Validity and reliability of auditory screening tests in demented and non-demented older adults

The validity and reliability of auditory screening tests were evaluated in 34 demented and 31 non-demented elderly outpatients. In reference to an audiometric gold standard (40-dB HL hearing loss in speech frequencies), 512-Hz and 1024-Hz tuning forks, finger rub, and whispered voice tests performed well (ROC curve areas = 0.82 to 0.94). Simultaneously high (greater than 0.80) sensitivities and specificities were achievable for all these tests in demented patients. In non-demented patients, however, only the whispered voice test achieved simultaneously high specificity and sensitivity. The most accurate rule for air conduction screening audiometry was the inability to hear greater than or equal to two of four 40-dB HL speech frequencies (sensitivity = 1.0, specificity = 0.75 in non-demented patients; sensitivity = 0.97, specificity = 0.74 in demented patients). Interobserver/test-retest reliability was generally high for tuning forks, finger rub, and whispered voice tests (range of intraclass correlation coefficients = 0.38 to 0.90), and was somewhat higher in demented than in non-demented patients. These results suggest that some of the simple, traditional methods of auditory screening may have considerable validity and reliability in demented and non-demented older adults.     

Dimensional prefernces in middle and old age

Dimensional preferences in 40 middle-aged (M = 41.62 years) and 40 elderly (M = 72.22 years) females were assessed using a dimensional choice task. Significant age differences in reaction times of choice but not in number of dimensional choices were obtained. There was a perfect rank-order correspondence between the two age groups in dimensional choices with form being the most preferred and color the least preferred perceptual dimension.     

Dimensional preferences in middle and old age

Dimensional preferences in 40 middle-aged (M = 41.62 years) and 40 elderly (M = 72.22 years) females were assessed using a dimensional choice task. Significant age differences in reaction times of choice but not in number of dimensional choices were obtained. There was a perfect rank-order correspondence between the two age groups in dimensional choices with form being the most preferred and color the least preferred perceptual dimension.     

Mattis Dementia Rating Scale

Abstract

This study provided information concerning the performance of 40 non-demented elderly individuals, mostly in the age range of 80-95 years, on the Mattis Dementia Rating Scale (DRS). The results indicated that age was not invariably associated with DRS performance. Elderly individuals residing in the community obtained total DRS scores that were virtually identical to those reported for the 9-year-younger DRS normative sample. However, residential facilities non-demented dwellers obtained total DRS scores that were, on average, 1 SD lower (p < .01) than those obtained by the community residents. Finally, DRS scores were significantly correlated (p < .01) with scores on the Questionnaire of Daily Functional Competence (QFDC).     

Clinical study of watershed infarct dementia

This clinical study of watershed infarct was carried out in two hospitals for elderly patients. The purpose of this study was an investigation of the clinical specificity of this type of infarct as compared with other types of infarcts. The most important point was to determine which patients with this type of infarct usually become demented. The items of investigation were brain CT findings, measurements of the width of the ventricles and the extent of sylvian fissures from CT images, blood pressure, past history of hypertension, diabetes mellitus, alcohol use and smoking, blood analysis of total cholesterol, HDL-cholesterol, hematocrit, hemoglobin A1 and uric acid and the incidence of patients in whom dementia had improved from the previous state. From CT findings, we classified all patients with brain infarcts into 4 groups; 173 patients with central infarcts, 56 patients with watershed infarcts, 20 patients with subcortical lesions of the Binswanger type and 11 patients with occlusion of main brain arteries. Among all investigated patients, there were 56 non-demented and 162 demented (74.3%) patients. Among the patients with watershed infarcts, there were 10 non-demented and 45 (81.8%) demented patients. In the group of demented patients with watershed infarcts, females were four times as many as males. Demented patients with watershed infarcts in the right hemisphere were twice as frequent as those with infarcts in the left hemisphere, while the number of non-demented patients with this type of infarct in right hemisphere was the same as that in the left hemisphere.(ABSTRACT TRUNCATED AT 250 WORDS)     

Apolipoprotein Eepsilon4 allele, a risk factor for late onset nonfamilial Alzheimer's disease among Israeli Jews

Apolipoprotein (apoE) genotypes were determined in 90 Israeli Jews with late onset sporadic Alzheimer's Disease (AD) and in 90 age- and sex-matched non-demented controls. The percentage of subjects carrying at least one apoEepsilon4 allele was 6% among the controls, and 42% among the patients (P<0.001), indicating a strong association between late onset sporadic AD and the apoEepsilon4 allele. However, no association was found between the apoEepsilon4 allele in demented and non-demented Jewish Israeli patients with Down's syndrome or Creutzfeldt-Jakob disease (CJD). The data presented in this paper confirmed several recent reports, suggesting that the apoEepsilon4 allele is a risk factor for the development of AD but not for the development of CJD or Down's syndrome among Israeli Jews.     

Measurement of low concentrations of bovine thyrotrophin by iodide uptake and organification in porcine thyrocytes

Thyrocytes isolated from porcine thyroids by mechanical and enzymatic dispersion and cultured in Eagle's minimal essential medium, supplemented with 5% (v/v) fetal calf serum, glutamine and cortisol, formed a continuous monolayer within 48 h. This monolayer was without cytochemical peroxidase and diaphorase (NADPH reoxidation) activity. In the presence of bovine thyrotrophin (bTSH; 50 mu./l) the cells developed a follicular-like architecture which was maximal at 4 days before reverting back to a uniform monolayer at 6 days. There were no detectable changes in the total DNA content over this period. The follicular structures had marked diaphorase and peroxidase activity, the latter being apically distributed. Concomitant with follicle formation bTSH induced uptake and organification of iodide presented to the cells during the last 6 h of culture. The extent of this process depended on the dose of bTSH and the duration of stimulation. The most sensitive effects for both iodide uptake and organification occurred with 1 mu. bTSH/l and were maximal with 100 mu./l. Uptake and organification were increased 20 +/- 8-fold and 9.6 +/- 2-fold (n = 10) respectively over the control with 100 mu./l and the doses of bTSH at which a half maximal response was seen (ED50) were 15 +/- 2 and 7 +/- 1 (S.D) mu./l (n = 10) respectively. On changing the culture medium to a serum-free system using HB101 culture medium the stimulation time for the most sensitive bTSH effect was reduced to 2.5 days.(ABSTRACT TRUNCATED AT 250 WORDS)     

Focal left temporal slow EEG activity is related to a verbal recent memory deficit in a non-demented elderly population

Neuropsychological measures of memory and cognition and topographical quantitative EEG were obtained on 35 healthy, non-demented, right-handed, elderly subjects aged 60-81. All were free of medications which impair cognition. They were divided into a left temporal slow abnormality group (n = 9) and a control group (n = 26) on the basis of topographically normalized measures of both delta and theta activity for the left temporal lead T3. The group with left temporal slow activity was significantly deficient on measures of memory savings and memory losses derived from the Logical Memory (Story Recall) Test in the Wechsler Memory Scale--Revised. There were no significant differences between these two groups on the non-memory cognitive tasks. This predominant verbal recent memory deficit profile is reasonably similar to the neuropsychological deficit profile of very mildly demented Alzheimer patients. Because left temporal slow EEG activity is also the predominant EEG abnormality in mild Alzheimer patients, a prospective study should be done to determine if this abnormality in non-demented elderly subjects is most often a preclinical sign of Alzheimer's disease.     

Reduced Global Cerebral Blood Flow in Non-Demented HIV Positive Patients

Twelve non-demented HIV positive men with different degrees of immunodeficiency were examined with single photon emission computed tomography (SPECT). Reduction in relative global cerebral blood flow was found in HIV positive patients compared to healthy HIV negative controls (p = 0.014). In the patients there was also a change in cerebral flow distribution, with lower global flow compared to central flow (p = 0.01), most pronounced in patients with early disease. In the patients with advanced HIV disease the relative cerebral blood flow was lower than in the controls in 108 of 116 (93%) regions investigated.     

Medial temporal lobe atrophy in vascular dementia: visual temporal lobe rating scale

Medial temporal lobe atrophy (MTA) as assessed by magnetic resonance imaging (MRI) can be measured in several ways. First of all, visual rating scale is a quick and easy measurement. MTA is a sensitive marker for Alzheimer's disease (AD), but not specific. It has been documented in other dementias including vascular dementia (VD). This study is to evaluate the degree of MTA in VD patients using a standardized visual rating scale and to suggest the importance of the possible role of MTA in VD. Twenty-five VD, 33 AD and 27 non-demented patients underwent a coronal three-dimensional magnetization prepared rapid gradient echo brain MRI sequence. MTA was rated visually using a 5-point rating scale from 0 (no atrophy) to 4 (severe atrophy). The mean summed MTA score was 5.39 in AD, 2.16 in VD and 0.56 in non-demented patients. Most of the VD patients (80%) showed MTA. They were greater in bilateral sides compared with the non-demented group, but milder than in AD. Additionally, MTA of left side score was significantly associated with age. Medial temporal lobe volumes measured visually are smaller in size in patients with VD, although not to the same extent as in AD. This suggests that MTA in VD patients may be associated with pre-existing AD.     

Asthma treatment preference study: a conjoint analysis of preferred drug treatments

OBJECTIVE: Assessment of patient preferences for attributes of asthma treatments. METHODS: Two hundred ninety-eight patients (age range, 18 to 60 years) from 15 centers in Sweden completed a questionnaire concerning their asthma, and ranked 18 alternative treatments using conjoint analysis. Patients were receiving treatment with either inhaled corticosteroids (ICS) and short-acting bronchodilator (n = 123) or ICS and long-acting bronchodilator (separate inhalers, n = 87; combination inhaler, n = 88). Attributes analyzed were maintenance treatment, additional reliever, time to onset and duration of reliever, number of symptom-free days (SFDs) per month, and out-of-pocket cost per month. RESULTS: Conjoint analysis showed that the most important aspect of treatment was SFD. Forty percent of the patients had 相似文献   

Patterns of chromosomal breakpoint locations in Burkitt's lymphoma: relevance to geography and Epstein-Barr virus association.

We have examined, by Southern blotting, the patterns of chromosomal breakpoint locations in 55 cases of Burkitt's lymphoma (BL) with respect to geography and Epstein-Barr virus (EBV) association. We have confirmed the association between chromosome 8 breakpoint and geography: 74% of endemic (eBL) but only 9% of sporadic BL (sBL) had breakpoints outside the HindIII fragment encompassing the c-myc gene (P2 less than .00001). Conversely, not only did 91% of sBL manifest a rearranged HindIII fragment, but at least 56% of these cases, in contrast to 17% of eBL cases, had a breakpoint within the first exon or intron of c-myc (P2 less than .004). Breakpoints outside the switch mu (S mu) region (ie, the HindIII fragment encompassing S mu) on chromosome 14 were twice as common overall (73%) as those within S mu (27%), but in the 15 tumors with S mu breakpoints, 13 (87%) had a rearranged c-myc gene. Breakpoints outside the HindIII fragment encompassing c-myc on chromosome 8 were predominantly associated with non-S mu breakpoints on chromosome 14 (85%) and this was the combination most frequently associated with eBL (65%; 6% of sBL, P2 less than .00001). In sBL, the most frequent breakpoint combination was a rearranged c-myc gene with a non-S mu breakpoint (63%; 13% of eBL). Twenty-eight percent of sBL and 13% of eBL had breakpoints both within c-myc and within S mu. EBV DNA was present in 19 of 20 tumors with breakpoints outside c-myc, in none of 7 with a breakpoint in the immediate 5' region of c-myc, in 4 of 5 tumors with breakpoints in the first exon, and in 7 of 12 tumors with breakpoints in the first intron. These data suggest that the pathogeneses of eBL and sBL differ with regard to the mechanism of c-myc deregulation, and probably also with regard to the state of differentiation of the target cell for malignant transformation. We have formulated a testable hypothesis regarding the potential role of EBV in pathogenesis: that it is required to contribute to the deregulation of c-myc in the presence of some, but not all, types of c-myc damage arising from the chromosomal translocations.     

A visual recognition memory test for the assessment of cognitive function in aging and dementia

Young, non-demented elderly, and elderly demented subjects were administered a computerized visual recognition memory task. In the task, subjects were instructed to point out the new object from a group of objects whose number was progressively incremented. The test was subject-paced and made use of face-valid stimulus materials; it is closely comparable to tests developed for memory assessment in non-human primates that are sensitive to the effects of hippocampal ablation. The present task was found to elicit significant differences in performance between young and non-demented aged subjects, between the non-demented and demented elderly, and between demented subjects in the early and more advanced stages of senile dementia of the Alzheimer type (SDAT). In a discriminant analysis, the visual recognition memory test scores correctly classified 72.6% of the aged subjects and early SDAT patients. No significant difference in task performance was found between SDAT patients and demented patients with a significant cerebrovascular etiological component. Thus, although the task does not appear to be suitable for diagnostic purposes it would be useful for the assessment of treatment effects upon age-related cognitive dysfunction.     

Screening for hydroxychloroquine toxicity by Texas ophthalmologists

OBJECTIVE: To determine current practice patterns for screening for hydroxychloroquine (HCQ) toxicity by Texas ophthalmologists. METHODS: A survey was sent to all comprehensive ophthalmologists and retina specialists in the state of Texas. Questions included need for baseline examinations, frequency of followup, tests used to monitor for toxicity, and influences on monitoring regimen. RESULTS: Two hundred ninety of 577 surveys were returned correctly completed (response rate = 50.3%). Two hundred fifty-seven respondents (88.6%) felt a baseline examination was necessary prior to beginning HCQ therapy, and 223 (76.9%) followed patients every 6 months during HCQ therapy. Visual acuity, slit lamp examination, and dilated fundus examination were performed on almost all patients, and about three-quarters of respondents also checked visual fields and color vision. While 183 ophthalmologists (63.1%) used the Ishihara pseudoisochromatic plates to check color vision, there was no consensus on the preferred visual field test. One hundred twenty-two respondents (42.1%) stated they had diagnosed a patient with HCQ ocular toxicity. CONCLUSION: Most ophthalmologists in Texas continue to perform baseline examinations and follow HCQ patients semiannually for the development of ocular toxicity despite recent recommendations questioning the need for such close followup. The majority check visual acuity, perform slit lamp and dilated fundus examinations, and test color vision and visual fields, although there is no consensus on the preferred method to test visual fields.     

Pharmacological treatment of agitation in a nursing home.

Agitation is a significant problem in the management of residents in long-term care settings. This study assessed the pharmacological treatment of agitation in a 550-bed nursing home and correlated nurses' ratings of agitation with pharmacological treatment. It further examined the differential use of various psychotropic agents in the management of several sub-types of agitated behavior. Significant results included: (1) subjects designated as demented and agitated were most likely to receive neuroleptics, while non-demented agitated residents were most likely to be treated with a benzodiazepine; (2) agitated individuals received significantly less antidepressant treatment than non-agitated patients. The sub-typing of agitation may allow for the possibility of more selective treatment of various agitation syndromes.     

Morphometry and kinetics of jejunal epithelium in rats with niacin deficiency

In niacin deficient rats, it was performed a kinetic and morphometric study of jejunal epithelium. It was observed that the deficient animals showed less villosity (515.1 mu x 570.1 mu; p less than 0.008), enterocyte (35.3 mu x 38.5 mu; p less than 0.004) and mitotic index (4.4% x 5.7%; p less than 0.001) and bigger crypt (238.0 mu x 186.1 mu; p less than 0.001) and cellular renovation time (22.9h x 17.8h; less than 0.001) according to control animals. It is suggested that NAD (nicotinamide-adenine dinucleotide) deficiency can be responsible for the observed alterations.     

Interface between culturally based preferences and genetic preferences: female mate choice in Poecilia reticulata

The relative contribution of genetic and socio-cultural factors in the shaping of behavior is of fundamental importance to biologists and social scientists, yet it has proven to be extremely difficult to study in a controlled, experimental fashion. Here I describe experiments that examined the strength of genetic and cultural (imitative) factors in determining female mate choice in the guppy, Poecilia reticulata. Female guppies from the Paria River in Trinidad have a genetic, heritable preference for the amount of orange body color possessed by males. Female guppies will, however, also copy (imitate) the mate choice of other females in that when two males are matched for orange color, an "observer" female will copy the mate choice of another ("model") female. Three treatments were undertaken in which males differed by an average of 12%, 24%, or 40% of the total orange body color. In all cases, observer females viewed a model female prefer the less colorful male. When males differed by 12% or 24%, observer females preferred the less colorful male and thus copied the mate choice of others, despite a strong heritable preference for orange body color in males. When males differed by 40% orange body color, however, observer females preferred the more colorful male and did not copy the mate choice of the other female. In this system, then, imitation can "override" genetic preferences when the difference between orange body color in males is small or moderate, but genetic factors block out imitation effects when the difference in orange body color in males is large. This experiment provides the first attempt to experimentally examine the relative strength of cultural and genetic preferences for a particular trait and suggests that these two factors moderate one another in shaping social behavior.     

Parkinson's disease and Alzheimer's disease--similarities in magnetic resonance imaging parameters and their possible explanation

Eight demented and eight non-demented Parkinson patients are compared with ten controls and 22 Alzheimer patients. NMR images as well as NMR parameters (T1) show similarities within the demented and non-demented sub-groups. The neuropathological and physiological basis of this finding is discussed.     

How Should Toilets be Labelled for People With Dementia?

A mailed survey of 28 residential facilities for ambulant people with dementia questioning the types of labelling of residents' toilets yielded 24 replies: 42% (10) had no labelling, “Toilet” was used in 50% and “Male” or “Female” was used in 8%. The survey was followed by asking elderly people in an acute medical hospital ward and in an aged care residential complex their preferences for toilet word and symbol labelling There were 21 elderly people with normal cognition, 11 people with mild dementia and 16 people with moderate dementia. The international symbol was preferred by people with normal cognition or mild dementia but a symbol more representative of a toilet was preferred by people with moderate dementia (p < 0.05). “Ladies” or “Gents” was the word most preferred by people with normal cognition. “Toilet” was the word preferred by people with moderate dementia (p < 0.05). We recommend the use of the word “Toilet” accompanied by a picture of a toilet for labelling toilet doors for people with dementia.