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β-Amyloid precursor polypeptide in SAMP8 mice affects learning and memory

Senescence accelerated (SAMP8 [P8]) mice develop age-related deficits in memory and learning. We show that increased expression of amyloid precursor protein (APP) and its mRNA in the hippocampus are also age-related. Immunocytochemical data suggest that a critical amount of APP expression may be needed to generate amyloid (Abeta) protein plaques in the hippocampus. Deficits in acquisition and retention test performance were alleviated by administration of antibody to Abeta protein into the cerebral ventricles. This reversal of cognitive deficits provides a link between increased expression of both APP and Abeta protein and learning and memory loss in these mice.

THE RAPID COGNITIVE SCREEN (RCS): A POINT-OF-CARE SCREENING FOR DEMENTIA AND MILD COGNITIVE IMPAIRMENT

ObjectivesThere is a need for a rapid screening test for mild cognitive impairment (MCI) and dementia to be used by primary care physicians. The Rapid Cognitive Screen (RCS) is a brief screening tool (< 3 min) for cognitive dysfunction. RCS includes 3-items from the Veterans Affairs Saint Louis University Mental Status (SLUMS) exam: recall, clock drawing, and insight. Study objectives were to: 1) examine the RCS sensitivity and specificity for MCI and dementia, 2) evaluate the RCS predictive validity for nursing home placement and mortality, and 3) compare the RCS to the clock drawing test (CDT) plus recall.MethodsPatients were recruited from the St. Louis, MO Geriatric Research Education and Clinical Center (GRECC), Veterans Affairs Medical Center (VAMC) hospitals (study 1) or the Saint Louis University Geriatric Medicine and Psychiatry outpatient clinics (study 2). Study 1 participants (N=702; ages 65–92) completed cognitive evaluations and 76% (n=533/706) were followed up to 7.5 years for nursing home placement and mortality. Receiver operator characteristic (ROC) curves were computed to determine sensitivity and specificity for MCI (n=180) and dementia (n=82). Logistic regressions were computed for nursing home placement (n=31) and mortality (n=176). Study 2 participants (N=168; ages 60–90) completed the RCS and SLUMS exam. ROC curves were computed to determine sensitivity and specificity for MCI (n=61) and dementia (n=74).ResultsRCS predicted dementia and MCI in study 1 with optimal cutoff scores of ≤ 5 for dementia (sensitivity=0.89, specificity=0.94) and ≤ 7 for MCI (sensitivity=0.87, specificity=0.70). The CDT plus recall predicted dementia and MCI in study 1 with optimal cutoff scores of ≤ 2 for dementia (sensitivity=0.87, specificity=0.85) and ≤ 3 for MCI (sensitivity=0.62, specificity=0.62). Higher RCS scores were protective against nursing home placement and mortality. The RCS predicted dementia and MCI in study 2.ConclusionsThe 3-item RCS exhibits good sensitivity and specificity for the detection of MCI and dementia, and higher cognitive function on the RCS is protective against nursing home placement and mortality. The RCS may be a useful screening instrument for the detection of cognitive dysfunction in the primary care setting.

Veterans affairs Saint Louis university mental status examination compared with the Montreal cognitive assessment and the short test of mental status

To compare the ability of the Veterans Affairs Saint Louis University Mental Status (SLUMS) examination to detect mild cognitive impairment (MCI) and dementia according to the Clinical Dementia Rating Scale (CDR) with that of two other well‐known screening instruments, the Montreal Cognitive Assessment (MoCA) and the Short Test of Mental Status (STMS).

The veterans affairs Saint Louis University mental status exam (slums exam) and the mini-mental status exam as predictors of mortality and institutionalization

ObjectiveTo evaluate predictive validity of cognitive dysfunction of the Saint Louis University Mental Status (SLUMS) exam or Mini-Mental State Exam (MMSE) for institutionalization and mortality after 7.5-years.DesignLongitudinal study.SettingGeriatric Research, Education and Clinical Center Veterans Affairs Hospital St. Louis, MO.ParticipantsPatients (N=705) were screened for cognitive dysfunction in 2003 using the SLUMS exam and MMSE, and mortality and institutionalization up to 7.5-years later were evaluated as outcome measures.MeasurementThe associations between outcome measures and MMSE and SLUMS exam total scores, and cognitive status were examined using Kaplan-Meier curves and Cox proportional-hazards regression.ResultsFive hundred thirty-three charts were reviewed, 176/533(33%) patients had died and 31/526 (6%) were institutionalized during 7.5-year follow-up period. All subjects were male with a mean age of 75 years and most had high school education or greater (71%). MMSE dementia, SLUMS dementia (ps<.001) and MCI (p<.05) groups had significantly lower survival rates than normal cognition group in the Kaplan-Meier curves. Scores classified as dementia on SLUMS (HR=2.4, 95% CI 1.6–3.7; p <.001) or MMSE (HR=2.3, 95% CI 1.5–3.6; p <.001) both predicted mortality and, also, institutionalization (SLUMS: HR=3.5, 95% CI 1.3–9.1; p <.01; MMSE: HR=3.8, 95% CI 1.6–9.0; p <.001) after adjustment for covariates. Unadjusted SLUMS exam MCI predicted morality (HR=1.5, 95% CI 1.1–2.2; p <.019) but not institutionalization.ConclusionThe SLUMS exam and MMSE both predict mortality and institutionalization for male patients screened as positive for dementia.

Eye Disease and the Older Diabetic

Elderly diabetic persons are 1.5 times more likely than age-matched nondiabetic persons to develop vision loss and blindness. Annually, between 12,000 and 24,000 diabetic patients in the United States become legally blind because of complications caused by diabetic retinopathy. Even more diabetic persons experience vision loss caused by comorbid ocular and periocular conditions such as dry eye syndrome, cataracts, macular degeneration, and glaucoma. This article discusses the synergy between these conditions and diabetes. Standards of care that slow the progression of vision loss and exciting new research on new strategies of care that may reverse vision loss are presented.

Bioterrorism and Emergency Preparedness in Aging (BTEPA): HRSA-Funded GEC Collaboration for Curricula and Training

Abstract Frail elders living alone or in long-term care settings are particularly vulnerable to bioterrorism and other emergencies due to their complex physical, social and psychological needs. This paper provides an overview of the recent literature on bioterrorism and emergency preparedness in aging (BTEPA); discusses federal initiatives by the health resources and services administration (HRSA) to address BTEPA; describes the collaborative efforts of six HRSA-funded geriatric education centers (GECS) to develop BTEPA geriatric curricula and training; and offers recommendations for BTEPA education and training, clinical practices, policy, and research. The GEC/BTEPA collaboration has produced model curricula, including emergency planning for diverse groups of older persons; enhanced networking among stakeholders in a fast paced environment of information sharing and changing policies; and developed interdisciplinary educational resources and approaches to address emergency preparedness for various settings in the elder care continuum.

The Use of Games to Improve Patient Outcomes

Abstract In gerontology and geriatrics, learning often requires both the acquisition of new facts and a change in attitude towards elderly persons. Games, in addition to stimulating a desire to learn, are powerful instruments to change attitudes. This paper introduces games currently being used by the Gateway Geriatric Education Center to teach gerontological and geriatric principles to healthcare providers. It summarizes assessments that have been used to measure the effectiveness of those games to promote learning. Arguments are made that more rigorous methodologies of evaluation for games should be adopted in order to demonstrate the effects of that learning on improved patient outcomes.

Education partnerships between GRECCs and other VA organizations, Non-VA governmental agencies, academic medical centers, and centers of excellence

Gerontology and geriatrics are interdisciplinary professions. The quality of the care and services provided by the members of these professions depends upon the strength and integrity of the partnerships between the professionals working together. This article summarizes the partnerships created by the Department of Veterans Affairs Geriatric Research, Education, and Clinical Centers. This myriad of partners has formed the basis of successful programming to improve clinical care, to expand research projects, and most specifically, to produce educational opportunities in geriatrics and gerontology that have the potential to improve the quality of life for older Veterans.

Dissemination Strategies: The Evolution of Learning Resources on the Evaluation of Delirium, Dementia, and Depression

Clinicians experience great pressures to provide timely, effective, and evidence-based medical care. Educators can aid these clinicians through the development of new tools that can facilitate timely completion of clinical tasks. These tools should summarize evidence-based information in a convenient format that allows easy use. This article describes one process in which a group of Geriatric Research, Education, and Clinical Center educators identified an area where important new information accrued, their development of a new clinical and teaching tool for imparting the new information, the initial dissemination of the tool to a preliminary target audience, and the initial evaluation of the new tool to determine how to improve its distribution and use beyond the original target audience. This article not subject to U.S. copyright law. Opinions expressed in this article are those of the authors and do not reflect official policy of the Department of Veterans Affairs.

A Legacy of Leadership in Geriatric Education: The Twenty Geriatric Research, Education and Clinical Centers of the U.S. Department of Veterans Affairs

The health and well-being of the Americans who had served in the U.S. military during the Second World War became, after the Armistice, the responsibility of the Veterans Administration’s (VA—since 1989, the Department of Veterans Affairs, but still widely referred to as “VA”) Department of Medicine and Surgery. This responsibility was only the latest embodiment of a pillar of civilization: the pact between a citizenry and those who risk their lives in its defense. Other examples can be found in ancient Greece, the Plymouth Colony, and Lincoln’s Second Inaugural Address. But the magnitude of this particular responsibility, involving 16 million Veterans, was unprecedented. Initially it involved a Herculean organizational effort to provide health care to Veterans across the country. Then, in the 1960s, those charged with leading the VA began to realize that whatever challenges posed by the sheer number of potential patients with acute health needs would shortly begin to be eclipsed by the complexity and expense of caring for their health and chronic conditions as they lived into their seventh decades and beyond. These would no longer be young soldiers with battlefield injuries; they would be aging adults. The solution was the creation of the Geriatric Research, Education and Clinical Centers (GRECCs). GRECCs were a uniquely successful refinement of earlier concepts. The National Institutes of Health had initiated aging-focused blended research and education activities in the 1950s in the form of Geriatric Research and Training Centers, which in time became the Claude D. Pepper Centers. Eugene Towbin, MD, assembled and then led a group of clinician-educators and innovators at the Little Rock VA to undertake interdisciplinary teambased clinical approaches. These set the stage for Geriatric Evaluation and Management, Home-Based Primary Care, and Adult Day Health Care—but a