Age-related changes in the dynamics of human albino visual pathways.

A deficiency of melanin in the retinal pigment epithelium, which regulates the development of neural retina, leads to chiasmal misrouting such that the uncrossed pathway (to the ipsilateral hemisphere) is reduced relative to the crossed pathway (to the contralateral hemisphere). This study examines age-related changes in the flash and pattern appearance visual evoked potentials (VEP) of human albinos. Scalp recorded cortical VEPs to flash (FVEP) and pattern appearance stimulation were recorded in 58 albino (8 months to 60 years) and 34 normal subjects (4-55 years). VEPs were analysed by amplitude and latency. The contralateral hemisphere FVEP amplitude decreased with age in albino subjects, as in both hemispheres in normals. However, the ipsilateral hemisphere FVEP amplitude was significantly lower in young albino subjects, initially giving a marked interhemispheric asymmetry, but this normalized with age. Significant interhemispheric FVEP latency asymmetries were not observed. The contralateral pattern appearance VEP latency in albino subjects decreased with age, as in both hemispheres in normals; the ipsilateral latency increased significantly with age. Significant interhemispheric pattern appearance VEP amplitude asymmetries were not observed. These novel and unexpected observations indicate significant age-related changes in the retinocortical pathways of the human albino. These changes have implications for our understanding of development and plasticity of the central visual pathways.

A Longitudinal Study of Participation in Nursing Home Activity Programs.

The authors evaluated participation in activity programs in a prospective study of 198 new nursing home admissions. Both on admission and after 1 year, approximately 50% of patients were not participating in activities. Nonparticipation was associated with greater cognitive and functional impairment and the use of restraints and neuroleptics. Over the year, activity status changed for approximately 50% of patients in relation to these factors. These findings indicate current limitations in nursing home activity programs and suggest that participation is a dynamic process influenced by identifiable clinical variables. Revision of activity programs is necessary to meet OBRA regulations to improve the quality of patients' lives.

Underutilization of Physical and Mental Health Services Prior to Nursing Home Admission.

The authors interviewed the families of 420 nursing home admissions to examine the relationship between patients' need for nursing and mental health services and their use of these services prior to nursing home placement. Although the majority of demented and nondemented patients needed help with activities of daily living, and many needed help with behavioral disorders, fewer than one-third of the families of these patients used community nursing and mental health services for these problems. Increased awareness of the potential value of and improved access to these services may postpone or prevent nursing home placement.