Low occurence of Tuberculosis and HIV among Ukrainian Immigrants of War at the Border post in Uzhorod – Vysne Nemecke at point prevalence testing (note)

Point prevalence studies bring us approximate situations in border emergency settings where longitudinal or comparative studies are not realistic from logistic safety points of view. The one day point prevalence study performed at most frequently used checkpoints between Ukraine (UA) and Slovakia (SK). No case of TB screened by the WHO recommended questionnaire, or HIV performed by rapid test has been noted on day 7 after the war was declared.

Integrative Health Policy for Migrants in Germany

It is not a new topic for Germany in receiving immigrants from various nations. However, it is thought-provoking how German integration policy is criticized to be exclusionist based on its immigration policies. 1 In Germany, efforts to integrate the current demand and needs of the migrant population into the healthcare system have proved uncoordinated and scattered as much as diversity in policy is slowly under the implementation process. Frequently, immigrants are not facing any complicated legal restrictions but it is reported that they experience extremely challenging access with barriers resulting in the worst results trying to utilize healthcare services. 2 Equal access to health care services is a crucial aspect of Germany's national health policy. Factors contributing to access barriers to healthcare are said to be: cultural differences; education; political issues; the absence of complementary voluntary health insurance. Therefore, this paper will explore the migrants’ health and barriers to healthcare access in Germany

Nonconscious Perception, Where are You?

In three studies, no evidence of nonconscious perception was found, although general procedures used in previous studies reporting the effect were followed. Presence/absence thresholds (Exps. 1 and 2) or recognition threshold (Exp. 3) were established for each subject. There was no difference in the effects of related and unrelated primes on voice reaction time during a word naming task. These findings raise questions about the robustness of nonconscious priming effects.

A Semantic Priming Test of Bilingual Language Storage and the Compound vs Coordinate Bilingual Distinction with Latvian-English Bilinguals

The unified and separate storage models of bilingual language storage and the compound vs coordinate bilingual distinction were tested with a semantic priming test using 47 Latvian-English bilinguals, some of whom learned the two languages at the same time and in the same environment and some of whom learned the two languages at different times and in different environments. Subjects named target words in their two languages, preceded by related or unrelated words in the same or a different language. Analyses of naming latencies provided no evidence of the compound vs coordinate distinction; however, results provided evidence favoring the separate storage model and suggested that seeing a word in a one language prepared the person to say another word in the same language.

Compensatory strategies in picture description across severity levels in Alzheimer's disease: A longitudinal study

Communication changes over time were studied in 55-persons with Alzheimer's disease (AD) who completed a picture description task at entry, six, and 12-months. Differences at three levels of AD severity (early, middle, late) were investigated using six discourse measures (total utterances, length of utterance, words, abandoned utterances, information units, and conciseness), and six pragmatic measures (questions, turns, unsure statements, judgments, egocentric comments, and giving names). Across all three groups, subjects were less concise over time, made shorter utterances, asked more questions, and provided fewer information units. Increasing percentages of subjects made unsure statements with time. However, performance varied by severity group, with increasing unsureness occurring only at early AD, and all other observed changes occurring at late AD. Persons with AD appear to strive for communication competence as language declines by increasing certain compensatory pragmatic aspects (questions and unsure statements) at different severity levels of the disorder. This suggests that compensatory pragmatic devices are used with flexibility, and that the desire to communicate is maintained throughout the course of AD.

Pragmatic and Internal Validity Issues in Sampling in Caregiver Studies

Objectives: Studies of caregivers illustrate a classic sampling dilemma: maximizing recruitment without compromising study validity. Because caregivers are defined in relation to a care recipient, sampling methods are often determined by pragmatic decisions such as access, efficiency, and costs. However, overlooking validity may result in selection bias, misclassification of caregiver status, and the confounding of results. Validity and pragmatic concerns were compared in four caregiver studies that used different sampling frames: community based, Alzheimer’s disease registry, and ancillary studies to existing epidemiologic studies. Methods: Systematic comparison of validity and of pragmatic aspects of sampling frames, recruitment methods, and participation rates, with attention to caregiver identification, inclusion criteria, and sample restriction. Results: All studies used task-based inclusion criteria. Caregiver participation rates ranged from 81% to 96%, with higher rates in community-based and registry-based studies than in ancillary studies. The latter studies benefited from unbiased selection of noncaregivers. Discussion: Regardless of sampling frame, standard task-based inclusion criteria to define caregivers may enhance validity.

A randomized pilot clinical trial of the safety of pioglitazone in treatment of patients with Alzheimer disease

OBJECTIVES

To evaluate the safety of the peroxisome proliferator-activated receptor gamma agonist pioglitazone in nondiabetic patients with Alzheimer disease (AD) and to explore treatment effect sizes on clinical outcomes.

DESIGN

Double-blind, placebo-controlled randomized controlled trial of 18-month duration.

SETTING

Two academic medical center outpatient clinics.

PATIENTS

Nondiabetic patients meeting research criteria for probable AD were enrolled. Twenty-five of 29 subjects completed the study; no withdrawals were attributable to adverse effects.

INTERVENTION

Subjects received pioglitazone (Actos), titrated to 45 mg daily, or matching placebo, and 200 IU of vitamin E daily. Patients maintained treatment with cholinesterase inhibitors and could begin memantine therapy when it became available during the study.

MAIN OUTCOME MEASURES

The primary outcome was frequency of reported adverse effects (AEs). Secondary outcomes were measures of cognition, activities of daily living, neuropsychiatric symptoms, and global function.

RESULTS

Peripheral edema was the principal AE occurring more frequently in subjects taking pioglitazone than placebo (28.6% vs 0%). This is consistent with the known AE profile of pioglitazone. No group differences in laboratory measures were identified. No significant treatment effect was observed on exploratory analysis of clinical efficacy.

CONCLUSIONS

Pioglitazone was generally well tolerated in this pilot study. There were no serious or unanticipated adverse events or clinical laboratory changes attributable to pioglitazone over a long-term exposure in nondiabetic patients with AD. The tolerability of pioglitazone in this population and peroxisome proliferator-activated receptor gamma effects in laboratory models of AD support further study of this drug class in earlier disease stages.

TRIAL REGISTRATION

clinicaltrials.gov Identifier: NCT00982202.

Is exhaled carbon monoxide level associated with blood glucose level? A comparison of two breath analyzing methods

The level of exhaled carbon monoxide (eCO) is considered a marker of oxidative stress in diabetes. Previous findings indicated that eCO levels correlated with blood glucose level. The aim of this work was to apply and compare two independent analyzing methods for eCO after oral glucose administration. Glycemia, eCO, and exhaled hydrogen were measured before and after oral administration of glucose. Six healthy nonsmoking volunteers participated. For eCO analysis, we used two methods: a commercially available electrochemical sensor, and a high-precision laser spectrometer developed in our laboratory. The precision of laser-spectroscopic eCO measurements was two orders of magnitude better than the precision of the electrochemical eCO measurement. eCO levels measured by laser spectrometry after glucose administration showed a decrease of 4.1%+/-1.5% compared to the baseline (p<0.05). Changes in the eCO measured by the electrochemical sensor were not significant (p=0.08). Exhaled hydrogen levels increased by 40% within the first 10 min after glucose administration (p<0.05). The previous finding that the glycemia increase after glucose administration was associated with a significant increase in eCO concentrations was not confirmed. We propose that previous eCO measurements with electrochemical sensors may have been affected by cross sensitivity to hydrogen.

NO detection in biological samples: differentiation of 14 NO and 15 NO using infrared laser spectroscopy

Accurate characterization of the biochemical pathways of nitric oxide (NO) is essential for investigations in the field of NO research. To analyze the different reaction pathways of enzymatic and non-enzymatic NO formation, determination of the source of NO is crucial. Measuring NO-related products in biological samples distinguishing between (14)NO and (15)NO offers the opportunity to specifically analyze NO signaling in blood and tissue. The aim of this study was to establish a highly sensitive technique for the specific measurement of NO in an isotopologue-selective manner in biological samples. With the cavity leak-out spectroscopy setup (CALOS) a differentiation between (14)NO and (15)NO is feasible. We describe here the employment of this method for measurements in biological samples. Certified gas mixtures of (14)NO/N(2) and (15)NO/N(2) were used to calibrate the system. (14)NO2- and (15)NO2- of aqueous and biological samples were reduced in a triiodide solution, and the NO released was detected via CALOS. Gas-phase chemiluminescence detection (CLD) was used for evaluation. The correlation received for both methods for the detection of NO in the gas phase was r=0.999, p<0.0001. Results obtained using aqueous and biological samples verified that CALOS enables NO measurements with high accuracy (detection limit for (14)NO2- 0.3 pmol and (15)NO2- 0.5 pmol; correlation (14)NO: p<0.0001, r=0.975, (15)NO: p<0.0001, r=0.969). The CALOS assay represents an extension of NO measurements in biological samples, allowing specific investigations of enzymatic and non-enzymatic NO formation and metabolism in a variety of samples.

Height and Alzheimer's disease: findings from a case-control study

The purpose of this study is to examine the relationship of height, Apolipoprotein E genotype (APOE) and Alzheimer's disease (AD). Using a case-control design, subjects were recruited from the research registry of the University Memory and Aging Center of Case Western Reserve University and University Hospitals of Cleveland. On entry to the study, height was measured on 239 probable or possible AD patients and 341 healthy controls living in northeast Ohio. Risk of AD was modeled as a function of quartile of height, APOE genotype, years of education and year of birth. Analyses were stratified by gender. For men, cases were more likely to be shorter when compared to controls (p=0.001). There was only a small difference in mean height between AD cases and controls among women (p=0.05). For men, height in the highest quartile [>179.7 cm (70.75 in)] had a 59% lower risk of developing AD that in the lowest quartile [< 169.5 cm (66.75 in)], controlling for year of birth, and education (p=0.03). For women without an APOE epsilon4 allele, increasing height was associated with lower risk for AD (OR=0.88; p=0.01) but no significant association was found for women with at least one epsilon4 allele (OR=1.03; p=0.56).

Cognitive functioning in healthy aging: the role of reserve and lifestyle factors early in life

PURPOSE

According to the reserve perspective on cognitive aging, individuals are born with or can develop resources that help them resist normal and disease-related cognitive changes that occur in aging. The reserve perspective is becoming more sophisticated, but gaps in knowledge persist. In the present research, we considered three understudied questions about reserve: Is reserve primarily static (unchangeable) throughout the life course or dynamic (changeable, in terms of increases or decreases)? Can reserve be increased at any point in life, or are there optimal time periods--such as early life, midlife, or late life--to increase it? Does participation in different types of leisure and occupational activities in early life and midlife have different effects depending on specific domains of late-life cognitive functioning? Here we link early cognitive and activity data--gathered from archival sources--with cognitive data from older adults to examine these issues.

DESIGN AND METHODS

349 participants, all mid-1940s graduates of the same high school, underwent telephone cognitive screening. All participants provided access to adolescent IQ scores; we determined activity levels from yearbooks. We used path analysis to evaluate the complex relationships between early life, midlife, and late-life variables.

RESULTS

Adolescent IQ had strong direct effects on global cognitive functioning, episodic memory, verbal fluency, and processing speed. Participants' high school mental activities had direct effects on verbal fluency, but physical and social activities did not predict any cognitive measure. Education had direct effects on global cognitive functioning, episodic memory, and, most strongly, processing speed, but other midlife factors (notably, occupational demands) were not significant predictors of late-life cognition. There were weak indirect effects of adolescent IQ on global cognitive functioning, episodic memory, and processing speed, working through high school mental activities and education. Verbal fluency, in contrast, was affected by adolescent IQ through links with high school mental activities, but not education.

IMPLICATIONS

Our study suggests that reserve is dynamic, but it is most amenable to change in early life. We conclude that an active, engaged lifestyle, emphasizing mental activity and educational pursuits in early life, can have a positive impact on cognitive functioning in late life.

The Role of Adolescent IQ and Gender in the Use of Cognitive Support for Remembering in Aging

The purpose of this study was to examine the role of adolescent IQ (AIQ) and gender in older adults' ability to use cognitive support to enhance memory. Subjects were 269 mid-1940s graduates of the same high school. Adolescent IQ scores were gathered from archives, and subjects' memory for words was tested with tasks that provided increasing cognitive support. Overall, subjects benefited from support; women recalled more words than men; and persons with a high AIQ remembered more words than persons with a lower AIQ. However, while all subjects showed gains from cognitive support, men with a lower AIQ performed worse than men with a high AIQ. Women's performance was not dependent on their AIQ. Analysis of qualitative memory indicators suggested that women and persons with a high AIQ had better encoding and retrieval operations. Men with a lower AIQ appear to be particularly vulnerable to memory deficits in aging. This may be due to low "cognitive reserve" or generally poorer episodic memory function.

Alzheimer's Disease and Smoking: Bias in Cohort Studies

The discrepancy between cohort and case-control studies regarding the association between smoking and Alzheimer's disease (AD) has been attributed to the competing risk of early mortality of smokers. A simulation study was conducted to show that the bias favoring smokers acts also on cohort studies. In the model, individuals {grow older} and have smoking habits according to published year-age-gender-specific patterns, with morbidity and mortality according to their demographic and smoking profiles. Those individuals dying of smoking-related causes ("phantoms") remain at risk of AD and of death from other causes. Three scenarios were considered: no association of AD and smoking, increased risk for smokers, and decreased risk for smokers. For each simulation of a cohort study, two incidence density ratios (IDR) were computed: one including the phantoms that developed AD (thus ignoring smoking-related deaths) and another excluding them (thus mimicking real-life studies). For all scenarios, the simulations show that smoking-related death creates a bias, resulting in smokers having an understated risk of AD compared to non-smokers. The speculation that the conflicting results of case-control and cohort studies are solely due to the increased mortality in smokers thus appears unjustified. Other factors must also be considered to explain the discrepancy in results.

Use of live theater to increase minority participation in Alzheimer disease research

Recruitment and retention of African Americans into Alzheimer disease (AD) research studies poses challenges owing to long-standing socio-economic and cultural differences, pragmatic difficulties in reaching the African American population, and a legacy of distrust of medical research. In this study, we report on our efforts to use live theater to educate African Americans about AD research and to increase minority participation in it. We describe our experiences at the University Memory and Aging Center (Cleveland, OH) in commissioning, writing, and producing several theater productions focused on themes related to African Americans and their experiences dealing with family members with AD. Analysis of recruitment data, gathered before and after one of our productions, indicated that minority enrollment into our Center's Research Registry increased after the play. Survey data, gathered before and after production of a different play, indicated that viewing this piece increased knowledge about: (1) the symptoms of AD; (2) the fact that memory loss is not a part of normal aging; and (3) the greater prevalence of AD among African Americans. Also, after viewing this production, more audience members: (1) reported knowing how to become involved in research; (2) felt comfortable involving family members in research; and (3) would recommend research to others. We conclude that live theater that dramatizes the experiences of a family living with a person with AD can increase knowledge about AD, improve attitudes about taking part in research, and lead to greater participation in AD research studies. An explanatory model is offered to account for our findings.

Multicolor fluorescence in situ hybridization (M-FISH) on cells from urine for the detection of bladder cancer

Bladder cancer is the fifth most common cancer in adults. Because of the high recurrence rate (up to 70%) new tumor markers for urine are necessary for monitoring patients. In this study, we investigated the value of M-FISH on cells from urine for the detection of bladder cancer. Urine samples from 141 patients suspicious of bladder cancer were analyzed in this study. Cells were isolated from urine before surgical therapy. For FISH analysis, a commercial kit (UroVysion) containing hybridization probes for chromosomes 3, 7, 9p21 and 17, was used. Twenty-five cells were analyzed in each case by two observers. A FISH result was obtained in 121 cases. Overall, sensitivity was 60% and specificity reached 82.6%. Sensitivity and specificity by cytology were 24.1% and 90.5%, respectively. Analyzing results concerning T-category, sensitivity of FISH and cytology was 36.1% and 15% in pTa, 65.2 and 25.7% in pT1, 100% and 66.7% in pT2-3 tumors, respectively. Concerning tumor grade, similar results were obtained: sensitivity was 37% and 14% in G1, 65.4% and 40% in G2, 91.7% and 50% in G3 tumors, for FISH and cytology, respectively. In conclusion, FISH on cells from urine has been shown in all studies to be highly sensitive and specific for detection of bladder cancer. Sensitivity of FISH is higher than conventional cytology and can be used in routine diagnosis additionally to conventional cytology especially in doubtful or negative cases. FISH can detect recurrence earlier than other methods like cytology, cystoscopy or biopsy histological examination.

Mental health and diurnal salivary cortisol patterns among African American and European American female dementia family caregivers

Using a sociocultural stress and coping model, this pilot study examines the influence of depressive symptoms and stress on diurnal salivary cortisol patterns among African American (N=30) and European American (N=24) female dementia caregivers and noncaregivers (African American, N=48; European American, N=15). Caregiving participants completed the Center for Epidemiological Studies Depression Scale (CES-D), Perceived Stress Scale (PSS), and Stress-Related Growth Scale (SRGS) as respective measures of depressive symptoms, stress, and stress resilience. Participants also collected five saliva samples daily for two consecutive days. African American caregivers scored significantly higher than European American caregivers on the SRGS, but they did not differ on the PSS and CES-D scales. Regression analyses with age, ethnicity, caregiving status, and depressive symptoms as predictors, and cortisol slope as criterion, showed that only age and ethnicity predicted cortisol slope. African Americans had flatter slopes than the European Americans sampled, regardless of caregiving status. Findings highlight the role of cultural beliefs and of ethnicity in explaining cortisol function.

Participation in novelty-seeking leisure activities and Alzheimer's disease

The objective was to study the associations between participation in different types of mentally stimulating leisure activities and status as Alzheimer's disease (AD) case or normal control. Research suggests that participation in leisure activities, especially mentally stimulating activities, is associated with a lower risk for AD. However, no study has yet evaluated associations between AD and different types of mental leisure activities, especially those involving "novelty seeking." The authors used a case-control design to compare participation in activities across the life span in persons with AD and normal controls. Cases (n = 264) were recruited from clinical settings and from the community. Controls were drawn from 2 populations. Control group A members (n = 364) were the friends or neighbors of the cases or members of the same organizations to which the cases belonged. Control group B members (n = 181) were randomly drawn from the community. The 2 control groups did not differ in their responses to most activity questions, so they were combined. Factor analysis of activity questions identified 3 activity factors: (1) novelty seeking; (2) exchange of ideas; and (3) social. Logistic regression analysis indicated that, adjusting for control variables, greater participation in novelty-seeking and exchange-of-ideas activities was significantly associated with decreased odds of AD. The odds of AD were lower among those who more often participated in activities involving exchange of ideas and were lower yet for those who more frequently participated in novelty-seeking activities. We conclude that participation in a variety of mental activities across the life span may lower one's chances of developing AD.

Associations Between Dementia/Mild Cognitive Impairment and Cognitive Performance and Activity Levels in Youth

OBJECTIVES

To study the associations between dementia/mild cognitive impairment (MCI) and cognitive performance and activity levels in youth.

DESIGN

Retrospective cohort study.

SETTING

Research volunteers living throughout the United States.

PARTICIPANTS

A total of 396 persons (mean age 75) who were graduates of the same high school in the mid-1940s.

MEASUREMENTS

Adolescent intelligence quotient (IQ) scores were gathered from archived student records, and activity levels were determined from yearbooks. A two-stage telephone screening procedure (Modified Telephone Interview for Cognitive Status or Informant Questionnaire on Cognitive Decline in the Elderly followed by Dementia Questionnaire) was used to determine adult cognitive status. Data were analyzed using logistic regression to model the risk of cognitive impairment (dementia/MCI) versus no cognitive impairment as a function of IQ and activity level, adjusting for sex and education.

RESULTS

High adolescent IQ and greater activity level were each independently associated with a lower risk for dementia/MCI (odds ratio (OR) for a 1-standard deviation increase in IQ=0.51, 95% confidence interval (CI)=0.32-0.79; OR for a unit increase in activity=0.32, 95% CI=0.12-0.84). No association was found between sex or education and adult cognitive status in this model.

CONCLUSION

High IQ and greater activity levels in youth reduce the risk for cognitive impairments in aging. The mechanism(s) underlying these associations are unknown, but intelligence may be a marker for cognitive/neurological "reserve," and involvement in activities may contribute to "reserve." Early neuropathology and ascertainment bias are also possible explanations for the observed associations.

The relationships between television viewing in midlife and the development of Alzheimer’s disease in a case-control study

The relationship between leisure activities and development of cognitive impairment in aging has been the subject of recent research. We examined television viewing in association with risk of developing Alzheimer's disease (AD) in a case-control study. Given recent focus on the importance of intellectually stimulating activities as preventive measures against cognitive decline, it is important to examine the effects of less stimulating but common activities. Data are from 135 Alzheimer's disease cases and 331 healthy controls. Demographic characteristics and life history questionnaire responses on the number of hours spent on 26 leisure activities during middle-adulthood (ages 40-59) were analyzed. Logistic regression was used to examine the effects of middle-adulthood leisure activities on case vs. control status. Results indicate that for each additional daily hour of middle-adulthood television viewing the associated risk of AD development, controlling for year of birth, gender, income, and education, increased 1.3 times. Participation in intellectually stimulating activities and social activities reduced the associated risk of developing AD. Findings are consistent with the view that participation in non-intellectually stimulating activities is associated with increased risk of developing AD, and suggest television viewing may be a marker of reduced participation in intellectually stimulating activities.

Worker functions and traits associated with occupations and the development of AD

OBJECTIVE

To investigate the association between Alzheimer disease (AD) and worker functions and traits associated with occupations.

BACKGROUND

Studies have reported that occupational attainment is related to AD. However, most have not identified specific worker functions and traits (i.e., occupational demands) of occupations that may explain the association, nor have they accounted for changing occupational demands over time.

METHODS

Within- and between-group differences in mental, motor, physical, and social occupational demands of 122 AD cases and 235 control subjects were compared across four decades of life (20s, 30s, 40s, and 50s) using repeated-measures analyses of covariance adjusted for race, gender, year of birth, and education.

RESULTS

Overall, mental occupational demands were significantly lower and physical occupational demands were significantly higher for cases than for control subjects. Case/control differences in mental demand scores were not found in their 20s but only in later decades. Differences in physical demands were found in all decades but their 30s. Social and motor demands did not differ between cases and control subjects. Among cases only, there were no significant occupational demand score differences across decades. In contrast, mental and social demand scores of control subjects increased in later decades, and motor demand scores declined. Like cases, physical demand scores of control subjects remained stable across the decades.

CONCLUSIONS

The authors' results may indicate a relatively early influence of Alzheimer disease neuropathology on capacity to pursue mentally demanding occupations. However, results also are consistent with the notion that mentally demanding occupations have a direct influence on Alzheimer disease neuropathology.

Factor structure of the CERAD neuropsychological battery

The Consortium to Establish a Registry for Alzheimer's Disease (CERAD) neuropsychological battery was developed to evaluate cognitive impairments associated with Alzheimer's disease (AD). Previous studies have suggested that the battery is multi-dimensional, represented by either 3 or 5 dimensions. In this study a principal factor analysis was conducted using contemporary quantitative methods for determining the number of factors. Exploratory factor analysis of the CERAD battery and MMSE was conducted using one-half of the CERAD database (total N = 969). Glorfeld's modification of Horn's parallel analysis method suggested that there was 1 common factor in the variable matrix. Characterization of patterns of deficits in AD requires supplementation of measures derived from the CERAD and MMSE with other tests.

Development of a scale to predict decline in patients with mild Alzheimer's disease

OBJECTIVES

To develop a scale that can assist in predicting likelihood of decline from mild dementia over 1 year in patients with Alzheimer's disease (AD).

DESIGN

Retrospective cohort study.

SETTING

University Memory and Aging Center.

PARTICIPANTS

Patients with probable or possible AD and Clinical Dementia Rating (CDR) of 1 at baseline, divided into development and validation cohorts (n = 118 each).

MEASUREMENTS

The CDR and neurological and neuropsychological assessments were given at baseline and 1 year later.

RESULTS

In the development cohort, high education, low Mini-Mental State Examination score, poor insight, psychotic symptoms, and greater activity of daily living impairment predicted decline in CDR from 1 to 2 or 3. Receiver operating characteristics (ROC) curve analysis identified cutoff scores that maximized sensitivity and specificity for each significant predictor of decline. Based on the cutoff, raw scores were recoded to reflect risk for decline, weighted, and summed to create a final scale score. ROC curve analysis established a cutoff to indicate risk for decline on the final scale score. Sensitivity, specificity, and area under the ROC were 0.76, 0.74, and 0.83 in the development cohort and 0.77, 0.69, and 0.80 in the validation cohort, respectively. Positive and negative predictive values were 0.71 and 0.78 in the development cohort and 0.68 and 0.78 in the validation cohort, respectively.

CONCLUSIONS

Decline from mild to moderate or severe impairment represents significant clinical change, with implications for patient and caregiver quality of life and treatment options. The clinical scale developed uses data to enhance prediction about change from mild to moderate or severe stages of AD.

Effects of educational attainment and occupational status on cognitive and functional decline in persons with Alzheimer-type dementia

Researchers have suggested that educational attainment and occupational status--indicators of cognitive and/or neurologic "reserve"--can help persons compensate for clinical manifestations of Alzheimer's disease (AD), such as the rates of cognitive and functional decline. The effects of educational attainment on rates of decline could be "direct" independent of occupational status), "indirect" (working through occupational status), or both. We used multilevel analysis for repeated measures to study the effects of educational attainment and occupational status on rates of decline in cognition (Mini-Mental State Examination, MMSE) and function (Cleveland Scale for Activities of Daily Living). Subjects included persons with "probable" or "possible" AD, drawn from our Alzheimer's Disease Research Center registry (N = 482 in the analysis of cognitive decline, and N = 450 in the analysis of functional decline). When controlling for year of birth, gender, ethnicity, and duration of illness, we found that there was an inverse relationship between number of years of education and rate of decline in MMSE, but effects of occupational status were not significant. This implies a "direct" effect of education on decline in MMSE, but no "indirect" effect through occupational status. Neither educational attainment nor occupational status affected rate of decline in functional ability. We conclude that education slows the rate of cognitive decline in persons with AD, but not through its impact on occupational status. Thus, the protective effects of reserve may be established early in life, before people enter the workforce.

Everyday problem solving in African Americans and European Americans with Alzheimer's disease: an exploratory study

In this exploratory study, we compared the performance of 10 African American and 26 European American persons with early- to mid-stage Alzheimer's disease (AD) to 20 nondemented elderly (NE), using a shortened version of the Test of Problem Solving (TOPS). The TOPS measures verbal reasoning to solve everyday problems in five areas: explaining inferences, determining causes, answering negative why questions, determining solutions, and avoiding problems. Six linguistic measures were also examined: total utterances, abandoned utterances, length of utterances, maze words, questions, and total words. NE performed better than AD subjects on all but one measure of verbal reasoning ability. AD subjects also showed a trend to use more total utterances and abandoned utterances than NE. For the AD group, no ethnic differences were found for verbal reasoning or linguistic measures. The findings from this preliminary investigation suggest that, compared to European Americans, African American persons with AD demonstrate similar everyday problem solving and linguistic skills. Thus, assessments such as TOPS that examine everyday problem solving may be a useful nonbiased evaluation tool for persons with AD in these two ethnic groups.

Effects of educational attainment on the clinical expression of Alzheimer's disease: results from a research registry

The "reserve" hypothesis suggests that education should affect the clinical expression of Alzheimer's disease (AD), but results from studies examining this idea are not consistent. In a single study, we evaluated the effects of educational attainment on three aspects of the clinical expression of AD: age at symptom onset, rate of cognitive decline, and survival. Subjects were 258 persons with mild- or moderate-stage Alzheimer's, drawn from our AD Research Registry. With statistical adjustment for confounding variables present in a clinic-based design, we found that higher educational attainment was associated with slightly earlier reports of symptom onset and a slower rate of cognitive decline on the Mini-Mental State Exam (MMSE). Education did not affect time of survival until death. We conclude that, for subjects in our sample, education had modest effects on aspects of the clinical expression of AD. These effects were not fully consistent with predictions derived from the "reserve" hypothesis.

Patients with Alzheimer's disease have reduced activities in midlife compared with healthy control-group members

The development of Alzheimer's disease (AD) later in life may be reflective of environmental factors operating over the course of a lifetime. Educational and occupational attainments have been found to be protective against the development of the disease but participation in activities has received little attention. In a case-control study, we collected questionnaire data about 26 nonoccupational activities from ages 20 to 60. Participants included 193 people with probable or possible AD and 358 healthy control-group members. Activity patterns for intellectual, passive, and physical activities were classified by using an adaptation of a published scale in terms of "diversity" (total number of activities), "intensity" (hours per month), and "percentage intensity" (percentage of total activity hours devoted to each activity category). The control group was more active during midlife than the case group was for all three activity categories, even after controlling for age, gender, income adequacy, and education. The odds ratio for AD in those performing less than the mean value of activities was 3.85 (95% confidence interval: 2.65-5.58, P < 0.001). The increase in time devoted to intellectual activities from early adulthood (20-39) to middle adulthood (40-60) was associated with a significant decrease in the probability of membership in the case group. We conclude that diversity of activities and intensity of intellectual activities were reduced in patients with AD as compared with the control group. These findings may be because inactivity is a risk factor for the disease or because inactivity is a reflection of very early subclinical effects of the disease, or both.

Electrical impedance scanning for classifying suspicious breast lesions: first results

It has long been established that cancer cells exhibit altered local dielectric properties compared with normal cells. Consequently, different electrical conductivity and capacitance are measurable in malignant vs normal tissues. In this study we evaluated the reliability of electrical impedance scanning (EIS), a new technology, for the classification of suspicious lesions: differentiating benign from malignant, and as a primary means of detection of breast cancer. Fifty-two women with 58 sonographically and/or mammographically suspicious findings were examined using electrical impedance scanning. Two different examination modes of TransScan TS2000 (Siemens, Erlangen, Germany), the standard-resolution mode for a routine overview examination, and the targeted high-resolution mode for a local examination of the suspicious lesion were used. All patients were additionally imaged by MR mammography (MRM) and underwent core-biopsy and/or surgical treatment after the EIS examination. With respect to the histopathological findings (29 malignant and 29 benign lesions) 27 of 29 (93.1%) malignant lesions were correctly identified using the high-resolution mode of EIS, whereas 19 of 29 (65.5%) benign lesions were correctly identified as benign (10 of 29 benign lesions showed as false-positive findings). Negative and positive predictive values of 90.5 and 73.0% were observed, respectively. Using the standard-resolution mode 22 of 29 malignancies were correctly detected (sensitivity 75.9%), whereas 22 of 29 were correctly identified as benign (specificity 72.4%). Electrical impedance scanning appears to be a promising new technology providing a relatively high sensitivity for the verification of suspicious mammographic and/or sonographic lesions especially using the high-resolution mode for local examinations. Artifacts, such as signals from superficial skin lesions, poor contact, and air bubbles, are currently a limitation.

Electrical impedance scanning: a new technique in the diagnosis of lymph nodes in which malignancy is suspected on ultrasound

Differentiation between inflammatory and malignant lymph nodes by ultrasound is difficult. Electrical impedance scanning (EIS) is a new diagnostic tool, so far used primarily for the identification of malignant breast lesions. Cancer cells have altered dielectric properties compared with normal cells, thereby distorting the local electrical field. The induced changes in capacitance and conductivity are measurable using EIS. We evaluated EIS in demonstrating the cause of lymph node enlargement. 51 lymph nodes that were suspicious for malignancy on ultrasound (32 patients, mean age 32 years), with a mean size of 18 mm x 12 mm x 10 mm, were examined. The following lymph node locations were included in the study: cervical, inframandibular, axillary, paraaortic and inguinal. EIS results were compared with histopathological and follow-up findings. 30/34 malignant lymph nodes were correctly detected using EIS, while 14/17 inflammatory or benign lymph nodes were correctly identified as benign by EIS; thus, there were 4/51 false negative and 3/51 false positive cases. The sensitivity was 88.2% and the specificity was 82.4%. Corresponding negative and positive predictive values were 77.8% and 90.9%, respectively. Results from this initial study suggest the potential usefulness of EIS as an adjunctive imaging modality in the differentiation of lymphadenopathy that is equivocal on ultrasound. The best accuracy was obtained in the cervical, axillary and inguinal regions. Owing to technical restrictions of the present system, examination of inframandibular and paraaortic lymph nodes should be limited to special cases.

Linear analysis applied to the comparative study of the I-D-P phase of chlorophyll fluorescence as induced by actinic PS-II light, PS-I light and changes in CO2-concentration

The investigation of the kinetics of chlorophyll-fluorescence under continuous background light enables the application of linearizing conditions. This approach, which provides a quantitative evaluation by means of curve-fitting routines, is applied to the investigation of the linear kinetics of the I-D-P phase. Using changes in PS II-light, PS I-light and in CO2-concentration as input signals showed that a pool at the acceptor side of PS I, in addition to the plastoquinone pool, plays an essential role in the generation of the dip. The occurrence of the dip is related to the sign of the faster one of the two components related to the I-D and the D-P phase. This sign can be inverted by the ratio of PS I and PS II light. However, model calculations show that the change of this sign does not allow a decision which one of the two components is related to which one of the two pools. The dependence of the sign of the faster component on light conditions can generate different types of I-D-P transitions, namely nearly monophasic increases, sigmoid responses or dips. As these phenomena are already created by the linear responses, non-linear effects or additional loops between PS II and PS I are not required for the explanation of the basic features.