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Biomedical subjects

Peter A Lichtenberg

Publications and source records attributed to Peter A Lichtenberg.

13 recordsLinked to original sources

Reading ability mediates the relationship between education and executive function tasks.

Neuropsychological test results are affected by multiple factors, but usually age and education are the only variables by which norms are stratified. Some authors have questioned whether these variables alone are sufficient (e.g., Marcopulos et al., 1997; Manly et al., 2002), since such norms have lead to problems, such as poor specificity for African Americans on dementia screening devices (Fillenbaum et al., 1990). Recent research has shown that reading ability, a measure of educational quality, attenuated racial differences in test performance (Manly et al., 2002). We specifically examined whether reading ability would account for a greater amount of variance than education in executive function tests in a population traditionally subject to poor educational quality. Results determined that reading ability accounted for a significantly greater amount of variance than years of education for Letter-Number Sequencing, Similarities, COWA, Trail Making Test, and Coloured Progressive Matrices. Reading ability was found to significantly mediate the relationship between each of these tests and education. Animal naming appears to be least affected by educational quality or quantity. These findings hold implications for the interpretation of neuropsychological test results, especially in those exposed to substandard educational quality, and for the way that test norms are constructed.

Achievement↗

Cerebrovascular risk factors, activity limitations, and depressed mood in African American older adults.

This study investigated the association between cerebrovascular risk factors (CVRFs), physical activity limitations, and depressed mood. The 12-item Short-Form Health Survey (SF-12) was administered to 1,034 urban African American older adults. A chi-square analysis demonstrated that the prevalence of depressed mood among those with high CVRF burden (13.4%) was significantly higher than among those with low vascular burden (7.6%). Physical activity limitations also predicted depressed mood, but this relationship did not mediate the relationship between cerebrovascular burden and depression. These findings highlight the relationships among cerebrovascular burden, physical activity limitations, and depressed mood among African American older adults.

Black or African American↗

"Vascular depression" predicts verbal fluency in older adults.

Past research has found links among cerebrovascular risk factors (CVRFs), depression, and cognition in older adults. This study investigated how well baseline cerebrovascular burden and depression predicted verbal fluency three and six months later. Participants were 139 medical rehabilitation patients, age 60 and above. The Geriatric Depression Scale, Charlson Co-Morbidity Index, and Dementia Rating Scale were administered at baseline, and verbal fluency was measured three and six months later. Structural equation modeling found that depression significantly predicted verbal fluency at both time points, independently of demographic variables, baseline cognition, or medical burden. CVRFs correlated with depressive symptoms but did not independently predict verbal fluency. Findings suggest that vascular depression may be a possible signal of impaired brain integrity, consistent with Alexopoulos and colleague's (2000) conceptual framework.

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The effects of preexisting depression on cerebrovascular health outcomes in geriatric continuing care.

BACKGROUND: Previous studies have investigated depression as the cause and outcome of vascular deficit in elderly persons. METHODS: The authors wanted to determine whether baseline depression is predictive of subsequent cardiovascular events in very elderly persons residing in a continuing care retirement community (n = 181). RESULTS: Controlling for demographic factors, both depression and the number of cardiovascular risk factors (CVRFs) at baseline were strongly predictive of stroke, whereas only CVRFs strongly predicted myocardial infarctions. Depression accounted for 12% of the variance in stroke incidence, beyond the contribution of CVRFs. Path analysis indicated that depression was also a partial moderator of the effect of CVRFs. CONCLUSIONS: In support of the vascular depression hypothesis, the study findings indicate that, for the oldest old, depression may be a strong predictor of future stroke. The presence of depression in elderly patients should alert physicians to carefully investigate other stroke risk factors and to integrate depression into an overall intervention regimen for reducing patients' risks for stroke.

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Pilot study of behavioral treatment in dementia care units.

PURPOSE: This article reports on the development and use of behavioral treatment as a well-being intervention for individuals with dementia residing at special care units in a nursing home. DESIGN AND METHODS: The project took place upon the construction and opening of two new home-like units for dementia care in a rural community-care center. Twenty older adults with Alzheimer's disease or related dementia diagnoses participated. One of the units was randomly selected for its residents to receive the behavioral treatment, and the other unit received usual care. A trained nursing assistant implemented the behavioral treatment three times per week for 20 to 30 min each session. The intervention lasted for 3 months. Measures taken before and after the intervention included depression and behavioral disturbance. RESULTS: Compared with the usual care group, the behavioral treatment group demonstrated reduced severity in behavioral disturbance in terms of being troublesome to caregivers or dangerous to residents. Both the behavioral treatment and the usual care groups demonstrated a reduced frequency of behavioral disturbance overall. There were no differences with regard to depressive symptoms or diagnoses. The behavioral treatment was enthusiastically received by the facility staff and by the family caregivers of the participants.

Aged↗

Risk factors for geriatric depression: the importance of executive functioning within the vascular depression hypothesis.

BACKGROUND: Results from recent studies addressing the vascular depression hypothesis have been mixed, with cerebrovascular risk factors (CVRFs) predicting depression in some geriatric patients but not in others. The current study seeks to examine executive dysfunction as a potential moderator of the relationship between CVRFs and depressive symptoms. METHODS: Data concerning CVRFs, executive functioning, and depressive symptoms from 77 geriatric rehabilitation patients were incorporated to test the hypothesis that patients with executive dysfunction and greater CVRFs would demonstrate the highest levels of depression over time. CVRFs (diabetes, hypertension, atrial fibrillation) were measured via diagnosis by treating physician. Depression was assessed using the 15-item Geriatric Depression Scale (GDS) at baseline and at 6-month and 18-month follow-ups. Executive functioning was measured at baseline using the Initiation/Perseveration (IP) Subtest of the Mattis Dementia Rating Scale. RESULTS: Multivariate analysis of variance demonstrated a significant statistical interaction between the number of CVRFs and scores on the IP Subtest on depressive symptoms. Patients with two or more CVRFs and lower IP scores demonstrated significantly greater depressive symptoms at baseline and at 18-month follow-up than patients with fewer CVRFs and higher IP scores. The univariate effect at 6 months was not significant. CONCLUSION: The current data suggest that scores on an index of executive functioning may moderate the relationship between CVRFs and depressive symptoms. Interpretation of these findings is provided in the context of the vascular depression hypothesis and related frontostriatal dysfunction. Patients with greater CVRF burden and poor executive functioning may be at particularly high risk for depression.

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Normative health research experiences among African American elders.

OBJECTIVE: Data are meager regarding the prevalence of participation and the overall experience of African American elders in research across a variety of health-related studies. This study sought to increase our knowledge about older African Americans' participation in health research by capturing some of their normative experiences and attitudes. METHODS: A telephone-based survey was conducted on 1,290 urban African Americans greater than or equal to 60 years old. The assessment focused on issues of housing, neighborhoods, health, and experiences with health research. RESULTS: The overall prevalence of respondents who took part in a health research project was 14%. Significant predictors included income, attitudes about fairness, perceptions of protection from harm, understanding of research as a key to improving health care, and participation in survey research. DISCUSSION: Findings underscore the importance of addressing economic, educational, and trust barriers to research participation as well as the importance of conveying a sense of caring for the health of individuals and the community as a whole.

Black or African American↗

Living arrangements decisions at discharge and later: differences in criteria and outcomes.

This study examined the pattern of post rehabilitation living arrangements over 18 months of 172 adults discharged from a geriatric rehabilitation unit at a large urban medical center, all of whom were living alone prior to admission. Results showed the diminishing importance of physical function and cognition as factors in decisions to return home as the length of time after hospital discharge increased. Patients who returned home to live alone after a period of time living in more supported environments had significantly lower assessment scores on physical function (p < 0.001) and cognition (p < 0.001) compared to patients who went home to live alone immediately upon discharge. As well, patients who returned home to live alone later than three months post discharge were significantly more likely to move to more supported environments by 18 months after discharge (p = 0.043) and to experience re-hospitalizations (p = 0.008), which raises questions about the appropriateness of these later decisions.

Activities of Daily Living↗

More than meets the eye: how examiner training affects the reliability of the MacNeill-Lichtenberg decision tree in geriatric rehabilitation patients.

OBJECTIVE: To examine the effect of examiner training on the test-retest reliability of the MacNeill-Lichtenberg Decision Tree (MLDT), a tool for guiding clinicians' decision making for referrals for mental health problems. DESIGN: Correlational analyses and chi-squares were used to examine the influence of demographic variables on MLDT performance and the test-retest reliability of its cognitive and affective components. SETTING: Rehabilitation unit of a large, freestanding, urban hospital. PARTICIPANTS: In study 1, 39 older, medical rehabilitation patients consecutively referred to the neuropsychology service. In study 2, 57 older, consecutively admitted medical rehabilitation patients. INTERVENTIONS: In study 1, patients underwent testing with the MLDT by a novice examiner. In study 2, patients were tested by trained examiners. Both sets of results were compared with those obtained by experienced examiners. MAIN OUTCOME MEASURES: The temporal stability of participants' performance on the cognitive and affective components of the MLDT was compared between the 2 studies. RESULTS: Training was associated with high test-retest reliability on both the cognitive and affective components. A lack of training was associated with reduced reliability in depression screening. CONCLUSION: These findings support the use of the MLDT as a mental health triage tool for older adults in inpatient medical settings. Its use is dependent on training and accurate administration.

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Correlates of rehabilitation hospital length of stay among older African-American patients.

This study addresses a gap in the current literature on the correlates of rehabilitation hospital length of stay for older African Americans. Using data from 616 consecutively admitted rehabilitation patients who ranged in age from 50 to 103 years old, we tested the effect of patient's primary medical impairment; structural factors such as admit and discharge setting; level of depression (Geriatric Depression Scale); functional ability upon hospital admission (FIM score); and other control variables. Hierarchical linear regression models show that medical impairment alone was not a robust predictor of LOS. However, when controlling for structural and psychosocial factors, and medical condition, then circulation/amputation impairment was directly associated with longer LOS. Being unmarried or at risk for depression were also directly related to longer LOS. Consequently, rehabilitation administrators and hospital staff should note these findings to determine whether and how these factors affect discharge outcomes in their particular rehabilitative environments.

Black or African American↗

After rehabilitation: an 18-month follow-up of elderly inner-city women.

OBJECTIVE: Elderly inner-city women (n = 125) greater than the age of 60 and living alone and who were consecutively admitted to a large, urban, university-based rehabilitation hospital were followed to (a) examine the power of standardized clinical measures to predict who was living alone 18 months after discharge, (b) determine whether live-alone women at 18 months' follow-up were more independent in instrumental activities of daily living (IADL) than women who were not living alone, and (c) investigate whether women who return home to live alone and have low or declining physical function are at risk for subsequent relocation or death. METHOD: Data from four standardized assessments (physical function, cognition, comorbidity, and depression) and demographic information were gathered during in-patient rehabilitation. Self-report IADL data were collected via telephone interviews at 3, 6, and 18 months' follow-up. RESULTS: Statistical analysis of results showed that physical function, cognition, and comorbidity were significant and independent predictors of living alone at 18 months' follow-up. Women living alone at 18 months reported significantly greater IADL independence than women who were not living alone. Path analysis confirmed that the relationship between the clinical measures and living situation at 18 months was mediated by self-reported IADL functioning. CONCLUSION: Standard clinical data obtained at discharge are useful to identify who can return home to live alone after rehabilitation, but in-home assessment of IADL remains key to understanding the complex skills required to live alone.

Activities of Daily Living↗

Post-stroke and clinically-defined vascular depression in geriatric rehabilitation patients.

OBJECTIVE: The authors examined the vascular depression hypothesis by comparing the frequency of post-stroke depression and clinically-defined vascular depression and by examining the relationship between vascular burden and depression. METHODS: Data from 670 geriatric rehabilitation patients were incorporated to compare the frequency of depression in three patient groups: 1) those with no evidence of vascular disease or stroke, 2) those with cerebrovascular risk factors (CVRFs) but no evidence of stroke, and 3) patients with stroke. They examined the unique relationship between CVRFs and depression by use of logistic-regression analysis. RESULTS: Although the frequency of depression was not significantly different between stroke (36.4%), CVRF (35.2%), and non-vascular patients (28.7%), there was a significant increase in the frequency of depression in patients without stroke as CVRF burden increased. This effect was not observed among stroke patients. CVRF burden predicted depression among patients without stroke even after controlling for general medical comorbidity, cognitive functioning, and ADL limitations. CONCLUSIONS: These findings provide empirical support for the vascular depression hypothesis and also indicate that the rates of clinically-defined vascular depression and post-stroke depression are similar in geriatric rehabilitation patients.

Activities of Daily Living↗

Longitudinal support for the relationship between vascular risk factors and late-life depressive symptoms.

OBJECTIVE: The authors examined longitudinal support for the vascular depression hypothesis by assessing the extent to which baseline vascular burden was associated with depressive symptoms 6 and 18 months after discharge from inpatient medical rehabilitation. METHODS: One hundred consecutive geriatric rehabilitation patients were assessed during their rehabilitation stay and subsequently screened for depression 6 and 18 months after discharge. Baseline vascular burden was entered into logistic-regression analyses predicting depression at 6 and 18 months after controlling for baseline levels of depression, general medical burden, limitations in activities of daily living, cognitive impairment, and demographic variables including age, education, gender, and race. RESULTS: Logistic-regression results demonstrated that, after controlling for the covariates described above, baseline vascular burden was associated with increased odds of positive depression screens at 6- and 18-month follow-up assessments. Furthermore, among patients who were not depressed during their rehabilitation stay, vascular burden was predictive of positive depression screens at 6- and 18-month follow-up assessments. CONCLUSIONS: Greater vascular burden was positively associated with depressive symptoms over time. These findings provide further support for the vascular depression hypothesis in late life and highlight the need for careful clinical monitoring of this frail group of elderly patients.

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