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Biomedical subjects

David Carr

Publications and source records attributed to David Carr.

17 recordsLinked to original sources
PubMed2006

Stealth monitoring of adherence to topical medication: adherence is very poor in children with atopic dermatitis.

BACKGROUND: Atopic dermatitis is a common problem for which topical agents are the primary treatment. When topical medications fail, further therapy may include systemic agents with the potential for greater toxicity. Adherence to topical treatment of atopic dermatitis has not been well characterized. Poor adherence to topical medication could account for failure of topical therapy. PURPOSE: To determine adherence to topical treatment in patients with atopic dermatitis. METHODS: Thirty-seven children were given 0.1% triamcinolone ointment and were counseled to use it twice daily. They were told to return in 4 weeks, at which time they were told to continue treatment for another 4 weeks. Electronic monitors were used to measure adherence over the entire 8 week study. Patients were not informed of the compliance monitoring until the end of the study. RESULTS: Twenty-six patients completed 8 weeks of treatment. Mean adherence from the baseline to the end of the study was 32%. Adherence was higher on or near office visit days and subsequently decreased rapidly. LIMITATIONS: This study was limited by the large number of subjects who failed to return for follow-up appointments or withdrew from the study. CONCLUSIONS: Adherence to topical medications is very poor in a clinic population of children with atopic dermatitis. Office visits are one means to increase adherence. If adherence to topical treatment can be improved, exposure to more costly and potentially toxic systemic agents may be avoidable.

Administration, Topical↗
PubMed2006

IL-4/IL-13 pathway genetics strongly influence serum IgE levels and childhood asthma.

BACKGROUND: IgE production, a hallmark of asthma and atopic disease, may be under genetic control. Genes of the IL-4 and IL-13 pathway, central for IgE regulation, have so far only been assessed in studies of single gene effects. OBJECTIVE: Here we analyzed combined extended haplotypes involving IL-4, IL-13, their shared receptor chain IL-4Ralpha, and the intracellular signal transducer and activator of transcription, STAT6, to assess the combined effect of single nucleotide polymorphisms in this important immunological signaling pathway. METHODS: We genotyped a large cross-sectional population of 1120 children age 9 to 11 years for 18 polymorphisms in the respective genes of the IL-4/IL-13 pathway. One polymorphism per gene was selected because of its putative functional role, and extended haplotypes were built in a stepwise procedure where gene-by-gene interactions were assessed by using a Cordell model. RESULTS: Combining polymorphisms in all 4 major pathway genes in a stepwise procedure, the risk for high serum IgE levels increased 10.8-fold (P = .02) and the risk for the development of asthma increased by a factor of 16.8-fold (P = .005) compared with the maximum effect of any single polymorphism. Significant interactions in a model with additive and dominant effects, for both pair and triplet combinations for asthma (lowest P = .005), and for pairs of polymorphisms in IgE regulation were observed (lowest P = .054). CONCLUSION: These data indicate that only the combined analyses of genetic alterations in the IL-4/IL-13 pathway reveal its actual significance to the development of atopy and childhood asthma.

Asthma↗
PubMed2005

G-Protein-coupled receptor polymorphisms are associated with asthma in a large German population.

RATIONALE: Recently, a new asthma susceptibility gene, GPRA (G-protein-related receptor for asthma), has been identified by positional cloning. Initial association studies in a Finnish and Canadian population suggested an association with asthma and elevated serum IgE levels. OBJECTIVE: In a large, nested case-control study, associations between GPRA polymorphisms, asthma, and serum IgE levels were analyzed. METHODS: Using matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) technology, 1,872 German children aged 9 to 11 years (including 624 children with asthma and/or bronchial hyperresponsiveness) were genotyped for seven polymorphisms in the GPRA gene. MEASUREMENTS: Hardy-Weinberg equilibrium was assessed, and association studies with single nucleotide polymorphisms (SNPs) and haplotypes were performed. MAIN RESULTS: SNP 546333 increased the risk for asthma (odds ratio [OR], 1.40; 95% confidence interval [CI], 1.04-1.88; p = 0.025) and concomitant asthma and bronchial hyperresponsiveness (BHR; OR, 2.38; 95% CI, 1.22-4.66; p = 0.009). Also, SNP 585883 was associated with asthma (OR, 1.34; 95% CI, 1.04-1.72; p = 0.022) and asthma in combination with BHR (OR, 2.71; 95% CI, 1.45-5.09; p = 0.001). Furthermore, SNP 585883 was associated with elevated serum IgE levels (OR, 1.63; 95% CI, 1.10-2.42; p = 0.015). Haplotype combinations of risk alleles increased the OR for asthma to 1.83 (95% CI, 1.08-3.08; p = 0.024) and for asthma and concomitant BHR to OR 3.51 (95% CI, 1.08-11.37; p = 0.036). CONCLUSIONS: These results indicate that GPRA polymorphisms increase the susceptibility for asthma and BHR, and to a lesser degree for the elevation of serum IgE, in a German population, confirming initial observations in other white populations.

Analysis of Variance↗
PubMed2005

Oral vitamin B12 therapy in the primary care setting: a qualitative and quantitative study of patient perspectives.

BACKGROUND: Although oral replacement with high doses of vitamin B12 is both effective and safe for the treatment of B12 deficiency, little is known about patients' views concerning the acceptability and effectiveness of oral B12. We investigated patient perspectives on switching from injection to oral B12 therapy. METHODS: This study involved a quantitative arm using questionnaires and a qualitative arm using semi-structured interviews, both to assess patient views on injection and oral therapy. Patients were also offered a six-month trial of oral B12 therapy. One hundred and thirty-three patients who receive regular B12 injections were included from three family practice units (two hospital-based academic clinics and one community health centre clinic) in Toronto. RESULTS: Seventy-three percent (63/86) of respondents were willing to try oral B12. In a multivariate analysis, patient factors associated with a "willingness to switch" to oral B12 included being able to get to the clinic in less than 30 minutes (OR 9.3, 95% CI 2.2-40.0), and believing that frequent visits to the health care provider (OR 5.4, 95% CI 1.1-26.6) or the increased costs to the health care system (OR 16.7, 95% CI 1.5-184.2) were disadvantages of injection B12. Fifty-five patients attempted oral therapy and 52 patients returned the final questionnaire. Of those who tried oral therapy, 76% (39/51) were satisfied and 71% (39/55) wished to permanently switch. Factors associated with permanently switching to oral therapy included believing that the frequent visits to the health care provider (OR 35.4, 95% CI 2.9-432.7) and travel/parking costs (OR 8.7, 95% CI 1.2-65.3) were disadvantages of injection B12. Interview participants consistently cited convenience as an advantage of oral therapy. CONCLUSION: Switching patients from injection to oral B12 is both feasible and acceptable to patients. Oral B12 supplementation is well received largely due to increased convenience. Clinicians should offer oral B12 therapy to their patients who are currently receiving injections, and newly diagnosed B12-deficient patients who can tolerate and are compliant with oral medications should be offered oral supplementation.

Administration, Oral↗
PubMed2005

NOD1 variation, immunoglobulin E and asthma.

Asthma is a familial inflammatory disease of the airways of the lung. Microbial exposures in childhood protect against asthma through unknown mechanisms. The innate immune system is able to identify microbial components through a variety of pattern-recognition receptors (PRRs). NOD1 is an intracellular PRR that initiates inflammation in response to bacterial diaminopimelic acid (iE-DAP). The NOD1 gene is on chromosome 7p14, in a region that has been genetically linked to asthma. We carried out a systematic search for polymorphism in the gene. We found an insertion-deletion polymorphism (ND(1)+32656) near the beginning of intron IX that accounted for approximately 7% of the variation in IgE in two panels of families (P<0.0005 in each). Allele*2 (the insertion) was associated with high IgE levels. The same allele was strongly associated with asthma in an independent study of 600 asthmatic children and 1194 super-normal controls [odds ratio (OR) 6.3; 95% confidence interval (CI) 1.4-28.3, dominant model]. Differential binding of the two ND(1)+32656 alleles was observed to a protein from nuclei of the Calu 3 epithelial cell line. In an accompanying study, the deletion allele (ND(1)+32656*1) was found to be associated with inflammatory bowel disease. The results indicate that intracellular recognition of specific bacterial products affects the presence of childhood asthma.

Adaptor Proteins, Signal Transducing↗
PubMed2004

A comprehensive analysis of interleukin-4 receptor polymorphisms and their association with atopy and IgE regulation in childhood.

BACKGROUND: The interleukin (IL) 4/IL13 pathway is involved in the regulation of IgE production associated with atopic diseases. Numerous polymorphisms have been identified in the coding region of the IL4 receptor alpha chain (IL4Ra) and previous association studies have shown conflicting results. Based on their putative functional role, polymorphisms A148G, T1432C and A1652G, located in the coding region of IL4Ra, were selected for association and haplotype studies in a large German population sample (n = 1,120). METHODS: Genotyping was performed using allele-specific PCR and restriction-enzyme-based assays. Haplotypes were estimated, and population-derived IgE percentiles (50% IgE >60 IU/ml, 66% IgE >115 IU/ml and 90% IgE >457 IU/ml) were calculated as outcome variables in a haplotype trend regression analysis. RESULTS: In our population, only polymorphism T1432C showed a trend for a protective effect against atopic rhinitis (odds ratio, OR: 0.52, 95% confidence interval, CI: 0.26-1.02, p = 0.05). When haplotypes were calculated, one haplotype was significantly associated with elevated serum IgE levels at the 50th percentile (OR 1.60, 95% CI 1.08-2.37, p = 0.02). CONCLUSIONS: These data indicate that IL4Ra polymorphisms, although suggested to be functionally relevant by in vitro studies, have only a minor influence on IgE regulation in our large population sample.

Asthma↗
PubMed2004

Factors associated with difference in prevalence of asthma in children from three cities in China: multicentre epidemiological survey.

OBJECTIVE: To determine the factors associated with difference in prevalence of asthma in children in different regions of China. DESIGN: Multicentre epidemiological survey. SETTING: Three cities in China. PARTICIPANTS: 10,902 schoolchildren aged 10 years. MAIN OUTCOME MEASURES: Asthma and atopic symptoms, atopic sensitisation, and early and current exposure to environmental factors. RESULTS: Children from Hong Kong had a significantly higher prevalence of wheeze in the past year than those from Guangzhou and Beijing (odds ratio 1.64, 95% confidence interval 1.35 to 1.99). Factors during the first year of life and currently that were significantly associated with wheeze were cooking with gas (odds ratio 2.04, 1.34 to 3.13), foam pillows (2.58, 1.66 to 3.99), and damp housing (1.89, 1.26 to 2.83). Factors protecting against wheeze were cotton quilts and the consumption of fruit and raw vegetables. CONCLUSION: Environmental factors and diet may explain the differences in prevalence of asthma between children living in different regions of China.

Asthma↗
PubMed2004

A signal transducer and activator of transcription 6 haplotype influences the regulation of serum IgE levels.

BACKGROUND: Because of its central role in the IL-4/IL-13 pathway, the intracellular signaling molecule signal transducer and activator of transcription 6 ( STAT6 ) may be crucial for IgE production in asthma and allergy. OBJECTIVE: We analyzed the association between polymorphisms in the STAT6 gene and the regulation of serum IgE levels. Methods In a population of 1120 German schoolchildren (age 9-11 years), we genotyped 6 previously identified polymorphisms spanning the STAT6 gene by using the matrix-assisted laser desorption ionization-time of flight mass spectrometry method. Haplotypes were estimated and population-derived IgE percentiles (50% IgE > 60 IU/mL, 66% IgE > 115 IU/mL, and 90% IgE > 457 IU/mL) were modeled as outcome variables in haplotype-trend regression analysis. RESULTS: Polymorphisms located in intron 2 (C2892T) and the 3' untranslated region (T12888C) significantly and consistently contributed to elevated total serum IgE levels. One STAT6 haplotype showed increased odds ratios of 1.58 (95% CI, 1.08-2.32; P = .020), 1.82 (95% CI, 1.19-2.77; P = .006), and 3.92 (95% CI, 1.93-7.96; P = .0002) for elevated IgE levels at percentiles 50%, 66%, and 90%, respectively. Because C2892T is located within a nuclear factor kappaB transcription factor binding site, a functional role of this polymorphism is very likely. CONCLUSION: The data indicate that within the IL-4/IL-13 pathway, genetic variants in the STAT6 gene significantly contribute to the regulation of serum IgE levels.

Base Sequence↗
PubMed2003

Positional cloning of a novel gene influencing asthma from chromosome 2q14.

Asthma is a common disease in children and young adults. Four separate reports have linked asthma and related phenotypes to an ill-defined interval between 2q14 and 2q32 (refs. 1-4), and two mouse genome screens have linked bronchial hyper-responsiveness to the region homologous to 2q14 (refs. 5,6). We found and replicated association between asthma and the D2S308 microsatellite, 800 kb distal to the IL1 cluster on 2q14. We sequenced the surrounding region and constructed a comprehensive, high-density, single-nucleotide polymorphism (SNP) linkage disequilibrium (LD) map. SNP association was limited to the initial exons of a solitary gene of 3.6 kb (DPP10), which extends over 1 Mb of genomic DNA. DPP10 encodes a homolog of dipeptidyl peptidases (DPPs) that cleave terminal dipeptides from cytokines and chemokines, and it presents a potential new target for asthma therapy.

Amino Acid Sequence↗
PubMed2003

Incidence and risk factors of respiratory syncytial virus-related hospitalizations in premature infants in Germany.

UNLABELLED: Premature infants have an increased risk of developing complicated respiratory syncytial virus (RSV) infections. Epidemiological data on RSV-related hospitalizations are a prerequisite to develop guidelines for the use of preventive measures. The objective of this study was to determine incidence and risk factors of RSV-related rehospitalizations (RSV-RH) of premature infants. We recruited 1,103 infants with a gestational age of less than 35 weeks, primarily admitted to nine neonatologic care units in southern Germany between Nov. 1, 1998 and Oct. 31, 1999. Questionnaires were sent to all parents of infants discharged from neonatal care units to determine the risk of rehospitalization for acute respiratory infections (ARI-RH) and RSV-RH in the 1999-2000 season. The questionnaire response rate was 68.4%. The 717 included infants of the responders had a mean gestational age of 31.6 weeks (Range: 23-35) and a mean birth weight of 1,747 g (range: 430-4,050 g). The risk for an ARI-RH was 10.6% and the risk for RSV-RH 5.2% during the observation period. Premature infants with chronic lung disease (CLD) had a probability of 24.5% for ARI-RH and of 15% for RSV-RH. The following factors were independently associated with an increased risk of RSV-RH: male gender (adjusted Odds-Ratio (OR): 8.7; 95% confidence interval (CI): 2.6-29.1), chronic lung disease (OR: 3.99; 95%CI: 1.4-11.2), discharge between October and December (OR: 2.1; 95%CI: 0.99-4.4), day-care attendance of siblings (OR: 3.9; 95%CI: 1.9-8.3). CONCLUSIONS: The risk for RSV rehospitalization among premature infants discharged from neonatal care facilities in southern Germany was low. Additional risk factors and high costs of prophylaxis have to be considered when infants are selected for RSV prophylaxis using monoclonal antibodies.

Acute Disease↗
PubMed2003

Economic evaluation of possible prevention of RSV-related hospitalizations in premature infants in Germany.

UNLABELLED: Palivizumab (Synagis, MedImmune Inc./Abbott Laboratories) has been shown to reduce the number of respiratory syncytial virus (RSV)-related hospitalizations in premature infants. The cost-effectiveness ratio of this prophylaxis, however, has not been evaluated in the German health-care system to date. The aim of the study was to assess the costs and benefits of Palivizumab among premature infants </=35 weeks with different risk factors. Projecting a societal perspective, we used decision analysis to compare the strategies of a prophylaxis with and without Palivizumab. Probabilities and costs of hospitalization were derived from a retrospective, population-based cohort study on 1,103 prematurely born infants primarily admitted to nine neonatologic care units in southern Germany between November 1998 and October 1999. Costs of prophylaxis were based on hospital sources. Efficacy of prophylaxis and estimates of RSV mortality were derived from the literature. Effectiveness was defined as the number of averted hospitalizations. The cost-effectiveness ratio of Palivizumab varied strongly among the different risk groups. While demonstrating no net cost savings related to RSV prophylaxis for any of the risk groups analyzed, Palivizumab showed the best cost-effectiveness ratio among male infants with chronic lung disease, discharge from primary neonatal care between October and December, and the presence of siblings visiting a day-care group. One averted hospitalization in this high-risk group was associated with costs of Euro 6,639 (number needed to treat (NNT): 4). For infants in other risk groups, the ratios varied from Euro 25,288 (NNT: 8) to Euro 204,684 (NNT: 54) per hospitalization averted. The cost-effectiveness ratios were sensitive to varying assumptions about probabilities and costs of rehospitalization, efficacy, and costs of Palivizumab prophylaxis. CONCLUSIONS: The results of this cost-effectiveness analysis do not justify the widespread use of Palivizumab among preterm infants. Lowering the costs of prophylaxis would be the most direct way to improve the cost-effectiveness ratio of Palivizumab.

Antibodies, Monoclonal↗
PubMed2003

A complete screening of the IL4 gene: novel polymorphisms and their association with asthma and IgE in childhood.

BACKGROUND: IL-4, a cytokine with immunomodulatory functions, is involved in the upregulation of IgE production characteristic of asthma and allergy. Thus far, 2 single nucleotide polymorphisms (SNPs) in the promoter (C-589T) and 5' untranslated region (C-33T) of the IL4 gene have been identified. Polymorphism C-589T was reported to influence total serum IgE levels and bronchial hyperresponsiveness. However, no study has investigated the putative existence of further SNPs in exons, introns, and flanking regions of the IL4 gene. OBJECTIVE: A complete screening of the IL4 gene and its flanking regions for new polymorphisms was performed. Large-scale association studies in 1120 German schoolchildren were conducted to determine the effect of all polymorphisms present in the IL4 gene on the phenotypic expression of atopic diseases. METHODS: Denaturing HPLC and standard sequencing techniques were performed to detect novel polymorphisms in 33 unrelated subjects unselected for atopic diseases. Linkage disequilibrium was assessed for all polymorphisms in the IL4 gene, and association studies were performed. RESULTS: A total of 16 polymorphisms were identified in the IL4 gene, 14 of which were not reported previously. The pattern of linkage disequilibrium observed in IL4 could not be explained by physical distance. A significant association between a cluster of polymorphisms in strong linkage disequilibrium with each other and a physician's diagnosis of asthma and total serum IgE levels was found. CONCLUSION: These results indicate a possible involvement of SNPs in the IL4 gene in the development of asthma and the regulation of total serum IgE.

Asthma↗
PubMed2003

Association between polymorphisms in caspase recruitment domain containing protein 15 and allergy in two German populations.

BACKGROUND: Early exposure to microbial matter such as LPS may influence the development of asthma and allergies by activation of innate immunity pathways as indicated by studies in farming environments. Recently, polymorphisms in caspase recruitment domain containing protein 15 (CARD15), an intracellular LPS receptor protein, have been associated with Crohn's disease. Because these polymorphisms lead to changes in LPS recognition, they may affect the development of asthma and allergies. OBJECTIVE: We genotyped a large population of German schoolchildren (N = 1872) from East and West Germany for 3 functional relevant CARD15 polymorphisms for their role in the development of asthma and allergy. METHODS: By use of parental questionnaires, skin prick testing, pulmonary function tests, bronchial challenge tests, and measurements of serum IgE levels, children were phenotyped for the presence of atopic diseases. Genotyping was performed with PCR-based restriction enzyme assays. To assess associations between atopic phenotypes and genotypes standard statistical procedures were applied. RESULTS: Children with the polymorphic allele C2722 had a more than 3-fold risk to develop allergic rhinitis (P <.001) and an almost 2-fold risk for atopic dermatitis (P <.05). Furthermore, the T2104 allele was associated with an almost 2-fold risk for allergic rhinitis (P <.05). When a C insertion at position 3020 was present, the risk of atopy increased by 50% (P <.05) and serum IgE levels were elevated (P <.01). CONCLUSION: The shared genetic background between Crohn's disease and atopy may indicate that an impaired recognition of microbial exposures results in an insufficient downregulation of excessive immune responses, giving rise to either T(H)2 dominated allergies or T(H)1 related Crohn's disease.

Carrier Proteins↗
PubMed2002

Environmental exposure to endotoxin and its relation to asthma in school-age children.

BACKGROUND: In early life, the innate immune system can recognize both viable and nonviable parts of microorganisms. Immune activation may direct the immune response, thus conferring tolerance to allergens such as animal dander or tree and grass pollen. METHODS: Parents of children who were 6 to 13 years of age and were living in rural areas of Germany, Austria, or Switzerland where there were both farming and nonfarming households completed a standardized questionnaire on asthma and hay fever. Blood samples were obtained from the children and tested for atopic sensitization; peripheral-blood leukocytes were also harvested from the samples for testing. The levels of endotoxin in the bedding used by these children were examined in relation to clinical findings and to the cytokine-production profiles of peripheral-blood leukocytes that had been stimulated with lipopolysaccharide and staphylococcal enterotoxin B. Complete data were available for 812 children. RESULTS: Endotoxin levels in samples of dust from the child's mattress were inversely related to the occurrence of hay fever, atopic asthma, and atopic sensitization. Nonatopic wheeze was not significantly associated with the endotoxin level. Cytokine production by leukocytes (production of tumor necrosis factor alpha, interferon-gamma, interleukin-10, and interleukin-12) was inversely related to the endotoxin level in the bedding, indicating a marked down-regulation of immune responses in exposed children. CONCLUSIONS: A subject's environmental exposure to endotoxin may have a crucial role in the development of tolerance to ubiquitous allergens found in natural environments.

Adolescent↗
PubMed2002

Modeling annual benzene, toluene, NO2, and soot concentrations on the basis of road traffic characteristics.

The investigation of potential adverse health effects of urban traffic-related air pollution is hampered by difficulties encountered with exposure assessment. Usually public measuring sites are few and thereby do not adequately describe spatial variation of pollutant levels over an urban area. In turn, individual monitoring of pollution exposure among study subjects is laborious and expensive. We therefore investigated whether traffic characteristics can be used to adequately predict benzene, NO2, and soot concentrations at individual addresses of study subjects in the city area of Munich, Germany. For all road segments with expected traffic volumes of at least 4000 vehicles a day (n = 1840), all vehicles were counted manually for a single weekday in 1995. The proportion of vehicles in "stop-go" mode, an estimate of traffic jam, was determined. Furthermore, annual concentrations of benzene, NO2, and soot from 18 high-concentration sites (means: 8.7, 65.8, and 12.9 micrograms/m3, respectively) and from 16 school sites with moderate concentrations (means: 2.6, 32.2, and 5.7 micrograms/m3, respectively) were measured from 1996 to 1998. Statistical analysis of the data was performed using components of two different statistical models recently used to predict air pollution levels in comparable settings. Two traffic characteristics, traffic volume and traffic jam percentage, adequately described air pollutant concentrations (R2: 0.76-0.80, P < 0.0001). This study shows that air pollutant concentrations can be accurately predicted by two traffic characteristics and that these models compare favorably with other more complex models in the literature.

Air Pollutants↗
PubMedDate not supplied

Impaired physical performance and the assessment of dementia of the Alzheimer type.

CONTEXT: Impaired physical performance may confound the clinical assessment of dementia of the Alzheimer type (DAT). OBJECTIVES: Determine whether: (1) Physical Performance Test (PPT) scores are associated with the Clinical Dementia Rating (CDR), (2) PPT scores are correlated with clinical measures of health, and (3) impaired physical performance affects the clinical assessment of DAT. DESIGN: A retrospective and cross-sectional study. SETTING: An Alzheimer's Disease Research Center. PARTICIPANTS: Ninety-nine research volunteers aged 85 years and older were assessed from September 1997 through July 1999; 45 had DAT (CDR = 0.5-2), and 54 were nondemented controls. MEASUREMENTS: Clinical health history, daily functioning, physical and neurologic status, CDR, sum of boxes, and total PPT score were obtained during clinical evaluation. Independently assessed psychometric measures of verbal and nonverbal episodic and semantic memory, visuospatial abilities, and psychometric speed yielded to a factor score representing general cognitive function. Our outcome measure was the CDR (ie, the clinical dementia rating, where higher scores indicate greater dementia severity). RESULTS: The majority (88%) of subjects in this sample of demented and nondemented older adults had some degree of physical impairment as measured by the PPT. Correlational analyses identified clinically important relationships (/taub/ > 0.30, p < 0.05) between impaired PPT performance, higher CDR rating, and poor general health, including difficulty ambulating. The correlation between PPT performance and dementia severity (taub = -0.36) decreased after controlling for cognitive ability (taub = -0.19). The correlation between the cognitive factor score and dementia severity when PPT performance was controlled (taub = -0.60) was similar to the unadjusted correlation of the factor score with dementia severity (taub = -0.64). CONCLUSIONS: The presence of some degree of physical impairment was common in our sample, and PPT scores correlated with both physical and cognitive impairment. Nevertheless, Alzheimer Disease Research Center clinicians appear able to successfully distinguish between physical and cognitive causes of functional impairment and assign a CDR rating that accurately reflects DAT severity in individuals with impaired physical performance.

Activities of Daily Living↗