bluuebunny/crossref_metadata_2025 huggingface dataset:
African American Issues in Geriatric Psychiatry: A Perspective on Research Opportunities
Authors: Cohen Gene D.
Published: March 2014

Racial, ethnic, and cultural factors influencing mental health in later life are important to study in their own right. However, they also offer an opportunity to expand our understanding of mental health and mental illness in older adults independent of race, ethnicity, or culture. Any time an opportunity arises to examine a problem from a different perspective, chances increase that new light will be shed on the problem. For example, while suicide is greatest in older Americans compared with any other US population group, it is less frequent in older blacks than older whites. Why? Among the different theories that have been advanced, one holds that older African Americans in reaching later life have surmounted more threats to self-esteem (compared with whites) and are thereby better adapted to new challenges associated with aging.1 Still, the discrepancy in suicide rates between older blacks and whites remains an important research question. In studying suicide with attention to racial and ethnic variables, the opportunity presents itself to gain a more fundamental understanding of suicide itself—to the benefit of all older adults, indeed to the benefit of all age groups.

This paper focuses on some African American issues pertinent to geriatric psychiatry and identifies areas for further research. In addition to a selected literature review, the author draws on his own research from a 20-year longitudinal study, initiated in 1971, of a senior citizens' apartment building in Washington, DC, with a predominantly African American population.2 (1 = Group for the Advancement of Psychiatry, Committee on Cultural Psychiatry: Suicide and Ethnicity in the United States. New York, Bruner/Mazel, 1989; and 2 = Cohen GD: Lessons from longitudinal studies of mentally ill and mentally healthy elderly: A 17-year perspective, in Bergener M, Finkel SI (eds): Clinical and Scientific Psychogeriatrics, Vol. 1. New York, Springer, 1990.)
Convex Third Ventricle: A Possible Sign for Dementia Using MRI
Authors: Powell Artiss L. , Mezrich Reuben S. , Coyne Andrew C. , Loesberg Andrew , Keller Irwin
Published: March 2014

The shape and thickness of the third ventricles were studied with magnetic resonance imaging in 46 patients under evaluation for memory impairment. We compared this population with 23 subjects imaged for other reasons. The study group consisted of patients with diagnoses of probable dementia of the Alzheimer's type (DAT; 35.6%), multi-infarct dementia (MID; 22.2%), depression (8.9%), alcoholic dementia (6.7%), other dementias (OD; 13.2%) and no dementia (6.7%). Within the study group, there were no significant differences across diagnostic categories for duration of symptoms or level of education. Patients with DAT were, however, more impaired than others (Mini-Mental State Examination scores: DAT 14.6 [±8.2] versus MID 17.4 [±6.2] versus OD 21.2 [±6.4]). Demented subjects were more likely than nondemented individuals to have a convex third ventricle and greater wall separation. The results suggest that the shape of the third ventricle may correlate with dementia. Possibly, the dorsal medial nucleus of the thalamus is involved in the dementia.
Preliminary Findings of High-Dose Thiamine in Dementia of Alzheimer's Type
Authors: Meador Kimford , Loring David , Nichols Martha , Zamrini Edward , Rivner Michael , Posas Hernan , Thompson Elaine , Moore Eugene
Published: March 2014

Thiamine is important not only in the metabolism of acetylcholine but also in its release from the presynaptic neuron. Pathologic, clinical, and biochemical data suggest that thiamine deficiency is detrimental to the cholinergic system and that thiamine-dependent enzymes may be altered in Alzheimer's disease. Two previous studies reported contradictory results in patients with dementia of Alzheimer's type treated with 3 g/day of thiamine. In the present study, we examined the effects of 3 to 8 g/day thiamine administered orally. Our results suggest that thiamine at these pharmacologic dosages may have a mild beneficial effect in dementia of Alzheimer's type. The mechanism of the observed effect is unknown, but the findings warrant further investigation, not only for their therapeutic implications but for their possible etiologic clues. In addition, the results suggest long-term carry-over effects that should be considered in the design of future studies.
Selected Psychiatric Symptoms Associated With Rate of Cognitive Decline in Patients With Alzheimer's Disease
Authors: Miller Terry P. , Tinklenberg Jared R. , Brooks John O. , Fenn Howard H. , Yesavage Jerome A.
Published: March 2014

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.
Brief Report: Sleep in Bereavement-Related Depression During and After Pharmacotherapy With Nortriptyline
Authors: Pasternak Rona E. , Reynolds Charles F. , Houck Patricia R. , Schlernitzauer Maryann , Buysse Daniel J. , Hoch Carolyn C. , Kupfer David J.
Published: March 2014

Our objective was to assess the effects of nortriptyline on electroencephalographic sleep and subjective sleep quality in spousally bereaved, depressed elders. Ten elderly volunteers with bereavement-related major depression had electroencephalographic sleep studies while depressed, after remission of depressive symptoms while still taking nortriptyline, and after nortriptyline discontinuation. Changes in sleep measures over time were compared both within bereaved subjects and with age– and sex-matched healthy controls. Remission of depressive symptoms while still on nortriptyline was associated with improvements in sleep quality ( P < .002), rapid eye movement (REM) percent ( P < .02), REM latency ( P < .05), REM density ( P < .05), and delta sleep ratio ( P < .05). After discontinuation of nortriptyline, REM percent, REM latency, and delta ratio reverted to pretreatment levels, while sleep efficiency and sleep quality continued to show improvement coincident with sustained clinical remission. These data suggest that nortriptyline may be clinically useful in treating the sleep disturbance of elders with bereavement-related depression and that a double-blind, placebocontrolled, randomized clinical trial is warranted.
Late-Life-Onset Panic Disorder: Clinical and Demographic Characteristics of a Patient Sample
Authors: Hassan Rakhshanda , Pollard C. Alec
Published: March 2014

Although panic disorder is generally believed to begin in young adulthood, 13 cases of panic disorder with an initial onset after age 60 years have recently been seen at our clinics. Other than the time of life in which the first panic attack occurred, clinical and demographic profiles of these 13 patients were similar to those that have been reported for panic disorder patients whose panic began earlier in life. These findings indicate that panic disorder can affect older adults with no previous history of panic attacks, but further research is needed to determine the clinical and theoretical significance of late-life-onset panic disorder.
The Earliest Signs of Alzheimer's Disease
Authors: Oppenheim Gerald
Published: March 2014

Insufficient clarity of definition of the clinical features in the earliest stages of developing Alzheimer's disease (AD) has impeded the execution of clinical and biologic studies into this major public health problem. Defining the earliest signs of a disease with such an insidious onset can prove to be a most elusive task, particularly in a disease whose very nature renders the patients' self-report unreliable. We therefore administered a structured interview to the close family caregivers of 83 patients with probable AD, in order to investigate the earliest perceived signs of illness in the patients.

In 44 (53%) of patients, the earliest objective sign of change was not memory impairment. The initial sign of change was of a psychiatric type in 27 (32.5%); of a neurologic type in nine (10.9%); and of a noncoping type in eight (9.6%). Such nonmemory signs, as perceived by caregivers, preceded objective memory impairment by a mean of 1.8 years. In 39 patients (47%), memory impairment was the initial perceived sign of illness.

These findings suggest thatthe earliest clinical manifestations of AD may, in many cases, significantly predate objective signs of memory impairment.
Stroke-Related Aphasias Mistaken for Psychotic Speech: Two Case Reports
Authors: Sambunaris Angelo , Hyde Thomas M.
Published: March 2014

A large portion of the human central nervous system is dedicated to and specialized for language function. Aphasias, disorders of language, can be seen in many psychiatric and neurologic conditions. On occasion, it is difficult to differentiate between language abnormalities secondary to a patient's psychiatric illness and those secondary to a superimposed neurologic condition. In particular, in the evaluation of a patient with a history of a psychotic illness, it is easy to misinterpret the presentation of “abnormal” speech as an exacerbation of the patient's pre-existing psychiatric illness. To show this psychoneurologic comorbidity, two case reports are presented.
Cytoskeletal Neurofilament Gene Expression in Brain Tissue from Alzheimer's Disease Patients. I. Decrease in NF-L and NF-M Message
Authors: Kittur Smita , Hoh John , Endo Hidetoshi , Tourtellotte Wallace , Weeks Benjamin S. , Markesbery William , Adler William
Published: March 2014

The cytoskeletal changes seen in brains of patients with Alzheimer's disease include neurofibrillary tangles, neuritic plaques, Hirano bodies, and granulovacuolar degeneration. Northern and slot blot analyses were used to investigate the expression of the genes coding for actin, tubulin, neurofilaments, and histone in brain tissue from Alzheimer's disease patients and normal aged controls. We found a marked decrease of 94% in the expression of the neurofilament gene coding for the medium size subunit (150 kDa) and a 73% decrease in the expression of the gene coding for the small subunit (68 kDa) in Alzheimer's disease patients as compared to controls. Expression of the other genes, such as actin and histone, did not show any significant difference. Expression of the gene coding for medium size, neurofilament gene was not decreased in other neurodegenerative diseases, such as amyotrophic lateral sclerosis and Parkinson's disease. This abnormality in neurofilament gene expression may explain some of the pathologic features found in Alzheimer's disease patients.
Age-Related Differences in Visual Search Task Performance: Relative Stability of Parallel but not Serial Search
Authors: Oken Barry S. , Kishiyama Shirley S. , Kaye Jeffrey A.
Published: March 2014

The hypothesis that visual search tasks requiring effortful, serial processing are more sensitive to aging than those requiring relatively automatic, parallel processing was tested in 96 healthy adults who performed parallel and serial visual search tasks with fixed presentation times. Reaction times and error rates increased with age in both tasks, but there was no difference between young and old in the effect of increasing numbers of distractors on reaction times. However, the older subjects made significantly more errors with increasing numbers of distractors in the serial search task. Older subjects have disproportionately more difficulty performing serial compared to parallel visual search tasks than do younger subjects. Additionally, this difference is not caused solely by cautious response strategies in the elders.
Psychoactive Medications in the Long-Term Care Setting: Differing Perspectives among Physicians, Nursing Staff, and Patients
Authors: Jacobson Daniel H. , Winograd Carol Hutner
Published: March 2014

Differences in perceptions among nursing home patients, nursing staff, and physicians were compared in this preliminary study regarding nighttime disorders and psychoactive medications. Nighttime disorders, including both insomnia and behavior problems, are prevalent among institutionalized elderly and are frequently managed with psychoactive medications. All nursing home patients receiving psychoactive medications, the nursing staff, and the physicians involved in their care were interviewed regarding the description, etiology, management, and impact of the nighttime disorder including side effects of the prescribed medications. Overall, the differences in responses among the three groups ranged from 47% to 63%. While both physicians and nurses reported problems more often than did the patients, nurses reported problems more frequently than did physicians. This preliminary study suggests that patients, nursing staff, and physicians perceive nighttime disorders and their management differently. These differences point to the need for improved methods of communication and education to mutually identify the targeted disorder and develop appropriate management.
Prevalence of Personality Disorders in Community-Living Elderly
Authors: Ames Ashley , Molinari Victor
Published: March 2014

There has been limited research on the prevalence of personality disorders in the aged. No studies have documented the extent of personality disorders in community-dwelling elderly with the use of a structured scale specifically designed to detect personality disorders and anchored to DSM-III-R criteria. One hundred male and 100 female community-living elderly (mean age, 72.1 years) were administered the Structured Interview for Disorders of Personality-Revised to compare prevalence rates for specific personality disorders with those of young adults (mean age, 41.7 years) and to identify demographic variables associated with personality disorders in the elderly. Results indicate a tendency toward fewer personality disorders in older than young adults, no differences in the frequency of personality disorders between male and female elderly, and significantly more prior mental health consultations in elderly with personality disorders than in elderly without these disorders. Aging processes and methodologic issues that could accountfor differences in personality disorder distribution between young and older adults are discussed. Recommendations for future research are outlined.
The Zung Self-Rating Depression Scale: Screening for Depression Among the Hong Kong Chinese Elderly
Authors: Lee Hing Chu , Chiu Helen Fung Kum , Wing Yun Kwok , Leung Chi Ming , Kwong Po Keung , Chung Dicky Wai Sau
Published: March 2014

Two studies were conducted respectively to examine the reliability and validity of the standard Zung Self-rating Depression Scale (SDS), and a 10-item shorter version of the same test. In particular, the scale's usefulness as a screening instrument for depression among the Hong Kong Chinese elderly was investigated. In addition to the SDS, the Geriatric Depression Scale and the Chinese Hamilton Depression Scale were used to assess the convergent validity of the SDS. Data were collected from 113 nondepressed community-dwelling and 80 depressed elderly subjects. The findings showed that both the original and the shorter version of the SDS were highly reliable and valid. Both versions were appropriate for use as screening instruments for geriatric depression in Hong Kong. When compared with the original scale, the shorter version appeared to be slightly superior in its sensitivity and specificity in discriminating between the depressed and nondepressed subjects.
Changes in Tardive Dyskinesia Symptoms in Elderly Patients Treated with Ganglioside GM1 or Placebo
Authors: Sommer Barbara R. , Cohen Bruce M. , Satlin Andrew , Cole Jonathan O. , Jandorf Lina , Dorsey Frank
Published: March 2014

The unique role of ganglioside GM1 in neuronal plasticity led two centers, New York University and McLean Hospital, to study the effect of GM1 or placebo in patients with tardive dyskinesia. Results from the NYU cohort have already been published. We now present data from the entire cohort, allowing us to evaluate the effects of GM1 in the elderly compared to young adults. Subjects with tardive dyskinesia were randomly assigned to single-blind placebo injections for 1 week, followed by 1 month of double-blind intramuscular placebo or GM1100 mg. The final sample included 29 patients: 12 younger than 55 years of age and 17 older. There was no GM1-versus-placebo difference observed in either-age group, or in the total group. However, whether on placebo or GM1, repeated measures analysis of variance (RANOVA) found a significant difference in response between Abnormal Involuntary Movement Scale scores, taken baseline and week 4, in the elderly compared to young adults. Scores for the young adults show initial improvement then deterioration back to baseline, and those for the elderly show continuing improvement during the 4-week trial. The importance of the placebo effect in the elderly and its meaning for studies of GM1 in tardive dyskinesia are discussed.
Prevalence of Depression in Alzheimer's Disease and Validity of Research Diagnostic Criteria
Authors: Vida Stephen , Des Rosiers Pascale , Carrier Louise , Gauthier Serge
Published: March 2014

This study was undertaken to estimate the point-prevalence of Research Diagnostic Criteria (RDC) depressive syndromes in Alzheimer's disease (AD) and to evaluate the validity of existing and potential alternative diagnostic criteria for major depression in the presence of probable AD. Twenty-six subjects with probable AD of mild to moderate severity and their caregivers were interviewed to estimate the prevalence of RDC depressive syndromes. For the evaluation of the validity of RDC for major depression, an additional 8 probable-AD subjects with suspected depression were added to the sample. Sensitivity, specificity, and correlation with diagnosis of RDC major depression were calculated for each diagnostic criterion, and existing major depressive criteria were compared to potential alternative criteria currently used for RDC minor depression. Of the subjects in our prevalence sample, 15.4% were found to have major depression; 23.1%, minor depression; and 11.5%, intermittent depression. In our validation sample, two criteria for major depression, self-reproach/guilt and thinking/concentration difficulty, were weakly associated with the final diagnosis of major depression because of poor sensitivity or specificity. In contrast, three possible alternative criteria were significantly associated with the diagnosis of major depression and showed high sensitivity and specificity. These included nonverbal manifestations of depression, irritability/complaining, and demandingness/dependency. We conclude that RDC depressive syndromes are common in probable AD of mild to moderate severity. In the presence of AD, the validity of some existing major depressive criteria may be limited in comparison to several potential alternative criteria because of relatively poor sensitivity and/or specificity.
The Factor Structure of the Brief Psychiatric Rating Scale in Alzheimer's Disease
Authors: Ownby Raymond L. , Koss Elisabeth , Smyth Kathleen A. , Whitehouse Peter J.
Published: March 2014

The factor structure of the Brief Psychiatric Rating Scale (BPRS) is well established with young psychiatric patients. A study by Overall and Beller showed, however, that its factor structure was different with geropsychiatric patients. Although the BPRS has been used in assessing the behavioral characteristics of patients with probable Alzheimer's disease (AD), its factor structure has not been established with these patients. The present study investigated the factor structure of the BPRS among patients with clinically diagnosed AD by (NINCDS/ADRDA) criteria. The scale had limited usefulness with outpatients with mild AD. The factor structure obtained was similar to that found with other patient groups, but a unique factor, including the items Tension and Uncooperativeness, probably reflects the behavioral and psychological agitation characteristic of some AD patients. We recommend caution be taken in generalizing data from younger psychiatric samples to older adult patients with dementia.
Early Detection of Neuroleptic-Induced Parkinsonism in Elderly Patients with Dementia
Authors: Sweet Robert A. , Pollock Bruce G. , Rosen Jules , Mulsant Benoit H. , Altieri Linda P. , Perel James M.
Published: March 2014

The recently promulgated Health Care Finance Administration guidelines regarding the use of neuroleptic medications for nursing home residents do not offer criteria for the frequency or nature of the required assesments of neuroleptic-induced parkinsonism (NIP). NIP has been poorly characterized in the elderly and empirical evidence on which to base guidelines for monitoring NIP is sparse. We examined the onset of NIP in 12 closely monitored, elderly psychiatric inpatients diagnosed with dementia being treated with perphenazine. Significant increases in the Simpson Extrapyramidal Side Effect Scale total score were detected by day 4 of treatment with perphenazine at a mean dose of 8.0 mg. This increase was highly correlated with the final NIP severity. This is the first report to demonstrate that routine screening “of elderly patients can detect NIP within days of the initiation of neuroleptic treatment. Early detection of NIP may allow for effective intervention to reduce the ultimate severity and associated morbidity of NIP.
Sundown Syndrome in Severely Demented Patients with Probable Alzheimer's Disease
Authors: Little John T. , Satlin Andrew , Sunderland Trey , Volicer Ladislav
Published: March 2014

A retrospective review of 71 patients with probable Alzheimer's disease was analyzed with respect to nursing evaluations of sundowning status (recurring confusion or agitation in the late afternoon or early evening). The prevalence of sundowning (including probable sundowners) was 24%. Sundowners and non-sundowners differed with regard to number of sedatives received daily, particularly chloral hydrate, and the number of days on the inpatient unit. There were no differences between sundowners and non-sundowners with respect to other types of medications, medical diagnoses, current age, age of onset of Alzheimer's disease, or Mini-Mental State Exam. Restlessness was the most common sundowning behavior, although multiple behavioral disturbances were seen. This survey suggests that the sundown syndrome is a common problem in severely demented Alzheimer's patients and requires further study.
Primitive Reflexes in Alzheimer's Disease and Vascular Dementia
Authors: Vreeling Fred W. , Houx Peter J. , Jolles Jellemer , Verhey Frans R.J.
Published: March 2014

Data on the prevalence and clinical value of primitive reflexes (PRs) in dementia are controversial, mainly due to a lack of standardization of the methods by which these signs are elicited and scored. A standardized protocol was used to investigate eight PRs in 20 patients with Alzheimer's disease (AD), 20 patients with vascular dementia (VD), and 20 control subjects for each group. Both patient groups showed considerably more PRs than the control groups. The prevalence of PRs was related to the severity of dementia. No single reflex or combination of PR pathognomonic for dementia could be distinguished. The PR profile of AD and VD patients were similar.
Disabling Parkinsonism Due to Lithium: A Case Report
Authors: Holroyd Suzanne , Smith Donnie
Published: March 2014

Two cases of disabling parkinsonism have been previously reported in association with lithium treatment and only one occurred without other signs of lithium toxicity. We report a case of an elderly female who suddenly developed disabling parkinsonism, apparently as a side effect from treatment with lithium carbonate without other signs of lithium toxicity. All neurologic symptoms completely resolved on discontinuation of lithium. Resuming lithium at serum levels below 0.7 mmol/L resulted in no further neurologic side effects, but serum levels of 0.7 to 0.9 mmol/L resulted in the return of mild Parkinson's symptoms. Older age, longer duration of lithium treatment, and high therapeutic levels of lithium may be risk factors for this side effect. Implications for clinicians are discussed.
Delusions of Infestation during Delirium in a Patient with Restless Legs Syndrome
Authors: O'Keeffe Shaun T.
Published: March 2014

A case is described in which delusions of infestation developed during delirium secondary to pneumonia in a patient with restless legs syndrome (RLS). This case demonstrates how tactile sensations may precede and give rise to delusional misinterpretations. Since RLS is relatively common in elderly people and may be due to a treatable cause such as iron deficiency, it is worth considering this sydrome in patients with delusions of infestation.
Comparison of New and Traditional Methods for Detection of Senile Plaques in Alzheimer's Disease
Authors: Raskin Lisabeth S. , Applegate Michael D. , Price Donald L. , Troncoso Juan C. , Hedreen John C.
Published: March 2014

The pathologic diagnosis of Alzheimer's disease (AD) rests upon the identification of senile plaques and neurofibrillary tangles (NFT) in brain tissue. Methods for staining these structures vary in their sensitivity. Six different silver stains and immunocytochemistry for the β-amyloid (Aβ) peptide were compared for sensitivity in staining of plaques and tangles. For staining of plaques, the silver stains fell into two groups: one group stained primarily large, distorted neurites in classic plaques, and the other stained primarily fine, filamentous elements in diffuse plaques and at the periphery of classic plaques. Our recently developed “quick silver” method demonstrated the highest number of plaques. Sensitivity of NFT staining also varied considerably. The quick silver and Yamamoto-Hirano methods were best for staining both plaques and NFT.
Psychiatric Screening in Geriatric Primary Care: Should It Be for Depression Alone?
Authors: Lish Jennifer D. , Zimmerman Mark , Farber Neil J. , Lush David , Kuzma Mary Ann , Plescia Gary
Published: March 2014

Depression in the elderly is highly prevalent, associated with functional disability and increased medical costs, and treatable; however, it is infrequently recognized and treated. The Agency for Health Care Policy and Research has advocated, therefore, increased case-finding efforts for depression in primary geriatric care. Anxiety, substance, and somatoform disorders in the elderly are similarly prevalent, associated with disability and cost, treatable, and also infrequently detected and treated. We believe that psychiatric case-finding in geriatric primary care should attend to these disorders, therefore, as well as to depression. In the present study, we examined whether the association between depressive and nondepressive forms of psychopathology was similar in geriatric and nongeriatric medical patients. We also examined the relationship between each type of pathology and health care utilization and global ratings of physical and mental health. In a VA hospital general medical outpatient clinic, 508 patients completed the SCREENER, which is a brief self-report questionnaire that screens for a range of psychiatric disorders, along with a self-report questionnaire regarding subjective health and medical care utilization. Of these patients, 98% were male, and the median age was 63 years. Patients aged 63 and over were compared to younger patients. In both geriatric and younger adult patients, we found substantial comorbidity between depressive and nondepressive forms of pathology. Moreover, in both age groups, there were significant associations between both depressive and nondepressive symptoms and fair-to-poor self-rated physical and mental health and increased medical care utilization. Approximately half of the cases of nondepressive disorders in the elderly were not comorbid with depression, and thus would not have been detected by screening for depression alone. Therefore, psychiatric case finding in primary care of geriatric males should be directed at anxiety, substance, and somatoform disorders, as well as at depression, for treatment resources to be triaged to maximally decrease morbidity and cost.
Efficacy of Risperidone for Behavioral Disorders in the Elderly: A Clinical Observation
Authors: Raheja Ram K. , Bharwani Ishwer , Penetrante A. E.
Published: March 2014

Standard antipsychotics are ineffective in some geriatric patients. In addition, they are not helpful for apathy and withdrawal. Studies have demonstrated that 5HT2 antagonists improve affective symptoms and anxiety; therefore, the efficacy of risperidone on agitation and withdrawal was considered. The literature on risperidone was reviewed, and the efficacy and limitations of risperidone observed in two geriatric patients, one with agitation and another with apathy and withdrawal. Risperidone proved to be effective in controlling disruptive behavior in geriatric patients. Combined antagonism of D2 and 5HT2 receptors might be effective in improving agitation and withdrawal. Risperidone, with both D2 and 5HT2 antagonistic properties, seems to have potential as an alternative agent in controlling agitation and withdrawal in geriatric patients. Caution and need for further observation is recommended.
Neuropsychiatric Manifestations of Diffuse Lewy Body Disease
Authors: Beck B. J.
Published: March 2014

This article reviews the nature and prevalence of Lewy bodies (LBs) found during postmortem examination of demented individuals. Neuropathologic findings associated with diffuse Lewy body disease (DLBD) are contrasted with those of other causes of dementia (e.g., Pick's disease and Alzheimer's disease). A sufficiently specific clinical syndrome is suggested to enhance the antemortem diagnosis of DLBD. Current and speculative clinical management strategies of DLBD are discussed.
Graphomotor Perseveration and Wandering in Alzheimer's Disease
Authors: Ryan Jeanne P. , McGowan John , McCaffrey Nancy , Ryan G. Terrence , Zandi Taher , Brannigan Gary G.
Published: March 2014

Perseveration, spatial orientation, and attention/concentration were assessed in 15 patients with a probable diagnosis of senile dementia of the Alzheimer's type. Subjects were divided into two groups, wanderers and nonwanderers, based on caregiver ratings using a modified version of the Caregiver Checklist. Graphic productions of wanderers on the Bender Visual Motor Gestalt Test and Clock Drawing Test displayed greater total perseveration and more recurrent and continuous perseverations than those of nonwanderers. Spatial orientation and attention/concentration were similar between groups. These preliminary results suggest that graphomotor perseverations exhibited during the mild to moderate stages may serve as a marker for wandering in Alzheimer's disease.
Evaluation of Cycloserine in the Treatment of Alzheimer's Disease
Authors: Fakouhi T. Daniel , Jhee Stanford S. , Sramek John J. , Benes Charles , Schwartz Patricia , Hantsburger Gary , Herting Robert , Swabb Edward A. , Cutler Neal R.
Published: March 2014

This multicenter study evaluated the efficacy and safety of cycloserine and measured its effects on explicit and implicit memory tests in patients with Alzheimer's disease (AD). Four hundred ten patients with AD, aged 50 years or older, were enrolled in this parallel-group, double-blind, placebo-controlled, randomized trial of 5,15, or 50 mg cycloserine or placebo twice daily, and 403 entered the double-blind treatment phase. Two hundred sixty-five patients completed the entire 26-week treatment phase. There were no baseline differences among the four treatment groups. Cognitive Drug Research (CDR) efficacy assessments showed no differences between active treatments and placebo from baseline to study weeks 2, 6, 14, or 26. Patients receiving 15 mg of cycloserine improved significantly on one section of an implicit memory test. No differences among treatments were observed for any other assessment scales evaluated. The incidence and severity of adverse events were similar across treatment groups. Cycloserine was well tolerated but did not demonstrate consistent evidence of efficacy during the course of therapy. Higher doses may be necessary to achieve efficacy in the AD population and do not appear to be precluded by the adverse event profile seen in this study.
Effect of Tacrine on Behavioral Symptoms in Alzheimer's Disease: An Open-Label Study
Authors: Kaufer Daniel I. , Cummings Jeffrey L. , Christine Dianne
Published: March 2014

We conducted an open-label study designed to assess the effects of tacrine on behavioral changes in patients with Alzheimer's disease (AD). Twenty-eight subjects completed a baseline evaluation and at least one assessment during treatment. Behavioral symptoms and cognitive function were assessed with the Neuropsychiatric Inventory (NPI) and Mini-Mental State Examination (MMSE), respectively. The mean NPI score at the maximum individual dose of tacrine attained was markedly decreased (behavior improved, compared to baseline). Symptoms of anxiety, apathy, hallucinations, aberrant motor behaviors, and disinhibition were most responsive. Subject stratification by dementia severity revealed a substantially reduced mean NPI score only in the group with moderate dementia, independent of cognitive response. Over half of the subjects with cognitive improvement had a marked reduction in behavioral symptoms, particularly apathetic behaviors. These data suggest that tacrine may be beneficial for selected behavioral symptoms in AD patients, particularly at higher doses and in those with moderate cognitive deficits.
Multimodal Evoked Potentials in Alzheimer's Disease and Binswanger's Disease
Authors: Tachibana Hisao , Takeda Masanaka , Okuda Bungo , Kawabata Keita , Nishimura Hiroyuki , Kodama Norihiko , Iwamoto Yasumichi , Sugita Minoru
Published: March 2014

Somatosensory evoked potentials (SEPs), brainstem auditory evoked potentials (BAEPs), visual evoked potentials (VEPs), and auditory event-related potentials (ERPs) were studied in 15 patients with Alzheimer's disease (AD), eight patients with Binswanger's disease (BD), and 15 normal subjects. Patients with BD showed significant prolongation of the interpeak latency between N13 and N20 (N13-N20) and N20-P40 of SEPs as compared with the normal controls, whereas patients with AD only demonstrated significant prolongation of N20-P40. The interpeak latency between waves I and V of BAEPs in patients with both AD and BD was significantly longer than that of controls. There were no significant differences in P100 latency of VEPs among these three groups. Both groups with dementia showed significant prolongation of N200 and P300 latencies of ERPs compared with normal controls. In addition, patients with AD showed significant prolongation of P200 latency. We conclude that these two dementing diseases have different electrophysiologic features that may be related to their underlying pathogenetic mechanisms. Furthermore, the measurement of multimodal evoked potentials may be helpful in the differential diagnosis of AD and BD.
Drug-Induced Parkinsonism Associated with Dysphagia and Aspiration: A Brief Report
Authors: Bashford Guy , Bradd Patricia
Published: March 2014

Idiopathic Parkinsonism is a well-recognized cause of dysphagia and resultant aspiration. Symptoms and signs attributable to dopaminergic underactivity after administration of antipsychotic medication are commonly seen in elderly patients. We report a case of a 74-year-old woman, without prior symptoms of Parkinsonism or dysphagia, who presented with the temporal association of both after administration of trifluoperazine hydrochloride. Dysphagia is a potentially life-threatening complication of drug-induced parkinsonism. Its early recognition allows treatment by simple medical, physical, and dietary manipulations.
Patient Characteristics, MRI Examination, and Dopaminergic Drug Response in Clinical Possible Parkinson's Disease
Authors: Larsen Jan P. , Ødegaard Helge , Tandberg Elise , Hødnebø Anne , Aarsland Dag
Published: March 2014

Patients with parkinsonism can be classified as clinical definite, probable, possible, or unlikely Parkinson's disease (PD). Possible PD includes patients with PD according to conventional diagnostic criteria and with at least a moderate response to dopamine agonists. However, these patients have clinical features that may reduce the probability for idiopathic PD. The objective of this study was to clinically characterize patients with possible disease in a prevalence study of PD and to indicate the frequency of idiopathic PD in this group of patients. The diagnostic re-evaluation was based on detailed MRI examinations and investigations of dopaminergic drug response after several years of treatment. In a community-based prevalence study in Norway, comprising 245 PD patients, we found 36 patients (15%) with clinical possible PD. The patients with possible disease had significant and clinically important differences in demographic and disease characteristics compared to patients with definite and probable PD. Possible PD patients were older at disease onset, more disabled, and had more neurobehavioral disorders. MRI examinations of 14 of the 36 patients with possible PD in the prevalence study revealed significant group effects compared to an age-matched control group, with reduced pars compacta width and increased cortical atrophy. In individual patients, signal attenuation consistent with vascular lesions of the basal ganglia contributed to diagnostic reclassification. Dopaminergic drug withdrawal revealed no response in 4 of 12 examined patients. Two of the remaining eight patients had a clear short-duration drug response. Six patients had only a varying degree of long-duration response. The re-evaluation of diagnosis indicates that probably less than half of the patients with clinical possible PD have idiopathic disease. Patients with atypical features and diagnosed as possible PD should thus be excluded from studies with a presumed high specificity for idiopathic PD.
Diffuse Lewy Body Disease without Amyloid Plaques in a Patient Homozygous for Apolipoprotein E Allele Epsilon 4: A Case Report
Authors: Seltzer Benjamin , Fratkin Jonathan , Clejan Sanda
Published: March 2014

A middle-aged woman developed extrapyramidal motor symptoms, personality and behavioral changes, and rapidly progressive dementia. Apolipoprotein E genotyping revealed that she was homozygous for the epsilon 4 allele. At autopsy, there were numerous cortical and subcortical Lewy bodies but no neuritic plaques (NPs) or neurofibrillary tangles (NFTs). This case, the first explicitly reported patient homozygous for the epsilon 4 allele having dementia of the Lewy body type (DLBT) without NPs and NFTs, reinforces the distinction between DLBT and dementia of the Alzheimer type. It calls into question the pivotal role of the epsilon 4 allele in the pathogenesis of NPs and NFTT but raises the possibility of its being an independent risk factor for the development of DLBT.
Rapidly Progressive Dementia: A Clinicopathologic Correlation
Authors: Adair John C. , Schwartz Ronald L. , Eskin Thomas A. , Yachnis Anthony T. , Heilman Kenneth M.
Published: March 2014

We evaluated a 66-year-old man with a rapidly progressive, akinetic-rigid dementia syndrome. Despite extensive testing, which included magnetic resonance imaging (MRI), we were unable to make the correct antemortem diagnosis. Autopsy demonstrated spontaneous progressive multifocal leukoencephalopathy. This report illustrates that even in the absence of characteristic MRI findings, this uncommon cause of dementia should be considered in the differential diagnosis of rapidly progressive, akinetic-rigid syndromes with dementia.
Delirium in Geropsychiatric Patients: Patient Characteristics and Treatment Outcomes
Authors: McGee Scott B. , Orengo Claudia A. , Kunik Mark E. , Molinari Victor A. , Workman Richard H.
Published: March 2014

The authors examined the effect of hospitalization on cognitive and behavioral symptoms in delirious elderly patients with and without dementia. Forty-four (13%) of the patients admitted to a Veterans Affairs Medical Center geropsychiatric unit were diagnosed with delirium and were administered the Mini-Mental State Examination, the Hamilton Depression Rating Scale, the Brief Psychiatric Rating Scale (BPRS), the Rating Scale for Side Effects, and the Cohen-Mansfield Agitation Inventory. The total sample significantly improved on all measures. When patients with delirium were divided into subgroups with and without dementia, both subgroups improved similarly. Patients discharged to more restrictive environments improved significantly on the BPRS only.
Utility of Developmental Reflexes in the Differential Diagnosis and Prognosis of Incontinence in Alzheimer's Disease
Authors: Franssen Emile H. , Souren Liduïn E.M. , Torossian Carol L. , Reisberg Barry
Published: March 2014

Four developmental reflexes, the tactile suck reflex, the palmar and plantar grasp reflexes, and the plantar extensor reflex, were examined in 784 individuals, including healthy elderly, cognitively and functionally mildly impaired individuals, and patients with Alzheimer's disease (AD) in all stages of clinical severity. The study population was classified into six categories of increasingly impaired functional performance, and prevalence of the four individual reflexes and of a summary reflex measure, consisting of a combination of these four reflexes, was determined for each category. Prevalence of all five reflex measures was more than six times higher for those categories that comprised only permanently doubly incontinent patients as compared to those categories that comprised only continent individuals ( P < .001). Frequency of developmental reflexes rose sharply with the onset of progressive incontinence. Since the return of these reflexes in AD is associated with severe cortical dysfunction, it is concluded that these developmental reflexes are useful in differentiating incontinence of cortical origin from incontinence resulting from potentially reversible causes.
Symptomatic Treatment of Elderly Patients with Early Alzheimer's Disease at a Memory Clinic
Authors: Walstra Gerard J.M. , Teunisse Saskia , van Gool Willem A. , van Crevel Hans
Published: March 2014

It is widely accepted that excess disability (treatable coexisting physical disorders and psychiatric phenomena) is common in demented patients, and should be looked for carefully and treated properly, as it may result in improvement. This idea, however, does not state what investigations should be performed and what kind of improvement can be expected. Therefore, we studied prospectively in elderly outpatients with early Alzheimer's disease the prevalence of excess disability, the results of medication treatment, and the added value of investigations for diagnosis, treatment, and outcome after clinical examination. Outcome was assessed clinically and clinimetrically (using instruments with regard to cognition, disability in daily functioning, behavior, and caregiver burden). Excess disability was present in 66% of patients. Medication treatment was effective with regard to target symptoms, but (partial) reversal of dementia did not occur. Only blood tests produced unexpected results with consequences for treatment and outcome. Positive treatment effects often resulted from clinical examination only. We recommend blood tests in all patients; other investigations can be performed on clinical indication.
Disruptive Behavior and Actigraphic Measures in Home-Dwelling Patients with Alzheimer's Disease: Preliminary Report
Authors: Friedman Leah , Kraemer Helena C. , Zarcone Vincent , Sage Stephanie , Wicks Deryl , Bliwise Donald L. , Sheikh Javaid , Tinklenberg Jared , Yesavage Jerome A.
Published: March 2014

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.
Venlafaxine-Induced Reset Osmostat Syndrome: Case of a 79-Year-Old Depressed Woman
Authors: Ranieri Piera , Franzoni Simone , Rozzini Renzo , Trabucchi Marco
Published: March 2014

The presence of hyponatremia, especially in a frail and very old patient, is associated with a greater morbidity and mortality rate. We report the case of a depressed 79-year-old woman who was treated with venlafaxine, in whom a drug-induced hyponatremia occurred in the absence of other possible causes. The case is discussed in the context of the multipotential factors that induce hyponatremia, with particular attention to the geriatric patient.
Neuropsychiatric Factors in the Illusion of Visitors among Geriatric Patients: A Case Series
Authors: Jenkins Melissa A. , Cimino Cynthia , Malloy Paul F. , Salloway Stephen , Cohen Ronald , Kohn Robert , Westlake Robert
Published: March 2014

The ‘illusion of visitors' is a common phenomenon among geriatric patients presenting for psychiatric or neurologic evaluation and treatment. Although these illusory beliefs are etiologically diverse, patients may commonly have visual impairment and functional and/or structural disruption of frontal and right-hemisphere-mediated cognitive functioning. This article outlines eight cases of illusory beliefs among elderly patients, presenting psychiatric, neurologic, neuroimaging, and neuropsychological findings among these patients. Commonalities and differences among these cases are discussed, and a framework is provided for multidisciplinary assessment and treatment of patients presenting with illusory beliefs.
The Mattis Dementia Rating Scale in Nursing Home Octogenarians and Nonagenarians: Effects of Age and Education
Authors: Bennett Alexandre , Nadler Jodi , Spigler Melanie , Rafalson Luba , Abraham Susy , Relkin Norman
Published: March 2014

Despite their increasing representation in the population, little is known about the neuropsychological test performance of the oldest old, particularly those who live in residential settings. Limited published data and clinical experience suggest that this group is more likely to perform in the impaired range on standardized tests when cutoffs developed with younger groups are used. We examined the Dementia Rating Scale (DRS) performance of 82 nondemented nursing home residents, aged 80 to 99, with a mean education level of 11 years. Using published norms and cutoffs, a large percentage of this sample performed in the impaired range, particularly on the initiation and conceptualization subtests and on the total score. Education, but not age, was significantly related to performance in this sample. Percentages of patients misclassified were substantial in all groups, but were higher in those with less than 13 years of education. Using a lower total-score cutoff of 110 reduced the percentage of misclassifications markedly. We recommend the development and use of revised cutoff scores for the evaluation of very elderly nursing home residents.