Papers by hillel grossman
Cognitive and Behavioral Neurology, Mar 31, 1994
Geriatrics, 2004
Antidepressants can be vital and restorative treatment for elders who suffer from major depressio... more Antidepressants can be vital and restorative treatment for elders who suffer from major depression. Major depression can be a tricky diagnosis and there is a tendency towards overinclusiveness in its diagnosis. Overuse of the depression diagnosis can lead to ignoring key aspects of the patient's presentation and inappropriate treatment.
This study examined the relationship between violence and substance abuse among patients with chr... more This study examined the relationship between violence and substance abuse among patients with chronic mental illness living in the community. All referrals over a one-year period to an urban assertive community treatment team were evaluated systematically with a standardized intake protocol. Thirty-seven patients with a history of violence in the community were compared with 27 patients without such a history on a variety of clinical and demographic variables. More than half of the patients (58 percent) had a history of violence in the community. The only significant differences between those with a history of violence and those without involved alcohol or drug use. The single best predictor of violence was the onset of alcohol or drug abuse in late childhood or early adolescence. In this sample, very early onset of substance abuse among people who developed mental illness was associated with the greatest risk of community violence. Thus at least some of the causal determinants of violence in this sample may precede the onset of adult mental illness.
This study examined the relationship between violence and substance abuse among patients with chr... more This study examined the relationship between violence and substance abuse among patients with chronic mental illness living in the community. All referrals over a one-year period to an urban assertive community treatment team were evaluated systematically with a standardized intake protocol. Thirty-seven patients with a history of violence in the community were compared with 27 patients without such a history on a variety of clinical and demographic variables. More than half of the patients (58 percent) had a history of violence in the community. The only significant differences between those with a history of violence and those without involved alcohol or drug use. The single best predictor of violence was the onset of alcohol or drug abuse in late childhood or early adolescence. In this sample, very early onset of substance abuse among people who developed mental illness was associated with the greatest risk of community violence. Thus at least some of the causal determinants of violence in this sample may precede the onset of adult mental illness.
This study examined the relationship between violence and substance abuse among patients with chr... more This study examined the relationship between violence and substance abuse among patients with chronic mental illness living in the community. All referrals over a one-year period to an urban assertive community treatment team were evaluated systematically with a standardized intake protocol. Thirty-seven patients with a history of violence in the community were compared with 27 patients without such a history on a variety of clinical and demographic variables. More than half of the patients (58 percent) had a history of violence in the community. The only significant differences between those with a history of violence and those without involved alcohol or drug use. The single best predictor of violence was the onset of alcohol or drug abuse in late childhood or early adolescence. In this sample, very early onset of substance abuse among people who developed mental illness was associated with the greatest risk of community violence. Thus at least some of the causal determinants of violence in this sample may precede the onset of adult mental illness.
Alzheimers & Dementia, 2010
not available S4-
This chapter focuses on the amnestic syndrome or an impairment in the ability to form new memorie... more This chapter focuses on the amnestic syndrome or an impairment in the ability to form new memories. The chapter first describes the history of amnestic disorder and provides a background on memory and memory function. Descriptions of the four amnestic syndromes (Wernicke–Korsakoff syndrome, transient global amnesia, mild cognitive impairment, and hysterical amnesia) are then provided. Finally, the etiology, evaluation, and treatment of amnestic syndrome are described.
Archives of Neurology, 2008
Background-Neuritic plaques (NPs) and neurofibrillary tangles (NFTs) in the brain, especially in ... more Background-Neuritic plaques (NPs) and neurofibrillary tangles (NFTs) in the brain, especially in the hippocampus, entorhinal cortex, and isocortex, are hallmark lesions of Alzheimer disease and dementia in the elderly. However, this association has not been extensively studied in the rapidly growing population of the very old.
American Journal of Geriatric Psychiatry, 2010
There is evidence that major depression increases the risk for dementia, but there is conflicting... more There is evidence that major depression increases the risk for dementia, but there is conflicting evidence as to whether depression may accelerate cognitive decline in dementia. The authors tested the hypothesis that decline in cognitive function over time is more pronounced in patients with dementia with comorbid depression, when compared with patients with dementia without depression history. Prospective, longitudinal cohort study of aging. Nursing home. Three hundred thirteen elderly nursing home residents (mean age at baseline: 86.99 years, standard deviation = 6.7; 83.1% women). At baseline, 192 residents were diagnosed with dementia, and another 27 developed dementia during follow-up. Thirty residents suffered from major depression at any point during the study, and 48 residents had a history of depression. The authors measured cognitive decline using change in Mini-Mental State Examination (MMSE) scores over up to 36 months. The authors calculated multilevel regression models to estimate the effects of age, gender, education, dementia status, depression, depression history, and an interaction between dementia and depression, on change in MMSE scores over time. Beyond the effects of age, gender, and education, residents showed steeper cognitive decline in the presence of dementia (β = -13.69, standard error = 1.38) and depression (β = -4.16, SE = 1.2), which was further accelerated by the presence of both depression and dementia (β = -2.72, SE = 0.65). In dementia, the presence of depression corresponds to accelerated cognitive decline beyond gender and level of education, suggesting a unique influence of depression on the rate of cognitive decline in dementia.
American Journal of Geriatric Psychiatry, 2009
Ejection fractions; left atrial diameter; cognitive functioning; oldest old; APOE genotype This i... more Ejection fractions; left atrial diameter; cognitive functioning; oldest old; APOE genotype This interim study describes the relationships of neuropsychological functioning with directly measured ejection fraction (EF) and left atrial diameter (LAD) in a very elderly cohort. Subjects were 196 male veterans, 75 years old and above, outpatients at the James J. Peters Veteran Administration Medical Center, Bronx, NY. All had Clinical Dementia Rating (CDR) score of zero (no dementia) at this baseline assessment. None had a history of cerebrovascular disease. All subjects provided informed consent approved by the VA IRB. LAD (cm) and EF (%) were measured using
Alzheimers & Dementia, 2007
Background: Recent findings suggest that socially or mentally stimulating activity may protect ag... more Background: Recent findings suggest that socially or mentally stimulating activity may protect against dementia. Objective: To examine, cross sectionally, the association of several leisure activities with cognitive functioning in a non-demented community dwelling very elderly sample from an ongoing longitudinal study on risk and protective factors for Alzheimer's disease. Methods: Factor analyses of the neuropsychological variables yielded two rotated varimax factors: memory (primarily immediate and delayed recall, recognition, and Savings) and executive functioning (primarily Trail Making Tests A and B, and Shipley Vocabulary Test). The 10 leisure activities (watching news on TV, listening to radio, games, theater, courses, social gatherings, travel, gardening, art with hands, and writing) were not strongly inter-correlated. Multiple partial correlation assessed the association of the leisure activities with the neuropsychological factors, controlling for age, sex, and education. Results: 148 subjects (61% women, mean ageϭ 87.3Ϯ5.8 and mean education 15.1Ϯ3.2) had complete data. For memory, the multiple partial correlation did not reach statistical significance (Rϭ.32; F(10,134)ϭ1.56; pϭ.13). The only significant partial correlation for individual leisure activities was for art with hands (rϭ.21; pϭ.01). For executive functioning, the significant association (Rϭ.39; F(10,134)ϭ2.33; pϭ.02) reflected writing (rϭ.23; pϭ.005), (not) watching news on TV (rϭ-.18; pϭ.03), listening to radio (rϭ.17; pϭ.04), and travel (rϭ.16; pϭ.05). Partial correlations with writing of the Shipley Vocabulary Test (rϭ.24; pϭ.003) was stronger than with the Trails A (rϭ-.15; pϭ.07) and B (rϭ-.16; pϭ.06) suggesting that the association with the executive functioning factor reflected cognition rather than simple motor ability. Conclusions: In this interim sample, cognition was associated with increasing frequency of several leisure activities, after adjusting for age, sex, and years of education, in non-demented community dwelling subjects who are very old and thus at high risk for dementia. Leisure activities are a modifiable life style characteristic that might contribute to prevention of dementia.
Dementia and Geriatric Cognitive Disorders, 2008
Aims-To assess the relationships between early and late antemortem measures of dementia severity ... more Aims-To assess the relationships between early and late antemortem measures of dementia severity and Alzheimer disease (AD) neuropathology severity.
Neurobiology of Aging, 2004
Journal of The American Geriatrics Society, 2006
Homocysteine is a sulfur-containing metabolite of methionine that is emerging as an independent r... more Homocysteine is a sulfur-containing metabolite of methionine that is emerging as an independent risk factor for atherosclerosis, 1 arterial and venous thrombosis, 2 and mortality. 3 Previous studies, focusing on relatively young older people, have shown that homocysteine is higher in men and increases with age, smoking, lower vitamin B 12 , folate, and renal function levels. Recently, we studied the relationships between homocysteine levels and the clinical and laboratory measures that have been typically associated with them in younger cohorts, using a sample of 117 well-functioning, cognitively intact communitydwelling oldest-old (aged ≥ 85). The relationship between change in homocysteine over time and these same factors was also examined in the subsample for whom follow-up data were available.
American Journal of Medical Genetics Part B-neuropsychiatric Genetics, 2008
Survival from Alzheimer's disease (AD) and other dementias into late old age may be a useful phen... more Survival from Alzheimer's disease (AD) and other dementias into late old age may be a useful phenotype for genetic studies of successful cognitive aging. To support molecular genetics studies for successful cognitive aging, we conducted a two-stage study to determine an optimal age phenotype for successful cognitive aging. First, risk of AD was evaluated, through informant interviews, in 4,794 parents and siblings of 976 elderly nondemented probands who were divided into three different proband age groups: those aged 60–74, 75–89, and 90+. Relatives of probands aged 90+ had a significantly lower risk than the relatives of the other two proband groups. Second, this sample was combined with an earlier sample (combined nondemented elderly probands: n = 2,025; relatives: n = 10,506), and a series of proband age groups (i.e., 75–79, 80–84, 85–89, 90+) were used to determine which optimally identifies a group of relatives with low AD risk. Using the relatives of the nondemented proband aged 60–74 as the reference group, there were reductions in cumulative risk among relatives of probands aged 85–89 and 90+, but only the latter group also showed significant reductions to the relatives of probands aged 75–79, 80–84, and 85–89. This pattern of results varied little by sex. Finally, cumulative AD risk curves were similar between relatives of probands aged 90–94 and 95+. These results suggest that age 90 is an optimal age threshold to use for both men and women in genetic studies seeking to identify genes associated with successful cognitive aging. © 2007 Wiley-Liss, Inc.
Alzheimers & Dementia, 2006
extraverts (RRϭ1.07, 95%CIϭ0.80-1.45). However, no effect of high neuroticism (RRϭ1.12, 95% CIϭ0.... more extraverts (RRϭ1.07, 95%CIϭ0.80-1.45). However, no effect of high neuroticism (RRϭ1.12, 95% CIϭ0.75-1.68) or introversion (RRϭ1.07, 95%CIϭ0.73-1.57) on dementia incidence was observed. These results did not change by further controlling for baseline depression, lie score, and co-morbidity. In addition, a significant interaction between neuroticism and dementia on mortality was detected. Neuroticism was associated with greater mortality among the demented persons (RRϭ1.73, 95% CIϭ1.01-2.94) but it was not among non-demented elderly (RRϭ0.89, 95% CIϭ0.69-1.15). Conclusions: Elderly people with high neuroticism are at a higher risk of developing cognitive impairment but not dementia compared with those who were less neuroticism. Survival bias may be potential explanation of the null effect of neuroticism on dementia incidence among these very old people. No effect of extraversion on cognitive impairment or dementia was detected.
Mechanisms of Ageing and Development
Background-Advanced glycations end products increase oxidant stress, inflammation, and neurotoxic... more Background-Advanced glycations end products increase oxidant stress, inflammation, and neurotoxicity. Serum levels are increased in diabetes and aging. We examined the relationship between serum methylglyoxal derivatives (sMG), and cognitive decline, in 267 non-demented elderly.
Alzheimers & Dementia, 2011
Archives of General Psychiatry, 2006
The hallmark pathological changes in Alzheimer disease (AD) are abundant plaque and tangle format... more The hallmark pathological changes in Alzheimer disease (AD) are abundant plaque and tangle formation, especially in the temporal lobes and hippocampus. Although there is increasing evidence that major depression may interact with neuropathological processes in AD, there have been no studies of neuropathological changes in AD as a function of history of major depression. To test the hypothesis that neuritic plaques and neurofibrillary tangles are more pronounced in the hippocampus of patients with AD with a lifetime history of major depressive disorder, as compared with patients with AD without depression history. Postmortem study. Nursing home. The brains of 52 patients with AD without a lifetime history of major depression were compared with the brains of 50 patients with AD with a lifetime history of major depression. Neuropathological ratings from the Consortium to Establish a Registry in Alzheimer Disease battery. Brains of patients with AD with a lifetime history of depression showed higher levels of both plaque (P<.005) and tangle (P<.002) formation within the hippocampus than brains of patients with AD without a history of depression. Post hoc analyses showed that patients with AD who had a history of depression exhibited more rapid cognitive decline than patients without a history of depression (P<.004). Furthermore, within the group of patients with AD with a history of depression, patients who exhibited concurrent depression at the time of first diagnosis of AD exhibited more pronounced neuropathological changes in the hippocampus (P<.006). In AD, the presence of a lifetime history of depression corresponds to increases in AD-related neuropathological changes within the hippocampus. These changes go along with more rapid cognitive decline in patients with AD with a history of depression, and are more pronounced in patients with AD suffering from depression early on in the disease process, suggesting an interaction between major depression and AD neuropathology.
Cns Drugs, 2008
Alzheimer's disease is an ever-increasing... more Alzheimer's disease is an ever-increasing health concern among the aging population, and as we research new and existing treatments for this disease we begin to uncover possibilities for its prevention. Observational studies and animal models have provided promising findings and generated excitement, but placebo-controlled clinical trials are required to demonstrate true efficacy for these treatments.In the past two decades, clinical trials have led to the approval of symptomatic treatments for Alzheimer's disease, including cholinesterase inhibitors and, more recently, an NMDA receptor antagonist. Clinical trials have also examined antioxidants, NSAIDs, hormone replacement, nutritional supplements and nonpharmacological interventions for the treatment and prevention of Alzheimer's disease. While the results of many of these trials have been disappointing, new mechanisms targeting the hallmark pathology of Alzheimer's disease are currently under investigation, including immunotherapy and secretase modulation, targeted at reducing the amyloid burden, for which we await the results. We review the evidence from completed trials, support for ongoing studies and propose directions for future research.
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Papers by hillel grossman