Biomedical subjects

Rochelle E Tractenberg

Publications and source records attributed to Rochelle E Tractenberg.

26 records · Page 2Linked to original sources

PubMed2002

Investigating emergent symptomatology as an outcome measure in a behavioral study of Alzheimer's disease.

These retrospective analyses represent a pilot study of a potential new outcome, expected emergence. The Behavior Rating Scale for Dementia (BRSD) was administered at the baseline and 12-month visits of a multicenter study. The authors computed the rates at which each BRSD symptom emerged over 12 months in normal elderly control subjects (n=64). These normal rates were then applied as the expected emergent rate (EER) to a population of individuals with Alzheimer's disease (n=235). The comparison of expected emergence to observed emergence in Alzheimer's disease showed interpretable differences. EER assesses whether treatments limit emergence in the target, relative to the standard, population. The ratio of expected to observed emergence provides an intuitively appealing quantification of treatment efficacy and can be used with any instrument that uses categorical or frequency ratings.

Aged↗

PubMed2002

No long-term effect of behavioral treatment on psychotropic drug use for agitation in Alzheimer's disease patients.

Th determine if teaching caregivers behavior management techniques (BMTs) reduces long-term psychotropic use in Alzheimer's disease (AD) patients, we examined 12-month follow-up data from a 4-month randomized study comparing placebo, BMTs, trazodone, and haloperidol for the treatment of agitated behaviors in persons with AD. After 4 months, treatment was allowed with any agent. Between 42.8% and 51% of AD patients received additional psychotropics between 4 and 12 months. The relative risk of being prescribed any psychotropic drug after the 4-month trial was at or about 1.0 for subjects in each drug arm or placebo arm versus BMTs. We concluded that teaching caregivers BMTs did not diminish long-term prescription of psychotropic drugs.

Aged↗

PubMed2002

Emergent psychopathology in Alzheimer's disease patients over 12 months associated with functional, not cognitive, changes.

In a large, well-characterized population of community-dwelling persons with Alzheimer's disease (AD), we investigated the emergence of behavioral symptomatology and its association with changes in cognitive, global-clinical, and functional status. Behavioral Rating Scale for Dementia (BRSD) item responses from 235 AD patients with varying levels of dementia severity and without significant behavioral disturbance were taken from the baseline and 12-month visits in a study of cognitive and behavioral instruments. Item-level analysis revealed new symptoms at every dementia severity level. The symptoms that emerged in the greatest proportion of patients were change in weight, change in appetite, diurnal confusion, uncooperativeness, restlessness, clingy behavior, loss of initiative, and change in sleeping pattern. Changes in cognitive status over the 12 months were associated with changes in functional status and not with the emergence of behavioral symptomatology; however, change in the latter two domains tended to be associated. The findings support the hypothesis that increasing behavioral disturbance is not strongly associated with decreasing cognitive status and that, except for psychotic symptoms, a previously observed association between dementia severity and behavioral status may have been mediated partly by changes in functional abilities.

Activities of Daily Living↗

PubMedDate not supplied

Assessing Alzheimer's disease patients with the Cohen-Mansfield Agitation Inventory: scoring and clinical implications.

We explored the applicability of the standard scoring of the Cohen-Mansfield Agitation Inventory (CMAI), a widely used nursing-home derived instrument, to community-dwelling persons with Alzheimer's disease (AD). Item responses to the CMAI were gathered from participants in two large clinical studies, one of which specifically included patients with behavioral disturbances. Confirmatory factor analysis in these two groups of well-characterized AD patients suggested that conventional CMAI subscoring did not adequately describe the responses of these two groups. Exploratory factor analysis indicated that the four CMAI subscores, based on a verbal-physical and aggressive-non-aggressive conceptualization of behavioral disturbance, did not fit community dwelling persons with AD. Based on cross-sectional and longitudinal analyses, there was suggestive evidence for three behavioral clusters, but these clusters did not achieve statistical significance Overall, the CMAI seemed best suited to describe the overall level rather than the specific subtypes of behavioral dyscontrol in community-dwelling persons with AD.

Aged↗

PubMedDate not supplied

Exploring hypotheses about phonological awareness, memory, and reading achievement.

Reading-related skills were tested in adults with and without reading disabilities (RD) and adults with profound hearing impairment (PHI) who did not differ on average Performance IQ. The RD group and the PHI group both demonstrated levels of phonological awareness lower than the control group's, but only the RD group also exhibited deficits in other skills, including verbal short-term memory, morphological awareness, speeded written naming, and reading comprehension. The average reading level of the PHI group was significantly higher than that of the RD group. Three control group members also demonstrated limited phonological awareness without other deficits in a pilot study, performing similarly to the PHI group. The results support other studies suggesting that processes dependent on memory, not solely phonological awareness, may contribute to determining reading achievement.

Adult↗

PubMedDate not supplied

One-trial 10-item free-recall performance in Taiwanese elderly and near-elderly: A potential screen for cognitive decline.

To explore a one-trial 10-item free-recall test as a potential dementia screening tool, we analyzed recall scores and individualized serial position effects in near-elderly (N = 2,336) and elderly (N = 2,371) participants in a population-based survey in Taiwan. Age and sex were significantly associated with recall score [younger > older (p < 0.001); men > women (p < 0.001)]; after controlling for gender and age group, weak association between recall and education was still observed. By contrast, serial position effects (SPEs), defined for each participant and analyzed aggregated over each age group, were not associated with education and tended not to be associated with sex. Primacy effects were observed in 67 to 80 percent, and recency effects were observed in 41 to 54 percent of respondents. Because SPEs were defined for each respondent, we could determine that loss of the primacy effect was associated with significantly larger losses in total recall score in elderly persons who had exhibited both SPEs at the first survey, as compared to those who maintained both SPEs at successive surveys (p < 0.01). Elderly subjects showed slight longitudinal decline in free recall. A one-trial 10-item free-recall test demonstrated age-related cognitive decline in this Taiwanese population survey cohort; SPEs at the individual level may be useful markers for important cognitive change and warrant further study and benchmarking against valid and reliable tests of memory and cognitive decline.

Age Factors↗

PubMedDate not supplied

Modeling dimensions of choice in accepting the smallpox vaccine.

OBJECTIVE: To model the dimensionality of understanding refusal to be vaccinated against smallpox. METHOD: The Smallpox Vaccination Choice Questionnaire was administered to a convenience sample of students. Through a series of factor analyses, responses were subjected to a statistical evaluation of the underlying factor structure of potential influences on choice. RESULTS: The analyses suggest 5 dimensions: knowledge, perceptions of risk and worry, psychological distress, general beliefs about vaccines, and age. CONCLUSION: This model will be used to help identify targets of intervention to increase acceptance of the vaccine and satisfaction with choice.

Adolescent↗

PubMedDate not supplied

Reliability of monitoring the clinical dementia rating in multicenter clinical trials.

CONTEXT: The Clinical Dementia Rating (CDR) is quickly becoming a criterion standard in multicenter clinical trials in Alzheimer disease. An abbreviated version, with formal monitoring for consistency across sites and raters, is currently used in the Alzheimer's Disease Cooperative Study (ADCS). OBJECTIVE: To demonstrate the degree of agreement on CDR scoring of clinical monitors working independently from ADCS-CDR worksheets. DESIGN: Three members of the ADCS who are experienced and highly trained with respect to the CDR independently reviewed the ADCS-CDR worksheets of 15 subjects, assigning box and global CDR scores according to the prescribed algorithm. SETTING: The ratings were assigned during a single, 3-hour session in a closed room. PARTICIPANTS: Two clinical monitors and one project director/clinical monitor supervisor. MAIN OUTCOME MEASURES: Percent agreement, Kendall's tau-b, and Cohen's kappa were used to assess the degree of agreement of the raters with the previously established gold standard assessment on global and box scores for the 15 subjects. RESULTS: Raters, blinded to patient groupings, were in agreement with the Gold Standard global CDR assessment on 87% of ratings. Kappa values indicated good (kappa = 0.66, orientation and judgment & problem solving boxes) to excellent (kappa = 0.83, global CDR) agreement. CONCLUSIONS: The ADCS-CDR worksheets were reliably and consistently scored by clinical monitors, who may be considered proxy gold standards for CDR assessment.

Clinical Trials as Topic↗