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A case of Posterior Cortical Atrophy syndrome of a suspected non-Alzheimer disease pathology type is presented to illustrate prospective diagnosis and course.A 54-year-old woman with vague memory complaints underwent serial neuropsychological assessment, MRI, PET, and CSF screening; data are reviewed.While early diagnosis was confounded by multiple factors, classic visuospatial symptoms were later demonstrated using routine neuropsychological methods. Serial MRI, PET, and CSF screening argued strongly for an alternative underlying pathology to AD. At age 59, her condition had progressed to dementia.Findings underscore the need for further research on suspected non-amyloid-based pathologies.

Objectives:Longitudinal research indicates that cognitive load dual-task gait assessment is predictive of cognitive decline and thus might provide a sensitive measure to screen for mild cognitive impairment (MCI). However, research among older adults being clinically evaluated for cognitive concerns, a defining feature of MCI, is lacking. The present study investigated the effect of performing a cognitive task on normal walking speed in patients presenting to a memory clinic with cognitive complaints.Methods:Sixty-one patients with a mean age of 68 years underwent comprehensive neuropsychological testing, clinical interview, and gait speed (simple- and dual-task conditions) assessments. Thirty-four of the 61 patients met criteria for MCI.Results:Repeated measure analyses of covariance revealed that greater age and MCI both significantly associated with slower gait speed,psConclusions:The present study increases the external validity of dual-task gait assessment of MCI. Differences in dual-task gait speed appears to be largely attributable to executive attention processes. These findings have clinical implications as they demonstrate expected patterns of gait-brain behavior relationships in response to a cognitive dual task within a clinically representative population. Cognitive load dual-task gait assessment may provide a cost efficient and sensitive measure to detect older adults at high risk of a dementia disorder. (JINS, 2017,23, 493–501)

Objectives Research has longitudinally linked dual-task gait dysfunction to mild cognitive impairment (MCI) and dementia risk. Our group previously demonstrated that dual-task gait speed assessment distinguished between subjective cognitive complaints (SCC) and MCI in a memory clinic setting, and also found that differences in dual-task gait speed were largely attributable to executive attention processes. This study aimed to reproduce these findings in a larger diverse sample and to extend them by examining whether there were group differences in single- versus dual-task cognitive performance (number of letters correctly sequenced backward). Method Two-hundred fifty-two patients (M age = 66.01 years, SD = 10.46; 119 MCI, 133 SCC) presenting with cognitive complaints in an academic medical setting underwent comprehensive neuropsychological and gait assessment (single- and dual-task conditions). Results Patients with MCI walked slower and showed greater decrement in cognitive performance than those with SCC during dual-task conditions. Neuropsychological measures of executive attention accounted for significant variance in dual-task gait performance across diagnostic groups beyond demographic and health risk factors. Discussion Reproduction of our results within a sample over four times the previous size provides support for the use of dual-task gait assessment as a marker of MCI risk in clinical settings.

Background: Although an association between the apolipoprotein E ( APOE) ∊4 allele and increased risk of Alzheimer’s disease (AD) is established, the utility of APOE genotyping in the clinical diagnosis of AD is still under investigation. Methods: Medical records of 89 patients with cognitive impairment and APOE genotype data underwent a retrospective review. Results: Comparison of age, age at onset, education, Mini-Mental State Examination, months of follow-up, and family history of dementia did not reveal statistical difference among the patients with different APOE genotypes. The APOE ∊4 carriers had a higher percentage of AD diagnoses after a median 16 months follow-up than non- APOE ∊4 carriers. The APOE ∊4 designation had a high sensitivity and high positive predictive value for the diagnosis of AD but a low negative predictive value and specificity. Conclusions: The APOE genotyping may be helpful in diagnosing AD especially in patients presenting with atypical features or early age of onset of dementia.

Inconsistencies in reports on methamphetamine (METH) associated cognitive dysfunction may be attributed, at least in part, to the diversity of study sample features (eg, clinical and demographic characteristics). The current study assessed cognitive function in a METH-dependent population from rural South Carolina, and the impact of demographic and clinical characteristics on performance. Seventy-one male (28.2%) and female (71.8%) METH-dependent subjects were administered a battery of neurocognitive tests including the Test of Memory Malingering (TOMM), Shipley Institute of Living Scale, Paced Auditory Serial Addition Test (PASAT), Symbol Digit Modalities Test (SDMT), Grooved Pegboard Test, California Verbal Learning Test (CVLT), and Wisconsin Card Sorting Test (WCST). Demographic and clinical characteristics (eg, gender, frequency of METH use) were examined as predictors of performance. Subjects scored significantly lower than expected on one test of attention and one of fine motor function, but performed adequately on all other tests. There were no predictors of performance on attention; however, more frequent METH use was associated with better performance for males and worse for females on fine motor skills. The METH-dependent individuals in this population exhibit very limited cognitive impairment. The marked differences in education, Intellectual Quotient (IQ), and gender in our sample when compared to the published literature may contribute to these findings. Characterization of the impact of clinical and/or demographic features on cognitive deficits could be important in guiding the development of treatment interventions. Language: en

Background/Aims: The recruitment of culturally diverse subject populations into research studies, particularly African-Americans (AA), has been the focus of intense interest by many groups. Methods: In this paper, we present the methodology utilized to create a predominantly AA cohort for the longitudinal study of risk factors in Alzheimer’s disease (AD). The underlying strategy was that of identifying geographically diverse clinical venues within South Carolina (SC) where large numbers of AA patients already come to seek medical care. Results: This strategy was successful, although recruitment rates for AA subjects (43.4%) still fell below those for white subjects (70.3%; p = 0.0025). Subject characteristics of AA subjects that chose to enroll were not substantially different from those that declined to participate. The demographic characteristics of this cohort were largely similar to those of the SC Alzheimer Disease Registry, a population-based database. The problems of standardization of subject recruitment and assessment across diverse clinical venues are also addressed. Conclusion: The utilization of geographically diverse sites for research recruitment where minorities already receive medical care is one practical solution to the problem of minority participation in research. Multi-site recruitment to improve minority recruitment can be accomplished with acceptable standardization and inter-rater reliability.

African Americans are at significantly increased risk for the development of Alzheimer's disease (AD), yet are seriously underrepresented in research trials. Preliminary experiences on a large scale, multi-site, 5-year longitudinal trial investigating the psychometric expression and progression of AD targeting an aging Southern rural cohort of African Americans are reported. Sixty-five participants, ranging from asymptomatic to severely demented, underwent extensive individual diagnostic and psychometric evaluation. Results indicated that cultural factors strongly influenced the data. Recruitment with asymptomatic volunteers were found to have greater educational attainment than other participant groups. Psychomotor measures showed greater impairment in African Americans compared to Caucasians suggesting increased cerebrovascular burden. African Americans' performance on the Boston Naming Test and the Wechsler Test of Adult Reading tests were significantly different than performance of Caucasian groups. The findings demonstrated that a better understanding of sociocultural factors associated with AD in the African American population may facilitate the development of primary and secondary preventions, especially when considering the role of cerebrovascular comorbidity which is a modifiable risk factor.

This research adds to the psychometric validation of the Test of Memory Malingering (TOMM) by providing data for samples of elderly patients who are cognitively intact, cognitively impaired (non-dementia), and with dementia. Subjects were 78 individuals referred for evaluation of memory complaints. Significant group differences emerged between the dementia group and the two other groups (normals and cognitively impaired), although the latter two did not differ from each other. One hundred percent of normals and 92.7% of the cognitively impaired group made fewer than five errors (the suggested cut-off) on Trial 2 or the Retention trial of the TOMM, yielding an overall correct classification rate of 94.7%. However, the rate of misclassification for persons with dementia was high whether using a cut-point score of five, eight, or ten errors. This investigation extends the validity and clinical utility of this instrument. Results suggest that the TOMM is an useful index for detecting the malingering of memory deficits, even in patients with cognitive impairment, but only when dementia can be ruled out.

OBJECTIVE: Attention has recently been drawn to the potential dangers of firearm use among patients with dementia. However, little is known about the actual prevalence of firearms in households with demented family members. This study seeks to determine the prevalence and loaded status of firearms in households with a demented family member in a sample of outpatients at a University memory disorders clinic. DESIGN: Utilizing a cross-sectional design, subjects underwent a structured NINCDS-ADRDA criteria comprehensive evaluation to assess dementia and were also administered a questionnaire to assess level of mood disturbance. Family members were administered a behavioral checklist and surveyed about the number and loaded status of firearms in the patient's household. SETTING: The study took place in an outpatient Medical University memory disorders clinic in the Southern United States. PATIENTS: Subjects were 106 consecutive outpatients referred for symptoms suggestive of dementia. MAIN OUTCOME MEASURES: Firearm presence was coded as “present,” “not present,” and “unsure.” In cases where firearms were present, the number and loaded status were collected. Other outcome measures included the Clinical Dementia Rating of each patient, the Yesavage Mood Inventory, and the Revised Memory and Behavior Problems Checklist. RESULTS: A high prevalence of firearm prevalence in households with demented family members was revealed (60.4%). Gun ownership was equally prevalent in households regardless of the severity of the dementia (chi-square, P = .426), severity of behavioral disturbance (ANOVA P = .88), or depressive symptoms (ANOVA P = .37). In households with firearms, 44.6% of the families reported that the guns were kept loaded; 38% reported that they did not know whether the guns were loaded. Only 16.9% of the families reported that guns were maintained in an unloaded state. CONCLUSIONS: This study suggests that many family members living in households in which there are demented patients do not take appropriate action to remove or unload firearms in their households, regardless of the severity of dementia, behavioral disturbance, or depression. These findings suggest that clinicians need to ask families specifically about the presence of firearms and advocate for their removal.

As we enter the 21st century, certain forces have emerged that shape a woman's decision to breastfeed or provide milk substitutes for her infant. Human lactation appears to be sensitive to a variety of interrelated psychological factors that include both individual and group-derived beliefs and attitudes, as well as psychophysiologic mediating mechanisms. This article explores the known psychological, sociocultural, and physiologic factors that surround a woman's decision to breastfeed.

The mirror sign is a delusional misidentification symptom (DMS) characterized by an inability to recognize one's own image in the mirror, often in the presence of an intact ability to recognize others in the mirror. The symptom has been only sparsely reported previously, and primarily within the Alzheimer's disease literature. A case is reported of an 82-year-old female with abrupt onset of mirror sign following a hypotensive crisis. Neuroradiographic studies revealed periventricular white matter change in the bifrontal and bilateral parietal occipital regions, right greater than left, as well as scattered lacunar infarcts. The patient was unable to recognize herself in the mirror and became progressively paranoid in response to the stranger in the mirror'. However, there was no evidence of prosopagnosia and she was able to recognize others in the mirror. Results from the neurobehavioral examinations replicated a previous report of mirror sign, and were consistent with those reported for other DM...

This study assessed the validity of a measure of visual recall and recognition memory using a modified administration of the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) Constructional Praxis task to extend the capacity of the CERAD neuropsychological battery's ability to assess nonverbal free and recognition recall. The sample consisted of consecutive university hospital memory disorders clinic patients (n = 77). To test the measures' ability to discriminate dementia severity based on an independently derived clinical dementia rating, scores on Free Visual Recall showed expected group differences as a function of dementia severity (ANOVA, F = 12.7, p = .0001), but exhibited a floor effect in the moderately severe dementia range. Recognition Visual Recall was also able to discriminate dementia severity based on an independently derived clinical dementia rating (ANOVA, F = 10.6, p = .0001). Both Free Visual Recall and Recognition Visual Recall measures were found to have strong concurrent validity based on intercorrelations with the Wechsler Memory Scale-Revised (WMS-R; Wechsler, 1987) Visual Reproduction I and II. In addition, moderate to strong discriminant validity for Free Visual Recall was demonstrated based on correlations with a family member self-report of memory problems in everyday life.

Atypical cortical degenerative syndromes of the non-Alzheimer's disease type are becoming increasingly recognized in the literature. Three cases consisting of primary progressive aphasia, posterior cortical atrophy, and frontal lobe dementia of the non-Alzheimer's type are presented to replicate and extend emerging literature. Detailed clinical description and neuropsychological data, coupled with confirmatory neurofunctional imaging, are presented to provide empirical support that specific inclusion and exclusion criteria can be applied to clinically diagnosis atypical degenerative cortical dementias.

A case of a 60-year-old man with biopsy-proven diffuse Lewy body disease was presented with clinical and serial neuropsychological data. Findings showed a rapid decline over a 2-year period characterized by an atypical degenerative dementia, including a global mental decline with preserved orientation, profound perceptual deficits, and no specific relative progressive memory impairment. Few extrapyramidal signs were noted, but subtle visual hallucinations and vivid nightmares occurred throughout the course. He underwent an experimental trial of tacrine, but showed an adverse reaction. Of the few detailed neurocognitive case descriptions of this disease found in the literature, this article highlights the unique variability and clinical manifestations that differentiate this disorder from the dementia of the Alzheimer's type.

The purpose of this study was to examine the effect of cortical versus subcortical and right versus left hemispheric vascular lesion site on rehabilitative functional status. Seventy patients were prospectively studied. A 2 × 2 ANOVA showed significant group differences with the cortical group being more impaired on both the initial admission and discharge Functional Independence Measure (FIM) scores ( F = 14.2, p F = 12.2, p

Unawareness of cognitive deficit following brain damage was investigated in a sample of 108 cerebrovascular accident patients and 30 orthopaedic controls. The purpose of this study was to: 1. investigate the incidence of unawareness, 2. test if neurocognitive factors were predictive of unawareness, and 3. determine which specific neuroanatomic lesion sites were predictive of the phenomenon. Neuroanatomic lesion site was identified by CT/MRI. Unawareness of cognitive deficit was assessed using a structured unawareness interview, while neurocognitive status was quantified on several indices. Results showed unawareness was associated with brain injury (p

The Wechsler Adult Intelligence Scale—Third Edition (WAIS-III) often poses problems for many populations due to the length of administration. Twenty geriatric subjects were administered the full WAIS-III. Three abbreviated forms of the WAIS-III (Satz–Mogel abbreviation ( Satz & Mogel, 1962 ); seven-subtest short form ( Ward, 1990 ); and a clinically derived abbreviation) were evaluated by rescoring original full WAIS-III protocols. Results showed that the abbreviated WAIS-III protocols were highly correlated with complete protocols, and classification rules were the highest for the clinically derived abbreviation. The clinically derived abbreviation was reevaluated in a college LD/ADHD population yielding similarly high correlations. Results support the use of abbreviated forms of the WAIS-III in the evaluation of elderly patients and young adults, and point to the clinically derived abbreviation as providing the smallest discrepancies from FSIQ.

Objective: An in vitro model was devised to compare the relative effects of recombinant transforming growth factor-alpha (TGFα), aqueous human milk, and human milk macrophage (HMM) medium on human fetal small intestinal cell (FHs-74) proliferation. Methods: Recombinant TGFα at increasing concentrations (range 0.01–1,000 ng/ml media), the aqueous fraction of human milk (AHM), or HMM medium was added to FHs-74 cells in the presence or absence of a neutralizing TGFα antibody (1 µg/ml medium). At 24 h, cell proliferation was measured and expressed as percent control. The experimental variables were (1) activators of cell growth (TGFα, AHM, and HMM medium); (2) increasing concentrations of TGFα, and (3) neutralizing antibody to TGFα. The dependent variable for all experiments was cell proliferation. Results: Significant effects for growth stimulators and TGFα concentration as measured by cell proliferation were found. Specifically, there was a dose-dependent effect of TGFα on cell proliferation to the 5-ng/ml concentration, with a plateau reached in cell proliferation at higher concentrations. The stimulatory effect of TGFα was decreased in the presence of TGFα antibody (mean ± SD 22 ± 7.1% decline, p < 0.001). In the presence of TGFα antibody, there was a 25 ± 3.1% decline in HM-stimulated growth (p < 0.004), and a 27.6 ± 3.2% decline in HMM medium-stimulated growth (p < 0.001). Conclusions: Neutralization of recombinant TGFα and that present in human milk and HMM medium by TGFα antibody led to a consistent decrease in in vitro human fetal small intestine epithelial proliferation without affecting cell viability. These results support the hypothesis that TGFα, whether derived from human recombinant sources, human milk or HMM medium has a measurable, trophic effect on in vitro human gut epithelial cells.

Transforming growth factor-alpha (TGFα) is a polypeptide that plays an important role in the growth and differentiation of a variety of ectodermal and mesodermal cells both during fetal and postnatal life. Epidermal growth factor (EGF), a growth factor that acts similarly to TGFα through binding of the EGF receptor, is associated with fetal growth and maturation: EGF cord blood concentrations correlate significantly with birth weight and placental weight (Biol Neonate, 1992:61). It is unknown if a similar relationship exists between cord blood TGFα concentration and advancing gestational age. We sought to determine if such an association exists. Eighty newborns ranging in age from 26 to 42 weeks gestation were enrolled in the study, and clinical data collected prospectively. At delivery, a cord blood sample was collected from each placenta and processed within 4 hours for serum separation. Serum samples were then frozen at -80°C until later analysis. Each sample was analyzed for TGFα concentration (pg/mL) by a commercially available RIA (RDI; sensitivity 1 pg/100 μL; cross-reactivity with EGF of 0%). The concentration of cord serum TGFα was expressed as the mean ± S.D. There was a strong association between TGFα cord serum concentration and gestational age (p

The newborn GI tract undergoes extensive maturational changes in the weeks following birth. Activation of the epidermal growth factor receptor (EGFr) following its binding of EGF or TGFα is thought to play a major role in that process. Both growth factors are present in human milk. While milk-derived EGF has been shown to induce gut epithelial proliferation in bothin vitro and in vivo models, the role of TGFα is less clear. We devised an in vitro model to compare the effect of recombinant, human milk- and HMM-derived TGFα on small intestinal cell proliferation. A fetal small intestinal cell line with epithelial characteristics (FhS-74; American Tissue Type Co.) was grown to confluence in the presence of Hybri-Care medium with EGF (30 ng/ml medium). The cells were removed from flasks following Trypsan-EDTA exposure, washed in EGF-free medium, then placed in culture in EGF-free medium at a concentration of 104 cells/well (60% confluence; 96-well plates). After 24 hr, either recombinant TGFα (0.01-50 ng/mL media), human milk supernatant (0.5 -1 ng TGFα/mL) or HMM media (20-100 pg TGFα/mL) was added to separate wells (5 wells/condition) in the presence or absence of 1° monoclonal TGFα antibody (RDI; 1 μg/mL media) for 24 hr. Cell proliferation was then measured (CellTiter 96-AQ, Promega) and expressed as% above control. A positive dose-response effect on cell proliferation by all three agents that paralleled TGFα concentration was observed. This effect was decreased in the presence of 1° TGFα antibody: 22 ± 7.1% decline of TGFα-stimulated proliferation; 25 ± 3.1% decline of HM-stimulated growth; and 27.6 ± 3.2% decline of HMM media-stimulated growth at all concentrations tested. With removal of the 1° antibody, cell proliferation returned to control levels. Binding of the TGFα present in human milk and HMM media led to a consistent decrease in in vitro gut epithelial proliferation without affecting cell viability. The proliferative effect of human milk on the gut appears to be due, in part, to TGFα.

This study reports the school-age developmental and health status of a preventilatory surfactant cohort. The sample consisted of 39 surviving subjects (21 experimental and 18 controls) born at 25 to 29 weeks gestation who were studied at 6 and 12 months and 5 to 7 years of age. At 6- and 12-month follow-ups, the cohort was functioning close to the population normative mean. Although cognitive and motor assessments at school age also showed no group differences, 8 of 19 (42%) in the surfactant group and 9 of 17 (53%) in the normal saline group attained a McCarthy General Cognitive Index score of < or = 84 (abnormal range). On the Connors' Parental Questionnaire, both groups scored high on the Learning Disability Subscale. The surviving cohort at 5 to 7 years had no identified long-term sequelae due to surfactant therapy, yet both groups were at risk for neurodevelopmental and educational morbidity.