Bilingual Hispanic children's performance on the English and Spanish versions of the Cognitive Assessment System.

This study compared the performance of referred bilingual Hispanic children on the Planning, Attention, Simultaneous, Successive (PASS) theory as measured by English and Spanish versions of the Cognitive Assessment System (CAS; Naglieri & Das, 1997a). The results suggest that students scored similarly on both English and Spanish versions of the CAS. Within each version of the CAS, the bilingual children earned their lowest scores in Successive processing regardless of the language used during test administration. Small mean differences were noted between the means of the English and Spanish versions for the Simultaneous and Successive processing scales; however, mean Full Scale scores were similar. Specific subtests within the Simultaneous and Successive scales were found to contribute to the differences between the English and Spanish versions of the CAS. Comparisons of the children's profiles of cognitive weakness on both versions of the CAS showed that these children performed consistently despite the language difference. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

WISC-III and CAS: Which Correlates Higher with Achievement for a Clinical Sample?

The relationships between Wechsler Intelligence Scale for Children-Third Edition (WISC-III) and the Cognitive Assessment System (CAS) with the Woodcock-Johnson Tests of Achievement (WJ-III) were examined for a sample of 119 children (87 males and 32 females) ages 6 to 16. The sample was comprised of children who were referred to a specialty clinic for evaluation. Participants were administered the WISC-III, the CAS, and the WJ-III, in that order. Results indicated that CAS/WJ-III correlations were consistently significantly higher than those found for the WISC-III/WJ-III. The four separate CAS scales added more variance above and beyond the four separate WISC-III scales than the WISC-III added above and beyond the CAS. In addition, the CAS Full Scale accounted for more unique variance and was a stronger predictor of WJ-III Academic Skills Cluster than the WISC-III Full Scale IQ. These results support the validity of the Planning, Attention, Simultaneous, and Successive theory as measured by the CAS in relation to the general intelligence model measured using the WISC-III for explaining variance in achievement for this clinical sample. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Role of Alzheimer's type dementia among dementias of the elderly]

In the authors experience of a memory clinic, about 2/3 of the patients fulfilled the criteria for dementia and among the demented patients 2/3 had probable Alzheimer's disease. Vascular dementia is the second cause of dementia in elderly people, but two other degenerative disorders fulfilling the NINCDS-ADRDA criteria for Alzheimer disease (Mc Khann et al., 1984) account for degenerative dementia. There is now a consensus for the clinical diagnosis and the neuropathological aspects of these two diseases: Dementia with Lewy Bodies (Mc Keith et al., 1996) and fronto-temporal dementia (the Lund and Manchester groups, 1994). The authors emphasize the clinical aspects of those two diseases at an early stage in comparison with dementia of Alzheimer type.     

Psychiatric assessments of nursing home residents under OBRA-87: should PASARR be reformed? Pre-Admission Screening and Annual Review

OBJECTIVE: As part of nursing home practice reforms, OBRA-87 mandates formal psychiatric assessments (PASARR) of nursing home residents suspected of having mental disorders, a responsibility it delegates individually to states. We describe the initial year of implementation of the PASARR process in King County, Washington, and characterize the mental disorders and mental health services needs of nursing home residents referred for psychiatric screening. DESIGN: Cross-sectional study. SETTING: The 54 Medicare-certified King County nursing homes (total beds = 7013). PARTICIPANTS: All patients referred for psychiatric evaluation under PASARR (n = 510). MEASUREMENTS: A systematic, multidimensional evaluation including a semistructured psychiatric diagnostic examination, validated measures of cognitive dysfunction, depression, and global psychopathology, functional variables relevant to need for nursing home care, and selected mental health services indicators. RESULTS: Fewer than 10% of all nursing home residents were referred for psychiatric evaluation. A primary mental illness, evenly divided between psychoses and mood disorders, was found in 60% of the sample, and a psychiatric disorder associated with dementia or mental retardation was found in 25%. Six percent had complex neuropsychiatric features defying classification, and 4% had no mental disorder. Other disorders, such as substance abuse, were rare. Cognitive impairment and global psychopathology were prevalent in all diagnostic groups, and depressive symptoms were common even in patients without affective diagnoses. Eighty-eight percent of the sample were appropriately placed, based on their needs for daily care. Fifty-five percent had unmet mental health services needs. CONCLUSIONS: The PASARR referral process detected a group of seriously mentally ill, functionally disabled patients, most of whom required the level of care that nursing homes provide. Depressed and psychiatrically impaired dementia patients were underrepresented in the referral pool as measured against widely accepted prevalence figures for mental disorders in nursing home populations. The PASARR process as currently configured appears to be most efficient in identifying schizophrenic patients, who represent a small minority of nursing home residents, and the skewed sample it generates fails to provide an adequate basis for estimating overall mental health services needed in nursing homes. The PASARR process should be altered to improve referral rates for depressed and behaviorally disturbed dementia patients.     

Diagnostic dilemma: cognitive impairment in the elderly

Cognitive impairment is a significant health problem for the elderly and is associated with severe negative consequences: higher morbidity and mortality and a diminished capacity to care for self. The accurate diagnosis of acute confusion, dementia, and depression depends on the routine, systematic, and comprehensive assessment of cognition, best achieved through the use of a mental status questionnaire and a behavioral rating scale. Nonspecific clinical features, atypical and variable presentations of symptomatology, and the frequent coexistence of acute confusion, dementia, and depression make an accurate diagnosis of the specific form of cognitive impairment difficult. The primary cognition disorder in acute confusion is that of attention, memory with dementia, and mood with depression.     

Generation II knee bracing for severe medial compartment osteoarthritis of the knee

OBJECTIVE: The tolerability of clonazepam in geropsychiatric inpatients was examined in patients with and without a diagnosis of dementia. DESIGN: Forward-looking retrospective study comprising consecutive patients placed on clonazepam. SETTING: A geropsychiatry unit of a large Veterans Affairs Medical Center. PATIENTS: All geropsychiatry inpatients placed on clonazepam over a 21-month period of time. MEASURE: Mini-Mental State Examination, Brief Psychiatric Rating Scale, Cohen-Mansfield Agitation Inventory and the Rating Scale for Side Effects were performed at admission and discharge as part of an ongoing database. RESULTS: Twenty-four geropsychiatric inpatients were treated with clonazepam (mean dose of 1.2 mg for a minimum of 2 weeks) during the 21 months studies. About one half of the patients had a primary diagnosis of dementia and the remainder had a diagnosis of an affective or psychotic disorder. Two of these patients were discontinued because they had responded to the acute need for clonazepam and a third patient was discontinued because of the development of sedation and confusion. For the remaining 21 patients, scores improved significantly on the Brief Psychiatric Rating Scale (p = 0.017), the Cohen-Mansfield Agitation Inventory (p = 0.011), the Rating Scale for Side Effects (0.004) and the Global Assessment of Functioning (p < 0.000), with no differences in amount of improvement between demented and non-demented patient groups. Scores on the Mini-Mental State Examination remained unchanged. CONCLUSIONS: Clonazepam shows promise as a benzodiazepine with good tolerability in the elderly.     

Memory span procedures in Alzheimer's disease.

In a working memory framework, the forward memory span involves a subsidiary system that maintains information, and the backward span relies on a central executive system (CES) that allocates processing resources. The authors hypothesized that a measure of the CES derived from the backward span would distinguish Alzheimer's disease (AD) patients (n&≠&?9) from elderly controls without dementia (n&≠&?9), vary as a function of disease severity, and underlie other cognitive disturbances. Memory span procedures were Digit Span Forward and Backward and Visual Memory Span Forward and Backward. Derived CES measures discriminated between groups, predicted dementia severity, and predicted performance on some of the cognitive tasks examined. However, working memory subsidiary systems also appeared to be affected in AD, and some cognitive deficits in AD were independent of working memory disturbances. The visual memory span backward was the best predictor of group and of dementia severity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparative evolution of Alzheimer disease, vascular dementia, and mixed dementia

OBJECTIVE: To compare the evolution of Alzheimer disease (AD), vascular dementia (VaD), and mixed dementia by cognitive domain. SETTING: The University of Western Ontario Dementia Study, which is a registry of cases of dementia seen for secondary and tertiary assessment in a university memory disorders clinica with extensive follow-up data and histopathological confirmation of clinical diagnoses. PATIENTS: One hundred twenty-nine patients with definite or probable AD, 12 patients with definite or probable VaD, and 36 patients with definite or probable mixed dementia. METHODS: Patients were grouped as having an early, moderate, or advanced stage of disease according to the extended scale for dementia (ESD). The ESD was subdivided into cognitive domains, and the domain scores were compared for each stage of disease by diagnostic category with the use of a 2-way analysis of variance with repeated measures. RESULTS: As expected, the scores in all domains decreased significantly with increasing severity. There was a significant difference in the decline in memory among the diagnostic groups (P = .02) that was mostly attributable to the difference between AD and mixed dementia (P = .03), with the difference between AD and VaD only approaching significance (P = .06). There was a similar finding for praxis. The interaction between diagnosis (AD and VaD) and severity was significant only for memory (P = .02), showing a less severe memory deficit at onset but a proportionately more rapid progression in VaD and arithmetic ability (AD and mixed dementia [P = .03]). CONCLUSIONS: Alzheimer disease, VaD, and mixed dementia evolve similarly as assessed using cognitive domains obtained by subdivision of the ESD in a patient population derived from a memory clinic and by analyzing VaD as a single entity. Only memory impairment evolves differently between AD and VaD, with this depending on the severity. Memory is more severely impaired in the early stage of AD; however, with increasing severity of dementia, memory impairment in VaD accelerates and catches up with AD at the level of moderate impairment. The differences between AD and mixed dementia are greater than those between mixed dementia and VaD, suggesting an important role for the ischemic component of mixed dementia. Simple neuropsychological tools (eg, the ESD) may be incapable of distinguishing between AD and VaD, and more focused instruments may be required. Inherent bias in case selection may prevent extrapolation of these results to VaD in general, but the neuropsychological criteria for VaD may need to vary, depending on the severity.     

The validity of new memory complaints in the elderly

OBJECTIVE: To determine the validity of new subjective memory complaints (MCs) from individuals who previously, when without dementia, denied having MCs. DESIGN: Prospective cohort. SETTING: Longitudinal, community-based study of aging and dementia. PATIENTS: One hundred thirty-three community-dwelling elderly individuals who were part of a registry for the study of conditions related to aging in North Manhattan, NY. Patients were selected if they were initially without dementia and had completed at least 2 successive annual clinical and neuropsychological evaluations and provided their own medical history. MAIN OUTCOME MEASURES: Performance on memory tests--the Buschke Selective Reminding Test and a visual memory task--and global performance on a neuropsychological test battery and clinical evaluation, by which questionable dementia or dementia was diagnosed according to a well-defined paradigm. RESULTS: Fifty-three subjects with MCs at the initial evaluation performed no worse on the memory test than the 80 subjects who denied MCs initially. There was a weak association between MCs and the diagnosis of questionable dementia at baseline (P = .04), but this was nonsignificant after adjusting for age and education. At 1-year follow-up, 21 of the 80 without baseline MCs now reported MCs. At the follow-up evaluation, these 21 subjects performed significantly worse on the memory tests, were 5 times more likely to have significant cognitive impairment, and had shown significantly greater decline over the preceding year on several of the cognitive measures than the 59 who continued to deny MCs. CONCLUSION: New MCs from individuals, who when without dementia recently denied MCs, may suggest the presence of significant impairment of memory or cognition.     

Posatirelin in the treatment of vascular dementia: a double-blind multicentre study vs placebo

INTRODUCTION: The usefulness of posatirelin (L-pyro-2-aminoadipyl-L-leucyl-L-prolinamide), a synthetic peptide having modulatory activity on the monoaminergic and cholinergic systems and neurotrophic effects, was evaluated in vascular dementia. PATIENTS AND METHODS: A multicentre, parallel groups, double-blind clinical study vs placebo was carried out with patients suffering from probable vascular dementia according to the NINDS-AIREN criteria. The study consisted of a two-week run-in of a once daily, orally administered, placebo phase, followed by 12 weeks of intramuscular treatment with posatirelin 10 mg/ml or placebo given once a day and a follow-up after one month's withdrawal. Efficacy was assessed using the Gottfries-Br?ne-Steen (GBS) Rating Scale for dementia, the Randt Memory Test and the Toulouse-Piéron Attention Test. Data were evaluated using analysis of variance and covariance. RESULTS: As regards GBS scores, patients treated with posatirelin showed a significant improvement in intellectual performance, in orientation, motivation and memory as compared to controls. The improvement of memory performance was also confirmed by the acquisition score and memory index of the Randt Memory Test. At the end of the follow-up period the differences between treatments were still maintained. Tolerability was good. CONCLUSIONS: The significant improvement observed in cognitive functions, attention and motivation of demented patients treated with posatirelin suggests the potential usefulness of this drug in vascular dementia. Furthermore, the presence of a long-lasting effect after drug withdrawal suggests the possibility of administering the drug cyclically.     

The Test of Memory Malingering (TOMM): Normative data from cognitively intact and cognitively impaired individuals.

Four experiments were undertaken to validate the Test of Memory Malingering (TOMM). In the first 3 experiments, the TOMM was administered to 475 community-dwelling individuals and 161 neurologically impaired patients (traumatic brain injury, aphasia, cognitive impairment, and dementia). Both clinical participants and community-dwelling adults achieved exceptionally high scores. A criterion score of 45 (90% correct) on the 2nd trial correctly classified 95% of all non-demented patients (91% of all patients) as not malingering. In a 4th experiment, the criterion score readily distinguished individuals who deliberately faked memory impairments from those who did not. The results from all 4 experiments show that the TOMM is relatively insensitive to genuine memory impairment and holds considerable promise for detecting exaggerated or deliberately faked memory impairment in clinical situations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Marburg and Ebola hemorrhagic fevers: does the primary course of infection depend on the accessibility of organ-specific macrophages?

The consistency of measures from informants' report and from objective testing, both incorporated into the CAMDEX interview, was tested for elderly persons with mild dementia (n = 46), with moderate dementia (n = 41), and without cognitive impairment (controls, n = 56). Informants' reports permitted grading severity of dementia and provided measures of memory and mental functioning in everyday activities highly related to indices derived from objective testing.     

Hearing loss and cognition in the Baltimore Longitudinal Study of Aging.

Objective: To determine the relationship between hearing loss and cognitive function as assessed with a standardized neurocognitive battery. We hypothesized a priori that greater hearing loss is associated with lower cognitive test scores on tests of memory and executive function. Method: A cross-sectional cohort of 347 participants ≥55 years in the Baltimore Longitudinal Study of Aging without mild cognitive impairment or dementia had audiometric and cognitive testing performed in 1990–1994. Hearing loss was defined by an average of hearing thresholds at 0.5, 1, 2, and 4 kHz in the better-hearing ear. Cognitive testing consisted of a standardized neurocognitive battery incorporating tests of mental status, memory, executive function, processing speed, and verbal function. Regression models were used to examine the association between hearing loss and cognition while adjusting for confounders. Results: Greater hearing loss was significantly associated with lower scores on measures of mental status (Mini-Mental State Exam), memory (Free Recall), and executive function (Stroop Mixed, Trail Making B). These results were robust to analyses accounting for potential confounders, nonlinear effects of age, and exclusion of individuals with severe hearing loss. The reduction in cognitive performance associated with a 25 dB hearing loss was equivalent to the reduction associated with an age difference of 6.8 years. Conclusion: Hearing loss is independently associated with lower scores on tests of memory and executive function. Further research examining the longitudinal association of hearing loss with cognitive functioning is needed to confirm these cross-sectional findings. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Accuracy of MMPI-based inferences regarding memory and concentration in closed-head-trauma patients.

This study examined the validity of MMPI scores and MMPI-based cognitive complaints as indicators of memory and concentrational disturbances in 70 closed-head-trauma patients. The relation of scores on the MMPI Depression (D), Schizophrenia (Sc), Mental Dullness (D4), Lack of Ego Mastery, Cognitive (Sc2A), and Organic Symptoms (Org) scales to actual memory performance on the WAIS—R Digit Span and Wechsler Memory Scale (Russell's revision) subtests was explored. The results suggest an absence of any relation between actual memory performance on any of these subtests and MMPI scores or a Cognitive Complaint Index consisting of 8 MMPI items. Findings are discussed in light of the questionable validity of memory complaints in other samples, as well as possible limitations in the ecological validity of current tests of memory. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Stimulation Program Health Research. X. Evaluation of the program section 'Psychogeriatrics'

In the programme section 'Psychogeriatrics' of the SGO Health Research Promotion Programme a longitudinal study was carried out in Amsterdam from 1989 until 1994, concerning the course of mild cognitive decline in elderly people (the AMSTEL project). The scientific aims were the development of diagnostical instruments for the early diagnosis of dementia, the development of criteria which predict the course of mild cognitive impairment and the expansion of knowledge on the relationship between somatic and psychiatric pathology and dementia. The programme also had aims regarding medical education and patient care. The results include the following: in order to diagnose dementia in general practice questions regarding orientation and short-term memory are helpful. Risk factors for cognitive deterioration in elderly people include hippocampal atrophy on the MRI scan, a low level of education and subjective complaints regarding memory. Subjective complaints regarding memory are not primarily caused by a depressive mood, as is often thought, but are important as correct self-observations of cognitive deterioration, and go with an increased risk of developing dementia. Besides the AMSTEL project a feasibility study was carried out concerning a psychogeriatric case register in Amsterdam.     

TV News Test: A new measure of everday memory for prose.

In independent samples of 364 normal volunteers (mean age 56.58 yrs) and 30 individuals from a drug study (mean age 62.10 yrs), previous performance on the TV News Test (TVNT), a computerized measure of everyday verbal memory, was significantly correlated with the Logical Memory subtest of the Wechsler Memory Scale (WMS). Both test performances reflected significant associations with the Wechsler Adult Intelligence Scale (WAIS) Vocabulary subtest. The TVNT alone was significantly correlated with Ss' age. The TVNT and the Logical Memory subtest both had significant associations with self-reported memory functions. Logical Memory was significantly related to a third measure of verbal memory, WMS Paired Associate Learning. The cognitive demands of the TVNT and the Logical Memory task may differ. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Memory failures in progressive idiopathic dementia.

14 patients with progressive idiopathic dementia (PID) were compared with 14 normal controls (average age 61.2 yrs) on psychometric and laboratory measures of cognitive processes. Patients had significantly lower scores than controls on the Wechsler Memory Scale and the WAIS Performance IQ, but not on WAIS Verbal or Full Scale IQ or Digit Span tests. Patients performed more poorly on learning and memory tasks than controls. Unlike the latter, patients' recall of categorized word lists was no better than their recall of unrelated words, and they did not consistently remember information that had been previously recalled. Patients also were unable to generate as many words that start with a given letter or that belong to a given category as controls did. Data show that while many intellectual functions are preserved, PID patients are unable to access structures in semantic memory and therefore fail to effectively encode episodic events so that they are memorable. Differences in cognitive dysfunction in PID and in depression are discussed. (32 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Subjective memory complaints, psychological distress, and longitudinal change in objective memory performance.

Between 1992 and 1993, the Memory Function Questionnaire General Frequency of Forgetting Scale (MFQ-GEN), the Symptom Checklist-90—Revised General Severity Index (GSI), and Mayo Cognitive Factor Scales Learning and Retention (MCFS-LRN and MCFS-RET) current and change scores were obtained for 294 of 397 (74% ) participants, ages 55–97 years, originally assessed in a 1988–1990 normative study. In multiple regression modeling, the GSI and MCFS-LRN current score contributed 20% and 3%, respectively, to MFQ-GEN variance. Thus, emotional status was a better predictor of subjective memory ratings than either absolute objective memory performance or objective longitudinal memory change. Persons who developed cognitive impairment over the longitudinal interval reported greater memory problems, but memory complaints had little sensitivity in identifying these persons. In an approximate census sample of these older people, minor memory problems were reported to be frequent but not serious. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Construct Validity of the PASS Theory and CAS: Correlations With Achievement.

The relationship among Planning, Attention, Simultaneous, and Successive (PASS) processing scores of the Cognitive Assessment System (CAS) and the Woodcock-Johnson Revised Tests of Achievement (WJ-R) were examined with a sample of 1,559 students aged 5-17 years. Participants were part of the CAS standardization sample and closely represented the U.S. population on a number of important demographic variables. Pearson product-moment correlation between CAS Full Scale and the WJ-R Skills cluster was .71 for the Standard and .70 for the Basic CAS Battery scores, providing evidence for the construct validity of the CAS. The CAS correlated with achievement as well if not better than tests of general intelligence. The amount of variance in the WJ-R scores the CAS accounted for increased with age between 5- to 13-year-olds. The 4 PASS scale scores cumulatively accounted for slightly more of the WJ-R variance than the CAS Full Scale score. (PsycINFO Database Record (c) 2010 APA, all rights reserved)