Biomedical subjects

L E Harrell

Publications and source records attributed to L E Harrell.

At least 37 records · Page 2Linked to original sources

PubMed1997

Cognitive models that predict physician judgments of capacity to consent in mild Alzheimer's disease.

OBJECTIVE: To identify cognitive measures that predict consent capacity of normal and demented older adults as judged by experienced physicians. This study is a companion to the physician competency judgment research reported in this issue. DESIGN: Predictor models for competency judgments of individual physicians were developed using independent patient neuropsychological test measures and discriminant function analyses (DFA). SETTING: University medical center. PARTICIPANTS: Subjects were 16 normal older controls and 29 patients with mild AD (MMSE > or = 20). Five experienced medical center physicians were recruited as competency decision-makers. MEASUREMENTS: Subjects were videotaped responding to a standardized consent capacity interview (SCCI) designed to evaluate capacity to consent to treatment. Interview subjects were also independently administered (off videotape) a battery of neuropsychological measures theoretically and empirically linked to competency function. Study physicians blinded to subject diagnosis and neuropsychological test performance individually viewed each SCCI videotape and made a judgment of competent or incompetent to consent to treatment. Stepwise DFA identified neuropsychological predictors of each physician's competency judgments for the full sample (N = 45). Classification DFAs determined how accurately these predictor models classified competency outcomes assigned by the individual physician. RESULTS: Cognitive models differed across individual physicians and were related to stringency of judgments for AD patients. Under stepwise DFA, delayed verbal recall (R2 = .57, P < .0001) predicted judgments of Physician 1 (incompetency rate of 90% for AD patients), short term verbal recall (R2 = .43, P < .0001) predicted judgments of Physician 2 (incompetency rate of 52%), phonemic word fluency (R2 = .27, P < .001) predicted judgments of Physician 3 (incompetency rate of 24%), and visuomotor tracking/sequencing (R2 = .31, P < .001) predicted judgments of Physician 4 (incompetency rate of 14%). (No predictor model was available for Physician 5 as this physician found all subjects to be competent). These single predictor solutions correctly classified 93%, 87%, 87%, and 96% of cases for Physicians 1-4, respectively. Use of two predictor solutions achieved successful classification rates between 98% and 100%. CONCLUSIONS: We identified two cognitive models of consent capacity as judged by physicians: (1) verbal recall and (2) simple executive function. The verbal recall model predicted judgments of physicians likely to find mild AD patients incompetent, whereas the executive function model predicted judgments of physicians likely to find mild AD patients competent. Assessment of verbal recall and simple executive functions may provide important information in the clinical evaluation of capacity to consent to treatment.

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PubMed1997

Magnetic resonance cisternography in the diagnosis of delayed iatrogenic cerebrospinal fistula: a case report.

A 52-year-old woman presented with a clinical picture consistent with bacterial meningitis 3 years after functional endoscopic sinus surgery. Diagnosis of a cerebrospinal fluid (CSF) fistula was made clinically, and the site of the fistula was confirmed using magnetic resonance cisternography. The utilization of this technique in the diagnosis of CSF disorders is gaining popularity. Its usefulness in the context of other imaging modalities is discussed.

Cerebrospinal Fluid Rhinorrhea↗

PubMed1997

Development and validation of a Structured Telephone Interview for Dementia Assessment (STIDA): the NIMH Genetics Initiative.

As part of the NIMH Genetics Initiative Alzheimer's Disease (AD) Study Group, a brief structured telephone interview to distinguish individuals with normal cognitive functioning from those with changes in cognition and daily functioning suggestive of early AD was developed. The Structured Telephone Interview for Dementia Assessment (STIDA), yields a dementia score between 0 and 81 (higher scores indicating greater impairment). Subscales corresponding to the subscales of the Clinical Dementia Rating Scale (CDR) can be derived. The STIDA performed well as a screening instrument for mildly demented individuals. When a score of 10 or more (based on informant interview and subject testing) was used to identify mildly impaired individuals, the STIDA had a sensitivity of .93 and a specificity of .92 for a clinician-derived CDR of 0.5 or more. The STIDA was also capable of accurately assessing the level of dementia. STIDA-derived CDR ratings agreed with clinician-derived CDR scores in 23 of 28 cases, corresponding to an unweighted kappa of.71 and a weighted kappa of.81. A much-abbreviated short STIDA that could be administered directly to the subject was able to detect possible impairment with a sensitivity of .93 and a specificity of.77. These results suggest that the short STIDA provides a sensitive and fairly specific telephone screen for dementia, and that the full STIDA, consisting of an interview with a knowledgeable informant and subject testing, approximates the success of a face-to-face clinical interview, and provides reliable and valid screening and staging of dementia over the telephone.

Aged↗

PubMed1997

ApoE-4 and age at onset of Alzheimer's disease: the NIMH genetics initiative.

OBJECTIVE: To explore the impact of apoE-4 on Alzheimer's disease (AD) and its age at onset. DESIGN: A genetic linkage study using affected relative pairs, predominantly siblings. SETTING: Three academic medical centers ascertained subjects from memory disorder clinics, nursing homes, and the local community. SUBJECTS: 310 families including 679 subjects with AD by NINCDS/ADRDA and/or Khachaturian criteria and 231 unaffected subjects. OUTCOME MEASURE: ApoE genotype. ANALYTIC METHODS: Association, affected pedigree member, sibling pair, and lod score analyses. RESULTS: ApoE-4 was strongly associated with AD in this sample (allele frequency = 0.46 vs. 0.14 in controls, p < 0.000001). Results of lod score, affected pedigree member analysis, and sib-pair analysis also supported apoE-4 as a risk factor for AD. When the sample was stratified on family mean age at onset, the risk conferred by apoE-4 was most marked in the 61 to 65 age group. Individuals with two copies of apoE-4 had a significantly lower age at onset than those with one or no copies (66.4 vs. 72.0, p < 0.001), but individuals with one copy did not differ from those with none. Within families, the individual with the earliest age at onset had, on average, significantly more apoE-4 alleles (p < 0.0001) than the individual with the latest onset. DISCUSSION: This work supports previous reports of an association between apoE-4 and the development of AD and demonstrates that apoE-4 exerts its maximal effect before age 70. These findings have important implications for the potential use of apoE genotyping for diagnosis and prediction of disease. They also underscore the need to identify additional genetic factors involved in AD with onset beyond age 70 years.

Age of Onset↗

PubMed1997

Subscale validity of the Mattis Dementia Rating Scale.

The Mattis Dementia Rating Scale (DRS), a widely used dementia screening instrument, generates five subscale scores in the areas of Attention (ATT), Initiation-Perseveration (IP), Construction (CN), Conceptualization (CON), and Memory (MEM). The present study sought to determine the criterion validity of the DRS subscales in a sample of 50 patients with Alzheimer's disease (25 with mild and 25 with moderate dementia). Subject performance on the five DRS subscales was correlated with performance on five well-validated neuropsychological criterion measures using Pearson r and stepwise regression. On a univariate level, each DRS subscale correlated most strongly with its assigned neuropsychological criterion measure. On a multivariate level, each DRS subscale emerged as the Step 1 predictor of its assigned criterion measure, with the exception of DRS CN, which was the Step 2 predictor. The results suggested that overall the DRS subscales are valid measures of their respective constructs and have value for both clinical and research purposes in mild and moderate dementia.

Journal Article↗

PubMed1997

Regional stability of cerebral blood flow measured by repeated technetium-99m-HMPAO SPECT: implications for the study of state-dependent change.

UNLABELLED: The replicability of resting state rCBF has implications for the analysis of cerebral activation protocols and the interpretation of rCBF in disease states. This study examined the stability of rCBF as measured by two resting state 99mTc-HMPAO brain SPECT scans with an emphasis on examining the contribution of specific cerebral regions to within and between subjects variance. METHODS: Nine normal, medically healthy subjects underwent two 99mTc-HMPAO brain SPECT scans under identical conditions separated by 48 hr. A reference system and semiautomated computer ROI method was used to enable accurate alignment and cortical analysis of the two scans. RESULTS: Mean within-subject difference between Scans 1 and 2 was 2.8% (range 0%-7.8%) for the 36 cortical ROIs. The mean between-subject coefficient of variation was 10% (range 7%-15%) for these ROIs. Correlation analysis of rCBF pattern replication for all slice levels yielded a highly significant overall consistency of pattern within subjects (Pearson r = 0.698, p = 0.0001). Variance component analysis revealed regional heterogeneity in between-subjects variance, with significantly greater variability found in frontal regions. The within-subject repeated measures variability was not significantly different across regions. CONCLUSION: Good within-subject 48-hr replicability indicates that individual resting state rCBF reflects fairly stable, subject-specific factors. This also justifies comparing state-dependent studies separated by a modest length of time. Although individual patterns of rCBF replicate well, the larger contribution of frontal regions to normal between-subjects variance makes evaluating the frontal effects of disease or activation more difficult.

Aged↗

PubMed1996

Sympathetic sprouting reverses decreases in membrane-associated activity of protein kinase C following septohippocampal denervation of the rat hippocampus.

Hippocampal sympathetic ingrowth (HSI), a form of neuronal plasticity, is induced by medial septal lesions and consists of the sprouting of peripheral sympathetic fibers, arising from the superior cervical ganglion, into the dentate gyrus and CA3 region of the hippocampus. HSI has been previously shown to alter learned and spontaneous behaviors, phosphatidyl inositide hydrolysis, and the antagonist binding kinetics of both muscarinic cholinergic receptors and phorbol ester receptors. We now report that sympathetic sprouting reverses decreases in membrane-associated activity of protein kinase C (PKC) following septohippocampal denervation of the rat hippocampus. Further, no changes were found in alpha, beta or gamma PKC isoenzymes among experimental groups, suggesting that the group A PKC isoforms do not mediate the observed changes in activity and phorbol ester binding.

Analysis of Variance↗

PubMed1996

Utility of Mini-Mental State Exam scores in predicting functional impairment among white and African American dementia patients.

BACKGROUND: The Mini-Mental State Exam (MMSE) is widely used to assess cognitive impairment. Although education and race have been shown to affect the validity of the MMSE in detecting dementia, whether race and education influence the validity of the MMSE in gauging severity of dementia is unknown. METHODS: Patients diagnosed with Alzheimer's and other dementias (59 African American, 112 White) were administered the MMSE, and information was gathered on patient functional impairment, including Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL), and the Memory and Behavior Problems Checklist (MBPC). Demographic information, including patient and caregiver education, and patient age, was also assessed. RESULTS: African American and White patients did not differ significantly on the MMSE or functional impairment variables, but White patients had higher educational attainment. Hierarchical multiple regression analysis showed that race and education did not predict functional impairment, and MMSE scores were strong predictors of ADL and IADL levels for both African American and White patients. MMSE predicted variability in MBPC scores for White patients only, perhaps related to racial differences in subjective caregiver report of behavioral problems. CONCLUSIONS: While race and education may affect the validity of the MMSE in detecting the presence of cognitive impairment, the MMSE can be a useful predictor of degree of ADL and IADL impairment in patients diagnosed with dementia, regardless of race.

Activities of Daily Living↗

PubMed1996

Association between Alzheimer's disease and bound autochthonous IgM on T cells.

OBJECTIVE: To determine whether there is an association between the number of peripheral T cells binding IgM per total T cell population (%IgM+ T cells) and dementia. DESIGN: Cross-sectional study. SETTING: Two inpatient and two outpatient sites at a university medical center. PARTICIPANTS: Fifty-three adults. MEASUREMENTS: Peripheral blood was collected from each individual, and the %IgM+ T cells was determined by flow cytometry. The data obtained by medical record chart review were analyzed to determine whether the %IgM+ T cells correlated with cognitive diagnoses, demographic variables, medical diagnoses, or prescribed medications. RESULTS: The %IgM+ T cells was negatively correlated with MMSE scores (r = -.33, P = .016). There was a significant difference in the mean %IgM+ T cells between Alzheimer's disease (AD) and non-AD patients (35.6% +/- 30.2% vs 14.6% +/- 23.9%, P < .001) but no statistically significant association between the mean %IgM+ T cells and age, sex, race, prescribed medications (except gastrointestinal (GI) medications), or medical diagnoses (except stroke). After statistically controlling for GI medications and stroke, AD remained independently associated with the %IgM+ T cells (P = .008). CONCLUSIONS: Patients with AD had significantly more of their T cells coated with IgM than did non-AD patients.

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PubMed1996

The consortium to establish a registry for Alzheimer's Disease (CERAD). Part XIII. Obtaining autopsy in Alzheimer's disease.

Although autopsy rates in the United States have been decreasing steadily, the necessity for brain autopsy to confirm Alzheimer's disease (AD) remains. Of 308 consecutively deceased AD patients at 24 CERAD (Consortium to Establish a Registry for Alzheimer's Disease) sites, 167 (54%) were autopsied; 141 (46%) were not. The autopsied and nonautopsied groups were comparable in gender (men, 57.5% versus 49.7%), marital status (married, 69.3% versus 67.1%), age at entry (73 versus 74 years), age at death (76 versus 77 years), and stage of disease at entry (mild, 46% versus 43%). However, the autopsied patients were significantly more likely to be white (94.5% versus 82.1%), to be better educated (13.1 versus 11.3 years), to have been in the study longer (mean, 3.3 versus 2.6 years), and to have had longer total duration of AD (8.1 versus 6.7 years). Of the 24 CERAD sites, 13 stressed the importance of autopsy by dedicating a staff member to seek autopsy and by providing free autopsy and transportation; 11 did not. Logistic regression analysis showed that white race (odds ratio [OR] = 2.74; 95% confidence interval [CI] = 1.10-6.83), increased education (OR = 1.12; 95% CI = 1.04-1.21), and emphasis on autopsy (OR = 4.69; 95% CI = 2.67-8.25) were the only significant factors. Although race and education were important, autopsy was more likely to be obtained when sites dedicated resources to this endeavor.

Aged↗

PubMed1996

Toward a neurologic model of competency: Cognitive predictors of capacity to consent in Alzheimer's disease using three different legal standards.

OBJECTIVE: To identify cognitive predictors of competency performance and status in Alzheimer's disease (AD) using three differentially stringent legal standards for capacity to consent. DESIGN: Univariate and multivariate analyses of independent neuropsychological test measures with three dependent measures of competency to consent to treatment. SETTING: University medical center. SUBJECTS: 15 normal older controls and 29 patients with probably AD (15 mild and 14 moderate). MAIN OUTCOME MEASURES: Subjects were administered a batter of neuropsychological measures theoretically linked to competency function, as well as two clinical vignettes testing capacity to consent to medical treatment under five legal standards (LSs). The present study focused on three differentially stringent LSs: the capacity simply to "evidence a treatment of choice" (LS1), which is a minimal standard; the capacity to "appreciate the consequences" of a treatment of choice (LS3), a moderately stringent standard; and the capacity to "understand the treatment situation and choices" (LS5), the most stringent standard. Control subject and AD patient neuropsychological test scores were correlated with scores on the three LSs. The resulting univariate correlates were than analyzed using stepwise regression and discriminant function to identify key multivariate predictors of competency performance and status under each LS. RESULTS: No neuropsychological measures predicted control group performance on the LSs. For the AD group, a measure of simple auditory comprehension predicted LS1 performance (r(2)=0.44, p < 0.0001), a word fluency measure predicted LS3 performance (r(2)=0.58, p < 0.0001), and measures of conceptualization and confrontation naming together predicted LS5 performance (r(2)=0.81, p < 0.0001). Under discriminant function analysis, confrontation naming was the best single predictor of LS1 competency status for all subjects, correctly classifying 96% of cases (42/44). Measures of visumotor tracking and confrontation naming were the best single predictors, respectively, of competency status under LS3 (91% [39/43]) and LS5 (98% [43/44]). CONCLUSIONS: Multiple cognitive functions are associated with loss of competency in AD. Deficits in conceptualization, semantic memory, and probably verbal recall are associated with the declining capacity of mild AD patients to understand a treatment situation and choices (LS5); executive dysfunction with the declining capacity of mild to moderate AD patients to identify the consequences of treatment choice (LS3); and receptive aphasia and severe dysnomia with the declining capacity of advanced AD patients to evidence a simple treatment choice (LS1). The results offer insight into the relationship between different legal thresholds of competency and the progressive cognitive changes characteristic of AD, and represent an initial step toward a neurologic model of competency.

Alzheimer Disease↗

PubMed1995

The effect of hippocampal sympathetic ingrowth and cholinergic denervation on hippocampal M2 cholinergic receptors.

After cholinergic denervation of the hippocampus, via medial septal (MS) lesions, peripheral sympathetic fibers, originating from the superior cervical ganglia, grow into the hippocampus. In this study, we sought to determine the effect of hippocampal sympathetic ingrowth (HSI) on the M2 subtype of muscarinic cholinergic receptors, by examining the membrane binding of [3H]AF-DX 384 in hippocampal tissue from control rats, rats with HSI and rats with MS lesions + concurrent ganglionectomy (CD group). In dorsal hippocampus, Kd was found to be increased while Bmax was decreased in the CD group as compared with both the HSI and control group which did not differ from one another. In ventral hippocampus, Kd was found to be increased while Bmax was decreased in the CD group when compared only with the control group. These results suggest that sympathetic ingrowth, which has its greatest concentration in dorsal hippocampus, can 'normalize' the M2 receptor in hippocampus.

Animals↗

PubMed1995

Hippocampal sympathetic ingrowth and cholinergic denervation uniquely alter muscarinic receptor subtypes in the hippocampus.

Following cholinergic denervation of the hippocampus by medial septal lesions, and unusual neuronal reorganization occurs, in which peripheral sympathetic fibers, originating from the superior cervical ganglia, grow into the hippocampus. Previously, we have found that both hippocampal sympathetic ingrowth (HSI) and cholinergic denervation (CD), alone, altered the total number and affinity of muscarinic cholinergic receptors (mAChR). In this study, we utilized the muscarinic antagonist [3H]Pirenzepine, in combination with membrane radioligand binding techniques, to determine the effects of HSI and CD on hippocampal M1 and M1 + M3 mAChR subtypes, 4 weeks after MS lesions. In both the dorsal and ventral hippocampus, HSI was found to markedly diminish the number of M1 AChRs, while CD was found to increase the number of M1 AChRs. Neither treatment affected the affinity of the M1 AChR. However, when M1 + M3 binding was assessed, CD was found to decrease the affinity in both hippocampal regions, without altering the number of receptors. Neither affinity nor number of M1 + M3 receptors was altered by HSI. The results of this study suggest that both cholinergic denervation and hippocampal sympathetic ingrowth uniquely affect hippocampal muscarinic receptors.

Acetylcholine↗

PubMed1995

The effect of cholinergic denervation and hippocampal sympathetic ingrowth on the internalization of muscarinic receptors in rat hippocampus.

Following cholinergic denervation of the hippocampus by medial septal (MS) lesions, an unusual neuronal reorganization occurs in which peripheral sympathetic fibers, originating from the superior cervical ganglia, grow into the hippocampus (hippocampal sympathetic ingrowth; HSI). Previously, we have found that with MS lesions, animals with (the HSI(+) group) and without (HSI(-) group) ingrowth differed in carbachol stimulated PI hydrolysis, in PKC activity, and in muscarinic cholinergic receptors (mAChR). In this study, performed in hippocampal slices obtained four weeks after MS lesions, we utilized the hydrophilic muscarinic antagonist [3H]N-methylscopolamine ([3H]NMS) and hydrophobic muscarinic antagonist [3H]quinuclidinyl benzilate ([3H]QNB) in the presence of either 4-alpha-phorbol or phorbol 12,13-dibutyrate (PDBu) to determine the effect of MS lesions with and without ingrowth on PKC-mediated mAChR internalization. In the presence of PDBu, a group effect was observed in [3H]NMS binding, with control groups > HSI(+) group > HSI(-) group. However, [3H]QNB binding was similar across groups. These results suggest that the cholinergic denervation of the hippocampus enhances the internalization of mAChRs, which is modified in the presence of HSI.

Acetylcholine↗

PubMed1995

SSCP analysis and sequencing of the human prion protein gene (PRNP) detects two different 24 bp deletions in an atypical Alzheimer's disease family.

Alzheimer's disease (AD) is a progressive, degenerative neurological disorder of the central nervous system. AD is the fourth leading cause of death in elderly persons 65 years or older in Western industrialized societies. The etiology of AD is unknown, but clinical, pathological, epidemiological, and molecular investigations suggest it is etiologically heterogeneous. Mutations in the amyloid protein are rare and segregate with the disease in a few early-onset familial AD (FAD) families. Similarities between AD and the unconventional viral (UCV) diseases, and between the amyloid and prion proteins, implicate the human prion protein gene (PRNP) as another candidate gene. Single strand conformation polymorphism (SSCP) analysis was used to screen for mutations at this locus in 82 AD patients from 54 families (30 FAD), vs. 39 age-matched controls. A 24-bp deletion around codon 68 that codes for one of five Gly-Pro rich octarepeats was identified in two affected sibs and one offspring of one late-onset FAD family. Two other affected sibs, three unaffected sibs, and three offspring from this family, in addition to one sporadic AD patient and three age-matched controls, were heterozygous for another octarepeat deletion located around codon 82. Two of the four affected sibs had features of PD, including one who was autopsy-verified AD and PD. Although these deletions were found infrequently in other AD patients and controls, they appear to be a rare polymorphism that is segregating in this FAD family. It does not appear that mutations at the PRNP locus are frequently associated with AD in this population.

Alzheimer Disease↗

PubMed1995

Assessing the competency of patients with Alzheimer's disease under different legal standards. A prototype instrument.

OBJECTIVE: To assess empirically the competency of patients with Alzheimer's disease (AD) to consent to medical treatment under different legal standards (LSs). DESIGN: Comparison of normal older subjects and patients with AD on measures of competency to consent to medical treatment. SETTING: University medical center. SUBJECTS: Normal older control subjects (n = 15) and patients with probable AD (n = 29 [15 with mild and 14 with moderate AD]). MAIN OUTCOME MEASURES: Two specialized clinical vignettes were developed that test a subject's capacity to consent to medical treatment under five well-established LSs for this competency: LS1, evidencing treatment choice; LS2, making the reasonable choice; LS3, appreciating consequences of choice; LS4, providing rational reasons for choice; and LS5, understanding treatment situation and choices. Performance on the LSs was compared across control and AD groups using Student's t test, chi 2, and analysis of variance. Demented subjects were categorized as competent, marginally competent, or incompetent under each LS by using a cutoff score derived from normal control performance. RESULTS: No differences between groups emerged for LS1 and LS2. Control subjects performed significantly better than patients with mild AD on LS4 and LS5, and significantly better than patients with moderate AD on LS3, LS4, and LS5. Patients with mild AD performed significantly better than patients with moderate AD on LS4 and LS5. With respect to competency status, patients with AD showed a consistent and progressive pattern of compromise (marginal competence or incompetence) related to dementia severity and stringency of the LS. CONCLUSIONS: A reliable prototype instrument validly discriminated the competency performance and classified the competency status of control subjects and patients with mild and moderate AD under five LSs for competency to consent to medical treatment. While the groups performed equivalently on minimal standards requiring merely a treatment choice (LS1) or the reasonable treatment choice (LS2), patients with mild AD had difficulty with more difficult standards requiring rational reasons (LS4) and understanding treatment information (LS5), and patients with moderate AD had difficulty with appreciation of consequences (LS3), rational reasons (LS4), and understanding treatment (LS5). The results raised the concern that many patients with mild AD may not be competent to consent to treatment and supported the value of standardized clinical vignettes for assessment of competency in dementia.

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PubMed1995

Neuropsychologic predictors of competency in Alzheimer's disease using a rational reasons legal standard.

OBJECTIVE: To identify neuropsychologic predictors of competency performance and status in Alzheimer's disease (AD) using a specific legal standard (LS). This study is a follow-up to the competency assessment research reported in this issue of the archives. DESIGN: Univariate and multivariate analyses of independent neuropsychologic test measures with a dependent measure of competency to consent to treatment. SETTING: University medical center. SUBJECTS: Fifteen normal older control subjects and 29 patients with probable AD. MAIN OUTCOME MEASURES: Subjects were administered a battery of neuropsychologic measures theoretically linked to competency function, as well as two clinical vignettes testing their capacity to consent to medical treatment under five different LSs. The present study focused on one specific LS: the capacity to provide "rational reasons" for a treatment choice (LS4). Neuropsychologic test scores were correlated with scores on LS4 for the normal control group and the AD group. The resulting univariate predictors were then analyzed using stepwise regression and discriminant function to identify the key multivariate predictors of competency performance and status under LS4. RESULTS: Measures of word fluency predicted the LS4 scores of controls (R2 = .33) and the AD group (R2 = .36). A word fluency measure also emerged as the best single predictor of competency status for the full subject sample (n = 44), correctly classifying 82% of cases. Dementia severity (Mini-Mental State Examination score) did not emerge as a multivariate predictor of competency performance or status. Interestingly, measures of verbal reasoning and memory were not strongly associated with LS4. CONCLUSIONS: Word fluency measures predicted the normative performance and intact competency status of older control subjects and the declining performance and compromised competency status of patients with AD on a "rational reasons" standard of competency to consent to treatment. Cognitive capacities related to frontal lobe function appear to underlie the capacity to formulate rational reasons for a treatment choice. Neuropsychologic studies of competency function have important theoretical and clinical value.

Aged↗

PubMed1995

Psychological, social, and health impact of caregiving: a comparison of black and white dementia family caregivers and noncaregivers.

Psychological, social, and health variables were compared in 175 Black and White family caregivers of patients with dementia and 175 Black and White noncaregivers. Caregivers and noncaregivers did not differ within race on demographic variables. Caregiving was associated with increased depression and decreased life satisfaction only in White families. However, caregiving appears to have similar social consequences for Black and White families, including restriction of social activity and increased visits and support by family from outside of the home. Race, but not caregiving, was associated with physical health variables. Methodological issues in comparing well-being in Black and White caregivers, in particular the importance of including noncaregiving comparison subjects are discussed.

Activities of Daily Living↗