Susan Rottunda

Synchronous neural interactions assessed by magnetoencephalography: a functional biomarker for brain disorders

We report on a test to assess the dynamic brain function at high temporal resolution using magnetoencephalography (MEG). The essence of the test is the measurement of the dynamic synchronous neural interactions, an essential aspect of the brain function. MEG signals were recorded from 248 axial gradiometers while 142 human subjects fixated a spot of light for 45-60 s. After fitting an autoregressive integrative moving average (ARIMA) model and taking the stationary residuals, all pairwise, zero-lag, partial cross-correlations (PCC(ij)(0)) and their z-transforms (z(ij)(0)) between i and j sensors were calculated, providing estimates of the strength and sign (positive, negative) of direct synchronous coupling at 1 ms temporal resolution. We found that subsets of z(ij)(0) successfully classified individual subjects to their respective groups (multiple sclerosis, Alzheimers disease, schizophrenia, Sjögrens syndrome, chronic alcoholism, facial pain, healthy controls) and gave excellent external cross-validation results.

The Influence of Age and Gender on the Driving Patterns of Older Adults

ABSTRACT The purpose of this study was to investigate the influences of age and gender on the driving patterns of 300 older adults. Odds of driving less than every day increased significantly with age and female gender. However, no differences were found in the reduction of overall driving. Females were more likely than men to have stopped or reduced driving under certain adverse conditions and for elective purposes. The driving patterns of todays cohort of older females suggest that the gender gap may be narrowing. Social and cultural issues such as security, safety, and identity with driving may explain existing gender differences.

Older Women and Driving Cessation

The purpose of this study was to understand the lived-experience of driving cessation for older women. A qualitative, collective case study method was used. From in-depth interviews of former drivers, three categories of themes emerged: driving history, the process of stopping driving, and the experience of being a non-driver. Overall, the women had felt comfortable and skilled behind the wheel and they missed driving. Adaptation came easiest to those who planned ahead for driving cessation and made the decision voluntarily. Remaining independent and mobile were important considerations in the decision to stop driving. Many of the women regularly use formal transit services although riding with friends provides a social context. Family is not the preferred choice for transportation except in an emergency or for basic care. Social workers must acknowledge the importance women place on their independence when helping them work through issues of driving cessation.

Driving Habits and Patterns in Older Men with Glaucoma

Abstract Glaucoma, an eye disorder that gradually decreases peripheral vision, affects millions of older adults. Consequences of glaucoma can mean changes in the ability to perform familiar tasks, including driving an automobile. We surveyed older drivers with glaucoma and a control comparison group in order to learn more about their driving habits and expectations about driving cessation. Findings indicate that compared to the control group, drivers with glaucoma are significantly more likely to change their driving habits with regard to driving at night (p = 0.003), on freeways (p = 0.05), and in unfamiliar areas (p = 0.01). Drivers with glaucoma were also significantly more likely to report family concern about their driving (p = 0.01). However, the drivers with glaucoma did not anticipate that their disease would force them to discontinue driving. Social workers play a pivotal role in coordinating the complex care needs of visually impaired elders. When driving skills are affected, social workers must address transportation, housing as well as quality of life concerns.

The Older Driver with Parkinson's Disease

Abstract This study surveyed older drivers with Parkinsons disease (PD) and a control group for the purpose of obtaining information about driving history, habits, and expectations about driving cessation. Compared to control subjects, PD drivers were more likely to have reduced their driving over the past 5 years (p = 0.002). In addition, PD drivers had significantly more crashes (p = 0.003). Not surprisingly, families of PD drivers expressed greater concern about patient driving (p = 0.0001). Because of the complexities of the issue of driving and PD, social workers have the responsibility to provide emotional and practical supports to their PD clients and family members.

Driving cessation and AD: Issues congronting patients and family

This study surveyed older drivers with Alzheimers disease (AD), collaterals familiar with the patients driving, and a control group for the purpose of obtaining information about driving habits and plans for driving cessation. Drivers with dementia are at a greater risk for getting lost and having crashes than other older drivers. Family members are concerned about crashes to the extent that they are trying to prevent the AD driver from driving. Despite their concerns, many AD drivers and their families have not made plans for driving cessation. These results can assist health care professionals in developing approaches to assist AD drivers and their families as they make the transition to non-driving status.

Caregivers Dependent upon Drivers with Dementia

This paper reports findings of a preliminary study of caregivers dependent upon drivers with dementia. Fifteen caregivers who perceived themselves as dependent upon their partner for transportation and 15 who perceived themselves as independent were surveyed. Dependent caregivers were significantly more likely to rely on the cognitively impaired driver for routine daily activities such as shopping, medical appointments, and visiting family and friends. Only 20% of the dependent caregivers believed that the driver with dementia should decrease or discontinue driving. Dependent caregivers were less likely than independent caregivers to take an active approach in encouraging driving cessation. Compared to the independent caregivers, the dependent caregivers believed that if the patient with dementia could no longer drive, it would significantly affect their quality of life. The authors discuss the issues and problems uniquely associated with the dependent caregiver.

Change in the mini-mental state exam in Alzheimer's disease over 2 years: The experience of a dementia clinic

The decline in the Mini-Mental State Exam (MMSE) over 2 years was assessed in males with Alzheimers disease (AD; N = 136) seen in a dementia clinic. The average initial MMSE was 21.0 (SD+/-3.9; range 14--29) and declined 2.8 points (+/-4.7; range -17 to +6) over 2 years. The mode for change on the MMSE was 0 (N = 22) while the median fell between 2 and 3 points lost. Fifty-five of 136 patients (39.7%) had unchanged or better scores. There was no significant correlation between the initial MMSE and rate of change (r = -0.16; p = 0.06). While the progression of AD is quite variable from patient to patient, our data indicate that in most it is associated with little if any change in the MMSE even over 2 years. The MMSE is not an adequate tool to monitor change in the individual patient with AD.

The Driver With Dementia: A Review of the Literature

The authors review 10 studies of driving and dementia. They found poor agreement among the researchers with regard to the stage at which a patient with dementia should discontinue driving and the appropriate tools to be used for an assessment of driving skills. They make recommendations for a comprehensive driving assessment and for the clinical management of drivers with dementia. Because the impaired driver is a medical as well as a public safety concern, clinicians and policymakers must work together to address the many problems associated with this issue.

Fluorodeoxyglucose positron emission tomography of mild cognitive impairment with clinical follow-up at 3 years

Alzheimers disease (AD) is the most common dementing illness. Development of effective treatments directed at AD requires an early diagnosis. Mild cognitive impairment (MCI) often heralds AD. Thus, characterizing MCI is fundamental to the early diagnosis of AD.