David M. Stein

Vascular Factors and Risk for Neuropsychiatric Symptoms in Alzheimer’s Disease: The Cache County Study

OBJECTIVE To examine, in an exploratory analysis, the association between vascular conditions and the occurrence of neuropsychiatric symptoms (NPS) in a population-based sample of incident Alzheimers disease (AD). METHODS The sample consisted of 254 participants, identified through two waves of assessment. NPS were assessed using the Neuropsychiatric Inventory. Prior to the onset of AD, data regarding a history of stroke, hypertension, hyperlipidemia, heart attack or coronary artery bypass graft (CABG), and diabetes were recorded. Logistic regression procedures were used to examine the relationship of each vascular condition to individual neuropsychiatric symptoms. Covariates considered were age, gender, education, APOE genotype, dementia severity, and overall health status. RESULTS One or more NPS were observed in 51% of participants. Depression was most common (25.8%), followed by apathy (18.6%), and irritability (17.7%). Least common were elation (0.8%), hallucinations (5.6%), and disinhibition (6.0%). Stroke prior to the onset of AD was associated with increased risk of delusions (OR = 4.76, p = 0.02), depression (OR = 3.87, p = 0.03), and apathy (OR = 4.48, p = 0.02). Hypertension was associated with increased risk of delusions (OR = 2.34, p = 0.02), anxiety (OR = 4.10, p = 0.002), and agitation/aggression (OR = 2.82, p = 0.01). No associations were observed between NPS and diabetes, hyperlipidemia, heart attack or CABG, or overall health. CONCLUSIONS Results suggest that a history of stroke and hypertension increase the risk of specific NPS in patients with AD. These conditions may disrupt neural circuitry in brain areas involved in NPS. Findings may provide an avenue for reduction in occurrence of NPS through the treatment or prevention of vascular risk conditions.

Cognitive Stimulation and Cognitive and Functional Decline in Alzheimer's Disease: The Cache County Dementia Progression Study

OBJECTIVES To examine the association of engagement in cognitively stimulating activities with cognitive and functional decline in a population-based sample of incident Alzheimers disease (AD). METHOD After diagnosis, 187 participants (65% females) were followed semiannually for a mean 2.7 (SD = 0.4) years. Mean age and education were 84.6 (SD = 5.8) and 13.2 (SD = 2.9) years. Caregivers enumerated cognitively stimulating leisure activities via the Lifestyle Activities Questionnaire. Cognition was assessed using the Mini-Mental State Examination and functional ability via the Clinical Dementia Rating sum of boxes. Linear mixed models tested the association between stimulating activities and change over time in each outcome. Covariates were demographic factors, estimated premorbid IQ, presence/absence of the APOE ε4 allele, duration of dementia, level of physical activity, and general health. RESULTS At initial assessment, 87% of participants were engaged in one or more stimulating activities, with mean (SD) activities = 4.0 (3.0). This number declined to 2.4 (2.0) at the final visit. There was a statistical interaction between dementia duration and number of activities in predicting rate of cognitive decline (p = .02) and overall functional ability (p = .006). DISCUSSION Active involvement in cognitively stimulating pursuits may be beneficial for persons with AD.

A prospective analysis of eating disorder risk factors: drive for thinness, depressed mood, maladaptive cognitions, and ineffectiveness

This study examined whether elevations on four variables (drive for thinness, depressed mood, maladaptive cognitions, and ineffectiveness) were related to increased severity of eating disorder symptoms over a 4-year prospective interval in a sample of female undergraduates (N=80). Results indicated that initial scores on the four variables were related to severity of anorexic and bulimic symptoms 4 years later. Examination of each variable individually indicated that anorexia and bulimia may have different risk pathways, and that initial maladaptive cognitions and drive for thinness scores were more related to later eating disorder symptoms than were depressed mood or ineffectiveness.

Predicting success and failure in juvenile drug treatment court: A meta-analytic review

This meta-analysis summarizes 41 studies that examined associations between characteristics of adolescent participants in juvenile drug treatment court and outcomes (i.e., premature termination, recidivism). A summary of within- and post-program recidivism rates was calculated, as was a global estimate of the premature drop-out rate. One clear trend in the available studies was the dramatic difference in recidivism rates for adolescents who succeed in graduating from drug court, relative to those who do not. In addition, the review revealed that behavior patterns evidenced during drug court participation were most strongly associated with both the probability of graduating successfully from drug court and recidivism (e.g., few in-program arrests, citations, detentions, and referrals; greater length of time in program or amount of treatment; lower use of drug and alcohol use, few positive urine screens, greater school attendance). Unfortunately, non-white participants tend to have a lower probability of graduation from drug court and experience higher recidivism during and following the program. Available juvenile drug treatment court studies confirm a number of reputed adolescent risk factors associated with substance abuse, criminality, treatment failure, and recidivism among adolescents (e.g., higher levels of emotional and behavioral problems, higher levels and severity of pre-program substance abuse, male gender). Suggestions for improving the effects of juvenile drug treatment court based on key results of the meta-analysis are offered.

The scaling of restraint and the prediction of eating

The most frequently used measure of dietary restraint in controlled experiments involving arduous dieters is the Revised Restraint Scale (Herman & Mack, 1975). To date, researchers who have used the measure in controlled experiments have created a “high” versus “low” artificial dichotomy based on a median split of scores on the scale, apparently in an attempt to apply a standard analysis of variance model. The present study replicates a basic ice cream taste test experiment. It compares study results that emerge from using the Revised Restraint Scale as an artificial dichotomy (“factor”) versus a continuous independent variable in a general linear model. Results showed that an important joint effect emerged when restraint was treated as a continuous variable, which would likely have gone undetected using standard ANOVA, and that a greater proportion of variance could be accounted for in the continuous variable model. Researchers to date may have failed to optimally outline the nature of the relationship between dietary restraint and other variables that have been of interest.

The Effect of Computerized Dietary Analysis Nutrition Education on Nutrition Knowledge, Nutrition Status, Dietary Compliance, and Quality of Life of Hemodialysis Patients

■ Objective: To assess the effect of nutrition education, using computerized dietary analysis, on nutrition knowledge, nutrition status, dietary compliance, and quality of life in hemodialysis patients. ■ Design: A 6-month nonrandomized control study including 3 months of prestudy data. ■ Setting: A free-standing dialysis center that treated approximately 50 hemodialysis patients. ■ Patients: Twenty chronic hemodialysis patients (treatment: n=12, control: n=8) who voluntarily agreed to participate. ■ Interventions: All study participants completed prestudy and poststudy quality-of-life assessments, a depression inventory, and a nutrition knowledge assessment. Patients in the treatment group completed monthly 3-day food records, which were analyzed by computer nutrient analysis software. Results were discussed with the patients during one-on-one education sessions. Control patients completed prestudy and poststudy 3-day food records. ■ Main outcome measures: Change in prestudy and poststudy assessment scores, nutritionrelated laboratory data, anthropometric data, and dietary data. ■ Results: The treatment groups nutrition knowledge test scores significantly improved. Nutrient intakes showed no significant changes except for calorie intake, which decreased in the treatment group. Serum albumin and total protein increased in both groups, and the protein catabolic rate (PCR) of the treatment group increased significantly. The treatment group showed improvement in the alertness behavior area of the Sickness Impact Profile (SIP), and the control group declined in the recreation and pastimes area of the SIP. ■ Conclusions: Computerized dietary analysis is an effective instruction tool, is helpful in improving dietary protein intake as measured by PCR, and may contribute to improved quality of life of hemodialysis patients.

The Effectiveness of Juvenile Treatment Drug Courts: A Meta-Analytic Review of Literature

Reviewed are 31 studies that evaluated recidivism rates from juvenile drug treatment courts relative to a random-assignment or convenience comparison group. Recidivism was defined as re-referral, new charges, or re-arrest. Mean effect sizes and confidence intervals are provided for the three recidivism assessment time frames most often used by researchers (e.g., recidivism occurring “during the drug court program”; “during, plus post-program”; and “post-program only”). Characteristics of youths and programs that were hypothesized to correlate with the size of effect (e.g., gender and ethnic proportions of program participants, methodological quality of studies) were examined in an attempt to account for variation in effect sizes across studies. The average premature termination rate from drug court programs, as a face-valid indicator of typical program effectiveness, is also reported. The results, based on significantly more studies than past reviews, show that juvenile drug court treatment program youths, relative to controls, had slightly more gains than short-term, pre-to-post-program assessments. Results are compared to adult drug court outcomes, and program and participant correlates of effect size are discussed. Suggestions for further research into possible improvements of programs are offered.

Voice Synthesis Supplement to a Computerized Interviewing Training Program: Retention Effects

We examined the effects of adding microcomputer-generated voice synthesis to a computer-assisted learning exercise involving clinical interviewing. Three modes of presenting case material were studied: (a) video text only, (b) voice only, and (c) synthesized voice-plus-video text. College students prefered either the voice-only or text-only presentation, but they more accurately recalled details of the case material in the voice-plus-video text mode.

Anorexia nervosa: Empirical basis for the restricting and bulimic subtypes

Abstract The future revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) will describe diagnostic criteria for two anorexia nervosa subgroups: a binge eating or bulimic subtype, and a severe food restriction subtype. The present literature review will help orient nutrition and dietetic students, educators and researchers to the empirical bases for these subtypes. Available research on these two subtypes is equivocal. However, some important trends have emerged. Compared with restricting anorexics, bulimic anorexics are described by others as being significantly more unhappy during childhood and displaying a greater range of impulsive behaviors. In addition, bulimic anorexics have a higher lifetime prevalence of formal mood disorders, tend to use more alcohol and drugs, and tend to meet the criteria for DSM III-R Cluster B Personality disorders rather than those for Cluster C. Also, the bulimic subtype tends to have a more chaotic family environment. Finally, more patients of the bulimic subtype seem to show subaverage bone density, suggesting a higher risk for chronic osteoporosis. The present review discusses the significant research and treatment implications of the differences between these anorexic subtypes.

Cognitive activity and decline in Alzheimer's disease: The Cache County study

expert consensus panel. IADL limitations were obtained from interviews with informants for the participant. Results: Among individuals with dementia, a large number of participants did not complete the tests due to cognitive impairment or other reasons (e.g., 18.3% for Animal Fluency Test, 50.2% for Trail Making Test A, 77.6% for Trail Making Test B). Among those completing the test, significantly higher proportion of those with CIND and dementia had abnormal scores compared to those with normal cognition for each test (p < 0.001 for all tests). 18.4% of those with normal cognition, 57.0% of those with CIND and 89.1% of those with dementia had abnormal scores for at least one test. Among those with normal cognition or CIND, worse test scores were associated with a greater number of limitations in IADLs (p < 0.01 for all tests). Conclusions: Impairment on executive function measures may be common even among individuals without dementia, and it may be associated with IADL limitations. Assessing executive function for those without dementia may help to identify individuals with greater needs for daily support.