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Medical Sciences	95%

Selected Abstracts

Screening for depression and anxiety disorders in primary care patients

DEPRESSION AND ANXIETY, Issue 7 2007
Adomas Bunevicius B.S.
Abstract Mood and anxiety disorders are highly prevalent in primary health care. In this study we assessed performance of the Hospital Anxiety and Depression Scale (HADS) for screening of depression and anxiety disorders in a population of primary care patients. A total of 503 primary care patients consecutively admitted to the primary care medical center in Kaunas, Lithuania, completed the study. We found that the HADS subscale of depression (HADS-D) at a cutoff score of 6 or more showed the best performance screening for a major depressive episode diagnosed by means of the Mini International Neuropsychiatric Interview (MINI), with a sensitivity of 80%, specificity of 69%, positive predictive value of 80%, negative predictive value of 92%, and area under the receiver operating characteristic (ROC) curve of 0.75. Performance of the HADS-D against MINI diagnosis of dysthymia was weak. The HADS subscale of anxiety (HADS-A) at a cutoff score of 9 or more showed the best performance screening for MINI diagnosis of overall anxiety disorders, with a sensitivity of 77%, specificity of 75%, positive predictive value of 53%, negative predictive value of 90%, and area under the ROC curve of 0.76. These results suggest that in primary care patients HADS is an adequate screening instrument for the MINI diagnoses of major depressive episode, but not for dysthymia at a cutoff score of 6, and for anxiety disorders at a cutoff score of 9. Depression and Anxiety 24:455,460, 2007. © 2006 Wiley-Liss, Inc. [source]

Psychometric evaluation of the mini-social phobia inventory (Mini-SPIN) in a treatment-seeking sample,

DEPRESSION AND ANXIETY, Issue 6 2007
Justin W. Weeks M.A.
Abstract The Mini-Social Phobia Inventory (Mini-SPIN) is a 3-item, self-rated screening instrument to assess social anxiety disorder, but its psychometric properties have not yet been examined in a sample seeking treatment for psychiatric disorders. We analyzed responses from 291 adults who telephoned the Adult Anxiety Clinic of Temple (AACT) seeking treatment for social anxiety or generalized anxiety and worry. The Mini-SPIN demonstrated strong internal consistency. Support for the convergent validity of the Mini-SPIN was provided by moderate correlations with several self-report measures and a clinician-administered measure of social anxiety completed by the subsample of callers who later came to the AACT for evaluation. Furthermore, the Mini-SPIN correlated significantly with two of three measures of functional disability, but not with a measure of life satisfaction. Correlations with measures of other constructs were nonsignificant, providing support for the discriminant validity of the Mini-SPIN. In addition, a cutoff score of 6 on the Mini-SPIN yielded strong sensitivity and diagnostic efficiency in the subsample of treatment seekers that later completed pretreatment evaluation, although the specificity of this cutoff score was not optimal in this sample. Overall, the Mini-SPIN demonstrated sound psychometric properties in this treatment-seeking sample. Depression and Anxiety 24:382,391, 2007. Published 2006 Wiley-Liss, Inc. [source]

The development and initial validation of the Terminally Ill Grief or Depression Scale (TIGDS)

INTERNATIONAL JOURNAL OF METHODS IN PSYCHIATRIC RESEARCH, Issue 4 2005
Vyjeyanthi S. Periyakoil
Abstract Patients often experience ,preparatory-grief' as they cope with the dying process. Some may be depressed. The Terminally Ill Grief or Depression Scale (TIGDS), comprising grief and depression sub-scales, is a new self-report measure designed to differentiate between preparatory-grief and depression in adult inpatients. The initial 100-item inventory was assembled based on literature review, interviews with clinicians and dying patients and then shortened to 42 items based on consensus expert opinion. Validity and reliability were tested in a sample of 55 terminally ill adults. The consensus clinical opinion was used as the gold standard to differentiate between preparatory grief and depression. The intra-class correlation coefficient was high (it was calculated to estimate the test-retest reliability for the 47 patients who had completed the TIGDS twice , retest was administered 2 to 7 days after the initial test), ranging from 0.86 (grief) to 0.97 (depression). The validity of TIGDS was assessed using a receiver operating characteristic curve analysis, comparing the first test with the clinical criterion. The first and only variable and cut-point was the depression score (chi-square = 18.4,p < 0.001, cut point = 3). The sensitivity of the TIGDS was 0.727 and specificity was 0.886 for the depression = 3 cutoff score. The construct validity of the TIGDS was tested by comparing with the Hospital Anxiety and Depression Scale (HADS). The TIGDS depression subscale showed strong convergent validity and the TIGDS grief subscale showed strong discriminant validity with the HADS total score. Copyright © 2005 John Wiley & Sons, Ltd. [source]

The Overlap Syndrome of Depression and Delirium in Older Hospitalized Patients

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 8 2009
Jane L. Givens MD
OBJECTIVES: To measure the prevalence, predictors, and posthospitalization outcomes associated with the overlap syndrome of coexisting depression and incident delirium in older hospitalized patients. DESIGN: Secondary analysis of prospective cohort data from the control group of the Delirium Prevention Trial. SETTING: General medical service of an academic medical center. Follow-up interviews at 1 month and 1 year post-hospital discharge. PARTICIPANTS: Four hundred fifty-nine patients aged 70 and older who were not delirious at hospital admission. MEASUREMENTS: Depressive symptoms assessed at hospital admission using the 15-item Geriatric Depression Scale (cutoff score of 6 used to define depression), daily assessments of incident delirium from admission to discharge using the Confusion Assessment Method, activities of daily living at admission and 1 month postdischarge, and new nursing home placement and mortality determined at 1 year. RESULTS: Of 459 participants, 23 (5.0%) had the overlap syndrome, 39 (8.5%) delirium alone, 121 (26.3%) depression alone, and 276 (60.1%) neither condition. In adjusted analysis, patients with the overlap syndrome had higher odds of new nursing home placement or death at 1 year (adjusted odds ratio (AOR)=5.38, 95% confidence interval (CI)=1.57,18.38) and 1-month functional decline (AOR=3.30, 95% CI=1.14,9.56) than patients with neither condition. CONCLUSION: The overlap syndrome of depression and delirium is associated with significant risk of functional decline, institutionalization, and death. Efforts to identify, prevent, and treat this condition may reduce the risk of adverse outcomes in older hospitalized patients. [source]

Sensitivity and Specificity of the Mini-Mental State Examination for Identifying Dementia in the Oldest-Old: The 90+ Study

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 2 2007
Kristin Kahle-Wrobleski PhD
OBJECTIVES: To evaluate the sensitivity and specificity of the Mini-Mental State Examination (MMSE) in identifying dementia in the oldest-old when stratified by age and education. DESIGN: Cross-sectional. SETTING: Research clinic and in-home visits. PARTICIPANTS: Population-based sample of adults aged 90 and older (n=435) who are enrolled in the 90+ Study, a longitudinal, population-based study. MEASUREMENTS: Neurological examination to determine dementia diagnosis, MMSE, and demographic data. RESULTS: Receiver operating characteristic (ROC) analyses indicated that the MMSE had high diagnostic accuracy for identifying dementia in subjects aged 90 and older across different age and education groups (area under the ROC curve values ranged from 0.82 to 0.98). A range of possible cutoff values and corresponding sensitivity and specificity are provided for the following age groups: 90,93, 94,96, and ,97. Age groups were subdivided by educational attainment (,high school, vocational school or some college, college degree or higher). In subjects aged 90 to 93 with a college degree or higher, the suggested MMSE cutoff score is ,25 (sensitivity=0.82, specificity=0.80). In those aged 94 to 96 with a college degree or higher, the suggested cutoff is ,24 (sensitivity=0.85, specificity=0.80). Those aged 97 and older with an education of high school or less had the lowest suggested cutoff ,22 (sensitivity=0.80, specificity=0.76). CONCLUSION: Overall, the MMSE had good sensitivity and specificity across all age and educational groups. Optimal cutoff points were lower in the older age groups and those with less education, primarily to preserve specificity. This screening instrument is appropriate for use with the oldest-old. [source]

Postpartum Depression Beyond the Early Postpartum Period

JOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 4 2004
IBCLC, Janice H. Goodman MSN
Objective: To review the literature concerning maternal postpartum depression beyond the early postpartum period. Data Sources: A literature search was conducted using Cinahl, Medline, and PsychInfo electronic databases. Keywords included postpartum depression, postpartum depressive symptoms, course, prevalence, incidence, and remission. Study Selection: Studies selected included incidence of maternal depression or depressive symptoms, existing in the early postpartum period, and measured again at postpartum points from 6 months through 2 1/2 years after delivery. Only studies published in English were included. Twenty-three articles were located, and a recent relevant study conducted by the current author also was included. Data Extraction: Studies were reviewed and data organized according to year, sample characteristics, time of depression assessment, instrument used, cutoff score, rate of depression, and factors associated with depression at later postpartum time points. Data Synthesis: For a significant percentage of women, postpartum depressive symptoms continue for months or even years after giving birth. Factors associated with postpartum depression at later time points are identified. Conclusions: Continued evaluation of women with elevated depression levels at initial screening, and treatment for women whose depression does not remit spontaneously within the first few weeks or months postpartum is recommended. Further research is needed to understand the phenomenon of persistent postpartum depression. [source]

Detection of Maternal Alcohol Use Problems in the Pediatric Emergency Department

ALCOHOLISM, Issue 7 2006
Heather A. Flynn
Background: Maternal alcohol use problems may impact the health and well-being of children, but often remain unrecognized. Mothers of young children seldom seek outpatient care for themselves; thus, pediatric settings may present an opportunity for the detection of maternal alcohol use problems. This study examines the feasibility of screening for and prevalence of alcohol use problems in mothers of young children in the context of seeking pediatric emergency care. We also examined the relationship of maternal alcohol use problems with use of pediatric emergency care. Methods: A total of 361 English-speaking mothers of children aged 7 and younger completed screening measures during their child's emergency care visit. TWEAK was used to screen for alcohol use problems. The screening survey also included information on children's health status and health care use, demographics, and the Center for Epidemiological Studies Depression Scale. Results: Of the women approached, 90% agreed to complete the screening measure. On the basis of cutoff score of 2 or more, 7% of women had elevated TWEAK scores. Those women with a TWEAK score >2 reported greater use of the pediatric emergency department (PED) than women scoring below the cutoff. On the basis of multivariate analyses, significant predictors of recent PED use included the presence of child chronic illness, younger maternal age, and TWEAK score. Conclusions: Screening for alcohol use problems among mothers of young children using the TWEAK appears to be feasible in a busy PED setting. The PED setting is promising for identifying risk drinking among women who may be less likely to be otherwise detected and for whom alcohol use may be impacting child outcomes. [source]

Validity of the Alcohol Use Disorders Identification Test in College Students

ALCOHOLISM, Issue 6 2004
Patricia K. Kokotailo
Background: High-risk alcohol use among college students is associated with accidents, partner violence, unwanted sexual encounters, tobacco use, and performance issues. The identification and treatment of high-risk drinking students is a priority for many college campuses and college health centers. The goal of this study was to test the psychometric properties of the Alcohol Use Disorders Identification Test (AUDIT) in college students. Methods: A convenience sample of students coming into a college health clinic was asked to complete the 10-question AUDIT and then participate in a research interview. The interview focused on assessing students for alcohol abuse and dependence by using the Composite International Diagnostic Interview Substance Abuse Module and timeline follow-back procedures to assess a 28-day drinking history. Results: A total of 302 students met the eligibility criteria and agreed to participate in the study. The sample consisted of 185 females (61%) and 117 males (39%), with a mean age of 20.3 years. Forty students were abstinent, 88 were high-risk drinkers, and 103 met criteria for a 12-month history of dependence. Receiver operator curves demonstrated that the AUDIT had the highest area under the cure for detecting high-risk alcohol use (0.872) and the lowest for identifying persons with a lifetime history of alcohol abuse or dependence (0.775). An AUDIT cutoff score of 6 or greater demonstrated a sensitivity of 91.0% and a specificity of 60.0% in the detection of high-risk drinkers. Conclusions: The AUDIT has reasonable psychometric properties in sample of college students using student health services. This study supports the use of the AUDIT in this population. [source]

Psychometric Properties of the Brazilian Version of the Drug Use Screening Inventory

ALCOHOLISM, Issue 10 2002
Denise De Micheli
Background Adolescent involvement with alcohol and other drugs is rising in Brazil, and there is an increasing need for psychometrically sound assessment tools to detect early drug involvement. Methods The psychometric properties of the Brazilian version of the Drug Use Screening Inventory (DUSI) were examined in a sample composed of 71 non,drug-dependent adolescents and 142 adolescents who met DSM-III-R criteria for drug dependence. Results With a cutoff score of 13% or lower for the absolute density index of the substance use area, DUSI correctly classified 80% of the drug-dependent adolescents and 90% of the non,drug-dependent adolescents, thus correctly classifying 83.6% of the sample. Factor analysis applied to each of the 10 DUSI areas indicated their unidimensionality, with substantial percentages of variance on the first factor. The Brazilian version of DUSI presented strong internal consistency reliability for the whole sample (drug-dependents and non,drug-dependent adolescents) with an average across all 10 scales for Cronbach's , reliability coefficient of 0.96 (standard deviation = 0.02) and for the split-half reliability coefficient of 0.88 (standard deviation = 0.08). Conclusions These results suggest that the Brazilian version of DUSI preserves its original psychometric properties and is a sensitive and useful screening instrument for drug use. [source]

Frequency of social phobia and psychometric properties of the Liebowitz social anxiety scale in Parkinson's disease,

MOVEMENT DISORDERS, Issue 12 2008
Arthur Kummer MD
Abstract There are few studies about social anxiety disorder in Parkinson's disease (PD). The objective of this study was to assess its frequency and to explore the psychometric properties of the Liebowitz social anxiety scale (LSAS) in PD. Ninety patients with PD underwent neurologic and psychiatric examination. Psychiatric examination was composed by a structured clinical interview (MINI-Plus) followed by the application of the LSAS, the Hamilton depression rating scale (Ham-D), and the Hamilton anxiety rating scale (Ham-A). Neurologic examination included the MMSE, the UPDRS, the Hoehn-Yahr Scale, and the Schwab-England scale of activities of daily living. Social phobia was diagnosed in 50% of PD patients. The disorder was not associated with any sociodemographic or neurological feature, but was associated to major depression (P = 0.023), generalized anxiety disorder (P = 0.023), and obsessive-compulsive disorder (P = 0.013). The score of LSAS correlated positively with the scores of Ham-D and Ham-A (P < 0.001 for both). A ROC curve analysis of the LSAS suggested that a cutoff score in 41/42 provided the best balance between sensitivity and specificity. This disorder seems to be more common and not just restricted to performance as previously thought. © 2008 Movement Disorder Society [source]

FSFI Scores of Women with Persistent Genital Arousal Disorder Compared with Published Scores of Women with Female Sexual Arousal Disorder and Healthy Controls

THE JOURNAL OF SEXUAL MEDICINE, Issue 2 2009
Sandra R. Leiblum PhD
ABSTRACT Introduction., Although persistent genital arousal disorder (PGAD) has been mistaken for hypersexuality, there is no research documenting the sexual functioning of PGAD women to support or refute such an assumption. Aim., To compare the Female Sexual Function Index (FSFI) scores of PGAD women to that of women diagnosed with female sexual arousal syndrome (FSAD) and healthy controls. Methods., The FSFI scores of heterosexual women who met all five features qualifying for a diagnosis of PGAD (N = 172) on an online questionnaire were compared with previously published FSFI scores of women diagnosed with FSAD (N = 128) and healthy controls (N = 131). Main Outcome Measure., Total and subscale scores on the FSFI. Results., On every subscale of the FSFI with the exception of desire, the PGAD women obtained scores between that of the FSAD and the healthy control group. The FSAD women displayed the greatest problems in desire, arousal, lubrication, orgasm, and pain while women with PGAD reported somewhat more desire than the control group but did not meet the cutoff score for sexual dysfunction. PGAD women are more similar to the normal control group than women with FSAD. Conclusions., There is no evidence to support the belief that women who meet criteria for a diagnosis of PGAD are "hypersexual." In fact, their overall sexual functioning falls within the normal range and is significantly better than that of women diagnosed with FSAD. Leiblum SR, and Seehuus M. FSFI scores of women with persistent genital arousal disorder compared with published scores of women with female sexual arousal disorder and healthy controls. J Sex Med 2009;6:469,473. [source]

Enthesis inflammation in recurrent acute anterior uveitis without spondylarthritis

ARTHRITIS & RHEUMATISM, Issue 7 2009
Santiago Muñoz-Fernández
Objective To investigate whether patients with idiopathic recurrent acute anterior uveitis (AAU) have enthesis alterations comparable with those in patients with spondylarthritis (SpA). Methods A blinded, controlled study of enthesis evident on ultrasound (US) examination was performed in 100 patients and controls classified into 5 groups, as follows: patients with confirmed SpA (group 1), patients with recurrent AAU who were positive for HLA,B27 and did not have SpA (group 2), patients with recurrent AAU who were negative for HLA,B27 and did not have SpA (group 3), patients with forms of uveitis other than those related to SpA (group 4), and healthy controls (group 5). In total, 12 enthesis locations were explored in each patient and control subject by 2 ultrasonographers who were blinded with regard to the diagnosis. A newly developed US method, the Madrid Sonography Enthesitis Index (MASEI), in which the diagnosis of SpA is determined as a cutoff score of 18 points, was used. Results A total of 1,200 entheses were explored by US in 100 patients and controls. The MASEI cutoff limit was met or exceeded by 81%, 55.6%, 40%, 10%, and 19% of the subjects in the 5 groups, respectively. The MASEI score was significantly higher in groups 1 and 2 than in groups 4 and 5. The differences between groups 1 and 3 were also found to be significant. Conclusion Our findings indicate that a high percentage of HLA,B27,positive patients with idiopathic recurrent AAU without features of SpA have enthesis lesions comparable with those seen in patients with SpA. These data suggest that patients with recurrent AAU, especially those who are HLA,B27 positive, have an abortive or incomplete form of SpA. [source]

Reliability and validity of the Japanese version of the child abuse potential inventory abuse scale

ASIA-PACIFIC PSYCHIATRY, Issue 3 2009
Yoshiya Kawamura BE MD
Abstract Introduction: The present study examined the reliability, validity, and cutoff scores of the Japanese version of the Child Abuse Potential Inventory (CAPI) abuse scale, which screens for parents at risk of child abuse. Methods: Samples consisted of 1,809 parents, 109 students, and 33 child abusers in Japan. The CAPI was administered to all participants, and twice to the student sample at a 2-week interval. Internal consistency was evaluated by Cronbach's ,, and construct validity by principal factor analysis with the parent sample. Test-retest reliability was assessed with Pearson's r with the student sample. With regard to predictive validity, the cutoff scores and classification rates were calculated through discriminant analysis between abusers and matched non-abusers. Results: Internal consistency (Cronbach's ,=0.88), test-retest reliability (Pearson's r=0.93; two-tailed P<0.001), and predictive validity (overall diagnostic power=90%) were all highly satisfactory. Regarding construct validity, the six-factor structure of the original version was not replicated; only three factors were obtained. The discriminant analysis showed the basic cutoff score as 159. The conservative cutoff score for the upper 5% of the parent sample was 218. Discussion: The Japanese version of the CAPI abuse scale showed highly satisfactory internal consistency, test-retest reliability, and predictive validity. The construct correspondence with the original version was more compromised. This version of the CAPI identified parents with scores of 159 or greater as being at risk of abusing a child. [source]

Brief Screening for Adolescent Depressive Symptoms in the Emergency Department

ACADEMIC EMERGENCY MEDICINE, Issue 1 2008
Maia S. Rutman MD
Abstract Background:, Depression is the most common psychiatric disorder among adolescents and is more prevalent among those seeking care in the emergency department (ED). However, adolescents are rarely screened for depressive symptoms in the pediatric emergency department (PED). Objectives:, To evaluate the sensitivity and specificity of one- and two-item screens for depressive symptoms compared to the 20-question Center for Epidemiologic Studies Depression Scale (CESD) among adolescents seeking care in a PED. Methods:, This was a cross-sectional study of a convenience sample of adolescents 12,17 years old presenting to an urban PED with subcritical illness or injury. Participants completed three screening instruments: the two-question screen, the single-question screen, and the CESD. Results:, A total of 321 patients were approached to enter the study, of whom 212 (66%) agreed to participate. Seventy-eight (37%) of the study participants screened positive for depression on the CESD using a cutoff score of ,16. The two-question screen had a sensitivity of 78% (95% confidence interval [CI] = 73% to 84%) and specificity of 82% (95% CI = 77% to 87%) for depressive symptoms compared with the CESD. The single-question screen had a sensitivity of 56% (95% CI = 50% to 63%) and specificity of 93% (95% CI = 90% to 96%) compared with the CESD. Conclusions:, The two-question screen is a sensitive and specific initial screen for depressive symptoms in adolescents being seen in the PED. This quick, simple instrument would be ideal for use in the busy PED setting and would allow clinicians to identify adolescents who require more extensive psychiatric evaluation. [source]

Development of a Brief Mental Health Screen for Intimate Partner Violence Victims in the Emergency Department

ACADEMIC EMERGENCY MEDICINE, Issue 3 2007
Debra Houry MD
Background: Emergency physicians routinely treat victims of intimate partner violence (IPV) and patients with mental health symptoms, although these issues may be missed without routine screening. In addition, research has demonstrated a strong association between IPV victimization and mental health symptoms. Objectives: To develop a brief mental health screen that could be used feasibly in an emergency department to screen IPV victims for depressive symptoms, posttraumatic stress disorder (PTSD) symptoms, and suicidal ideation. Methods: The authors conducted a pretest/posttest validation study of female IPV victims to determine what questions from the Beck Depression Inventory II, Posttraumatic Stress Diagnostic Scale, and Beck Scale for Suicide Ideation would predict moderate to severe levels of depressive symptoms, PTSD symptoms, and suicidal ideation. A principal components factor analysis was conducted to determine which questions would be used in the brief mental health screen. Scatter plots were then created to determine a cut point. Results: Scores on the brief mental health screen ranged from 0 to 8. A cutoff score of 4 was used, which resulted in positive predictive values of 96% for the brief mental health screen for depression, 84% for PTSD symptoms, and 54% for suicidal ideation. In particular, four questions about sadness, experiencing a traumatic event, the desire to live, and the desire to commit suicide were associated with moderate to severe mental health symptoms in IPV victims. Conclusions: The brief mental health screen provides a tool that could be used in an emergency department setting and predicted those IPV victims with moderate to severe mental health symptoms. Using this tool can assist emergency physicians in recognizing at-risk patients and referring these IPV victims to mental health services. [source]

Application of Regression-Discontinuity Analysis in Pharmaceutical Health Services Research

HEALTH SERVICES RESEARCH, Issue 2 2006
Ilene H. Zuckerman
Objective. To demonstrate how a relatively underused design, regression-discontinuity (RD), can provide robust estimates of intervention effects when stronger designs are impossible to implement. Data Sources/Study Setting. Administrative claims from a Mid-Atlantic state Medicaid program were used to evaluate the effectiveness of an educational drug utilization review intervention. Study Design. Quasi-experimental design. Data Collection/Extraction Methods. A drug utilization review study was conducted to evaluate a letter intervention to physicians treating Medicaid children with potentially excessive use of short-acting ,2 -agonist inhalers (SAB). The outcome measure is change in seasonally-adjusted SAB use 5 months pre- and postintervention. To determine if the intervention reduced monthly SAB utilization, results from an RD analysis are compared to findings from a pretest,posttest design using repeated-measure ANOVA. Principal Findings. Both analyses indicated that the intervention significantly reduced SAB use among the high users. Average monthly SAB use declined by 0.9 canisters per month (p<.001) according to the repeated-measure ANOVA and by 0.2 canisters per month (p<.001) from RD analysis. Conclusions. Regression-discontinuity design is a useful quasi-experimental methodology that has significant advantages in internal validity compared to other pre,post designs when assessing interventions in which subjects' assignment is based on cutoff scores for a critical variable. [source]

The MMSE orientation for time domain is a strong predictor of subsequent cognitive decline in the elderly

INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 12 2009
Elizabeth Guerrero-Berroa
Abstract Background The mini-mental state exam (MMSE) has been used to address questions such as determination of appropriate cutoff scores for differentiation of individuals with intact cognitive function from patients with dementia and rate of cognitive decline. However, little is known about the relationship of performance in specific cognitive domains to subsequent overall decline. Objective To examine the specific and/or combined contribution of four MMSE domains (orientation for time, orientation for place, delayed recall, and attention) to prediction of overall cognitive decline on the MMSE. Methods Linear mixed models were applied to 505 elderly nursing home residents (mean age,=,85,,>,12 years education,=,27%; 79% F, mean follow-up,=,3.20 years) to examine the relationship between baseline scores of these domains and total MMSE scores over time. Results Orientation for time was the only domain significantly associated with MMSE decline over time. Combination of poor delayed recall with either attention or orientation for place was associated with significantly increased decline on the MMSE. Conclusions The MMSE orientation for time predicts overall decline on MMSE scores over time. A good functioning domain added to good functioning delayed recall was associated with slower rate of decline. Copyright © 2009 John Wiley & Sons, Ltd. [source]

Factor structure of the Cornell Scale for Depression in Dementia among Japanese poststroke patients

INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 8 2002
Andrea S. Schreiner
Abstract Background The present study reports on the first translation and use of the Cornell Scale for Depression in Dementia (CSDD) (Alexopoulos, Abrams, Young, & Shamoian, 1988) among poststroke patients (n,=,101) in Japan. Objectives The study had three main purposes: 1. To examine the factor structure of the CSDD among Japanese poststroke patients; 2. To compare this with the factor structure identified for Anglo-American Alzheimer's (AD) patients; and 3. To examine the prevalence and covariates of depressive symptoms among the Japanese stroke survivors. Methods Poststroke patients and their caregivers (n,=,202), at a random sample of neurological hospitals in western Japan, were interviewed using the study instruments. Data was also collected from patient charts. All subjects at each site who met the study criteria participated in the study. Results The four-factor solution for poststroke subjects was analogous to that found among AD patients with 2 main exceptions. In contrast to AD patients: 1. Physical complaints were unrelated to depressed mood in stroke patients; and 2. Agitation and psychosis loaded with depressed mood in stroke patients rather than as a separate unique factor as in AD patients. However, in the exploratory 5-factor model, agitation and suicidal ideation comprised a unique factor. Using standard cutoff scores for the CSDD, 58.2% of poststroke patients had scores suggesting possible depression. CSDD scores were not related to functional ability, or stroke characteristics such as aphasia or right or left-sided paralysis. However, scores were significantly higher among subjects,2 years poststroke. Feelings of irritability, anxiety, sadness, and sleep problems were most prevalent. Discussion Despite the prevalence of depressive symptoms, none of the subjects were currently receiving any mental health treatment. Findings suggest that symptoms differ by poststroke duration, which may necessitate different treatment approaches. Copyright © 2002 John Wiley & Sons, Ltd. [source]

Clinical Utility of Office-Based Cognitive Predictors of Fitness to Drive in Persons with Dementia: A Systematic Review

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 12 2006
Frank J. Molnar MDCM
OBJECTIVES: To perform a systematic review of evidence available regarding in-office cognitive tests that differentiate safe from unsafe drivers with dementia. DESIGN: A comprehensive literature search of multiple databases including Medline, CINAHL, PsychInfo, AARP Ageline, and Sociofile from 1984 to 2005 was performed. This was supplemented by a search of Current Contents and a review of the bibliographies of all relevant articles. SETTING: English prospective cohort, retrospective cohort, and case-control studies that used accepted diagnostic criteria for dementia or Alzheimer's disease and that employed one of the primary outcomes of crash, simulator assessment, or on-road assessment were included. PARTICIPANTS: Two reviewers. MEASUREMENTS: The reviewers independently assessed study design, main outcome of interest, cognitive tests, and population details and assigned a Newcastle-Ottawa quality assessment rating. RESULTS: Sixteen articles met the inclusion criteria. Tests recommended by guidelines (e.g., the American Medical Association (AMA) and Canadian Medical Association guidelines) for the assessment of fitness to drive did not demonstrate robustly positive findings (e.g., Mini-Mental State Examination, Trails B) or were not evaluated in any of the included studies (e.g., Clock Drawing). Fifteen studies did not report any cutoff scores. CONCLUSION: Without validated cutoff scores, it is impossible to employ tests in a standardized fashion in front-line clinical settings. This study identified a research gap that will prevent the development of evidence-based guidelines. Recommendations to address this gap are that driving researchers routinely perform cutoff score analyses and that stakeholder organizations (e.g., AMA, American Geriatrics Society) sponsor consensus fora to review driving research methodologies. [source]

Systematic determination of ion score cutoffs based on calculated false positive rates: application for identifying ubiquitinated proteins by tandem mass spectrometry

JOURNAL OF MASS SPECTROMETRY (INCORP BIOLOGICAL MASS SPECTROMETRY), Issue 3 2008
Julian Vasilescu
Abstract We report a simple approach for determining ion score cutoffs that permit the confident identification of ubiquitinated proteins by tandem mass spectrometry (MS/MS). Initial experiments involving the analysis of gel bands containing multi-Ubiquitin chains with quadrupole time-of-flight and quadrupole ion trap mass spectrometers revealed that standard ion score cutoffs used for database searching were not sufficiently stringent. We also found that false positive and false negative rates (FPR and FNR) varied significantly depending on the cutoff scores used and that appropriate cutoffs could only be determined following a systematic evaluation of false positive rates. When standard cutoff scores were used for the analysis of complex mixtures of ubiquitinated proteins, unacceptably high FPR were observed. Finally, we found that FPR for ubiquitinated proteins are affected by the size of the protein database that is searched. These observations may be applicable for the study of other post-translational modifications. Copyright © 2007 John Wiley & Sons, Ltd. [source]