Gayatri Devi, M.D.

A retrospective chart review of course of hypertension in Alzheimer's disease patients
Devi G.; Shin E.; Lo V.; Doumlele K.
2010 ;17:364-364, European journal of neurology
Introduction: Higher blood pressure (BP) levels have been associated with dementia, particularly for Alzheimer's disease. Therefore, a significant proportion of patients with AD are on antihypertensive medications. However, during the course of AD, BP levels decline due to a number of factors, including degeneration of brain stem autonomic neurons. Such changes appear to reduce and possibly eliminate need for antihypertensive drugs. Continued maintenance on antihypertensive medications in these situations may predispose patients to falls, fractures and episodes of confusion. Objective: To determine the relationship between the progressions of Alzheimer's disease (AD) and pre-existing hypertension. Methods: We retrospectively reviewed the charts of all patients diagnosed of possible or probable Alzheimer's disease using National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's disease and Related Disorders Association (NINCDSADRDA) criteria from our own private clinical practice who had antihypertensive medications discontinued subsequent to being diagnosed. Results: There were 16 patients with probable or possible AD who demonstrated a significant decrease in their BP requiring discontinuation of their antihypertensive drugs as their condition progressed. None of these patients experienced an increase in BP requiring reinstitution of their anti-hypertensives. Conclusions: From a review of the literature and based on our small exploratory study, clinicians may do well to periodically reassess need for antihypertensive medications in patients with Alzheimer's disease
— id: 113821, year: 2010, vol: 17, page: 364, stat: Journal Article,

Which Presidents Are Most Memorable?
Devi, Gayatri; Zhivotovskaya, Emiliya; Schultz, Sarah
2010 Feb;25(1):32-36, American journal of Alzheimer's disease & other dementias
Background/rationale. Episodic memory loss is a hallmark of Alzheimer's disease (AD), with recall of recent events becoming progressively difficult. A commonly used tool, the recollection of US presidents, was assessed in evaluating episodic versus semantic memory loss among AD patients compared with spouse controls. Methods. A total of 36 patients (12 men, 24 women) with possible or probable AD were asked to 'give the names of 5 US presidents' and concurrently administered the Mini-Mental State Examination (MMSE). Twenty-three spouses (12 men, 11 women) were controls. The year 1980 demarcated 'remote' versus 'recent' presidents. Results. Patients were older, had lower MMSE scores (P< .001), and recalled fewer presidents than controls (P< .005), after controlling for age. Among patients, men were more educated than women (P < .05) and recalled more presidents (P < .001). No gender differences were observed in controls. Conclusions. Patients with AD preferentially recalled remote presidents, supporting retention of semantic memory in this group. There were no gender differences between groups
— id: 93726, year: 2010, vol: 25, page: 32, stat: Journal Article,

AMWA Position Statement: Genetic Testing
Devi, G; Glodowski, M; Shin, E
2009 JUN ;18(6):785-786, Journal of women's health (Larchmont, N.Y. : 2002)
— id: 100445, year: 2009, vol: 18, page: 785, stat: Journal Article,

AMWA position statement on abortion and reproductive rights
Devi, Gayatri; Glodowski, Michele; Shin, Elizabeth
2009 Mar;18(3):299-300, Journal of women's health (Larchmont, N.Y. : 2002)
— id: 96332, year: 2009, vol: 18, page: 299, stat: Journal Article,

AMWA position statement: cervical cancer prevention
Devi, Gayatri; Glodowski, Michele; Shin, Elizabeth
2009 Feb;18(2):153-153, Journal of women's health (Larchmont, N.Y. : 2002)
— id: 93725, year: 2009, vol: 18, page: 153, stat: Journal Article,

Episodic vs. semantic memory loss and president recall in Alzheimer's disease
Devi, G; Zhivotovskaya, E; Schultz, SE
2008 AUG ;15(1-3):37-37, European journal of neurology
— id: 86814, year: 2008, vol: 15, page: 37, stat: Journal Article,

A retrospective chart review of the tolerability and efficacy of intravenous immunoglobulin in the treatment of Alzheimer's disease
Devi, Gayatri; Schultz, Sarah; Khosrowshahi, Lynn; Agnew, Abby; Olali, Esther; Devi, Gayatri
2008 Apr;56(4):772-774, Journal of the American Geriatrics Society
— id: 93727, year: 2008, vol: 56, page: 772, stat: Journal Article,

A double-blind, placebo-controlled trial of donepezil for the treatment of menopause-related cognitive loss
Devi, G; Massimi, S; Schultz, S; Khosrowshahi, L; Laakso, UK
2007 NOV-DEC ;14(6):1094-1094, Menopause
— id: 98155, year: 2007, vol: 14, page: 1094, stat: Journal Article,

A double-blind, placebo-controlled trial of donepezil for the treatment of menopause-related cognitive loss
Devi, Gayatri; Massimi, Steve; Schultz, Sarah; Khosrowshahi, Lynn; Laakso, Ulla K
2007 Dec;4(4):352-358, Gender medicine
BACKGROUND: Perimenopausal and menopausal women are more likely to complain of memory loss than are premenopausal women, although the association between menopause and cognitive loss remains controversial. Recently published studies on the risks of hormone therapy have left many women and their physicians seeking effective nonhormonal treatments for menopausal symptoms, including cognitive loss. OBJECTIVE: This study investigated the efficacy of the cholinesterase agent donepezil in the treatment of menopause-related cognitive loss. METHODS: Community-dwelling women in natural menopause were recruited for a randomized, double-blind, placebo-controlled study of donepezil. To qualify for enrollment, the Brief Cognitive Rating Scale was used to determine cognitive symptoms, and women with depression were excluded. Subjects were randomized to receive either donepezil, commencing at 5 mg/d, or placebo. At week 6 of randomization, the dosage of donepezil was increased to 10 mg/d. Treatment continued throughout the 26-week study. The primary outcome measure was the overall change in neurocognitive test results over time. Outcome variables of test scores were analyzed before and after receipt of donepezil or placebo. RESULTS: A total of 28 women aged 46 to 60 years were enrolled. Fourteen women were randomized to receive active drug, 14 to placebo. Two women dropped out of the placebo group. There were no statistically significant differences between treatment groups in post-/pre-dose mean score ratios. No interactions were statistically significant. The P values for tests of equal variances did not reveal a difference in the means. Subjective measures did show some trends toward improvement in memory and cognition. CONCLUSION: Donepezil was no more effective than placebo in treating the symptoms of menopause- related memory and cognitive loss
— id: 93728, year: 2007, vol: 4, page: 352, stat: Journal Article,

Motor disorders in dementia syndromes
Devi G
Motor disorders Philadelphia PA : Lippincott Williams & Wilkins, 2005,
— id: 4597, year: 2005, vol: , page: ?, stat: Chapter,

Prevalence of memory loss complaints and other symptoms associated with the menopause transition: a community survey
Devi, Gayatri; Hahn, Katherine; Massimi, Stephen; Zhivotovskaya, Emiliya
2005 Dec;2(4):255-264, Gender medicine
BACKGROUND: Complaints of memory loss are increasingly noted as part of the constellation of symptoms experienced in the menopause transition. Studies evaluating such complaints in this population have yielded varying results. OBJECTIVE: The aim of this study was to determine if complaints of memory loss are a component of the menopause transition and a part of the menopausal symptom complex in a population of women not selected for menopausal symptoms. METHODS: Faculty members of a Long Island, New York, school district were asked to participate ina survey of menopausal symptoms. Demographic data were analyzed using chi(2) statistics. The presence or absence of memory complaints, hot flashes/night sweats, vaginal dryness, depression, reduced libido, and incontinence were analyzed as dichotomous variables in a logistic regression analysis after adjusting for demographic differences. RESULTS: Seventy-two percent (375/521) of the faculty members in the school district were eligible;of these, 217 (58%) completed the survey. After excluding pregnant women, those with hysterectomies or other nonmenopausal causes of amenorrhea, and those aged <30 or >60 years, 151 women were included in the analysis. Of these, 103 (68%) were experiencing natural menopause or perimenopause and 48 (32%) had no changes in menstrual cycle (the comparison group). The menopausal women were significantly older than the women in the comparison group (mean [SD] 51.2 [5.0] years vs 39.6 [7.2] years; P < 0.001), and they were more likely to be white than the women in the comparison group (P < 0.001). Menopausal women were several-fold more likely to complain of memory loss (odds ratio [OR], 3.2; 95% CI, 1.2-8.8; P < 0.02), hot flashes/night sweats (OR, 4.3; 95% CI, 1.4-13.3; P < 0.01), and reduced libido (OR, 4.5; 95% CI, 1.3-15.7; P < 0.02) than were women in the comparison group, after adjusting for differences in age and race. There were no significant differences in the prevalence of depression, vaginal dryness, or incontinence. CONCLUSIONS: In our exploratory survey, complaints of memory loss were a part of the symptom complex of the menopause transition, as were hot flashes and reduced libido. Longitudinal followup of women with these symptoms may be helpful in understanding the menopause transition in women
— id: 74310, year: 2005, vol: 2, page: 255, stat: Journal Article,

Ovarian sex cord tumour with annular tubules diagnosed by fine needle aspiration cytology--a case report
Premalata, Chennagiri S; Amirtham, Usha; Devi, Gayatri; Biswas, Siddartha; Ud, Bafna; Umadevi, K
2005 Jul;48(3):358-360, Indian journal of pathology & microbiology
Sex cord tumor with annular tubules (SCTAT) is a rare ovarian neoplasm with distinctive morphological features whose cytological features have rarely been described. We report a case of SCTAT diagnosed on fine needle aspiration cytology (FNAC) with a brief review of literature. A 35 year old female presented with recurrent abdominal mass. Fine needle aspiration was done under ultra sound guidance. Cytology smears showed three dimensional tubular structures, metachomatic hyaline masses and uniform neoplastic cells dispersed and in cohesive clusters. Cell block study showed the characteristic simple and complex tubules leading to the diagnosis. The cytological findings of a rare ovarian neoplasm are described, which is only the third such report in English literature. The cytologic features of ovarian SCTAT are as distinctive as its histologicfeatures. Cell block study brings out the distinctive architecture of the tumor and helps in differentiating it from other closely related tumors
— id: 93729, year: 2005, vol: 48, page: 358, stat: Journal Article,

What your doctor may not tell you about Alzheimer's disease : the complete guide to preventing, treating, and coping with memory
Devi, Gayatri; Mitchell, Deborah R
New York : Warner Books, 2004,
— id: 1355, year: 2004, vol: , page: , stat: ,

A comparison of family history of psychiatric disorders among patients with early- and late-onset Alzheimer's disease
Devi, Gayatri; Williamson, Jennifer; Massoud, Fadi; Anderson, Karen; Stern, Yaakov; Devanand, D P; Mayeux, Richard
2004 Winter;16(1):57-62, Journal of neuropsychiatry & clinical neurosciences
OBJECTIVE: Both early-onset Alzheimer's Disease (EOAD) and late-onset Alzheimer's Disease (LOAD) present with cognitive and psychiatric features. Some studies suggest that EOAD patients are more likely than LOAD patients to have psychiatric symptoms. If this is true, relatives of EOAD patients with a similar clinical presentation may be more likely to be misclassified as having a primary noncognitive psychiatric disorder rather than a dementing disorder. Family history studies may underestimate familial aggregation of EOAD. METHODS: The authors compared the presence of psychiatric symptoms in parents and siblings of 131 EOAD patients (diagnosed at or before age 60), with the parents and siblings of 131 LOAD patients (diagnosed at or after age 65). Early onset Alzheimer's Disease and LOAD patients were matched for diagnosis (probable versus possible AD), gender, and ethnic group. Logistic regression analysis was performed on the outcome variable of patient group (EOAD, LOAD) with family history of psychiatric symptoms as the risk factor, adjusting for family size and patient's education. RESULTS: There was a nearly two and one-half-fold increase in family history of psychiatric symptoms among EOAD patients when compared with LOAD patients (RR = 2.4; 95% C.I. 1.2-4.7). CONCLUSIONS: The authors found preliminary evidence of a higher prevalence of a history of psychiatric symptoms among relatives of EOAD patients when compared to LOAD patients. This may be due to differential misclassification of AD, a syndromic disorder with both noncognitive psychiatric and cognitive deficits in relatives of EOAD patients. Alternatively, shared genetic or other familial etiologies may underlie subtypes of EOAD and some psychiatric disorders
— id: 61394, year: 2004, vol: 16, page: 57, stat: Journal Article,

Management of drug and alcohol withdrawal
Devi, Gayatri
2003 Jul 24;349(4):405-407, New England journal of medicine
— id: 61395, year: 2003, vol: 349, page: 405, stat: Journal Article,

Review of Diseases of the Nervous System: Clinical Neuroscience and Therapeutic Principles (3rd Edition)
Devi, Gayatri
2003 ;15(3):381-382 Sum, Journal of neuropsychiatry & clinical neurosciences
More than 220 distinguished contributors from 14 countries and six continents collaborated on this encyclopedic treatise of neurology. The editors state that their purpose is 'not to focus on incidence, natural history, phenomenology... (but) on mechanisms of neurological disease and the principles that form the basis for management and therapeutics.' According to the reviewer, they admirably achieve this goal, providing a forum for elegant explanations of the pathophysiologic underpinnings of many brain disorders, with but a few regrettable oversights.
— id: 74311, year: 2003, vol: 15, page: 381, stat: Journal Article,

Surface, core, and X genes of hepatitis B virus in hepatocellular carcinoma: an in situ hybridization study
Jayshree, Rudrapatna S; Sridhar, Hema; Devi, Gayatri M
2003 Feb 25;99(1):63-67, Cancer
BACKGROUND: The incidence of hepatocellular carcinoma (HCC) and the seroprevalence of hepatitis B virus (HBV) in this disease state are significantly higher in South India than in North India. Because data on serologic studies do not project the actual association between the two parameters, this study was undertaken. METHODS: The prevalence of HBV genes in HCC patients was studied using nonisotopic in situ hybridization. Fifty patients from South India were diagnosed with HCC after performing ultrasound-guided fine-needle aspiration biopsies of liver lesions. The diagnosis was confirmed by cell block studies. Sections cut from paraffin-embedded cell blocks made out of the aspirates were probed with digoxigenin-labeled surface, core, and X regions of the viral genome. RESULTS: Nuclear integration of the surface gene was observed in 100% (50 of 50), the core gene was positive in 94% (47 of 50), and the X gene was present in 98% (49 of 50) of the cases. An episomal form of the virus was not found. Serum hepatitis B surface antigen was positive only in 48% (12 of 25) of the patients screened. CONCLUSIONS: We found molecular evidence that HBV is an important contributing factor in the etiology of HCC in South India. In HCC, the S gene of the virus was the most prevalent followed by the X and C genes. Only integrated forms of the viral DNA were observed. Nonisotopic in situ hybridization using multiple regions of the viral genome is a good technique for studying this association. It has an added advantage over polymerase chain reaction, of localization of signals in a tumor cell. Cell blocks made from fine-needle aspirates are ideal for in situ hybridization
— id: 93730, year: 2003, vol: 99, page: 63, stat: Journal Article,

My patient, the doctor, and me
Devi G
This side of doctoring : reflections from women in medicine Thousand Oaks CA : Sage Publications, 2002,
— id: 4598, year: 2002, vol: , page: ?, stat: Chapter,

"Diagnosis and Management of Dementia: a manual for memory disorders teams" / Ed. Wilcock GK, Bucks RS, Rockwood K [Book
Devi G
2000 ;12:281-282, Journal of neuropsychiatry & clinical neurosciences
— id: 74330, year: 2000, vol: 12, page: 281, stat: Journal Article,

Novel presenilin 1 mutations associated with early onset of dementia in a family with both early-onset and late-onset Alzheimer disease
Devi, G; Fotiou, A; Jyrinji, D; Tycko, B; DeArmand, S; Rogaeva, E; Song, Y Q; Medieros, H; Liang, Y; Orlacchio, A; Williamson, J; St George-Hyslop, P; Mayeux, R
2000 Oct;57(10):1454-1457, Archives of neurology
Two children of an adult with early-onset, autopsy-confirmed Alzheimer disease (AD) developed dementia in their late 20s and were subsequently found to have novel mutations in codon 434 of the presenilin 1 (PS1) gene on chromosome 14, a G-to-T substitution at nucleotide 1548 and a C-to-G substitution at nucleotide 1549. The younger of the 2 children had AD confirmed at postmortem examination. The disease course in these 3 individuals was characterized by cognitive and behavioral problems accompanied by myoclonus, seizures, and aphasia within 5 years after onset. Two grandparents had clinically diagnosed AD with stroke beginning at ages 78 and 66 years, but neither had a PS1 mutation. No other living family member was demented, nor did any other family member have the PS1 mutation. We conclude that the affected parent of the proband was a likely recent founder for these novel mutations in PS1. The family demonstrates the clinical and genetic heterogeneity of AD. Arch Neurol. 2000;57:1454-1457
— id: 74316, year: 2000, vol: 57, page: 1454, stat: Journal Article,

Familial aggregation of Alzheimer disease among whites, African Americans, and Caribbean Hispanics in northern Manhattan
Devi, G; Ottman, R; Tang, M X; Marder, K; Stern, Y; Mayeux, R
2000 Jan;57(1):72-77, Archives of neurology
BACKGROUND: Alzheimer disease (AD) aggregates in families. OBJECTIVE: To compare the familial aggregation and lifetime risk of AD to the age of 90 years in the first-degree relatives of patients with AD and unrelated controls among Caribbean Hispanics, African Americans, and whites in Washington Heights, Manhattan, New York, NY. METHODS: Family history of AD and demographic information were obtained from informants of 435 patients with probable or possible AD concerning 1577 siblings and parents and from 1094 controls without dementia concerning 3952 siblings and parents. RESULTS: Lifetime risk of AD to the age of 90 years was 25.9% in relatives of patients and 19.1% in relatives of controls. Rate ratio (RR) for AD in relatives of patients compared with relatives of controls was 1.5 overall (95% confidence interval [CI], 1.2-1.9), and was greater for siblings (RR, 1.8; 95% CI, 1.2-2.5) than for parents (RR, 1.2; 95% CI, 0.9-1.8). Within ethnic groups, RR for AD among relatives was significantly elevated in whites (RR, 2.0; 95% CI, 1.2-3.3) and Hispanics (RR, 1.5; 95% CI, 1.1-2.1), but the difference did not reach statistical significance in African Americans (RR, 1.4; 95% CI, 0.7-2.7). Risk of AD was greater among relatives who were women compared with men (RR, 1.5; 95% CI, 1.2-1.9). CONCLUSIONS: Familial aggregation of AD was increased among families of patients compared with those of controls in all 3 ethnic groups. Risk of AD was highest among siblings and women relatives
— id: 74315, year: 2000, vol: 57, page: 72, stat: Journal Article,

Approaches to memory loss in neuropsychiatric disorders
Devi, G; Silver, J
2000 Oct;5(4):259-265, Seminars in clinical neuropsychiatry
Many neuropsychiatric disorders affect memory. Brain regions important in the neuroanatomic substrate of memory include the hippocampus, and sections of the frontal, temporal, and parietal cortices and the thalamus. Acetylcholine and many other neurotransmitters and neuromodulators including dopamine, glutamate, GABA, the catecholamines, and estrogen modulate cognitive function. Treatment approaches to memory loss typically use Alzheimer's dementia as the template, and are discussed in this report
— id: 74318, year: 2000, vol: 5, page: 259, stat: Journal Article,

Estrogen memory and menopause : 136 questions and answers on the symptoms and treatment of hormone related memory and mood
Devi, Gayatri
Plymouth VT : Five Corners Publications, 2000,
— id: 1356, year: 2000, vol: , page: , stat: ,

Estrogen memory and menopause : 136 questions and answers on the symptoms and treatment of hormone related memory and mood
Devi, Gayatri
New York : Alphasigma Books, 2000,
— id: 1357, year: 2000, vol: , page: , stat: ,

The role of routine laboratory studies and neuroimaging in the diagnosis of dementia: a clinicopathological study
Massoud, F; Devi, G; Moroney, J T; Stern, Y; Lawton, A; Bell, K; Marder, K; Mayeux, R
2000 Oct;48(10):1204-1210, Journal of the American Geriatrics Society
OBJECTIVE: To determine the neuropathological diagnoses of longitudinally followed patients with potentially reversible causes of dementia and to examine the results of the 'dementia work-up,' especially neuroimaging, by comparison with the pathological diagnosis. DESIGN: A neuropathologic series of 61 consecutive patients, with review of clinical, laboratory, neuroimaging, and pathological results. RESULTS: Of the 61 patients, forty-eight (79%) had a clinical diagnosis of probable or possible Alzheimer's disease (AD). Compared with the pathological diagnosis, the sensitivity and specificity of the clinical diagnosis of AD were 96% and 79%, respectively. Of the 61 patients, 9 had abnormal laboratory tests, the correction of which did not improve the subsequent course. These patients were found to have AD8 and frontotemporal dementia on pathology. In two patients, neuroimaging was helpful in the clinical diagnoses of frontotemporal dementia and progressive supranuclear palsy (PSP). Neuroimaging revealed cerebrovascular disease in 18 patients, only two of whom were suspected clinically. Pathology confirmed AD in 17 and PSP in 1 of these patients. Sensitivity and specificity for the clinical diagnosis of cerebrovascular disease in comparison with pathology were 6% and 98%, respectively. With the added information from neuroimaging, that sensitivity increased to 59% and specificity decreased to 81%. CONCLUSIONS: All cases with abnormal laboratory or neuroimaging results had AD or some other neurodegenerative disease on pathology. The 'dementia work-up' did not reveal any reversible causes for dementia in this group of patients. Neuroimaging may have a role, especially in the diagnosis of possible AD with concomitant cerebrovascular disease
— id: 74317, year: 2000, vol: 48, page: 1204, stat: Journal Article,

Clinical features of very early onset (ages 27-35) familial Alzheimer's disease
Devi G; Fotiou A; Gonzalez A; et al
1999 ;11:139-139, Journal of neuropsychiatry & clinical neurosciences
— id: 74331, year: 1999, vol: 11, page: 139, stat: Journal Article,

Influence of APOE genotype on familial aggregation of AD in an urban population
Devi, G; Ottman, R; Tang, M; Marder, K; Stern, Y; Tycko, B; Mayeux, R
1999 Sep 11;53(4):789-794, Neurology
OBJECTIVE: To examine the influence of the proband's APOE genotype on AD among first-degree relatives in a community-based study of African Americans, whites, and Caribbean Hispanics. METHODS: History of AD and demographic information were obtained on 1,073 siblings and parents of 312 patients with AD and 2,722 siblings and parents of 802 nondemented controls. APOE genotyping was performed on all 1,114 patients and controls. RESULTS: A higher proportion of patients with AD (35%) than controls (27%) had one or more APOE-epsilon4 alleles (p = 0.03). When compared with relatives of controls without an APOE-epsilon4 allele, the risk for AD was increased in first-degree relatives of both patients (rate ratio [RR] = 1.9, 95% confidence interval [CI] = 1.2 to 3.1) and controls (RR = 1.8, 95% CI = 1.2 to 2.6) with one or more APOE-epsilone alleles, regardless of ethnic group. There was a similar trend of increased risk in relatives of patients without an APOE-epsilon4 allele, but this was limited to Hispanics and African Americans. CONCLUSIONS: The presence of an APOE-epsilon4 allele increases risk for AD among first-degree relatives, regardless of the probands' disease status, among all ethnic groups. Relatives of patients without an APOE-epsilon4 allele were also at increased risk for AD among Hispanics and African Americans, suggesting that other genes or risk factors may influence risk
— id: 74313, year: 1999, vol: 53, page: 789, stat: Journal Article,

Alois Alzheimer, neuroscientist (1864-1915)
Devi, G; Quitschke, W
1999 Jul-Sep;13(3):132-137, Alzheimer disease & associated disorders
Little is known about the person behind the eponymous dementia, Alois Alzheimer. We wished to study his life and contributions to the field of neuroscience. All cited articles about Alzheimer by his contemporaries and selected correspondence by him was translated from German. Additional personal information was obtained from his granddaughter. Alois Alzheimer made seminal contributions to the field of neuroscience, not only through his own research but also through the numerous scientists and physicians whom he taught. His contributions made a lasting impact not only in the area of Alzheimer disease but also other aspects of brain disease. In addition, he emerges as a complex person who coped successfully with numerous personal and career-related dilemmas that remain relevant in the academic environment today
— id: 74312, year: 1999, vol: 13, page: 132, stat: Journal Article,

A clinicopathological comparison of community-based and clinic-based cohorts of patients with dementia
Massoud, F; Devi, G; Stern, Y; Lawton, A; Goldman, J E; Liu, Y; Chin, S S; Mayeux, R
1999 Nov;56(11):1368-1373, Archives of neurology
OBJECTIVES: To compare the sensitivity and specificity of the clinical diagnosis of Alzheimer disease, the distribution of pathological causes, and the demographic and clinical characteristics of 2 different groups of patients with dementia. DESIGN: Retrospective clinicopathological study. SETTING: A memory disorder clinic in a university hospital and a multiethnic community. PATIENTS: Sixty-three patients from a memory disorder clinic and 26 patients from a large community-based study who underwent autopsy after clinical evaluation. MAIN OUTCOME MEASURES: Differential distribution of clinical and pathological findings, with clinicopathological correlations. RESULTS: Clinic patients were younger at diagnosis, more educated, and more likely to be white. Of the 63 clinic patients we evaluated, 29 (46%) had a pathological diagnosis of definite AD, 15 (24%) had a diagnosis of mixed AD, and 19 (30%) had a diagnosis of another type of dementia. The pathological diagnoses in the community patients were distributed as follows: 6 (23%) had definite AD, 6 (23%) had mixed AD, 6 (23%) had cerebrovascular disease, and 8 (31%) had another type of dementia. The difference in distribution of pathological diagnoses between these 2 groups was only significant for cerebrovascular diseases. For patients seen at the clinic, the sensitivity of the clinical diagnosis of AD was 98% and the specificity was 84%; for the community group, the sensitivity was 92% and the specificity was 79%. CONCLUSIONS: The difference in sensitivity and specificity of clinical diagnosis was not statistically significant between the groups of clinic patients and community patients. Dementia associated with cerebrovascular disease was more prevalent in the community sample. This difference may be attributable to clinical and demographic differences between the 2 groups
— id: 74314, year: 1999, vol: 56, page: 1368, stat: Journal Article,

Validity of family history for the diagnosis of dementia among siblings of patients with late-onset Alzheimer's disease
Devi, G; Marder, K; Schofield, P W; Tang, M X; Stern, Y; Mayeux, R
1998 ;15(3):215-223, Genetic epidemilogy
We examined 180 siblings of 127 probands with probable or possible Alzheimer's dementia (AD) in a family study of AD. The overall sensitivity of a simple family history questionnaire was 64% and the specificity was 84%. Sensitivity improved 90-100% with minimal decline in specificity when we considered clinic-based vs. population survey patients. Higher education among informants and the availability of a spouse or a sibling as informant significantly increased sensitivity. Awareness of such factors may improve the yield of the family history in AD using a simple questionnaire
— id: 74319, year: 1998, vol: 15, page: 215, stat: Journal Article,

Familial aggregation of Alzheimer's disease and the influence of apolipoprotein E genotype in Caucasians, African Americans, and Caribbean Hispanic populations in northern Manhattan
Devi, G; Ottman, R; Tang, MX; Marder, K; Tyko, B; Stern, Y; Mayeux, R
1998 SEP ;44(3):496-496, Annals of neurology
— id: 74329, year: 1998, vol: 44, page: 496, stat: Journal Article,

Estrogen in Alzheimer's Disease
Devi G
1997 ;4(10):58-63, Primary Psychiatry
— id: 74332, year: 1997, vol: 4, page: 58, stat: Journal Article,

Alois Alzheimer : influential alienist
Devi G; Loreck R
1997 ;48:263-263, Neurology
— id: 74333, year: 1997, vol: 48, page: 263, stat: Journal Article,

Safety and tolerability of the antioxidant OPC-14117 in HIV-associated cognitive impairment
Kieburtz, K; Schifitto, G; McDermott, M; Heo, M; Irvine, C; Palumbo, D; Orme, C; Zimmerman, C; Gelbard, H; Hickey, C; Casaceli, C; Guthrie, B; Rumfola, L; Epstein, L; Marder, K; Ramachandran, G; Albert, S; Dooneief, G; Stern, Y; Todak, G; FriedmanClouse, R; Polanco, C; Winston, T; Mayeux, R; DalPan, G; Selnes, O; Sacktor, N; Hasenauer, D; Esposito, D; NanceSproson, L; McArthur, JC; Shoulson, I; Oakes, D; Reichman, R; OSullivan, J
1997 JUL ;49(1):142-146, Neurology
Cognitive impairment is a common and disabling complication of advanced HIV infection. Antiretroviral agents are the only proven therapies currently used for the treatment of HIV dementia, but the response to these agents is frequently unsatisfactory, short-lived, or complicated by intolerable side effects. We hypothesized that OPC-14117, a lipophilic antioxidant that acts to scavenge superoxide anion radicals, might ameliorate the toxic interactions between HIV infected macrophages and neurons. We conducted a double-blind, placebo-controlled, randomized clinical trial to assess the safety and tolerability of OPC-14117 240 mg per day. All 30 patients enrolled (15 per group) had cognitive impairment based on performance on neuropsychological tests. The primary outcome was tolerability of the study drug as measured by the proportion of subjects able to complete the study on their assigned dosage of experimental medication. Overall OPC-14117 was as well tolerated as placebo. Five subjects withdrew because of adverse experiences (two placebo, three OPC-14117). The OPC-14117-treated group had better scores on a clinical global impression scale, compared with the placebo group. There were trends toward improvement in the cognitive test scores; however, these changes were not statistically significant. These results demonstrate that this antioxidant intervention is well tolerated in cognitively impaired patients with advanced HIV infection, and suggest that a larger efficacy trial to assess the impact of OPC-14117 on cognitive performance is warranted
— id: 74326, year: 1997, vol: 49, page: 142, stat: Journal Article,

Incidence of extrapyramidal syndromes in AIDS patients and a comparison group of medically ill inpatients
Ramachandran, G; Glickman, L; Levenson, J; Rao, C
1997 Fall;9(4):579-583, Journal of neuropsychiatry & clinical neurosciences
The authors retrospectively reviewed the charts of 29 inpatients with AIDS and 24 medically ill inpatients, all of whom were exposed to neuroleptics. Results adjusted for age, gender, type and dosage of neuroleptic, and extrapyramidal prophylaxis indicated that inpatients with AIDS were 7 times more likely to develop extrapyramidal syndromes (EPS) from neuroleptics than the comparison group of medically ill inpatients. Possible neuroanatomic, neuropathologic, and neurochemical reasons for the vulnerability of patients with AIDS to EPS are reviewed
— id: 74323, year: 1997, vol: 9, page: 579, stat: Journal Article,

Clinical confirmation of the American Academy of Neurology algorithm for HIV-associated cognitive/motor disorder
Marder, K; Albert, S; Dooneief, G; Stern, Y; Ramachandran, G; Todak, G; FriedmanClouse, R; Polanco, C; Winston, T; Schofield, P; Mayeux, R; Pan, GD; Selnes, O; Sacktor, N; Hasenauer, D; Esposito, D; NanceSproson, L; McArthur, J; Kieburtz, K; Schifitto, G; McDermott, M; Palumbo, D; Orme, C; Zimmerman, C; Gelbard, H; Hickey, C; Casaceli, C; Guthrie, B; Rumfola, L; Epstein, L
1996 NOV ;47(5):1247-1253, Neurology
Objective: Our goal was to put into operation the American Academy of Neurology (AAN) algorithm for the definition of minor cognitive/motor disorder and human immunodeficiency virus type 1 (HIV-1)-associated dementia complex (ADC) and examine the neuropsychological, neurologic, psychiatric, and functional deficits in affected subjects. Design: Two hundred seventy-one HIV-positive men and women with CD4 count of <200 or demonstrated cognitive impairment were recruited from three sites (Columbia University, The Johns Hopkins University, and the University of Rochester) and underwent standardized assessments. Results: Sixty-five subjects met criteria for ADC (cognitive, functional, and neurologic or behavioral), 56 met criteria for minor cognitive/motor disorder, and 150 met criteria for neither. Seventy-eight subjects met neuropsychological and neurologic/behavioral criteria but did not demonstrate functional impairment. Those with ADC performed significantly worse on speeded motor and verbal memory tests and demonstrated more extrapyramidal signs and behavioral symptoms than did the other two groups. Both ADC and minor cognitive/motor disorder were independently predictive of poor physical function, after adjustment for age, gender, years of education, log (CD4 count), hemoglobin, number of HIV diagnoses and medications, and depression. Conclusions: The operationalization of AAN criteria demonstrates that it is rare to have both cognitive and functional impairment without associated neurologic and/or behavioral deficits. Functional impairment in isolation is also rare. Dementia is an independent predictor of physical function
— id: 74327, year: 1996, vol: 47, page: 1247, stat: Journal Article,

A preliminary study of apolipoprotein E genotype and psychiatric manifestations of Alzheimer's disease
Ramachandran, G; Marder, K; Tang, M; Schofield, P W; Chun, M R; Devanand, D P; Stern, Y; Mayeux, R
1996 Jul;47(1):256-259, Neurology
We evaluated the frequency of depression and psychosis in 46 patients with AD and 135 control subjects with the apolipoprotein (APO) E3/3 or E3/4 genotype. Patients with AD and the APOE3/4 genotype had a more than threefold increase in the signs of depression and psychosis when compared with either patients with the APOE3/3 genotype or to control subjects. Our preliminary study suggests that the phenotype of AD associated with the epsilon 4 allele is more likely to include psychiatric manifestations
— id: 74324, year: 1996, vol: 47, page: 256, stat: Journal Article,

A simple auditory oddball task in young adult males at high risk for alcoholism
Ramachandran, G; Porjesz, B; Begleiter, H; Litke, A
1996 Feb;20(1):9-15, Alcoholism: clinical & experimental research
The reduction in the amplitude of the auditory P300 in young adult males at high risk for alcoholism has not been as consistently replicated as has been the reduction in the visual P300 amplitude in the same group. The easier nature of the auditory task was thought to be responsible for the inconsistency. We examined the auditory P300 amplitude in a group that has not yet been studied, young adult sons of alcoholics (mean age = 24.9 years, n = 48), and compared them with age and sex-matched controls (mean age = 27.8 years, n = 23). We found the auditory P300 amplitude to be reduced in the high-risk group and this reduction to be the greatest over the posterior centroparietal and occipital areas when individual leads were examined. We further analyzed the data using current source density, a mathematical transformation that circumvents some of the errors inherent in measuring scalp-evoked potentials, and found reduced current source density in the high-risk group in the posterior central and parietal areas. Thus, we found that a simple auditory oddball task was effective in eliciting P300 differences in groups at high and low risk for alcoholism. The clinical significance of the P300 is discussed, as well as the relevance of task difficulty in eliciting auditory P300 differences in young males at high risk for alcoholism
— id: 74325, year: 1996, vol: 20, page: 9, stat: Journal Article,

Subjective memory complaints predict decline in memory and cognition at 1-year follow-up in individuals with cognitive impairment
Schofield, P; Marder, K; Dooneief, G; Bell, K; Chun, M; Ramachandran, G; Jacobs, DM; Sano, M; Stern, Y
1996 FEB ;46(2):6017-6017, Neurology
— id: 74328, year: 1996, vol: 46, page: 6017, stat: Journal Article,