Associations between falls and general health, nutrition, dental health and medication use in Swedish home-dwelling people aged 75 years and over.

The vast majority of elderly people in Sweden live in private homes in their communities for as long as possible. Poor health and a high risk of falls are very common among this group. This cross-sectional study investigates the association between falls and general health, appetite, dental health, and the use of multiple medications among home-dwelling men and women aged ≥ 75 years. Data were collected between October 2008 and March 2009 using a postal questionnaire. A total of 1243 people participated in the questionnaire survey (74% response rate), of which 1193 were included in the analysis. The majority of participants were women (n = 738, 62%). Falls in the previous 12-month period were reported by 434 (36%) participants. Most fallers (n = 276, 64%) were women. The majority of the fallers lived in a flat (n = 250, 58%). Poor health (aOR: 1.61; CI: 1.34-1.95), poor dental health (aOR: 1.22; CI: 1.07-1.39) and the use of four or more types of medication daily (aOR: 1.13; CI: 1.03-1.25) were significantly associated with falls in all participants. Poor dental health was found irrespectively of living in a flat (aOR: 1.23; CI: 1.04-1.46) or living in a house (aOR: 1.28; CI: 1.02-1.61), and both were significantly associated with falls. The use of more than four different types of medication daily (aOR: 1.25; CI: 1.11-1.41) was associated with falls for those living in a flat. The results highlight that falls are associated with poor general health, poor dental health and the use of four or more types of medication daily. Health professionals should provide health promotion education and investigate dental health and risk factors for oral disease. Likewise, medical and clinical practices of physicians and community care nurses should include assessing the risk of falling, and treatment that predisposes falls.

Non-Verbal and Verbal Fluency in Prodromal Huntington's Disease.

BACKGROUND: This study examines non-verbal (design) and verbal (phonemic and semantic) fluency in prodromal Huntington's disease (HD). An accumulating body of research indicates subtle deficits in cognitive functioning among prodromal mutation carriers for HD. METHODS: Performance was compared between 32 mutation carriers and 38 non-carriers in order to examine the magnitude of impairment across fluency tasks. The predicted years to onset (PYTO) in mutation carriers was calculated by a regression equation and used to divide the group according to whether onset was predicted as less than 12.75 years (HD+CLOSE; n = 16) or greater than 12.75 years (HD+DISTANT; n = 16). RESULTS: The results indicate that both non-verbal and verbal fluency is sensitive to subtle impairment in prodromal HD. HD+CLOSE group produced fewer items in all assessed fluency tasks compared to non-carriers. HD+DISTANT produced fewer drawings than non-carriers in the non-verbal task. PYTO correlated significantly with all measures of non-verbal and verbal fluency. CONCLUSION: The pattern of results indicates that subtle cognitive deficits exist in prodromal HD, and that less structured tasks with high executive demands are the most sensitive in detecting divergence from the normal range of functioning. These selective impairments can be attributed to the early involvement of frontostriatal circuitry and frontal lobes.

Personality changes in Alzheimer's disease: a systematic review.

OBJECTIVE: People with Alzheimer's disease (AD) commonly exhibit changes in personality that sometimes precede the other early clinical manifestations of the condition, such as cognitive impairment and mood changes. Although these personality changes reflect the impact of progressive brain damage, there are several possible patterns of personality change with dementia. Early identification of personality change might assist with the timely diagnosis of AD. The objective of this study was to review studies of personality change in AD. METHODS: Systematic searches of the PubMed, Ovid Medline, EBSCOhost, PsychINFO and CINAHL databases were undertaken from inception to November 2009. Published studies of informant-rated personality traits in AD patients were identified. Studies that mapped changes in traits from the five-factor model of personality which includes factors for Neuroticism, Extraversion, Openness, Agreeableness and Conscientiousness, were selected for analysis. The change in each of these five traits was calculated as the mean difference in score before and after the diagnosis of AD. RESULTS: There was a mean increase in Neuroticism of 10-20 T scores (equivalent to 1-2 SD), a decrease of the same magnitude in Extraversion, consistently reduced Openness and Agreeableness, and a marked decrease in Conscientiousness of about 20-30 T scores (equivalent to 2-3 SD). These changes were systematic and consistent. Particularly striking was the similarity of both the magnitude and direction of change in all studies reviewed. CONCLUSIONS: Conscientiousness and Neuroticism are the personality traits that exhibit the most change in dementia. These traits might be useful early markers of dementia.

Comparative use of complementary medicine, allied health, and manual therapies by middle-aged and older Australian women.

We compared use of Complementary and Alternative Medicines (CAM) and therapies, Allied Health interventions (AH), and Manual Therapies (MT) in middle-aged and older Australian women. Cross-sectional data from the 2007 phase of the Longitudinal study of Aging in Women (LAW study) was analyzed. Self-reported 12-month usage patterns of CAM, AH, and MT were determined by mailed questionnaire. Results revealed that 56.2% of the middle-aged group, and 55.0% of the older group used CAM, AH, and MT services in the previous 12 months (a nonsignificant difference). In contrast, there was a highly significant difference between the overall use of CAM products by middle-aged women (88.2%) and older women (67.7%: p = .002).

WAIS-R features of preclinical Huntington's disease: implications for early detection.

BACKGROUND/AIMS: The main purpose of the study was to determine whether the predicted age of onset of Huntington's disease (HD) affects cognitive function as measured by the Wechsler Adult Intelligence Scale-Revised (WAIS-R). The subscales and subtests, and their potential selectivity were examined in preclinical HD (30 mutation carriers and 34 noncarriers) with no motor or neuropsychiatric signs of HD. METHODS: The predicted age of onset in mutation carriers was calculated by a regression equation allowing this group to be divided according to whether onset was predicted as within 12 years (HD+CLOSE) or longer than this (HD+DISTANT). RESULTS: The HD+CLOSE group scored significantly lower on Verbal, Performance, and Full Scale IQ compared to noncarriers and performed significantly lower on 7 of the 11 WAIS-R subtests, with low average scores in language abilities, attention, abstract thinking, problem solving, visuospatial ability, and psychomotor speed. CONCLUSION: These low average scores affect general intelligence and functioning of HD+CLOSE carriers and are likely to reflect dysfunction of frontal cortex and frontostriatal circuits more than a decade before manifest symptoms. Our findings support a continuous linear model of slow cognitive decline in HD.

Early cognitive deficits in Swedish gene carriers of Huntington's disease.

The primary focus of this study was to examine whether there is early neuropsychological impairment in presymptomatic Huntington's disease (HD). A broad neuropsychological assessment battery was administered to 24 asymptomatic gene carriers (HD+) and 31 noncarriers (HD-). The gene carriers revealed inferior cognitive functioning as compared with the noncarriers in memory and executive functions. When the gene carriers were assigned to 2 groups based on predicted years to onset (with 15 and over being HD+ late and under 15 being HD+ near), the HD+ near group performed significantly worse than the HD+ late group in all domains but ability to shift conceptually and visuospatial memory. Results suggest that early cognitive deficits are detectable prior to motor symptoms, first in memory functions and then in executive functions and perceptual motor speed.

Work situation of registered nurses in municipal elderly care in Sweden: a questionnaire survey.

BACKGROUND: Organizational changes have occurred in municipal elderly care in Sweden during the past decades. The 'Adel' reform transferred responsibility for the care of older persons from the county councils to the municipalities. Furthermore, the specialisation in dementia care divided elderly care into two groups: dementia and general care. This change has had a significant impact on the work situation of registered nurses (RNs). AIM: The main focus was to describe RNs' work situation and their characteristics in municipal elderly care. Another aim was to compare RNs working solely in dementia care with those working in general care of older persons with diverse diagnoses. DESIGN: A non-experimental, descriptive design with a survey research approach was used. SETTINGS: Sixty special housing units with underlying units including those offering daytime activities in a large city in the middle of Sweden. PARTICIPANTS: The number of participating RNs was a total of 213, with a response rate of 62.3%. Of the 213 RNs, 95 (44.6%) worked in dementia care, and 118 (55.4%) in general care. METHOD: A questionnaire survey. RESULTS: The results indicated high levels of time pressure in both groups. Greater knowledge and greater emotional and conflicting demands were found in dementia care. The majority perceived a greater opportunity to plan and perform daily work tasks than to influence the work situation in a wider context. Support at work was perceived as generally high from management and fellow workers and higher in dementia care. CONCLUSION: It is important to decrease RNs' time pressure and increase their influence on decisions made at work.

To know or not to know: a review of behaviour and suicidal ideation in preclinical Huntington's disease.

OBJECTIVE: At present, the problems associated with suicidal ideation and suicide in Huntington's disease (HD), worldwide, are much the same as 2 decades ago. This study seeks to investigate the psychological complications of predictive testing in HD at risk populations. METHODS: The key problems of predictive testing, fear of acquiring carrier status, psychological consequences, autonomy, and rights to know are discussed. RESULTS: This review (1) describes psychological affect and problems of persons facing the decision to test for HD, (2) discusses suicidal ideation, behaviour, and catastrophic events associated with predictive testing, (3) assesses ethical questions raised in the genetic counselling, (4) questions whether counsellors should promote or advocate predictive testing, and finally (5) discusses what professionalism actually is in genetic counselling. CONCLUSION: The need for professional counselling, using a well designed protocol, and the importance of focusing on the suicide risk of participants in predictive testing programs are emphasized. PRACTICE IMPLICATIONS: The counsellor has an obligation to provide adequate information. The professionals should not promote nor advocate presymptomatic DNA-testing. Depression, hopelessness, anxiety, emotional distress, suicidal tendencies, and social dysfunction grading should be considered in predictive testing of HD.

Olfactory functions in asymptomatic carriers of the Huntington disease mutation.

Huntington's disease (HD) is a neurodegenerative disorder initially affecting the basal ganglia and especially the head of the caudate nucleus. Neuropsychological research has indicated that olfactory dysfunction may appear early in HD, prior to the onset of significant motor or cognitive dysfunction. The aim of this study was to examine whether asymptomatic carriers of the Huntington disease mutation also exhibit olfactory dysfunction. To address this issue we presented an extensive olfactory test battery comprising tasks assessing olfactory sensitivity, intensity discrimination, quality discrimination, episodic odor memory, and odor identification, to a group of gene carriers and nonmutation carriers of the disease. The results showed that gene carriers were selectively impaired in discriminating odor quality, although performance did not differ from noncarriers across the other tasks. The role played by striatum and then in particular the caudate nucleus for olfactory processing in general, and for odor quality discrimination in particular, is discussed.