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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.

Introduction Severity of dementia and neuropsychiatric symptoms contribute to increasing informal care costs. We examined which neuropsychiatric symptoms subdomains (NPS-SD) were associated with informal costs in a population-based sample. Methods Dementia progression and informal costs (2015 dollars) were estimated from the Cache County Dementia Progression Study. Overall NPS and specific NPS-SD were assessed with the Neuropsychiatric Inventory. Generalized Estimating Equations (GEE with gamma-distribution/log-link) modeled the relationship between NPS-SDs and informal cost trajectories. Results Two hundred eighty participants (52.1% female; age M = 85.67, SD = 5.60) exhibited an adjusted cost increase of 5.6% (P = .005), 6.4% (P, Highlights • Specific neuropsychiatric symptoms/areas affect informal costs of dementia care differently over time; some have little to no impact. • Agitation/aggression, affective, and psychosis increase persons with dementia informal costs of dementia care over time. • Apathy increases rate of change in informal costs of dementia care over time.

Nutritional status may be a modifiable factor in the progression of dementia. We examined the association of nutritional status and rate of cognitive and functional decline in a U.S. population-based sample. Study design was an observational longitudinal study with annual follow-ups up to 6 years of 292 persons with dementia (72% Alzheimer’s disease, 56% female) in Cache County, UT using the Mini-Mental State Exam (MMSE), Clinical Dementia Rating Sum of Boxes (CDR-sb), and modified Mini Nutritional Assessment (mMNA). mMNA scores declined by approximately 0.50 points/year, suggesting increasing risk for malnutrition. Lower mMNA score predicted faster rate of decline on the MMSE at earlier follow-up times, but slower decline at later follow-up times, whereas higher mMNA scores had the opposite pattern (mMNA by time β = 0.22, p = 0.017; mMNA by time2 β = −0.04, p = 0.04). Lower mMNA score was associated with greater impairment on the CDR-sb over the course of dementia (β = 0.35, p < 0.001). Assessment of malnutrition may be useful in predicting rates of progression in dementia and may provide a target for clinical intervention.

PURPOSE Studies have reported faster cognitive/functional decline in persons with dementia (PWD) with malnutrition. We investigated whether baseline nutritional status predicted severe dementia and mortality in a population-based sample. PATIENTS A maximum of 300 PWD were assessed annually for up to 8.6 years. METHODS Nutritional status was assessed using a modified Mini-Nutritional Assessment (mMNA). Severe dementia was defined as: "severe" rating on the Clinical Dementia Rating or Mini-Mental State Examination score ≤10. Using Cox proportional hazards models, we examined the association between baseline mMNA score (or its subcomponents) with each outcome. Covariates included demographics; dementia onset age, type, and duration; APOE genotype; and residency with caregiver. RESULTS Compared with "well-nourished," "malnourished" PWD had 3-4 times the hazard of severe dementia [hazard ratio (HR), 4.31; P=0.014] and death (HR, 3.04; P

Closer caregiver-care recipient (CG-CR) relationships have been associated with lower informal care costs and better cognitive and functional outcomes in persons with dementia. Considering difficulties in treating neuropsychiatric symptoms (NPS) and their significant detrimental effects on caregivers and care-recipients in dementia, we examined whether closer CG-CR relationships were associated with severity of overall NPS and specific subdomains in dementia. NPS were assessed by the Neuropsychiatric Inventory-12 (NPI-12) in 252 CG-CR dyads in the Dementia Progression Study a longitudinal-population based study in Cache County Utah. Caregivers reported on relationship closeness using the Whitlach Relationship Scale. Linear mixed models examined the association between NPI-12 total score and symptom subdomains with CG-CR closeness (time-varying) in separate models. When controlling for caregiver burden, kin relationship, and dementia severity, each increasing unit of closeness was associated with an approximate 3-point lower NPI-12 score (b=-2.73, p=.002), and an approximate 1-point slower increase in NPI total score per year (b=-0.92, p=0.046). In NPI subdomains, closer relationships were associated with lower affective domain scores (b=-0.15, p

Introduction Identifying factors associated with lower dementia care costs is essential. We examined whether two caregiver factors were associated with lower costs of informal care. Methods A total of 271 care dyads of the Cache County Dementia Study were included. Estimates of informal costs were based on caregiver reports of time spent in care-related activities and inflation-adjusted 2012 Utah median hourly wages. Caregiver coping and emotional closeness with the care-recipient were assessed using the Ways of Coping Checklist–Revised and Relationship Closeness Scale, respectively. Results Higher closeness was associated with 24% lower costs (expβ = 0.763 [95% confidence interval: 0.583–0.999]) in linear mixed models controlling for demographics and baseline dementia severity and duration. Problem-focused coping was not associated with informal costs ( P = .354). Discussion Caregiver closeness, a potentially modifiable factor, predicted lower dementia informal care costs over time. Future studies examining the care environment in closer dyads may identify specific care-related behaviors or strategies that are associated with lower costs.

Background Low catalase levels and cellular vacuolation in the epidermis of patients with vitiligo support major oxidative stress in this compartment. There is now in vivo evidence for increased epidermal hydrogen peroxide (H(2)O(2)) accumulation in this patient group by utilizing noninvasive Fourier Transform Raman spectroscopy (FT Raman). Epidermal H(2)O(2) can be removed with a topical application of narrow band UVB activated pseudocatalase cream (PC-KUS). (Mn/EDTA-bicarbonate complex, patent No. EPO 58471 1 A), yielding initiation of repigmentation. Dead Sea climatotherapy is another successful treatment modality for vitiligo, but the mode of action has escaped definition so far. Methods Epidermal hydrogen peroxide (H(2)O(2)) was assessed in vivo before and after 21 days treatment at the Dead Sea using noninvasive Fourier-Transform Raman spectroscopy. The effectiveness of repigmentation was followed in 59 patients with vitiligo by comparing Dead Sea climatotherapy alone with the combination of Dead Sea climatotherapy/pseudocatalase cream (PC-KUS) as well as Dead Sea climatotherapy/placebo cream. Clinical repigmentation was documented by standardized black/white photography using non-UV coated bulbs as flashlight and by color photography. Results This study on 59 patients who had vitiligo for an average time of 17 years (range 3-53 years) confirmed in vivo H(2)O(2) accumulation in mM concentrations in the epidermis of untreated patients. Furthermore, we demonstrated a pseudocatalase activity after 15 min of Dead Sea bathing, but the decrease of epidermal H(2)O(2) levels was significantly less compared to narrowband UVB activated pseudocatalase cream (PC-KUS). Initiation of repigmentation was already observed between day 10 and day 16 after a combination of Dead Sea climatotherapy/pseudocatalase cream compared to conventional pseudocatalase monotherapy (8-14 weeks) and Dead Sea climatotherapy alone (5-6 weeks). Conclusion The results of this study show a significantly faster initiation of repigmentation in vitiligo after a combination of short-term climatotherapy (21 days) at the Dead Sea in combination with a pseudocatalase cream (PC-KUS) compared to either conventional climatotherapy at the Dead Sea alone or with placebo cream in combination with climatotherapy. This combined therapy is significantly faster in repigmentation than narrowband UVB activated pseudocatalase cream (PC-KUS) treatment alone. The results of this study support the necessity of epidermal H2O2 removal as well as the influence of solar UV-light in the successful treatment of vitiligo.

Antidementia medication use (ADMU) is associated with a delay in the progression of dementia symptoms, but their association with informal costs of dementia care has not been well-studied. Using the Cache County Dementia Progression Study, a population-based sample of persons with dementia (PWD), we examined daily caregiving hours for 219 PWD (46.9% female, mean (SD) age = 85.8 (5.0) years), which were estimated from the Caregiver Activity Survey. Informal costs were then calculated using the replacement cost method by multiplying hours of care by Utahan median wages in the visit year. Cost was adjusted for inflation using the Medical Consumer Price Index and expressed in 2015 dollars. ADMU was based on inspection of each participant’s medications and interview. Linear mixed models, with gamma log-link function, tested the association between antidementia medications and informal costs. Covariates included: psychotropic and anticholinergic medication use, participant’s health status, gender, and dementia severity (measured by the Clinical Dementia Rating Scale-Sum of Boxes). ADMU was 30.7% at baseline and median informal costs were $9.95/day. Overall, ADMU was not associated with informal costs (expβ = .79, p = .090) in the entire sample. In analyses restricted to participants with mild dementia severity at baseline, ADMU was associated with 28% lower costs (expβ = .72, p = .039). Among covariates, only dementia severity (time-varying) was significantly associated with informal costs. These results suggest that ADMU is associated with lower informal costs, particularly among PWD using these medications while in mild stages of dementia severity.

In this paper an approach for automatic user-specific 3D model generation and expression classification is proposed. User performance-driven avatar animation is recently in the focus of research due to the increasing amount of low-cost acquisition devices with integrated depth map computation. Thereby challenging is the user-specific emotion classification without a complex manual initialisation. Correct classification and emotion intensity identification can only be done with known expression specific facial feature displacement which differs from user to user. The use of facial feature tracking on predefined 3D model expression animations is presented here as solution statement for automatic emotion classification and intensity calculation. Consequently with this approach partial occlusions of a presented face do not hamper expression identification due to the symmetrical structure of human faces. Thus, a marker less, automatic and easy to use performance-driven avatar animation approach is presented.