Alzheimer Disease: Kasper JD

Chan DC, Kasper JD, Black BS, Rabins PV. · Harvard Geriatric Medicine Fellowship Program, Boston, Massachusetts, USA. · J Geriatr Psychiatry Neurol. · Pubmed #17548780 No free full text.

Abstract: Little is known about the prevalence and correlates of psychotropic drug use in community-dwelling elders with dementia. Baseline data from 285 community-dwelling elders with a research classification of dementia enrolled in the observational Memory and Medical Care Study were analyzed. Of these, 33.3% with a research classification of dementia were clinically diagnosed, 28.8% used at least 1 psychotropic drug, and 61.8% had at least 1 behavioral or psychologic symptom of dementia. Presence of a behavioral or psychologic symptom of dementia was associated with a higher likelihood of a clinical diagnosis of dementia. A clinical diagnosis of dementia, not a behavioral or psychologic symptom of dementia, was associated with psychotropics use. Clinical recognition of dementia appears to be an intermediate step between presence of symptoms of dementia and the prescription of psychotropics. Most community-dwelling elders meeting the research criteria for dementia were not clinically diagnosed, despite contact with a physician (89%) in the previous year.

Fredman L, Tennstedt S, Smyth KA, Kasper JD, Miller B, Fritsch T, Watson M, Harris EL. · Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA. · J Aging Health. · Pubmed #15030662 No free full text.

Abstract: OBJECTIVES: Studies of caregivers illustrate a classic sampling dilemma: maximizing recruitment without compromising study validity. Because caregivers are defined in relation to a care recipient, sampling methods are often determined by pragmatic decisions such as access, efficiency, and costs. However, overlooking validity may result in selection bias, misclassification of caregiver status, and the confounding of results. Validity and pragmatic concerns were compared in four caregiver studies that used different sampling frames: community based, Alzheimer's disease registry, and ancillary studies to existing epidemiologic studies. METHODS: Systematic comparison of validity and of pragmatic aspects of sampling frames, recruitment methods, and participation rates, with attention to caregiver identification, inclusion criteria, and sample restriction. RESULTS: All studies used task-based inclusion criteria. Caregiver participation rates ranged from 81% to 96%, with higher rates in community-based and registry-based studies than in ancillary studies. The latter studies benefited from unbiased selection of noncaregivers. DISCUSSION: Regardless of sampling frame, standard task-based inclusion criteria to define caregivers may enhance validity.