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Objective: To standardize a new rating scale for the assessment of apathy in Alzheimer disease (AD) and report on its reliability, structure, and relation to other clinical features of AD., Background: apathy is a common prominent behavioral syndrome accompanying AD and is associated with excess disability and increased caregiver burden. Current instruments for the assessment of apathy in AD do not explicitly and systematically attempt to differentiate limited activity and engagement due to lack of interest from inability or longstanding, premorbid personality traits. The present assessment, the Dementia Apathy Interview and Rating (DAIR), was developed taking these discriminations into account in question construction and interview format., Methods: One hundred participants (50% women) in the University Memory and Aging Center Research Registry with Probable or Possible AD (by NINCDS-ADRDA criteria) were assessed through caregiver interview or direct patient assessment for apathy, depression, and severity of cognitive and functional deficits. Item distribution characteristics, factor analysis, and evaluation of reliability were used to develop the final item set for the DAIR, and correlations with other measures were examined., Results: A 16-item unidimensional apathy scale with excellent internal consistency (alpha = 0.89) and temporal reliability ( = 0.85 over 2 months) was developed. Individual differences in apathy on the DAIR were unrelated to dysphoria. Apathy was significantly associated with functional and cognitive impairment, while depression was not., Conclusions: The DAIR is a reliable informant-based assessment of apathy in persons with AD. Although apathy is assessed with respect to behaviors within the repertoire of patients, this behavioral syndrome remains associated with more severe deficits in cognitive and adaptive functioning. Associations between depression and dementia severity reported in some studies may reflect the confounding of apathy and depression in some assessment instruments.

To examine the relationship between emotional activation and information gathering in schizophrenia, the eye movements and emotional responses of 20 patients with schizophrenia and 10 patients without history of psychosis were recorded while viewing 30 images varying in pleasantness. Emotionally activating pictures were more extensively explored than neutral pictures by both groups but especially by schizophrenia patients. Comparison patients explored pictures more extensively during the early part of image exposure, whereas patients with schizophrenia took longer to engage in informative exploration. The scan path lengths and the proportions of fixation time spent in regions of interest did not differ between groups, although persons with schizophrenia had longer fixations and looked at fewer regions of interest in neutral pictures. Emotion reports did not differ between groups. Schizophrenia patients' results are consistent with the hypothesized normalizing effects of emotional activation on the distribution of attention.

Objective: The purpose of this study was to investigate eye movement patterns of patients with Alzheimer disease (AD) and healthy older adults while viewing photographs of facial expression., Background: Individuals with Alzheimer disease appear to have deficits in emotion perception, but the underlying mechanisms are not understood well. It is not known whether individuals with AD visually explore facial stimuli and extract information needed to make emotion identification from faces in the same way as do healthy older adults., Method: Seventeen AD patients and 15 older adult control patients were shown faces that depicted different emotions and were asked to identify the emotion displayed from two alternatives. The eye movements of participants were recorded during the emotion identification task., Results: No differences were seen between AD patients and older adult controls regarding their accuracy of emotion identification. However, AD patients differed from older adult controls on eye movement patterns during the emotion identification task. Alzheimer disease patients fixated less on the face and, in particular, on the eyes. Alzheimer disease patients also spent more time viewing areas off the face. There was no relationship between the severity of cognitive impairment and emotion identification or eye movement patterns., Conclusions: Although the AD patients and older adult controls showed similar accuracy for the emotion identification task, their visual processing strategies differed. Relative to older adult controls, AD patients fixated less on discriminating regions and attended more to irrelevant aspects of stimuli. The eye movement differences were particularly evident in AD patients who did more poorly for the emotion identification task. These differences were not attributable to the global cognitive deterioration accompanying AD, but suggested a specific deficit in visual processing abilities.

Latinos, principally Puerto Rican, and Euro-American psychiatric outpatients diagnosed with schizophrenia or major depression were compared on their responses to the Brief Symptom Inventory (BSI). The internal consistency reliability of the BSI dimensions and factor structures were comparable in the two cultural groups. Puerto Rican respondents scored significantly higher than Euro-Americans on the Global Severity Index, an index of distress, as well as on several subscales of the instrument. Multiple regression analysis suggested differences in expression of symptoms between Latinos and Euro-Americans only for obsessive compulsive and anxiety symptoms once general severity of symptom expression was controlled. Differences in symptom expression on the BSI associated with ethnicity were greater than those associated with diagnosis.

The aim of this study was to examine multivariate patterns of relationships between oculomotor performance, psychopathology, and neuropsychology. Performance on smooth pursuit and saccadic eye movement tasks was assessed in three DSM-III-R diagnosis-based groups of subjects; normal (N = 55), schizophrenic (N = 29), and bipolar disorder (N = 26) and analyzed in relation to age, gender, scale for the Assessment of Negative Symptoms, Scale for the Assessment of Positive Symptoms, and Brief Psychiatric Rating Scale scores, Shipley intelligence quotient, and Wisconsin Card Sorting Test Performance. The greatest difference was a higher proportion of errors in the antisaccade task in the schizophrenic and bipolar groups, which was related to worse Wisconsin Card Sorting Test performance and was not accounted for by gender, age, education, or intelligence quotient. A significant gender and bipolar interaction showed bipolar women to have worse antisaccade performance. Abnormal smooth pursuit was more specific to schizophrenia. Antisaccade task and sine wave root-mean-square error were correlated in bipolar but not schizophrenic subjects. Scale for the Assessment of Negative Symptoms and Scale for the Assessment of Positive Symptoms scores had independent associations with the antisaccade task. Faster reaction times in the schizophrenic group to antisaccade errors were observed, suggesting an abnormality in visual attention processing and perhaps sensory gating functions. These results confirm abnormal smooth pursuit in schizophrenia and suggests that impairments in saccadic function are less specific to diagnostic group. Oculomotor performance and psychopathology seem related in complex ways to age, gender, intelligence quotient, and executive neuropsychological and possibly visual attention functions.

Caregivers of Alzheimer's disease patients provided characterizations of the patients' premorbid personality traits and current personality traits on two occasions nearly 1 year apart. Characterizations of pre-illness personality traits did not differ between the two assessments. Changes in personality over the year were found for neuroticism, extraversion, and conscientiousness. The findings support the reliability of observer's descriptions of premorbid personality using the NEO-PI and the sensitivity of the instrument to personality change in dementia.

Epidemiologic studies on dioxin, specifically 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD), have not consistently found an increased cancer risk. This study examines mortality rates for 754 employees at a chemical plant after an accident in 1949 in which 122 workers developed chloracne from high exposure to TCDD. We also examined exposure to 4-aminobiphenyl, a potential bladder carcinogen. Although the numbers are small, and confounding factors cannot be ruled out, workers exposed to 4-aminobiphenyl who developed chloracne from the accident had increased mortality rates from soft tissue sarcoma, bladder cancer, and respiratory cancer. All soft tissue sarcomas occurred among workers with potential 4-aminobiphenyl exposure, whereas no soft tissue sarcomas occurred among workers with TCDD exposure alone. In these workers, exposure to TCDD alone at levels great enough to cause chloracne was not associated with increased cancer rates.

The perinatal health status and behavioral characteristics of 47 newborns of multirisk (psychiatric and socioenvironmental) mothers who received either comprehensive intervention services or community-based services are described. Obstetric and postnatal health measures did not differ between groups, but there was a tendency for infants of comprehensively treated women to be healthier. Both groups were similar on Brazelton Neonatal Behavioral Assessment Scale cluster scores at 3 to 5 days of age. However, by 1 month of age, there was very little progress in Orientation and Autonomic Regulation capacities, and in some cases the infants' performance declined markedly on other clusters. The infants who did not receive comprehensive services had significantly less optimal motor performance and autonomic regulation scores. That worrisome patterns of adaptation were detected quite early in life suggests that these may be a particularly vulnerable subset of newborns.

Perceptual span was assessed in schizophrenic, bipolar affective disorder-manic, bipolar affective disorder-depressed, and nonpsychotic inpatients. Both schizophrenics and manics processed less information than depressives, and did not differ from each other. This suggests that reduced span may be a concomitant of psychoses characterized by distractibility and thought disorder, rather than a trait specific to schizophrenia.

The reaction-time crossover phenomenon discovered by Rodnick and Shakow has come to be studied mainly with the embedded isotemporal sets procedure and indexed by the difference in reaction time to regular and irregular trials at a 7-second preparatory interval (PI). A 1983 report in this journal by Galbraith et al. (J Nerv Ment Dis 171:670-675) demonstrated that the magnitude of crossover at this PI was influenced by the duration of the preparatory interval immediately prior (PPI) to the first trial of the 7-second isotemporal blocks. Secondary analyses reported here extend the examination of PPI influences and indicate: a) that the crossover phenomenon as assessed in the embedded sets procedure is due mainly to the very slow reaction time to the first trial of the 1-second isotemporal blocks; and b) that crossover in this paradigm is partially due to uncontrolled PPI influences across the 1-, 3-, and 7-second embedded blocks. These are further reasons for returning to the original Rodnick-Shakow method as Galbraith et al. recommended.