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Articles by E Veledar
Total Records ( 3 ) for E Veledar
  L Wang , F.C Goldstein , E Veledar , A.I Levey , J.J Lah , C.C Meltzer , C.A Holder and H. Mao
 

BACKGROUND AND PURPOSE: Mild cognitive impairment (MCI) is a risk factor for Alzheimer disease and can be difficult to diagnose because of the subtlety of symptoms. This study attempted to examine gray matter (GM) and white matter (WM) changes with cortical thickness analysis and diffusion tensor imaging (DTI) in patients with MCI and demographically matched comparison subjects to test these measurements as possible imaging markers for diagnosis.

MATERIALS AND METHODS: Subjects with amnestic MCI (n = 10; age, 72.2 ± 7.1 years) and normal cognition (n = 10; age, 70.1 ± 7.7 years) underwent DTI and T1-weighted MR imaging at 3T. Fractional anisotropy (FA), apparent diffusion coefficient (ADC), and cortical thickness were measured and compared between the MCI and control groups. We evaluated the diagnostic accuracy of 2 methods, either in combination or separately, using binary logistic regression and nonparametric statistical analyses for sensitivity, specificity, and accuracy.

RESULTS: Decreased FA and increased ADC in WM regions of the frontal and temporal lobes and corpus callosum (CC) were observed in patients with MCI. Cortical thickness was decreased in GM regions of the frontal, temporal, and parietal lobes in patients with MCI. Changes in WM and cortical thickness seemed to be more pronounced in the left hemisphere compared with the right hemisphere. Furthermore, the combination of cortical thickness and DTI measurements in the left temporal areas improved the accuracy of differentiating MCI patients from control subjects compared with either measure alone.

CONCLUSIONS: DTI and cortical thickness analyses may both serve as imaging markers to differentiate MCI from normal aging. Combined use of these 2 methods may improve the accuracy of MCI diagnosis.

  A. M Seidler , M. L Pennie , E Veledar , S. D Culler and S. C. Chen
 

Objective  To assess health care resources consumed by melanoma in the population 65 years or older, a group with comparatively poor outcomes.

Design  Database analysis.

Setting  The Surveillance, Epidemiology, and End Results (SEER)–Medicare-linked population-based database for fiscal years 1991 through 1996.

Participants  A total of 1858 subjects with pathological confirmation of melanoma.

Main Outcome Measures  Resource consumption was examined by stage and treatment phase. Outcomes were measured in monthly charges obtained from the data set and costs were estimated by application of cost to charge ratios. Annual resource consumption by melanoma in patients 65 years or older in the United States was also estimated by incorporation of published SEER cancer statistics.

Results  Average monthly, per-patient melanoma charges were $2194 during the initial 4 months of treatment; they dropped by more than half to $902 during the interim phase, which varied in length depending on survival. Monthly charges increased to $3933 during the terminal 6 months of treatment. The estimated annual charge of treating melanoma in the population 65 years or older was $390 million. By using cost to charge ratios, we found the annual cost of melanoma to be up to $249 million and the per-patient lifetime costs to be $28 210 from the time of diagnosis to the time of death.

Conclusions  Melanoma care presents a significant economic burden in the elderly population, particularly in late-stage disease. If effective, prevention and early detection efforts may reduce the economic burden.

  V Vaccarino , J Votaw , T Faber , E Veledar , N. V Murrah , L. R Jones , J Zhao , S Su , J Goldberg , J. P Raggi , A. A Quyyumi , D. S Sheps and J. D. Bremner
 

Background  Major depressive disorder (MDD) is associated with coronary heart disease (CHD), but the mechanisms are unclear. The presence of MDD may increase CHD risk by affecting microvascular circulation. It is also plausible that genetic factors influencing MDD may overlap with those for CHD. We sought to examine the relationship between MDD and coronary flow reserve (CFR), the ratio of maximum flow during stress to flow at rest measured in milliliters per minute per gram of tissue.

Methods  We examined 289 male middle-aged twins, including 106 twins (53 twin pairs) discordant for a lifetime history of MDD and 183 control twins (unrelated to any twins in the experimental group) without MDD. To calculate CFR, we used positron emission tomography with nitrogen 13 (13N) ammonia to evaluate myocardial blood flow at rest and after adenosine stress. A standard perfusion defect score was also used to assess myocardial ischemia.

Results  There was no difference in myocardial ischemia between twins with and without MDD. Among the dizygotic twin pairs discordant for MDD, the CFR was 14% lower in the twins with MDD than in their brothers without MDD (2.36 vs 2.74) (P = .03). This association was not present in the monozygotic discordant pairs who were genetically matched (2.86 vs 2.64) (P = .19). The zygosity-MDD interaction after adjustment was significant (P = .006). The CFR in the dizygotic twins with MDD was also lower than in the control twins.

Conclusions  Our results provide evidence for a shared genetic pathway between MDD and microvascular dysfunction. Common pathophysiologic processes may link MDD and early atherosclerosis.

 
 
 
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