Kathryn Kaye

High prevalence of cobalamin deficiency in elderly outpatients.

Objective: To measure the prevalence of cobalamin (vitamin B12) deficiency in geriatric outpatients as documented by both low serum cobalamin levels and elevations of serum methylmalonic acid and homocysteine and to determine the response to cobalamin treatment.

Executive Cognitive Abilities and Functional Status Among Community‐Dwelling Older Persons in the San Luis Valley Health and Aging Study

OBJECTIVES: The purpose of this study was to evaluate the contribution of the executive cognitive functions to self‐reported and observed performance of activities of daily living and instrumental activities of daily living.

RELIABILITIES, NORMS AND FACTOR STRUCTURE OF THE BEHAVIORAL DYSCONTROL SCALE '

This is a report on the statistical properties of a research and clinical measure of cognitive and behavioral functioning, which has so far demonstrated utility among elderly persons. This instrument, the Behavioral Dyscontrol Scale, is adapted from Lurias approach to the assessment of frontal lobe dysfunction. The scale shows high internal consistency and very good interrater reliability. In a clinically stable, elderly population, test-retest reliability is high. Normative data are presented for three different samples: 47 young adults, 141 cognitively normal elderly persons, and our total elderly sample of 229. A principal components analysis yielded 3 factors consistent with Lurias theory.

Incidence and correlates of depersonalization following head trauma

Using the criteria of the Structured Clinical Interview for DSM-III-R Dissociative Disorders (SCID-D), we assessed the incidence of feelings of unreality among a sample of 70 persons who had sustained head injuries. Among those whose head trauma could be classified as mild, more than 60% complained of a depersonalization syndrome. Among those with a significant period of unconsciousness, only 11% had similar complaints. There was a high comorbidity with post-traumatic stress disorder and vertigo. Feelings of unreality were not associated with cognitive impairment or elevated personality test scores, nor were there significant relationships with gender or involvement in litigation. A conservative estimate of incidence of depersonalization among persons with minor head trauma is 13%, while, at the upper end, as many as 67% of persons who sustain mild head injury may experience feelings of unreality.

Behavioral disturbance and impairment of executive functions among, the elderly

Among the elderly, measures of general cognitive ability are not consistently related to the capacity for independent functioning. Some elder patients perform well on global tests of cognition, yet demonstrate behavior that is disruptive to their lives and those of their families. The genesis of these behavior problems is poorly understood, and caregivers, both professional and non-professional, frequently attribute their behavior to wilful misconduct. We propose that there are sufficient data concerning the so-called executive functions of the brain and their impairment in both normal aging and various types of dementia, to support the hypothesis that many behavioral disturbances among demented older adults are a function of different degrees of loss of the capacity to engage in purposeful, goal-directed activity. The executive functions are complex, and include the capacities for planning, organization and active problem solving, and the ability to engage in purposeful, goal-directed behavior. Impaired executive functioning is common in dementia, but also may be present in the context of an age-related decline in the speed and capacity of information processing and varying levels of general cognitive impairment. We review data in support of this model, and discuss a patient whose case illustrates deficits in the independent regulation of behavior, an important executive function mediated primarily by the prefrontal area. In the discussion we address several hypotheses suggested by this perspective.

Prevalence of Disorders of Executive Cognitive Functioning among the Elderly: Findings from the San Luis Valley Health and Aging Study

The San Luis Valley Health and Aging Study is a population-based epidemiologic study of chronic illness and disability among Hispanic and non-Hispanic white persons over the age of 60 in two counties in rural southern Colorado, USA. Between 1993 and 1995, we examined the prevalence of impaired executive cognitive functioning in a sample of 1,313 individuals living both in the community and in nursing homes. Overall, 1 person in 3 was found to have at least mild impairment, while 1 in 6 had moderate to severe deficits. Increasing levels of executive functioning impairment were associated with lower education, advancing age, and Hispanic ethnicity. After controlling for education and acculturation, the differences by ethnic group were no longer significant.

Alphanumeric Sequencing and Cognitive Impairment among Elderly Persons

Alphanumeric Sequencing involves the alternating recitation of counting and the alphabet. We report data on the use of this measure among 112 VA patients ranging in age from 61 to 100 years who were administered the Alphanumeric Sequencing, Trail Making Test, Digits Forward and Backward, the Mini-Mental State Examination, and the Behavioral Dyscontrol Scale. Persons who obtained scores < 27 on the Mini-Mental State Examination or < 14 on the Behavioral Dyscontrol Scale performed significantly more poorly than those who scored higher. Both the time and errors were correlated (.11 to -.49) with measures of information processing and short-term memory.