Timothy I. Standish

Alternate forms of logical memory and verbal fluency tasks for repeated testing in early cognitive changes.

BACKGROUND Repeat cognitive testing is an essential diagnostic strategy to measure changes in cognition over time when following people with memory problems. Alternate forms may avert practice effects that can mimic improvements in cognition. We evaluated alternate forms of verbal fluency and logical memory (paragraph recall) tasks to evaluate their equivalence for clinical use. METHODS Participants with mild cognitive impairment (MCI) and dementia were recruited from five outpatient memory clinics and one nursing home. Participants with normal cognition (NC) were recruited from family members or friends. Verbal fluency categories of animals, cities & towns, fruits & vegetables and first names were used. Scores were recorded for 0-30 seconds, 31-60 seconds and errors. For the logical memory task, participants were read one of three different paragraphs and then were asked to recall the story. Immediate recall and delayed recall scores were recorded. The Standardized Mini-mental State Examination, the AB Cognitive Screen and the 15-point Geriatric Depression Scale were administered as part of the assessment. Analyses were performed using means, frequency distributions, t-tests, receiver-operating characteristic curves and effect sizes. RESULTS There were 46 NC participants, 45 with MCI and 55 with dementia. For verbal fluency, the mean number of animals, cities & towns, names or fruits & vegetables named in 60 seconds did not differ significantly within each cognitive group. First names was an easier category than the others: NC named 16.9-22.3 items, MCI named 11.6-14.4 items and dementia named 8.1-11.4 items. The mean number of items immediately recalled in logical memory was not significantly different for the three paragraphs. The verbal fluency task (in 60 seconds) and logical memory immediate recall were highly sensitive and specific to differences between NC and MCI (areas under the curves 0.87 and 0.76, respectively). CONCLUSIONS Alternate forms allow serial testing without learning bias. Verbal fluency and logical memory tasks are sensitive to early cognitive changes.

A multicenter, blinded, randomized, factorial controlled trial of doxycycline and rifampin for treatment of Alzheimer's disease: the DARAD trial.

Preliminary evidence suggested that doxycycline and rifampin might stop or slow the progression of Alzheimers disease (AD). We carried out a randomized trial to confirm or refute these findings.

Alendronate therapy in men with primary hyperparathyroidism.

OBJECTIVE To determine the skeletal effects of alendronate therapy in men with primary hyperparathyroidism (PHPT) in comparison with those in postmenopausal women. METHODS There essentially are no published data on the effects of bisphosphonate therapy in men with PHPT. We previously conducted a double-blind, randomized, single- crossover trial of alendronate, 10 mg daily, in PHPT and reported that alendronate significantly increases bone mineral density (BMD) at 12 months relative to baseline values. That study sample included both women (n = 28) and men (n = 9) and both premenopausal (n = 4) and postmenopausal (n = 24) women. Study subjects were randomly assigned to receive either alendronate or placebo during the first year, and all subjects received alendronate during the second year. Among the men, 3 received alendronate and 6 received placebo during the first year. The current analysis focuses on the skeletal effects of alendronate therapy in the 9 men during their first year of treatment versus the 6 men during their first year while receiving placebo as well as the 24 postmenopausal women during their first year of alendronate therapy. Paired t tests comparing baseline and 12-month data were performed for the 9 treated men and the 6 control subjects; unpaired t tests were used to compare the 9 treated men and the 24 treated women. RESULTS Alendronate therapy for 1 year (n = 9) resulted in a 4.8% increase in BMD at the lumbar spine (P = .1) in comparison with the men who received 1 year of placebo (n = 6). Relative to baseline, men receiving alendronate showed a significant 4.4% gain in BMD at the lumbar spine (P = .009) and a 2.95% gain in total hip BMD (P =.027). A 47% decline in serum levels of bone-specific alkaline phosphatase activity was also noted with alendronate therapy (P = .003). Changes in BMD in the male population were similar to previously reported effects of alendronate therapy in postmenopausal women with PHPT. CONCLUSION Alendronate therapy in men with PHPT is associated with improvements in BMD and reductions in bone turnover. These data, similar to the findings in postmenopausal women with PHPT, suggest that aminobisphosphonates may be of value in providing skeletal protection for men with PHPT. Further study is needed to confirm skeletal protection and fracture efficacy in this population.

Effect of a new nootropic agent, CGS 5649B, on cognition, function, and behavior in dementia

To determine the efficacy of CGS 5649B, the authors conducted a series of randomized, double-masked, single-subject studies using pairs of treatment periods, each pair including four weeks of active drug administration and four weeks of placebo administration. Thirty-two moderately demented patients completed three treatment pairs, receiving doses of 90, 200, or 600 mg of CGS 5649B during the active periods. Two patients met criteria for individual response in the behavioral measures. In the group analysis none of the differences achieved statistical significance. The authors conclude that CGS 5649B had a favorable impact on behavior for two of 32 patients.

Behavioural and psychological symptoms in community-dwelling elderly persons with cognitive impairment and dementia : Prevalence and factor analysis

Abstract Background: Our objective was to describe the frequency of behavioural and psychological symptoms of dementia (BPSD) in community-dwelling elderly adults with cognitive impairment and to determine whether these symptoms and behaviours assemble into distinct, clinically relevant categories. Methods: BPSD were measured using the Dysfunctional Behaviour Rating Instrument (DBRI). Principal components analysis was used to detect effects in caregiver responses in the DBRI. Results: The DBRI was scored on 921 patients. The frequency of individual BPSD ranged from 20% (spouse not spouse) to 83% (repeating questions). The frequency of BPSD increased with decline in cognitive function. Behaviours sorted into five broad domains: Anger, Delusions/Paranoia, Withdrawn/Wandering, Agitation, and Repetitive Behaviours. Conclusions: BPSD are common in community-dwelling elderly persons with memory loss and may be aggregated into distinct, clinically relevant categories.