DIMENSIONS Summer 1998


by Julie Cleveland

In May, the 1998 annual scientific meeting of the American Geriatrics Society and the American Federation for Aging Research was held in Seattle at the Sheraton Seattle Hotel and the Washington State Trade and Convention Center. The meeting is considered one of the foremost forums for new and up-to-date information in all areas of geriatrics--clinical care, delivery systems, research, education, ethics, and health policy. Alzheimer's Disease Research Center (ADRC) researchers from the UW were involved in over ten symposia and five research posters. Published abstracts of the research posters follow:

Diagnostic Outcomes in a Population-Based Alzheimer's Disease Patient Registry E.B. Larson, MD; W.A. Kukull, PhD; W. McCormick, MD; L. Teri, PhD; J.D. Bowen, MD

The purpose of this study was to describe diagnostic outcomes of an incident-case Alzheimer's Disease Patient Registry (ADPR). Participants with newly detected ( less than one year) cognitive impairment were selected from an established Seattle HMO with a population-base of 23,000 persons over age 60. From 1987-1997, 970 of 1,028 ADPR enrollees completed a standardized evaluation. Mean age was 78 years, and 60 percent were female. The diagnostic outcomes were as follows: Probable Alzheimer's disease (AD) 57 percent; vascular dementias 10 percent; Parkinson's disease 4 percent; alcohol related dementias 3 percent; for new post-traumatic or post-hypoxic 2 percent; drugs 1 percent; mixed, or other unclassifiable 6 percent; not demented 13 percent. The primary diagnosis of 168 completed autopsies were: Alzheimer's disease 70 percent; Parkinson's disease 7 percent; possible AD 5 percent; vascular dementias 4 percent; other 10 percent; normal 4 percent. The study concludes that Alzheimer's disease is the most common form of incident dementia in a population-based registry. Age of onset is typically in the late 70s or early 80s and dementia before age 60 is rare.

Anxiety in Alzheimer's Disease: Prevalence and Comorbidity L. Teri, PhD; L.E. Ferretti, PhD; L.E. Gibbons, PhD; R.G. Logsdon, PhD; S.M. McCurry, PhD; W.A. Kukull, PhD; E.B. Larson, MD

Anxiety may be associated with psychiatric morbidity, disability, increased health care utilization, and mortality in Alzheimer's disease patients as it is in the general adult population. However, the phenomenology of anxiety in AD and its relationship to dementia progression, comorbid depression, and the presence of other problematic behaviors have not yet been examined.

Data on anxiety symptoms and their coexistence with other factors were obtained in 545 community dwelling AD patients via interviews with their caregivers and direct physical examination. The prevalence of anxiety symptoms and their association to patient depression, other behavioral problems, gender and age was investigated.

Anxiety symptoms were common, occurring in 69 percent of subjects. Anxiety symptoms were significantly correlated with activities of daily living (ADL) impairment and other behavioral disturbances,including wandering,sexual misconduct, hallucinations, verbal threats, and physical abuse. Comorbidity of anxiety-depression was also prevalent: 53 percent of the sample had both anxiety and depression symptoms. ADL impairment and problem behaviors were significantly associated with anxiety-depression, however, this association with problem behaviors was explained entirely by the presence of anxiety. These results indicate the need for additional research into the phenomenology of anxiety and comorbid anxiety-depression in AD, and for the development and investigation of effective assessment and treatment of anxiety in AD clinical practice.

Wandering: A Significant Problem Among Community Residing Individuals with Alzheimer's Disease R.G. Logsdon, PhD; L. Teri, PhD; S.M. McCurry, PhD; L.E. Gibbons, PhD; W.A. Kukull, PhD; E.B. Larson, MD

This investigation evaluated the frequency, predictors, and impact of wandering in a population-based sample of 193 individuals with Alzheimer's disease. Although wandering occurred in subjects at all levels of cognitive impairment, analysis of variance indicated that for the group as a whole, greater frequency of wandering was associated with significantly more impairment in cognition, day-to-day functioning, and behavior. Caregiver distress also increased significantly with increased frequency of wandering. Logistic regression modeling identified functional impairment and disruptive behavior problems as the strongest independent predictors of wandering occurring within the past week. Cluster analysis revealed four characteristic groups of wanderers that represented a continuum of wandering frequency, each having a unique pattern of other behavioral disturbances. Based on this analysis, recommendations for further evaluation and treatment of wandering are being developed by ADRC researchers.

Characteristics of Sleep Disturbance in Community-Dwelling AD Patients S.M. McCurry,PhD; R.G. Logsdon, PhD; L.E. Gibbons, PhD; L. Teri, PhD; W.A. Kukull, PhD; E.B. Larson, MD

The purpose of this study was to describe the frequency, predictors, and impact of seven sleep-related behaviors in a population-based sample of 205 Alzheimer's disease patients. Participants were selected from Group Health Cooperative, a large HMO in Seattle, WA. Patient sleep ratings, behavior, cognitive functioning, and functional status were all assessed. The frequency of sleep problems during the past week varied, with sleeping more than usual and early morning awakenings most common (40 percent and 31 percent of patients, respectively). Nighttime and early morning awakenings, day-night reversals, and trouble getting out of bed were associated with increased disruptive behaviors and declining cognition. Women were less likely to develop sleep problems than men. Of all sleep-related behaviors, nighttime awakenings were most disturbing to caregivers. Using logistic regression analyses, the strongest predictor of night awakenings among patients was overall disruptive behavior. This study concludes that the development of effective strategies to improve sleep would likely reduce excess disability in community dwelling AD patients.

Neuropsychological Batteries in Alzheimer's Disease--Multivariate or Redundant? L.E. Gibbons, PhD; C.L. Jones, MS; G. van Belle, PhD; W.A. Kukull, PhD; E.B. Larson, MD; L. Teri, PhD

The objective of this study was to identify redundancies in the neuropsychological battery used by an Alzheimer's Disease Patient Registry (ADPR) that would help clinicians and researchers optimize time and minimize patient fatigue. Five hundred and twenty-one patients with new onset cognitive impairment were selected from a population based ADPR. Mean patient age was 77 years. After consensus, 72 percent of the subjects met the NINCDS/ADRA criteria for AD or other dementia.

Patients were evaluated using a standard battery that included the Mattis, Mini-Mental State Exam, Wechsler Memory Scale-Revised, and Wechsler Adult Intelligence Scale-Revised (WAIS-R). Detailed interviews of patients and caregivers and a complete physical exam were conducted. Principal variable analyses indicated that 16 of the 20 neuropsychological tests or subscales accounted for 93 percent of the total variability in patient response, 76 percent could be explained with 9 tests, and 44 percent with the four WAIS-R subscales. For predicting dementia, any one of ten tests was significant in logistic regression analyses. Additional tests were not significant.

The study concludes that one test is as good as a larger battery in identifying dementia diagnoses in most instances. Even if dementia diagnosis is not the only goal, the test battery can be considerably reduced without sacrificing much information.

In addition to the posters summarized above, a number of ADRC faculty, including Drs. Linda Teri, Thomas Bird, Murray Raskind, George Martin, Soo Borson, Eric Larson, Jim Leverenz and Richard Veith, gave presentations on topics ranging from molecular biology and genetics to treatment of Alzheimer's disease.

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