Terry P. Miller

Correlates of memory decline : a 4-year longitudinal study of older adults with memory complaints

Change in memory performance and its correspondence to change in speed of performance and self-reported memory functioning were investigated longitudinally in 30 older adults with memory complaints. Subjects were assessed by self-report questionnaires and cognitive tests 3 times, at near 2-year intervals. A significant decline in word-recall scores was found, which was accompanied at the group level by significant self-reported decline in everyday memory functioning and nonsignificant decline in Wechsler Adult Intelligence Scale Digit Symbol scores (alpha = .05). The oldest subjects showed the most substantial declines in memory performance. At the individual level, however, memory change did not significantly correlate with either change in self-reports or change in Digit Symbol scores. Although these results do not support a cognitive slowing model of decline at the intraindividual level, they do have implications for intervention of age-related memory decline.

Cognitive and Noncognitive Symptoms in Dementia Patients: Relationship to Cortisol and Dehydroepiandrosterone

We investigated the relationship between basal cortisol and dehydroepiandrosterone (DHEA) levels and impairment in different cognitive and noncognitive measures and the possible interaction of DHEA with hypercortisolemia in dementia in 27 patients diagnosed with Alzheimers disease (AD). There were 17 men and 10 women. Patients were mildly to moderately cognitively impaired at the time of the initial cortisol measures. Patients were administered the Alzheimers Disease Assessment Scale (ADAS) and Folstein Mini-Mental State Examination (MMSE) at approximately 6-month intervals. Cortisol and DHEA were determined using conventional 125I radioimmunoassay procedures. Pearson product-moment correlations among cortisol and DHEA measures and both initial and longitudinal clinical measures were calculated. There was a relationship between baseline 8 a.m. cortisol levels and cognitive function at the initial testing as measured by the ADAS cognitive measure, with higher cortisol levels being associated with a greater level of impairment. We did not document a relationship between cortisol or DHEA levels and noncognitive measures. There was a significant correlation between both the initial MMSE and ADAS cognitive measures and initial DHEA level, with lower DHEA levels unexpectedly being associated with better performance on these measures. The initial DHEA levels did not predict decline in cognitive function over time. These findings bring into question the potential usefulness of DHEA as a therapeutic agent.

A Comparison of Assessment Techniques Measuring the Effects of Methylphenidate, Secobarbital, Diazepam and Diphenhydramine in Abstinent Alcoholics

In two studies, we studied the comparative sensitivity of different subjective and objective measures to methylphenidate (10 and 20 mg) and secobarbital (100 mg) versus placebo, and diphenhydramine (50 mg) and diazepam (10 and 20 mg) versus placebo in abstinent alcoholics. Subjective measures used were the Visual Analog Mood Scale and the Profile of Mood States. Objective measures were the Stroop and two microcomputer-controlled tasks developed in our lab - a dual pursuit tracking/reaction time task (P-Trak) and a reaction time task with regular and irregular preparatory intervals (PI) of varying length (Reactest). In addition, several baseline measures (Eysenck Personality Inventory, Spielberger State-Trait Anxiety Inventory and NIMH Mood Scale Elderly) were evaluated for their correlation to drug response. All three central nervous system depressants impaired performance on Reactest at the longer PIs and showed a main effect with irregular PIs, but only the 20-mg dose of diazepam impaired reaction time at the shortest PI and showed a main effect with regular PIs. On P-Trak, secobarbital and diazepam 20 mg impaired both tracking and reaction time, while methylphenidate 20 mg improved only the reaction time component. Only diazepam 20 mg affected mood. No effects were noted on the Stroop. The implications of these findings are discussed. Both P-Trak and Reactest with long PIs were more sensitive than VAMS, POMS or Stroop to drug effects. As lower doses of central nervous system depressants impaired reaction time only with longer PIs and showed a main effect only with irregular PIs, cognitive effects of these drugs may be missed if only subjective or short, regular PI tasks are examined.(ABSTRACT TRUNCATED AT 250 WORDS)

Desglycinamide-9-arginine-8-vasopressin (DGAVP, Organon 5667) in patients with dementia☆

Vasopressin peptides have been shown to facilitate learning and memory in both animals and humans; however, the effectiveness in humans is controversial. In a double blind parallel group study, 17 demented subjects (either Alzheimers or alcoholic) were given either desglycinamide-9-arginine-8-vasopressin (DGAVP) 92 micrograms intranasally TID or an identical placebo for 1 week after having received 1 week of placebo. To our knowledge, this is the first report of DGAVP being used in subjects with dementia. The DGAVP group had a statistically significant improvement on the Buschke list learning of low imagery words. However, for various reasons discussed in the paper, we feel this finding needs to be replicated before any definite conclusions can be drawn. Since there were no other appreciable behavioral effects of this DGAVP regimen, our results should be considered negative. There was no evidence of any DGAVP-related adverse effects, except for possible weight gain.

ERYTHROCYTE SEDIMENTATION RATE IN ALZHEIMER'S DEMENTIA

made it difficult for him to follow serial programs on television. He said that his wife accused him of being snappy. His wife reported that his behavior had changed dramatically during the last 6 years. He behaved disgracefully, and he was shunned in the home where they lived; his memory had gone. On examination he was cooperative but a bit slow, and, except for the date, fully orientated in time. Assessment of the mental status showed failures only on memory tasks. Although the available information was strongly suggestive for dementia (DSM-111-R) his wife also mentioned that she had never been happy with him. Aggravation was suspected. Information from the team at the day center based on several months’ observations indicated that he behaved more like a volunteer than a patient in that setting. He was not demented, in their opinion, and he was kind and helpful to others. It became obvious that his personality had not altered but that his wife was tired of him. His diagnosis was then changed from Dementia to a mild Amnestic Syndrome

Dual-Task Assessment of Attentional Capacities in Aging and Dementia

This chapter discusses the theoretical background for using dual-task methods to measure human attentional capacities, and describes in detail a microcomputerized dual-task procedure useful in studying elderly individuals. The two tasks in this procedure (pursuit-tracking of a randomly moving target on a videoscreen, and visual monitoring of a stimulus for changes in configuration) are first performed separately and then simultaneously. A decrement in the dual-task performance relative to the single-task conditions suggests that attentional capacities of the individual have been exceeded. Attractive features of this dual-task procedure for psychometric assessments in older individuals include good patient acceptance, minimal equipment and personnel requirements, adaptability to subjects with a wide range of abilities, and the capability for concurrent psychophysiologic measurements such as heart rate. It is predicted that computerized dual-task techniques will become an increasingly important aspect of future cognitive assessments of the elderly.

Anxiety Disorder and Pyridoxal Phosphate—A Possible Association:

TOTHEEDITOR: In Hong Kong, self-medication with Western drugs or herbal medicines is a common practice among the general public. In our survey of 1701 general medical admissions to the Prince of Wales Hospital in 1990, adverse reactions caused by self-medication with prescription drugs or herbal medicines accounted for 0.47 and 0.18 percent of these cases, respectively.P Although the manufacturers of Western drugs usually list the dosage, indications, and ingredients of their products in the package insert, the general public may not necessarily be warned of the potential danger of taking these products without a physicians supervision. We treated a patient with Cushings syndrome secondary to self-medication with an analgesic preparation containing dexamethasone. We report this case to highlight the danger of self-medication with Western drugs and the importance of including a warning in the package insert. A 72-year-old woman presented toourhospital in December 1993 because of dizziness, malaise, andsymptoms of upperrespiratory tractinfection for I day. Shehada history of osteoarthritis of theknees, obesity, hypertension, andnoninsulin-dependent diabetes mellitus. Assuggested bya friend whoworked in a drug storein HongKong, she was takingthreeAtrofin-A (Europharm Lab,France) capsules daily for3 months before admission forherjointpain. Each capsule contains dexamethasone 0.5mg,indomethacin 25mg,vitamin BI 50mg,vitamin B6 50 mg, vitamin B12 100ug,andmagnesium trisilicate 100mg.For12months before admission shealsowastaking twoChinese medicines forherdiabetes mellitusandknee painthatwereprescribed in China. Eachof these Chinese medicines consisted of three to sixherbal extracts. Shefirstwasprescribed fenfluramine 20 mg/d bya general practitioner in HongKong a fewyears earlier for treatment of herobesity. Shecontinued totakethisdrugwithout medical supervision before admission. As recommended byherdaughters friend, whoworked as a sales representative for a natural drug/food products company, she also was takingtwo Japanese preparations, Dunaliella andChlostanin Gold, forweight reduction, generalwell-being, andjointpainfor4 months before admission. These products cost

Selected Psychiatric Symptoms Associated With Rate of Cognitive Decline in Patients With Alzheimer's Disease

200(US) perbottle. On admission, shewas fully alert, BPwas1701100 mmHg,HRwas78 beats/min, andT was37.6 C. Shehadclassic cushingoid features, including moon face, truncalobesity, supraclavicular fat pad,buffalo hump,thinskin,andmildproximal myopathy. Bonycrepitus waspresentoverherknees. Movement overher right shoulder wasrestricted because ofpain. Baseline investigations revealed a reduced plasma potassium (3.1 mmol!L), elevated fasting plasma glucose (8.5 mmol!L), a suppressed morning cortisol concentration (190nmol!L), buta normal chest X-ray anda white cellcount. Theclinical diagnoses were iatrogenic Cushings syndrome caused by dexamethasone, osteoarthritis of thekneejoints,andchestinfection. The latterwastreated witha course of amoxicillin therapy, following which her symptoms improved. Shewasstarted onhydrocortisone replacement therapy after admission. Herjointpainwascontrolled by naproxen, dologesic, andtopical salicylates. Whenshewasdischarged from thehospital on day8,herchestinfection hadsubsided. HerBPwas140190 mmHg.Herdiabetes mellitus wascontrolled by dietalone. Herhome medications included hydrocortisone 20mgeverymorning and 10mgat night, naproxen 250mg tid prn withantacids, and topical salicylates. Shewaswarned about thedanger of self-medication with Atrofin-A. Shewasseen in theoutpatient clinic inFebruary andApril 1994. Hydrocortisone andanalgesic therapy wascontinued andmetformin 250mgbidwasadded. Her diabetes mellitus waswell controlled. Hermostrecent BPwas130190 mmHg. The danger of self-medication with prescription drugs without medical supervision is illustrated by this case. She had gross cushingoid features with her obesity, hypertension, and diabetes mellitus aggravated by the prolonged use of dexamethasone. Fenfluramine, an amphetarninelike drug used for short-term (less than three months) adjunctive treatment of obesity, may cause life-threatening complications such as blood disorders and pulmonary hypertension. Our patient, having taken this drug for a few years prior to admission, was very fortunate not to have developed these adverse reactions so far. There are many reasons for self-medication with Western drugs or herbal medicines being a common practice in Hong Kong. The health system is structured around general practice (mainly private). Consultation fees may prevent both initial and subsequent visits to general practitioners. Some people may find it more convenient to obtain their treatment from a drug store and advice for their illness from the nonmedical staff working there. Our patient continued to take Atrofin-A until presentation but without knowing its adverse effects, possibly because of the advice from her friend and the lack of such a warning in the package insert. The information listed on the package for consumers includes only the composition, actions, indications, and dosage of the product written in English and Chinese. There was no mention about its adverse effects or the need to consult a doctor. There is an obvious need for educating the general public about the danger of self-medication without a physicians supervision and the need to include a warning in the package insert.