David Bachman | Medical University of South Carolina (original) (raw)

Papers by David Bachman

Research paper thumbnail of Persistent racial disparity in stroke hospitalization and economic impact in young adults in the buckle of stroke belt

Stroke; a journal of cerebral circulation, 2014

Mounting evidence points to a decline in stroke incidence. However, little is known about recent ... more Mounting evidence points to a decline in stroke incidence. However, little is known about recent patterns of stroke hospitalization within the buckle of the stroke belt. This study aims to investigate the age- and race-specific secular trends in stroke hospitalization rates, inpatient stroke mortality rates, and related hospitalization charges during the past decade in South Carolina. Patients from 2001 to 2010 were identified from the State Inpatient Hospital Discharge Database with a primary discharge diagnosis of stroke (International Classification of Diseases, Ninth Revision codes: 430-434, 436, 437.1). Age- and race-stroke-specific hospitalization rates, hospital charges, charges associated with racial disparity, and 30-day stroke mortality rates were compared between blacks and whites. Of the 84,179 stroke hospitalizations, 31,137 (37.0%) were from patients aged<65 years and 29,846 (35.5%) were blacks. Stroke hospitalization rates decreased in the older population (aged≥65...

Research paper thumbnail of Oscillating Square Wave Transcranial Direct Current Stimulation (tDCS) Delivered During Slow Wave Sleep Does Not Improve Declarative Memory More Than Sham: A Randomized Sham Controlled Crossover Study

Brain Stimulation, 2015

A 2006 trial in healthy medical students found that anodal slow oscillating tDCS delivered bi-fro... more A 2006 trial in healthy medical students found that anodal slow oscillating tDCS delivered bi-frontally during slow wave sleep had an enhancing effect in declarative, but not procedural memory. Although there have been supporting animal studies, and similar findings in pathological groups, this study has not been replicated, or refuted, in the intervening years. We therefore tested these earlier results for replication using similar methods with the exception of current waveform (square in our study, nearly sinusoidal in the original). Our objective was to test the findings of a 2006 trial suggesting bi-frontal anodal tDCS during slow wave sleep enhances declarative memory. Twelve students (mean age 25, 9 women) free of medical problems underwent two testing conditions (active, sham) in a randomized counterbalanced fashion. Active stimulation consisted of oscillating square wave tDCS delivered during early Non-Rapid Eye Movement (NREM) sleep. The sham condition consisted of setting-up the tDCS device and electrodes, but not turning it on during sleep. tDCS was delivered bi-frontally with anodes placed at F3/F4, and cathodes placed at mastoids. Current density was 0.517 mA/cm(2), and oscillated between zero and maximal current at a frequency of 0.75 Hz. Stimulation occurred during five-five minute blocks with 1-min inter-block intervals (25 min total stimulation). The primary outcomes were both declarative memory consolidation measured by a paired word association test (PWA), and non-declarative memory, measured by a non-dominant finger-tapping test (FTT). We also recorded and analyzed sleep EEG. There was no difference in the number of paired word associations remembered before compared to after sleep [(active = 3.1 ± 3.0 SD more associations) (sham = 3.8 ± 3.1 SD more associations)]. Finger tapping improved, (non-significantly) following active stimulation [(3.6 ± 2.7 SD correctly typed sequences) compared to sham stimulation (2.3 ± 2.2 SD correctly typed sequences)]. In this study, we failed to find improvements in declarative or performance memory and could not replicate an earlier study using nearly identical settings. Specifically we failed to find a beneficial effect on either overnight declarative or non-declarative memory consolidation via square-wave oscillating tDCS intervention applied bi-frontally during early NREM sleep. It is unclear if the morphology of the tDCS pulse is critical in any memory related improvements.

Research paper thumbnail of PLATELET PAROXETINE BINDING TO 5HT UPTAKE SITES IN ELDERLY PATIENTS WITH ALZHEIMERʼS DISEASE WITH AGITATION AND AGGRESSION

American Journal of Geriatric Psychiatry, 1999

fied on several measures: DRS, PSMS, PODS, and CIRS-G totals (O/OϾY/O, PϽ0.05), suggesting that r... more fied on several measures: DRS, PSMS, PODS, and CIRS-G totals (O/OϾY/O, PϽ0.05), suggesting that relatively healthy old-old were at increased risk of experiencing deficits in these domains compared to their younger counterparts. Conclusions: Although our results are limited by cross-sectional design, the findings suggest that normal elderly do show impairments in cognition and in everyday functioning. P21 DIVALPROEX USE BY ELDERLY NURSING HOME RESIDENTS.

Research paper thumbnail of Demographic and biologic influences on survival in whites and blacks: 40 Years of follow-up in the Charleston heart study

International Journal for Equity in Health, 2006

In the United States, life expectancy is significantly lower among blacks than whites. We examine... more In the United States, life expectancy is significantly lower among blacks than whites. We examined whether socioeconomic status (SES) and cardiovascular disease (CVD) risk factors may help explain this disparity.

Research paper thumbnail of The Impact of ICD-9 Revascularization Procedure Codes on Estimates of Racial Disparities in Ischemic Stroke

Journal of Stroke and Cerebrovascular Diseases, 2014

The use of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9... more The use of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9) diagnostic codes can identify racial disparities in ischemic stroke hospitalizations; however, inclusion of revascularization procedure codes as acute stroke events may affect the magnitude of the risk difference. This study assesses the impact of excluding revascularization procedure codes in the ICD-9 definition of ischemic stroke, compared with the traditional inclusive definition, on racial disparity estimates for stroke incidence and recurrence. Patients discharged with a diagnosis of ischemic stroke (ICD-9 codes 433.00-434.91 and 436) were identified from a statewide inpatient discharge database from 2010 to 2012. Race-age specific disparity estimates of stroke incidence and recurrence and 1-year cumulative recurrent stroke rates were compared between the routinely used traditional classification and a modified classification of stroke that excluded primary ICD-9 cerebral revascularization procedures codes (38.12, 00.61, and 00.63). The traditional classification identified 7878 stroke hospitalizations, whereas the modified classification resulted in 18% fewer hospitalizations (n = 6444). The age-specific black to white rate ratios were significantly higher in the modified than in the traditional classification for stroke incidence (rate ratio, 1.50; 95% confidence interval [CI], 1.43-1.58 vs. rate ratio, 1.24; 95% CI, 1.18-1.30, respectively). In whites, the 1-year cumulative recurrence rate was significantly reduced by 46% (45-64 years) and 49% (≥ 65 years) in the modified classification, largely explained by a higher rate of cerebral revascularization procedures among whites. There were nonsignificant reductions of 14% (45-64 years) and 19% (≥ 65 years) among blacks. Including cerebral revascularization procedure codes overestimates hospitalization rates for ischemic stroke and significantly underestimates the racial disparity estimates in stroke incidence and recurrence.

Research paper thumbnail of Real Versus Sham Acupuncture in the Treatment of Paralysis in Acute Stroke Patients: A CT Scan Lesion Site Study

Neurorehabilitation and Neural Repair, 1992

... Acute Stroke Patients: A CT Scan Lesion Site Study 1 Margaret A. Naeser, PhD, 1,2 Michael P. ... more ... Acute Stroke Patients: A CT Scan Lesion Site Study 1 Margaret A. Naeser, PhD, 1,2 Michael P. Alexander, MD, 1Denise Stiassny-Eder, MS, OTR, 3 Vicki Galler, PT, MEd, 3 Judith Hobbs, PT, and 1,4 David Bachman, MD From ...

Research paper thumbnail of The Geographic Variation in Stroke Incidence in Two Areas of the Southeastern Stroke Belt : The Anderson and Pee Dee Stroke Study

Stroke, 1998

Carolina and the southeastern United States have maintained the highest stroke mortality in the c... more Carolina and the southeastern United States have maintained the highest stroke mortality in the country. The Anderson and Pee Dee Stroke Study is an assessment of cerebrovascular disease incidence in 2 geographically defined communities in the stroke belt. Methods-Strokes were identified in the Anderson and Pee Dee areas of South Carolina. All hospitalized and out-of-hospital deaths occurring during 1990 among the residents of these 2 areas were included. Strokes were classified by an independent panel of neurologists using a standard protocol that included specific criteria for stroke and subtypes. Results-The overall age-adjusted stroke incidence rates (per 100 000 population) were significantly higher in the Pee Dee population (293.1) compared with Anderson (211.2). The geographic differences were more dramatic in the younger age groups of 35 to 64 years. Likewise, incidence rates for blacks were nearly twice the rates for whites. The rates in the Pee Dee were higher than the rates from other studies in the United States and other parts of the world. Although the stroke subtypes did not vary between the 2 regions, race-sex differences were identified. Conclusions-High stroke incidence and disease rates persist for all 4 race-sex groups in the Southeast and reflect similar risks as mortality rates. However, geographic variability in stroke rates suggests that the pattern of disease in the region is not so much a "belt" of increased stroke in contiguous areas but rather more a "necklace" of different levels of risk. These results should be useful in the identification of factors associated with this geographic enigma.

Research paper thumbnail of Does It Stick? Effects of an Integrated Vertical Undergraduate Aging Curriculum on Medical and Surgical Residents

Journal of the American Geriatrics Society, 2000

Experts acknowledge the unmet need for all physicians to have basic knowledge of aging and compet... more Experts acknowledge the unmet need for all physicians to have basic knowledge of aging and competency in geriatric care given the context of population aging. The University of South Carolina (USC) School of Medicine implemented a highly successful program of aging-oriented undergraduate medical training, including a geriatrics vertical curriculum and its senior mentor programFa required, 4-year experience matching students with older community volunteers, referred to herein as the integrated vertical curriculum in geriatrics (IVC). In earlier work, it was established that IVC graduating classes were significantly more likely to report exposure to and coverage of various geriatrics topics than prior USC classes or other U.S. medical graduates. Here the results of a follow-up survey of USC graduating classes before and after exposure to the IVC and contemporaneous Medical University of South Carolina (MUSC) graduates after two to three years of residency (before the initiation of a senior mentor program at MUSC) is reported. Of 403 graduates, 227 returned questionnaires (response rate 56%). Significantly more IVC than pre-IVC (2003) and 2003 and 2004 MUSC graduates rated themselves fairly or very well prepared by their undergraduate education to treat older adults seen in residency (95% vs 77% and 52%; Po.001). Implications of this and other findings are discussed. J Am Geriatr Soc 56:132-138, 2008. Ã Po.05. w Classification of primary care residencies, per the South Carolina Commission of Higher Education, includes internal and family medicine, pediatrics, psychiatry and neurology, obstetrics and gynecology, and emergency medicine.

Research paper thumbnail of Risk of Dementia Among White and African American Relatives of Patients With Alzheimer Disease

JAMA, 2002

Context Evidence exists that the incidence of Alzheimer disease (AD), as well as risk attributabl... more Context Evidence exists that the incidence of Alzheimer disease (AD), as well as risk attributable to specific genetic factors such as apolipoprotein E (APOE) genotype, may vary considerably among ethnic groups. Family studies of probands with AD offer an opportunity to evaluate lifetime risk of dementia among relatives of these probands.

Research paper thumbnail of Phase III quality-of-life study results: impact on patients’ quality of life to reducing xerostomia after radiotherapy for head-and-neck cancer—RTOG 97-09

International Journal of Radiation Oncology*Biology*Physics, 2003

Methods and Materials: Patients were to receive at least 50 Gy to 50% of the volume of the major ... more Methods and Materials: Patients were to receive at least 50 Gy to 50% of the volume of the major salivary glands, provide unstimulated and stimulated saliva samples, and complete the University of Washington head-and-neck QOL tool before RT and 3 and 6 months after RT. Patients were randomized to receive pilocarpine 5 mg or placebo q.i.d. Results: A total of 249 patients was randomized between March 1998 and January 2000. Of these, 214 were eligible for QOL analysis. Patients were evenly distributed between arms by race, gender, tobacco use, tumor site, T stage (50% T2-T3), and salivary function. A Karnofsky performance status of 90% was more common in the pilocarpine arm. Twenty percent of the patients on the pilocarpine arm and 29% of the patients on the placebo arm were taking nutritional supplements. The placebo arm patients had greater mouth pain and chewing difficulties. Compliance for the QOL tool at 3 and 6 months was 65% and 50%, respectively. Despite statistically significant (p ‫؍‬ 0.047 and p ‫؍‬ 0.049, respectively) preservation of salivary function in the pilocarpine arm, patients on the pilocarpine arm reported difficulties with swallowing (75%), activity (80%), hyposalivation (64%), and taste (81%). No difference was noted between arms at 3 months in mucositis scores, with both arms demonstrating increased requirement for oral nutrients. Conclusion: Objective prevention of hyposalivation did not affect patients' assessment of salivary function or QOL because of the greater impact mucositis plays in QOL after RT.

Research paper thumbnail of Establishment of a Predominantly African-American Cohort for the Study of Alzheimer’s Disease

Dementia and Geriatric Cognitive Disorders, 2009

The recruitment of culturally diverse subject populations into research studies, particularly Afr... more The recruitment of culturally diverse subject populations into research studies, particularly African-Americans (AA), has been the focus of intense interest by many groups. In this paper, we present the methodology utilized to create a predominantly AA cohort for the longitudinal study of risk factors in Alzheimer&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s disease (AD). The underlying strategy was that of identifying geographically diverse clinical venues within South Carolina (SC) where large numbers of AA patients already come to seek medical care. This strategy was successful, although recruitment rates for AA subjects (43.4%) still fell below those for white subjects (70.3%; p = 0.0025). Subject characteristics of AA subjects that chose to enroll were not substantially different from those that declined to participate. The demographic characteristics of this cohort were largely similar to those of the SC Alzheimer Disease Registry, a population-based database. The problems of standardization of subject recruitment and assessment across diverse clinical venues are also addressed. The utilization of geographically diverse sites for research recruitment where minorities already receive medical care is one practical solution to the problem of minority participation in research. Multi-site recruitment to improve minority recruitment can be accomplished with acceptable standardization and inter-rater reliability.

Research paper thumbnail of Depression as a Risk Factor for Alzheimer Disease

Archives of Neurology, 2003

Depression symptoms may be associated with the development of Alzheimer disease (AD). To evaluate... more Depression symptoms may be associated with the development of Alzheimer disease (AD). To evaluate the association between depression symptoms and risk of AD, and to explore the temporal aspects of this association. Academic institutions with specialized memory clinics. Cross-sectional, family-based, case-control study with standardized self- and proxy questionnaires to collect information on depression symptoms and other risk factors. A total of 1953 subjects with AD and 2093 of their unaffected relatives enrolled in the Multi-institutional Research in Alzheimer&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s Genetic Epidemiology Study. Odds ratios (ORs) of AD were estimated with and without depression symptoms, adjusted for age, sex, education, history of head trauma, and apolipoprotein E status. There was a significant association between depression symptoms and AD (adjusted OR, 2.13; 95% confidence interval [CI], 1.71-2.67). In families where depression symptoms first occurred within 1 year before the onset of AD, the association was higher (OR, 4.57; 95% CI, 2.87-7.31), while in the families where the depression symptoms first occurred more than 1 year before the onset of AD, the association was lower (OR, 1.38; 95% CI, 1.03-1.85). In families where depression symptoms first occurred more than 25 years before the onset of AD, there was still a modest association (OR, 1.71; 95% CI, 1.03-2.82). Depression symptoms before the onset of AD are associated with the development of AD, even in families where first depression symptoms occurred more than 25 years before the onset of AD. These data suggest that depression symptoms are a risk factor for later development of AD.

Research paper thumbnail of Independent Predictors of Cognitive Decline in Healthy Elderly Persons

Archives of Neurology, 2002

Several studies have shown that individually memory, hippocampal volume, and motor measures presa... more Several studies have shown that individually memory, hippocampal volume, and motor measures presage the onset of dementia. It is unclear if these independently contribute to the prediction of mild cognitive impairment. To determine the ability of memory, hippocampal volume, and a gait speed to independently predict cognitive decline in healthy elderly persons. A prospective, longitudinal, observational cohort study with a mean follow-up of 6 years. One hundred eight optimally healthy elderly cognitively intact subjects. Any cognitive impairment noted on the Clinical Dementia Rating Scale (score = 0.5) or persistent or progressive cognitive impairment. Cox modeling determined if time to onset of cognitive impairment was associated with baseline logical memory II test score (a measure of delayed recall), hippocampal volume (magnetic resonance imaging), or gait speed (time to walk 30 ft [9 m]) independent of age, sex, depression, or the allele producing the epsilon4 type of apolipoprotein E (APOE epsilon4). Questionable dementia occurred in 48 participants in a mean (SD) of 3.7 (2.4) years. This progressed to persistent cognitive impairment in 38 of these participants in a mean (SD) of 4.4 (2.4) years. Logical memory II test performance and hippocampal volume each predicted onset of questionable dementia, independent of age and sex. Time to walk 30 ft additionally contributed independently to the prediction of time to onset of persistent cognitive impairment. Possessing the APOE epsilon4 allele and depression did not enter either model significantly. Models combining multiple risk factors should refine the prediction of questionable dementia and persistent cognitive impairment, harbingers of dementia. Individuals at risk for cognitive impairment may represent a high-risk group for intervention.

Research paper thumbnail of Association Between Apolipoprotein E Genotype and Alzheimer Disease in African American Subjects

Archives of Neurology, 2002

Apolipoprotein E (APOE) plays a signiWcant role in lipid metabolism and has been implicated in th... more Apolipoprotein E (APOE) plays a signiWcant role in lipid metabolism and has been implicated in the growth and repair of injured neurons. Two small studies have suggested an association between APOE genotype and cerebral palsy. We investigated if APOE genotype is associated with an increased risk for cerebral palsy, inXuences the type of cerebral palsy or interacts with prenatal viral infection to inXuence risk of cerebral palsy. The population-based case-control study comprised newborn screening cards of 443 Caucasian patients with cerebral palsy and 883 Caucasian matched controls. APOE genotyping was performed on DNA extracted from dried blood spots. Allelic and genotypic frequencies did not diVer between cases and controls and combined frequencies were 0.10 ( 2), 0.76 ( 3), 0.14 ( 4), 0.03 ( 2/ 2), 0.10 ( 2/ 3), 0.03 ( 2/ 4), 0.02 ( 4/ 4), 0.21 ( 3/ 4), 0.61 ( 3/ 3). APOE genotype was correlated with cerebral palsy, type of cerebral palsy, gestation at birth and the presence of viral nucleic acids detected in previous work. Analysis by gestational age (all gestational ages, ¸37, 32-36 and <32 weeks) and type of cerebral palsy (all types, diplegia, hemiplegia and quadriplegia) showed no association between APOE genotype and cerebral palsy in this Caucasian population. An association between prenatal viral infection, APOE genotype and cerebral palsy was not demonstrated. These results did not conWrm an association between APOE genotype, cerebral palsy, type of cerebral palsy and prenatal infection in a Caucasian population. Given the low frequency of APOE 2 and some of the heterozygote and homozygote combinations in this study, a larger study is assessing this further.

Research paper thumbnail of Preliminary examination of progression of Alzheimer's disease in a rural Southern African American cohort

Archives of Clinical Neuropsychology, 2007

African Americans are at significantly increased risk for the development of Alzheimer's disease ... more African Americans are at significantly increased risk for the development of Alzheimer's disease (AD), yet are seriously underrepresented in research trials. Preliminary experiences on a large scale, multi-site, 5-year longitudinal trial investigating the psychometric expression and progression of AD targeting an aging Southern rural cohort of African Americans are reported. Sixty-five participants, ranging from asymptomatic to severely demented, underwent extensive individual diagnostic and psychometric evaluation. Results indicated that cultural factors strongly influenced the data. Recruitment with asymptomatic volunteers were found to have greater educational attainment than other participant groups. Psychomotor measures showed greater impairment in African Americans compared to Caucasians suggesting increased cerebrovascular burden. African Americans' performance on the Boston Naming Test and the Wechsler Test of Adult Reading tests were significantly different than performance of Caucasian groups. The findings demonstrated that a better understanding of sociocultural factors associated with AD in the African American population may facilitate the development of primary and secondary preventions, especially when considering the role of cerebrovascular comorbidity which is a modifiable risk factor.

Research paper thumbnail of Higher Incidence of Mild Cognitive Impairment in Familial Hypercholesterolemia

The American Journal of Medicine, 2010

Objective-Hypercholesterolemia is an early risk factor for Alzheimer's disease. Low density lipop... more Objective-Hypercholesterolemia is an early risk factor for Alzheimer's disease. Low density lipoprotein (LDL) receptors may be involved in this disorder. Our objective was to determine the risk of mild cognitive impairment in a population of patients with heterozygous familial hypercholesterolemia, a condition involving LDL receptors dysfunction and life long hypercholesterolemia.

Research paper thumbnail of Commentary: “Ceramide and cholesterol: Possible connections between normal aging of the brain and Alzheimer’s disease. Just hypotheses or molecular pathways to be identified?” By Claudio Costantini, Rekha M.K. Kolasani, and Luigi Puglielli

Alzheimer's & Dementia, 2005

Research paper thumbnail of P3-060

Alzheimer's & Dementia, 2006

Background: One of the most important obstacles in the research on dementia and cognitive functio... more Background: One of the most important obstacles in the research on dementia and cognitive function in elderly population in developing country is "illiteracy." Most of the neuropsychological tests which are currently used in this era have been designed for literate people. The Clock Drawing Test is one of the appropriate neuropsychological tests which can be used in the screening of dementia in illiterate people even though there are not enough studies on this test in the developing countries such as Iran. Objective(s): To propose an original evaluation and validation of the Persian Clock Test (PCT). Methods: We developed PCT after translation and back translation in four parts: drawing, completion, reading and clock setting. The study sample consisted of 250 healthy subjects aged over 50 years that were screened for probable cognitive impairment. Then we selected 181 subjects without dementia and administered PCT. Also 30 patients with dementia were assessed by this test. The score of each part of PCT and the total score of each subject was derived. After test-retest, sensitivity, specificity, cut off point, reliability and validity were computed. Also we analyzed the correlation between age, gender and the level of education with the scores of each subject. We evaluated the accuracy of four parts of PCT by Receiver Operating Characteristic Curve (ROC) analysis. Yuden's Index was used for determination of cut off point. Results: The highest discriminatory power based on the area under the ROC curve was seen for the reading, clock setting and completion (0.9, 0.88, 0.82 and 0.72 respectively). The correlation between accuracy of reading, setting, completion and drawing was significant. The least correlation was found between drawing and other parts of PCT. The score of cut off point was 10/11 (total: 18). We found a significant correlation between the total score and the level of education. Conclusion: PCT is a valid tool and easy to conduct test which could be used for screening of dementia in the Iranian elderly population. The best discriminatory power of this test is seen in the reading, clock setting and completion part and the least power is seen in drawing test.

Research paper thumbnail of O1-01-08: Cognitive impairment in heterozygous familial hypercholesterolemia

Alzheimer's & Dementia, 2008

... Carolina, Charleston, SC, USA. ,; Pedro Mata: Affiliations. Jiménez Díaz Foundation, Madrid, ... more ... Carolina, Charleston, SC, USA. ,; Pedro Mata: Affiliations. Jiménez Díaz Foundation, Madrid, Spain. ,; Rodrigo Alonso: Affiliations. Jiménez Díaz Foundation, Madrid, Spain. ,; David Bachman: Affiliations. Medical University of South Carolina, Charleston, SC, USA. ,; Felix Cruz-Sanchez ...

Research paper thumbnail of Effect of methylphenidate on attention in apathetic AD patients in a randomized, placebo-controlled trial

Little is known about the effect of methylphenidate (MPH) on attention in Alzheimer&amp;amp;a... more Little is known about the effect of methylphenidate (MPH) on attention in Alzheimer&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s disease (AD). MPH has shown to improve apathy in AD, and both apathy and attention have been related to dopaminergic function. The goal was to investigate MPH effects on attention in AD and assess the relationship between attention and apathy responses. MPH (10 mg PO twice daily) or placebo was administered for six weeks in a randomized, double-blind trial in mild-to-moderate AD outpatients with apathy (Neuropsychiatric Inventory (NPI) Apathy ≥ 4). Attention was measured with the Wechsler Adult Intelligence Scale--Digit Span (DS) subtest (DS forward, selective attention) and apathy with the Apathy Evaluation Scale (AES). A mixed effects linear regression estimated the difference in change from baseline between treatment groups, defined as δ (MPH (DS week 6-DS baseline)) - (placebo (DS week 6-DS baseline)). In 60 patients (37 females, age = 76 ± 8, Mini-Mental State Examination (MMSE) = 20 ± 5, NPI Apathy = 7 ± 2), the change in DS forward (δ = 0.87 (95% CI: 0.06-1.68), p = 0.03) and DS total (δ = 1.01 (95% CI: 0.09-1.93), p = 0.03) favored MPH over placebo. Of 57 completers, 17 patients had improved apathy (≥3.3 points on the AES from baseline to end point) and 40 did not. There were no significant associations between AES and NPI Apathy with DS change scores in the MPH, placebo, AES responder, or non-responder groups. DS scores did not predict apathy response to MPH treatment. These results suggest MPH can improve attention and apathy in AD; however, the effects appear independent in this population.

Research paper thumbnail of Persistent racial disparity in stroke hospitalization and economic impact in young adults in the buckle of stroke belt

Stroke; a journal of cerebral circulation, 2014

Mounting evidence points to a decline in stroke incidence. However, little is known about recent ... more Mounting evidence points to a decline in stroke incidence. However, little is known about recent patterns of stroke hospitalization within the buckle of the stroke belt. This study aims to investigate the age- and race-specific secular trends in stroke hospitalization rates, inpatient stroke mortality rates, and related hospitalization charges during the past decade in South Carolina. Patients from 2001 to 2010 were identified from the State Inpatient Hospital Discharge Database with a primary discharge diagnosis of stroke (International Classification of Diseases, Ninth Revision codes: 430-434, 436, 437.1). Age- and race-stroke-specific hospitalization rates, hospital charges, charges associated with racial disparity, and 30-day stroke mortality rates were compared between blacks and whites. Of the 84,179 stroke hospitalizations, 31,137 (37.0%) were from patients aged<65 years and 29,846 (35.5%) were blacks. Stroke hospitalization rates decreased in the older population (aged≥65...

Research paper thumbnail of Oscillating Square Wave Transcranial Direct Current Stimulation (tDCS) Delivered During Slow Wave Sleep Does Not Improve Declarative Memory More Than Sham: A Randomized Sham Controlled Crossover Study

Brain Stimulation, 2015

A 2006 trial in healthy medical students found that anodal slow oscillating tDCS delivered bi-fro... more A 2006 trial in healthy medical students found that anodal slow oscillating tDCS delivered bi-frontally during slow wave sleep had an enhancing effect in declarative, but not procedural memory. Although there have been supporting animal studies, and similar findings in pathological groups, this study has not been replicated, or refuted, in the intervening years. We therefore tested these earlier results for replication using similar methods with the exception of current waveform (square in our study, nearly sinusoidal in the original). Our objective was to test the findings of a 2006 trial suggesting bi-frontal anodal tDCS during slow wave sleep enhances declarative memory. Twelve students (mean age 25, 9 women) free of medical problems underwent two testing conditions (active, sham) in a randomized counterbalanced fashion. Active stimulation consisted of oscillating square wave tDCS delivered during early Non-Rapid Eye Movement (NREM) sleep. The sham condition consisted of setting-up the tDCS device and electrodes, but not turning it on during sleep. tDCS was delivered bi-frontally with anodes placed at F3/F4, and cathodes placed at mastoids. Current density was 0.517 mA/cm(2), and oscillated between zero and maximal current at a frequency of 0.75 Hz. Stimulation occurred during five-five minute blocks with 1-min inter-block intervals (25 min total stimulation). The primary outcomes were both declarative memory consolidation measured by a paired word association test (PWA), and non-declarative memory, measured by a non-dominant finger-tapping test (FTT). We also recorded and analyzed sleep EEG. There was no difference in the number of paired word associations remembered before compared to after sleep [(active = 3.1 ± 3.0 SD more associations) (sham = 3.8 ± 3.1 SD more associations)]. Finger tapping improved, (non-significantly) following active stimulation [(3.6 ± 2.7 SD correctly typed sequences) compared to sham stimulation (2.3 ± 2.2 SD correctly typed sequences)]. In this study, we failed to find improvements in declarative or performance memory and could not replicate an earlier study using nearly identical settings. Specifically we failed to find a beneficial effect on either overnight declarative or non-declarative memory consolidation via square-wave oscillating tDCS intervention applied bi-frontally during early NREM sleep. It is unclear if the morphology of the tDCS pulse is critical in any memory related improvements.

Research paper thumbnail of PLATELET PAROXETINE BINDING TO 5HT UPTAKE SITES IN ELDERLY PATIENTS WITH ALZHEIMERʼS DISEASE WITH AGITATION AND AGGRESSION

American Journal of Geriatric Psychiatry, 1999

fied on several measures: DRS, PSMS, PODS, and CIRS-G totals (O/OϾY/O, PϽ0.05), suggesting that r... more fied on several measures: DRS, PSMS, PODS, and CIRS-G totals (O/OϾY/O, PϽ0.05), suggesting that relatively healthy old-old were at increased risk of experiencing deficits in these domains compared to their younger counterparts. Conclusions: Although our results are limited by cross-sectional design, the findings suggest that normal elderly do show impairments in cognition and in everyday functioning. P21 DIVALPROEX USE BY ELDERLY NURSING HOME RESIDENTS.

Research paper thumbnail of Demographic and biologic influences on survival in whites and blacks: 40 Years of follow-up in the Charleston heart study

International Journal for Equity in Health, 2006

In the United States, life expectancy is significantly lower among blacks than whites. We examine... more In the United States, life expectancy is significantly lower among blacks than whites. We examined whether socioeconomic status (SES) and cardiovascular disease (CVD) risk factors may help explain this disparity.

Research paper thumbnail of The Impact of ICD-9 Revascularization Procedure Codes on Estimates of Racial Disparities in Ischemic Stroke

Journal of Stroke and Cerebrovascular Diseases, 2014

The use of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9... more The use of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9) diagnostic codes can identify racial disparities in ischemic stroke hospitalizations; however, inclusion of revascularization procedure codes as acute stroke events may affect the magnitude of the risk difference. This study assesses the impact of excluding revascularization procedure codes in the ICD-9 definition of ischemic stroke, compared with the traditional inclusive definition, on racial disparity estimates for stroke incidence and recurrence. Patients discharged with a diagnosis of ischemic stroke (ICD-9 codes 433.00-434.91 and 436) were identified from a statewide inpatient discharge database from 2010 to 2012. Race-age specific disparity estimates of stroke incidence and recurrence and 1-year cumulative recurrent stroke rates were compared between the routinely used traditional classification and a modified classification of stroke that excluded primary ICD-9 cerebral revascularization procedures codes (38.12, 00.61, and 00.63). The traditional classification identified 7878 stroke hospitalizations, whereas the modified classification resulted in 18% fewer hospitalizations (n = 6444). The age-specific black to white rate ratios were significantly higher in the modified than in the traditional classification for stroke incidence (rate ratio, 1.50; 95% confidence interval [CI], 1.43-1.58 vs. rate ratio, 1.24; 95% CI, 1.18-1.30, respectively). In whites, the 1-year cumulative recurrence rate was significantly reduced by 46% (45-64 years) and 49% (≥ 65 years) in the modified classification, largely explained by a higher rate of cerebral revascularization procedures among whites. There were nonsignificant reductions of 14% (45-64 years) and 19% (≥ 65 years) among blacks. Including cerebral revascularization procedure codes overestimates hospitalization rates for ischemic stroke and significantly underestimates the racial disparity estimates in stroke incidence and recurrence.

Research paper thumbnail of Real Versus Sham Acupuncture in the Treatment of Paralysis in Acute Stroke Patients: A CT Scan Lesion Site Study

Neurorehabilitation and Neural Repair, 1992

... Acute Stroke Patients: A CT Scan Lesion Site Study 1 Margaret A. Naeser, PhD, 1,2 Michael P. ... more ... Acute Stroke Patients: A CT Scan Lesion Site Study 1 Margaret A. Naeser, PhD, 1,2 Michael P. Alexander, MD, 1Denise Stiassny-Eder, MS, OTR, 3 Vicki Galler, PT, MEd, 3 Judith Hobbs, PT, and 1,4 David Bachman, MD From ...

Research paper thumbnail of The Geographic Variation in Stroke Incidence in Two Areas of the Southeastern Stroke Belt : The Anderson and Pee Dee Stroke Study

Stroke, 1998

Carolina and the southeastern United States have maintained the highest stroke mortality in the c... more Carolina and the southeastern United States have maintained the highest stroke mortality in the country. The Anderson and Pee Dee Stroke Study is an assessment of cerebrovascular disease incidence in 2 geographically defined communities in the stroke belt. Methods-Strokes were identified in the Anderson and Pee Dee areas of South Carolina. All hospitalized and out-of-hospital deaths occurring during 1990 among the residents of these 2 areas were included. Strokes were classified by an independent panel of neurologists using a standard protocol that included specific criteria for stroke and subtypes. Results-The overall age-adjusted stroke incidence rates (per 100 000 population) were significantly higher in the Pee Dee population (293.1) compared with Anderson (211.2). The geographic differences were more dramatic in the younger age groups of 35 to 64 years. Likewise, incidence rates for blacks were nearly twice the rates for whites. The rates in the Pee Dee were higher than the rates from other studies in the United States and other parts of the world. Although the stroke subtypes did not vary between the 2 regions, race-sex differences were identified. Conclusions-High stroke incidence and disease rates persist for all 4 race-sex groups in the Southeast and reflect similar risks as mortality rates. However, geographic variability in stroke rates suggests that the pattern of disease in the region is not so much a "belt" of increased stroke in contiguous areas but rather more a "necklace" of different levels of risk. These results should be useful in the identification of factors associated with this geographic enigma.

Research paper thumbnail of Does It Stick? Effects of an Integrated Vertical Undergraduate Aging Curriculum on Medical and Surgical Residents

Journal of the American Geriatrics Society, 2000

Experts acknowledge the unmet need for all physicians to have basic knowledge of aging and compet... more Experts acknowledge the unmet need for all physicians to have basic knowledge of aging and competency in geriatric care given the context of population aging. The University of South Carolina (USC) School of Medicine implemented a highly successful program of aging-oriented undergraduate medical training, including a geriatrics vertical curriculum and its senior mentor programFa required, 4-year experience matching students with older community volunteers, referred to herein as the integrated vertical curriculum in geriatrics (IVC). In earlier work, it was established that IVC graduating classes were significantly more likely to report exposure to and coverage of various geriatrics topics than prior USC classes or other U.S. medical graduates. Here the results of a follow-up survey of USC graduating classes before and after exposure to the IVC and contemporaneous Medical University of South Carolina (MUSC) graduates after two to three years of residency (before the initiation of a senior mentor program at MUSC) is reported. Of 403 graduates, 227 returned questionnaires (response rate 56%). Significantly more IVC than pre-IVC (2003) and 2003 and 2004 MUSC graduates rated themselves fairly or very well prepared by their undergraduate education to treat older adults seen in residency (95% vs 77% and 52%; Po.001). Implications of this and other findings are discussed. J Am Geriatr Soc 56:132-138, 2008. Ã Po.05. w Classification of primary care residencies, per the South Carolina Commission of Higher Education, includes internal and family medicine, pediatrics, psychiatry and neurology, obstetrics and gynecology, and emergency medicine.

Research paper thumbnail of Risk of Dementia Among White and African American Relatives of Patients With Alzheimer Disease

JAMA, 2002

Context Evidence exists that the incidence of Alzheimer disease (AD), as well as risk attributabl... more Context Evidence exists that the incidence of Alzheimer disease (AD), as well as risk attributable to specific genetic factors such as apolipoprotein E (APOE) genotype, may vary considerably among ethnic groups. Family studies of probands with AD offer an opportunity to evaluate lifetime risk of dementia among relatives of these probands.

Research paper thumbnail of Phase III quality-of-life study results: impact on patients’ quality of life to reducing xerostomia after radiotherapy for head-and-neck cancer—RTOG 97-09

International Journal of Radiation Oncology*Biology*Physics, 2003

Methods and Materials: Patients were to receive at least 50 Gy to 50% of the volume of the major ... more Methods and Materials: Patients were to receive at least 50 Gy to 50% of the volume of the major salivary glands, provide unstimulated and stimulated saliva samples, and complete the University of Washington head-and-neck QOL tool before RT and 3 and 6 months after RT. Patients were randomized to receive pilocarpine 5 mg or placebo q.i.d. Results: A total of 249 patients was randomized between March 1998 and January 2000. Of these, 214 were eligible for QOL analysis. Patients were evenly distributed between arms by race, gender, tobacco use, tumor site, T stage (50% T2-T3), and salivary function. A Karnofsky performance status of 90% was more common in the pilocarpine arm. Twenty percent of the patients on the pilocarpine arm and 29% of the patients on the placebo arm were taking nutritional supplements. The placebo arm patients had greater mouth pain and chewing difficulties. Compliance for the QOL tool at 3 and 6 months was 65% and 50%, respectively. Despite statistically significant (p ‫؍‬ 0.047 and p ‫؍‬ 0.049, respectively) preservation of salivary function in the pilocarpine arm, patients on the pilocarpine arm reported difficulties with swallowing (75%), activity (80%), hyposalivation (64%), and taste (81%). No difference was noted between arms at 3 months in mucositis scores, with both arms demonstrating increased requirement for oral nutrients. Conclusion: Objective prevention of hyposalivation did not affect patients' assessment of salivary function or QOL because of the greater impact mucositis plays in QOL after RT.

Research paper thumbnail of Establishment of a Predominantly African-American Cohort for the Study of Alzheimer’s Disease

Dementia and Geriatric Cognitive Disorders, 2009

The recruitment of culturally diverse subject populations into research studies, particularly Afr... more The recruitment of culturally diverse subject populations into research studies, particularly African-Americans (AA), has been the focus of intense interest by many groups. In this paper, we present the methodology utilized to create a predominantly AA cohort for the longitudinal study of risk factors in Alzheimer&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s disease (AD). The underlying strategy was that of identifying geographically diverse clinical venues within South Carolina (SC) where large numbers of AA patients already come to seek medical care. This strategy was successful, although recruitment rates for AA subjects (43.4%) still fell below those for white subjects (70.3%; p = 0.0025). Subject characteristics of AA subjects that chose to enroll were not substantially different from those that declined to participate. The demographic characteristics of this cohort were largely similar to those of the SC Alzheimer Disease Registry, a population-based database. The problems of standardization of subject recruitment and assessment across diverse clinical venues are also addressed. The utilization of geographically diverse sites for research recruitment where minorities already receive medical care is one practical solution to the problem of minority participation in research. Multi-site recruitment to improve minority recruitment can be accomplished with acceptable standardization and inter-rater reliability.

Research paper thumbnail of Depression as a Risk Factor for Alzheimer Disease

Archives of Neurology, 2003

Depression symptoms may be associated with the development of Alzheimer disease (AD). To evaluate... more Depression symptoms may be associated with the development of Alzheimer disease (AD). To evaluate the association between depression symptoms and risk of AD, and to explore the temporal aspects of this association. Academic institutions with specialized memory clinics. Cross-sectional, family-based, case-control study with standardized self- and proxy questionnaires to collect information on depression symptoms and other risk factors. A total of 1953 subjects with AD and 2093 of their unaffected relatives enrolled in the Multi-institutional Research in Alzheimer&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s Genetic Epidemiology Study. Odds ratios (ORs) of AD were estimated with and without depression symptoms, adjusted for age, sex, education, history of head trauma, and apolipoprotein E status. There was a significant association between depression symptoms and AD (adjusted OR, 2.13; 95% confidence interval [CI], 1.71-2.67). In families where depression symptoms first occurred within 1 year before the onset of AD, the association was higher (OR, 4.57; 95% CI, 2.87-7.31), while in the families where the depression symptoms first occurred more than 1 year before the onset of AD, the association was lower (OR, 1.38; 95% CI, 1.03-1.85). In families where depression symptoms first occurred more than 25 years before the onset of AD, there was still a modest association (OR, 1.71; 95% CI, 1.03-2.82). Depression symptoms before the onset of AD are associated with the development of AD, even in families where first depression symptoms occurred more than 25 years before the onset of AD. These data suggest that depression symptoms are a risk factor for later development of AD.

Research paper thumbnail of Independent Predictors of Cognitive Decline in Healthy Elderly Persons

Archives of Neurology, 2002

Several studies have shown that individually memory, hippocampal volume, and motor measures presa... more Several studies have shown that individually memory, hippocampal volume, and motor measures presage the onset of dementia. It is unclear if these independently contribute to the prediction of mild cognitive impairment. To determine the ability of memory, hippocampal volume, and a gait speed to independently predict cognitive decline in healthy elderly persons. A prospective, longitudinal, observational cohort study with a mean follow-up of 6 years. One hundred eight optimally healthy elderly cognitively intact subjects. Any cognitive impairment noted on the Clinical Dementia Rating Scale (score = 0.5) or persistent or progressive cognitive impairment. Cox modeling determined if time to onset of cognitive impairment was associated with baseline logical memory II test score (a measure of delayed recall), hippocampal volume (magnetic resonance imaging), or gait speed (time to walk 30 ft [9 m]) independent of age, sex, depression, or the allele producing the epsilon4 type of apolipoprotein E (APOE epsilon4). Questionable dementia occurred in 48 participants in a mean (SD) of 3.7 (2.4) years. This progressed to persistent cognitive impairment in 38 of these participants in a mean (SD) of 4.4 (2.4) years. Logical memory II test performance and hippocampal volume each predicted onset of questionable dementia, independent of age and sex. Time to walk 30 ft additionally contributed independently to the prediction of time to onset of persistent cognitive impairment. Possessing the APOE epsilon4 allele and depression did not enter either model significantly. Models combining multiple risk factors should refine the prediction of questionable dementia and persistent cognitive impairment, harbingers of dementia. Individuals at risk for cognitive impairment may represent a high-risk group for intervention.

Research paper thumbnail of Association Between Apolipoprotein E Genotype and Alzheimer Disease in African American Subjects

Archives of Neurology, 2002

Apolipoprotein E (APOE) plays a signiWcant role in lipid metabolism and has been implicated in th... more Apolipoprotein E (APOE) plays a signiWcant role in lipid metabolism and has been implicated in the growth and repair of injured neurons. Two small studies have suggested an association between APOE genotype and cerebral palsy. We investigated if APOE genotype is associated with an increased risk for cerebral palsy, inXuences the type of cerebral palsy or interacts with prenatal viral infection to inXuence risk of cerebral palsy. The population-based case-control study comprised newborn screening cards of 443 Caucasian patients with cerebral palsy and 883 Caucasian matched controls. APOE genotyping was performed on DNA extracted from dried blood spots. Allelic and genotypic frequencies did not diVer between cases and controls and combined frequencies were 0.10 ( 2), 0.76 ( 3), 0.14 ( 4), 0.03 ( 2/ 2), 0.10 ( 2/ 3), 0.03 ( 2/ 4), 0.02 ( 4/ 4), 0.21 ( 3/ 4), 0.61 ( 3/ 3). APOE genotype was correlated with cerebral palsy, type of cerebral palsy, gestation at birth and the presence of viral nucleic acids detected in previous work. Analysis by gestational age (all gestational ages, ¸37, 32-36 and <32 weeks) and type of cerebral palsy (all types, diplegia, hemiplegia and quadriplegia) showed no association between APOE genotype and cerebral palsy in this Caucasian population. An association between prenatal viral infection, APOE genotype and cerebral palsy was not demonstrated. These results did not conWrm an association between APOE genotype, cerebral palsy, type of cerebral palsy and prenatal infection in a Caucasian population. Given the low frequency of APOE 2 and some of the heterozygote and homozygote combinations in this study, a larger study is assessing this further.

Research paper thumbnail of Preliminary examination of progression of Alzheimer's disease in a rural Southern African American cohort

Archives of Clinical Neuropsychology, 2007

African Americans are at significantly increased risk for the development of Alzheimer's disease ... more African Americans are at significantly increased risk for the development of Alzheimer's disease (AD), yet are seriously underrepresented in research trials. Preliminary experiences on a large scale, multi-site, 5-year longitudinal trial investigating the psychometric expression and progression of AD targeting an aging Southern rural cohort of African Americans are reported. Sixty-five participants, ranging from asymptomatic to severely demented, underwent extensive individual diagnostic and psychometric evaluation. Results indicated that cultural factors strongly influenced the data. Recruitment with asymptomatic volunteers were found to have greater educational attainment than other participant groups. Psychomotor measures showed greater impairment in African Americans compared to Caucasians suggesting increased cerebrovascular burden. African Americans' performance on the Boston Naming Test and the Wechsler Test of Adult Reading tests were significantly different than performance of Caucasian groups. The findings demonstrated that a better understanding of sociocultural factors associated with AD in the African American population may facilitate the development of primary and secondary preventions, especially when considering the role of cerebrovascular comorbidity which is a modifiable risk factor.

Research paper thumbnail of Higher Incidence of Mild Cognitive Impairment in Familial Hypercholesterolemia

The American Journal of Medicine, 2010

Objective-Hypercholesterolemia is an early risk factor for Alzheimer's disease. Low density lipop... more Objective-Hypercholesterolemia is an early risk factor for Alzheimer's disease. Low density lipoprotein (LDL) receptors may be involved in this disorder. Our objective was to determine the risk of mild cognitive impairment in a population of patients with heterozygous familial hypercholesterolemia, a condition involving LDL receptors dysfunction and life long hypercholesterolemia.

Research paper thumbnail of Commentary: “Ceramide and cholesterol: Possible connections between normal aging of the brain and Alzheimer’s disease. Just hypotheses or molecular pathways to be identified?” By Claudio Costantini, Rekha M.K. Kolasani, and Luigi Puglielli

Alzheimer's & Dementia, 2005

Research paper thumbnail of P3-060

Alzheimer's & Dementia, 2006

Background: One of the most important obstacles in the research on dementia and cognitive functio... more Background: One of the most important obstacles in the research on dementia and cognitive function in elderly population in developing country is "illiteracy." Most of the neuropsychological tests which are currently used in this era have been designed for literate people. The Clock Drawing Test is one of the appropriate neuropsychological tests which can be used in the screening of dementia in illiterate people even though there are not enough studies on this test in the developing countries such as Iran. Objective(s): To propose an original evaluation and validation of the Persian Clock Test (PCT). Methods: We developed PCT after translation and back translation in four parts: drawing, completion, reading and clock setting. The study sample consisted of 250 healthy subjects aged over 50 years that were screened for probable cognitive impairment. Then we selected 181 subjects without dementia and administered PCT. Also 30 patients with dementia were assessed by this test. The score of each part of PCT and the total score of each subject was derived. After test-retest, sensitivity, specificity, cut off point, reliability and validity were computed. Also we analyzed the correlation between age, gender and the level of education with the scores of each subject. We evaluated the accuracy of four parts of PCT by Receiver Operating Characteristic Curve (ROC) analysis. Yuden's Index was used for determination of cut off point. Results: The highest discriminatory power based on the area under the ROC curve was seen for the reading, clock setting and completion (0.9, 0.88, 0.82 and 0.72 respectively). The correlation between accuracy of reading, setting, completion and drawing was significant. The least correlation was found between drawing and other parts of PCT. The score of cut off point was 10/11 (total: 18). We found a significant correlation between the total score and the level of education. Conclusion: PCT is a valid tool and easy to conduct test which could be used for screening of dementia in the Iranian elderly population. The best discriminatory power of this test is seen in the reading, clock setting and completion part and the least power is seen in drawing test.

Research paper thumbnail of O1-01-08: Cognitive impairment in heterozygous familial hypercholesterolemia

Alzheimer's & Dementia, 2008

... Carolina, Charleston, SC, USA. ,; Pedro Mata: Affiliations. Jiménez Díaz Foundation, Madrid, ... more ... Carolina, Charleston, SC, USA. ,; Pedro Mata: Affiliations. Jiménez Díaz Foundation, Madrid, Spain. ,; Rodrigo Alonso: Affiliations. Jiménez Díaz Foundation, Madrid, Spain. ,; David Bachman: Affiliations. Medical University of South Carolina, Charleston, SC, USA. ,; Felix Cruz-Sanchez ...

Research paper thumbnail of Effect of methylphenidate on attention in apathetic AD patients in a randomized, placebo-controlled trial

Little is known about the effect of methylphenidate (MPH) on attention in Alzheimer&amp;amp;a... more Little is known about the effect of methylphenidate (MPH) on attention in Alzheimer&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s disease (AD). MPH has shown to improve apathy in AD, and both apathy and attention have been related to dopaminergic function. The goal was to investigate MPH effects on attention in AD and assess the relationship between attention and apathy responses. MPH (10 mg PO twice daily) or placebo was administered for six weeks in a randomized, double-blind trial in mild-to-moderate AD outpatients with apathy (Neuropsychiatric Inventory (NPI) Apathy ≥ 4). Attention was measured with the Wechsler Adult Intelligence Scale--Digit Span (DS) subtest (DS forward, selective attention) and apathy with the Apathy Evaluation Scale (AES). A mixed effects linear regression estimated the difference in change from baseline between treatment groups, defined as δ (MPH (DS week 6-DS baseline)) - (placebo (DS week 6-DS baseline)). In 60 patients (37 females, age = 76 ± 8, Mini-Mental State Examination (MMSE) = 20 ± 5, NPI Apathy = 7 ± 2), the change in DS forward (δ = 0.87 (95% CI: 0.06-1.68), p = 0.03) and DS total (δ = 1.01 (95% CI: 0.09-1.93), p = 0.03) favored MPH over placebo. Of 57 completers, 17 patients had improved apathy (≥3.3 points on the AES from baseline to end point) and 40 did not. There were no significant associations between AES and NPI Apathy with DS change scores in the MPH, placebo, AES responder, or non-responder groups. DS scores did not predict apathy response to MPH treatment. These results suggest MPH can improve attention and apathy in AD; however, the effects appear independent in this population.