M F Folstein's research while affiliated with Johns Hopkins University and other places

Publications (106)

Article
Neuropathological examination confirmed the clinical diagnosis of possible or probable Alzheimer disease (AD) in 90 of the first 100 patients who came to autopsy at the Johns Hopkins Alzheimer's Disease Research Center. In 10 cases, postmortem brain examination did not confirm AD but revealed variable patterns of neuronal loss in neocortex and limb...
Article
Evidence suggests that the neuropathology of Huntington's disease, a neuropsychiatric disorder due to a mutation on chromosome 4, results from excessive activation of glutamate-gated ion channels, which kills neurons by oxidative stress. Therefore, the authors hypothesized that alpha-tocopherol, which reduces oxyradical damage to cell membranes, mi...
Article
To detect cases of Alzheimer's disease (AD) in a large population of twins living throughout the United States and to examine concordance for AD in twins as a function of age and genotype for apolipoprotein E (APOE). Nationwide survey. Multistage screening and field evaluation beginning with two telephone interviews and culminating with laboratory...
Article
Several case-control studies have reported head injury to be more common among patients with Alzheimer's disease (AD) than healthy elderly controls. The present study sought to determine whether milder head injury is also a risk factor for AD. Furthermore, it was hypothesized that head injury would be more common among AD patients without a genetic...
Article
We reviewed the records of 210 patients in the Johns Hopkins Alzheimer's Disease Research Center to evaluate the role of nonsteroidal anti-inflammatory drugs (NSAIDs) on clinical features and progression of the disease. We compared patients taking NSAIDs or aspirin on a daily basis (N = 32) to non-NSAID patients (N = 177) on clinical, cognitive, an...
Article
While cognitive and functional deficits are the hallmark of Alzheimer's disease (AD), loss of social function (and the dependence this implies) is also critical, especially in early stages of disease. Little attention has been directed to this facet of dementing disease. We describe a scale for assessing dependency in AD and present a baseline prof...
Article
The aims of this study were to estimate the prevalence and investigate the comorbidity and potential consequences of DSM-III personality disorders in the community. A total of 810 adults were examined in the second stage of the Eastern Baltimore Mental Health Survey in 1981, part of the National Institute of Mental Health Epidemiologic Catchment Ar...
Article
A total of 810 adults were examined by psychiatrists in the second stage of the Eastern Baltimore Mental Health Survey. A semistructured examination, the Standard Psychiatric Examination, was used. The relationships between obsessions and compulsions and personal characteristics, childhood behaviors, family history, and other psychopathology were e...
Article
Quantitative power spectral analysis (PSA) was applied to frontal (F3, F4, F7, F8), temporal (T5, T6), and occipital (O1, O2) EEGs of 16 Huntington's disease (HD) patients and eight healthy control subjects. PSA revealed HD patients' EEGs to be abnormal: (i) raw and percent Alpha power were reduced; (ii) raw and percent Theta power were reduced at...
Article
Over 3 years we followed 8 pairs of male twins one or both of whom had suspected Alzheimer's disease (AD) including 'mild/ambiguous' changes suggestive of incident AD. These pairs were screened in 1988 and 1989 from 339 pairs in the (US) National Academy of Sciences-National Research Council Registry (NASR) of aging veteran twins, then 61-72 years...
Article
Over 3 years we followed 8 pairs of male twins one or both of whom had suspected Alzheimer's disease (AD) including 'mild/ambiguous' changes suggestive of incident AD. These pairs were screened in 1988 and 1989 from 339 pairs in the (US) National Academy of Sciences – National Research Council Registry (NASR) of aging veteran twins, then 61–72 year...
Article
To compare the Mental Alternation Test, a new 60-second bedside test of cognition, with the Mini-Mental State Exam (MMSE) and the Trailmaking Test, parts A and B, in patients with human immunodeficiency virus (HIV) infection. Cohort study. Sixty-two inpatients with HIV infection. The AIDS service of a referral hospital. Scores on the MMSE; the Trai...
Article
To determine the contribution of genetic factors to cognitive functioning in older men. Cognitive testing by telephone interview in an epidemiologically defined population. 2077 monozygotic and 2225 dizygotic male twin pairs, all between the ages of 62 and 73 years, recruited from the National Academy of Sciences twin registry. The Telephone Interv...
Article
The causes of Alzheimer's disease (AD) remain a mystery despite the recent identification of several putative environmental risk factors and the discovery of several linked genetic loci and point mutations associated with the disease. Particularly uncertain is the generalizability of the genetic findings to the common forms of disease encountered i...
Article
The aim of this study was to assess the relationships between specific personality disorders and DSM-III axis I conditions in a community sample. A total of 810 subjects were examined by psychiatrists in the second stage of the Eastern Baltimore Mental Health Survey, part of the Epidemiological Catchment Area Program of the National Institute of Me...
Article
Synopsis Psychiatrists used a semi-structured Standardized Psychiatric Examination method to examine 810 adults drawn from a probability sample of eastern Baltimore residents in 1981. Of the population, 5·9% was found to be significantly depressed. DSM-III major depression (MD) had a prevalence of 1·1% and ‘non-major depression’ (nMD), our collecti...
Article
Linear discriminant analysis was used to construct a series of discriminant functions including subsets of demographic variables and Mini-Mental State Examination item responses for a case series and a population sample. A 9-item discriminant function including the variables for time orientation, recall, calculation, copying a figure, age, writing,...
Article
The presence of mental disorder and cognitive functioning were examined in groups of 20 multiple sclerosis (MS) and homosexual acquired immunodeficiency syndrome (AIDS) ambulatory male outpatients matched for disability and demographic features. Patients who were somatically ill, had past central nervous system infection or tumours or abused intrav...
Article
The Hopkins Competency Assessment Test (HCAT), a brief instrument for evaluating the competency of patients to give informed consent or write advance directives, consists of a short essay and a questionnaire for determining patients' understanding of the essay. In a study to validate the instrument, 41 medical and psychiatric inpatients answered th...
Article
Magnetic resonance imaging and a comprehensive cognitive evaluation were carried out in a series of 29 patients with mild to moderate Huntington's disease (HD). A factor analysis of the neuropsychological test scores provided three factors: a memory/speed-of-processing factor, a "frontal" factor, and a response inhibition factor. The memory/speed f...
Article
The purpose of this study was to determine the frequency and type of psychotic symptoms in patients with probable Alzheimer's disease and to test whether there is a relationship between specific psychotic symptoms and episodes of physical aggression. From 209 patients with possible or probable Alzheimer's disease who had been assessed in a research...
Article
We studied the sleep characteristics of 108 outpatients with probable Alzheimer's disease and found that sleep disturbance was significantly related to daytime behavioral disturbance but not to cognitive impairment. Possible treatment strategies and neuropathological and neurochemical mechanisms are discussed.
Article
SYNOPSIS A two-stage probability sample of community subjects was developed with a full psychiatric examination employing DSM-III criteria in conjunction with the Epidemiological Catchment Area (ECA) survey conducted in Baltimore, MD. This report details the observation on those subjects diagnosed with compulsive personality disorder and compulsive...
Article
We studied the sleep characteristics of 108 outpatients with probable Alzheimer’s disease and found that sleep disturbance was significantly related to daytime behavioral disturbance but not to cognitive impairment. Possible treatment strategies and neu-ropathological and neurochemical mechanisms are discussed. (Aging 3: 193-196, 1991)
Article
To determine the prevalence rates of major depressive disorder and of depressive symptoms and their relationship to mortality in nursing homes, research psychiatrists examined 454 consecutive new admissions and followed them up longitudinally for 1 year. Major depressive disorder occurred in 12.6% and 18.1% had depressive symptoms; the majority of...
Article
The effect of acute, intravenous administration of physostigmine on measures of brain activity and cognitive functioning were investigated in 14 patients with Alzheimer's disease. Regional cerebral glucose metabolism was assessed using (18F)-fluoro-2-deoxy-D-glucose and positron emission tomography, and cerebral blood flow was assessed using 123I-i...
Article
Two hundred ten community-dwelling patients with Alzheimer's disease were examined prospectively by psychiatrists as part of a longitudinal study. Twenty-five of these patients who were institutionalized during the next 3 years were then matched to 25 patients who were not institutionalized, and the groups were compared. The patients who had been i...
Article
Individuals with Down syndrome develop neuropathologic and in some cases clinical evidence of Alzheimer disease after age 40. We compared CT scans of 18 Down syndrome subjects, 26-70 years old (seven of whom satisfied criteria for dementia), with 175 screened normal volunteer control subjects for evidence of cortical and subcortical atrophy. CT sca...
Article
Full-text available
Synopsis In conjunction with the Epidemiological Catchment Area (ECA) survey conducted in Baltimore, MD, a two-stage probability sample of community subjects was developed with a full psychiatric examination employing DSM-III criteria. This report details the observations on those subjects diagnosed with the DSM-III diagnosis Histrionic Personality...
Article
For each of 41 index patients with probable Alzheimer's disease and a first episode of major depression and 71 nondepressed Alzheimer's disease patients, two first-degree relatives were interviewed by a rater blind to presence or absence of depression in the proband. The depressed patients had significantly more first- and second-degree relatives w...
Article
The emergence of Alzheimer's disease from relative obscurity to front-page news is related to the increased life expectancy and increased proportion of the population over 65 years old. About 8 percent of the US elderly population suffer from the disease.
Article
Two psychiatrists, using standardized clinical examinations, found that 21% of 125 patients newly admitted to nursing homes had delusions. The psychiatric disorders associated with these delusions are described. Delusional patients were more behaviorally disturbed before admission than nondelusional patients. These behavior problems were often the...
Article
To investigate whether individuals who suffer from chronic, severe headaches have more personality abnormalities or emotional disorders than their healthy counterparts, 162 young adults with classical migraine, ascertained by community survey, were compared to matched control subjects without migraine. On the General Health Questionnaire, the preva...
Article
The (US) National Academy of Sciences Registry of aging twin veterans contains 15,924 pairs of white male twins born between 1917 and 1927. About 8,000 pairs are living today. In preparation for a study of Alzheimer's disease (AD) in this Registry, we investigated 829 members of pairs living in North and South Carolina, Virginia, in the District of...
Article
Five patients with trisomy 21 (Down's syndrome (DS], referred to us for evaluation of dementia, were instead found to have major depression. All had shown cognitive and behavioural deterioration and this had led to a mistaken diagnosis of Alzheimer's disease in two. We outline and contrast the features of major depression and Alzheimer's disease in...
Article
Underrecognition and undertreatment of affective disorders (i.e., major depressive disorder and bipolar affective disorder) constitute a serious public health problem in this country. The recent availability of sufficient mapped restriction fragment length polymorphism (RFLP) probes to cover the human genome and of improved methods of genetic linka...
Article
In a double-blind, placebo-controlled, crossover study of intravenously administered naloxone hydrochloride, 54 subjects with clinically ascertained Alzheimer's disease tested at three university centers showed no significant improvement in neuropsychological performance after 1-mg or 10-mg doses; 15 patients at 1 center were similarly unimproved a...
Article
In his classic case, Alzheimer described cognitive symptoms such as amnesia, aphasia, and apraxia and noncognitive symptoms such as delusions and agitation. Recent studies have suggested that depression also occurs in Alzheimer's disease. In this study, 144 patients who met criteria for Alzheimer's disease were examined for depression on a modified...
Article
In order to comprehensively evaluate pathological involvement of the locus coeruleus (LC) and cortically projecting raphe nuclei in Alzheimer's disease (AD), we have recently completed a study (Zweig, et al., 1988) in which numbers of neurons containing neuromelanin within the LC and large nucleolus-containing neurons within the dorsal raphe nucleu...
Article
Cognitive performance on the Mini-Mental State Examination (MMSE) was assessed in depressed patients (diagnosis of major depression) with cerebrovascular lesions, with Parkinson's disease, or with functional depression (no known brain lesions). Controls for patients with brain lesions or Parkinson's disease were nondepressed patients with the same...
Article
CT-scan measurements of cortical and subcortical atrophy were carried out in 34 patients with Huntington's disease (HD). While a significant correlation was observed between parameters of subcortical atrophy (bicaudate ratio, bifrontal ratio and third ventricular ratio) and duration of the disease, there was no significant correlation between these...
Article
Full-text available
Measurements of cortical and subcortical atrophy were made on CT scans of 34 patients with Huntington's disease. Significant correlations were found between the bicaudate ratio (BCR) and an eye movement scale (r = 0.44, p less than 0.01), and activities of daily living scale (r = 0.57, p less than 0.001) and the Mini-Mental State Exam (r = 0.49, p...
Article
Neuronal loss and the presence of neurofibrillary tangles (NFTs) within aminergic nuclei were examined in a series of patients with Alzheimer's disease (AD). Neuromelanin-containing neurons within the locus ceruleus and large nucleolus-containing neurons within the dorsal raphe nucleus and the central superior (raphe) nucleus were counted in 25 pat...
Article
A recombinant DNA marker has been identified to predict those individuals who will develop Huntington's Disease. It is important to determine when genotype positive individuals are developing the first manifestations of Huntington's disease. Furthermore, objective preclinical measures of disease would facilitate assessment of potential therapeutic...
Article
The authors describe the Standardized Psychiatric Examination (SPE), a new method for conducting psychiatric examinations in both clinical and research settings that preserves the clinical method. The SPE provides a consistent replicable format for eliciting and recording psychiatric history, signs, and symptoms without perturbing the patient-clini...
Chapter
Clinical features related to age of onset, including amnesia, aphasia, apraxia, agnosia, depression, and fingerprint and platelet abnormalities, suggest heterogeneity in Alzheimer’s disease. Since some of these features run in Alzheimer’s disease families there could be genetic heterogeneity. Understanding the mechanisms which determine the age of...
Article
In a Maryland survey of Huntington disease, the prevalence in blacks was unexpectedly high and equal to that in whites. Age at onset was earlier in blacks, and their clinical features, at all ages at onset, were similar to those seen in juvenile-onset Huntington disease. Blacks had more severe bradykinesia and abnormalities of eye movement and less...
Article
Psychiatric patients with tardive dyskinesia (TD) may be difficult to distinguish from those with Huntington's Disease (HD), who frequently have psychiatric symptoms. This study compared 14 patients with HD with 21 patients (15 schizophrenics and 6 with affective disorder), matched for involuntary movements, using a quantitated neurological examina...
Article
A research psychiatrist using a standardized interview found that 94% of a random sample of residents at a large, intermediate-care nursing home had mental disorders according to DSM-III criteria. Primary degenerative dementia and multi-infarct dementia were the most common diagnoses. In addition, the majority of demented patients also had noncogni...
Article
We investigated all patients in Maryland reported to have Huntington's disease (HD), and found considerable diagnostic inaccuracy. Fifteen percent of cases reported as HD actually had some other diagnosable condition; 11% of cases that met diagnostic criteria for HD had been given some other diagnosis. Diagnostic errors could be reduced by document...
Article
The volume flowmeter is a simple, noninvasive Doppler ultrasound technique that provides accurate measurement of carotid artery diameter and flow. The device provides a useful laboratory test that can aid significantly in diagnosis of carotid stenosis and dementia.
Article
Matched groups of patients suffering from Huntington's disease and Alzheimer's disease were compared for psychiatric morbidity prior to the onset of dementia. The Huntington's disease group showed twice the incidence of major affective disorder. This finding suggests a specific relationship between Huntington's disease and major affective disorder...
Article
We studied DSM-III diagnoses made by the lay Diagnostic Interview Schedule (DIS) method in relation to a standardized DSM-III diagnosis by psychiatrists in the two-stage Baltimore Epidemiologic Catchment Area mental morbidity survey. Generally, prevalence estimates based on the DIS one-month diagnoses were significantly different from those based o...
Article
Clinical criteria for the diagnosis of Alzheimer's disease include insidious onset and progressive impairment of memory and other cognitive functions. There are no motor, sensory, or coordination deficits early in the disease. The diagnosis cannot be determined by laboratory tests. These tests are important primarily in identifying other possible c...
Article
To determine how accurately dementia was diagnosed among medical inpatients, we compared the judgments of medical interns with diagnoses based on standard criteria. Fifty-seven interns rendered opinions regarding the presence of dementia in 380 medical inpatients who were simultaneously examined by physician-investigators applying criteria derived...
Article
The clinical signs of Alzheimer Disease can be quantitated and correlated with neuropathological evidence of the disease. These clinical signs which include amnesia, aphasia and apraxia can be screened for using instruments such as the Mini-Mental State Exam. In addition, each of these cognitive functions can be quantitated using specific tests. St...
Article
Full-text available
Clinical and laboratory methods were developed to detect motor abnormalities in patients with Huntington Disease. For clinical evaluation a quantitated neurological examination was used which factor analyzed into 2 scales: a chorea scale (a measure of involuntary movement) and a motor impairment scale (a measure of abnormalities of voluntary moveme...
Article
The purpose of the current study was to replicate the finding of reduced mood variability among lithium-treated manic-depressives using a more sensitive index of mood variation in order to determine whether a placebo-controlled blinded study would be warranted.
Article
Of 20 patients receiving ECT, those with high anticholinergic drug levels after ECT were at greater risk for developing post-ECT confusional states than were patients with low levels.
Article
The psychiatric manifestations of Huntington's Disease (HD) include dementia, irritability and apathy, a major affective syndrome, and hallucinosis. The theoretical and practical utility of chorea as a focus of research interest in HD is questioned, whereas the data reviewed suggest that assessments of cognition, functional capacity and motor impai...
Article
Nine delirious patients suffering from lithium intoxication were examined with the Mini-Mental State Exam (MMS) to describe the clinical course of the disorder. Serial serum lithium levels were also obtained. Serum lithium levels fell rapidly, but the cognitive impairment associated with the delirium typically persisted for another week or two. Lat...
Article
The reported case describes the onset of complex hallucinations in a previously healthy woman following a right temporoparietoocipital infarction identified by computed tomographic (CT) scan. The case is of interest because of the patient's capacity to report her mental experiences (which were in every way similar to schizophrenic experiences) in g...
Article
Medically ill patients diagnosed at index admission as delirious, i.e., suffering cognitive decline and an altered state of consciousness, had higher fatality rates than demented, cognitively intact or depressed patients. At a one-year follow-up the death rate of those who had been delirious was still higher than that of demented patients. Deliriou...
Article
The Visual Analogue Mood Scale (VAMS) was completed for 30 consecutive days by 124 psychiatric patients and 36 non-patients control subjects. The 64 euthymic manic-depressive patients on chronic lithium therapy had similar mean mood ratings to the non-patient controls, but had lower mood variability as measured either by standard deviation of the m...
Article
During a study of the effect of plasma exchange on glycosphingolipid metabolism, a patient with Fabry's disease noted a dramatic improvement in his painful acroparesthesia. A controlled study was therefore undertaken. Observations were made of nerve conduction times, graded exercise testing, and psychometric evaluations during and after two planned...