Talkativeness in Cognitively Normal Women at Genetic Risk for Alzheimer’s Disease

Previous research has suggested a correlation between some linguistic patterns and the risk for Alzheimer’s disease (AD). There is increasing clinical need to identify factors that can be used alone or in combination to predict the onset of AD. The purpose of the present study was to explore the association of language skills and genetic risk for Alzheimer’s disease. Oral and written language samples of cognitively normal women with a susceptibility gene for AD (ApoE e4) were compared to those of noncarriers on measures of grammatical complexity, topic relevance, and talkativeness by observers unaware of participant genotypes. Participants included 29 ApoE e4 carriers 49-73 years of age, and 29 e4 noncarriers 48-76 years of age, most of whom had a first-degree relative with AD. Carriers and noncarriers were group matched for age, educational level, and estimated IQ. Participant groups did not differ significantly in language complexity or topic relevance. However, the ApoE e4 group was significantly more talkative than the noncarrier group (p < .05).     

Perceptions of Familial Risk in those Seeking a Genetic Risk Assessment for Alzheimer’s Disease

Perceived risk is a complex concept that influences the genetic counseling process and can affect client coping and behavior. Although the association between family history and risk perception is well recognized in the literature, no studies have explored this relationship specifically in those seeking genetic susceptibility testing for a common chronic condition. REVEAL is a randomized trial assessing the impact of APOE disclosure and genetic risk assessment for Alzheimer’s disease (AD). Using baseline REVEAL data, we hypothesized that there would be a significant association between the degree of AD family history and risk perception of AD, and that this relationship would be stronger in those who believed that genetics is a very important AD risk factor. In our sample of 293 participants, we found that a higher self-perceived risk of AD was associated with strength of family history of AD (p < 0.001), belief in genetics as an important AD risk factor (p < 0.001), being female (p < 0.001) and being Caucasian (p = 0.02). These results are the first to demonstrate the association between family history and risk perception in persons volunteering for genetic susceptibility testing for a common complex disease.     

Working Memory and Learning in Early Alzheimer’s Disease

Cognitive deficits associated with early Alzheimers disease (AD) have been recently operationalised in terms of an acquisition deficit and the research supporting this view is presented. However, there is still debate concerning the nature of this deficit and how underlying cognitive processes may be detrimentally affecting the ability to acquire new information in early AD. This review argues that the pattern of cognitive deficits contributing to the acquisition impairment in early AD patients may be readily interpreted within the context of a working memory model. Isolating the component processes of working memory that underlie the acquisition deficit in early AD patients will aid in the design of clinical applications that are focussed at enhancing the ability to acquire new information in everyday life.     

Living at Risk: The Sibling’s Perspective of Early-Onset Alzheimer’s Disease

Early-onset Alzheimer’s disease (EOAD) is an increasingly diagnosed condition and is associated with genetic risk factors. This is one of the first studies exploring the lived experience of siblings of individuals with EOAD. We used structured questionnaires and semi-structured interviews to assess a broad range of siblings’ experiences with and beliefs about EOAD, including knowledge, perceptions of personal risk, level of worry, and effects on life decisions. Participants (n = 24) were predominantly female (62.5%) and middle-aged (mean = 56.8 years; range 37–83). When asked about risk factors, genetics was cited most frequently (62.5%). Several potential means of reducing AD risk were endorsed, with 54% reporting engagement in behaviors for this purpose (e.g., keeping mentally active). Participants ranged widely in their perceived personal risk of AD (range: 0–100; mean = 35.6%), with higher perceived risk associated with worry about AD (p < 0.01). Understanding siblings’ experiences with EOAD can inform how genetic counselors and healthcare professionals work with this population to facilitate risk communication and decision-making about testing and healthcare.     

Apraxia and Alzheimer’s Disease: Review and Perspectives

Apraxia is one of the cognitive deficits that characterizes Alzheimer’s disease. Despite its prevalence and relevance to diagnosing Alzheimer’s disease, this topic has received little attention and is without comprehensive review. The review herein is aimed to fill this gap by first presenting an overview of the impairment caused in different clinical situations: pantomime of tool use, single tool use, real tool use, mechanical problem solving, function and manipulation knowledge tasks, and symbolic/meaningless gestures. On the basis of these results, we then propose alternative interpretations regarding the nature of the underlying mechanisms impaired by the disease. Also presented are principal methodological issues precluding firm conclusions from being drawn.     

Functional Brain Connectivity Using fMRI in Aging and Alzheimer’s Disease

Normal aging and Alzheimer’s disease (AD) cause profound changes in the brain’s structure and function. AD in particular is accompanied by widespread cortical neuronal loss, and loss of connections between brain systems. This degeneration of neural pathways disrupts the functional coherence of brain activation. Recent innovations in brain imaging have detected characteristic disruptions in functional networks. Here we review studies examining changes in functional connectivity, measured through fMRI (functional magnetic resonance imaging), starting with healthy aging and then Alzheimer’s disease. We cover studies that employ the three primary methods to analyze functional connectivity—seed-based, ICA (independent components analysis), and graph theory. At the end we include a brief discussion of other methodologies, such as EEG (electroencephalography), MEG (magnetoencephalography), and PET (positron emission tomography). We also describe multi-modal studies that combine rsfMRI (resting state fMRI) with PET imaging, as well as studies examining the effects of medications. Overall, connectivity and network integrity appear to decrease in healthy aging, but this decrease is accelerated in AD, with specific systems hit hardest, such as the default mode network (DMN). Functional connectivity is a relatively new topic of research, but it holds great promise in revealing how brain network dynamics change across the lifespan and in disease.     

Parkinson’s Disease: Patients’ Knowledge,Attitudes, and Interest in Genetic Counseling

The objective of this study was to assess the genetics knowledge of patients with Parkinson’s disease (PD), and to explore their attitudes on genetic testing and interest in genetic counseling. We surveyed 158 patients from the University of Maryland Parkinson’s Disease and Movement Disorders Center. Patients averaged a score of 63% on general genetics knowledge and 73% on PD genetics knowledge. Participants had an overall positive attitude toward genetic testing: 80% believed that the use of genetic tests among people should be promoted, and 83% would undertake genetic test for PD if it was available. Patients reported a high interest to discuss the benefits, risks, and impacts of genetic testing for PD (mean sum score?=?26, range?=?9–35), and 43% patients expressed interest in meeting with a genetic counselor. Multivariate regression analysis showed that patients who had more positive attitudes toward genetic testing for PD were more interested in meeting with a genetic counselor (β?=?0.6, p?<?0.001). This study is the first to demonstrate an interest in genetic counseling among patients with PD. Our findings demonstrate a new niche for genetic counselors to support patients in clarifying gaps or misconceptions in knowledge about PD genetics as well as the possible risks, benefits, and limitations of genetic testing.     

Family Therapy with Couples and Individuals with Parkinson’s Disease

Family therapists are increasingly called upon to work with individuals and families with medical issues, but often do not have sufficient background on the issue to be most helpful. The purpose of this paper is to help family therapists understand Parkinson’s Disease (PD) and its impact on the individual and his or her family. PD is the second most prevalent neurodegenerative disorder in the United States, following Alzheimer’s disease (Hirtz et al., Neurology 68:326–337, 2007). According to the Parkinson’s Disease Foundation, approximately 60,000 individuals are diagnosed with PD every year, and approximately one million Americans are currently living with PD. In this paper, we provide an overview of PD based on research and the second author’s many years of providing services for individuals with PD, as well as offer specific recommendations for providing family therapy using narrative, solution-focused and emotionally focused therapy based on the first author’s work as a family therapist with individuals, groups, and couples dealing with PD.     

Differences Between African American and White Research Volunteers in Their Attitudes,Beliefs and Knowledge Regarding Genetic Testing for Alzheimer’s Disease

Genetic susceptibility testing for common diseases is expanding, but little is known about race group differences in test perceptions. The purpose of this study was to examine differences between African Americans and Whites in knowledge, attitudes, and motivations regarding genetic susceptibility testing for Alzheimer’s disease (AD). Before enrolling in an AD genetic testing research trial, 313 first-degree relatives of AD patients (20% African American; 71% female; mean age = 58 years) were surveyed regarding: (1) knowledge about genetics and AD risk; (2) concerns about developing AD; and (3) reasons for seeking testing. In comparison to Whites, African Americans were less knowledgeable about genetics and AD risk (p < .01) and less concerned about developing AD (p < .05), with lower levels of perceived disease risk (p = .04). The results suggest that African Americans and Whites differ notably in their knowledge, beliefs, and attitudes regarding genetic testing for AD. Additional research with more representative samples is needed to better understand these differences.     

Memory for Music in Alzheimer’s Disease: Unforgettable?

The notion that memory for music can be preserved in patients with Alzheimer’s Disease (AD) has been raised by a number of case studies. In this paper, we review the current research examining musical memory in patients with AD. In keeping with models of memory described in the non-musical domain, we propose that various forms of musical memory exist, and may be differentially impaired in AD, reflecting the pattern of neuropathological changes associated with the condition. Our synthesis of this literature reveals a dissociation between explicit and implicit musical memory functions. Implicit, specifically procedural musical memory, or the ability to play a musical instrument, can be spared in musicians with AD. In contrast, explicit musical memory, or the recognition of familiar or unfamiliar melodies, is typically impaired. Thus, the notion that music is unforgettable in AD is not wholly supported. Rather, it appears that the ability to play a musical instrument may be unforgettable in some musicians with AD.     

The Role of Placement History and Current Family Environment in Children’s Aggression in Foster Care

Predictors of the physical and relational aggressive behavior of children in foster care were examined (N?=?160, 50.9% male, M age?=?7.57, SD?=?2.39). First, predictors representative of children’s placement histories were examined in relation to the children’s aggression at T1. Next, predictors representing characteristics of the current family environment were examined in relation to the children’s aggression at T2 (4 months later). Results revealed that a greater number of prior group home placements and being in a non-kinship home were associated with higher physical aggression at T1. A greater number of prior group home placements, a fewer number of regular home placements, being in a non-kinship home, and prior removal from the home due to neglect were associated with higher relational aggression at T1. The results also revealed that higher foster sibling relational aggression at T1 predicted lower child physical aggression at T2. If foster siblings were biological children of the foster parent, higher levels of a foster sibling’s physical aggression at T1 predicted reduced child physical aggression at T2. The opposite pattern was observed if foster siblings were not biological children of the foster parent. Lastly, longer time in the current placement, more children in the home, and the presence of a sibling that was a biological child of the parent predicted higher child relational aggression at T2. These findings provide initial insights into how placement history and current family environment are associated with the physical and relational aggressive behavior of children in foster care.     

Women’s Perceptions of the Personal and Family Impact of Genetic Cancer Risk Assessment: Focus Group Findings

Women with a personal or family history of breast or ovarian cancer are increasingly presenting for genetic cancer risk assessment (GCRA). To explore the personal and family impact of GCRA, four focus groups were conducted of women seen for risk assessment. Participants were 22 primarily non-Latina White women with a personal or family history of breast or ovarian cancer. Analysis of the data identified new themes related to balancing time to assimilate risk information with the need to make timely healthcare decisions, physicians’ lack of sufficient genetic knowledge, and concern for daughters regardless of the daughters’ age. Other themes related to protecting others, knowledge as empowerment, reassessing personal attribution of cancer risk, managing uncertainty, reappraising body image, and experiencing divergent family responses to communication of cancer risk and healthcare decisions. Understanding the personal and family impact of GCRA may enable genetics professionals to tailor their counseling efforts to better meet the needs of these women. Additional research is needed to extend these findings and identify interventions to support positive outcomes of GCRA.     

Very Early Decline in Recognition Memory for Odors in Alzheimer’s Disease

When in the progression of Alzheimer’s disease (AD) a decline in detection sensitivity and recognition memory for odors begins, and whether a fast progression in dementia is related to a fast loss in odor sensitivity, was determined by studying 78 patients with probable AD, categorized as very mild, mild, or moderate in degree of dementia, and 78 controls. Taste and vision were studied for comparison. Whereas the earliest decline in odor sensitivity and visual memory was found in mild patients, a decline in odor memory was found in the very mild patients. Similar taste thresholds in the four groups suggest that the poor odor detectability in AD was not related to task demands in threshold testing. A fast progression in dementia was also found to be related to a fast loss in odor sensitivity. The findings imply that memory-based olfactory tests may contribute to early diagnosis of AD.     

Prosaccade and Antisaccade Paradigms in Persons with Alzheimer’s Disease: A Meta-Analytic Review

Persons with Mild Cognitive Impairment (MCI) are at high Alzheimer’s Disease (AD) risk but the development of sensitive measures to assess subtle cognitive decline in this population poses a major challenge for clinicians and researchers. Eye movement monitoring is a non-invasive, sensitive way to assess subtle cognitive processes in clinical populations. We conducted a critical review and a meta-analysis of the literature on pro and antisaccade paradigm in AD/MCI. The meta-analysis included 20 studies, all of which used the prosaccade paradigm and 13 of which studied the antisaccade paradigm as well. Our meta-analysis showed that AD but not MCI patients showed longer prosaccade latencies when compared to controls. While antisaccade latencies did not differentiate between patients from controls, antisaccade error rate were significantly increased among patients in comparison to controls in over 87% of the studies. These findings highlight antisaccade error rate as a reliable tool to distinguish inhibition abilities between AD/MCI and healthy older persons.     

Common Brain Structural Alterations Associated with Cardiovascular Disease Risk Factors and Alzheimer’s Dementia: Future Directions and Implications

Neuropsychology Review - Recent reports suggest declines in the age-specific risk of Alzheimer’s dementia in higher income Western countries. At the same time, investigators believe that...     

Parents’ and Children’s ADHD in a Family System

ADHD symptoms “run in families”. However, relatively little is known about the ways in which parents’ symptoms might additively and interactively work with the parenting environment, to influence (and be influenced by) the developmental trajectory of symptoms in children and adolescents. In this commentary on the special section addressing this gap in knowledge, emphasis is placed on the importance of replicating and extending family-wide studies of ADHD symptoms and etiology. The current papers exemplify the leading-edge of such efforts, demonstrating the feasibility and rigor with which studies are being conducted, utilizing longitudinal and experimental designs. Families and parenting environments operate as a system in which individuals influence each other’s symptoms and functioning. In so doing, parents produce tremendous variability within (as well as between) each family in individuals’ ADHD symptoms from childhood through adulthood, via gene-environment transactions that may even begin during prenatal development.     

Eye-Hand Coordination in Aging and in Parkinson’s Disease

Aiming movements to defined target positions were performed as fast and as accurately as possible by younger and older subjects and by patients in the early stages of Parkinson's disease (PD). Movement time and accuracy were tested in two conditions: with and without a centre cue. Older subjects exhibited slower movement time relative to the younger subjects only when the centre cue was present suggesting inefficient feedback processing. The performance of patients with PD was found to be as precise as that of older subjects. The movements of PD subjects, however, were slower in both conditions. Finally, the performance of subjects improved over trials. The data suggest that there is no difference in the nature of the control processes used by older and early-stage PD subjects, but that there is a reduction in the speed of these processes in PD.