Emily D. Richardson

MRI and neuropsychological differences in early- and late-life-onset geriatric depression

We sought to determine whether geriatric patients with late-life-onset major depression have more subcortical hyperintensities on MRI and greater cognitive impairment than age-matched geriatric patients with early-life-onset major depression, suggesting that subcortical disease may be etiologic in late-life depression. Most negative studies of the clinical significance of subcortical hyperintensities on MRI in geriatric patients have sampled from a restricted range of subjects, have employed limited batteries of neuropsychological tests, or have not quantified MRI changes; the present study attempted to address these limitations. Thirty subjects from a geriatric psychiatry inpatient service who were over 60 years of age and presented with major depression were divided into groups with onset of first depression after age 60 (mean = 72.4 years, 15 women, 0 men), and onset of first depression before age 60 (mean = 35.8 years, 12 women, 3 men). Quantitative analysis of MRI yielded the volume of: periventricular hyperintensities (PVH) and deep white-matter hyperintensities (DWMH). Subjects were administered a neuropsychological battery and measures of depression by raters blind to age of onset. The late-onset group had significantly more PVH and DWMH. They were also more impaired on executive and verbal and nonverbal memory tasks. Discriminant function analysis using the severity of subcortical signal hyperintensities on MRI, cognitive index, and depression scores correctly predicted late versus early onset of depression in 87% of the early-onset group and 80% of the late-onset group. These findings suggest that late-life-onset depression may be associated with an increased severity of subcortical vascular disease and greater impairment of cognitive performance. NEUROLOGY 1996;46: 1567-1574

Development of a Test Battery to Identify Older Drivers at Risk for Self‐Reported Adverse Driving Events

OBJECTIVES: The purposes of this study were (1) to develop a battery of tests that assessed a wide range of functional abilities relevant to driving yet could be performed in a clinicians office and (2) to determine which of these tests were most closely associated with self‐reported adverse driving events.

The effect of estrogen replacement therapy on cognitive function in women: A critical review of the literature

OBJECTIVE To conduct a review of the available clinical trials to determine whether sufficient evidence exists to support the conclusion that estrogen replacement therapy has a beneficial effect on cognitive performance in post-menopausal women and in women with Alzheimers disease. Studies were identified through a MEDLINE search of all English-language publications between 1970 and 1996 in which the words estrogen and cognition or estrogen and memory appeared. DATA EXTRACTION Data were extracted for each study, including features of subjects and eligibility criteria, duration of follow-up, and treatment regimen. Baseline characteristics were evaluated, including age; menopausal status; follicle-stimulating hormone, luteinizing hormone, and estradiol levels; mood; and measures of cognitive function. Psychological tests were evaluated for construct validity. RESULTS Nineteen studies were reviewed, including 10 randomized trials of estrogen replacement therapy versus placebo. Extreme heterogeneity among subjects and variability in the use of cognitive measures across the studies precluded performing a quantitative summary. Of the 10 randomized trials, eight claimed therapeutic benefits for estrogen therapy, three of which reported significant improvements in memory and two of which showed improvements in attention. These studies did not control for potential confounds such as depression and vasomotor symptoms. Of the nine observational studies, five found a significant association between estrogen use and cognitive function. CONCLUSION Although several observational studies provide encouraging evidence for the beneficial effect of estrogen on cognitive function, there is currently inadequate evidence available from randomized, controlled trials to support the conclusion that estrogen replacement therapy improves cognitive function in post-menopausal women or women with Alzheimers dementia.

Neuropsychologic Prediction of Performance Measures of Daily Living Skills in Geriatric Patients

The current study examined the capacity of an abbreviated neuropsychologic (NP) battery topredict performance-based activities of daily living (ADLs) in a psychogeriatric sample. Inpatientsof a geriatric evaluation unit (34 men and 74 women), mean age 74, underwent neuropsychologicassessment and performance assessment of ADLs. Results revealed a strong overall relation(canonical R

A Predictive Model for ADL Dependence in Community‐Living Older Adults Based on a Reduced Set of Cognitive Status Items

OBJECTIVE: To develop and validate a simple tool, based on a reduced set of Mini‐Mental State Examination (MMSE) items, that can be used to predict the onset of ADL dependence, and to compare the predictive accuracy of this new tool with that of the MMSE.

Dichotic listening and complex partial seizures

This study reports on 24 patients with multiple symptoms of untreated complex partial seizures (CPSz) who performed poorly at baseline assessment on a brief dichotic word listening task and subsequently improved following successful anticonvulsant therapy directed at treating seizure symptoms. These preliminary findings suggest that, in the absence of macroscopic structural lesions, dynamic electrophysiological dysfunction may interfere with the processing and transmission of simultaneously presented auditory information.

Education-Specific normative data on common neuropsy-chological indices for individuals older than 75 Years

Abstract Few norms are available to judge the performance of the very elderly individual on widely used neuropsychological tests. Similarly, little information is available to adjust for educational history, a factor that has been consistently shown to impact performance on neuropsychological tests. The current study presents both age- and education-specific normative information on commonly used neuropsychological tests for individuals older than age 75 years and with educational levels ranging from 4th grade to college education. Participants were 101 independently living, active drivers who were recruited from a cohort of community-residing elderly adults. The mean performances of individuals with 12 or more years of education in the current study were comparable to norms available in the literature. However, the mean performances of those with less than 12 years education were significantly poorer than their better educated counterparts. These data confirm the well-established relation between cogniti...

Memory processes in depressed geriatric patients with and without subcortical hyperintensities on MRI.

In this study, 12 patients over age 60 with depression with moderate to severe subcortical hyperintensities (SH) localized to the periventricular white matter were identified by quantitative MRI. Using the California Verbal Learning Test, they were compared with 12 age‐, education‐, and severity‐matched patients with depression with minimal white matter changes on specific aspects of memory performance. Patients with cortical lesions, neurologic or systemic illness affecting cognition, and history of substance abuse were excluded. Patients in the group with high SH showed reduced use of semantic encoding strategies (p < 0.05), reduced learning efficiency (p < 0.05), and a greater discrepancy between free recall and recognition discriminability (p < 0.05) than their low SH counterparts. This pattern of performance on memory tasks is similar to that found in previous studies to be associated with subcortical degenerative disorders such as Huntingtons and Parkinsons diseases. Geriatric patients with depression with SH may represent a subgroup with greater subcortical involvement, with associated cognitive and functional decline.

Othello Syndrome Secondary to Right Cerebrovascular Infarction

The Othello syndrome, or delusional jealousy, occurs in idiopathic psychoses and in neurodegenerative diseases, but has rarely been described in patients with cerebrovascular infarction. A patient was observed to exhibit the delusion shortly after cerebral ischemic injury in the absence of other psychiatric symptoms. The underlying pathology was consistent with recent reports on content-specific delusions, implicating right hemisphere and frontal lobe involvement in the mis interpretation and misidentification of complex information. Psychological factors were hypothesized to shape the content of the delusional misinterpretations. (J Geriatr Psychiatry Neurol 1991;4:160-165).

Psychosocial Aspects of Aging

The process of aging into the elderly years (i.e., 65 years and older) often involves a number of progressive physiological changes. Within the context of these changes, and often related to them, prominent issues of psychological and social adjustment emerge. Such issues include coping with declines in physical and functional abilities, changing social relationships and roles, and dealing with multiple losses. Throughout this period of life, which presents individuals with an increasing number of life stressors and adjustments, elderly people strive to maintain a sense of purpose and well-being. This chapter will familiarize the reader with major psychosocial changes and adjustments that occur with aging. Areas of discussion include life satisfaction, retirement, marriage, sexuality, and bereavement. The chapter concludes with a discussion of successful aging.