Susan E. MacNeill

Effective screening for Alzheimer's disease among older African Americans.

Relatively little data exist concerning the utility of brief cognitive measures to detect dementia among African Americans. The current study evaluated the clinical utility of the Mini-Mental Status Exam (MMSE) and the Fuld Object Memory Evaluation (FOME) in detecting Alzheimers disease (AD) among both African American and European American older adults. One hundred and forty geriatric patients from a large urban academic medical center were examined. Overall, the FOME appeared to be more effective in detecting AD than was the MMSE (93% sensitivity vs. 75% sensitivity, respectively), although both measures suffered from relatively low specificity (63.5) in the full sample. The FOME demonstrated exceptional clinical utility among African American patients (sensitivity 98.3%; specificity=64.5; positive predictive power 83.8%; negative predictive power 95.2%). The results of this study support the use of the FOME among older African Americans to detect dementia.

Expanded Normative Data for the Mattis Dementia Rating Scale for Use with Urban, Elderly Medical Patients

Normative data for the Mattis Dementia Rating Scale (MDRS), stratified by age and education, are provided for use with older adults (ages 61–94) in urban medical settings. Age and education accounted for the greatest amount of variance in MDRS performance. Gender and race were also associated with total MDRS scores, though to a lesser extent. The present normative data are more appropriate for use with older patients seen in urban medical settings than normative data obtained from samples of better-educated, relatively healthy, Caucasian adults. This study provides additional evidence of the significant influence of age and education on MDRS total score (MDRS-T) performance, and highlights the importance of matching an examinees demographic background to the normative sample with which his or her test score is being compared. Careful consideration of this match is likely to lead to more accurate diagnostic conclusions and potentially improved patient care.

Elderly Inner City Women Who Return Home to Live Alone

This study examined the status of 107 elderly inner city women who returned to their home after being in a geriatric rehabilitation unit at a large urban medical center. Prior to admission, all women had been living at home alone. After rehabilitation, 50 of the women were discharged directly to their homes, 26 followed within 3 months, 11 were back home alone by 6 months, and 20 additional women were still not home by 6 months. Results showed that, as measured by standardized assessments of physical functioning and cognition, the women who were most functionally independent returned home alone more quickly. Furthermore, those who achieved live-alone status some time after discharge (but not at discharge) did not report the same level of self-care and home maintenance task independence as women who were discharged home alone immediately at discharge. The findings raise questions about the minimum level of functional performance required to return home alone and the interaction of functional ability, assistance from others, and a variety of social and environmental factors on live-alone status.

Living Arrangement Decisions at Discharge and Later: Differences in Criteria and Outcomes

ABSTRACT This study examined the pattern of post rehabilitation living arrangements over 18 months of 172 adults discharged from a geriatric rehabilitation unit at a large urban medical center, all of whom were living alone prior to admission. Results showed the diminishing importance of physical function and cognition as factors in decisions to return home as the length of time after hospital discharge increased. Patients who returned home to live alone after a period of time living in more supported environments had significantly lower assessment scores on physical function (p < 0.001) and cognition (p < 0.001) compared to patients who went home to live alone immediately upon discharge. As well, patients who returned home to live alone later than three months post discharge were significantly more likely to move to more supported environments by 18 months after discharge (p = 0.043) and to experience re-hospitalizations (p = 0.008), which raises questions about the appropriateness of these later decisions.

A MIMIC model approach to research in geriatric neuropsychology: The case of vascular dementia

The goal of the current study is to demonstrate a new methodology that can be used in neuropsychological research concerning differential diagnosis research. The multiple indicators, multiple causes (MIMIC) model is a latent variable methodology which can examine group differences on individual tests while controlling group differences in global cognitive impairment. As a demonstration, neuropsychological data from 217 dementia patients were incorporated into a MIMIC model to examine the influence of cerebrovascular disease (CVD) upon (1) dimensions of global cognitive impairment and (2) upon individual tests after controlling for global impairment. The presence of CVD in dementia (i.e., vascular dementia [VaD]) was not significantly related to dimensions of global impairment. In addition, the presence of CVD within dementia did not significantly contribute to impairment on 9 out of 10 neuropsychological tests/subscales examined after controlling global cognitive impairment. These results are discussed in the context of current vascular dementia research, and are focused primarily upon the MIMIC model methodology and suggestions for its use in future research.

Functional outcome differences in acute versus subacute geriatric rehabilitation

The present study compared 69 acute and 53 subacute geriatric rehabilitation patients matched on demographic and medical characteristics. Patients were admitted for rehabilitation secondary to stroke, hip fractures, deconditioning, and amputation. Patients had a mean age of 78 years; 64% were women, and 40% were African American. Subacute patients had significantly lower Functional Independence Measure (FIM) scores at admission and at discharge, despite having a mean length of stay of 36 days versus 13 days in the acute sample. Differences were found on discharge disposition, with 74% of the acute sample returning to the community compared to 51% of the subacute sample. These data highlight the differences between the acute and subacute patients and may suggest that the goals of subacute care be redefined.

Prospective validity study of a triaging method for mental health problems: The Macneill-Lichtenberg decision tree (MLDT)

ABSTRACT The MacNeill-Lichtenberg Decision Tree (MLDT) is a method for triaging older adult patients in health care settings with regards to their need for cognitive and affective assessment. Originally validated with 173 individuals in a retrospective study (MacNeill, Lichtenberg, Kuiken & Roth, 1997), the present investigation focused on using the MLDT pro-spectively with 39 consecutively referred older medical rehabilitation patients. Overall, using the MLDT provided effective and efficient screening; accurately identifying cases in need of assessment while also reducing unnecessary assessments.