Emotional Responses to APO E Genotype Disclosure for Alzheimer Disease

The purpose of our study is to assess the emotional responses to disclosing APO E genotype to asymptomatic older adults at increased risk for Alzheimer disease (AD). This is a longitudinal cohort study of volunteer subjects who were aged 50 years or over, asymptomatic for (AD), had a family history of AD, passed a psychological assessment, and participated in pre- and post-test genetic counseling and three follow-up visits over 10 months. We analyzed responses by three emotional constructs: depressed, worried, and relieved. Three hundred and twenty-eight subjects were screened, 76 received their APO E genotype. When emotional responses occurred it was immediate, between baseline and the 1 month follow-up. Emotional reactions did not change significantly past 1 month. Our results suggest that for emotionally stable persons, disclosing results of their APO E genotype, high risk subjects did not report more depression or worry and low risk subjects felt relieved by knowing the results. Future studies should evaluate the risks of disclosure to family members involved in the diagnostic work-up of a relative and include subjects from a broader range of emotional stability and socioeconomic background.     

Religious Coping, Psychological Distress and Disability Among Patients with End-Stage Pulmonary Disease

A growing body of literature suggests that individuals who face life-threatening situations turn to religion to help them cope. Religion has been cited as the most frequently used resource to cope with stressful events (K. I. Pargament, 1997). The present study was the first to investigate the religious coping methods of patients with lung disease who are awaiting transplant and to identify which coping methods are associated with distress and disability. The study was an exploratory, cross-sectional analysis of 90 patients with end-stage pulmonary disease who were being evaluated for transplant. Results indicated that religiosity was highly prevalent. Patients employed a combination of religious coping efforts, but mostly used coping methods considered positive. Patients with late-onset pulmonary diseases used religious coping strategies more frequently than patients with cystic fibrosis. Hierarchical regression analyses identified a subset of religious coping strategies that predicted 27%, 14%, and 34% of the unique variance in depression, overall disability, and psychosocial disability, respectively.     

In Search of a Conceptualization of Multiple Sclerosis: A Historical Perspective

A thorough understanding of Multiple Sclerosis (MS) is necessary to offer individuals informed options for treatment and planning. To assist in this quest, the following historical analysis examined how MS has been conceived from the 14th century through the early 20th century. Primary sources were consulted whenever possible, and many of the original archival materials were accessed by the first author (MB) during an on-site visit to the Rare Book Room of the New York Academy of Medicine. There is a striking similarity between how MS symptoms have presented throughout history compared with the 21st century. Sensorimotor and cognitive sequelae have been observed in patients since the 1800s. Cognitive symptoms were acknowledged in the 1800s, but disregarded in the early 1900s and were not given recognition again until the latter part of the 20th century. If conceptualizations of MS are inaccurate, patients will not be served well. In contrast to the shared symptomatology across time, early conceptualizations of etiology and treatment choices differed dramatically from today, a genuine reflection of the times in which they were created.     

Evidence for the substantia nigra pars compacta as an essential component of a memory system independent of the hippocampal memory system

The aim of the present study was to test if the nigrostriatal pathway is an essential component for a water maze cued task learning and if it works independently of the hippocampal memory system. This hypothesis was tested using an animal model of Parkinson's disease in which male Wistar rats were lesioned in the substantia nigra pars compacta (SNc) by the intranigral infusion of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP), thus causing a partial depletion of striatal dopamine. SNc-lesioned and sham-operated animals were implanted bilaterally with guide cannulae above the dorsal hippocampus in order to be tested after the administration of 0.4 microl 2% lidocaine or saline into this structure. The animals were tested in a spatial or in a cued version of the water maze, memory tasks previously reported to model hippocampal-dependent spatial/relational and striatal-dependent S-R learning, respectively. Hippocampal inactivation, but not SNc lesion, impaired learning and memory in the spatial version of the water maze. An opposite situation was observed with the cued version. No significant interaction was observed between the SNc lesion and hippocampal inactivation conditions affecting scores in the spatial or in the cued version of the water maze. These results suggest that the nigrostriatal pathway is an essential part of the memory system that processes S-R learning and that it works independently of the hippocampal memory system that processes spatial/relational memories.     

Remote Odor Memory in Alzheimer's Disease: Deficits as Measured by Familiarity

Deficit in olfaction and remote nonolfactory memory in Alzheimer's disease (AD) motivated the present study of remote memory for odors and faces, operationally defined as rated familiarity, in patients with AD and controls. Uncommon engineering symbols were rated for familiarity to ensure task comprehension. Results showed that patients with AD rate odors, but not faces, as significantly less familiar than do controls, which is indicative of deficit in remote odor memory. Follow-up testing 1 year later again showed this result. Poor odor-detection sensitivity in patients, with AD, but lack of significant correspondence between sensitivity and familiarity, suggests an existing but limited effect of sensitivity on familiarity. The findings provide further evidence that olfaction may be a useful modality for early identification of AD.     

Making Decisions About Life-Sustaining Medical Treatment in Patients With Dementia

The problem of decision-making capacity in patients with dementia, such as those with early stage Alzheimer's, can be vexing, especially when these patients refuse life-sustaining medical treatments. However, these patients should not be presumed to lack decision-making capacity. Instead, an analysis of the patient's decision-making capacity should be made. Patients who have some degree of decision-making capacity may be able to make a choice about life-sustaining medical treatment and may, in many cases, choose to forgo treatment.     

Predictors of Psychosocial and Cognitive Adaptation in Children with Sickle Cell Syndromes

Examined the role of socioecological factors (family functioning and socioeconomic variables) in predicting behavioral and cognitive adaptation in children with sickle cell syndromes (SCD). Participants included 74 African American children and adolescents with SCD and their primary caretakers. Outcomes included internalizing and externalizing behavior symptoms, as rated by caretakers, as well as intellectual abilities and academic achievement, as assessed by individually administered standardized instruments. Family functioning consisted of both caretaker adjustment and family environment (i.e., family adaptability and cohesion). Hierarchical multiple regression analyses revealed that caretaker psychological adjustment predicted externalizing behaviors, while family environment (i.e., adaptability and cohesion) predicted neither behavioral nor cognitive functioning. Socioeconomic variables alone predicted intellectual abilities and academic achievement and also contributed to the prediction of child behavioral adaptation. Results are discussed in terms of relevant sociocultural issues and implications for family-level prevention and intervention.     

A Method for Introducing the Concepts of Chaos Theory to Medical Students

Chaos theory is beginning to find applications in the field of medicine. The theory of chaos should be introduced to students to help them as they make the transition from learning the scientific literature to actually applying this newly acquired knowledge in clinical situations. Chaos theory will give the students a powerful conceptual framework from which they can better understand the limits of predictability in clinical situations. Failure to understand the limits of predictability in chaotic natural systems will invariably lead to frustration in both patients and physicians.     

MULTICOMPONENT INTERVENTION FOR AGITATED BEHAVIOR IN A PERSON WITH ALZHEIMER'S DISEASE

We evaluated a multicomponent intervention for agitated behavior in a man with probable Alzheimer's disease. Hypotheses about variables controlling his agitated behavior guided intervention design. Based on staff interviews, direct observations, and brief experimental probes, intervention components were chosen to increase rate of reinforcement and decrease aversive aspects of his job. Intervention reduced agitated behavior without disrupting his work rate.     

Pseudodementia: A slow death

The clinical term pseudodementia has remained a permanent nosological entity in the literature for over 100 years. Indeed, recognition of the fact that clinical symptoms associated with reversible neuropsychiatric conditions can mimic irreversible disorders was known as early as the middle of the 19th century. The importance of the term lies in the inherent assumption that the presenting dementia is not real, or is at least reversible, and therefore treatable. Nonetheless, there continues to be controversy regarding the validity and appropriate clinical use of the term. This article reviews the evolution and clinical utility of the term pseudodementia and attempts to redirect investigative efforts toward an understanding of the neuroanatomical substrates that underlie depression and cognitive impairment in the elderly. Based on a critical analysis of the relevant literatures, a subcortical-frontal neuroanatomical substrate of late-life depression is supported. Further, the presence of leukoaraiosis, as measured by magnetic resonance imaging, is proposed as a potential neurobiological marker that contributes to the depressed mood, cognitive impairment, and later cognitive deterioration of some elderly depressed.