Secondhand smoke transfer and reductions by air sealing and ventilation in multiunit buildings: PFT and nicotine verification.

UNLABELLED: Surveys suggest that transfer of secondhand smoke (SHS) between units in multiunit residential buildings is common, but measured data are rare. This study was undertaken to quantify bulk air transfer between units and document transfer of SHS species before and after treatments that sealed boundaries between units and provided a minimum amount of continuous exhaust ventilation of each unit. Six buildings in Minnesota were studied. Treatments were performed in clusters of up to eight units in each building, including zero to two units occupied by smokers. Bulk air transfer was quantified through passive perfluorocarbon tracer (PFT) gas tests. SHS transfer was evaluated using passive nicotine sampling. The median fraction of air entering a unit that came from other units tagged with PFTs ranged from 0.021 in a new condominium building to 0.353 in a 1930s duplex, with an overall median of 0.041. Treatments provided a median decrease of 29% in the fraction of transferred air and reduced PFT concentrations by about 40%, because of increased ventilation of both source and target apartments. Nicotine was transferred at only one-sixth the rate of PFTs. Involuntary exposure to SHS can be reduced but not eliminated by modifying existing, occupied multiunit buildings. PRACTICAL IMPLICATIONS: Recent studies of secondhand smoke exposure in multiunit housing indicate transmission of SHS constituents from smokers' units to those occupied by nonsmokers. A straightforward solution for this problem is to eliminate air leakage transfer between these units. This study describes a 2-year investigation of air sealing and ventilation improvements in six multiunit buildings located in a heating-dominated climate region of the US. The results quantify the reduction in interunit transfer of air between smokers' and nonsmokers' units. While it is possible to reduce the transfer when done with care, it is extremely difficult to eliminate these flows unless the buildings are vacated and extensively rebuilt. Eliminating air leakage between smokers' and nonsmokers' units is not a practical means of solving SHS transmission in an existing building.

Mayo's older Americans normative studies: category fluency norms.

Age-adjusted normative data are presented for persons over age 55 years on a common measure of category fluency. Further adjustment for education is also provided. These data were obtained as part of a series of projects known collectively as Mayo's Older Americans Normative Studies (MOANS). The normative information provided here should prove useful for characterizing performance on the individual measure of category fluency. In addition, these data should promote greater accuracy in comparing category fluency scores with performance on any other measures with MOANS norms, including tests of letter fluency. Limitations and unique features of MOANS normative data are also discussed.

Apolipoprotein E genotype influences cognitive 'phenotype' in patients with Alzheimer's disease but not in healthy control subjects.

We examined the association of apolipoprotein E (apo E) genotype with cognitive performance in Alzheimer's disease (AD) and Mild Cognitive Impairment (MCI) patients and in normal subjects. One hundred fifty-seven AD patients, 35 MCI patients who developed AD during longitudinal follow-up, and 341 normal control subjects from the Mayo Clinic Alzheimer's Disease Patient Registry were studied. All participants were typed for apo E using polymerase chain reaction-based assay, epsilon 4+ and epsilon 4- groups were compared on cognitive factor scores of Verbal Comprehension, Perceptual Organization, Attention/Concentration, Learning, and Retention. Raw delayed verbal recall and visual confrontation naming scores supplemented these scores. Multivariate ANOVA was completed for cognitive scores. As expected, a main effect for diagnostic group was present across all scores. Multivariate main effects for age group and apo E genotype were also statistically significant. Subsequent within-group comparisons revealed no genotype differences for control subjects across all cognitive scores except raw delayed recall where an interaction indicated that older epsilon 4+ control subjects actually scored better than younger epsilon 4+ patients. Genotype differences were present for the Retention factor in the MCI sample and for Verbal Comprehension and Learning in the AD sample. In a combined cognitive impairment sample (AD + MCI), genotype differences were present for Verbal Comprehension, Learning, and Retention. Possession of an apo E epsilon 4 allele did not appear to be associated with poorer cognitive performance among normal control subjects. In the AD and MCI samples, epsilon 4+ status was associated with greater memory impairment in analyses including duration of illness as a covariate. In combined AD + MCI analyses, epsilon 4 homozygosity was associated with poorer retention, learning, and verbal comprehension at a given disease duration. Possession of the epsilon 4 genotype may influence cognition in a dose-response relationship.

Normative data for the Mattis Dementia Rating Scale.

Age-adjusted normative data are presented for persons over age 55 on the Mattis Dementia Rating Scale. Additional adjustment for the effect of education on test performance is also provided. These data were collected as part of Mayo's Older Americans Normative Studies (MOANS) in a continuing effort to develop age-appropriate norms for older persons on commonly used neuropsychological tests. The normative data presented here should prove more useful in characterizing the presence and severity of general cognitive dysfunction than currently available norms. Limitations and unique features of MOANS normative data are also discussed.

Factor analysis of the Mayo-Portland Adaptability Inventory: structure and validity.

Principal-components (PC) factor analysis of the Mayo-Portland Adaptability Inventory (MPAI) was conducted using a sample of outpatients (n = 189) with acquired brain injury (ABI) to evaluate whether outcome after ABI is multifactorial or unifactorial in nature. An eight-factor model was derived which explained 64-4% of the total variance. The eight factors were interpreted as representing Activities of Daily Living, Social Initiation, Cognition, Impaired-Self-awareness/Distress, Social Skills/ Support, Independence, Visuoperceptual, and Psychiatric, respectively. Validation of the Cognition factor was supported when factor scores were correlated with various neuropsychological measures. In addition, 117 patient self-rating total scores were used to evaluate the Impaired Self-awareness/Distress factor. An inverse relationship was observed, supporting this factor's ability to capture the two-dimensional phenomena of diminished self-awareness or enhanced emotional distress. A new subscale structure is suggested, that may allow greater clinical utility in understanding how ABI manifests in patients, and may provide clinicians with a better structure for implementing treatment strategies to address specific areas of impairment and disability for specific patients. Additionally, more precise measurement of treatment outcomes may be afforded by this reorganization.

Using word recognition tests to estimate premorbid IQ in early dementia: longitudinal data.

This study examined the utility of word recognition scores for estimating actual Verbal IQ scores obtained from 1-5 years earlier. Participants were 271 persons remaining normal and 24 initially normal persons who developed cognitive impairment over longitudinal follow-up. A previously published regression equation based on education and the American modification of the National Adult Reading Test (Nelson, 1982) was used to estimate Mayo Verbal IQ. In spite of correlating well with prior obtained scores (r = .7) the predicted score tended to overestimate the obtained Mayo Verbal IQ. A revised equation was developed in the normal sample, which improved accuracy of prediction. Among the 24 persons who developed cognitive impairment over a 5-year span, the revised predicted scores provided reasonable estimates of initial Mayo Verbal IQ. To aid in clinical interpretation, a table of the normal frequencies of predicted Mayo Verbal IQ minus contemporaneously obtained Mayo Verbal IQ is provided.