bluuebunny/crossref_metadata_2025_split huggingface dataset:
Noncognitive Disturbances in Alzheimer's Disease: Frequency, Longitudinal Course, and Relationship to Cognitive Symptoms
Authors: Marin Deborah B. , Green Cynthia R. , Schmeidler James , Harvey Philip D. , Lawlor Brian A. , Ryan Theresa M. , Aryan Mohsen , Davis Kenneth L. , Mohs Richard C. 
Published: April 2015

OBJECTIVE: To investigate the frequency and longitudinal course of symptoms of depression, agitation, and psychosis in a longitudinally studied sample of patients with Alzheimer's disease (AD).DESIGN: Longitudinal study of AD patients with follow‐up assessments at 6‐month intervals for an average of more than 3 years.SETTING: Alzheimer's Disease Research Center of the Mount Sinai Medical Center and the Bronx VA Medical Center, New York.PARTICIPANTS: A total of 153 AD patients.MEASUREMENTS: Blessed Test of Information, Memory and Concentration (BIMC) and the Alzheimer's Disease Assessment Scale cognitive (ADAS‐Cog) and noncognitive (ADAS‐NC) subscales.RESULTS: At entry into the study, more than 90% of patients had a behavioral disturbance that was rated as mild or worse on one of the 10 ADAS noncognitive items; and 40% had at least one rating that was moderate or severe. Correlational analyses indicated that, with the exception of the two mood‐related items, noncognitive symptoms on the ADAS were not highly correlated with one another. Only one of the noncognitive items, concentration, was strongly correlated with the severity of cognitive impairment. On average, patients showed progressively worse cognitive functioning over time as measured both by the ADAS‐Cog and the BIMC. The mean severity of noncognitive symptoms did not change during the course of a 5‐year follow up. The severity of behavioral disturbance at any one evaluation was negatively correlated with change in behavior during the next 6 months and was not correlated with cognitive decline.CONCLUSION: Mild behavioral disturbances are common, whereas moderate to severe behavioral symptoms are less frequent in this population of AD patients. Disturbances in mood and manifestations of agitation and psychotic symptoms are not closely related to one another and show little progressive worsening over time. Rather, they tend to be episodic such that increasing severity at one time is usually followed by improvement later. Concentration problems are a manifestation of cognitive dysfunction rather than behavioral disturbance in AD. Implications of these results for treatment of noncognitive disturbances in AD are discussed. J Am Geriatr Soc 45:1331–1338, 1997.
Validation of Multi‐Frequency Bioelectrical Impedance Analysis in Detecting Changes in Fluid Balance of Geriatric Patients
Authors: Rikkert Marcel G.M. Olde , Deurenberg Paul , Jansen René W.M.M. , van't Hof Martin A. , Hoefnagels Willibrord H.L. 
Published: April 2015

OBJECTIVES: Multi‐Frequency Bioelectrical Impedance Analysis (MFBIA) is a quick, simple, and inexpensive method to assess body fluid compartments. This study aimed at determining the validity of MFBIA in detecting clinically relevant changes of fluid balance in geriatric patients.DESIGN: A prospective, observational study.SETTING: The 22‐bed Geriatric Department of the University Hospital Nijmegen.PARTICIPANTS: Hospitalized patients were eligible if they did not have a pacemaker, were not suffering from terminal illnesses, and did not have psychogeriatric diseases likely to interfere with capacity to consent or comply. During a 16‐months period, 218 patients were admitted, of whom 78 patients were eligible and 53 consented to participate.MEASUREMENTS: Each subject's fluid balance was diagnosed twice a week as dehydrated, overhydrated, or euvolemic, based on standardized physical examination, laboratory tests, and weight evaluation. Changes in fluid balance were quantified by measuring total body water (TBW) and extracellular fluid (ECF) applying deuterium‐and bromide‐dilution techniques. Impedance at 1, 5, 50, and 100 kHz and body weight were measured daily. Sensitivity and Guyatt's responsiveness indexes of MFBIA in detecting dehydration and overhydration were determined.RESULTS: In total, 1071 MFBIA measurements were performed, during which 14 transitions from dehydration to euvolemia and 13 transitions from overhydration to euvolemia were monitored. Rehydration of dehydrated patients caused an increase in TBW and ECF of 3.4 ± 1.8 L and 1.9 ± 1.9 L, respectively, which resulted in significant decreases in impedance of 133 ± 67 Ω at 1 kHz and 93 ± 61 Ω at 100 kHz (P = .001). Treatment of overhydrated patients caused a TBW and ECF loss of 3.8 ± 4.2 L and 3.1 ± 3.8 L, respectively, which resulted in significant increases in impedance of 104 ± 72 Ω at 1 kHz and 81 ± 68 Ω at 100 kHz (P < .001). Sensitivity of a single MFBIA in diagnosing dehydration and overhydration was 14% and 17%, respectively. Responsiveness indexes of weighing and MFBIA for dehydration and overhydration were similar at all frequencies and greater than one.CONCLUSION: The sensitivity of a single impedance measurement in detecting dehydration and overhydration was low. However, responsiveness of serial measurements to intra‐individual changes in fluid balance was good. Therefore, this noninvasive technique may be used in clinical practice to improve monitoring fluid balance in geriatric patients, especially when daily weighing is difficult. J Am Geriatr Soc 45:1345–1351, 1997.
Acceptability of Mobile Mammography Among Community‐Dwelling Older Women
Authors: Levin Jennifer R. , Hirsch Susan H. , Bastani Roshan , Ganz Patricia A. , Lovett Marci L. , Reuben David B. 
Published: April 2015

OBJECTIVE: To test the acceptability of mobile mammography among community‐dwelling older women and to identify factors predictive of mobile mammography acceptance.DESIGN: Case series.SETTING: Twelve community meal sites sponsored by the City of Los Angeles Area on Aging.PARTICIPANTS: Two hundred fifty‐five volunteers aged 60 to 84 years who attended community meal sites.INTERVENTION: On‐site mammography offered to women who had not had a mammogram within the last year.MEASUREMENTS: Mammography acceptance rates, reasons for accepting or declining the mammogram, and breast cancer knowledge, beliefs, and intentions.MAIN RESULTS: One hundred seven of the 255 (42%) women were ineligible because they had received mammograms within the last year. Of the 148 women eligible, 57% accepted the mammograms and 43% declined; moreover, 20 of the 42 (48%) women who had not had a mammogram within the last 5 years or who never had a mammogram also accepted on‐site mammography in the mobile van. Variables identified as predictive of mammogram acceptance included Asian American status, not being an HMO member, being married, a reported willingness to accept a screening mammogram if recommended by a physician, and previous mammogram screening history.CONCLUSION: Mobile mammography is acceptable to many older community‐dwelling women. Although mobile mammography does not eliminate all barriers that inhibit a woman from receiving a mammogram, it may substantially increase screening for some groups.J Am Geriatr Soc 45:1365–1370, 1997.
Eligibility of Alzheimer's Disease Clinic Patients for Clinical Trials
Authors: Schneider Lon S. , Olin Jason T. , Lyness Scott A. , Chui Helena C. 
Published: April 2015

OBJECTIVES: To identify the percentage of patients with Alzheimer's disease (AD) in a general clinic population who would be provisionally eligible for randomized clinical trials and the extent to which these patients represent the overall clinic‐based population.BACKGROUND: Many randomized clinical trials have restricted enrollment criteria that may limit generalizability, i.e., AD patients who fulfill selection criteria for phase III clinical trials may not be representative of other AD patients in clinical settings.DESIGN AND SETTING: Patients diagnosed as probable or possible AD from the nine clinical sites of the State of California's Alzheimer's Disease Diagnostic and Treatment Centers (ADDTC) were selected on the basis of their provisionally fulfilling the inclusion and exclusion criteria of two typical AD clinical trials at the time of their first visit (ECG and brain imaging criteria were not available).RESULTS: From a sample of 3470 subjects with possible or probable AD, overall, only 4.4% or 7.9% would have been provisionally eligible for each of two trials. Patients provisionally eligible were younger, relatively underrepresented by women, better educated, wealthier, and more likely to be white than ineligible patients. The major independent demographic predictors for eligibility were (1) income greater than $15,000 per year, (2) male gender, and (3) college education. More than 60% of probable AD patients were excluded because of significant behavioral problems; approximately one‐quarter each were excluded because of significant medical or neurological problems. Allowing patients with probable or possible AD to enroll would have resulted in 10.6% being eligible.CONCLUSION: Selection criteria for AD clinical trials result in a demographically and clinically constrained subgroup that is not representative of the overall clinic population. J Am Geriatr Soc 45:923–928, 1997.
Proxies' Decisions About Clinical Research Participation for Their Charges
Authors: Muncie Herbert L. , Magaziner Jay , Hebel J. Richard , Warren John W. 
Published: April 2015

OBJECTIVE: To examine the process by which proxies decide about their charges' participation in clinical research.DESIGN: Using eight hypothetical research studies encompassing a variety of risks and benefits, we interviewed 315 competent persons > 65 years old (charges) and, separately, the individuals who would be designated as their proxies if the charges were to become incompetent. The proxies were asked what they thought their charges would decide and what decisions they would make for their charges and for their own participation.SETTINGS: A medical house‐call program, two apartment complexes, and three nursing homes.PARTICIPANTS: Charges > 65 years old and their proxies.MAIN OUTCOME MEASURE: Comparison of decisions made by charges and by proxies for their charges.RESULTS: The agreement between the proxies' and charges' decisions was not significantly different from random agreement (range of kappa statistics, 0.05–0.15). Rather, proxies' decisions for their charges were significantly related to the proxies' decisions for themselves (kappas, 0.52–0.86). When the paired proxies' and charges' decisions differed, the proxies were protective, more frequently refusing their charges' participation in the perceived riskier research studies.CONCLUSIONS: Proxies did not know what their charges would decide. Their choices for the charges related more to the proxies' decisions about their own participation (which they knew) than to the decisions of their charges (which they didn't know). This is similar to the process of a reasonable person making the decision, a characteristic of decisions made in the best interests of the patient.
Adverse Drug Events In High Risk Older Outpatients
Authors: Hanlon Joseph T. , Schmader Kenneth E. , Koronkowski Michael J. , Weinberger Morris , Landsman Pamela B. , Samsa Gregory P. , Lewis Ingrid K. 
Published: April 2015

OBJECTIVE: To describe the prevalence, types, and consequences of adverse drug events (ADEs) in older outpatients with polypharmacy.DESIGN: A cohort study.SETTING: General Medicine Clinic at the Durham Veterans Affairs Medical Center.PATIENTS: A total of 167 high risk (taking > 5 scheduled medications) ambulatory older veterans who participated in a year long health service intervention trial.MEASUREMENTS: Potential ADEs were identified by asking patients during closeout interviews whether, in the past year, they had experienced any side effects, unwanted reactions, or other problems from any medication. All reported medications and corresponding adverse experiences were assessed for plausibility by a research clinical pharmacist using two standard pharmacological textbooks and categorized by predictability, therapeutic class, and organ system.RESULTS: Eighty self‐reported ADEs involving 72 medications taken by 58 (35%) of 167 patients were textbook confirmed. Seventy‐six of 80 (95%) ADEs were classified as Type A (predictable) reactions. Cardiovascular (33.3%) and central nervous system (27.8%) medication classes were most commonly implicated. Gastrointestinal (30%) and central nervous system (28.8%) ADE symptoms were common. Sixty‐three percent of patients with ADEs required physician contacts, 10% emergency room visits, and 11% hospitalization. Twenty percent of medications implicated with ADEs required dosage adjustments, and 48% of ADE‐related medications were discontinued. No significant differences (P > .05) were observed when ADE reporters (n = 58) and non‐reporters (n = 109) were compared.CONCLUSION: Predictable ADEs are common in high risk older outpatients, resulting in considerable medication modification and substantial healthcare utilization.
The Relationship Between Self‐Rated Health and Depressive Symptoms in an Epidemiological Sample of Community‐Dwelling Older Adults
Authors: Mulsant Benoit H , Ganguli Mary , Seaberg Eric C. 
Published: April 2015

OBJECTIVE: To confirm the association between depression and self‐rated general health, independent of demographics, functional disability, physical illness burden, and health services utilization.DESIGN: Logistic regression analyses of data obtained in a cross‐sectional epidemiological survey.SETTING: The mid‐Monongahela Valley, a rural, nonfarm, low SES community.PARTICIPANTS: Random sample of 880 subjects aged 65 and older.MEASUREMENTS: The dependent variable was self‐rated overall health, categorized as excellent, good, fair, or poor. The independent variables were demographics (age, gender, education), number of depressive symptoms, number of impaired instrumental activities of daily living (IADLs), measures of physical illness burden (individual medical conditions, number of affected organ systems or disease processes, and number of prescription medications), and measures of health services utilization (number of visits to physicians, and acute hospitalization).RESULTS: Univariate analyses indicated that poorer self‐rated health was associated with lesser education, higher numbers of depressive symptoms, impaired IADLs, prescription medications, physician visits, hospitalizations, and affected organ systems, and with the presence of several specific conditions. However, multiple logistic regression analyses revealed that only the following variables were associated independently with poorer self‐rated health: age less than 75 years, education less than high school graduation, greater numbers of depressive symptoms, impaired IADLs, prescription medications, and physician visits.CONCLUSIONS: Even when controlling for physical illness and functional disability, subjective rating of overall health remains strongly and independently associated with depressive symptoms.
Effect of the National Resident Assessment Instrument on Selected Health Conditions and Problems
Authors: Fries Brant E. , Hawes Catherine , Morris John N. , Phillips Charles D. , Mor Vince , Park Pil S. 
Published: April 2015

OBJECTIVE: To evaluate the effect of the implementation of the National Resident Assessment Instrument (RAI) system on selected conditions representing outcomes for nursing home residents.DESIGN: Quasi‐experimental, pre‐/post‐design, with assessments at baseline and 6‐month follow‐up.SAMPLE: Two thousand one hundred twenty‐eight residents from 268 nursing homes in 10 states before RAI implementation, and 2,088 from 254 of the same nursing homes after implementation.MEASURES: From the full RAI Minimum Data Set, measures of dehydration, falls, decubitus, vision problems, stasis ulcer, pain, dental status (poor teeth), and malnutrition were examined at baseline and 6 months later. Poor nutrition was evaluated using a body mass index score below 20 and vision using a 4‐level scale; other conditions were represented by their presence or absence. Decline and improvement were computed as the changes in level between baseline and follow‐up, limiting the sample to those who could manifest each such change.MAIN RESULTS: Of eight health conditions representing poorer health status, dehydration and stasis ulcer had significantly lower prevalence after the implementation of the RAI (1993) compared with 1990. At the same time, there was an increase in the prevalence of daily pain. Fewer residents declined over 6 months in nutrition and vision after implementation. Although for these two conditions there were also significantly reduced rates of improvement, the net was an overall reduction in the 6‐month rate of decline for all residents. Pain also demonstrated a decline in the postimplementation rate of improvement. The combined eight conditions showed reductions in the rates of both decline and improvement.CONCLUSIONS: Several outcomes for nursing home residents improved after implementation of the RAI. Of the four conditions for which there are significant declines in prevalence or outcome changes, three are specifically addressed in the care planning guidelines incorporated the RAI system (all except stasis ulcer, although there is a RAP for decubitus ulcer). Pain, the only other condition with a significant result — an increase in baseline prevalence — also has no RAP. Although the changes might be ascribed otherwise, they support the premise that the RAI has directly contributed to improved outcomes for nursing home residents.
Predictive Validity of the Pra Instrument Among Older Recipients of Managed Care
Authors: Pacala James T. , Boult Chad , Reed Richard L. , Aliberti Ellen 
Published: April 2015

OBJECTIVE: to determine the validity of the Pra instrument in predicting the use of health‐related services by older enrollees in a managed care plan.DESIGN: Cohort study. At baseline, a survey was administered by mail. Responses were entered into the Pra formula to estimate each person's probability of using health‐related services heavily in the future. The subjects' use of services during the following year was monitored through claims submitted to their managed care organization.SETTING: Urban and suburban areas of Southern California.PARTICIPANTS: Persons aged 65 years and older enrolled in a Medicare risk health plan (n = 6802).MEASUREMENTS: Baseline data included demographic, health‐related, social, functional, and previous‐use‐of‐service characteristics. Follow‐up data included the use of and claims for payment for inpatient hospital care, emergency room services, nursing home services, home care, ambulance services, outpatient surgery, and durable medical equipment.RESULTS: High‐risk subjects (highest quartile of Pra values) incurred hospital admissions and claims that were 2.5 and 2.7 times greater than those of low‐risk subjects (lower three quartiles).CONCLUSIONS: The Pra formula is recommended for screening older adults enrolled in managed care organizations (as well as for screening those in the fee‐for‐service environment). It identifies older people who may benefit from interventions designed to avert health crises and the need for expensive care.
Efforts to Improve Primary Care Delivery to Nursing Home Residents
Authors: Fama Teresa , Fox Peter D. 
Published: April 2015

OBJECTIVE: To describe a primary care practice model used by health maintenance organizations (HMOs) that serve Medicare beneficiaries to improve the provision of primary care to nursing home residents.PARTICIPANTS: Medicare beneficiaries who reside in nursing homes and who are enrolled in HMOs.CONCLUSION: Several HMOs are using physician‐nurse practitioner teams to provide primary care to nursing home residents. The potential to improve the delivery of these services in nursing homes, particularly to long‐stay residents, is apparent. However, obstacles arise in developing this practice model in HMOs, including difficulty recruiting both nurse practitioners and physicians and the lack of HMO‐based research on the effects of such a model.
GERIATRIC BIOSCIENCE: Speech Perception in Older Adults: The Importance of Speech‐Specific Cognitive Abilities
Authors: Sommers Mitchell S. 
Published: April 2015

OBJECTIVE: To provide a critical evaluation of studies examining the contribution of changes in language‐specific cognitive abilities to the speech perception difficulties of older adults.DESIGN: A review of the literature on aging and speech perception.CONCLUSIONS: The research considered in the present review suggests that age‐related changes in absolute sensitivity is the principal factor affecting older listeners' speech perception in quiet. However, under less favorable listening conditions, changes in a number of speech‐specific cognitive abilities can also affect spoken language processing in older people. Clinically, these findings suggest that hearing aids, which have been the traditional treatment for improving speech perception in older adults, are likely to offer considerable benefit in quiet listening situations because the amplification they provide can serve to compensate for age‐related hearing losses. However, such devices may be less beneficial in more natural environments, (e.g., noisy backgrounds, multiple talkers, reverberant rooms) because they are less effective for improving speech perception difficulties that result from age‐related cognitive declines. It is suggested that an integrative approach to designing test batteries that can assess both sensory and cognitive abilities needed for processing spoken language offers the most promising approach for developing therapeutic interventions to improve speech perception in older adults.
The Association Of Antihypertensive Agents with MRI White Matter Findings and with Modified Mini‐Mental State Examination in Older Adults
Authors: Heckbert Susan R. , Longstreth W.T. , Psaty Bruce M. , Murros Kari E. , Smith Nicholas L. , Newman Anne B. , Williamson Jeff D. , Bernick Charles , Furberg Curt D. 
Published: April 2015

OBJECTIVES: To examine the association of antihypertensive regimen with magnetic resonance imaging (MRI) white matter hyperintensity and with cognitive impairment in older adults.DESIGN: Cross‐sectional study.SETTING: The Cardiovascular Health study, an observational prospective cohort study of risk factors for coronary heart disease and stroke in men and women 65 years of age and older.PARTICIPANTS: 1268 men and women with pharmacologically treated hypertension.MEASUREMENTS: Information on medication use, medical history, and health habits was collected at clinic examinations. Participants completed the Modified Mini‐Mental State Examination (3MS) and underwent MRI examination. Without clinical information, study neuroradiologists assigned an overall grade of white matter signal intensity on MRI on a scale from 0 (no findings) to 9 (extensive findings).RESULTS: Adjusted mean white matter grade was higher for users of calcium channel blockers (2.59, P = .007) and users of loop diuretics (2.60, P = .015) than for users of beta blockers (2.12). The association was present for both dihydropyridine and non‐dihydropyridine calcium channel blockers. Adjusted mean 3MS scores were lower for users of calcium channel blockers (89.6, P < .002), especially dihydropyridines, and users of loop diuretics (89.7, P < .006) than for users of beta blockers (92.3). No statistically significant association could be shown for users of other drug regimens, including thiazides and ACE inhibitors.CONCLUSION: In this study, users of antihypertensive regimens which included calcium channel blockers or loop diuretics had more severe white matter hyperintensity on MRI and worse performance on 3MS than users of beta blockers. J Am Geriatr Soc 45:1423–1433, 1997.