The Relationship between Clinic Visit Accompanied by Family and Dementia Severity in Taiwan

Characteristics and Predictors of Alzheimer's Disease Resilience Phenotype

Alzheimer's disease (AD) is characterized by cognitive impairment in the presence of cerebral amyloid plaques and neurofibrillary tangles. Less is known about the characteristics and predictors of resilience to cognitive impairment in the presence of neuropathological evidence of AD, the focus of this study. Of 3170 adults age ≥65 years in the National Alzheimer's Coordinating Center (NACC) brain autopsy cohort, 1373 had evidence of CERAD level moderate to frequent neuritic plaque density and Braak stage V-VI neurofibrillary tangles. Resilience was defined by CDR-SOB and CDR-Global scores of 0-2.5 and 0-0.5, respectively, and non-resilience, CDR-SOB and CDR-Global scores >2.5 and >0.5, respectively. Multivariable logistic regression models were used to examine the independent associations of patient characteristics with resilience. There were 62 participants (4.8%) with resilience. Those with resilience were older (mean age, 88.3 vs. 82.4 years), more likely to be women (61.3% vs. 47.3%) and had a lower prevalence of the APOE-e4 carrier (41.9% vs. 56.2%). They also had a higher prevalence of hypertension, heart failure, atrial fibrillation, diuretic use, beta-blocker use, and APOE-e2 carrier status. Greater age at death, diuretic use, and APOE-e2 were the only characteristics independently associated with higher odds of the AD resilience phenotype (adjusted OR, 1.09; 95% CI, 1.05-1.13; p < 0.01; 2.00 (1.04-3.87), p = 0.04, 2.71 (1.31-5.64), p < 0.01, respectively). The phenotype of resilience to cognitive impairment is uncommon in older adults who have neuropathological evidence of AD.

[Influence of the companion in Primary Care consultations on communication skills and interview time]

OBJETIVES

To know the influence of the companion in triadic clinical encounter on the quality of doctor-patient communication and the duration of the interview.

DESIGN

Cross-sectional descriptive study.

LOCATION

10 Primary Care Centers.

PARTICIPANTS

Resident doctors of Family and Community Medicine.

INTERVENTIONS

Peer review of video recordings of clinical demand consultations.

MAIN MEASUREMENTS

CICAA-2 questionnaire to assess communication skills (improvable, acceptable or adequate); age and sex, reasons for consultation and duration of the interview. Bivariate and multivariate analyses. Ethical authorization, oral informed consent and custody of the video recordings.

RESULTS

73 RD (53.8% women, 32.9±7.7 years) participated with 260 interviews (60.3% women and 2.1±1.0 clinical demands). 27.7% of consultations with a companion (female sex 65.3%). The mean duration of the interviews was 8.5±4.0min. Clinical encounters lasted longer when a companion attended (2.7±0.5min more; p<.001 Student t) and with a greater number of clinical demands (40% with ≥3 reasons, p=0.048 X²). The mean value of the total score of the CICAA-2 scale (46.9±16.5; difference 4.6±2.3) and Task 2 (39.3±15.8 with difference 4.4±2.2) were higher when companion was present (p<.05 Student t). The model obtained with logistic regression shows a longer duration of the consultation with a companion (OR 1.2; CI [1.1-1.3]) and possibly a better score in Task 2 communication skills (OR 1.02; CI [0.99-1.1]).

CONCLUSIONS

Triadic communications challenge the clinician's communication skills, improving their abilities to identify and understand patient problems, albeit at the cost of a greater investment of time.

Goodness-of-fit tests for a logistic regression model with missing covariates

Model checking for logistic regression with covariates missing at random is considered. Based on the ideas of Copas (1989) and Osius and Rojek (1992) and studies of Homser et al. (1997), proposed are the two-type goodness-of-fit tests, Pearson chi-squared and unweighted residual sum-of-squares tests, in which their test statistics are centralized by subtracting their estimated mean to be mean-zero-form test statistics via the inverse probability weighting (IPW) and nonparametric multiple imputation (MI) methods to solve the missing value problem. The asymptotic properties of these test statistics are established under the null hypothesis and some regularity conditions. The test statistics conducted by using the IPW and MI estimators are asymptotically equivalent. Proposed are the IPW method and two bootstrap re-sampling approaches for estimation of the variances of the proposed test statistics to solve the issue of underestimating their variances by the MI method of Rubin (1987). Simulation studies are carried out to assess the finite-sample power performances of these proposed tests. Two real data examples are used to illustrate the applicability of the proposed tests.