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Predicting functional status in older adults
44
Abstracts from the 18th Annual Meeting
ents of older children with TBI experience more global marital distress than parents who have non-injured adolescent/young adult children. The experimental mothers and fathers reported greater dissatisfaction with the amount of affection and understanding in their marriage. Mothers of injured children significantly differed from the others in their more frequent report of being under a physician's care for serious medical problems. There were no significant differences between the two sets of couples on levels of select BSI dimensions. For TBI group mothers, BSI (Global Psychological Distress) related to global marital distress. The coping style of TBI group parents reflected significantly more seeking of guidance and support than control parents. TBI group mothers and fathers did not significantly differ from each other on the MSI, BSI and CRI. However, when all mothers were compared to all fathers, gender differences emerged. The midlife men tended to describe their marriages more positively than their wives did. Whereas, wives reported greater marital distress, less satisfaction with marital communication and management of family finances. Mothers were more likely than their husbands to cope by seeking guidance and support and expressing negative emotions.
GERIATRIC NEUROPSYCHOLOGY I Baird, A. D., Podeli, K., & Lovell, M. R. Predicting Functional Status in Older Adults. A recommendation for additional supervision or assistance is a common outcome of neuropsychological assessment of elders. This study explores how mental status, depressive symptoms, and demographic variables relate to performance on an extensive functional status measure, the Independent Living Scales (ILS). We hypothesized that general cognitive status and depression correlated with the functional status measure. Thirty-three adults, 65 and older, completed the ILS, the Dementia Rating Scale (DRS), and the Geriatric Depression Scale (GDS) on clinical referral. On average the patient's age was 74 ___6.7 and years of education were 10.7 _+ 3.22. Twenty-one were women; one third were African Americans. Pearson correlation coefficients were not significant for. the ILS Full-Scale Standard Score (FSSS) and age, gender or ethnic status, respectively. Significant correlations were obtained between the ILS, FSSS and education (r = .46), the DRS total score (r = .73), and the GDS score (r = -.51). In the first discriminant analysis, we sought to predict which subjects scored above versus at or below one SD below the ILS FSSS mean in 400 independent elders constituting the normative group. DRS scores correctly classified 79% of cases (26/33) with no increase in classification with GDS and education. In the second analysis, we determined how well we could distinguish patients with ILS summary scores above versus at or below 70 or 2 standard deviations below mean performance in independent elders. Again the DRS score alone permitted classification of 79%, 94% of cases (31/33) were grouped successfully when the GDS score also was utilized. Once again, education did not contribute to classification, perhaps because of the moderate correlation between the DRS score and years of education (r = .45). The mean DRS score in the 19 patients with ILS FSSS above 70 was 125 ___12, while it was 106 _+ 12 for patients with ILS FSSS of 70 or lower. Only 1 of 8 patients with likely moderate dementia (DRS < 103) scored above 70 on the ILS FSSS and only 1 of 12 patients with DRS scores above 122 dipped below 70. However, patients with mild dementia were scattered about equally above and below 70 on the ILS FSSS. Depression appeared to be a possible contributor to impaired functional status in 2 of 4 individuals with DRS scores above 122 but ILS FSSS at or below 85. Our results suggest
Abstracts from the 18th Annual Meeting
45
that it is particularly important to examine functional status in older patients with mild dementia and in elders with significant depressive complaints. We need to determine how much training and improvement in physical and emotional health might boost functional scores in these groups.
Beckwith, B. E., Bergloff, P., Silvers, N., & Newland, D. Aricept (Donepezil) Improves Executive Functions but not Memory. Aricept has been available by prescription for nearly a year and a half and has been shown to improve cognition in patients with SDAT via cholinergic enhancement. This study examined the effects of treatment with Aricept on the Dementia Rating Scale (DRS) and the California Verbal Learning Test (CVLT). The design was a within-subject design whereby each patient was assessed before and after treatment with Aricept. Subjects were evaluated and diagnosed with SDAT through the standard protocol of a Memory Disorders Clinic and treated with Aricept (5 mg for 5 weeks followed by 10 mg thereafter) and 2,000 IU of vitamin E. The DRS and the CVLT were administered prior to treatment and again 4-12 months later. Treatment with Aricept increased overall DRS total score by about an average of about 7 points (p < 0.005). This was obtained by significant improvement in Initiation by an average of about 3 points (p < 0.05) and Conceptualization by an average of about nearly 3 points (p < 0.025). There were no changes in scores on Attention or Memory. Furthermore, treatment with Aricept did not enhance any measures from the CVLT. Apparently, treatment with Aricept enhances executive functions without significant improvement in memory.
Carey, M. E., Giovannetti, T., & Libon, D. J. A Comparison of Written Discourse in Alzheimer's Disease and Subcortical Ischemic Vascular Dementia. Language and communication deficits are known to occur among elderly patients with dementia. Although oral production is commonly investigated among patients with Alzheimer's disease (AD), few investigations have explored deficits in written production and spelling. To our knowledge, there is no study to date that compares written production and spelling between patients with AD and ischemic vascular dementia (IVD) due to subcortical white matter disease. These patient populations have been shown to differ in several other domains of cognitive functioning, including episodic memory, executive systems, and semantic knowledge processing. The present study includes patients with AD (n = 40) and IVD (n = 39) of equal age, education, and dementia severity (MMSE). Patients were asked to provide a written response to the "cookie theft" (CT) picture according to the directives from the Boston Diagnostic Aphasia Examination (BDAE). A comprehensive protocol of neuropsychological tests was also administered. CT writing samples were analyzed according to a scoring system designed to examine sentence complexity, spelling errors, the number and accuracy of semantic (people, objects and actions) references, and spatial organization. Between-group comparisons showed that AD and IVD groups did not differ in terms of time to completion, the total words produced, the total number of complete sentences, the number of semantic paraphasic errors, or vague semantic references. IVD patients produced fewer subject-verb-object combinations (SVO; p < .050) and fewer prepositional phrases (p < .044). Thus, the IVD subjects produced less grammatically complex sentences as compared to AD subjects. IVD patients also produced more total spelling errors (p < .028), misspelled nouns (p < .055), made more letter omissions (p < .020), and were more likely to produce phonologically incorrect spelling errors (p < .026) relative to AD patients. Further, IVD patients showed a preference for writing on only half of the page
Abstracts from the 18th Annual Meeting
ents of older children with TBI experience more global marital distress than parents who have non-injured adolescent/young adult children. The experimental mothers and fathers reported greater dissatisfaction with the amount of affection and understanding in their marriage. Mothers of injured children significantly differed from the others in their more frequent report of being under a physician's care for serious medical problems. There were no significant differences between the two sets of couples on levels of select BSI dimensions. For TBI group mothers, BSI (Global Psychological Distress) related to global marital distress. The coping style of TBI group parents reflected significantly more seeking of guidance and support than control parents. TBI group mothers and fathers did not significantly differ from each other on the MSI, BSI and CRI. However, when all mothers were compared to all fathers, gender differences emerged. The midlife men tended to describe their marriages more positively than their wives did. Whereas, wives reported greater marital distress, less satisfaction with marital communication and management of family finances. Mothers were more likely than their husbands to cope by seeking guidance and support and expressing negative emotions.
GERIATRIC NEUROPSYCHOLOGY I Baird, A. D., Podeli, K., & Lovell, M. R. Predicting Functional Status in Older Adults. A recommendation for additional supervision or assistance is a common outcome of neuropsychological assessment of elders. This study explores how mental status, depressive symptoms, and demographic variables relate to performance on an extensive functional status measure, the Independent Living Scales (ILS). We hypothesized that general cognitive status and depression correlated with the functional status measure. Thirty-three adults, 65 and older, completed the ILS, the Dementia Rating Scale (DRS), and the Geriatric Depression Scale (GDS) on clinical referral. On average the patient's age was 74 ___6.7 and years of education were 10.7 _+ 3.22. Twenty-one were women; one third were African Americans. Pearson correlation coefficients were not significant for. the ILS Full-Scale Standard Score (FSSS) and age, gender or ethnic status, respectively. Significant correlations were obtained between the ILS, FSSS and education (r = .46), the DRS total score (r = .73), and the GDS score (r = -.51). In the first discriminant analysis, we sought to predict which subjects scored above versus at or below one SD below the ILS FSSS mean in 400 independent elders constituting the normative group. DRS scores correctly classified 79% of cases (26/33) with no increase in classification with GDS and education. In the second analysis, we determined how well we could distinguish patients with ILS summary scores above versus at or below 70 or 2 standard deviations below mean performance in independent elders. Again the DRS score alone permitted classification of 79%, 94% of cases (31/33) were grouped successfully when the GDS score also was utilized. Once again, education did not contribute to classification, perhaps because of the moderate correlation between the DRS score and years of education (r = .45). The mean DRS score in the 19 patients with ILS FSSS above 70 was 125 ___12, while it was 106 _+ 12 for patients with ILS FSSS of 70 or lower. Only 1 of 8 patients with likely moderate dementia (DRS < 103) scored above 70 on the ILS FSSS and only 1 of 12 patients with DRS scores above 122 dipped below 70. However, patients with mild dementia were scattered about equally above and below 70 on the ILS FSSS. Depression appeared to be a possible contributor to impaired functional status in 2 of 4 individuals with DRS scores above 122 but ILS FSSS at or below 85. Our results suggest
Abstracts from the 18th Annual Meeting
45
that it is particularly important to examine functional status in older patients with mild dementia and in elders with significant depressive complaints. We need to determine how much training and improvement in physical and emotional health might boost functional scores in these groups.
Beckwith, B. E., Bergloff, P., Silvers, N., & Newland, D. Aricept (Donepezil) Improves Executive Functions but not Memory. Aricept has been available by prescription for nearly a year and a half and has been shown to improve cognition in patients with SDAT via cholinergic enhancement. This study examined the effects of treatment with Aricept on the Dementia Rating Scale (DRS) and the California Verbal Learning Test (CVLT). The design was a within-subject design whereby each patient was assessed before and after treatment with Aricept. Subjects were evaluated and diagnosed with SDAT through the standard protocol of a Memory Disorders Clinic and treated with Aricept (5 mg for 5 weeks followed by 10 mg thereafter) and 2,000 IU of vitamin E. The DRS and the CVLT were administered prior to treatment and again 4-12 months later. Treatment with Aricept increased overall DRS total score by about an average of about 7 points (p < 0.005). This was obtained by significant improvement in Initiation by an average of about 3 points (p < 0.05) and Conceptualization by an average of about nearly 3 points (p < 0.025). There were no changes in scores on Attention or Memory. Furthermore, treatment with Aricept did not enhance any measures from the CVLT. Apparently, treatment with Aricept enhances executive functions without significant improvement in memory.
Carey, M. E., Giovannetti, T., & Libon, D. J. A Comparison of Written Discourse in Alzheimer's Disease and Subcortical Ischemic Vascular Dementia. Language and communication deficits are known to occur among elderly patients with dementia. Although oral production is commonly investigated among patients with Alzheimer's disease (AD), few investigations have explored deficits in written production and spelling. To our knowledge, there is no study to date that compares written production and spelling between patients with AD and ischemic vascular dementia (IVD) due to subcortical white matter disease. These patient populations have been shown to differ in several other domains of cognitive functioning, including episodic memory, executive systems, and semantic knowledge processing. The present study includes patients with AD (n = 40) and IVD (n = 39) of equal age, education, and dementia severity (MMSE). Patients were asked to provide a written response to the "cookie theft" (CT) picture according to the directives from the Boston Diagnostic Aphasia Examination (BDAE). A comprehensive protocol of neuropsychological tests was also administered. CT writing samples were analyzed according to a scoring system designed to examine sentence complexity, spelling errors, the number and accuracy of semantic (people, objects and actions) references, and spatial organization. Between-group comparisons showed that AD and IVD groups did not differ in terms of time to completion, the total words produced, the total number of complete sentences, the number of semantic paraphasic errors, or vague semantic references. IVD patients produced fewer subject-verb-object combinations (SVO; p < .050) and fewer prepositional phrases (p < .044). Thus, the IVD subjects produced less grammatically complex sentences as compared to AD subjects. IVD patients also produced more total spelling errors (p < .028), misspelled nouns (p < .055), made more letter omissions (p < .020), and were more likely to produce phonologically incorrect spelling errors (p < .026) relative to AD patients. Further, IVD patients showed a preference for writing on only half of the page