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People frequently engage in the process of "heutagogy" (i.e., self-determined learning). Unlike pedagogy and andragogy, heutagogy occurs without a structure or leader setting the context and directing the learning toward a specific goal. The lack of structure and the possible self-determination of topic, value, source, and trust in information led us to wonder about the motivations, goals, and processes considered by college students as they engage in self-determined learning. We conducted a survey with 83 American college students regarding their information-seeking preferences and behaviors. Some students reported accessing different media depending on what information they were seeking, while others sought multiple forms of information from the same media. Family and community influenced their trust in media, yet they also recognized experts and data as important justifications for credibility of media. We exposed some relationships among personal characteristics, perceptions of information, and self-determined learning activities. We conclude with implications and directions for future research.

Objective: Bilateral thalamic infarction due to artery of Percheron (AOP) occlusion is rare (0.01–2% of all ischemic strokes) and neuropsychological sequelae are not well-defined. We present the case of a 50-year-old, right-handed, Caucasian woman, with 12 years of education, who presented with cognitive and behavioral symptoms following AOP stroke. Method: Following AOP stroke, the patient experienced seven-day hospitalization and one-month subacute rehabilitation. Symptoms after discharge from the latter included vertical gaze palsy, mild balance difficulties, impulsivity, and amnesia (retrograde and anterograde). Compared to neuroimaging five days after stroke, follow up imaging at three months revealed bilateral thalamic encephalomalacia (Figure 1), as well as small bilateral cerebellar infarcts. Neuropsychology was consulted six months post-stroke to evaluate persistent cognitive and emotional/behavioral symptoms. Results: (Test results in Table 1). Test results demonstrated average estimated premorbid functioning, amnesia (anterograde and retrograde) and executive dysfunction (including emotional lability, stimulus bound behaviors), which interfered with performances on processing speed and verbal fluency tasks. Attention, working memory, and core language/visuospatial skills were spared. These symptoms contributed to difficulty navigating/exacerbation of psychosocial stress and necessitated external support for daily functions. Neuropsychological evaluation data were used to identify strategies to optimize patient coping and reduce caregiver burnout. At 16-months post-stroke, persistent amnesia and reduced emotional lability were reported by her family. Conclusions: This case highlights the presence and need to characterize cognitive and behavioral deficits following bilateral thalamic infarction. Additionally, this case demonstrates the role of neuropsychology in characterization of cognitive and neuropsychiatric sequelae, including identification of relevant interventions/recommendations to inform treatment planning. [ABSTRACT FROM AUTHOR]

Background: Polymorphisms in genes coding for the neurotrophin, brain‐derived neurotrophic factor (BDNF) or its receptors, have been associated with Alzheimer's disease and related disorders (ADRD), with sex‐dependent effects. Associations with neuropsychiatric symptom (NPS) progression after dementia onset has been largely unexplored. In a population‐based cohort, we examined the relationships between BDNF gene single‐nucleotide polymorphisms (SNPs) and NPS progression after dementia onset. Method: 880 participants [61.3% female; mean (SD) age = 82.0 (71) years] with dementia [68.2% AD; 13.5% Vascular Dementia (VaD); 18.3% other dementia (OD)] were assessed on the Neuropsychiatric Inventory (NPI) every six‐to‐18 months. Mean(SD) baseline dementia duration was 2.9(2.7) years. The following SNPs were examined as predictors of NPI scores over time in linear mixed‐effects models: rs6265 (BDNF G196A/Val66Met), rs56164415 (BDNF C270T), rs2289656 (NTRK2 receptor TrkB), and rs2072446 (NGFR p75NTR). Covariates included age of dementia onset, education, apolipoprotein E genotype, and dementia type and duration at baseline. Result: Sex‐dependent effects were found for two SNPs. Compared to those with major alleles, males with the rs56164415 minor allele exhibited a lower initial Apathy score, that increased over time (C/t*sex*time2:b = ‐0.063, SE = 0.029, p =.033); by contrast, females showed no differences by SNP alleles. Females homozygous for the rs2289656 minor allele exhibited a rapid increase in Anxiety that decreased over time (t/t*sex*time2: b = ‐0.145, SE = 0.054, p =.0073). For both sexes, presence of minor alleles for BDNF polymorphisms rs6265 (G/a*time2: b = ‐0.017, SE = 0.004, p <.001; a/a*time2: b = ‐0.035, SE = 0.013, p =.006) and rs56164415 (C/t*time2: b = 0.019, SE = 0.005, p <.001) was associated with increased NPI Agitation/Aggression well after baseline. Rs6265 minor allele homozygotes (a/a*time2: b = ‐0.049, SE = 0.013, p <.001) and rs2072446 minor allele carriers (Ct/tt*time2: b = ‐0.012, SE = 0.005, p =.025) exhibited initial increases in Delusions, which diminished approximately 5 years thereafter. Conclusion: Specific BDNF genotypes were associated with NPS presentation after dementia onset, with some sex‐dependent effects. Future research on enhancing BDNF signaling may present possible targets for intervention. [ABSTRACT FROM AUTHOR]

Objectives: To examine the prevalence of neuropsychiatric symptoms (NPS) and cognitive correlates in severe dementia.Methods: A population-based sample of 56 individuals with severe dementia (85.7% Alzheimer's type; 67.9% female) were assessed with the Severe Cognitive Impairment Profile (SCIP) and the Neuropsychiatric Inventory (NPI). Descriptive statistics displayed the frequency of NPS and bivariate and multiple regression analyses examined the associations between cognitive domains on the SCIP and NPS total, domain, and cluster scores.Results: NPS were common in severe dementia with 98% of the sample exhibiting at least one symptom. Most common were delusions, apathy, agitation/aggression, and aberrant motor behavior, affecting 50% or more of participants. SCIP comportment was significantly associated with NPI total score and apathy (r = -.350 and -.292, respectively). All SCIP domains except for arithmetic, visuospatial, comportment, and motor behavior were significantly associated with agitation/aggression (r = -.285 to -.350). These associations remained in individual multiple regression models.Conclusion: In severe dementia, impairment in specific cognitive domains was associated with more severe NPS. Environmental manipulations to reduce processing demands in persons with severe dementia may be a useful strategy to target agitation and aggressive behaviors. [ABSTRACT FROM AUTHOR]

ABSTRACTBackground:The use of FDA approved medications for Alzheimer's disease [AD; FDAAMAD; (cholinesterase inhibitors and N-methyl-D-aspartate receptor antagonists)] has been associated with symptomatic benefit with a reduction in formal (paid services) and total costs of care (formal and informal costs). We examined the use of these medications and their association with informal costs in persons with dementia.Method: Two hundred eighty participants (53% female, 72% AD) from the longitudinal, population-based Dementia Progression Study in Cache County, Utah (USA) were followed up to ten years. Mean (SD) age at baseline was 85.6 (5.5) years. Informal costs (expressed in 2015 dollars) were calculated using the replacement cost method (hours of care multiplied by the median wage in Utah in the visit year) and adjusted for inflation using the Medical Consumer Price Index. Generalized Estimating Equations with a gamma log-link function were used to examine the longitudinal association between use of FDAAMAD and informal costs.Results: The daily informal cost for each participant at baseline ranged from $0 to $318.12, with the sample median of $9.40. Within the entire sample, use of FDAAMAD was not significantly associated with informal costs (expβ = 0.73, p = 0.060). In analyses restricted to participants with mild dementia at baseline (N = 222), use of FDAAMAD was associated with 32% lower costs (expβ = 0.68, p = 0.038).Conclusions: Use of FDAAMAD was associated with lower informal care costs in those with mild dementia only. [ABSTRACT FROM AUTHOR]

Objective: Closer caregiver-care recipient (CG-CR) relationships are associated with better cognitive and functional abilities, activities of daily living (in persons with dementia), and lower informal care costs.Methods: Due to the difficulty in treating neuropsychiatric symptoms (NPSs) and their detrimental effects on caregivers and care recipients, we examined whether closeness of CG-CR relationships was associated with overall NPS severity or with specific NPS symptom domains in care recipients. In a longitudinal population-based study in Cache County, Utah, the 12-item Neuropsychiatric Inventory (NPI-12) was assessed in 300 CG-CR dyads. Caregivers reported current relationship closeness using the Whitlatch Relationship Closeness Scale. Linear mixed models examined associations between CG-CR closeness and NPI-12 total score or selected symptom domains over time (observation period: 2002-2012).Results: In unadjusted linear mixed models, higher closeness scores were associated with a five-point lower NPI-12 score and a one-point lesser increase in NPI-12 per year. NPI scores also showed lower affective cluster scores (two points) and lesser increase in psychosis cluster (approximately 0.5 points per year) and agitation/aggression (0.16 points per year) for each unit increase in closeness. When controlling for NPI caregiver distress, associations between closeness and NPSs diminished to a 0.5-point lesser increase in total NPI-12 score per year. Adjusted models for NPI domains/clusters showed -0.32 points per year for the psychosis cluster, -0.11 points per year for agitation/aggression, and -0.67 overall for the affective cluster.Conclusion: Higher CG-CR closeness, a potentially modifiable factor, is associated with lower NPS severity and may provide a target for intervention. [ABSTRACT FROM AUTHOR]