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Anthony Winter, MD

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NCBI: db=pubmed; Term=(winter s[Author] or winter as[Author]) AND (John Peter Smith[Affiliation] OR JPS Health Network[Affiliation] OR JPS [Affiliation] OR University of North Texas Health Science Center [Affiliation] NOT Japan Pancreas Society[Affiliation])
Updated: 14 hours 12 min ago

Total testosterone and neuropsychiatric symptoms in elderly men with Alzheimer's disease.

Wed, 01/30/2019 - 07:27
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Total testosterone and neuropsychiatric symptoms in elderly men with Alzheimer's disease.

Alzheimers Res Ther. 2015;7(1):24

Authors: Hall JR, Wiechmann AR, Cunningham RL, Johnson LA, Edwards M, Barber RC, Singh M, Winter S, O'Bryant SE, Texas Alzheimer’s Research and Care Consortium

Abstract
INTRODUCTION: There has been a significant increase in the use of testosterone in aging men, but little investigation into its impact on men with Alzheimer's disease (AD). The findings of the few studies that have been done are inconsistent. In the present study, we investigated the relationship between total testosterone (TT) and neuropsychiatric symptoms (NPS) in a well-characterized sample of elderly men with mild to moderate AD.
METHODS: The sample, which was drawn from the Texas Alzheimer's Research Care Consortium Longitudinal Research Cohort, included 87 men who met the criteria for mild to moderate AD. The occurrence of NPS was gathered from caregivers and/or family members with the Neuropsychiatric Inventory. TT was analyzed, and the sample was divided into a low-testosterone group (TT ≤2.5 ng/ml; n = 44) and a borderline/normal group (TT ≥2.6 ng/ml; n = 43).
RESULTS: TT was correlated with symptoms of hallucinations, delusions, agitation, irritability and motor activity. The borderline/normal group was significantly more likely to have hallucinations (odds ratio (OR) = 5.56), delusions (OR = 3.87), motor activity (OR = 3.13) and irritability (OR = 2.77) than the low-testosterone group. Health status and apolipoprotein E ε4 status were not significant factors.
CONCLUSIONS: The findings of the present study have implications for the use of testosterone replacement therapy in men with AD or the prodromal stage of the disease.

PMID: 25937840 [PubMed]

Biomarkers of vascular risk, systemic inflammation, and microvascular pathology and neuropsychiatric symptoms in Alzheimer's disease.

Wed, 01/30/2019 - 07:27
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Biomarkers of vascular risk, systemic inflammation, and microvascular pathology and neuropsychiatric symptoms in Alzheimer's disease.

J Alzheimers Dis. 2013;35(2):363-71

Authors: Hall JR, Wiechmann AR, Johnson LA, Edwards M, Barber RC, Winter AS, Singh M, O'Bryant SE

Abstract
Numerous serum and plasma based biomarkers of systemic inflammation have been linked to both neuropsychiatric disorders and Alzheimer's disease (AD). The present study investigated the relationship of clinical biomarkers of cardiovascular risk (cholesterol, triglycerides, and homocysteine) and a panel of markers of systemic inflammation (CRP, TNF-α, IL1-ra, IL-7, IL-10, IL-15, IL-18) and microvascular pathology (ICAM-1, VCAM-1) to neuropsychiatric symptoms in a sample with mild AD. Biomarker data was analyzed on a sample of 194 diagnosed with mild to moderate probable AD. The sample was composed of 127 females and 67 males. The presence of neuropsychiatric symptoms was gathered from interview with caretakers/family members using the Neuropsychiatric Inventory. For the total sample, IL-15, VCAM (vascular adhesion molecule), and triglycerides were significantly and negatively related to number of neuropsychiatric symptoms, and total cholesterol and homocysteine were positively related and as a group accounted for 16.1% of the variance. When stratified by gender, different patterns of significant biomarkers were found with relationships more robust for males for both total symptoms and symptom clusters. A combination of biomarkers of systemic inflammation, microvascular pathology, and clinical biomarkers of cardiovascular risk can account for a significant portion of the variance in the occurrence of neuropsychiatric symptoms in AD supporting a vascular and inflammatory component of psychiatric disorders found in AD. Gender differences suggest distinct impact of specific risks with total cholesterol, a measure of cardiovascular risk, being the strongest marker for males and IL-15, a marker of inflammation, being the strongest for females.

PMID: 23403534 [PubMed - indexed for MEDLINE]

Characteristics and psychosocial predictors of psychiatric emergency center transport and length of stay in patients with dementia and Alzheimer's disease: a preliminary report.

Wed, 01/30/2019 - 07:27
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Characteristics and psychosocial predictors of psychiatric emergency center transport and length of stay in patients with dementia and Alzheimer's disease: a preliminary report.

J Psychiatr Pract. 2011 Jul;17(4):251-7

Authors: Nejtek VA, Hardy S, Hall JR, Winter AS

Abstract
BACKGROUND: Agitation and aggression are common behaviors that often lead to psychiatric emergency center (PEC) admission of nursing home patients with dementia or Alzheimer's disease. However, few if any data are available that adequately describe characteristics and psychosocial triggers of agitation and aggression leading to transport and admission to a PEC.
METHODS: A preliminary investigation to explore all possible characteristics and psychosocial predictors of PEC transport and length of stay in men and women nursing home patients with dementia or Alzheimer's disease was designed. Frequency distributions, chi-square, analyses of variance, and regression analyses were used to analyze the data.
RESULTS: One hundred PEC patient charts were reviewed, of which 58 charts were missing information and 42 charts provided evaluable data. Nursing homes located in impoverished areas transported patients to the PEC significantly more often than those in affluent areas. A disconnect between the agitated/aggressive mental state reported by nursing home staff leading to the PEC transport and the calm/cooperative mental status PEC clinicians observed during the admission process was evident. Data from the charts also showed that 74% of patients received off-label antipsychotics rather than FDA-approved medications to treat dementia or Alzheimer's disease.
CONCLUSIONS: This is one of the few studies to identify characteristics and psychosocial triggers of PEC use and length of stay in nursing home patients. We also highlight potentially dangerous antipsychotic use in dementia and Alzheimer disease. Thus, our data add to the existing knowledge base regarding PEC utilization, length of stay, and pharmacotherapy in nursing home patients with dementia and Alzheimer's disease. Given the preliminary nature of this study, however, the results should be interpreted with caution.

PMID: 21775826 [PubMed - indexed for MEDLINE]

Adolescent mental health: Challenges with maternal noncompliance.

Wed, 01/30/2019 - 07:27
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Adolescent mental health: Challenges with maternal noncompliance.

Neuropsychiatr Dis Treat. 2010 Apr 07;6:67-9

Authors: Nejtek VA, Hardy S, Winter S

Abstract
The leading cause of suicide ideation, attempts, and completion in adolescents is persistent and unresolved parental conflict. National statistics show extremely high rates of childhood neglect and abuse are perpetrated most often by single mothers. Psychiatric disorders arising from maternal-child dysfunction are well-documented. However, resources to prevent offspring victimization are lacking. Here, we report maternal neglect of a 15-year-old male brought to the psychiatric emergency room for suicidal ideation. An inpatient treatment plan including pharmacotherapy, family therapy and psychological testing was initiated. The patient's mother failed to attend clinic appointments or family therapy sessions. Clinician attempts to engage the mother in the treatment plan was met with verbal assaults, aggression, and threatening behavior. The patient decompensated in relation to the mother's actions. Child Protective Services were contacted and a follow-up assessment with the patient and mother is pending. Psychiatric treatment of the mother may be a necessary intervention and prevention regimen for both the adolescent and the mother. Without consistent Child Protective Services oversight, medical and psychosocial follow-up, the prognosis and quality of life for this adolescent is considered very poor. Stringent mental health law and institutional policies are needed to adequately intercede and protect adolescents with mental illness.

PMID: 20396638 [PubMed]