Elaine Souder

Dementia Diagnostic Guidelines: Methodologies, Results, and Implementation Costs

OBJECTIVE: To facilitate the diagnostic process for dementia. Five guidelines and four consensus statements on specific diagnostic recommendations, specialist referral recommendations, and costs of recommended diagnostic procedures were compared and summarized.

Disruptive Behaviors of Older Adults in an Institutional Setting

This study, as part of a larger project, examined the actual time recorded by nursing staff to manage 36 disruptive behaviors in older adults who are institutionalized. Disruptive behaviors were defined as socially unacceptable or isolating, observable actions with negative consequences. A prospective study was conducted using a sample of 153 patients in a Veterans Affairs institution (mean age = 72.6, SD = 10.8). Data related to time to manage disruptive behaviors were collected during 21 consecutive shifts for each patient. Nursing staff did not always intervene in all disruptive behaviors that occurred. When they did intervene, total time to manage a disruptive behavior ranged from 5.7 to 201.5 minutes (mean = 23.1 minutes, SD = 31.9).

Challenges in tailored intervention research

Although individuals and nurses value tailored health interventions, incorporating tailored interventions into research is fraught with pitfalls. This manuscript provides guidance on addressing challenges on developing, implementing, and evaluating tailored interventions (TIs). The initial step in designing TIs involves selecting the individual characteristics on which to tailor the intervention. After selecting critical characteristics for tailoring, researchers must decide how to assess these characteristics. Then researchers can use manuals, algorithms, or computer programs to tailor an intervention and maintain treatment fidelity. If desired outcomes are not achieved, focus groups or individual interviews may be conducted to gather information to improve the intervention for specific individuals/groups. Then, incorporating study arms of TIs in intervention studies, investigators may compare TIs with standardized interventions statistically and clinically. We believe TIs may have better outcomes, promote better adherence, and be more cost efficient.

Regional cerebral glucose metabolism in healthy volunteers determined by fluordeoxyglucose positron emission tomography: appearance and variance in the transaxial, coronal, and sagittal planes.

PURPOSE In this study, the contribution of the transaxial, coronal, and sagittal planes in evaluations of regional cerebral glucose metabolism was investigated in healthy volunteers as determined by fluorine-18-labeled 2-deoxy-2-fluoro-D-glucose (FDG) and high-resolution positron emission tomography (PET). METHODS One hundred twenty-seven healthy right-handed volunteers were injected with 4.2 MBq/kg (0.11 mCi) body weight FDG and imaged in a PENN PET H 240 scanner. Images were corrected for scatter and random coincidences and reconstructed in all three planes into 6- to 8-mm-thick slices. The reconstructed images were corrected for attenuation using the Chang algorithm. The transverse, coronal, and sagittal images were read independently of each other using a qualitative scale in which 1 = equal to, 2 = mildly, 3 = moderately, and 4 = markedly less than the area with the highest glucose metabolism in the respective plane. RESULTS The areas with the highest glucose metabolisms were the posterior cingulate gyri with mean scores of 1.1 to 1.2, thalami (1.2 to 1.3), basal ganglia (1.5 to 1.9), and visual cortex (1.6). The lowest values were found in the occipital cortex (2.7 to 2.8) and the cerebellum (2.3 to 2.4). Whereas reliable analysis of the mesial temporal aspects was not feasible in the sagittal plane, the anterior poles of the temporal and frontal lobes could not be evaluated in the coronal or the inferior temporal areas in the transaxial slices. In all three planes, regional glucose metabolism was less in the lateral temporal areas on the left than on the right (P < 0.001). The consistency of readings as measured in terms of coefficients of variation was greatest in the coronal plane for the caudates and posterior cingulate gyri, in the transaxial plane for the lateral temporal regions, and in the sagittal plane for the visual cortex. Age-dependent decreases in regional glucose metabolism in the inferior and lateral frontal regions and the parietal lobes were found in all three planes. CONCLUSIONS All three projection planes must be used for a comprehensive qualitative evaluation of the regional glucose metabolism of the brain.

Identifying Patterns of Disruptive Behavior in Long‐Term Care Residents

OBJECTIVES: To determine the frequency, timing, and pattern of 45 operationalized disruptive behaviors (DB) in older people in long‐term care units.

Disparities in Women's Cardiovascular Health

Cardiovascular disease (CVD) is the leading cause of death in women, and disparities affect the diagnosis, treatment, and outcomes of CVD for women. Biology, genetics, and race contribute to these disparities. Obstetric-gynecologic health care providers routinely encounter women who are at risk for developing CVD and are uniquely positioned as a point of access to intervene to improve/prevent CVD by assessing for risks and discussing healthy lifestyle changes during routine visits.

Assessing dressing ability in dementia

Cognitive impairment can profoundly affect the skills required for activities of daily living (ADL). Most cognitive screening measures assess cognitive status rather than the cognitive functions that underlie ADL tasks. The dressing assessment guide (DAG) assesses the cognitive and functional abilities in dressing of patients with dementia. The DAG evaluates everyday and overlearned tasks and uses cues to provide a context for action. Nurses can easily administer the guide, and the resulting data provide the basis for nursing interventions.

MRI Volumetric Studies in Alzheimer's Disease: Relationship to Clinical and Neuropsychological Variables

The authors studied 34 subjects with probable dementia of the Alzheimer type (DAT) and 28 healthy, age-matched control subjects, using a 1.5-tesla GE MRI scanner. Absolute volumes of ventricular and sulcal cerebrospinal fluid spaces and volumes, corrected for total intracranial volume, were significantly higher (P < 0.01) in the DAT group, compared to the control group. Right-left measures of hemispheric structural asymmetry were greater in the DAT group, whereas aging alone influenced brain structure in the control group. Also, in the DAT group, certain volumetric measures were significantly correlated with specific clinical indicators of severity of illness and some neuropsychological indices. These data demonstrate widespread structural abnormalities in relatively early DAT and a relationship between brain structure and some measures of cognitive dysfunction.

Use of Lay Educators to Overcome Barriers to Research with Black Older Adults: A Case Study Using an Alzheimer’s Disease Center

There are many well-documented barriers to recruitment of Black participants in clinical research. This is of concern in Alzheimers disease (AD) research because of the escalating rate of AD in this group, the increasing proportion of minority groups, and their low rate of research participation. Our Alzheimers Disease Center (ADC) Black Advisory Board recommended we try a lay educator (LE) approach to bridge the gap between the community and university-based research center. As a result, our LE program contributed to a significant increase in the number of AD presentations given to the Black community. Although the number of Black participants enrolled in our ADC program increased from 12% to 25%, the process was challenging. However, the LE program led to significant progress in our efforts to meet our enrollment expectations, fostered links between the university and the Black community, and furthered our understanding of the barriers created by our recruiting practices.

Perceptions of family history and genetic testing and feasibility of pedigree development among African Americans with hypertension.

Background: Pedigree development, family history, and genetic testing are thought to be useful in improving outcomes of chronic illnesses such as hypertension (HTN). However, the clinical utility of pedigree development is still unknown. Further, little is known about the perceptions of African Americans (AAs) of family history and genetic testing. Aims: This study examined the feasibility of developing pedigrees for AAs with HTN and explored perceptions of family history and genetic research among AAs with HTN. Methods: The US Surgeon General’s My Family Health Portrait was administered, and 30–60 min in-person individual interviews were conducted. Descriptive statistics were used to analyze pedigree data. Interview transcripts were analyzed with content analysis and constant comparison. Results: Twenty-nine AAs with HTN were recruited from one free clinic (15 women, 14 men; mean age 49 years, standard deviation (SD) 9.6). Twenty-six (90%) reported their family history in sufficient detail to develop a pedigree. Perceptions of family history included knowledge of HTN in the family, culturally influenced family teaching about HTN, and response to family history of HTN. Most participants agreed to future genetic testing and DNA collection because they wanted to help others; some said they needed more information and others expressed a concern for privacy. Conclusion: The majority of AAs in this sample possessed extensive knowledge of HTN within their family and were able to develop a three-generation pedigree with assistance. The majority were willing to participate in future genetic research.