Alzheimer Disease: Loewenstein DA

Acevedo A, Loewenstein DA. · Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, and Wien Center for Alzheimer's Disease and Memory Disorders, Mount Sinai Medical Center, Miami Beach, Florida 33140, USA. · J Geriatr Psychiatry Neurol. · Pubmed #18004010 No free full text.

Abstract: There have been increasing efforts to develop cognitive interventions to ameliorate cognitive problems experienced by older adults. In healthy elderly populations, cognitive training has centered on the enhancement of memory and speed of processing, with the goal of maximizing current function and reducing the risk of cognitive decline. Among elderly persons with nonprogressive neurological conditions such as traumatic brain injury (TBI) and stroke, there has been an emphasis on rehabilitation to help restore function. Most recently, there has been increased attention on the development of new cognitive techniques to treat persons with progressive neurodegenerative conditions such as Alzheimer disease. The literature is reviewed on current approaches to cognitive interventions in elderly healthy populations, and a particular emphasis is placed on the most recent strides in progressive neurocognitive conditions, particularly Alzheimer disease. Important issues such as study design, the use of ecologically and functionally valid outcome measures, the need to examine heterogeneous populations and cross-cultural variables, and the incorporation of technologically based systems are examined. It is concluded that cognitive interventions in the elderly show considerable promise and deserve further study.

Crocco EA, Loewenstein DA. · Department of Psychiatry, Mount Sinai Medical Center, 4300 Alton Road, MRI Building, 2nd Floor, Miami Beach, FL 33140, USA. · Curr Psychiatry Rep. · Pubmed #15717983 No free full text.

Abstract: Mild cognitive impairment in the elderly may represent a transitional phase between normal aging and early Alzheimer's disease (AD). It recently has been recognized as a distinct clinical entity with potentially different cognitive subtypes and etiologies. Like AD, studies have shown that psychiatric symptoms are more common than in the cognitively normal geriatric population. Understanding these symptoms has been recognized as important not only because they may impair patient function and caregiver burden, but also these symptoms may be relevant to understanding the development of AD in general. This article presents current information on psychiatric symptoms in mild cognitive impairment, their suggested role in the pathophysiology of AD and future research considerations on the subject.

Luis CA, Loewenstein DA, Acevedo A, Barker WW, Duara R. · Wien Center for Alzheimer's Disease and Memory Disorders, Mount Sinai Medical Center, Miami Beach, FL 33143, USA. · Neurology. · Pubmed #12939414 No free full text.

Abstract: Mild cognitive impairment (MCI), an intermediate state between normal aging and dementia, is characterized by acquired cognitive deficits, without significant decline in functional activities of daily living. Studies conducted on MCI have introduced new concepts regarding the possible distinctions between normal and pathologic aging of the brain. Neuroimaging and genetic testing have aided in the identification of individuals at increased risk for dementia. The measurement of change in cognitive and functional status in MCI remains challenging, because it requires instruments that are more sensitive and specific than those considered adequate for research in dementia. The authors provide an overview of the many methods that have been used to study MCI and directions that may help achieve greater uniformity in methodology. Considerable heterogeneity exists in research methodology used to study the epidemiology, thresholds for cognitive and functional impairment, rate of progression, risk factors, and defining subtypes of MCI. This article emphasizes the need for uniformity in the use of 1) appropriate and sensitive neuropsychological and functional measures to diagnose MCI, 2) reliable methods to determine progression or improvement of cognitive impairment, and 3) instruments in epidemiologic studies to establish population estimates for diverse ethnic and cultural groups. Greater consensus is needed to standardize definitions and research methodology for MCI, so as to make future studies more comparable and more useful for designing effective treatment strategies.

Loewenstein DA, Acevedo A, Czaja SJ, Duara R. · Wien Center for Alzheimer's Disease and Memory Disorders, Mount Sinai Medical Center, 4300 Alton Road, Miami Beach, FL 33140, USA. · Am J Geriatr Psychiatry. · Pubmed #15249277 No free full text.

Abstract: OBJECTIVE: The authors evaluated the efficacy of a new cognitive rehabilitation program on memory and functional performance of mildly impaired Alzheimer disease (AD) patients receiving a cholinesterase inhibitor. METHODS: Twenty-five participants in the Cognitive Rehabilitation (CR) condition participated in two 45-minute sessions twice per week for 24 total sessions. CR training included face-name association tasks, object recall training, functional tasks (e.g., making change, paying bills), orientation to time and place, visuo-motor speed of processing, and the use of a memory notebook. Nineteen participants in the Mental Stimulation (MS) condition had equivalent therapist contact and number of sessions, which consisted of interactive computer games involving memory, concentration, and problem-solving skills. RESULTS: Compared with the MS condition, participants in CR demonstrated improved performance on tasks that were similar to those used in training. Gains in recall of face-name associations, orientation, cognitive processing speed, and specific functional tasks were present post-intervention and at a 3-month follow-up. CONCLUSION: A systematic program of cognitive rehabilitation can result in maintained improvement in performance on specific cognitive and functional tasks in mildly impaired AD patients.

Eisdorfer C, Czaja SJ, Loewenstein DA, Rubert MP, Argüelles S, Mitrani VB, Szapocznik J. · Department of Psychiatry and Behavioral Sciences, University of Miami School of Medicine, 1695 N.W. 9th Avenue, Suite 3204, Miami, FL 33136, USA. · Gerontologist. · Pubmed #12937331 links to  free full text

Abstract: PURPOSE: The majority of persons with Alzheimer's disease (AD) are cared for at home by a family member such as a spouse or daughter. Caregiving places enormous demands on these caregivers, and the negative consequences associated with caregiving are well documented. This paper reports results from the Miami site of the REACH (Resources for Enhancing Alzheimer's Caregiver Health) program that examined the efficacy of a family therapy and technology-based intervention in reducing depressive symptoms (according to the Center for Epidemiological Studies Depression scale) among family caregivers of AD patients at 6 months and 18 months follow-up. DESIGN AND METHODS: There were 225 White American and Cuban American caregivers that were randomized into a structural ecosystems therapy, structural ecosystems therapy + computer-telephone integrated system, or minimal support control condition. RESULTS: Caregivers in the combined family therapy and technology intervention experienced a significant reduction in depressive symptoms at 6 months. The 18-month follow-up data indicated that the intervention was particularly beneficial for Cuban American husband and daughter caregivers. IMPLICATIONS: The results indicate that information technology has a promising role in alleviating distress and depression among groups of AD caregivers. The data also demonstrate that interventions have differential impacts according to ethnic group and the caregiver-patient relationship.

Loewenstein DA, Ownby R, Schram L, Acevedo A, Rubert M, Argüelles T. · Center for Adult Development and Aging, Department of Psychiatry and Behavioral Sciences, University of Miami School of Medicine, Florida 33140, USA. · J Clin Exp Neuropsychol. · Pubmed #11404806 No free full text.

Abstract: Neuropsychological test batteries are frequently used to assess the nature and severity of cognitive deficits among patients with early Alzheimer's Disease (AD) and related disorders. The NINCDS-ADRDA criteria are among the most widely used guidelines to diagnose dementia (McKhann et al.,1984). These criteria specify eight distinct areas of neuropsychological function that should be evaluated in patients with suspected cognitive impairment. Recent studies have suggested that neuropsychological deficits observed in AD may be explained by a single general factor related to memory deficits or to executive dysfunction. In contrast, the results of other investigations have indicated that multiple qualitatively different factors underlie cognitive abilities in AD. In the present study, we used confirmatory factor analysis to examine the structure of cognitive abilities in AD and to assess the extent to which single and multiple ability factors accurately represent neuropsychological test data obtained from patients with AD. Results indicated that the NINCDS-ADRDA model fit the data better than a single factor model. However, a more parsimonious model specifying memory, verbal abilities, visuospatial skills, executive function, and higher as well as lower functional activities of daily living fit the data better than the NINCDS-ADRDA model. These results have important theoretical and practical implications for diagnostic evaluation.

Loewenstein DA, Acevedo A, Agron J, Ownby R, Barker W, Strauman S, Duara R. · Wein Center for Alzheimer's Disease and Memory Disorders, Mount Sinai Medical Center, Miami Beach, FL 33140, USA. · Am J Geriatr Psychiatry. · Pubmed #19390301 No free full text.

Abstract: OBJECTIVE: This study evaluated the utility of the Florida Brief Memory Screen (FBMS), a new memory screening measure developed for Spanish-speaking and English-speaking subjects, which takes only 3-4 minutes to administer. METHODS: The FBMS was administered to 25 patients with probable Alzheimer disease, 23 patients with amnestic mild cognitive impairment, and 80 cognitively normal elderly. RESULTS: The FBMS evidenced good test-retest reliability and high correlation with standard measures of memory. In receiver operating characteristic analyses, the FBMS correctly classified 100% of patients with probable Alzheimer disease and 87.5% of normal elderly subjects. Sensitivity and specificity for patients with amnestic mild cognitive impairment was 82.6% and 87.5%, respectively. Performance on the FBMS was generally independent of the effects of age, education, or primary language. CONCLUSION: The FBMS is a reliable and a valid measure when screening for memory impairment in the elderly and when determining whether a more extensive evaluation is warranted.

Urs R, Potter E, Barker W, Appel J, Loewenstein DA, Zhao W, Duara R. · Department of Biomedical Engineering, University of Miami, Coral Gables, FL, USA. · J Comput Assist Tomogr. · Pubmed #19188789 No free full text.

Abstract: OBJECTIVE: Subjects with mild cognitive impairment (MCI) and mild Alzheimer disease (AD) can be distinguished from elderly subjects with no cognitive impairment (NCI) by the degree of atrophy in the entorhinal cortex (ERC) and the hippocampus (HPC), quantified by volumetric magnetic resonance image (MRI) studies. Because volumetric MRI requires rigorous standards for image acquisition and analysis and is not suitable for routine clinical use, we have used calibrated visual rating to measure atrophy in the ERC, HPC, and perirhinal cortex (PRC) and evaluated its utility in the diagnosis of very early AD. METHODS: Thus far, visual rating methods, which have been found to be reliable and sensitive only for measurement of atrophy of the HPC or for the entire medial temporal region, have been found to be relatively insensitive for discriminating mild AD from elderly NCI subjects. We have developed a computer-based visual rating system (VRS) using reference images for calibration of atrophy ratings in several discrete brain regions, including the ERC, HPC, and PRC. The VRS reference images facilitate training of raters and promote standardization of all atrophy ratings. Interrater and intrarater reliability measurements were assessed; subsequently, the ability of VRS to discriminate the diagnoses among 73 elderly subjects was studied (NCI = 27, MCI = 23, and AD = 23). RESULTS: Kappa values for interrater reliability of the ERC, HPC, and PRC were between 0.75 and 0.94, and for intrarater reliability, they were between 0.84 and 0.93, indicating that VRS enables highly reliable ratings to be obtained. Atrophy ratings in the ERC, HPC, and PRC distinguished AD from NCI subjects but did not distinguish AD from MCI subjects who tended to have intermediate levels of atrophy. Right and left ERC ratings and the right HPC rating distinguished MCI from NCI subjects. CONCLUSIONS: The visual rating system is the first semiquantitative method that enables reliable measurements of ERC atrophy, and ERC measurement was found to be the best discriminator between MCI and NCI subjects. Visual rating system is a user-friendly tool that can allow a radiologist or a clinician to use structural MRI scans to be used as a biomarker in the diagnosis of prodromal AD.

Duara R, Loewenstein DA, Potter E, Appel J, Greig MT, Urs R, Shen Q, Raj A, Small B, Barker W, Schofield E, Wu Y, Potter H. · Wien Center for Alzheimer's Disease and Memory Disorders, Mount Sinai Medical Center, 4300 Alton Rd., Miami Beach, FL 33140, USA. · Neurology. · Pubmed #19064880 No free full text.

Abstract: BACKGROUND: Despite convenience, accessibility, and strong correlation to severity of Alzheimer disease (AD) pathology, medial temporal lobe atrophy (MTA) has not been used as a criterion in the diagnosis of prodromal and probable AD. METHODS: Using a newly validated visual rating system, mean MTA scores of three bilateral medial temporal lobe structures were compared for subjects with no cognitive impairment (NCI) (n = 117), nonamnestic mild cognitive impairment (MCI) (n = 46), amnestic MCI (n = 45), and probable AD (n = 53). Correlations between MTA scores and neuropsychological test scores at baseline, and predictors of change in diagnosis at 1-year follow-up were evaluated. RESULTS: With NCI as the reference group, a mean MTA cut score of 1.33 yielded an optimal sensitivity/specificity of 85%/82% for probable AD subjects and 80%/82% for amnestic MCI subjects. MTA and Clinical Dementia Rating Sum of Boxes scores at baseline were independent and additive predictors of diagnosis at baseline, and of transition from NCI to MCI or from MCI to dementia at 1-year follow-up. CONCLUSION: Medial temporal lobe atrophy (MTA) scores 1) distinguish probable Alzheimer disease (AD) and amnestic mild cognitive impairment (MCI) subjects from nonamnestic MCI and no cognitive impairment (NCI) subjects, 2) help predict diagnosis at baseline, and 3) predict transition from NCI to MCI and from MCI to probable AD. MTA scores should be used as a criterion in the clinical diagnosis of AD.

Loewenstein DA, Acevedo A, Agron J, Martinez G, Duara R. · Wien Center for Alzheimer's Disease and Memory Disorders, Mount Sinai Medical Center, Miami Beach, FL 33140, USA. · J Clin Exp Neuropsychol. · Pubmed #17454350 No free full text.

Abstract: Both amnestic and nonamnestic deficits have been observed in patients with mild cognitive impairment (MCI). Most studies have focused on impairment on single cognitive tests rather than amalgamation of the results of several measures to arrive at a composite impairment index. In this investigation, we examined 20 MCI patients diagnosed as prodromal Alzheimer's disease, AD (mean Mini-Mental State Examination, MMSE = 26.1; SD = 1.7) and determined the extent to which they could be differentiated from 70 normal elderly controls based on composite measures at 1.5-SD and 2.0-SD cutoffs for impairment. At the 1.5-SD cutoff, the median number of memory indices impaired in the MCI-AD group was 5 of 7, whereas at the 2.0-SD cutoff, the median number was 4 of 7. A median of 3 of 7 and 2 of 7 nonmemory indices were impaired at 1.5- and 2.0-SD cutoffs for impairment. Receiver operator characteristics (ROC) analyses indicated that the total number of memory tests impaired at 2.0 SD (sensitivity = 95.0%/specificity = 84.3%) and the composite measure of both impaired memory and nonmemory measures (sensitivity of 85.0%/specificity of 100%) had high levels of discrimination and may have utility as indices of early impairment as well as severity of MCI.

Loewenstein DA, Acevedo A, Ownby R, Agron J, Barker WW, Isaacson R, Strauman S, Duara R. · Wien Center for Alzheimer's Disease and Memory Disorders, Mount Sinai Medical Center, Miami Beach, FL 33140, USA. · Am J Geriatr Psychiatry. · Pubmed #17068313 No free full text.

Abstract: OBJECTIVE: Although mild cognitive impairment (MCI) is characterized by performance on memory and other measures below expected normative values, neither a scientific rationale nor a consensus exists regarding which measures have the most use or the optimal cutoffs to use to establish impairment. METHODS: Different memory measures were administered to 80 normal community-dwelling subjects divided into two age groups. This provided conormed data on eight different memory indices by which to compare 23 nondemented clinically diagnosed patients with MCI who met all other criteria for Alzheimer disease (AD). RESULTS: On immediate memory for passages, delayed visual reproduction, object memory, and a measure sensitive to semantic interference, 70%-78% of patients with MCI were identified as impaired at 1.5 standard deviations or greater below expected levels. Conditional logistical regression for age-matched samples indicated that consideration of raw scores for these neuropsychologic tests in combination did not significantly change the odds of MCI diagnosis. When impairment relative to the total normal elderly sample was calculated based on one or more impairments at a 1.5 or greater cutoff, specificity fell below acceptable levels when more than three memory measures were considered. CONCLUSION: An array of widely used neuropsychologic measures demonstrated utility in distinguishing patients with MCI-AD from cognitively normal community-dwelling elders. The appropriateness of more or less stringent cutoffs was highly influenced by the number of measures considered. These findings have important implications regarding the choice of cut points for impairment used for the diagnosis of MCI in both research and clinical settings.

Loewenstein DA, Acevedo A, Agron J, Issacson R, Strauman S, Crocco E, Barker WW, Duara R. · Wein Center for Alzheimer's Disease and Memory Disorders, Mount Sinai Medical Center, Miami Beach, Fla, USA. · Dement Geriatr Cogn Disord. · Pubmed #16490966 No free full text.

Abstract: There has been increasing interest in determining whether amnestic, nonamnestic and multiple-domain subtypes of mild cognitive impairment (MCI) reflect different disease etiologies. In this study, we examined the extent to which cognitive profiles of nondemented patients with MCI diagnosed with prodromal Alzheimer's disease (AD) differed from those MCI patients diagnosed with vascular disease. We also compared these diagnostic groups to mildly demented patients diagnosed with AD and normal elderly controls. Results indicate that a majority of both MCI-AD and MCI-vascular patients experienced amnestic features and that multiple-domain was the most common presentation. MCI-AD and MCI-vascular groups did not differ on neuropsychological measures tapping memory, language, visuospatial skills/praxis or executive function. Further both MCI groups could be distinguished from dementia patients with regards to performance on measures of memory but not on non-memory measures. Considerable variability was observed in the degree of memory impairment among MCI patients with scores as much as 6 standard deviations below expected mean values. MCI-AD and MCI-vascular patients frequently exhibit both common and overlapping amnestic and nonamnestic features. The implication of these findings for future clinical research is discussed.

Luis CA, Barker WW, Loewenstein DA, Crum TA, Rogaeva E, Kawarai T, St George-Hyslop P, Duara R. · Wien Center for Alzheimer's Disease and Memory Disorders, Mount Sinai Medical Center, Miami, Fla. 33140, USA. · Dement Geriatr Cogn Disord. · Pubmed #15305108 No free full text.

Abstract: OBJECTIVE: To determine the conversion rates to dementia in patients diagnosed with mild cognitive impairment (MCI) thought to be caused by incipient Alzheimer's disease (MCI-AD) or with MCI with features of vascular disease (MCI-Vas). METHODS: On the basis of patient history, neurocognitive, neurological and MRI evaluation, 99 patients were diagnosed with MCI-AD and 35 with MCI-Vas. Conversion to dementia over an average of a 2.4 +/- 1.8-year period was determined. RESULTS: Over the follow-up period, 44% converted to dementia, 51.5% remained classified as MCI, and 4.5% were reclassified as cognitively normal. The conversion rate to dementia was significantly faster at 3 years for the MCI-AD (50.5%) than for the MCI-Vas group (25.7%). The neuropsychological test found to best differentiate converters from non-converters was the Fuld-OME, a measure of learning and recall. Age, education, gender or APOE epsilon4 allele frequency did not differentiate converters from non-converters. CONCLUSIONS: MCI-AD and MCI-Vas are clinically meaningful subtypes of MCI that may convert to dementia at different rates. Prospective studies on larger subsets of MCI patients are required to confirm these findings.

Ownby RL, Loewenstein DA, Schram L, Acevedo A. · Center on Aging and the Department of Psychiatry and Behavioral Sciences, University of Miami School of Medicine, Miami, Florida 33140, USA. · Int J Geriatr Psychiatry. · Pubmed #15027038 No free full text.

Abstract: BACKGROUND: Understanding the structure of cognitive abilities in Alzheimer's disease (AD) has considerable practical and theoretical importance. Some investigators have argued that a single cognitive process underlies the deficits seen in AD, while others have argued for multiple cognitive processes. As deficits in cognitive abilities may reflect the pathological process or processes occurring in AD, determination of the structure of abilities in AD is important. OBJECTIVES: The purpose of this study was to assess the utility of single and multiple ability factor models in differentiating patients with AD from normals. RESULTS: Findings show that although a single factor model accounts for a large part of the variability of a battery of measures used to differentiate patients and normals, a multiple factor model performed substantially better based on multiple fit criteria. CONCLUSIONS: At least in this sample, a multiple ability factor model of cognitive abilities fit data better than a single factor model in differentiating patients with AD from normals.

Loewenstein DA, Acevedo A, Luis C, Crum T, Barker WW, Duara R. · Department of Psychiatry, Wien Center for Alzheimer's Disease and Memory Disorders, Mount Sinai Medical Center, Miami Beach, Florida 33140, USA. · J Int Neuropsychol Soc. · Pubmed #14751011 No free full text.

Abstract: Impairment in delayed recall has traditionally been considered a hallmark feature of Alzheimer's disease (AD). However, vulnerability to semantic interference may reflect early manifestations of the disorder. In this study, 26 mildly demented AD patients (mild AD), 53 patients with mild cognitive impairment without dementia (MCI), and 53 normal community-dwelling elders were first presented 10 common objects that were recalled over 3 learning trials. Subjects were then presented 10 new semantically related objects followed by recall for the original targets. After controlling for the degree of overall memory impairment, mild AD patients demonstrated greater proactive but equivalent retroactive interference relative to MCI patients. Normal elderly subjects exhibited the least amount of proactive and retroactive interference effects. Recall for targets susceptible to proactive interference correctly classified 81.3% of MCI patients and 81.3% of normal elderly subjects, outperforming measures of delayed recall and rate of forgetting. Adding recognition memory scores to the model enhanced both sensitivity (84.6%) and specificity (88.5%). A combination of proactive and retroactive interference measures yielded sensitivity of 84.6% and specificity of 96.2% in differentiating mild AD patients from normal older adults. Susceptibility to proactive semantic interference may be an early cognitive feature of MCI and AD patients presenting for clinical evaluation.

Loewenstein DA, Acevedo A, Schram L, Ownby R, White G, Mogosky B, Barker WW, Duara R. · Department of Psychiatry and Behavioral Sciences, University of Miami School of Medicine, Miami Beach, FL 33140, USA. · Am J Geriatr Psychiatry. · Pubmed #12611756 No free full text.

Abstract: OBJECTIVE: The authors evaluated the usefulness and psychometric properties of the Semantic Interference Test (SIT) in patients with mild Alzheimer disease (AD). METHODS: Subjects were first presented with 10 common objects to be learned over three trials. Proactive interference was assessed by having subjects recall 10 new objects that were semantically related to the previous ones. Retroactive interference was assessed by having subjects recall the original 10 objects. RESULTS: Controlling for overall memory impairment, very mildly impaired AD patients demonstrated significantly greater proactive and retroactive interference effects than the normal, community-dwelling comparison group. The proactive score alone and the combined proactive-plus-retroactive score index were more effective than traditional neuropsychological measures of delayed recall in distinguishing between the very mildly impaired AD group and the normal-comparison group. CONCLUSION: The authors discuss the potential usefulness of the SIT in identifying vulnerability to semantic interference in early AD.

Argüelles S, Loewenstein DA, Eisdorfer C, Argüelles T. · Center on Adult Development and Aging, Department of Psychiatry and Behavioral Sciences, University of Miami School of Medicine, Florida 33136, USA. · J Geriatr Psychiatry Neurol. · Pubmed #11419574 No free full text.

Abstract: Research has demonstrated that caregivers of cognitively impaired patients may misjudge aspects of the patient's functional capacities. The nature and directions of these relationships are not well understood, however. Further, the effects that depression and perceived caregiver burden have on the caregivers' ability to render accurate judgments of patient's functional abilities have not been addressed. In this study, the primary caregivers of 128 patients with Alzheimer's disease (AD) were administered a questionnaire regarding the patients' functional capacities. These judgments were subsequently compared to actual functional performance of AD patients on an extended version of the Direct Assessment of Functional Status scale administered in the patients' home environment. A significant proportion of caregivers overestimated AD patients' functional performance in telling time, counting currency, making change for a purchase, brushing teeth, and using eating utensils. Further analyses revealed that self-reported depression, but not perceived burden, was related to the type of caregiver bias errors observed.

Loewenstein DA, Argüelles S, Bravo M, Freeman RQ, Argüelles T, Acevedo A, Eisdorfer C. · Center for Adult Development and Aging and the Department of Psychiatry and Behavioral Sciences, University of Miami School of Medicine, Florida, USA. · J Gerontol B Psychol Sci Soc Sci. · Pubmed #11245361 No free full text.

Abstract: The assessment of functional capacity is essential for the diagnosis of dementia by DSM-IV criteria and has important implications for patient intervention and management. Although ratings of functional disability by family or other proxy informants are widely used by clinicians, there have been concerns and empirical evidence that potential reporter biases may result in either overestimation or underestimation of specific functional deficits. In this study, we compared family members' judgments of the functional abilities of seventy-two patients diagnosed with Alzheimer's disease (AD). These judgments were compared to actual objective functional performance on an array of real-world tasks using the Direct Assessment of Functional Status (DAFS) scale. The results indicate that caregivers were extremely accurate in predicting the functional performance of AD patients who were not impaired during objective evaluation. In contrast, caregivers significantly overestimated the ability of impaired AD patients to tell time, to identify currency, to make change for a purchase, and to utilize eating utensils. Higher patient MMSE scores were associated with caregivers' overestimation of functional capacity, while the degree of caregivers' depressive symptoms, as measured by the CES-D depression scale, was not related to either overestimation or underestimation of patients' functional performance.

Acevedo A, Loewenstein DA, Barker WW, Harwood DG, Luis C, Bravo M, Hurwitz DA, Aguero H, Greenfield L, Duara R. · Cognitive Rehabilitation Program, Horizon Health Corporation, Mount Sinai Medical Center, Miami Beach, Florida, USA. · J Int Neuropsychol Soc. · Pubmed #11105466 No free full text.

Abstract: Category fluency tasks are an important component of neuropsychological assessment, especially when evaluating for dementia syndromes. The growth in the number of Spanish-speaking elderly in the United States has increased the need for appropriate neuropsychological measures and normative data for this population. This study provides norms for English and Spanish speakers, over the age of 50, on 3 frequently used measures of category fluency: animals, vegetables, and fruits. In addition, it examines the impact of age, education, gender, language, and depressed mood on total fluency scores and on scores on each of these fluency measures. A sample of 702 cognitively intact elderly, 424 English speakers, and 278 Spanish speakers, participated in the study. Normative data are provided stratified by language, age, education, and gender. Results evidence that regardless of the primary language of the examinee, age, education, and gender are the strongest predictors of total category fluency scores, with gender being the best predictor of performance after adjusting for age and education. English and Spanish speakers obtained similar scores on animal and fruit fluency, but English speakers generated more vegetable exemplars than Spanish speakers. Results also indicate that different fluency measures are affected by various factors to different degrees.

Harwood DG, Barker WW, Loewenstein DA, Ownby RL, St George-Hyslop P, Mullan M, Duara R. · The Wien Center for Alzheimer's Disease and Memory Disorders, Mount Sinai Medical Center and University of Miami School of Medicine, FL 33140, USA. · Neurology. · Pubmed #10025786 No free full text.

Abstract: BACKGROUND: The prevalence of AD appears to vary widely in different ethnic groups. Certain risk factors for AD are well established for the general population, but there is little information regarding the relevance of these risk factors in specific ethnic groups. OBJECTIVE: The authors examined the risk of AD associated with the APOE-epsilon4 allele, the APOE-epsilon2 allele, smoking, alcohol consumption, history of hypertension, low educational level, estrogen replacement therapy, and history of head trauma with loss of consciousness among samples of white non-Hispanics (WNH) (392 AD patients, 202 normal subjects) and white Hispanics (WHIS) (188 AD patients, 84 normal controls). DESIGN: This was a case-control study of patients evaluated at an outpatient memory disorders clinic and control subjects recruited from a free memory screening offered to the community. RESULTS: Increased risk for AD was associated with the APOE-epsilon4 allele after controlling for age, education, and gender among WNH (OR = 3.5; 95% CI = 2.3 to 5.5) and WHIS (OR = 3.1; 95% CI = 1.7 to 5.8). No protective effect was conferred by the APOE-epsilon2 allele, although this relationship approached significance among WNH (p = 0.02). Low levels of education increased the risk for AD among WNH (OR = 3.1; 95% CI = 1.8 to 5.9) but not WHIS. Alcohol use and hypertension approached significance as risk factors in WNH (p < 0.05) but not WHIS. Estrogen replacement treatment approached significance as a protective factor in both ethnic groups (p < 0.05). CONCLUSIONS: Although the APOE-epsilon4 allele is a risk factor for AD among WHIS and WNH, other risk factors such as low education and hypertension appear to be important only for WNH. Risk factors for AD reported or suggested previously that were not confirmed by this study include smoking and head trauma with loss of consciousness.

Bain LJ, Barker W, Loewenstein DA, Duara R. · Wien Center for Alzheimer's Disease and Memory Disorders, Mount Sinai Medical Center, 4300 Alton Road, Miami Beach, FL 33140, USA. · Alzheimer Dis Assoc Disord. · Pubmed #18525280 No free full text.

Abstract: The 5th annual Mild Cognitive Impairment Symposium, held on April 13th and 14th, 2007, in Miami Beach, Florida, focused on the question of whether the time has come to revise criteria for Alzheimer disease (AD). The symposium, sponsored by the Wien Center for Alzheimer's Disease and Memory Disorders, Mt Sinai Medical Center in Miami Beach, Florida; and the Byrd Alzheimer Center and Research Institute in Tampa, Florida, brought together an international group of clinicians and researchers to examine current evidence for developing new criteria for AD and for outlining areas that still require clarification. Neuropathologic, neuroimaging, epidemiologic, and clinical perspectives were presented and discussed, as well as the impact of ethnic and cultural differences. As became evident, each perspective introduces different challenges in terms of selecting the appropriate assessment tools; determining when, where, and by whom the diagnosis should be given; and deciding whether multiple sets of criteria are needed for use in different settings, for example, research versus primary care practices. As was intended, the symposium delivered no consensus; however, there was substantial support for the idea that AD can and probably should be diagnosed before the onset of dementia, particularly as new interventions become available.