Increasing depressive symptoms in children of Alzheimer parents.

Children of persons with Alzheimer disease (AD) are at increased risk of developing AD themselves, but specific factors that predict AD in this population have yet to be elucidated. Various studies indicate depressive symptoms may predate clinical AD and represent a risk factor and/or prodrome of incipient dementia, but their relevance for AD offspring remains uncertain. As part of a longitudinal family study of AD, we assessed depressive symptomatology in 30 middle aged AD offspring (mean age at baseline: 41.2). Their mean total scores on the Hamilton Depression Rating scale increased from 1.8 to 5.3 (P < .001) across a 20-year interval. Neurocognitive performance remained stable in a subset of this cohort (N = 25) over the same interval. Findings from this small convenience sample suggest emerging depressive symptoms may be among the earliest signs of subsequent dementia in this high-risk population but require confirmation through further longitudinal follow-up and replication in larger populations.

Two decades of research in Alzheimer disease: looking back to the first volume of ADAD.

During the first two decades of the life of this Journal (ADAD) much progress has been made in our understanding of Alzheimer disease (AD). Advancing knowledge, however, has been accompanied by increasing appreciation of the complexity and heterogeneity of this disease. Prevention and cure continue to elude us as the number of afflicted and the cost of their care continues to increase. New techniques together with long-term prospective follow-up studies, as well as utilization of data accumulated in existing data bases, are needed to move the field forward. We expect that during the next two decades, as new information accrues, reports published in ADAD will continue to contribute to the dissemination and elucidation of critical issues in Alzheimer research.

Middle-aged children of Alzheimer parents, a pilot study: stable neurocognitive performance at 20-year follow-up.

The objective of this pilot study on a convenience sample of 25 offspring of Alzheimer patients (mean age 61.5 +/- 8.8 years; range, 50-82) was the early detection of neurocognitive decline. This preliminary report appears to be the first one dealing with 20-year follow-up of neurocognitive data of Alzheimer's disease (AD) children. Digit symbol (Wechsler Adult Intelligence Scale) was the only of 11 neurocognitive measures with a significant decline. And that decline between first and last testing (mean = 19.98 +/- 0.30 years) was on raw scores, not scaled scores. Neither parents' age at onset of AD nor autopsy confirmation or offspring APOE-e4 status influenced neurocognitive results. More robust data than currently available are needed to confirm the findings of this first pilot study and to determine both the trajectory of neurocognitive decline in AD and the risks of developing AD faced by children whose parent had the disease.

Similar neurocognitive performance of adults with and without a history of parental Alzheimer's disease: a pilot study.

The first reported 20-year prospective follow-up of middle-aged children of Alzheimer patients failed to find statistically significant neurocognitive decline. Because that report did not include a comparison group, the current study compared the 20-year follow-up scores with scores obtained on the same 8 measures by an age-comparable sample of healthy adults without a family history of Alzheimer's disease. Both were convenience samples (n = 24). Statistical analyses (correcting for age) yielded no significant group differences in neurocognitive scores but did show a significantly higher mean score for the comparison group on the Mini-Mental State Examination (29.5 vs 28.8, P = .003, controlling for age). Even though this finding suggests that adult children of a parent with Alzheimer's disease performed well on a limited neurocognitive battery and on the Mini-Mental State Examination, the findings are preliminary and require confirmation on large representative samples with appropriate controls and long-term follow-up.

Predictors of alcohol-treatment seeking in a sample of older veterans in the GET SMART program.

OBJECTIVES: To examine the predictive value of demographic characteristics and substance abuse indicators to explain treatment seeking for substance abuse problems by older male medical patients. DESIGN: Longitudinal analysis of screening data and treatment-seeking behavior. SETTING: Inpatient medical and outpatient substance abuse treatment center. PARTICIPANTS: Participants in the study were 855 medically ill male veterans aged 55 and older, who were screened for alcohol problems during inpatient medical treatment after clinician referral. MEASUREMENTS: The CAGE alcohol screen (Cut down on your drinking, Annoyed by criticism of your drinking, Guilty about your drinking, Eye-opener), drug use, and demographic measures administered at time of screening. Predictors of treatment seeking in the sample were examined using structural equation modeling. RESULTS: Expressed interest in treatment and later attendance at a pretreatment evaluation were associated with younger age and a higher CAGE alcohol screening score. Being unmarried and using drugs in addition to alcohol were associated with treatment interest but not with evaluation attendance. In the path model tested, the effect of higher CAGE score partially explained the effect of younger age on treatment seeking. CONCLUSION: The model examined shows utility in predicting alcohol-treatment seeking in this sample. Age-related factors may deter treatment seeking by older male medical inpatients.

Age at Onset, Survival Duration, and Cognitive Performance in Probable Alzheimer's Disease.

The relative importance of age at onset, survival duration past testing, symptom duration, and education as predictors of cognitive performance was assessed in 50 patients with moderately severe dementia of the Alzheimer type. Survival past testing and duration of symptoms prior to assessment emerged as the strongest predictors of cognitive performance, and education effects were noted for several verbal tests. A robust association emerged between cognitive impairment and nearness to death. This association, first noted in studies of "normal" aging, requires further exploration. Age-at-onset effects, with poorer performance in early-onset disease, were observed only for a few measures.