bluuebunny/crossref_metadata_2025_split huggingface dataset:
SPECT in Dementia: Clinical and Pathological Correlation
Authors: Read Stephen L. , Miller Bruce L. , Mena Ismael , Kim Ronald , Itabashi Hideo , Darby Amy 
Published: April 2015

BACKGROUND: The clinical diagnosis of dementia continues to be flawed. Although the diagnosis of Alzheimer's disease (AD) is better than 90% at research centers in highly selected patients, the diagnosis of patients with non‐AD dementias and atypical AD patients is poor. Single photon emission computed tomography (SPECT) is a functional imaging technique touted as a diagnostic technique for the degenerative disorders. However there have been few clinicopathological studies using SPECT.METHODS: Twenty‐seven consecutive dementia patients were evaluated clinically at a University‐based specialty dementia clinic, and a diagnosis of a specific dementia was made. SPECT imaging was used in helping to select a clinical diagnosis. The correlations between clinical, SPECT and autopsy diagnoses were analyzed.RESULTS: Single photon emission computed tomography predicted pathologic diagnosis in 25 of 27 patients with dementia (92.6%), compared with clinical diagnosis, which was confirmed in 20/27 (74.1%). Distinct patterns were associated with dementia caused by AD, Fronto‐Temporal Dementia (FTD), and Jakob‐Creutzfeldt Disease (JCD). Vascular insults not seen with computerized tomography (CT) or magnetic resonance imaging (MRI) were found with SPECT. Three different pathologies were found in patients with Par‐kinsonian‐Dementias (PD): Lewy‐Body Variant of AD, Diffuse Lewy‐bodies without plaques, and substantia nigra neu‐ronal loss without plaques or Lewy‐bodies. All showed a temporal‐parietal pattern with SPECT that was similar to AD.CONCLUSION: SPECT provides useful positive information in dementia, particularly the differentiation of AD, FTD, and JCD. However, it does not distinguish PD from AD.
Effects of Endurance Exercise and Hormone Replacement Therapy on Serum Lipids in Older Women
Authors: Binder Ellen F. , Birge Stanley J. , Kohrt Wendy M. 
Published: April 2015

OBJECTIVE: To determine the effects of 11 months of exercise training and hormone replacement therapy (HRT), alone or in combination, on serum lipids and lipoproteins, in postmenopausal women.DESIGN: Controlled, prospective, 11‐month clinical trial. Healthy postmenopausal women (n = 71, age range 60–72 yrs) were assigned to four groups in a 2 × 2 design (control, exercise, HRT, exercise + HRT).SETTING: Large, midwestern urban community; subjects were recruited from the community‐at‐large. The exercise program was conducted at a university exercise facility.INTERVENTIONS: HRT consisted of conjugated estrogens at 0.625 mg/day and trimonthly medroxyprogesterone acetate 5 mg/day for 13 days. Exercise consisted of 2 months of low intensity exercise followed by 9 months of vigorous exercise for 45 min/day, 3 or more days/week, at 65–85% of maximal heart rate.MEASUREMENTS: Maximal aerobic power (V̇O2max), resting blood pressure, body composition, serum lipids and lipoproteins, and dietary intake at baseline and after 11 months.MAIN RESULTS: At the end of 11 months, subjects in the exercise group had decreased total cholesterol (TC; P < .01) and LDL‐cholesterol (LDL‐C; P < .05), but there was no change in HDL‐cholesterol (HDL‐C) or triglycerides. Women in the HRT group had decreased LDL‐C (P < .001) and increased HDL‐C (P < .01) and triglycerides (P < .01), but there was no change in TC. Exercise+HRT subjects had decreased TC (P < .05) and LDL‐C (P < .001), and increased HDL‐C (P < .001); exercise prevented the HRT‐related increase in triglycerides.CONCLUSIONS: Endurance exercise training and HRT have independent and complimentary effects on serum lipid profiles in healthy postmenopausal women. Such effects are likely to reduce the risk of cardiovascular morbidity in this population. J Am Geriatr Soc 44:231–236, 1996.
Hospital Admission Risk Profile (HARP): Identifying Older Patients at Risk for Functional Decline Following Acute Medical Illness and Hospitalization
Authors: Sager Mark A. , Rudberg Mark A. , Jalaluddin Muhammad , Franke Todd , Inouye Sharon K. , Landefeld C. Seth , Siebens Hilary , Winograd Carol H. 
Published: April 2015

OBJECTIVES: To develop and validate an instrument for stratifying older patients at the time of hospital admission according to their risk of developing new disabilities in activities of daily living (ADL) following acute medical illness and hospitalization.DESIGN: Multi‐center prospective cohort study.SETTING: Four university and two private non‐federal acute care hospitals.PATIENTS: The development cohort consists of 448 patients and the validation cohort consists of 379 patients who were aged 70 and older and who were hospitalized for acute medical illness between 1989 and 1992.MEASUREMENTS: All patients were evaluated on hospital admission to identify baseline demographic and functional characteristics and were then assessed at discharge and 3 months after discharge to determine decline in ADL functioning.RESULTS: Logistic regression analysis identified three patient characteristics that were independent predictors of functional decline in the development cohort: increasing age, lower admission Mini‐Mental Status Exam scores, and lower preadmission IADL function. A scoring system was developed for each predictor variable and patients were assigned to low, intermediate, and high risk categories. The rates of ADL decline at discharge for the low, intermediate, and high risk categories were 17%, 28%, and 56% in the development cohort and 19%, 31%, and 55% in the validation cohort, respectively. Patients in the low risk category were significantly more likely to recover ADL function and to avoid nursing home placement during the 3 months after discharge.CONCLUSION: Hospital Admission Risk Profile (HARP) is a simple instrument that can be used to identify patients at risk of functional decline following hospitalization. HARP can be used to identify patients who might benefit from comprehensive discharge planning, specialized geriatric care, and experimental interventions designed to prevent/reduce the development of disability in hospitalized older populations. J Am Geriatr Soc 44:251–257, 1996.
Injurious Falls in Nonambulatory Nursing Home Residents: A Comparative Study of Circumstances, Incidence, and Risk Factors
Authors: Thapa Purushottam B. , Brockman Kelly G. , Gideon Patricia , Fought Randy L. , Ray Wayne A. 
Published: April 2015

OBJECTIVE: To determine the circumstances of, incidence of, and risk factors for falls resulting in serious injuries in nonambulatory nursing home residents compared with those for ambulatory residents.DESIGN: Prospective cohort study with 1‐year follow‐upSETTING: Twelve community nursing homes in Tennessee.SUBJECTS: A total of 1228 residents, 65 years of age or older, of whom 725 (59%) were nonambulatory and 503 (41%) were ambulatory.MEASUREMENTS: Baseline data were obtained for potential risk factors for injurious falls. These included demographic characteristics, mental and physical function, vision, hearing, incontinence, and use of mechanical restraints and psychotropic drugs. Data were obtained from direct resident assessment, care provider interview, and the nursing home Minimum Data Set (MDS) (validated in a sample of residents).OUTCOME: There were 111 first falls resulting in serious injury (head injury with altered consciousness, fracture, joint dislocation or sprain, or sutured laceration) that received medical treatment (hospitalization, emergency room visit, physician visit, or on‐site radiological examination), ascertained from facility incident reports and nursing home charts.RESULTS: Nonambulatory residents had a substantially greater prevalence of mental and physical impairment. Circumstances of injurious falls in nonambulatory (n = 39 falls) and ambulatory (n = 72 falls) residents differed; those in the former group were more likely to involve equipment (87% vs 45%, P < .0001), occur while seated or during transferring (82% vs 21%, P < .0001), and from a chair/bed level (54% vs 6%, P < .0001). The incidence of injurious falls in nonambulatory residents (6.7 per 100 person‐years) was less than half that in ambulatory residents (17.0 per 100 person‐years, P < .0001). After controlling for other factors, the nonambulatory residents at highest risk were those not bed‐bound and with capacity for independent transfer (incidence density ratio (IDR) = 2.92, 95% CI = 1.07–7.99); the ambulatory residents at highest risk were baseline users of psychotropic drugs (IDR = 2.49, 95% CI = 1.43–4.33).CONCLUSIONS: In the study cohort, nonambulatory residents had 35% of injurious falls. Because the circumstances and risk factors of these events were substantially different from those for ambulatory residents, separate prevention strategies may be needed for this group. These data suggest that increasing the safety of transferring and of equipment are appropriate targets for interventions. J Am Geriatr Soc 44:273–278, 1996.
Psychotic Symptoms in Parkinson's Disease Patients with Dementia
Authors: Naimark David , Jackson Edward , Rockwell Enid , Jeste Dilip V. 
Published: April 2015

OBJECTIVE: To assess the prevalence of psychotic symptoms in a group of patients with Parkinson's disease (PD) and dementia and examine the association of psychotic symptoms with neuropsychiatric problems, the level of distress reported by caregivers, and cognitive and functional impairment.DESIGN: The psychotic and nonpsychotic patients with PD dementia were compared on a series of demographic, neuropsychiatric, behavioral, caregiver complaint, and cognitive measures.SETTING: The database from nine university‐based State of California Alzheimer's Disease Diagnostic and Treatment Centers (ADDTCs).PARTICIPANTS: 101 patients diagnosed with PD.RESULTS: A total of 36 of the 101 patients (35.6%) had either hallucinations, delusions, or both. The psychotic patients had significantly more insomnia, confusion, agitation, personality changes, and self‐care problems and were noted by their caregivers to be significantly more unmanageable at home than their nonpsychotic counterparts. On cognitive scales, psychotic patients were significantly more impaired.CONCLUSION: Many patients with PD and dementia experience psychosis. Psychotic symptoms in PD dementia patients are associated with major behavioral, cognitive, and functional problems. J Am Geriatr Soc 44:296–299, 1996.
Increased Baseline Sway Contributes to Increased Losses of Balance in Older People Following Triazolam
Authors: Robin Deborah W. , Hasan Samer S. , Edeki Timi , Lichtenstein Michael J. , Shiavi Richard G. , Wood Alastair J.J. 
Published: April 2015

OBJECTIVE: Although it has been stated frequently that older people are more sensitive to benzodiazepines, the relative roles of impaired baseline performance, impaired elimination, and altered responsiveness have not been defined. We evaluated postural sway and plasma triazolam concentrations after administration of placebo and triazolam 0.375 mg in both young and older healthy subjects.DESIGN: Double‐blind placebo‐controlled trial.PARTICIPANTS: Nine young and nine older healthy men.INTERVENTION: All subjects received triazolam 0.375 mg or placebo on different study days, which were separated by at least 48 hours.MEASUREMENTS: Postural sway, visual analog scale of drowsiness, and plasma triazolam levels.RESULTS: The older subjects swayed more during triazolam than did the younger subjects, and this resulted in an increased number of losses of balance. This difference appeared to be caused by greater baseline sway in the older subjects rather than higher concentrations or increased responsiveness. A subset of older people had a much greater number of losses of balance during triazolam than did the rest of the subjects, and these individuals could be identified from their baseline sway.CONCLUSIONS: In this study, the increase in drug effect seen in the older subjects was of similar magnitude to that of the young, but it resulted in greater postural sway after drug administration than was seen in the young. The higher postural sway and the corresponding increased instability seen in the older subjects may put these older persons at increased risk of drug‐related falls. This study also suggests that it should be possible to develop techniques that will identify individuals at particular risk of drug‐induced postural instability. J Am Geriatr Soc 44:300–304, 1996.
MODELS OF GERIATRICS PRACTICE: A Community Development and Outreach Program in Geriatric Mental Health: Four Years' Experience
Authors: Reuben David B. , Stoke Paul , Kessler Linda , Clair J. Kenneth Le 
Published: April 2015

OBJECTIVES: To describe a geriatric mental health outreach program based on a community development model and to review 4 years of experience with this program.DESIGN: Program model and description of implementation experience.SETTINGS: A geriatric mental health outreach program of a regional psychiatric hospital, serving a primarily non‐urban area, with offices in the community it serves.PARTICIPANTS: The program targets community‐dwelling or institutionalized older persons with late‐onset mental health problems and/or behavioral disturbances, persons with long‐standing psychiatric disorders with age‐related changes, and their caregivers.INTERVENTION: The program is a geriatric mental health outreach and consultation service that emphasizes community development and caregiver education. Program components include an interprofessional consultation team, a specialized information and resource service, educational service initiatives, and an ongoing role in planning and coordination activity in the local health care system.MEASUREMENTS: Program monitoring, including a patient database and a description of program activities.RESULTS: Cognitive impairment, behavioral disturbance, physical/medical problems and depression are the most common reasons for referral to the outreach program. Referred patients (mean age 78; 65% female) have usually (almost 90% of cases) been managed at a similar or lower level of care. Program activities have included focused educational initiatives in community and institutional settings and have emphasized the involvement and development of community caregivers and other local resources.CONCLUSION: The program is a multifaceted effort to make efficient use of scarce specialized resources in a manner that is sensitive and responsive to local circumstances and needs. Experience to date has shown evidence of the feasibility and potential benefits of a comprehensive approach to community development and outreach in geriatric mental health. J Am Geriatr Soc 44:314–320, 1996
Sex Differences in Survival After Myocardial Infarction in Older Adults: A Community‐Based Approach
Authors: Vaccarino Viola , Krumholz Harlan M. , de Leon Carlos F. Mendes , Holford Theodore R. , Seeman Teresa E. , Horwitz Ralph I. , Berkman Lisa F. 
Published: April 2015

OBJECTIVE: To determine sex differences in survival after myocardial infarction in older individuals.DESIGN: Prospective cohort study based on a community sample of older individuals. All patients were followed for 1 year after hospital admission.SETTING: Two hospitals in New Haven, Connecticut.PARTICIPANTS: The study included 103 women and 120 men who were participants in the New Haven, CT cohort of the Established Populations for the Epidemiologic Study of the Elderly (EPESE) program and who were diagnosed with myocardial infarction between the inception of the community study in 1982 and December 31, 1992. The mean age of women was 79.3 and of men, 77.3.MEASUREMENTS: Data on clinical characteristics were abstracted from medical records. Sociodemographic, psychosocial, and physical function information was derived from the EPESE interview preceding the infarction. The main outcome measure was all‐cause mortality, for which three end points were used: early mortality (first 30 days), late mortality (1‐year mortality among survivors of the first 30 days), and overall mortality (1‐year mortality from admission in the whole sample).RESULTS: Mortality in the first 30 days did not differ significantly in the two sexes. The relative risk (RR) of death in women compared with men was 0.85 (95% confidence interval [CI], 0.49‐1.47) before multivariable adjustment; this was unchanged after adjustment for demographic factors, comorbidity, functional status, psychosocial factors, and clinical severity (RR, 0.85, 95% CI, 0.41‐1.76). Among survivors of 30 days, women were almost two times more likely to survive at 1 year compared with men, both before multivariable adjustment (RR, 0.56,95% CI, 0.31‐1.02) and after controlling for demographic factors, comorbidity, physical function, psychosocial factors, clinical severity on admission, and hospital complications (RR, 0.44; 95% CI, 0.20‐0.99). Analyses involving 1‐year follow‐up from admission for the entire sample yielded intermediate results.CONCLUSION: There was little difference in mortality in the first 30 days after myocardial infarction between older men and women, but when the early deaths were excluded, women showed an increased survival compared with men in the first year after the myocardial infarction.
Antihypertensive Medication Use Among Recruits for the Trial of Nonpharmacologic Interventions in the Elderly (TONE)
Authors: Espeland Mark A. , Kumanyika Shiriki , Kostis John B. , Algire Jenifer , Applegate William B. , Ettinger Walter , Whelton Paul K. , Bahnson Judy 
Published: April 2015

OBJECTIVES: To examine the distribution and correlates of the classes of antihypertensive medications taken by persons aged 60 to 80.DESIGN: Cross‐sectional screening.SETTING: Four academic medical centers in the southern and eastern United States.PARTICIPANTS: Volunteers (N = 2601) entering a clinical trial testing the value of nonpharmacologic approaches to control blood pressure who were either taking one or two (single or combined) medications for the treatment of hypertension and expressed willingness to be withdrawn from these medications according to a standardized protocolMEASUREMENTS: Medication use, blood pressure, and data from self‐administered questionnaires collected during standardized clinic visits.RESULTS: Calcium channel blockers (23.9%) were the most frequent single agent antihypertensive medications used by cohort members, followed by diuretics (17.9%) and angiotensin‐converting enzyme (ACE) inhibitors (17.5%). The most common combination agents were composed of diuretics with either calcium channel blockers (5.4%), ACE inhibitors (4.0%), or β‐blockers (3.7%). Women were twice as likely to be taking diuretics, and less likely to be taking ACE inhibitors and β‐blockers, than men. Blacks were more likely to be taking diuretics and calcium channel blockers, and less likely to be taking β‐blockers and ACE inhibitors, than others. These relationships could not be attributed to differences in geographical area, other demographic factors, age, or medical history.CONCLUSIONS: These usage patterns appear to mirror those in the population of the United States as a whole, which has trended toward greater usage of calcium channel blockers and ACE inhibitors with declining use of diuretics. The distribution of antihypertensive medications among older hypertensives is markedly different between women and men and between black Americans and others.
The Care of Older Persons with Diabetes Mellitus: Families and Primary Care Physicians
Authors: Silliman Rebecca A. , Bhatti Shelah , Khan Amina , Dukes Kimberly A. , Sullivan Lisa M. 
Published: April 2015

OBJECTIVES: To determine the extent to which family members participate in the day‐to‐day management of diabetes mellitus in older persons, and in older diabetics' medical encounters, and to identify patient and family member characteristics associated with this participation.DESIGN: A longitudinal observational study, with baseline data being reported herein.SETTING: Three primary care practice settings in Seattle, Washington, Boston, Massachusetts, and Indianapolis, Indiana.PARTICIPANTS: Family members of patients 70 years of age or older participating in the Patient Outcomes Research Team (PORT) Study of type II diabetics.MAIN OUTCOME MEASUREMENTS: The two dependent variables represent, respectively, the extent of family members' assistance with diabetes‐related care and participation in older diabetics' medical encounters.RESULTS: The 357 family members enrolled were older (mean age = 66.3 years), were mostly women (76.2%), and were usually the spouses of diabetic patients (71.3%). Between 22% and 50% of family members reported helping with various aspects of diabetes care; 35.6% of family members participated regularly in their diabetic patients' medical encounters. A multiple linear regression model relating family assistance with diabetes‐related care to patient and family member characteristics included four variables: patients' physical function, and the family member's relationship to the patient, assistance with basic activities of daily living (ADLs), and understanding of diabetes management issues (all P < .05). A multiple logistic regression model relating family member participation in the medical encounter to patient and family member characteristics also included four variables: patient age and physical function, and family member assistance with instrumental activities of daily living (IADLs) and with diabetes‐related care (all P < .05).CONCLUSION: The family members studied frequently assisted older diabetics with diabetes‐specific care; more than one‐third were regular participants in older diabetics' medical encounters. Family member involvement in the day‐to‐day management of diabetes and in the medical encounter was more likely when patients were functionally disabled. Health care systems and physicians need to educate their older patients, and involved family members when patients are frail, about diabetes‐related care issues and support them in their roles in the management of diabetes as well as other chronic diseases. J Am Geriatr Soc 44:1314–1321, 1996.