Miriam K. Aronson

Clinico‐pathologic studies in dementia: Nondemented subjects with pathologically confirmed Alzheimer's disease

We compared neuropsychological findings in 28 longitudinally evaluated elderly subjects with their postmortem neuropathology, including senile plaque and neurofibrillary tangle counts from standardized sections. Nine of the subjects were not demented when evaluated just prior to their death. Numerous cortical senile plaques and other changes of Alzheimers disease (AD) occurred in six of nine nondemented old-old subjects. Five of these six subjects had shown decline on yearly neuropsychological tests but their cognitive impairment was too mild to meet clinical criteria for dementia. Whereas cortical senile plaque count did not distinguish well between demented and nondemented subjects, every subject with numerous cortical neurofibrillary tangles was demented. The nondemented subjects with Alzheimer pathology may have had “preclinical” AD, or numerous cortical plaques may occur in some elderly subjects who would never develop clinical dementia.

The Psychiatric Symptoms of Alzheimer's Disease

The authors used a semistructured interview administered to primary family caregivers to assess the prevalence and nature of psychiatric pathology in 175 well‐diagnosed community‐residing Alzheimers disease patients. Symptoms that are indicative of depression in the cognitively intact were virtually ubiquitous in this demented population. A variety of psychotic features were also regularly reported. The implications of these findings for the recognition and treatment of reversible psychiatric impairment are discussed.

Women, myocardial infarction, and dementia in the very old

Dementia is a major public health problem among the very old. Available information on incidence and prevalence is sparse and variable; however, there appears to be a higher prevalence among very old women. We present data from a prospective study of initially nondemented community-residing elderly. There were 75 incident dementia cases (up to 7 years of follow-up) of which at least 47% were probable Alzheimers disease. Based on a proportional hazards analysis, women were over 3 times more likely to develop dementia than men despite controlling for baseline demographic, psychosocial, and medical history variables. Poor word fluency and a high normal Blessed test score at baseline were also strong predictors of dementia. We did not find age, head trauma, thyroid disease, or family history of dementia to be risk factors. A new finding is that history of myocardial infarction (MI) is associated with dementia, such that women with a history of MI were 5 times more prone to dementia than those without a history. This observation was not true for men.

Object-memory evaluation for prospective detection of dementia in normal functioning elderly : predictive and normative data

In a prospective study of dementia in initially normal functioning elderly, a brief form of the Fuld Object-Memory Evaluation (OM) was administered to 474 cognitively normal community-residing volunteers aged 75-85 at baseline and annually thereafter. Seventy-two subjects later became demented. Memory test data from the last annual evaluation before cognitive change was noted were available for 56. Although the entire population recalled 7.28 (SD = 1.33) of the 10 objects on Trial 1 of the test at baseline, these 56 subjects recalled only 5.96 (SD = 1.85). When recall of 6 or fewer objects was used as a predictor, the OM test identified 32 of the 56 who subsequently became demented. Compared to an estimated base rate of 15% for dementia, the predictive value of a positive test (PV+) was 39%, and that of a negative test (PV-) was 89%. With a cutoff of 5 or fewer items recalled, the PV+ rose to 59% and the PV- was 94%. Although the OM test was only moderately sensitive to incipient dementia (.57), it was fairly specific (.84), and lowering the cutoff to 5 increased the specificity to .96. Memory testing would therefore seem to hold promise as a predictor of dementia in cognitively normal elderly.

Serum vitamin B12 levels and incidence of dementia in a healthy elderly population: a report from the Bronx Longitudinal Aging Study.

OBJECTIVE: To determine whether low serum B12 levels are associated with an increased incidence of dementing illness.

Distinguishing normal and demented elderly with the selective reminding test.

The selective reminding (SR) procedure, a popular technique for the study of verbal memory, was used to investigate aspects of memory functioning in a large group of normal elderly and in a smaller group of elderly subjects with Alzheimer Type Dementia (ATD). One hundred thirty-four normal elderly (mean age = 79.53 years) subjects and 21 ATD subjects (mean age = 68.3 years) were administered four versions of the SR test as part of a longitudinal study of risk factors in the development of dementia. Normative data were obtained for multiple components of memory functioning within the elderly sample. Test-retest reliability was .84 for long-term retrieval (LTR), .89 for sum of recall, and .92 for consistent retrieval. Clinical validity studies revealed that the components of sum of recall, storage estimate, LTR, and consistent long-term storage (CLTS) were most valuable in distinguishing mild ATD from normal aging. Positive predictive values ranged from 86% for CLTS, 89% for LTR, 91% for sum of recall, and 100% for storage estimate. These findings suggest that the SR test has considerable clinical utility in differentiating normal aging from dementia, and has promise as a useful tool in the preclinical detection of ATA.

Predicting development of dementia in the elderly with the Selective Reminding Test

The ability to predict the development of dementia through the detection of memory impairment in nondemented individuals was assessed with the Selective Reminding Test (SR), a popular test of verbal memory functioning in the elderly. The SR was administered to 385 nondemented volunteer subjects (mean age = 80.4 years) enrolled in a longitudinal study of risk factors in the development of dementia. Of these, 36 subjects ultimately became demented. SR scores obtained from 1 to 2 years prior to the diagnosis of dementia were compared with a set of previously established cutoff scores derived from a cognitively normal elderly sample. The results demonstrated that sum of recall and delayed recall were the SR measures best able to predict dementia with sensitivities of 47% and 44%, respectively. The predictive values were 37% and 40%, respectively, or better than two-and-one-half times the base rate. The contributions of both the SR Test and the Fuld Object-Memory Test (OM) were discussed in terms of the further understanding of the characteristics of the preclinical phase of dementia.

Dementia, Agitation, and Care in the Nursing Home

To examine the behavioral and functional problems of the cognitively impaired.

Drug Utilization in the Old Old and How it Relates to Self‐Perceived Health and All‐Cause Mortality: Results from the Bronx Aging Study

OBJECTIVE: To characterize medication use in a “well” very old population and relate the quantity and type of medication use to 10‐year mortality.

Applicability of depression scales to the old old person.

Depression is a major health problem in the elderly. The existing literature indicates that depression may be qualitatively different in this population. For example, a condition said to be prevalent among the elderly is masked depression which is marked by a cluster of vegetative symptoms without prominent dysphoria or guilt. Specific symptoms of depression reported most commonly in the elderly include loss of self‐esteem, feelings of helplessness, and complaints of cognitive deficit. Based on this information, the contents of six currently used depression rating scales were compared. It was found that although these scales are responsive to standard DSM‐III criteria for depression, for the most part they do not address the symptoms reported to be more common among depressed elderly. In addition, they had not been validated on the old old and therefore seem to have limited applicability as a sensitive screening tool for this rapidly growing segment of the population.