Emotional Awareness and Expression Therapy Achieves Greater Pain Reduction than Cognitive Behavioral Therapy in Older Adults with Chronic Musculoskeletal Pain: A Preliminary Randomized Comparison Trial.

OBJECTIVE: Emotional awareness and expression therapy (EAET) emphasizes the importance of the central nervous system and emotional processing in the etiology and treatment of chronic pain. Prior trials suggest EAET can substantially reduce pain; however, only one has compared EAET with an established alternative, demonstrating some small advantages over cognitive behavioral therapy (CBT) for fibromyalgia. The current trial compared EAET with CBT in older, predominately male, ethnically diverse veterans with chronic musculoskeletal pain. DESIGN: Randomized comparison trial. SETTING: Outpatient clinics at the West Los Angeles VA Medical Center. SUBJECTS: Fifty-three veterans (mean age = 73.5 years, 92.4% male) with chronic musculoskeletal pain. METHODS: Patients were randomized to EAET or CBT, each delivered as one 90-minute individual session and eight 90-minute group sessions. Pain severity (primary outcome), pain interference, anxiety, and other secondary outcomes were assessed at baseline, post-treatment, and three-month follow-up. RESULTS: EAET produced significantly lower pain severity than CBT at post-treatment and follow-up; differences were large (partial η2 = 0.129 and 0.157, respectively). At post-treatment, 41.7% of EAET patients had >30% pain reduction, one-third had >50%, and 12.5% had >70%. Only one CBT patient achieved at least 30% pain reduction. Secondary outcomes demonstrated small to medium effect size advantages of EAET over CBT, although only post-treatment anxiety reached statistical significance. CONCLUSIONS: This trial, although preliminary, supports prior research suggesting that EAET may be a treatment of choice for many patients with chronic musculoskeletal pain. Psychotherapy may achieve substantial pain reduction if pain neuroscience principles are emphasized and avoided emotions are processed.

The Fear of Alzheimer's Disease Scale: a new measure designed to assess anticipatory dementia in older adults.

BACKGROUND: As the prevalence of Alzheimer's disease (AD) is rapidly increasing, apprehension about developing the degenerative disease (anticipatory dementia or fear of developing AD) has become a topic of interest. However, most studies of anticipatory dementia have utilized brief, nonvalidated measures to explore older adults' apprehension. As such, there is a significant need for a psychometrically sound instrument to measure this fear. METHODS: The current study utilized 101 older adults ages 65 to 91 to develop and validate an important new scale, the Fear of Alzheimer's Disease Scale (FADS). Construct validity of the FADS was assessed with the State-Trait Anxiety Inventory-Form Y (STAI-Y). RESULTS: Analyses revealed a three-factor model for the FADS (i.e., General Fear, Physical Symptoms, and Catastrophic Attitude) and an α of 0.94 for the entire measure, indicating good internal consistency. The FADS demonstrated good construct validity, as it was significantly correlated with both the state and trait subscales of the STAI-Y, with the trait subscale yielding the highest correlation. CONCLUSION: The FADS is a reliable and valid instrument and is the first of its kind available to directly address anticipatory dementia among a general population of older adults.

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.

The neural correlates of naming and fluency deficits in Alzheimer's disease: an FDG-PET study.

OBJECTIVE: To examine the neural processes associated with language deficits in Alzheimer's disease (AD), and in particular to elucidate the correlates of confrontation naming and word retrieval impairments. METHODS: Sixty patients with probable AD were included. Confrontation naming was assessed using the number of words spontaneously named correctly on the Boston Naming Test. We recorded the number of additional words stated following phonemic cuing. We also assessed phonemic (FAS) and semantic (supermarket items) fluency. We then correlated performance on each measure with resting cortical metabolic activity using FDG-PET images. RESULTS: We found that poorer ability to spontaneously name an object was associated with hypometabolism of bilateral inferior temporal lobes. In contrast, when a phonemic cue was provided, successful naming under this condition was associated with higher metabolic activity in bilateral inferior frontal gyrus (IFG), right superior frontal gyrus (SFG), left temporal, and occipital regions. Consistent with these findings, we found that poorer semantic fluency was associated with hypometabolism in regions including both IFG and temporal regions, and poorer phonemic fluency was associated with hypometabolism in only left IFG. Across analyses, measures that required cued retrieval were associated with metabolism in the left IFG, whereas measures taxing semantic knowledge were associated with metabolic rate of left temporal cortex. CONCLUSIONS: Naming deficits in AD reflect compromise to temporal regions involved in the semantic knowledge network, and frontal regions involved in the controlled retrieval of information from that network.