Search

Objective To examine the relationship between measures of subclinical atherosclerosis and subsequent cognitive function. Method Participants from the Dallas Heart Study (DHS), a population-based multiethnic study of cardiovascular disease pathogenesis, were re-examined 8 years later (DHS-2) with the Montreal Cognitive Assessment (MoCA); N = 1904, mean age = 42.9, range 8–65. Associations of baseline measures of subclinical atherosclerosis (coronary artery calcium, abdominal aortic plaque, and abdominal aortic wall thickness) with MoCA scores measured at follow-up were examined in the group as a whole and in relation to age and ApoE4 status. Results A significant linear trend of successively lower MoCA scores with increasing numbers of atherosclerotic indicators was observed (F(3, 1150) = 5.918, p = .001). CAC was weakly correlated with MoCA scores ( p = .047) and MoCA scores were significantly different between participants with and without CAC (M = 22.35 vs 23.69, p = 0.038). With the exception of a small association between abdominal AWT and MoCA in subjects over age 50, abdominal AWT and abdominal aortic plaque did not correlate with MoCA total score ( p ≥ .052). Cognitive scores and atherosclerosis measures were not impacted by ApoE4 status ( p ≥ .455). Conclusion In this ethnically diverse population-based sample, subclinical atherosclerosis was minimally associated with later cognitive function in middle-aged adults. [ABSTRACT FROM AUTHOR]

Background: Centenarians with normal cognitive function have a 'longevity phenotype' characterized by large low-density lipoproteins (LDL) and high-density lipoproteins (HDL) and low incidence of metabolic syndrome, hypertension, and cognitive impairment. Alzheimer's disease (AD) is associated with a number of cardiovascular risk factors, but it is not known if they have or lack the 'longevity phenotype'. Objective: The study was designed to determine LDL size and body fat content and distribution in subjects with mild cognitive impairment (MCI) and AD. Results: Fifty-eight persons with MCI or AD (cases) and 42 control subjects of similar age had measurement of LDL size and lipoprotein lipids after a 12 h fast and analysis of body composition by dual x-ray absorptiometry. Cases had small LDL size more often than controls (73% versus 66%) associated with significantly higher triglycerides, lower HDL cholesterol, and higher triglyceride/HDL cholesterol ratio (p ≤ 0.02). Cases with large LDL had a better lipoprotein profile than those with small LDL. Cases and controls had similar percent body fat, fat index, and lean mass index. Forty-seven percent of cases and 39% of controls were obese. Conclusion: The prevalence of small LDL phenotype in MCI and AD cases contrasts with the 'longevity phenotype' reported for centenarians with preserved cognitive function. The small LDL phenotype is an atherogenic lipoprotein profile found in metabolic syndrome, type 2 diabetes, and insulin resistance. It is now also reported in persons with MCI and AD. [ABSTRACT FROM AUTHOR]

Background: Centenarians with normal cognitive function have a "longevity phenotype" characterized by large low-density lipoproteins (LDL) and high-density lipoproteins (HDL) and low incidence of metabolic syndrome, hypertension, and cognitive impairment. Alzheimer's disease (AD) is associated with a number of cardiovascular risk factors, but it is not known if they have or lack the "longevity phenotype".Objective: The study was designed to determine LDL size and body fat content and distribution in subjects with mild cognitive impairment (MCI) and AD.Results: Fifty-eight persons with MCI or AD (cases) and 42 control subjects of similar age had measurement of LDL size and lipoprotein lipids after a 12 h fast and analysis of body composition by dual x-ray absorptiometry. Cases had small LDL size more often than controls (73% versus 66%) associated with significantly higher triglycerides, lower HDL cholesterol, and higher triglyceride/HDL cholesterol ratio (p ≤ 0.02). Cases with large LDL had a better lipoprotein profile than those with small LDL. Cases and controls had similar percent body fat, fat index, and lean mass index. Forty-seven percent of cases and 39% of controls were obese.Conclusion: The prevalence of small LDL phenotype in MCI and AD cases contrasts with the "longevity phenotype" reported for centenarians with preserved cognitive function. The small LDL phenotype is an atherogenic lipoprotein profile found in metabolic syndrome, type 2 diabetes, and insulin resistance. It is now also reported in persons with MCI and AD. [ABSTRACT FROM AUTHOR]

The rate of functional change in persons with mild Alzheimer's disease (AD) was compared to that of cognitively normal elderly control subjects. A comparison of annualized rates of change on the Test of Everyday Functional Abilities (TEFA) was carried out, along with a brief measure of instrumental activities of daily living skills, in persons with mild AD (Mini-Mental State Exam score >20) and cognitively normal elderly controls. Persons with AD (N = 30) showed an 8.5 % (3.5 point) annualized decline in TEFA scores over an average of 1.2 years; there was no decline in a group of elderly normal controls (N = 20) over an average of 1.5 years. Persons with mild AD showed functional changes over the course of a year on a direct measure of instrumental activities of daily living; a comparable group of normally aging persons did not. [ABSTRACT FROM AUTHOR]

Primary objective: To determine if plasma levels of 24S-hydroxycholesterol, the primary catabolite of brain cholesterol, provide a measure of axonal damage in acute brain trauma. Research design: Determination of plasma 24S-hydroxycholesterol in a series of persons admitted to an intensive care unit for treatment of closed head injury. Methods and procedures: Levels of 24-S-hydroxycholesterol, 27-hydroxycholesterol, lathosterol and total cholesterol were measured in peripheral blood from 38 persons from 14-55 years of age treated by craniotomy and ventriculostomy for intractable intracerebral hypertension. Severity of brain injury was estimated by the Glasgow Coma Scale (range = 3-13, median = 6 points) and overall injury by the Injury Severity Scale (range = 10-48, median = 29). All subjects were intubated and anaesthetized with intravenous propofol. Plasma sterol levels were compared with those of age-matched control subjects. Outcomes and results: There was no significant increase in plasma 24-S-hydroxycholesterol in subjects with head injury, but measures of peripheral cholesterol synthesis were markedly reduced as compared with values for age-matched normal control subjects. Conclusion: Plasma 24S-hydroxycholesterol levels do not change with severe closed head injury. [ABSTRACT FROM AUTHOR]

Objectives: To compare scores for dementia patients on a newly developed direct test of instrumental activities of daily living (IADLs) to scores on a widely accepted functional measure. Methods: In 27 community-dwelling dementia patients, scores for the Test of Everyday Functional Ability (TEFA) were compared with scores on a widely used direct test of daily function (Independent Living Scale; ILS). Results: Mini-Mental State Examination scores ranged from 5 to 28 (mean ± SD = 20.7 ± 6.37). There was a highly significant correlation between total TEFA and total ILS scores (r(25) = 0.892, p < 0.001) as well as many of the comparable subscales. Conclusion: The TEFA is a valid measure of IADL competence for dementia patients. Copyright © 2006 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Two hundred forty-seven patients with early Alzheimer's disease were studied for the association of demographic, functional, and cognitive status and vascular comorbidities and risk factors present at index visit to rate of clinical disease progression over 3 years and to survival time. Patients who progressed to the moderate stage were designated fast progressors; those who remained in the early stage were designated slow progressors. At index visit, Mini- Mental State Exam score was significantly lower for the fast than the slow group; global impairment was significantly higher for the fast group. Cognitive scores showed greater annual decline in the fast group, and the fast group also had a greater annualized global change. The fast group had a shorter median survival time from onset, but age at onset, age at initial visit, history of heart problems, myocardial infarct, stroke, hypertension, diabetes, or past or current smoking did not differ between groups. [ABSTRACT FROM AUTHOR]

This randomized study evaluated the combined effect of a cognitive-communication program plus an acetylcholinesterase inhibitor (donepezil; donepezil-plusstimulation group; n = 26), as compared with donepezil alone (donepezil-only group; n = 28) in 54 patients with mild to moderate Alzheimer's disease (AD; Mini-Mental Status Examination score of 12-- 28) ranging in age from 54 to 91 years. It was hypothesized that cognitive-communication stimulation in combination with donepezil would positively affect the following: (a) relevance of discourse, (b) performance of functional abilities, (c) emotional symptoms, (d) quality of life, and (e) overall global function, as measured by caregiver and participant report and standardized measures. Cognitive-communication, neuropsychiatric, functional performance, and quality of life evaluations were conducted at baseline and Month 4, the month after the 2-month active stimulation period. Follow-up evaluations were performed at Months 8 and 12. The stimulation program consisted of 12 hr of intervention over an 8-week period and involved participantled discussions requiring homework, interactive sessions about AD, and discussions using salient life stories. Additive effects of active stimulation with donepezil were examined in 2 ways: (1) comparing mean group performance over time and (2) evaluating change scores from baseline. A Group x Time interaction was found for the donepezil-plus-stimulation group in the emotional symptoms of apathy and irritability as compared with the donepezil-only group. Evaluation of change scores from baseline to 12 months revealed a positive effect for the donepezilplus- stimulation group on discourse and functional abilities with a trend on apathy, irritability, and patient-reported quality of life. In sum, the research revealed benefits to the donepezil-plus-stimulation group in the areas of discourse abilities, functional abilities, emotional symptoms, and overall global performance. This stu... [ABSTRACT FROM AUTHOR]

To determine if Alzheimer's disease (AD), its Lewy body (LB) variant (LBV), and diffuse LB disease (DLBD) are distinguishable at initial clinical evaluation, data from autopsy-confirmed AD, LBV, and DLBD were examined. No significant differences were found in age at onset, age at death, total duration of illness, duration of illness before initial visit, duration of illness from initial visit to death, or severity of illness at initial evaluation. Hallucinations and delusions were significantly more frequent for LBV and DLBD, respectively, than for AD, and falls were more frequent for DLBD than for AD. Extrapyramidal symptoms (EPS) were less frequent in neuroleptic-free AD subjects than in LB subjects; the percentage of AD patients with EPS after neuroleptic exposure was less than that among LB patients. Seizures were significantly more common for DLBD than for AD or LBV. LB dementias differed from AD at initial evaluation, with more frequent hallucinations and delusions, EPSs, and seizures, and longitudinally in neuroleptic sensitivity, but the data did not distinguish LBV from DLBD. [ABSTRACT FROM AUTHOR]

In this post hoc analysis of baseline responses to the CERAD Behavior Rating Scale for Dementia in a clinical trial of interventions for agitation in Alzheimer's disease (AD), the authors investigated the distribution of, and relationships between, agitation, depression, and psychosis in 148 individuals with AD. Prevalence of depressive symptoms was highest (78.4%), followed by agitation (77.6%) and psychotic symptoms (69.3%); 51.1% of the sample had symptoms in all 3 domains. Cross-sectionally, psychotic symptoms were most closely associated with Mini-Mental State Examination (MMSE) scores, while agitation was less so. Depressive symptoms were relatively consistently prevalent across MMSE levels. After controlling for the presence of agitated symptoms, psychosis and depression were significantly associated, but neither symptoms of psychosis nor of depression were associated with agitation when depression or psychosis, respectively, was controlled for. Significant psychopathological comorbidity should be considered in the design of clinical trials targeting particular psychopathology in this disease population. [ABSTRACT FROM AUTHOR]

In a large, well-characterized population of community-dwelling persons with Alzheimer's disease (AD), we investigated the emergence of behavioral symptomatology and its association with changes in cognitive, global-clinical, and functional status. Behavioral Rating Scale for Dementia (BRSD) item responses from 235 AD patients with varying levels of dementia severity and without significant behavioral disturbance were taken from the baseline and 12-month visits in a study of cognitive and behavioral instruments. Item-level analysis revealed new symptoms at every dementia severity level. The symptoms that emerged in the greatest proportion of patients were change in weight, change in appetite, diurnal confusion, uncooperativeness, restlessness, clingy behavior, loss of initiative, and change in sleeping pattern. Changes in cognitive status over the 12 months were associated with changes in functional status and not with the emergence of behavioral symptomatology; however, change in the latter two domains tended to be associated. The findings support the hypothesis that increasing behavioral disturbance is not strongly associated with decreasing cognitive status and that, except for psychotic symptoms, a previously observed association between dementia severity and behavioral status may have been mediated partly by changes in functional abilities. [ABSTRACT FROM AUTHOR]

Th determine if teaching caregivers behavior management techniques (BMTs) reduces long-term psychotropic use in Alzheimer's disease (AD) patients, we examined 12-month follow-up data from a 4-month randomized study comparing placebo, BMTs, trazodone, and haloperidol for the treatment of agitated behaviors in persons with AD. After 4 months, treatment was allowed with any agent. Between 42.8% and 51% of AD patients received additional psychotropics between 4 and 12 months. The relative risk of being prescribed any psychotropic drug after the 4-month trial was at or about 1.0 for subjects in each drug arm or placebo arm versus BMTs. We concluded that teaching caregivers BMTs did not diminish long-term prescription of psychotropic drugs. [ABSTRACT FROM AUTHOR]

Many of the policy dilemmas that have confronted UNHCR and other international humanitarian institutions are the consequence of having to choose among conflicting norms. These include the traditional legal mandates of UNHCR to provide protection and assistance to refugees outside their country of nationality, and to support the principle of non-refoulement, and other international norms including the protection of internally displaced persons, the right to remain in one's own country, the right to return, the rights of women, the rights of minorities, human rights more broadly, and norms regarding genocide and other crimes against humanity. Conflicts within and among humanitarian institutions have arisen between advocates of instrumental humanitarianism and those who take a more restrictive legal and monistic view. The paper provides examples of such conflicts and suggests strategies for dealing with refugee and related complex humanitarian emergencies when policy makers are faced with having to choose among competing international norms. [ABSTRACT FROM PUBLISHER]

Examines the conflicts that produce refugees. Identifying the principal determinants of refugee flows; Global refugee population from 1980-1995; Options for international action.

The psychological consultant in a general hospital may be asked to evaluate physically ill patients who present ambiguous clinical symptomatology. The differential diagnoses of depression from the normal (conservation-withdrawal) reaction to stress is particularly difficult. A case study is presented illustrating the Rorschach test findings of a patient who appeared depressed upon initial clinical examination, but who illustrates conservation-withdrawal, an adaptive nonpathological stress reaction. [ABSTRACT FROM AUTHOR]

This article assesses the prevention and intervention strategies by the U.S. and European nations towards countries that generate refugees and migrants. In 1995 there were, according to the U.S. Committee on Refugees, 15.3 million refugees worldwide, with all but 2.8 million located outside Europe and North America. Germany and the U.S. have an interest in prevention and intervention strategies towards countries of origin for two reasons. The first is a matter of national self-interest. The second reason is humanitarian. The most promising policy instrument outside powers can use to stimulate the economies of sending countries, thereby improving production, wages and employment so as to reduce emigration pressure, is an expansion of trade. Meanwhile, financial payments to governments and communities for the purpose of improving wages, employment and economic conditions do not always slow the pace of emigration, but economic assistance can play a useful role in refugee repatriation and influencing the exit policies of other states. Some policy analysts have suggested that programmes to admit foreign guest workers for a limited duration can serve not only to provide employment for individual foreign workers but to improve economic conditions in sending countries.

Examines ways in which ethnic and religious conflicts within states give rise to international conflicts. Types of ethnic and religious claims; Regions of the world where conflicts are emerging; Implications for self-determination, sovereignty and borders in an increasingly global economy.

This article discusses various perspectives of immigration from receiving countries. Western Europe and the Gulf opted for a policy of admitting temporary rather than permanent migrants because they see manpower shortages as temporary. Western European governments assumed that the labor shortages of the 1950s and early 1960s would end when those born immediately after the war entered the labor force. Some sociologists and economists have suggested deeper structural explanations for the use of temporary foreign workers. One is that foreign workers can be a cushion in economies with fluctuations in employment. Another reason for admitting guest workers rather than permanent migrants is that the countries of Western Europe and the Gulf believed that they could thereby avoid becoming ethnically plural societies.

Purpose . To ascertain the nature of depression-related symptoms in AD. Method . The Hamilton Rating Scale for Depression (HAM-D) was administered as a semi-structured interview to 30 consecutive Alzheimer's disease (AD) patients who also underwent independent psychiatric evaluation. The HAM-D was also administered with a caregiver as the informant. Results . There was no relationship between the number of symptoms reported by patients or caregivers and patients' level of cognitive impairment. Symptom reports by caregivers living in the same household did not differ significantly from symptom reports by caregivers living elsewhere. Caregivers rated AD patients as having significantly more depressive symptoms than did patients themselves. The items most frequently endorsed by caregivers were psychic anxiety (77%), suspiciousness (50%), low energy (50%) and depression (43%). The items most frequently endorsed by AD patients were weight loss (36%), psychic anxiety (33%) and somatic anxiety (33%). Depression was endorsed by 20% of patients. Caregiver-respondent HAM-D scores suggested clinically significant depression in 27% of cases, but AD patients' scores suggested clinically significant depression in only 7% of cases. No case of major depression was found on psychiatric examination. Conclusions . Depressive symptoms seemed more an executive function loss than of primary mood disturbance in that guilt, suicidal rumination and self-perceived loss of interest were uncommon, suggesting that simple environmental measures might be the most appropriate treatment of these symptoms. [ABSTRACT FROM AUTHOR]

Compares the features of Alzheimer's disease and its Lewy body variants in postmortem cases. Proportionality of men; Prevalence of hallucinations and delusions; Frequency of extrapyramidal symptoms as a result from neuroleptics use; Cerebral spinal fluid homovanillic acid concentrations.

Investigates the prevalence and incidence of major depressive disorder in Alzheimer's disease. Use of the databases of the University of Texas Southwestern Medical Center and the Consortium to Establish a Registry for Alzheimer's Disease; Implications on dementia.

Investigates the impact of aging on psychotherapists and on the process of psychotherapy by interviewing American psychiatrists age 65 years or older who were still active professionally. Factors that affected the interviewees' conduct of psychotherapy; Interaction with patients; Attitude toward work.

Focuses on the importance of assessing cognitive ability and the consequences of cognitive style for therapy. Mutative element in psychotherapy; Origin of evidence of para-abstraction of patients; Issue on the efficacy of psychotherapeutic techniques that rely on analogy, simile, and metaphor.

Focuses on the appropriate identification in psychotherapy. Importance of identification in learning desirable behavior; Role of identification in ego and superego development; Role of identification in psychological development; Significance of identification in psychotherapy.

This paper examines the debate as to whether migration is a basic human right or if the claims of outsiders are superseded by the principle of national sovereignty -- the moral obligation of states to do the best for their own citizens. In evaluating migration and refugees it focuses on issues of open borders, migration selectivity, the capacity of sovereign states to control entry, the claims of refugees, the relationship between sovereignty and justifiable intervention, and the role of public opinion and morals throughout migration policies. [ABSTRACT FROM AUTHOR]

Validation of remote video teleconference (VTC)-based procedures for geropsychiatry applications is essential to ensure validity and reliability of diagnostic procedures. The current study demonstrates the similarity of scores obtained from several brief neurocognitive screening measures in an outpatient VA geropsychiatry clinic population when participants were tested in-person and via VTC. Results revealed similar mean scores and moderate to good consistency among our mixed geropsychiatric sample on brief measures of global cognition, attention, and visuospatial function. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Aging and Alzheimer's Disease: Lessons From the Nun Study," by David Snowdon from the February 1997 issue on the cognitive impacts of Alzheimer's disease, with a written reply from the author on the neuropathology of Alzheimer's evidenced in a study of Sister Mary, a centenarian nun diagnosed with the disease.

Background/Aims: Few studies have examined predictors of reversion from mild cognitive impairment (MCI) to normal cognition. We sought to identify baseline predictors of reversion, using the National Alzheimer's Coordinating Center Uniform Data Set, by comparing MCI individuals who reverted to normal cognition to those who progressed to dementia. Methods: Participants (n = 1,208) meeting MCI criteria were evaluated at the baseline visit and 3 subsequent annual visits. Clusters of baseline predictors of MCI reversion included demographic/ genetic data, global functioning, neuropsychological functioning, medical health/dementia risk score, and neuropsychiatric symptoms. Stepwise logistic regression models identified predictors of MCI reversion per cluster, which were then entered into a final comprehensive model to find overall predictor(s). Results: At 2 years, 175 (14%) reverted to normal cognition, 612 (51%) remained MCI, and 421 (35%) progressed to dementia, with sustained diagnoses at 3 years. Significant variables associated with MCI reversion were younger age, being unmarried, absence of APOE ε4 allele, lower CDR-SOB score, and higher memory/language test scores. Conclusion: A relatively sizable proportion of MCI individuals reverted to normal cognition, which is associated with multiple factors previously noted. Findings may enhance MCI prognostic accuracy and increase precision of early intervention studies of dementia. [ABSTRACT FROM AUTHOR]

Teleneuropsychology applications are growing, but a limited number of assessment tools have been studied in this context. The present investigation was designed to determine the feasibility and reliability of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) administration by comparing video teleconference (VTC) with face-to-face (FF) test conditions. Eighteen adult subjects over age 55 with and without cognitive impairment were administered FormsAand Bof theRBANS in VTC and FF settings in counterbalanced fashion. SimilarRBANS scores were obtained in both test conditions, with generally high correlations between administration methods. Results support the feasibility and reliability of remote administration of the RBANS via VTC. [ABSTRACT FROM AUTHOR]

Focuses on progress in research on the treatment of Alzheimer's disease. Symptomatic treatments' function of correcting neurotransmitter deficits that arise when brain cells die; Side effects of tacrine and related drugs; European researchers endorsement of the nootropics class of drugs; Attempts being made to alter the underlying disease process; Prevention of the accumulation of free radicals.

Alzheimer disease (AD) characteristically begins with episodic memory impairment followed by other cognitive deficits; however, the course of illness varies, with substantial differences in therateof cognitive decline. For research and clinical purposes it would be useful to distinguish between persons who will progress slowly from persons who will progress at an average or faster rate. Our objective was to use neurocognitive performance features and disease-specific and health information to determine a predictive model for the rate of cognitive decline in participants with mild AD. We reviewed the records of a series of 96 consecutive participants with mild AD from 1995 to 2011 who had been administered selected neurocognitive tests and clinical measures. Based on Clinical Dementia Rating (CDR) of functional and cognitive decline over 2 years, participants were classified as Faster (n= 45) or Slower (n= 51) Progressors. Stepwise logistic regression analyses using neurocognitive performance features, disease-specific, health, and demographic variables were performed. Neuropsychological scores that distinguished Faster from Slower Progressors included Trail Making Test - A, Digit Symbol, and California Verbal Learning Test (CVLT) Total Learned and Primacy Recall. No disease-specific, health, or demographic variable predicted rate of progression; however, history of heart disease showed a trend. Among the neuropsychological variables, Trail Making Test - A best distinguished Faster from Slower Progressors, with an overall accuracy of 68%. In an omnibus model including neuropsychological, disease-specific, health, and demographic variables, only Trail Making Test - A distinguished between groups. Several neuropsychological performance features were associated with the rate of cognitive decline in mild AD, with baseline Trail Making Test - A performance best separating those who declined at an average or faster rate from those who showed slower progression. [ABSTRACT FROM AUTHOR]

Abstract: To characterize the white matter structural changes at the tract level and tract group level, comprehensive analysis with 4 metrics derived from diffusion tensor imaging (DTI), fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AxD) and radial diffusivity (RD), was conducted. Tract groups, namely limbic, commissural, association, and projection tracts, include white matter tracts of similar functions. Diffusion tensor imaging data were acquired from 61 subjects (26 Alzheimer''s disease [AD], 11 subjects with amnestic mild cognitive impairment [aMCI], and 24 age-matched controls). An atlas-based approach was used to survey 30 major cerebral white matter tracts with the measurements of FA, MD, AxD, and RD. Regional cortical atrophy and cognitive functions of AD patients were also measured to correlate with the structural changes of white matter. Synchronized structural changes of cingulum bundle and fornix, both of which are part of limbic tract group, were revealed. Widespread yet distinctive structural changes were found in limbic, commissural, association, and projection tract groups between control and AD subjects. Specifically, FA, MD, and RD of limbic tracts, FA, MD, AxD, and RD of commissural tracts, MD, AxD, and RD of association tracts, and MD and AxD of projection tracts are significantly different between AD patients and control subjects. In contrast, the comparison between aMCI and control subjects shows disruption only in the limbic and commissural tract groups of aMCI subjects. MD values of all tract groups of AD patients are significantly correlated to cognitive functions. Difference between AD and control and that between aMCI and control indicates a progression pattern of white matter disruption from limbic and commissural tract group to other tract groups. High correlation between FA, MD, and RD measurements from limbic tracts and cortical atrophy suggests the disruption of the limbic tract group is caused by the neuronal damage. [Copyright &y& Elsevier]

Background: Leptin has been reported to have positive effects on cognition but has not been studied in a population-based sample or stratified by race or gender. Methods Leptin and fat mass were measured in 2,731 subjects, including 50% African Americans. Eight years later, subjects were administered the Montreal Cognitive Assessment (MoCA). Demographic factors and baseline measures, including a deficiency in leptin or levels in excess of what was predicted by fat, were investigated to see which predicted cognitive performance. Results:There was a statistical trend for lower leptin levels to be associated with higher cognitive scores. Once stratified by race and gender, excessive leptin was associated with lower MoCA total scores and delayed recall domain score for black men, but white men demonstrated a reverse relationship. Conclusion: Excess leptin appears to have differential effects on delayed recall in black and white men. [ABSTRACT FROM AUTHOR]

To determine if measures of adipokines and other blood lipids differentiate between normal controls and persons with Alzheimer's disease (AD), we examined levels of leptin, adiponectin, total cholesterol, high density lipoproteins (HDL), calculated low density lipoproteins (LDL), triglycerides and apolipoprotein E allele status in 148 early AD subjects and 198 normal controls. We were unable to demonstrate a significant difference between leptin and adiponectin levels between normal controls and AD subjects. We were able to confirm observations of lower HDL and higher total and LDL cholesterol concentration in AD subjects than in controls. As expected, the presence of the apolipoprotein E4 allele distinguished between the two groups. [ABSTRACT FROM AUTHOR]

The goals of this study were to evaluate brain activation in patients with probable Alzheimer's disease (AD), mild cognitive impairment (MCI), and controls while performing a working memory (WM) task. Eleven AD patients, ten MCI subjects, and nine controls underwent functional magnetic resonance imaging (fMRI) while performing a visual WM task. Statistical parametric maps of brain activation were obtained in each group, and group activation difference maps were generated. Ability to perform the task did not differ among the groups. Activation was observed in the parahippocampal region, superior-middle-inferior frontal gyri, parietal region, anterior-posterior cingulate, fusiform gyrus, and basal ganglia. MCI and AD groups showed more activation than the controls in the right superior frontal gyrus, bilateral middle temporal, middle frontal, anterior cingulate, and fusiform gyri. Activation in the right parahippocampal gyrus, left inferior frontal gyrus, bilateral cingulate and lingual gyri, right lentiform nucleus, right fusiform gyrus, and left supramarginal gyrus in the AD group was less than in the MCI group. The WM task evoked activation in widely distributed regions, consistent with previous fMRI studies. AD and MCI patients showed an increased extent of activation and recruitment of additional areas. [ABSTRACT FROM AUTHOR]

The extent to which sense of overall relationship loss (feeling less happy or emotionally close) is predicted by declines in satisfaction with opportunities for affectionate physical contact and sexual intimacy was investigated in 136 caregivers of physically and/or cognitively impaired elderly spouses. Changes in satisfaction and relationship loss were unrelated to demographic factors. Older caregivers and those with more cognitively impaired spouses evaluated their own physical health less favorably, but caregiver health was unrelated to declines in satisfaction with physical intimacy or relationship loss. The only significant predictor of declines in satisfaction was providing more care; the only significant predictor of more perceived relationship loss was greater decline in satisfaction with opportunities for affectionate physical contact and sexual intimacy. Thus, decrements in health have minimal influence on caregiver perceptions of loss in relationship quality – as long as they do not result in losses in satisfaction with physical intimacy. [ABSTRACT FROM AUTHOR]

We examined the validity of the revised Hopkins Verbal Learning Test (HVLT-R) by comparing performances on the HVLT-R and the California Verbal Learning Test (CVLT) in participants with Alzheimer's disease (AD). Total learning, delayed recall, intrusion errors, and recognition performance were significantly related across tests, but the number of perseverative responses showed no linear association. Despite similar results across measures, some of the variables were only modestly correlated, which may reflect differences in test procedures and the limited range of scores for some variables. Furthermore, the HVLT-R may not be challenging enough to elicit some of the types of recall errors commonly seen in AD to the same extent as the CVLT. Nonetheless, the HVLT-R shows promise for providing a multidimensional assessment of verbal learning and memory and may be ideal in cases where brief assessment of memory and/or serial evaluations are needed. [ABSTRACT FROM AUTHOR]

This study describes two well-characterized groups of Alzheimer's disease (AD) patients with similar levels of cognitive functioning, but with different overall behavioral disturbance levels. We sought to determine the nature of this difference—whether AD patients with higher levels of behavioral disturbance (n = 148) differ from less disturbed AD patients (n = 235) in terms of (a) the range of symptoms exhibited, (b) the frequency of occurrence of these symptoms, or (c) both of these. We defined and operationalized ‘diversity of behaviors’ and ‘frequency’ with respect to the item-level responses on the Cohen-Mansfield agitation inventory (CMAI). We found that, in these two samples of AD patients, differences occurred in the frequency of 10 out of 21 behaviors, rather than in a variety of endorsed behaviors. These 10 behaviors, observed at different frequencies in both groups, may be useful for monitoring change in studies of drugs or behavioral interventions for behavioral disturbance in persons with AD. Copyright © 2001 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Discusses the implications of psychotherapists' malpractice cases. Examination of issues between therapists and patients that have given rise to malpractice suits; Explanation of the most common reasons why mental health professionals are sued; Guidelines recommended to address malpractice issues.