Journal of Geriatric Psychiatry and Neurology RSS feed -- OnlineFirst Articles

Decreased C-Reactive Protein Levels in Alzheimer Disease

Fri, 20 Nov 2009 18:01:15 PST

C-reactive protein (CRP) is an acute-phase reactant that has been found to be associated with Alzheimer disease (AD) in histopathological and longitudinal studies; however, little data exist regarding serum CRP levels in patients with established AD. The current study evaluated CRP levels in 192 patients diagnosed with probable AD (mean age = 75.8 ± 8.2 years; 50% female) as compared to 174 nondemented controls (mean age = 70.6 ± 8.2 years; 63% female). Mean CRP levels were found to be significantly decreased in AD (2.9 µg/mL) versus controls (4.9 µg/mL; P = .003). In adjusted models, elevated CRP significantly predicted poorer (elevated) Clinical Dementia Rating Scale sum of boxes (CDR SB) scores in patients with AD. In controls, CRP was negatively associated with Mini-Mental State Examination (MMSE) scores and positively associated with CDR SB scores. These findings, together with previously published results, are consistent with the hypothesis that midlife elevations in CRP are associated with increased risk of AD development though elevated CRP levels are not useful for prediction in the immediate prodrome years before AD becomes clinically manifest. However, for a subgroup of patients with AD, elevated CRP continues to predict increased dementia severity suggestive of a possible proinflammatory endophenotype in AD.

Cross-Validation of the Florida Cognitive Activities Scale (FCAS) in an Alzheimer's Disease Research Center Sample

Schinka, J. A., Raj, A., Loewenstein, D. A., Small, B. J., Duara, R., Potter, H. — Mon, 24 Aug 2009 09:56:30 PDT

We conducted a cross-validation study of the Florida Cognitive Activities Scale (FCAS) in a sample of heterogeneously diagnosed elderly participants in the Florida Alzheimer’s Disease Research Center. FCAS scales were found to be significantly correlated with neuropsychological measures and with ratings of medial temporal atrophy (MTA). The pattern of significant differences in FCAS scores among groups of normals, those with mild cognitive impairment, and early-stage Alzheimer disease cases suggests that the cognitive activities tapped by the FCAS are affected throughout disease progression in the same way as the neuropsychological performance measures. Notably, FCAS score differences among these groups were as large as they were for ratings of MTA. The accumulation of reliability and validity data indicates that the FCAS scales are sensitive measures of individual differences in cognitive activity and would serve as valid longitudinal measures of change in the study of aging, cognitive decline, and degenerative dementia.

Thyroid Medication Use and Subsequent Development of Dementia of the Alzheimer Type

Harper, P. C., Roe, C. M. — Fri, 07 Aug 2009 15:45:07 PDT

Associations between medication use and the development of Alzheimer disease have been investigated since the late 1900s. Thyroid hormone supplementation is rarely a studied medication class in this area of research. We examined data from participants enrolled in longitudinal studies at the Washington University Alzheimer’s Disease Research Center for associations between thyroid disease, thyroid hormone supplementation therapy, and subsequent development of dementia of the Alzheimer type (DAT). Data collected between April 1992 and June 2008 from 499 participants, 184 men and 315 women, were analyzed. Mean age was 76.9 years (SD = 9.2). At baseline, 61 participants reported thyroid medication use and 87 were identified as having a history of thyroid dysfunction. These participants progressed to a DAT diagnosis more rapidly than individuals not taking thyroid medication (hazard ratios [HR]: 1.67, 95% CI: 0.99-2.78, P = .054). Although an interesting trend was seen, baseline thyroid disease was not significantly (P = .093) associated with time to DAT diagnosis. Our findings suggest that utilization of thyroid medication may be associated with the development of DAT.

Clinical Utility of the Mini-Mental Status Examination When Assessing Decision-Making Capacity

Pachet, A., Astner, K., Brown, L. — Thu, 06 Aug 2009 14:22:54 PDT

The main objectives of this study were to examine the relationship between cognitive deficits, as measured by the Mini-Mental Status Examination (MMSE), and decision-making capacity and to determine whether the sensitivity and specificity of the MMSE varied based upon the patient population assessed. Using a sample size of 152 patients and varying cutoff scores, the MMSE demonstrated extremely poor sensitivity. In contrast, the MMSE had excellent specificity when scores of 19 or less were obtained. In our sample, not one patient, regardless of diagnosis, was deemed to have capacity if their MMSE score was below 20. However, reliance on the MMSE for scores above 19 would too frequently lead to misclassification and incorrect assumptions about a patient’s decision-making abilities. Although a score below 20 consistently yielded findings of incapability in our sample, it remains our opinion that the MMSE should not be used as a stand-alone tool to make determinations related to capacity, especially when considering the complexities associated with capacity evaluations and the vital areas, such as executive functioning and individual values and beliefs, which are omitted by the MMSE.

Screening Depression Among Institutionalized Older Chinese Men by Minimum Data Set: We Need a New Instrument

Fri, 10 Jul 2009 13:19:57 PDT

Objective: To compare the effectiveness of the Minimum Data Set-based Depression Rating Scale (MDS-DRS) and Geriatric Depression Scale (GDS) in screening depression among older institutionalized Chinese men living in Taiwan. Method: MDS Nursing Home 2.1 Chinese version, Mini-Mental State Examination (MMSE), and short form Geriatric Depression Scale (GDS-15) were used among elderly residents in Banciao Veterans Home. Screening results of MDS-DRS and GDS-15, and relationship between 16 MDS Mood and Anxiety symptoms and depression were evaluated. Results: The prevalence of depression defined by MDS-DRS and GDS were 0.2% and 8.7%, respectively. Multiple logistic regression disclosed that E1a (OR: 12.9, 95% CI: 2.8-58.8, p = 0.001), E1k (OR: 15.6, 95% CI: 5.6-43.5, p < 0.001), and E1l (OR: 22.2, 95% CI: 6.1-83.3, p < 0.001) were all independent associative factors for GDS-defined depression but only explained 51.9% of all depressive subjects. Conclusions: The effectiveness of MDS-DRS is limited, and a new MDS-based depression screening instrument is needed.

Erratum

Wed, 10 Dec 2008 08:27:04 PST

X-Rated: Sexual Attitudes and Behaviors Associated With U.S. Early Adolescents' Exposure to Sexually Explicit Media

Brown, J. D., L' Engle, K. L. — Wed, 10 Dec 2008 08:27:04 PST

Correlates of use and subsequent sexual attitudes and behaviors predicted by exposure to sexually explicit content (i.e., pornography and erotica) in adult magazines, X-rated movies, and the Internet were examined in a prospective survey of a diverse sample of early adolescents (average age at baseline = 13.6 years; N = 967). Two-thirds (66%) of males and more than one-third (39%) of females had seen at least one form of sexually explicit media in the past year. At baseline, being black, being older, and having less-educated parents, lower socioeconomic status, and high need for sensation were related to greater exposure for both males and females. Longitudinal analyses showed that early exposure for males predicted less progressive gender role attitudes, more permissive sexual norms, sexual harassment perpetration, and having oral sex and sexual intercourse two years later. Early exposure for females predicted subsequently less progressive gender role attitudes, and having oral sex and sexual intercourse. Implications for healthy sexual socialization are discussed.