bluuebunny/crossref_metadata_2025 huggingface dataset:
The Responsibility of Doctrine: Bonhoeffer’s Ecclesiological Hermeneutics of Dogmatic Theology
Authors: Harasta Eva
Published: March 2014

Amidst uncertainty as to the place of doctrinal theology in the academy and its role in civil public discourse, the basic question of the nature and significance of dogmatics has acquired new urgency. This article discusses how Bonhoeffer’s interpretation and use of dogmatics can inspire contemporary doctrinal theology. Four elements of Bonhoeffer’s position seem particularly promising for continuing reflection upon the hermeneutics and function of Christian doctrine: his emphasis on the contextual character of doctrine, his stress upon the responsibility of doctrine in and for the church, his criticism of systematic thinking, and his appeal to christology as a resource for widening the horizon of doctrine.
Another Nibble at the Core
Authors: Howard Jay R. , Novak Katherine B. , Cline Krista M. C. , Scott Marvin B.
Published: March 2014

Identifying and assessing core knowledge has been and continues to be a challenge that vexes the discipline of sociology. With the adoption of a thematic approach to courses in the core curriculum at Butler University, faculty teaching Introductory Sociology were presented with the opportunity and challenge of defining the core knowledge and skills to be taught across course sections with a variety of themes. This study of students ( N = 280) enrolled in 12 sections of a thematically-focused Introductory Sociology course presents our attempt to both define and assess a core set of concepts and skills through a pretest-posttest questionnaire to measure student learning gains relative to: (1) a sociological perspective, (2) sociological theory, (3) research methods, and (4) key concepts in sociology. Results show significant learning gains on all four dimensions, with the greatest gains coming in sociological theory. There were no significant differences in pretest scores by gender or by whether students had taken a sociology course in high school. Seniors scored significantly higher on both the pretest and the posttest, but after we controlled for pretest scores seniors did significantly better only on the subset of questions related to sociological theory. Students who took a sociology course in high school scored lower on the methods subscale of the posttest and had lower overall total posttest scores than their counterparts.
The presence and growth of Legionella species in thermostatic shower mixer taps: an exploratory field study
Authors: van Hoof Joost , Hornstra Luc M , van der Blom Eric , Nuijten Oscar WW , van der Wielen Paul WJJ
Published: March 2014

Legislation in the Netherlands requires routine analysis of drinking water samples for cultivable Legionella species from high-priority installations. A field study was conducted to investigate the presence of Legionella species in thermostatic shower mixer taps. Water samples and the interior of ten thermostatic shower mixer taps were investigated for cultivable Legionella species. In seven cases, Legionella species was found in at least one of the samples. In four cases, Legionella species was detected in the biofilm on the thermostatic shower mixer taps interior, with the highest values on rubber parts, and in five cases in the cold supply water. These results show that thermostatic shower mixer taps can play a role in exceeding the threshold limit for cultivable Legionella species, but the cold supply water can also be responsible.

Practical implications: This study showed that contamination of thermostatic shower mixer taps (TSMTs) with Legionella spp. was frequently observed in combination with contamination of the water system. Consequently, a combined focus is necessary to prevent the proliferation of cultivable Legionella spp. in TSMTs. In addition, the results also demonstrated that biofilms on rubbers inside the TSMT had high numbers of Legionella spp., probably because rubber contains relatively high concentrations of biodegradable substrates. Therefore, improvement of the rubber materials is necessary to reduce the proliferation of cultivable Legionella spp. in TSMTs.
Prevalence, Risk Factors, Clinical Consequences, and Treatment of Enteral Feed Intolerance During Critical Illness
Authors: Gungabissoon Usha , Hacquoil Kimberley , Bains Chanchal , Irizarry Michael , Dukes George , Williamson Russell , Deane Adam M. , Heyland Daren K.
Published: March 2014

Background: We aimed to determine the incidence of enteral feed intolerance and factors associated with intolerance and to assess the influence of intolerance on nutrition and clinical outcomes. Methods: We conducted a retrospective analysis of data from an international observational cohort study of nutrition practices among 167 intensive care units (ICUs). Data were collected on nutrition adequacy, ventilator‐free days (VFDs), ICU stay, and 60‐day mortality. Intolerance was defined as interruption of enteral nutrition (EN) due to gastrointestinal (GI) reasons (large gastric residuals, abdominal distension, emesis, diarrhea, or subjective discomfort). Logistic regression was used to determine risk factors for intolerance and their clinical significance. A sensitivity analysis restricted to sites specifying a gastric residual volume ≥200 mL to identify intolerance was also conducted. Results: Data from 1,888 ICU patients were included. The incidence of intolerance was 30.5% and occurred after a median 3 days from EN initiation. Patients remained intolerant for a mean (±SD) duration of 1.9 ± 1.3 days . Intolerance was associated with worse nutrition adequacy vs the tolerant (56% vs 64%, P < .0001), fewer VFDs (2.5 vs 11.2, P < .0001), increased ICU stay (14.4 vs 11.3 days, P < .0001), and increased mortality (30.8% vs 26.2, P = .04). The sensitivity analysis demonstrated that intolerance remained associated with negative outcomes. Although mortality was greater among the intolerant patients, this was not statistically significant. Conclusions: Intolerance occurs frequently during EN in critically ill patients and is associated with poorer nutrition and clinical outcomes.
Relative Effects at Work
Authors: Braeken Johan , Mulder Joris , Wood Stephen
Published: March 2014

Assessing the relative importance of predictors has been of historical importance in a variety of disciplines including management, medicine, economics, and psychology. When approaching hypotheses on the relative ordering of the magnitude of predicted effects (e.g., the effects of discrimination from managers and coworkers are larger than that from clients), one quickly runs into problems within a traditional frequentist framework. Null hypothesis significance testing does not allow researchers to directly map research hypotheses on to results and suffers from a multiple testing problem that leads to low statistical power. Furthermore, all traditional structural equation modeling fit indices lose much of their suitability for model comparison, because order hypotheses are not countable in terms of degrees of freedom. To adequately tackle order hypotheses, we advocate a Bayesian method that provides a single internally consistent solution for estimation and inference. The key element in the proposed model comparison approach is the use of the Bayes factor and the incorporation of order constraints by means of a smart formulation of prior distributions. An easy-to-use software package BIEMS (Bayesian inequality and equality constrained model selection) is introduced and two empirical examples in the organizational behavior area are provided to showcase the method, both offering new findings that have implications for theory: the first on the differential impact of discrimination in the workplace from insiders and outsiders to the organization on employees’ well-being, and the second on Karasek’s stressor–strain theory about how the relative order of magnitude of the effects of job control and demands depends on the specific well-being outcome dimension.
Innovation and Creativity in Organizations
Authors: Anderson Neil , Potočnik Kristina , Zhou Jing
Published: March 2014

Creativity and innovation in any organization are vital to its successful performance. The authors review the rapidly growing body of research in this area with particular attention to the period 2002 to 2013, inclusive. Conceiving of both creativity and innovation as being integral parts of essentially the same process, we propose a new, integrative definition. We note that research into creativity has typically examined the stage of idea generation, whereas innovation studies have commonly also included the latter phase of idea implementation. The authors discuss several seminal theories of creativity and innovation and then apply a comprehensive levels-of-analysis framework to review extant research into individual, team, organizational, and multilevel innovation. Key measurement characteristics of the reviewed studies are then noted. In conclusion, we propose a guiding framework for future research comprising 11 major themes and 60 specific questions for future studies.
Intraoperative tranexamic acid in pediatric bloodless cardiac surgery
Authors: Hasegawa Tomomi , Oshima Yoshihiro , Maruo Ayako , Matsuhisa Hironori , Tanaka Akiko , Noda Rei , Yokoyama Shinji , Iwasaki Kazutaka
Published: March 2014

Objective

The aim of this study was to evaluate the clinical effects of intraoperative tranexamic acid administration in cardiac surgery without blood transfusion (bloodless cardiac surgery) in children.

Methods

Seventy-one consecutive patients weighing less than 20 kg, who underwent bloodless cardiac surgery for simple atrial or ventricular septal defects at Kobe Children’s Hospital from January 2011 to June 2013, were enrolled in this retrospective study. Tranexamic acid was administered during surgery from January 2012 (TXA group; n = 31), whereas it was not administered before January 2012 (control group; n = 40). Perioperative variables were compared between the TXA and control groups.

Results

There were no significant differences in patient characteristics or preoperative data between the 2 groups. Serial changes in perioperative hemoglobin and hematocrit levels, mixed venous oxygen saturation, and regional cerebral oxygenation during cardiopulmonary bypass were significantly higher in the TXA group compared to the control group. There were significant reductions in operative time, dopamine dose, peak serum lactate level, intubation time, chest tube drainage and duration, and hospital stay in the TXA group.

Conclusions

Intraoperative tranexamic acid administration was effective for blood conservation, and improved postoperative clinical outcomes in pediatric bloodless cardiac surgery.
Left ventricular pseudoaneurysm following balloon mitral valvuloplasty
Authors: Abhaichand Rajpal K , Sambasivam Kalpathi Ananthanarayanan , Wilson Bivin
Published: March 2014

Balloon mitral valvotomy is a commonly performed procedure for mitral stenosis. This procedure can lead to complications such as left ventricular perforation with tamponade, mitral regurgitation and stroke. Here we report a case of left ventricular pseudoaneurysm following balloon mitral valvotomy. It was a consequence of adherent pericardium secondary to open mitral valvotomy performed earlier. It was surgically corrected by pseudoaneurysm repair and mitral valve replacement. We believe that this is the first such reported case.
Multivariate statistics and the enactment of metabolic complexity
Authors: Levin Nadine
Published: March 2014

This ethnographic study, based on fieldwork at the Computational and Systems Medicine laboratory at Imperial College London, shows how researchers in the field of metabolomics – the post-genomic study of the molecules and processes that make up metabolism – enact and coproduce complex views of biology with multivariate statistics. From this data-driven science, metabolism emerges as a multiple, informational and statistical object, which is both produced by and also necessitates particular forms of data production and analysis. Multivariate statistics emerge as ‘natural’ and ‘correct’ ways of engaging with a metabolism that is made up of many variables. In this sense, multivariate statistics allow researchers to engage with and conceptualize metabolism, and also disease and processes of life, as complex entities. Consequently, this article builds on studies of scientific practice and visualization to examine data as material objects rather than black-boxed representations. Data practices are not merely the technological components of experimentation, but are simultaneously technologies and methods and are intertwined with ways of seeing and enacting the biological world. Ultimately, this article questions the increasing invocation and role of complexity within biology, suggesting that discourses of complexity are often imbued with reductionist and determinist ways of thinking about biology, as scientists engage with complexity in calculated and controlled, but also limited, ways.
Obfuscatory Relational Work and Disreputable Exchange
Authors: Rossman Gabriel
Published: March 2014

This article develops a model of how the structure of exchange can manage such disreputable exchanges as the commensuration of sacred for profane. Whereas existing research discusses the rhetorical reframing of exchange, I highlight structures that obfuscate whether an exchange is occurring and thereby mitigate exchange taboos. I identify three such exchange structures: bundling, brokerage, and gift exchange. Bundling uses cross-subsidization across multiple innocuous exchanges to synthesize a taboo exchange. Brokerage finds a third party to accept responsibility for exchange. Gift exchange delays reciprocity and reframes exchanges as expressions of friendship. All three strategies have alternative meanings and so provide plausible deniability to taboo commensuration. The article concludes by arguing that these sorts of exchange structures represent a synthesis of “nothing but” reductionism and “hostile worlds” moralism, rather than an alternative to them as Viviana Zelizer suggests.
The Problem of Excess
Authors: Abbott Andrew
Published: March 2014

This article argues for a new branch of theory based not on presumptions of scarcity—which are the foundational presumptions of most existing social theory—but on those of excess. The article first discusses the emergence of scarcity’s dominance in social theory. It then considers and rejects the idea that excess of one thing is simply scarcity of another. It discusses the mechanisms by which excess creates problems, noting three such mechanisms at the individual level (paralysis, habituation, and value contextuality) and two further mechanisms (disruption and misinheritance) at the social level. The article then considers four types of strategies with which we address excess: two reduction strategies (defensive and reactive) and two rescaling strategies (adaptive and creative). It closes with some brief illustrations of how familiar questions can be recast from terms of scarcity into terms of excess.
Older Patients with At-Risk and Problem Drinking Patterns: New Developments in Brief Interventions
Authors: Blow Frederic C. , Barry Kristen Lawton
Published: March 2014

The relationship between alcohol and some of the most prevalent physical and mental health issues of older adulthood and the fact that a large percentage (up to 60% in randomized clinical trials) of older at-risk drinkers may need either more intense or innovative approaches to help them cut down or stop drinking have led to new developments in alcohol screening and brief interventions with older adults. Technological and content innovations are critical elements in providing rapid, effective interventions with a spectrum of alcohol use problems in later adulthood. Both primary and specialty care providers can be trained to provide motivational brief alcohol interventions targeted to the older patient. Novel approaches to screening, brief interventions, and brief therapies can be combined with the use of new technologies to facilitate implementation in a range of health care settings. This will give mental health specialty providers additional strategies for addressing the complex needs of older at-risk drinkers using a family of efficient and effective approaches.
Alcohol Use in Late Life: Disability and Comorbidity
Authors: Oslin David W.
Published: March 2014

Alcohol use by older adults is common, yet the risks and/or benefits of drinking, especially moderate drinking, are not well understood. Heavy drinking is a well-established factor in causing disability and excessive mortality among all age groups, including the elderly. However, literature is emerging that suggests that among elders with chronic medical and emotional health disorders, even modest alcohol consumption can lead to excessive disability and poorer perceived health. This article reviews the current literature on alcohol use and the relationship to common health problems in late life and suggests a model for examining the interaction of alcohol use and disability. Implications for intervention development are also discussed.
Alcohol, Dementia, and Alzheimer's Disease: Comparison of Neuropsychological Profiles
Authors: Saxton Judith , Munro Cynthia A. , Butters Meryl A. , Schramke Carol , McNeil Melissa A.
Published: March 2014

Thirty-nine detoxified elderly alcoholics (mean age = 65.85) completed a comprehensive assessment designed to identify individuals meeting DSM-IV criteria for alcohol-related dementia. Ten subjects meeting criteria (mean age = 69.8; mean Mini-Mental State Examination [MMSE] = 25.1) were compared to the 29 nondemented alcoholics (mean age = 64.5; mean MMSE = 27.8), 9 patients with Alzheimer's disease (mean age = 73.4; mean MMSE = 22.3), and 15 control subjects (mean age = 70.8; mean MMSE = 28). Comparison of neuropsychological test scores revealed several statistically significant differences. Furthermore, the overall pattern of test performance between the two demented groups was different. Alzheimer's patients were more impaired on confrontation naming, recognition memory, animal fluency, and orientation. Alcohol dementia subjects were more impaired than controls on initial letter fluency, fine motor control, and free recall. However, alcohol dementia subjects did not differ from controls on tests of verbal recognition memory. This study suggests that it is possible to clinically differentiate the cognitive deficits of alcohol-related dementia from typical Alzheimer's disease. However, the results are preliminary and are based on small sample sizes so should be interpreted with caution.
Complexity in Late-Life Depression: Impact of Confounding Factors on Diagnosis, Treatment, and Outcomes
Authors: Kales Helen C. , Valenstein Marcia
Published: March 2014

Late-life depression is a heterogeneous syndrome. Although depression in elderly patients is highly treatable, a number of factors or confounds create complexity in its overall management. Patient factors, such as medical illness, neuropsychiatric comorbidity, and race, may interact with provider factors to make management more complex. Outcomes and services research indicate that these factors, particularly medical illness, affect whether late-life depression is appropriately detected, diagnosed, and treated. Attention to such factors must be included in an agenda for mental health services research, with emphasis on the delivery of effective treatment to elderly patients with depression and improved outcomes in clinical settings.
A Transcultural Study of Agitation in Dementia
Authors: Fuh Jong-Ling , Mega M. S. , Binetti G. , Wang S. J. , Magni E. , Cummings J. L.
Published: March 2014

Agitation is one of the most troublesome behaviors in demented patients. It is etiologically heterogeneous and has varied associated behaviors. To explore the transcultural differences in the manifestation of agitation, we evaluated 50 consecutive Alzheimer's disease (AD) patients in three countries (Taiwan, Italy, and the United States) using the Neuropsychiatric Inventory (NPI) and the Mini-Mental State Examination (MMSE). In a focused analysis, only patients with composite NPI scores > 2 for agitation were selected, with similar levels of disease severity as measured by the MMSE, from the three groups (n = 15 per group) to evaluate culturally specific correlates of agitation. Agitated Taiwanese had significantly more hallucinations than either Italian or American patients. Agitated Italian patients had significantly more apathy than both Taiwanese and American patients. Cultural factors may influence the manifestation of agitation more than a common underlying neuropathology. Management strategies targeting unique behavioral instigators of agitation may be specific for different ethnic groups.
Is Dementia with Lewy Bodies the Second Most Common Cause of Dementia?
Authors: Heidebrink Judith L.
Published: March 2014

Lewy bodies were originally described in isolated brainstem nuclei in persons with Parkinson's disease. They have since been recognized as a widespread and common neuropathologic finding in individuals with dementia. Dementia with Lewy bodies (DLB) is the preferred term for the dementia syndrome associated with Lewy bodies. Although DLB is acknowledged as the second most common degenerative dementia, trailing only Alzheimer's disease, its ranking with respect to vascular dementia remains controversial. Large, community-based studies of DLB with postmortem confirmation are lacking. Available data suggest that DLB is more common than pure vascular dementia but not more common than any vascular contribution to dementia. (J Geriatr Psychiatry Neurol 2002; 15:000–000).
Dementia with Lewy Bodies: Clinical Characteristics and Diagnostic Criteria
Authors: Walker Zuzana , Medicine Dip Geriatric , Stevens Tim
Published: March 2014

Dementia with Lewy bodies (DLB) is increasingly recognized as a distinct clinical and pathologic entity. It is a progressive dementia characterized by persistent and well-formed visual hallucinations, marked second-to-second fluctuations in attention, and progressive extrapyramidal signs. The diagnostic value of additional clinical features such as delusions, depression, falls, anosmia, and rapid progression continues to be debated. Despite the growing acceptance of the diagnosis, DLB has not yet been included in either International Classification of Disease (ICD-10) or Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria. However, the existing consensus diagnostic criteria continue to be validated. Most prospective studies to date indicate that their performance is acceptable, with specificity similar to the present diagnostic criteria for Alzheimer's disease. Nevertheless, at least one in five patients with DLB will continue to be misclassified. (J Geriatr Psychiatry Neurol 2002; 15:000–000).
Pharmacologic Therapy of Dementia with Lewy Bodies
Authors: Kaufer Daniel I.
Published: March 2014

As a clinicopathologically defined entity, dementia with Lewy bodies (DLB) has overlapping features of Alzheimer's disease (AD) and Parkinson's disease (PD). Analogous characteristics of DLB offer a provisional rationale for pharmacologic therapy based on remediating cholinergic and dopaminergic deficits, respectively. However, the distinct clinical manifestations and pathophysiologic substrates of DLB pose unique therapeutic opportunities and challenges. More severe cholinergic deficits in DLB relative to AD support clinical evidence that cholinergic therapy may be particularly beneficial in DLB patients. In contrast, DLB patients are generally more sensitive to the adverse effects of antipsychotic agents, warranting caution in treating visual hallucinations and other psychotic symptoms. Similarly, parkinsonian motor signs in DLB, often manifest as rigidity and bradykinesia, may be less amenable to dopaminergic therapies than in PD. Increasing recognition of DLB as a common form of dementia in the elderly underscores the need for large-scale, placebo-controlled therapeutic trials. (J Geriatr Psychiatry Neurol 2002; 15:000–000).
Capgras' Syndrome in Dementia with Lewy Bodies
Authors: Marantz Andrew G. , Verghese Joe
Published: March 2014

We report the occurrence of Capgras' syndrome, or the delusion of doubles, in a patient with dementia with Lewy bodies. The patient believed that several similar-looking impostors had replaced his wife of over 50 years. Uncharacteristically, he adopted a friendly attitude with these impostors. This unusual convivial reaction to the impostors may result from differential involvement of the dual visual pathways processing facial recognition and emotional responses to faces. The delusion resolved spontaneously, coincident with worsening of the dementia. In a retrospective chart review of 18 autopsy-confirmed cases of dementia with Lewy bodies, delusions were reported in 5 subjects (27.8%), of whom 1 had misidentification delusions much like Capgras' syndrome. (J Geriatr Psychiatry Neurol 2002; 15:000–000).
Delayed Late Component of Visual Global Field Power in Probable Alzheimer's Disease
Authors: Coburn Kerry L. , Ashford J. Wesson , Moreno Marco A.
Published: March 2014

A substantial literature shows that late components of visual evoked potentials (VEPs) are delayed in at least some forms of dementia in the elderly. The late-component delay is selective in that earlier components are not affected. More recent work with better defined clinical groups suggests that the selective late-component delay may be characteristic of Alzheimer's disease (AD) rather than an inevitable feature of dementia in general. To overcome problems in traditional VEP component latency measurement the present study uses reference-free Global Field Power (GFP) analysis to more objectively define VEP components and finds that the GFP peak corresponding to the late P2 component of the flash VEP is delayed in a probable AD group but not in a demented unlikely AD group, relative to age-equivalent healthy controls. The late-component delay is again found to be selective in that the GFP peak corresponding to the earlier PI component of the flash VEP does not differ between groups. These findings further strengthen the evidence for electrocortical changes in the visual system of AD patients.
The Nature and Time Course of Cognitive Side Effects During Electroconvulsive Therapy in the Elderly
Authors: Rubin Eugene H. , Kinscherf Dorothy A. , Figiel Gary S. , Zorumski Charles F.
Published: March 2014

Cognitive and clinical changes during hospitalization were examined in 48 elderly patients with major depression treated with electroconvulsive therapy (ECT) and 55 elderly depressed patients not treated with ECT. Cognitive changes with ECT involved orientation, attention and calculation, and recall. The maximal decrement during ECT averaged 3 points on the Mini-Mental State Examination and occurred after two thirds of the treatments were administered. Baseline cognitive values returned by time of discharge. The affective symptoms improved throughout the course of treatment and remained improved while cognition returned to normal. Patients not receiving ECT showed slightly improved cognitive performance during hospitalization and small, gradual, clinical improvement.
Microanalysis of Senile Plaques Using Nuclear Microscopy
Authors: Landsberg Judith , McDonald Brendan , Grime Geoff , Watt Frank
Published: March 2014

Silver-staining “senile” plaques occurring in the brain are a major part of the pathology of Alzheimer's disease. The elemental composition of these structures, and the possible presence of aluminum and silicon in these structures, has been the subject of an increasing research effort over the last decade. However, the results have often been contradictory.

Using a scanning proton microprobe, the elemental composition of senile plaques has been determined. This instrument, similar to an electron probe, uses a focused beam of protons scanned across a sample to map the elements. The technique is absolutely quantitative and is sensitive down to the parts per million level.

Tissue from six cases of clinically and pathologically characterized cases of Alzheimer's disease and two aged neurologically normal controls was scanned. It was found that aluminum and silicon occur at a level of 50 ppm or greater in the cores of 20% of senile plaques and that the total occurrence of aluminum or silicon in scans containing plaques was not above background.

The major uncertainties affecting interpretation of results of this kind are discussed, and it is suggested that the least controllable factor is contamination in the reagents used to prepare and stain the tissue. This indicates that until plaques can be unambiguously identified and analyzed in untreated tissue, no conclusion can be reached on whether senile plaques contain aluminum and silicon.
The Prevalence of Late-Onset Schizophrenia in a Psychogeriatric Population
Authors: Yassa R. , Dastoor D. , Nastase C. , Camille Y. , Belzile L.
Published: March 2014

Of 288 patients admitted to our psychogeriatric unit during a 4-year study, seven patients were diagnosed as having symptoms of paranoid schizophrenia (2.4% of all admissions). All the patients were women. Their symptoms included bizarre delusions and auditory hallucinations. Negative symptoms were rare. Attempts to reduce the dosage of neuroleptic medication led to reappearance of the symptoms in six patients and readmission of the seventh.
P300 and Reaction Time in Parkinson's Disease
Authors: Toda Kazuo , Tachibana Hisao , Sugita Minoru , Konishi Kenzo
Published: March 2014

The event-related potential and motor reaction time were simultaneously recorded in 35 patients with Parkinson's disease (26 nondemented and nine demented) and 15 age-matched neurologically normal control subjects during the performance of visual discrimination tasks. There were no significant differences in either the latency or amplitude of the P300 component between the nondemented patients and the control subjects, but the patients with nondemented Parkinson's disease had a significantly prolonged reaction time compared with the controls. In patients with demented Parkinson's disease, both P300 latency and reaction time were significantly prolonged compared with the normal controls.

These results suggest that response selection and execution are impaired in patients with nondemented Parkinson's disease, although the stimulus evaluation process is largely preserved, whereas patients with demented Parkinson's disease have impairment of stimulus evaluation, go/no-go response selection, and execution.
Single Photon Emission Computed Tomography in Dementia: Relationship of Perfusion to Cognitive Deficits
Authors: Engel Peter , Cummings Jeffrey L. , Villanueva-Meyer Javier , Mena Ismael
Published: March 2014

Sixteen patients with dementia (nine with Alzheimer's disease and seven with multi-infarct dementia) were studied with xenon-133 and hexamethyl-propyleneamine-oxime single photon emission computed tomography (SPECT). Quantification of cerebral blood flow was determined in 16 hemispheric regions of interest. Neuropsychological deficits were assessed with the Mini-Mental State Examination and the Neurobehavior Cognitive Status Examination. Alzheimer's disease patients had symmetric reduction of parietal lobe perfusion; multi-infarct dementia patients had multifocal perfusion deficits. Correlations were demonstrated between cerebral blood flow in the posterior brain regions and performance on tests of language, memory, attention, figure copying, judgment, and similarities. Alzheimer's disease patients exhibited more language impairment than multi-infarct dementia patients. SPECT promises to provide diagnostic information and data relevant to interpretation of neuropsychological deficits.
Failure To Thrive in the Elderly: Exploration of the Concept and Delineation of Psychiatric Components
Authors: Katz Ira R. , Beaston-Wimmer Patricia , Parmelee Patricia , Friedman Eitan , Lawton M. Powell
Published: March 2014

Findings from an exploratory study of the relationships between routine clinical laboratory tests and the clinical status of elderly patients living in a nursing home or congregate housing facility demonstrate that low albumin and anemia are associated with decreased survival and with self-care deficits, cognitive impairment, depression, and summary measures of the severity of medical illness. The interrelationships observed among these variables support the usefulness of the concept of failure to thrive. Although albumin can serve as a nutritional marker, findings on its relationship with sedimentation rate, triiodothyronine uptake, fasting plasma amino acids, and retinol-binding protein levels suggest that the low albumin related to failure to thrive is not a simple reflection of steady-state deficits in protein-calorie nutrition; it appears to be sensitive to more direct effects of disease and inflammation or to the interactions between nutrition and illness.
Alzheimer's Disease and Idiopathic Parkinson's Disease Coexistence
Authors: Rajput A. H. , Rozdilsky B. , Rajput Alex
Published: March 2014

Idiopathic Parkinson's disease (IPD) and Alzheimer's disease (AD) are common neurologic diseases of old age. Parkinson syndrome is easy to recognize even at an early stage, but identifying early AD is often difficult. Accurate clinical diagnosis is important for assigning the prognosis and for studies aimed at assessing the efforts to slow down progression of these diseases. During 22 years, we identified six patients who had clinical features of parkinsonism and dementia and who at autopsy had both IDP and AD and 20 parkinsonian patients without dementia who at autopsy had only IPD. The clinical profile in these two groups was compared. The onset of Parkinson syndrome in the patients with dual pathology had a bimodal distribution—before or after age 65 years. In the three cases with onset before age 65 years, there was sequential evolution of IPD and AD. In contrast, those older than 65 years at onset manifested the clinical features of both IPD and AD simultaneously. The mode of onset and the dominant parkinsonian features in the three patients with sequential clinical evolution were similar to those seen in the nondemented IPD cases; however, lack of self-confidence and inability to make decisions resulted in considerably greater functional disability than could be accounted for by parkinsonism alone. These characteristics may be helpful in early recognition of dual IPD and AD pathology. Psychiatric side effects of levodopa therapy were more common in those with dual pathology than in those with IPD alone.
Age and Cerebral Infarction: A Postmortem Study of 77 Cases of Cerebral Infarcts in the Middle Cerebral Artery Territory
Authors: Yelnik A. , Derouesné C. , Cambon H. , Duyckaerts C. , Hauw J-J.
Published: March 2014

Adverse effect of age on ischemic stroke short-term mortality was reported in some studies and attributed either to more frequent extracerebral causes of death or to an increased severity of ischemia in the aged brain. Relationship between age, size of infarcts, and causes of death were studied in 77 consecutive patients who died from infarction in the middle cerebral artery territory. Area of infarcts was assessed by planimetry, and results were expressed as an index of infarcted area. No significant relationship was found between age and the size of infarcts, the cause of death, or the interval from stroke to death. These results do not support the hypothesis of an increased severity of ischemia in the aged brain.
Assessment of Cognitive Impairment: Relationship of the Dementia Rating Scale to the Mini-Mental State Examination
Authors: Bobholz Julie Hoida , Brandt Jason
Published: March 2014

The relationship between the Dementia Rating Scale (DRS) and the Mini-Mental State Examination (MMSE) was examined in 50 patients referred for neuropsychological assessment. The correlation between these two tests was moderately high (ρ =.72; Pearson r =.78), supporting previous findings. Linear regression analysis yielded equations that allow prediction of scores from one test to the other. Neither age nor education correlated significantly with these two tests. Examination of the five DRS subscales and the eleven MMSE items revealed some unexpected relationships. These results suggest that these two cognitive screening instruments evaluate some overlapping mental abilities; however, the validity of the individual items and subscales is not well supported.
Prevalence of Advance Directives and Guardianship in Nursing Home Patients
Authors: Janofsky Jeffrey S. , Rovner Barry W.
Published: March 2014

The Patient Self-Determination Act (PSDA) now requires federally funded nursing homes to inform newly admitted patients of their right to determine their future medical care. Many nursing home patients may not be able to understand these rights, given the high prevalence of mental disorders, particularly dementia, in this population, and will need family members for assistance.

Prior to the onset of the PSDA we surveyed the families of all residents of a large, proprietary nursing home to determine whether family members understood the concept of advance directives and guardianship. We also ascertained the rate of use of these instruments in the population studied.

We found that the majority of family member respondents understood these concepts, but that substantial proportions of both competent and incompetent patients lacked surrogate decision-making authority, either in the form of a court-appointed guardian or a written advance-directive instrument.

Informing newly admitted patients and their families about advance directives is warranted because many lack these plans. However, the high proportion of incompetent patients among nursing home patients indicates the need to encourage currently competent patients to formulate advance directives prior to nursing home placement.
Alzheimer's Disease: The Problem of Incorrect Clinical Diagnosis
Authors: McDaniel Leslie D. , Lukovits Timothy , McDaniel Keith D.
Published: March 2014

We reviewed the medical records of eight patients clinically diagnosed with Alzheimer's disease who were found on autopsy to have neuropathologic findings inconsistent with Alzheimer's disease. The clinical criteria for the diagnosis of probable Alzheimer's disease from the National Institute of Neurological and Communicative Disorders and Stroke/Alzheimer's Disease and Related Disorders Association (NINCDS/ADRDA) were retrospectively applied to these patients. The patients presented with clinical features atypical for Alzheimer's disease early in the course of the disease, including focal neurologic findings, gait abnormalities, motor speech abnormalities, and extrapyramidal features. Attention to these clinical red flags may decrease the likelihood of misdiagnosis of Alzheimer's disease in a patient with a non-Alzheimer's disease cause of dementia.
Failure of CT Scan to Detect Ischemic Lesions in Patients With Dementia
Authors: Kurita Akira , Black Ronald S. , Blass John P. , Deck Michael D.F. , Nolan Karen A.
Published: March 2014

Although clinical series have described relatively high accuracy in the ability of computed tomographic (CT) scan to detect significant cerebrovascular damage in patients with dementia, a recent neuropathologically controlled study failed to document that relationship. We now present clinical, neuroradiologic (CT), and neuropathologic information on four patients in whom CT scans did not contribute to the diagnosis of multi-infarct dementia or mixed dementia, despite clinical and neuropathologic evidence of infarcts. In one patient, the failure of CT scan to detect ischemic lesions may be attributable to less sensitive neuroradiologic criteria in use at the time of the examination. In the other three, even neuroradiologic review after the pathology was known failed to reveal the infarcts. These observations suggest the advisability of caution in using CT scan as a criterion for the presence or absence of cerebrovascular damage in patients with dementia.
Psychotic Episodes in an Elderly Woman With an Anticentromere-Positive Scleroderma Variant, IgA Deficiency, and Hypothyroidism
Authors: Schmid A. H. , Meltzer B. R.
Published: March 2014

A 66-year-old woman presented with a recurrent psychotic disorder with central manifestations that initially suggested a delusional disorder. Peripheral stiffness was at first attributed to a dystonic reaction secondary to neuroleptic treatment. The atypical presentation led to suspicion of collagen vascular disease. Both the psychotic disorder and peripheral involvement responded to cortisone. Findings are discussed in light of recent information on the pathogenesis and neuropsychiatric manifestations of systemic lupus erythematosus, progressive systemic scleroderma and limited scleroderma variants (CREST, unclassifiable connective tissue disease) with positive anticentromere titers, including a discussion of the vasculitis hypothesis of collagen vascular cerebral involvement.
The Evaluation of Behavioral Disturbances in Alzheimer's Disease: The Utility of Three Rating Scales
Authors: Mack James L. , Patterson Marian B.
Published: March 2014

Behavioral disturbances, eg, wandering, irritability, depression, and delusions, are observed in Alzheimer's disease (AD). Determining the importance of such symptoms requires that they be evaluated objectively. The Behavioral Pathology in Alzheimer's Disease Rating Scale (Behave-AD), Cornell Scale for Depression in Dementia (Cornell), and Brief Psychiatric Rating Scale (BPRS) were administered to 61 AD and 20 elderly control subjects. Only one AD subject showed no behavioral symptoms. All scales were reliably rated for presence or absence of symptoms. However, assessment of reliability of severity ratings was limited, because symptom frequency and severity were low. Although the Cornell and Behave-AD appeared more appropriate for AD subjects than did the BPRS, neither scale provided a complete description of behavioral symptoms, and each showed problems that interfere with its use. We recommend the development of a comprehensive scale with a well-anchored system of scaling and detailed rater instructions.
Depression in Disabling Illness: Severity and Patterns of Self-Reported Symptoms in Three Groups
Authors: Langer Karen G.
Published: March 2014

The nature of association between depression and disabling illness, whether as an organic symptom or emotional consequence, has been the source of interest and controversy. Depression in three groups of medically ill, disabled patients (Parkinson's disease, right hemisphere stroke, and amputation) was studied. Mean depression severity and frequency of depression were equal for all groups. Severity of neurologic symptomatology was not consistently related to depression. Type of prosthesis, but not amputation type, was related to depression for amputees. Patterns of depression on discriminant analysis did differentiate the groups'. A depression symptom conglomerate suggesting guilt and body image change with fatigue characterized the Parkinson patients most and the amputees least. A second depression conglomerate suggesting indecisiveness and thoughts of death or self-harm characterized amputees most and stroke patients least. Depression as an emotional response may not be a singular, specific feature of disabling illness in general, given uniformity of prevalence and severity, but differential etiology in specific instances should be considered.
Clozapine in the Elderly
Authors: Frankenburg Frances R. , Kalunian Douglas
Published: March 2014

The authors reviewed the use of clozapine in eight patients over age 65 years with treatment-resistant psychoses. Six patients improved. Two patients became more confused. The authors suggest that clozapine be considered in treating elderly psychotic patients, and that its use need not be restricted to schizophrenic patients.
Fluoxetine-Nortriptyline Therapy of Treatment-Resistant Major Depression in a Geriatric Patient
Authors: Rothschild Bruce S.
Published: March 2014

A case of severe, treatment-resistant major depression in a geriatric patient who ultimately attained full remission on fluoxetine-nortriptyline combination therapy is reported.
Clomipramine in the Elderly: Tolerance and Plasma Levels
Authors: Kunik Mark E. , Pollock Bruce G. , Perel James M. , Altieri Linda
Published: March 2014

Five elderly, treatment-resistant, depressed, female patients were closely monitored in a research setting during treatment with clomipramine. Plasma clomipramine levels were determined to establish a steady state. Elderly patients (67 to 80 years old) reached a therapeutic steady state at doses lower than that reported for midlife patients. Overall, clomipramine was well tolerated in this group. Depression, measured by the Hamilton Rating Scale for Depression, decreased 42%, and the frequency of somatic complaints, measured by the Rating Scale for Side Effects, declined by 57%. Clomipramine is specifically indicated for the treatment of obsessive-compulsive disorder and may be an alternative for elderly depressed patients, provided that lower doses and plasma clomipramine monitoring are used.
Depression in Alzheimer's Disease: Receiver Operating Characteristic Analysis of the Cornell Scale for Depression in Dementia and the Hamilton Depression Scale
Authors: Vida Stephen , Des Rosiers Pascale , Carrier Louise , Gauthier Serge
Published: March 2014

This study compares the performance of the Cornell Scale for Depression in Dementia (CSDD) and the Hamilton Depression Scale (HDS) in detecting Research Diagnostic Criteria (RDC) major depression in subjects with mild-to-moderate Alzheimer's disease (AD). Thirty-four subjects with this diagnosis and their caregivers were interviewed. The senior author conducted a diagnostic interview to determine RDC diagnosis. An investigator, blind to diagnosis, obtained demographic information and administered the Mini Mental State Examination, Global Deterioration Scale, CSDD and HDS. For each depression scale, the correlation with the RDC diagnosis of major depression was calculated, as were the sensitivity and specificity at various cutoff scores. Nonparametric receiver operating characteristic analysis was used to compare the performance of the two scales.

The area under the receiver operating characteristic curve was .91 for the CSDD and .87 for the HDS. This differed from chance to a highly significant degree for both the CSDD and the HDS but the difference between the two scales was not statistically significant. Although the precision of the present study is limited by the small sample size, a cutpoint of 7 provided reasonable performance for both the CSDD and the HDS, yielding a sensitivity of .90 for both scales and a specificity of .75 for the CSDD and 0.63 for the HDS.

Although the CSDD and the HDS are rating scales rather than diagnostic instruments, receiver operating characteristic analysis indicates that both demonstrate statistically significant discriminating ability for RDC major depression in mild to moderate, probable AD. Our data suggest that for most clinical purposes, a cutpoint of 7 may be suitable for the detection of RDC major depression in mild-to-moderate probable AD.