Kristin Hannesdottir

The relationship between amnesia and crime: the role of personality

Abstract The aim of the study was to investigate the role of personality factors in crime-related amnesia. It was hypothesised that personality factors, such as introversion and good impulse control, would be associated with increased likelihood of psychogenic amnesia. The subjects were 37 offenders referred for a psychiatric evaluation, 18 of whom claimed partial amnesia for the offence. Their scores on a number of psychological tests were compared with the offenders who did not claim amnesia for the offence. Introversion, good impulse control and blaming the offence on mental factors, were significantly related to the reporting of amnesia for the offence. Over-controlled hostility and the scores on lie scales were not associated with the reporting of amnesia.

A study of the Alzheimer's Disease Assessment Scale-Cognitive (ADAS-Cog) in an Icelandic elderly population

The Alzheimers Disease Assessment Scale (ADAS) is designed for screening of cognitive and non-cognitive dysfunctions characteristic of persons with probable Alzheimers disease (AD). The cognitive part of the scale (ADAS-Cog) is both convenient for screening of probable AD and as a measure of cognitive functioning during drug intervention. The aim of this study was to translate the ADAS-Cognitive sub-test (ADAS-Cog) into Icelandic and to study its application in an elderly Icelandic population. The Mini-Mental State Examination (MMSE) and the ADAS-Cog were administered to 20 AD patients and 20 controls. Each patient was also rated on the Global Deterioration Scale (GDS). The probable AD patients were divided into two groups based on their GDS: 3-4 and 5-6 points. The patients were also divided into two groups based on their MMSE score: very mild to mild (23-30 points) and mild to moderate (15-22 points). Furthermore, the subjects were divided into two age groups: 65-76 and 77-92 years. Results revealed a highly significant difference on MMSE (22.3 - 3.4; 26.8 - 1.6; P < 0.05) and ADAS-Cog (18.4 - 7.7; 7.3 - 3.5; P < 0.05) scores for patients and controls respectively. AD patients also performed significantly worse than the elderly control group on eight of the 11 sub-tests. Thus, the present findings are mainly in line with those of previous studies. The scale exceeds other screening tests such as the MMSE in that it addresses in more detail the symptoms of AD and is valuable for early detection of the illness and staging. ADAS-Cog plays an important role in the diagnostic makeup of AD along with other detailed investigations, such as neuropsychological assessment.

THE RELATIONSHIP OF ALCOHOL WITHDRAWAL SYMPTOMS TO SUGGESTIBILITY AND COMPLIANCE

People who are experiencing alcohol withdrawal are disadvantaged in terms of their ability to cope with leading questions and interrogative pressure (i.e. interrogative suggestibility). What had not been studied previously was the relationship of the severity of alcohol withdrawal symptoms with suggestibility and compliance. Suggestibility and compliance scores, obtained during the first week of hospital admission, were correlated with the severity of alcohol symptoms measured on a daily basis over a 7‐day period in a group of 393 patients attending treatment for alcohol abuse problems. Separate analyses were performed for the male and female patients. Significant gender differences emerged. Among males, alcohol withdrawal symptoms correlated positively with suggestibility and compliance across days. In contrast, among the females alcohol withdrawal symptoms were not significantly correlated with suggestibility and compliance, but were related to confabulations in memory recall. The findings suggest that in relation to psychological vulnerabilities during questioning, alcohol withdrawal symptoms are associated with different psychological factors in males and females. The findings have implications for the potential unreliability of information obtained from people interviewed during alcohol withdrawal.

Validation of the Icelandic version of the Neuropsychiatric Inventory with Caregiver Distress (NPI-D)

Background: Dementia is a complex and often debilitating illness, presenting with not only wide-ranging cognitive impairment but also neuropsychiatric challenges, which can have diverse consequences in quality of life for both patient and caregiver. Aim: Studying the validity and reliability of an Icelandic translation of the Neuropsychiatric Inventory with Caregiver Distress (NPI-D). Methods: NPI-D was administered to 38 primary caregivers of dementia patients. The concurrent validity was explored by statistically comparing the NPI-D to the Behavioural Pathology in Alzheimers Disease Rating Scale (BEHAVE-AD) and the Geriatric Depression Scale (GDS). Regarding caregiver distress, concurrent validity was established between NPI-D, BEHAVE-AD Global Rating and two other caregiver distress scales. Results: Significant correlation was found when total score on the BEHAVE-AD was compared with total score on the NPI-D. All NPI-D subscales achieved significant correlation with the corresponding BEHAVE-AD subscales apart from the ‘depression/dysphoria subscale’. This NPI-D subscale correlated however, significantly with the GDS depression scale, a frequent and well validated measure of depressive symptoms in the elderly population. Cronbachs alpha coefficient indicated a high degree of overall internal consistency among the items of the NPI-D. Interestingly, apathy was the most frequent neuropsychiatric disturbance and the only subscale that differed significantly between dementia severity levels. Finally, when studying caregiver distress, the NPI-D showed good concurrent validity with other measures of caregiver burden and distress. Conclusions: The results demonstrate an acceptable level of validity and reliability; therefore the Icelandic translation of the NPI-D is well suited for identifying neuropsychiatric symptoms in dementia and associated caregiver burden.

The effects of alcohol withdrawal on memory, confabulation, and suggestibility

The aim of this study was to investigate the effects of alcohol withdrawal on the accuracy of information obtained during an interview, and in the ability of participants to cope with interrogative pressure. Participants were randomly assigned to one of two groups. Group 1: patients to be tested psychologically on the second or third day of their admission. Group 2: patients who were to be assessed towards the end of their 10-day stay in hospital (i.e. after 6 or more days). The participants were a group of 75 patients admitted as inpatients to a detoxification centre in Iceland. They completed measurements of alcohol withdrawal symptoms, Mini-Mental State, state and trait anxiety, suggestibility, memory, confabulation and compliance. Significant differences emerged, as predicted, with regard to impaired cognitive abilities and heightened anxiety symptoms, but no differences were found for suggestibility, confabulation and compliance. However, a significantly larger Shift score on the Gudjonsson Suggestibility Scale was observed on the third day as an in-patient, as compared with that obtained on the second day of admission and for patients in Group 2. The main conclusion from the study is that, on the third day of detoxification, patients become significantly less able to cope with interrogative pressure. This has practical implications for police interviewing.The aim of this study was to investigate the effects of alcohol withdrawal on the accuracy of information obtained during an interview, and in the ability of participants to cope with interrogative pressure. Participants were randomly assigned to one of two groups. Group 1: patients to be tested psychologically on the second or third day of their admission. Group 2: patients who were to be assessed towards the end of their 10-day stay in hospital (i.e. after 6 or more days). The participants were a group of 75 patients admitted as inpatients to a detoxification centre in Iceland. They completed measurements of alcohol withdrawal symptoms, Mini-Mental State, state and trait anxiety, suggestibility, memory, confabulation and compliance. Significant differences emerged, as predicted, with regard to impaired cognitive abilities and heightened anxiety symptoms, but no differences were found for suggestibility, confabulation and compliance. However, a significantly larger Shift score on the Gudjonsson Suggestib...

Retinal oxygen metabolism in patients with mild cognitive impairment

We have previously reported that retinal vessel oxygen saturation is increased in mild‐to‐moderate dementia of Alzheimers type when compared with healthy individuals. Mild cognitive impairment (MCI) is the predementia stage of the disease. The main purpose was to investigate if these changes are seen in MCI.

Subjective experiences following a diagnosis of Alzheimer's disease

accurately predicts driving safety. Methods: 45 patients at the Banner Alzheimer’s Institute received a driving test, either an on-road test or driving simulator. Analyses were conducted on the following variables to assess possible relationship of Passing, Failing, or Passing with Restrictions (PwR): age, sex, years of education, cognitive diagnosis, MMSE (total score and pentagons), MoCA (total score, trails, cube copy, and clock), informant concerns about driving, and location of driving test. Results: Univariate analyses demonstrate that patients in Pass, Fail, and PwR groups differed in terms of patient age (KW ANOVA p1⁄40.0312), MMSE-pentagon score (KW ANOVA p1⁄40.0279) and informant concerns about driving (Fisher’s exact p1⁄40.009). All other variables showed no significant difference (KWANOVA or Fisher’s exact p>0.05). In the pair-wise multiple comparison tests, patients in the Pass group showed a trend of having lower age than those in the Fail group (72.964.1 compared to 76.867.3, Multiple comparisons p1⁄40.061). MMSE-Pentagon score did not survive the multiple comparison tests (p>0.05). 91% of the patients who failed the driving test had informants with concerns for safety, compared to 38% of patients who passed (p1⁄40.000434, unadjusted for multiple comparison) and 38% who passed with restriction (p1⁄40.0407, unadjusted). Multivariate analysis with the General Classification and Regression Tree (GC&RT) created an algorithm (see figure) demonstrating that age, MMSE total score, MOCA-total score, MMSE-pentagon, MOCA-clock, and informant concerns with driving are useful in predicting outcome of the driving test. Conclusions: Further studies with larger population size are needed to help validate and improve the proposed algorithm to guide clinicians in determining driving safety in patients with dementia. Preliminary data suggest that age, MMSE total score, MOCA-total score, MMSE-pentagon, MOCA-Clock, and, informant concerns with driving may be associated with the driving test outcome.

Obstructive sleep apnea and daytime resting EEG in mild Alzheimer's disease

Background:AD is associated with memory impairments and neurodegeneration in the hippocampus. Others showed that normal elders with early AD evidenced by increased brain amyloid b (Ab), had impaired functional connectivity with posterior cingulated cortex or precuneus [J Neurosci. 2009 (40):12686-94; Biol Psychiatry. 2010 67(6):584-7]. Our goal was to test the hypothesis that early AD, evidenced by increased brain amyloid b (Ab), is associated with reduction of hippocampal volume and alternation of functional connectivity of the hippocampus-centeredmemory network, in the absence of neuropsychological change.Methods: Cognitive normal elderly (N1⁄424, aged 60 89 years) had brain Ab assessedwith florbetapir F 18 PET by visual ratings and standard uptake value ratio (SUVr). Nine participants were A b + and 15 were negative A b -. Whole brain resting-state fMRI was acquired and registered to a template T1 image. Correlation coefficient with a seed region in combined bilateral hippocampal head was calculated with every voxel in the forebrain gray matter. Hippocampal and cortical volumes were measured with Freesurfer and hippocampal subfield volumes in the body were measured with ASHS.Results: There were no effects of Ab on standard neuropsychological tests, a memory-related pattern separation test, or cortical gray matter volumes. In comparison with A b subjects, A b + subjects had reduced volumes in right CA3 of the hippocampal body (256 5 vs. 316 7 mm 3), left hippocampal head (14956 190 vs. 1757 6 209 mm 3), and entire hippocampus (7312 6 631 vs. 7912 6 705 mm 3). In comparison with the A b group, functional connectivity with the hippocampus seed in the A b + group increased in left thalamus but decreased in left middle frontal gyrus and left precentral gyrus (p<0.01 after correction, Figure 1). The connectivity between the hippocampus seed and the left thalamus cluster significantly correlated with SUVr even when covarying for either age or hippocampal volume (r1⁄40.50, p<0.05) and marginally significant for the other two clusters. Conclusions: Our finding of changes in structure and functional connectivity of the hippocampus in early AD demonstrates disruption of the hippocampus-centered memory network prior to neuropsychological changes. These neuroimaging findings may be used for early detection and to identify subjects for AD prevention trials.

Cognitive fluctuations and sleep disordered breathing in Alzheimer's disease: A pilot study

quality of working memory (P<0.015) and speed of retrieval of information held in memory (P<0.0001). Power of attention showed significant deficits from year one onwards, two other measures showed deficits by year one, and all showed significant deficits from year three onward. Conclusions: This study has demonstrated that the use of validated and sensitive tests of cognitive function can detect decline over a 5-year period in healthy elderly volunteers. Such testing is therefore fit for purpose for the evaluation of treatments aimed at preventing or even reversing age-related declines in cognitive function, as well as treatments which may delay the onset of Alzheimer’s disease in high risk but otherwise healthy populations.

Evidence of Sleep Apnea in MCI/Mild Dementia

Background: Recent epidemiological and pathological studies report that subcortical ischemic cerebrovascular disease (SIVD) is a common finding in elderly individualswith cognitive impairment, either in isolation or in combination with AD lesions. The goal of the present study was to investigate the rate and severity of SIVD lesions seen onMRI in an elderly cohort.Methods: We conducted a community-based study of cognitive and neuropsychiatric disorders in Caet e, a small town in southeast Brazil. A total of 639 participants (75+ years) completed the clinical evaluations from the study protocol and a sample of 120 subjects was imaged with a 3.0 Tesla MRI. Cognitive status was ascertained through an expert consensus panel. Participants were classified as cognitively healthy (controls), cognitive impairment no dementia (CIND) and dementia subjects. MR images were analyzed with the Fazekas et al. semiquantitative rating scale, with scores ranging from 0 to 3 for each of two types of white matter lesions (periventricular and deep white matter), yielding a total score range from 0 to 6, with greater values indicating more severe SIVD.Results: The sample was composed by 120 subjects (75 women, aged 80.146 4.10 years and with mean schooling of 2.99 6 2.70 years), being 49 cognitively healthy individuals controls, 36 cases with CIND and 35 patients with dementia. The mean Fazekas score for the whole sample was 3.58 6 1.67, with dementia patients presenting higher scores (3.97) than controls (3.16), although this difference did not reach statistical significance (p 1⁄4 0.06). Fazekas scores from 3 to 6, consistent with moderate to severe SIVD, were observed in 53% of the whole elderly group. No correlation was found between the Fazekas score and performance in the MMSE, although a trend was observed for an association between the former and the scores in delayed recall task and category fluency (p 1⁄4 0.064). Conclusions: The rate of moderate to severe SIVD was very high in this cohort of oldest-old individuals, confirming that it consists and important cause of cognitive impairment or comorbidity in this age range.