and follow-up as the more severely impaired subjects. The tests that exhibited longitudinal decline in the Alzheimer's disease patients constituted a subset of the tests that revealed cross-sectional deficits relative to the normal elderly. Differences in baseline cognitive test performance and in rate of cognitive deterioration were examined in relatively young versus relatively old Alzheimer's disease patients. Potential psychometric predictors of cognitive decline in the normal e...

Working memory impairment among persons with chronic progressive multiple sclerosis

Abstract: We examined short-term memory (STM) among a group of 23 definite, chronic progressive multiple sclerosis (MS) patients, all of whom had experienced recent significant disease activity, and a control group matched closely on age and education. MS patients were impaired, relative to controls, on the majority of the measures used. Although there were no significant differences between groups on the Mini Mental State Examination, patients performed more poorly on digits forward and backward, the Brown-Peterson test, and the logical memory scale of the Revised Wechsler Memory Scale (both immediate and delayed). Performance on tests sensitive to central processing capacity was significantly correlated with measures of STM. Working memory was significantly impaired in this sample of chronic progressive MS patients. In conjunction with previous research showing deficient information processing and prefrontal dysfunction among this population, the findings suggest that an impairment of central information processing may be a fundamental aspect of the mnestic and cognitive decline observed in many chronic progressive MS patients.

Rasmussen's chronic encephalitis in adults.

Abstract: • Objective. —Rasmussen's chronic encephalitis, a cause of intractable epilepsy in childhood, is described in three adults. Setting. —Inpatient epilepsy unit. Patients. —Of 11 patients with pathological confirmation of Rasmussen's encephalitis, three were adults with intractable seizures, progressive sensorimotor deficits, and cognitive decline beginning at the ages of 36, 24, and 16 years. Results. —Clinical, electroencephalographic, and magnetic resonance imaging findings indicated patchy, multifocal involvement of primarily one hemisphere, but the adults had more evidence of disease in the opposite hemisphere than occurs in children. The sensorimotor deficit that the adults developed was greater and the cognitive decline was less than in children. Seizure control following multilobe resection was proportionate to the amount of tissue removed. Cytomegalovirus genome was found in the resected cortical tissue of all three patients. Conclusions. —Rasmussen's encephalitis is a cause of intractable epilepsy with progressive neurological deficit in adults as well as children. Cytomegalovirus may be involved in the pathogenesis of the disease.

Desferrioxamine and Alzheimer's disease: video home behavior assessment of clinical course and measures of brain aluminum.

Abstract: Drug trials designed to modify the progression of Alzheimer's disease (AD) have required the development of mental state and behavior evaluation instruments that are sensitive to cognitive decline and measure skills useful in everyday living. We describe a videotaped home behavior (VHB) assessment instrument with high construct validity and reliability and a strong relationship to criterion references. The VHB was employed to test the hypothesis that aluminum is an important pathogenic factor in AD. The trivalent chelating agent desferrioxamine (DFO), 125 mg i.m. twice daily five days per week, was used in a randomized single-blind, oral lecithin, placebo-controlled clinical trial in 48 patients with AD. Analysis showed that the treatment and no-treatment groups were closely matched at entry into the trial but that the rate of decline, as measured by the VHB over 2 years of observation, was twice as rapid in the no-treatment group compared with the DFO-treated group. Furthermore, trace-metal analysis of autopsied brain confirmed that extended treatment with DFO lowered neocortical brain aluminum concentrations to near control concentrations. Aluminum ion-specific chelation may be a useful palliative treatment for AD, and further clinical trials are indicated.

A topographical study of senile plaques and neurofibrillary tangles in the hippocampi of patients with Alzheimer's disease and cognitively impaired patients with schizophrenia

Abstract: Neuropsychological testing of elderly schizophrenic patients reveals that a significant portion of this population exhibit varying degrees of cognitive impairment Since Alzheimer's disease is the most common cause of dementia in geriatric patients, we investigated whether the cognitive decline observed in schizophrenia is the result of degenerative changes analogous to those characteristic of Alzheimer's disease For this purpose, the number and distribution of senile plaques and neurofibrillary tangles were mapped in the hippocampi of 10 cognitively impaired schizophrenic patients, 10 patients with Alzheimer's disease, and 10 patients with dementia not attributed to either schizophrenia or Alzheimer's disease In Alzheimer's disease, degenerative changes invariably predominated in the CA1 subfield, subiculum, and proisocortex By contrast, findings characteristic of Alzheimer's disease were virtually never observed in the hippocampi of schizophrenic and other cognitively impaired patients In some patients with Alzheimer's disease, the presence of senile plaques in the molecular layer of the dentate gyrus suggested the existence of an underlying entorhinal cortex lesion Similar dentate gyrus pathology was never found in any of the other patients The authors conclude that cognitive impairment in schizophrenia is not the result of degenerative changes analogous to those found in Alzheimer's disease

Selected psychiatric symptoms associated with rate of cognitive decline in patients with Alzheimer's disease.

Abstract: We examined the relation between selected psychiatric symptoms and the average rate of decline in different areas of cognition in patients with Alzheimer's disease. Measures of decline were computed by determining patients' average rates of decline on the underlying factors of the Mini-Mental State Examination (MMSE). Patients with agitation or wandering declined more rapidly on the total MMSE score than did patients without either symptom. The Following Commands factor accounted for almost all of this decline. The findings suggest a relation between the presence of certain behavioral problems in Alzheimer's disease and decline in particular cognitive areas.

Cognitive decline in Alzheimer's disease: elaborating on the nature of the longitudinal factor structure of the Mini-Mental State Examination.

Abstract: The purpose of this paper was to use the Wechsler Adult Intelligence Scale (WAIS) to further define the nature of the underlying factors of the Mini-Mental State Examination (MMSE) as proposed by Tinklenberg et al. (1990). The MMSE was administered to 51 patients once every 6 months for at least one year; the WAIS was administered only at the beginning of the study. Stepwise regression analyses yielded these results: for the Following Commands factor, the best correlate was the Comprehension subtest; for the Language Repetition factor, the best correlate was the Picture Arrangement subtest; and for the Language Expression factor, the best correlates were the Digit Symbol and Object Assembly subtests. These relations help clarify the correlates of decline of AD patients on the MMSE.

Cognitive Change After Elective Surgery in Nondemented Older Adults.

Abstract: The authors report the results of repeated cognitive function tests administered over 10 months to 82 patients between the ages of 55 and 82 who underwent elective surgery. The Mini-Mental State Exam (MMSE) score, 10 months after surgery, was modeled by a multivariate linear regression that included the baseline demographics, baseline cognitive functions, and immediate postoperative MMSE scores. Immediate postoperative MMSE scores were highly significant to 10-month postoperative MMSE scores not explained by baseline variables. The results suggest that immediate postoperative cognitive change may predict later postoperative cognitive decline.

Vascular dementia: stroke prevention takes on new urgency.

Abstract: Vascular dementia is a clinical syndrome of acquired intellectual impairment resulting from brain injury due to a cerebrovascular disorder. It is a complex diagnosis, and diagnostic criteria vary. In community practice, the physician can probably make the diagnosis based on the history and medical examination. CT demonstration of one or more infarcts increases the likelihood of this diagnosis. Hypertension is a major risk factor for vascular dementia. Others include smoking, hyperlipidemia, atrial fibrillation, diabetes, and a sedentary lifestyle. Cerebrovascular disease is an important cause of cognitive decline in older patients. Therefore, it is important to recognize risk factors for stroke and institute measures for prevention.

Dementia testing in the elderly.

Abstract: Cognitive testing with the Dementia Rating Scale was performed serially over an 18-month period in 410 nursing home patients. The principal findings were: deterioration in patients with congestive failure but not cerebrovascular accident: continuous deterioration in organic mental syndrome cases in relation to initial severity; specific impairment of memory in patients on neuroleptics; and no evidence that the nursing home environment alone induced cognitive decline.

Clinical Experience with Aniracetam in the Treatment of Senile Dementia of the Alzheimer’s Type and Related Disorders

Abstract: The clinical efficacy and tolerability of aniracetam have been evaluated in elderly patients with senile dementia of the Alzheimer’s type (SDAT), and in patients with senile cognitive decline.