Erratum to: Association between Modifiable Risk Factors and Levels of Blood-Based Biomarkers of Alzheimer's and Related Dementias in the Look AHEAD Cohort.

[This corrects the article DOI: 10.14283/jarlife.2024.1.].

Association between Modifiable Risk Factors and Levels of Blood-Based Biomarkers of Alzheimer's and Related Dementias in the Look AHEAD Cohort.

Background: Emerging evidence suggests that a number of factors can influence blood-based biomarker levels for Alzheimer's disease (AD) and Alzheimer's related dementias (ADRD). We examined the associations that demographic and clinical characteristics have with AD/ADRD blood-based biomarker levels in an observational continuation of a clinical trial cohort of older individuals with type 2 diabetes and overweight or obesity. Methods: Participants aged 45-76 years were randomized to a 10-year Intensive Lifestyle Intervention (ILI) or a diabetes support and education (DSE) condition. Stored baseline and end of intervention (8-13 years later) plasma samples were analyzed with the Quanterix Simoa HD-X Analyzer. Changes in Aß42, Aß40, Aß42/Aß40, ptau181, neurofilament light chain (NfL), and glial fibrillary acidic protein (GFAP) were evaluated in relation to randomization status, demographic, and clinical characteristics. Results: In a sample of 779 participants from the Look AHEAD cohort, we found significant associations between blood-based biomarkers for AD/ADRD and 15 of 18 demographic (age, gender, race and ethnicity, education) and clinical characteristics (APOE, depression, alcohol use, smoking, body mass index, HbA1c, diabetes duration, diabetes treatment, estimated glomerular filtration rate, hypertension, and history of cardiovascular disease) . Conclusions: Blood-based biomarkers of AD/ADRD are influenced by common demographic and clinical characteristics. These factors should be considered carefully when interpreting these AD/ADRD blood biomarker values for clinical or research purposes.

A study of donepezil in female breast cancer survivors with self-reported cognitive dysfunction 1 to 5 years following adjuvant chemotherapy.

PURPOSE: Some breast cancer survivors report cognitive difficulties greater than 1 year after chemotherapy. Acetylcholinesterase inhibitors (AChEI) may improve cognitive impairment. We conducted a randomized, placebo-controlled, pilot study to assess the feasibility of using the AChEI, donepezil, to improve subjective and objective measures of cognitive function in breast cancer survivors. METHODS: Women who received adjuvant chemotherapy 1-5 years prior with current cognitive dysfunction symptoms were randomized to 5 mg of donepezil/day vs placebo for 6 weeks and if tolerated 10 mg/day for 18 weeks for a total of 24 weeks. A battery of validated measures of attention, memory, language, visuomotor skills, processing speed, executive function, and motor dexterity and speed was administered at baseline and at 24 and 36 weeks. Subjective cognitive function, fatigue, sleep, mood, and health-related quality of life were evaluated at baseline and at 12, 24, and 36 weeks. RESULTS: Sixty-two patients were enrolled, 76 % completed the study, self-reported compliance was 98 %, and toxicities were minimal. At the end of treatment, the donepezil group performed significantly better than the control group on two parameters of memory-the Hopkins Verbal Learning Test -Revised (HVLT-R) Total Recall (p = 0.033) and HVLT-R Discrimination (p = 0.036). There were no significant differences on other cognitive variables or in subjective cognitive function or quality of life. CONCLUSION: Accrual to this feasibility trial was robust, retention was good, compliance was excellent, and toxicities were minimal. IMPLICATIONS FOR CANCER SURVIVORS: Randomized clinical trials in breast cancer survivors to improve cognitive dysfunction are feasible. A phase III trial testing the efficacy of donepezil is warranted given these pilot results.

Itch characteristics in atopic dermatitis: results of a web-based questionnaire.

BACKGROUND: Itch significantly impairs the quality of life of patients with atopic dermatitis. However, only a few previous studies have examined the specific characteristics of itch in atopic dermatitis. OBJECTIVE: To examine the frequency, intensity and perceived characteristics of pruritus among individuals with atopic dermatitis. METHODS: Questionnaire reliability and validity were established in pilot testing. Survey participants completed the comprehensive, web-based 'Characteristics of itch' questionnaire. Participants provided anonymous demographic information and answered questions regarding itch intensity, frequency, timing, duration, location, associated symptoms and itch descriptors. RESULTS: A total of 304 individuals with atopic dermatitis completed the web-based questionnaire. Itch occurred at least once daily in 91% of the individuals surveyed. Of the 32 itch descriptors rated by survey participants, 31 demonstrated a statistically significant positive correlation with the participants' ratings of itch intensity (P < 0.001). More than half the survey participants reported pain (59%) and heat sensation (53%) associated with itch. CONCLUSION: The questionnaire was found to be a useful tool in characterization of itch. Pain appears to be an important component of atopic dermatitis. The strong correlation between itch descriptors and itch intensity suggests that such descriptors serve as strong indicators of the symptomatology in atopic dermatitis.

Diagnosed skin diseases among migrant farmworkers in North Carolina: prevalence and risk factors.

Skin diseases are common among farmworkers, yet little research documents their prevalence and risk factors. This analysis documents the prevalence of skin diseases among farmworkers in North Carolina, examines variation in the prevalence across the agricultural season, and delineates factors associated with skin disease. Data are from a longitudinal surveillance study with assessments at approximately three-week intervals from May through October 2005. The sample included 304 farmworkers from 45 camps with 1048 data points. Data collection included a structured interview and a standard set often digital photographs. A board-certified dermatologist reviewed the photographs and made specific diagnoses in five categories: inflammatory disease, infection, pigmentary disorder, tumor, and trauma. The prevalences of the five skin disease categories and specific diagnoses are described with counts and frequencies for the entire season and for six time periods. The inflammatory disease and infectious disease categories are modeled with an extension of logistic regression that accounts for repeated measures and clustering of farmworkers within camps. Farmworkers experience high levels of inflammatory skin disease (57.2%) including acne, folliculitis, and contact dermatitis; infectious skin disease (73.8%) including tinea pedis, onychomycosis, and warts; pigmentary disorders (19.1%); and trauma (34.5%). The odds of inflammatory skin disease decreased with age, while those for infectious skin disease increased with age. The odds of inflammatory skin disease increased with pesticide exposure and decreasing housing quality. Skin diseases are highly prevalent among farmworkers. Research is needed to delineate specific factors causing high levels of infection and inflammation in this population.

Skin disease among Latino farmworkers in North Carolina.

An estimated 4.2 million seasonal and migrant farmworkers and their dependents live in the U.S. Most of these farmworkers are Latino. These workers are exposed to numerous occupational and environmental risk factors that can result in skin disease. Few data exist on the prevalence of skin disease in this population. The purpose of this study was to estimate the prevalence and predictors of skin disease in a sample of Latino farmworkers in North Carolina. A sample of 59 farmworkers was recruited and interviewed at two camps during the 2004 agricultural season. A dermatologist completed a skin exam of each worker and recorded any skin disease present. Forty-two (77.7%) of the 54 men, and all five of the women examined had a diagnosed skin disease. For the men, onychomycosis (nail fungus, 31.5%), tinea pedis (foot fungus, 27.8%), and acne (24.1 %) were the most commonly diagnosed skin diseases, with contact dermatitis diagnosed in 5.6% of the sample. Other diagnoses included scars, sunburn, and atopic dermatitis. Among the women, diagnoses included melasma (dark patches on the face, 2 cases), xerosis (excessively dry skin, 1 case), tinea pedis (2 cases), onychomycosis (1 case), acne (1 case), and insect bites (1 case). There were no statistically significant differences between workers in the two camps despite different growing seasons and different crops harvested. Skin disease is prevalent among the North Carolina Latino farmworkers who participated in this study, with fungal disease being the most prevalent.

Anger and acne: implications for quality of life, patient satisfaction and clinical care.

BACKGROUND: Acne is a common skin disorder with a significant psychological and social impact for some people. Little is known about how personality and emotional traits affect acne and its impact on quality of life and treatment. Trait anger (TA), which is related to heart disease and other morbidities, may also affect acne and patients' adjustment to it. OBJECTIVES: To evaluate the relationship between TA and acne severity, skin-related quality of life, satisfaction with treatment, and adherence to treatment. PARTICIPANTS AND METHODS: A sample of 479 individuals with acne completed a survey instrument to assess acne severity, skin care practices, skin-related quality of life, satisfaction with treatment, adherence, TA and demographic variables. Respondents who reported high TA were compared with individuals with low TA on outcome variables. Regression analyses adjusted for covariates and identified the significant predictors of quality of life, satisfaction and adherence. RESULTS: High TA was unrelated to acne severity (P = 0.2) or frequency of face washing (P = 0.9). Anger was significantly related to both global quality of life (P < 0.001) and skin-related quality of life (P = 0.002) as well as to satisfaction with treatment (P = 0.001) and adherence to treatment advice (P = 0.05) in bivariate analyses. Regression analyses revealed that high TA remained a significant predictor of global (P < 0.001) and skin-related quality of life (P = 0.003) and satisfaction with treatment (P = 0.04), but not adherence to treatment advice (P = 0.8) after controlling for covariates. CONCLUSIONS: Anger is associated with the quality of patients' lives and with their satisfaction with treatment. Care of acne patients should include attention to anger and other chronic emotional states, quality of life, as well as to clinical severity. Simple guidelines are suggested for how clinicians might approach this important aspect of care.

Baseline experience with Modified Mini Mental State Exam: The Women's Health Initiative Memory Study (WHIMS).

The Modified Mini Mental State Exam (3MS) is widely used for screening global cognitive functioning, however little is known about its performance in clinical trials. We report the distribution of 3MS scores among women enrolled in the Women's Health Initiative Memory Study (WHIMS) and describe differences in these scores associated with age, education, and ethnicity. The 3MS exams were administered to 7,480 women aged 65-80 who had volunteered for and were eligible for a clinical trial on postmenopausal hormone therapy. General linear models were used to describe demographic differences among scores. Factor analysis was used to characterize the correlational structure of exam subscales.The distribution of 3MS scores at baseline was compressed in WHIMS compared to population-based data. Mean 3MS scores (overall 95.1) tended to decrease with age and increase with education, however these associations varied among ethnic groups (p< 0.0001) even after adjustment for health, physical disability and occupation attainment. Four factors accounted for 37% of the total variance. Each varied with education and ethnicity; the two most prominent factors also varied with age. Despite relatively narrow distributions in WHIMS, baseline 3MS scores retained associations with age and education. These associations varied among ethnic groups, so that care must be taken in comparing data across populations.

Social coping strategies associated with quality of life decrements among psoriasis patients.

BACKGROUND: Individuals with psoriasis often report significant psychological distress, physical disability, social strain and reduced quality of life. Little is known about how they cope with the illness. OBJECTIVE: The primary aim of this study is to determine whether patients' efforts to cope with psoriasis are associated with better or worse health-related quality of life (HRQL). METHODS: Focus groups identified seven commonly used coping strategies that were subsequently measured, along with HRQL and other variables, in a survey of 318 individuals with psoriasis. RESULTS: Results revealed: (i) that psoriasis is associated with decrements in all quality of life domains that were assessed, and (ii) that commonly used coping strategies such as telling others about psoriasis, covering the lesions and avoiding people were associated with greater decrements in HRQL after controlling for covariates; however, telling others that psoriasis is not contagious was associated with smaller HRQL decreases. CONCLUSIONS: How patients cope with the social aspects of psoriasis is associated with their quality of life.

Social support increases in the year after inpatient treatment of depression.

High levels of social support are reported to protect against major depressive episode (MDE), but little is known about how social support changes during MDE. In this study, we measured total social support and four subtypes of social support in 75 psychiatric inpatients at the time of admission and one year later. The four subtypes of social support were tangible support, affectionate support, positive social interaction, and emotional/informational support. The majority of the sample were women (81%) with a mean age of 53.7+/-14.9 years. The severity of depressive symptoms improved over the year and was accompanied by a significant increase in two types of social support -- positive social interaction, and emotional/informational support. There was no significant change in tangible support or affectionate support. Linear regression showed that changes in all four subtypes were correlated with changes in depressive severity after adjustment for age, gender, and baseline clinical characteristics. While Instrumental Activities of Daily Living (IADL) scores also improved throughout the period of observation, and while the change in IADL scores were significantly associated with changes in social support, change in IADL scores were no longer significantly associated with change in social support after adjustment for change in depression severity. These results suggest that supportive relationships improve after psychiatric hospitalization for MDE, and these changes are best explained by reduction in depression severity.

Measuring adherence to behavioral and medical interventions.

Measuring adherence to medical and behavioral interventions is important to clinicians and researchers since inadequate adherence can reduce the effectiveness of an intervention. Unfortunately, there is no gold standard for measuring adherence across health behaviors. Adherence needs to be defined situationally with parameters of acceptable adherence carefully delineated and appropriate to the health behavior being studied. Additionally, measurement methods must be valid, reliable, and sensitive to change; this paper reviews these criteria. Methods used to measure adherence to dietary interventions include 24-hour recalls, food diaries, and food frequency questionnaires. Direct and indirect calorimetry, doubly labeled water, and a variety of self-report methods can be used to measure adherence in physical activity interventions. Adherence to pharmacological interventions is assessed using self-report methods, biochemical measures, medication counts, and the automated pharmacy database review strategy. The strengths and weaknesses of these methods for measuring adherence to dietary, physical activity, and pharmacological interventions are reviewed. Control Clin Trials 2000;21:188S-194S

Introduction. The magnitude of skin disease in the United States.

Skin disease is common in the United States and accounts for a considerable fraction of all outpatient visits. Dermatologists care for more skin disease visits than any other single specialty, while still accounting for a minority of visits overall. The data presented in this introduction, from 1997, do not show a drastic drop in the number of visits to dermatologists as might be feared to occur with the growth in managed care. These visits for skin disease represent a considerable disease burden in the United States. Skin disease is not simply a cosmetic problem. As the data on psoriasis show, skin disease has a tremendous impact on HRQL. The magnitude of this impact on the individual patient is comparable to the impact of other medical disorders.

Physical function among older adults with knee pain: the role of pain coping skills.

OBJECTIVE: To evaluate the association between pain coping skills and disability among older adults with knee pain. METHODS: Baseline measures from 394 older adults with knee pain and disability who participated in a 30-month observational study were analyzed. Pain coping skills were correlated with self-reported disability and walking distance after controlling for covariates of disability. RESULTS: Pain coping skills were significantly associated with disability (P < 0.05) and distance walked (P < 0.05). Less catastrophic thinking and prayer, greater ignoring and reinterpretation of pain sensations, and stronger perceptions of pain control were associated with less disability and better physical function. CONCLUSION: Pain coping skills used by older adults with osteoarthritis and knee pain may play a significant role in determining disability.

Psoriasis causes as much disability as other major medical diseases.

BACKGROUND: Little is known about how the health-related quality of life (HRQL) associated with psoriasis compares with that of other patient populations. OBJECTIVE: We describe HRQL associated with psoriasis and compare it with HRQL of patients with other major chronic health conditions. A second aim is to identify which specific aspects of psoriasis contribute most to HRQL. METHODS: A total of 317 patients completed a non-disease-specific measure of HRQL. Responses were compared with those of patients with 10 other chronic health conditions. HRQL was regressed on ratings of 18 aspects of psoriasis. RESULTS: Patients with psoriasis reported reduction in physical functioning and mental functioning comparable to that seen in cancer, arthritis, hypertension, heart disease, diabetes, and depression. Six aspects of psoriasis predicted physical functioning, and 5 different disease aspects predicted mental functioning. CONCLUSION: The impact of psoriasis on HRQL is similar to that of other major medical diseases. Different aspects of psoriasis are related to the different dimensions of HRQL supporting the need for multidimensional treatment models.

Interpersonal concerns and psychological difficulties of psoriasis patients: effects of disease severity and fear of negative evaluation.

Psoriasis creates interpersonal difficulties for many sufferers, but little research has examined factors that contribute to the degree of social and psychological disability that a particular person experiences. In all, 318 psoriasis patients completed measures of psychological and social well-being, the severity of their psoriasis, and their dispositional level of fear of negative evaluation (FNE). Analyses showed that disease severity and FNE significantly predicted perceptions of being stigmatized, interpersonal discomfort, stress over others' reactions, distress regarding the observable symptoms of the disease, the degree to which psoriasis interfered with the patients' lives, and patients' quality of life. Furthermore, FNE exerted a particularly strong influence for patients who had severe cases of psoriasis.

The Women's Health Initiative Memory Study (WHIMS): a trial of the effect of estrogen therapy in preventing and slowing the progression of dementia.

Evidence from animal, human cross-sectional, case-control, and prospective studies indicate that hormone replacement therapy (HRT) is a promising treatment to delay the onset of symptoms of dementia. The Women's Health Initiative Memory Study (WHIMS) is the first double-masked, randomized, placebo-controlled, long-term clinical trial designed to test the hypothesis that HRT reduces the incidence of all-cause dementia in women aged 65 and older. WHIMS, an ancillary study to the Women's Health Initiative (WHI) funded by the National Institutes of Health, will recruit a subgroup of women aged 65 and older from among those enrolling in the HRT trial of the WHI. The WHI clinical centers and 10 affiliated satellites plan to enroll approximately 8300 women into WHIMS over a 2-year period. Participants will be followed annually for 6 years, receiving cognitive assessments via the Modified Mini-Mental State (3MS) Examination. Women who screen positively for cognitive impairment on the basis of an educational and age-adjusted 3MS cutpoint proceed to more extensive neuropsychological testing and neurologic evaluation. Each woman suspected to have dementia then undergoes a series of laboratory tests that confirm the clinical diagnosis and classify the type of dementia. WHIMS is designed to provide more than 80% statistical power to detect a 40% reduction in the rate of all-cause dementia, an effect that could have profound public health implications for older women's health and functioning.

The economic impact of psoriasis increases with psoriasis severity.

BACKGROUND: Psoriasis treatments are known to be costly, but little is known about the financial impact of psoriasis and the way in which it relates to the severity of the disease. OBJECTIVE: This study was performed to obtain an estimate of the treatment costs faced by patients with psoriasis. METHODS: A total of 578 anonymous mail surveys were distributed to patients with psoriasis; 318 surveys were returned (55%). Psoriasis severity was assessed with the previously validated Self-Administered Psoriasis Area Severity Index (SAPASI). RESULTS: The total and out-of-pocket expenses to care for psoriasis were correlated with psoriasis severity (r = 0.26, p = 0.0001). There were no sex (p = 0.9) or racial (p = 0.4) differences in total expenditures. Severity was correlated with how bothersome to the patient was the cost of treatment (r = 0.30, p = 0.0001), the time required for treatment (r = 0.38, p = 0.0001), and the time lost from work (r = 0.23, p = 0.0001). Lower quality of life at work and in money matters also correlated with severity of psoriasis. Higher family income was associated with less time spent caring for psoriasis and less interference with work around the home. CONCLUSION: As expected, the expenses caring for psoriasis are greater for patients with more severe disease. These costs and other financial implications are associated with lower quality of life for patients with more severe psoriasis.

Commercial tanning bed treatment is an effective psoriasis treatment: results from an uncontrolled clinical trial.

Phototherapy is highly effective in the therapy of psoriasis, but patient access to phototherapeutic facilities is not universal. Commercial tanning facilities are universal, but their efficacy in psoriasis treatment is unestablished. Our purpose was to conduct a study to assess the effect of a commercial tanning unit outfitted with nonprescription lamps on psoriasis. We conducted a 6-wk open study of 20 adult patients with stable psoriasis vulgaris. Clinical response was defined as a decrease in the Psoriasis Area Severity Index (PASI) or the Self-Administered PASI (SAPASI) by > or = 10%. There were 16 men and 4 women who participated with a mean (+/-SD) age of 43.0 +/- 14.8 y. Initial and final health-related quality of life information collected included the following instruments: the Brief Symptom Inventory (BSI), the Psoriasis-Related Stressor Scale (PRSS), and the Psoriasis Disability Scale (PDS). Side effects of tanning therapy were closely monitored. Fifteen subjects completed the entire 6-wk trial, and exit data on all subjects were used for analysis. The mean number of tanning sessions was 19 +/- 7.6 with a median of 19 and range of 3 to 29. Analysis of all 20 enrolled subjects found that 16 (80%) showed clinical response as measured by PASI, whereas 17 (85%) showed SAPASI response. Initial and final PASI scores decreased (p = 0.0001) from 7.96 +/- 1.77 to 5.04 +/- 2.5, and SAPASI scores also decreased (p = 0.02) from 11.8 +/- 4.4 to 7.9 +/- 7.7. When controlled for age and sex, a dose-response relationship was demonstrated with the PASI and SAPASI (p < 0.02). Decreases in the mean BSI and PRSS scales were demonstrated (p < 0.02), confirming the clinical significance of the reductions in disease severity scores. Episodes of mild burning occurred in 7 of 20 (35%) participants. Three subjects reported itching after one or two tanning sessions. This study showed that a tested commercial nonprescription tanning unit improved both psoriasis severity and health-related quality of life. Commercial tanning bed treatments may be a useful approach in patients unable to obtain office-based ultraviolet treatments.

The physical, psychological and social impact of psoriasis.

Psoriasis is a chronic, disabling skin disease affecting up to 2 percent of the population. Little is known about how physical, psychological and social features of the illness interact to create a negative impact. In this article, a biopsychosocial model of the impact of psoriasis is described, and results from a survey of 317 psoriasis patients are presented. The types of functional disability, psychological distress and disease-related stressors are described for highly strained patients (i.e. those with disease-related suicidal ideation) and compared with less strained patients (i.e. those without suicidal ideation). As predicted by the model, significantly more disability, psychological distress and disease-related stressors are found among highly strained patients. Logistical regression analysis revealed that strain is more strongly associated with disability, distress and disease-related stress level than with disease severity. Implications for research and clinical interventions are discussed.

Clinical variables influencing treatment decisions for agitated dementia patients: survey of physician judgments.

OBJECTIVE: To better understand primary treatment recommendations and the variables that might influence treatment decisions of physicians who treat agitated dementia patients. DESIGN: A written cross-sectional survey of three physician groups (geriatric psychiatrists, primary care physicians, and neurologists) who typically treat agitated dementia patients in community settings. We used a written clinical vignette describing a home-bound, agitated dementia patient to ask respondents to provide information regarding their primary treatment recommendation and to estimate the degree to which clinically relevant variables might influence their treatment recommendation. Using principal component analysis, the original set of clinical variables was collapsed into a smaller set of composite factors that better defined the fundamental constructs of the variables that influenced decision making. Analyses compared primary treatment recommendations and factors influencing treatment recommendations by physician groups. PARTICIPANTS: The pool of survey respondents consisted of a random selection of 207 primary care physicians from western North Carolina, 147 geriatric psychiatrists obtained from the roster of the 1991 American Association for Geriatric Psychiatry, and 120 neurologists obtained from the roster of the American Board of Medical Specialties. The response rate was 65% for geriatric psychiatrists, 38% for primary care physicians, and 33% for neurologists. RESULTS: Differences in primary treatment recommendations by physician group were not found. Physicians, regardless of specialty, recommended neuroleptic medications as their primary intervention. When medication classes were collapsed into a single category, medications as a primary intervention exceeded 55% for all physician groups. Twenty-two percent of all respondents recommended psychosocial interventions as primary treatment strategies. The principal component analysis of clinical variables influencing treatment recommendations solved for five components that accounted for 64% of the variance. Comparing the five components by specialty groups failed to find significant differences, except for Factor 5, the "Hassle Factor." Primary care physicians were more likely to indicate that this component influenced their decision making than were the other physician groups. CONCLUSIONS: The findings indicate that physicians, regardless of specialty, are likely to use medication and to weight clinically relevant information in a similar fashion when managing agitated dementia patients.