Predicting happiness among centenarians

BACKGROUND

Happiness is believed to evolve from the comparison of current circumstances relative to past achievement. However, gerontological literature on happiness in extreme old age has been limited.

OBJECTIVE

The purpose of this study was to determine how perceptions of health, social provisions, and economics link past satisfaction with life to current feelings of happiness among persons living to 100 years of age and beyond.

METHODS

A total of 158 centenarians from the Georgia Centenarian Study were included to conduct the investigation. Items reflecting congruence and happiness from the Life Satisfaction Index were used to evaluate a model of happiness. Pathways between congruence, perceived economic security, subjective health, perceived social provisions, and happiness were analyzed using structural equation modeling.

RESULTS

Congruence emerged as a key predictor of happiness. Furthermore, congruence predicted perceived economic security and subjective health, whereas perceived economic security had a strong influence on subjective health status.

CONCLUSION

It appears that past satisfaction with life influences how centenarians frame subjective evaluations of health status and economic security. Furthermore, past satisfaction with life is directly associated with present happiness. This presents implications relative to understanding how perception of resources may enhance quality of life among persons who live exceptionally long lives.

Family history and adaptation among centenarians and octogenarians

BACKGROUND

The purpose of this study was to analyze various 'family history' variables (i.e. childhood health, financial situation while growing up, living with grandparents before age 17, and number of children) among participants of the Georgia Centenarian Study.

OBJECTIVE

To determine whether family history variables predict critical outcome areas such as cognitive functioning, activities of daily living, mental health, and economic dependence.

METHODS

A total of 318 older adults (236 centenarians and 82 octogenarians) were assessed with regard to their mental status, ADL (activities of daily living) functioning, depression, family history, loneliness, and perceived economic status.

RESULTS

Analyses indicated that the number of children significantly predicted the ability to engage in activities of daily living and loneliness. In essence, the more children, the higher the activities of the daily living score and the lower the loneliness scores. In addition, childhood health significantly predicted loneliness. The poorer one's health in childhood, the higher the loneliness scores.

CONCLUSION

The results of this study confirm the importance of distal family history variables on present-day functioning.

Depression among centenarians and the oldest old: contributions of cognition and personality

BACKGROUND

An estimated 20% of adults over the age of 55 experience clinical mental disorders such as depression and anxiety. For older adults, mental health concerns are often undetected, concomitant with physical challenges, and ultimately go untreated. These realities have significant implications for older adults' day-to-day functioning, particularly among the oldest old.

OBJECTIVE

The present study examined the ability of cognition and personality in explaining depression within a sample of octogenarians and centenarians.

METHODS

Participants were assessed during the most recent cross-sectional data collection of the Georgia Centenarian Study. The final eligible sample included 76 octogenarians (mean: 84.25 years, SD: 2.82; range: 81-90) and 158 centenarians and near centenarians (mean: 99.82 years, SD: 1.72; range: 98-109).

RESULTS

Hierarchical regression analyses were conducted to examine the relation between key variables and depressive symptoms in the two age groups. Blocks entered into the analyses included: demographics (i.e. age group, residential status, sex, and ethnicity) and functioning, memory and problem-solving ability, and personality (i.e. extraversion and neuroticism). Models differed for octogenarians and centenarians. Decreased problem-solving ability was related to greater depressive symptoms among octogenarians. For centenarians, institutional residence and increased neurotic tendencies were related to greater depressive symptoms.

CONCLUSION

Study findings demonstrate the need to examine a variety of factors which influence mental health in later life and to consider the unique contexts and differential experiences of octogenarians and centenarians.

Distal and proximal resource influences on economic dependency among the oldest old

BACKGROUND

As exceptional survivors, centenarians may have characteristics that reduce their dependency on family and community support systems despite the expectation that their extreme age creates a burden on those systems. The Georgia Centenarian Study obtained information about assistance for income, medical care, and caregiving of all types for a sample of centenarians and octogenarians. Previous studies have not established which characteristics may contribute to economic dependency among the oldest old.

OBJECTIVE

To identify distal and proximal resource influences on economic dependency, considering past lifestyle, proximal health, economic resources, personality, and coping behavior.

METHODS

Analysis sample sizes ranged from 109 to 138 octogenarians and centenarians. Blockwise multiple regressions predicted whether they received income assistance, number of medical care events, number of caregiving types, and total caregiving hours.

RESULTS

Past life style, gender, ethnicity, socioeconomic status, functional health, and coping were not related to economic dependency. With the exception of the number of types of care, centenarians were not more dependent than octogenarians. Cognitive ability had the strongest effects for medical care and caregiving services. 'Extraversion', 'ideas', 'neuroticism', and 'competence' personality factors had significant effects for caregiving types and total hours of care received.

CONCLUSION

Monitoring and intervention to maintain cognitive ability are critical practices for autonomy and reduced economic dependency among the oldest old. Psychological resources are more important influences on social support than functional health and other proximal economic resources.

Social resources and longevity: findings from the Georgia centenarian study

BACKGROUND

As the proportion of adults aged 85 and older increases, investigations of resources essential for adapting to the challenges of aging are required.

OBJECTIVE

To comprehensively investigate the social resources of cognitively intact centenarians participating in the Georgia Centenarian Study and the association between these resources and residence status.

METHODS

Two widely used measures of social resources were investigated among participants living in private homes, personal care facilities, and nursing homes. Logistic regression was used to determine significant predictors of nursing home residence.

RESULTS

Differences in levels of social resources were found between centenarians and octogenarians, and among centenarians in different living situations. Analyses revealed differential findings between self- and proxy reports. Controlling for education, activities of daily living, and financial ability to meet needs, only one of the two social resources measures significantly reduced the odds of nursing home residence.

CONCLUSION

The findings of this study add to the existing literature on one of the basic adaptive resources (social resources) for centenarians. Whether a more specific assessment of network contact is employed, or a more global assessment is used, differences in these constructs exist between centenarians and octogenarians, among centenarians in differing living conditions, and across types of informants. Researchers examining the different resources that may contribute to extraordinary longevity and positive adaptation may find it essential to differentiate between the oldest old and centenarians, and to account for differences based upon measure, reporter type, and centenarian residence status.

Semantic memory activation in individuals at risk for developing Alzheimer disease

OBJECTIVE

To determine whether whole-brain, event-related fMRI can distinguish healthy older adults with known Alzheimer disease (AD) risk factors (family history, APOE epsilon4) from controls using a semantic memory task involving discrimination of famous from unfamiliar names.

METHODS

Sixty-nine cognitively asymptomatic adults were divided into 3 groups (n = 23 each) based on AD risk: 1) no family history, no epsilon4 allele (control [CON]); 2) family history, no epsilon4 allele (FH); and 3) family history and epsilon4 allele (FH+epsilon4). Separate hemodynamic response functions were extracted for famous and unfamiliar names using deconvolution analysis (correct trials only).

RESULTS

Cognitively intact older adults with AD risk factors (FH and FH+epsilon4) exhibited greater activation in recognizing famous relative to unfamiliar names than a group without risk factors (CON), especially in the bilateral posterior cingulate/precuneus, bilateral temporoparietal junction, and bilateral prefrontal cortex. The increased activation was more apparent in the FH+epsilon4 than in the FH group. Unlike the 2 at-risk groups, the control group demonstrated greater activation for unfamiliar than familiar names, predominately in the supplementary motor area, bilateral precentral, left inferior frontal, right insula, precuneus, and angular gyrus. These results could not be attributed to differences in demographic variables, cerebral atrophy, episodic memory performance, global cognitive functioning, activities of daily living, or depression.

CONCLUSIONS

Results demonstrate that a low-effort, high-accuracy semantic memory activation task is sensitive to Alzheimer disease risk factors in a dose-related manner. This increased activation in at-risk individuals may reflect a compensatory brain response to support task performance in otherwise asymptomatic older adults.

Semantic memory activation in amnestic mild cognitive impairment

Cognitively intact older individuals at risk for developing Alzheimer's disease frequently show increased functional magnetic resonance imaging (fMRI) brain activation presumably associated with compensatory recruitment, whereas mild cognitive impairment (MCI) patients tend not to show increased activation presumably due to reduced neural reserve. Previous studies, however, have typically used episodic memory activation tasks, placing MCI participants at a performance disadvantage relative to healthy elders. In this event-related fMRI study, we employed a low effort, high accuracy semantic memory task to determine if increased activation of memory circuits is preserved in amnestic MCI when task performance is controlled. Fifty-seven participants, aged 65-85 years, comprised three groups (n = 19 each): amnestic MCI patients; cognitively intact older participants at risk for developing Alzheimer's disease based on having at least one ApoE epsilon4 allele and a positive family history of Alzheimer's disease (At Risk); and cognitively intact participants without Alzheimer's disease risk factors (Control). fMRI was conducted on a 3T MR scanner while participants performed a famous name discrimination task. Participants also underwent neuropsychological testing outside the scanner; whole brain and hippocampal atrophy were assessed from anatomical MRI scans. The three groups did not differ on demographic variables or on fame discrimination performance (>87% correct for all groups). As expected, the amnestic MCI participants demonstrated reduced episodic memory performance. Spatial extent of activation (Fame--Unfamiliar subtraction) differentiated the three groups (Control = 0 ml, At Risk = 9.7 ml, MCI = 34.7 ml). The MCI and At Risk groups showed significantly greater per cent signal change than Control participants in 8 of 14 functionally defined regions, including the medial temporal lobe, temporoparietal junction, and posterior cingulate/precuneus. MCI participants also showed greater activation than Controls in two frontal regions. At Risk, but not MCI, participants showed increased activity in the left hippocampal complex; MCI participants, however, evidenced increased activity in this region when hippocampal atrophy was controlled. When performance is equated, MCI patients demonstrate functional compensation in brain regions subserving semantic memory systems that generally equals or exceeds that observed in cognitively intact individuals at risk for Alzheimer's disease. This hyperactivation profile in MCI is even observed in the left hippocampal complex, but only when the extent of hippocampal atrophy is taken into consideration.

Anxiety Sensitivity and Obsessive—Compulsive Disorder

Anxiety sensitivity (AS), a cognitive risk factor for anxiety disorders, was evaluated in a homogeneous obsessive—compulsive disorder (OCD) sample. A total of 280 individuals with OCD completed measures. Evaluation of the Anxiety Sensitivity Index revealed a latent structure that was congruent with previous studies showing a single higher order and three lower order factors, although greater variance was accounted for by the general factor than in a previous study. AS was significantly associated with OCD symptom severity after controlling for other putative cognitive risk factors, although the additional variance explained was small. Variability in the relationship of AS to OCD symptom severity was found across OCD symptom subgroups. Results suggest that AS might be an important aspect of OCD-relevant cognition for specific OCD subgroups, and the need for experimental evaluation is discussed.

Implicit learning, thought-focused attention and obsessive-compulsive disorder: a replication and extension

Although significant empirical support exists for both cognitive and neurobiological models of obsessive-compulsive disorder (OCD), there have been few efforts to integrate findings. In this investigation, we attempted to link models by examining relationships between performance on information processing tasks posited to be markers of OCD-related neuropathology and a self-report measure of excessive thought-focused attention (cognitive self-consciousness; CSC). Congruent with predictions and prior research, OCD patients' performance was impaired in comparison to an anxious control group on the Serial Reaction Time (SRT) Task, a measure of implicit procedural learning. Following completion of the SRT, participants' awareness of the embedded stimulus pattern was assessed. As predicted, participants with OCD demonstrated superior performance on this task. Scoring on a measure of CSC correlated with performance on both tasks, although the amount of variance accounted for was modest. Evaluation of OCD symptom subgroups revealed greater procedural learning impairment in a hoarding subgroup. Implications for theory and treatment are discussed.

Temporally graded activation of neocortical regions in response to memories of different ages

The temporally graded memory impairment seen in many neurobehavioral disorders implies different neuroanatomical pathways and/or cognitive mechanisms involved in storage and retrieval of memories of different ages. A dynamic interaction between medial-temporal and neocortical brain regions has been proposed to account for memory's greater permanence with time. Despite considerable debate concerning its time-dependent role in memory retrieval, medial-temporal lobe activity has been well studied. However, the relative participation of neocortical regions in recent and remote memory retrieval has received much less attention. Using functional magnetic resonance imaging, we demonstrate robust, temporally graded signal differences in posterior cingulate, right middle frontal, right fusiform, and left middle temporal regions in healthy older adults during famous name identification from two disparate time epochs. Importantly, no neocortical regions demonstrated greater response to older than to recent stimuli. Our results suggest a possible role of these neocortical regions in temporally dating items in memory and in establishing and maintaining memory traces throughout the lifespan. Theoretical implications of these findings for the two dominant models of remote memory functioning (Consolidation Theory and Multiple Trace Theory) are discussed.

Development of a Brief Cognitive Screen for Mild Cognitive Impairment and Neurocognitive Disorder

The purpose of this study was to develop and evaluate a brief cognitive screen for possible Mild Cognitive Impairment (MCI) and other neurocognitive impairment in a sample of general medical patients. Two hundred community-dwelling general medical patients aged 65 or older participated in this study. Age and education corrected scores from the Rey Auditory Verbal Learning Test and Mattis Dementia Rating Scale were used to classify participants into three groups: MCI, neurocognitive disorder, cognitively intact. Groups were then compared on an independent set of measures: the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) neuropsychological battery, Mini-Mental State Examination, and Clock Drawing Test. The MCI group constituted 9% of the sample, while 10.5% of the sample was classified into the neurocognitive disorder group. The CERAD Verbal Category Fluency and CERAD Word List Memory Test Delayed Recall measures were individually and collectively the most effective in differentiating cognitively intact elders from persons in both the MCI and neurocognitive disorder groups. We conclude that these two brief measures appear to be effective for detecting possible MCI or neurocognitive disorder, thereby facilitating identification of candidates who would benefit from more detailed neuropsychological assessment.

Cognitive self-consciousness, implicit learning and obsessive-compulsive disorder

The negative appraisal of commonly experienced intrusive thoughts is posited to play an important role in obsessive-compulsive disorder (OCD), although why some people focus on thought experiences and have difficulties dismissing intrusions is not well understood. To elucidate how intrusive thoughts might become obsessional problems, relations between thought-focused attention (cognitive self-consciousness; CSC), implicit sequence learning and OCD were evaluated in individuals with OCD (n=43) and in a nonclinical comparison group (n=41). Impaired performance on a serial reaction time test, but enhanced recognition of the embedded stimulus pattern, was predicted for the OCD group based on hypothesized nonconscious processing differences. Predicted differences were found and CSC score predicted reaction time and pattern recognition. CSC might be a consequence of conscious processing gating problems that increase thought salience and the likelihood of the negative appraisal of intrusive thoughts. Implications for theory and treatment are discussed.

Age-related functional recruitment for famous name recognition: an event-related fMRI study

Recent neuroimaging research shows that older adults exhibit recruitment, or increased activation on various cognitive tasks. The current study evaluated whether a similar pattern also occurs in semantic memory by evaluating age-related differences during recognition of Recent (since the 1990s) and Enduring (1950s to present) famous names. Fifteen healthy older and 15 healthy younger adults performed the name recognition task with a high and comparable degree of accuracy, although older adults had slower reaction time in response to Recent famous names. Event-related functional MRI showed extensive networks of activation in the two groups including posterior cingulate, right hippocampus, temporal lobe and left prefrontal regions. The Recent condition produced more extensive activation than the Enduring condition. Older adults had more extensive and greater magnitude of activation in 15 of 20 regions, particularly for the Recent condition (15 of 15; 7 of 15 also differed for Enduring); young adults did not show greater activation magnitude in any region. There were no group differences for non-famous names, indicating that age differences are task-specific. The results support and extend the existing literature to semantic memory tasks, indicating that older adult brains use functional recruitment to support task performance, even when task performance accuracy is high.

Screening for dementia in community-based memory clinics

PROBLEM

Dementia is a significant public health problem that is underrecognized in primary care settings. This study examined the usefulness of 3 brief screening tests in detecting dementia and mild cognitive impairment (MCI) in persons seeking consultation for memory complaints within a network of memory diagnostic clinics in Wisconsin.

METHODS

This prospective study of consecutive referrals for memory diagnostic evaluation analyzed data for 364 patients > or = 50 years. Scores on 3 cognitive screening measures-the Mini-Mental State Examination (MMSE), Clock Drawing, and Animal Naming--were compared to clinical diagnosis of normal cognitive aging, MCI, or dementia.

RESULTS

Using the standard cut score of <24, the MMSE identified only 60% of persons diagnosed with dementia. By contrast, using a recommended cut score of <14 words per minute, Animal Naming identified 85% of persons with dementia with a relatively low (12%) false positive rate. Clock Drawing was intermediate to the other 2 measures in screening effectiveness.

CONCLUSIONS

Animal Naming was moderately to highly effective in identifying dementia. The naming procedure is easy to administer and may have value as a brief initial dementia screen in busy practice settings. More demanding cognitive measures may be needed to improve screening accuracy for MCI.

Use of clerkship learning objectives by members of the Association of Directors of Medical Student Education in Psychiatry

OBJECTIVE

The authors aimed to determine the extent and use of the 1995 psychiatry clerkship goals and objectives published by the Association of Directors of Medical Student Education in Psychiatry (ADMSEP) and to obtain members' guidance regarding their proposed revision.

METHODS

ADMSEP members were surveyed regarding their awareness and current use of the objectives, their advantages and disadvantages, and suggestions for revision.

RESULTS

Fifty-four of approximately 130 members returned surveys, including 60% of members who identified as clerkship directors. Ninety percent of respondents were aware of the objectives and 48% used them. Use was significantly related to years of ADMSEP membership. Those who used the objectives did so moderately or extensively, and 84% found them moderately to very useful. Reasons for nonuse were the employment of other objectives, unawareness of them, too lengthy/not user-friendly, and lack of resources to implement them. Comprehensiveness and specificity were cited as both their most useful aspects and their least useful aspects. The most frequently suggested revisions included prioritization, adding more clinical competencies, decreasing the total number, and developing supporting documents such as clinical cases, references, sample examinations, and a resource manual. Respondents held strongly favorable attitudes regarding the utility of learning objectives.

CONCLUSION

The ADMSEP psychiatry clerkship learning objectives were widely but not uniformly used among members surveyed, and use is significantly related to years of membership. Respondents strongly favor using learning objectives and desire that a new iteration of the document be more user-friendly, oriented to competencies, and supported by resource materials.

Combination rapid transcranial magnetic stimulation in treatment refractory depression

High frequency (>1 Hz) repetitive transcranial magnetic stimulation (rTMS) applied to the left prefrontal cortex and low frequency ( Collapse

Key Words

• transcranial magnetic stimulation
• treatment resistant depression

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MESH Headings Collapse

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Medical students' exposure to and attitudes about drug company interactions: a national survey

CONTEXT

While exposure to and attitudes about drug company interactions among residents have been studied extensively, relatively little is known about relationships between drug companies and medical students.

OBJECTIVE

To measure third-year medical students' exposure to and attitudes about drug company interactions.

DESIGN, SETTING, AND PARTICIPANTS

In 2003, we distributed a 64-item anonymous survey to 1143 third-year students at 8 US medical schools, exploring their exposure and response to drug company interactions. The schools' characteristics included a wide spectrum of ownership types, National Institutes of Health funding, and geographic locations. In 2005, we conducted a national survey of student affairs deans to measure the prevalence of school-wide policies on drug company-medical student interactions.

MAIN OUTCOME MEASURES

Monthly frequency of students' exposure to various activities and gifts during clerkships, and attitudes about receiving gifts.

RESULTS

Overall response rate was 826/1143 (72.3%), with range among schools of 30.9%-90.7%. Mean exposure for each student was 1 gift or sponsored activity per week. Of respondents, 762/818 (93.2%) were asked or required by a physician to attend at least 1 sponsored lunch. Regarding attitudes, 556/808 (68.8%) believed gifts would not influence their practices and 464/804 (57.7%) believed gifts would not affect colleagues' practices. Of the students, 553/604 (80.3%) believed that they were entitled to gifts. Of 183 students who thought a gift valued at less than $50 was inappropriate, 158 (86.3%) had accepted one. The number of students who simultaneously believed that sponsored grand rounds are educationally helpful and are likely to be biased was 452/758 (59.6%). Students at 1 school who had attended a seminar about drug company-physician relationships were no more likely than the nonattending classmates to show skepticism. Of the respondents, 704/822 (85.6%) did not know if their school had a policy on these relationships. In a national survey of student affairs deans, among the 99 who knew their policy status, only 10 (10.1%) reported having school-wide policies about these interactions.

CONCLUSIONS

Student experiences and attitudes suggest that as a group they are at risk for unrecognized influence by marketing efforts. Research should focus on evaluating methods to limit these experiences and affect the development of students' attitudes to ensure that physicians' decisions are based solely on helping each patient achieve the greatest possible benefit.

Medial temporal lobe activity for recognition of recent and remote famous names: an event-related fMRI study

Previous neuroimaging studies examining recognition of famous faces have identified activation of an extensive bilateral neural network [Gorno Tempini, M. L., Price, C. J., Josephs, O., Vandenberghe, R., Cappa, S. F., Kapur, N. et al. (1998). The neural systems sustaining face and proper-name processing. Brain, 121, 2103-2118], including the medial temporal lobe (MTL) and specifically the hippocampal complex [Haist, F., Bowden, G. J., & Mao, H. (2001). Consolidation of human memory over decades revealed by functional magnetic resonance imaging. Nature Neuroscience, 4, 1139-1145; Leveroni, C. L., Seidenberg, M., Mayer, A. R., Mead, L. A., Binder, J. R., & Rao, S. M. (2000). Neural systems underlying the recognition of familiar and newly learned faces. Journal of Neuroscience, 20, 878-886]. One model of hippocampal functioning in autobiographical, episodic memory retrieval argues that the hippocampal complex remains active in retrieval tasks regardless of time or age of memory (multiple trace theory, MTT), whereas another proposal posits that the hippocampal complex plays a time-limited role in retrieval of autobiographical memories. The current event-related fMRI study focused on the medial temporal lobe and its response to recognition judgments of famous names from two distinct time epochs (1990s and 1950s) in 15 right-handed healthy older adults (mean age=70 years). A pilot study with an independent sample of young and older subjects ensured that the stimuli were representative of a recent and remote time period. Increased MR signal activity was observed on a bilateral basis for both the hippocampus and parahippocampal gyrus (PHG) during recognition of familiar names from both the recent and remote time periods when compared to non-famous names. However, the impulse response functions in the right hippocampus and right PHG demonstrated a differential response to stimuli from different time epochs, with the 1990s names showing the greatest MR signal intensity change, followed by the 1950s names, followed by foils. The finding that recognition of famous names produced significant bilateral MTL activation regardless of time epoch relative to foils provides support for the MTT model. However, the finding of a temporal gradient in the right MTL also provides support for the HC model, given the greater MTL response associated with recently famous names relative to remotely famous names.

Screening for Major Depression in Epilepsy with Common Self-report Depression Inventories

PURPOSE

Major depression is a common psychiatric comorbidity in chronic epilepsy that is frequently unrecognized and untreated. A variety of self-report mood inventories are available, but their validity as well as ability to detect major depression in epilepsy remains uncertain. The purpose of this study was to determine the ability of two common depressive symptom inventories to identify major depression in people with epilepsy.

METHODS

In total, 174 adult patients with epilepsy underwent standardized psychiatric interview techniques [Mini International Neuropsychiatric Interview (MINI) and Mood Disorders module of the Structured Clinical Interview for DSM-IV Axis I Disorders-Research Version (SCID-I)] to determine the presence of current major depression. Subjects completed two self-report depression inventories [Beck Depression Inventory-II (BDI-II), Center for Epidemiological Study of Depression (CES-D)]. The ability of these self-report measures to identify major depression as identified by the gold standard structured interviews was examined by using diagnostic efficiency statistics.

RESULTS

Both the BDI-II and the CES-D exhibited significant ability to identify major depression in epilepsy. All ROC analyses were highly significant (mean area under the curve, 0.92). Mean sensitivity (0.93) and specificity (0.81) were strong, with excellent negative predictive value (0.98) but lower positive predictive value (0.47).

CONCLUSIONS

Common self-report depression measures can be used to screen for major depression in clinical settings. Use of these measures will assist in the clinical identification of patients with major depression so that treatment can be initiated.

Who seeks genetic susceptibility testing for Alzheimer’s disease? Findings from a multisite, randomized clinical trial

PURPOSE

Alzheimer's disease, for which one form of the apolipoprotein E (APOE) genotype is a risk factor, provides a paradigm in which to examine response to susceptibility testing for common, complex diseases. This study's main purposes were to estimate interest in such testing and to examine demographic predictors of study participation.

METHODS

In this 3-site, randomized clinical trial (RCT), the intervention was a risk assessment program wherein genetic counselors educated adult children of AD patients about lifetime risk of disease based on their gender, family history, and APOE genotype. Two groups of participants were followed from initial contact to RCT enrollment: those who were systematically contacted through research registries, and those who were self-referred.

RESULTS

Of 196 systematically contacted participants, 47, or 24%, progressed from initial contact to RCT enrollment. These participants were more likely to be below age 60 (adjusted OR = 3.83, P < 0.01) and college educated (adjusted OR = 3.48, P < 0.01). Of 179 self-referred participants, 115, or 64%, progressed from initial contact to RCT enrollment. Most self-referred participants had a college education and were female (79%).

CONCLUSIONS

In the first RCT to examine genetic susceptibility testing for AD, uptake rates were sufficiently high to merit concern that future test demand may strain available education and counseling resources. Findings suggest that susceptibility testing for AD may be of particular interest to women, college educated persons, and persons below age 60.

Factors affecting medical student career choice of psychiatry from 1999 to 2001

OBJECTIVE

The proportion of students matching into psychiatry (PMP) at each medical school results from a complex interplay between extrinsic (e.g., national trends, geographic region) and intrinsic factors (e.g., the quality of psychiatric education). The goal of the study was to learn the extent to which regional and local extrinsic factors (and one intrinsic factor) influenced PMP at medical schools in the U.S. from 1999 to 2001.

METHODS

The authors obtained data about these factors from deans of student affairs, the National Resident Matching Program (NRMP), American Medical Association (AMA), Association of American Medical Colleges (AAMC), American Psychiatric Association (APA), and Harvard University's HealthSystem Consortium.

RESULTS

The best predictor of a school's PMP is the PMP of the prior year for that particular school. Local and regional extrinsic factors were not significantly associated with PMP. There was a modest inverse correlation between PMP and the proportion of international medical graduates (IMGs) in psychiatry residency.

CONCLUSIONS

The authors infer that intrinsic factors are most important for recruitment, and they make recommendations for addressing these factors.