Somatic and affective anxiety symptoms and menopausal hot flashes.

OBJECTIVE: Menopausal hot flashes have been associated with increased scores on measures of anxiety. Anxiety measures are typically composed of items measuring somatic and affective symptoms. Because hot flash symptoms are similar to symptoms of somatic anxiety, we wanted to examine the differential contribution of somatic anxiety and affective anxiety to hot flash scores. METHODS: A total of 80 psychologically well-functioning postmenopausal women aged 50 to 64 years were administered the Zung Anxiety Index (ZAI), from which total score, somatic anxiety subscale score, and affective anxiety subscale score were calculated. The outcome measure was a hot flash score that incorporated both frequency and severity based on a 7-day diary. A linear regression analysis examined the association between hot flashes and the two anxiety subscales controlling for age, education, and sleep quality. RESULTS: Higher score on somatic anxiety was significantly associated with higher hot flash score (P = 0.04), whereas the association with affective anxiety was not significant (P = 0.80). Higher total score on the ZAI was also significantly associated with higher hot flash score (P = 0.02). CONCLUSIONS: These results suggest that the positive association between higher ZAI scores and hot flashes in recently postmenopausal women may be due to the overlap between the somatic manifestation of hot flashes and anxiety symptoms rather than to an affective anxiety disturbance. These results have potential implications for the care and treatment of postmenopausal women, but replication is required in other samples including women at different transition stages of menopause and women with psychiatric comorbidities.

Computerized cognitive assessment in primary care to identify patients with suspected cognitive impairment.

The incidence and prevalence in those over age 65 of neurodegenerative disorders and chronic diseases, which often have deleterious effects on cognition, are rapidly increasing in western societies. Primary care physicians (PCPs) provide the majority of medical treatment for older people and in order to effectively care for their patients with suspected cognitive impairment, they must have tools that will allow them to accurately assess their patient's cognitive function. This knowledge will assist the PCPs in formulating a diagnosis of dementia or cognitive impairment and provide an indication of risk of progression to dementia. It will also assist with monitoring response to treatment and care decisions, including medication management, capacity judgments, and the need for family involvement. Tests currently used in primary care, such as the Mini-Mental State Examination, do not accurately assess patients with mild cognitive impairments, and other tests more suitable for this purpose require further validation and may be too time-consuming in the primary care setting. A possible solution is the use of patient-administered computerized cognitive testing in the PCP's office. This systematic review identified eleven test batteries and three were judged potentially appropriate for cognitive assessment in the PCP's office. These three varied in their presentation format and the quality of cross-sectional validation studies, and none had longitudinal data for dementia prediction. Thus the existing test batteries show potential for use in primary care but further study is needed to demonstrate their feasibility and effectiveness in this setting.