Stability of Subjective Executive Functioning in Older Adults with aMCI and Subjective Cognitive Decline.

OBJECTIVE: Subjective memory concerns are characteristic of individuals with amnestic mild cognitive impairment (aMCI) and subjective cognitive decline (SCD), though subjective changes in executive functions have also been reported. In a cohort study, we examined the temporal stability of subjective report of executive functioning in a high education (mean = 16.8 years) sample of cognitively normal (CN) older adults and those with aMCI or SCD. METHOD: Participants (CN, n = 22; aMCI, n = 21; SCD, n = 24) and their informants completed the BRIEF-A and neuropsychological tests at two time points separated by approximately 1 year. RESULTS: Analyses focused on those with diagnostic stability (95.7%). Participants with aMCI and SCD, and their informants, endorsed worse executive functions relative to CN at both time points. No group by time interaction was observed for subjective or objective measures of executive function. CONCLUSIONS: Diagnostically stable CN older adults, and those with prodromal dementia conditions, report stable executive functioning at 1-year follow-up.

Visual contrast sensitivity in Alzheimer's disease, mild cognitive impairment, and older adults with cognitive complaints.

Deficits in contrast sensitivity (CS) have been reported in Alzheimer's disease (AD). However, the extent of these deficits in prodromal AD stages, including mild cognitive impairment (MCI) or even earlier, has not been investigated. In this study, CS was assessed using frequency doubling technology in older adults with AD (n = 10), amnestic MCI (n = 28), cognitive complaints without performance deficits (CC; n = 20), and healthy controls (HC; n = 29). The association between CS and cognition was also evaluated. Finally, the accuracy of CS measures for classifying MCI versus HC was evaluated. CS deficits were found in AD and MCI, while CC showed intermediate performance between MCI and HC. Upper right visual field CS showed the most significant difference among groups. CS was also associated with cognitive performance. Finally, CS measures accurately classified MCI versus HC. The CS deficits in AD and MCI, and intermediate performance in CC, indicate that these measures are sensitive to early AD-associated changes. Therefore, frequency doubling technology-based measures of CS may have promise as a novel AD biomarker.

Personality traits in women with multiple sclerosis: discrepancy in patient/partner report and disease course.

OBJECTIVE: Patients diagnosed with multiple sclerosis (MS) are believed to undergo personality changes, which could have implications for how they perceive themselves and are perceived by others. We endeavored to examine the extent to which patients' self-perceptions are congruent with how they are perceived by significant others across five trait domains as demarcated by the well known Five-Factor Model (FFM). METHODS: The NEO Five-Factor Inventory (NEOFFI) (Costa and McCrae, 1992) was administered to women with MS (n=70) and their spouses or partners. Pearson correlations and general linear models (GLMs) were employed to test for differences between patient self-reports and partner reports of FFM traits. RESULTS: Correlation analyses revealed good correspondence between patient and partner NEOFFI data in relapsing-remitting MS patients, but not secondary progressive patients. There was no significant correlation among progressive course patients for all NEOFFI domains, except Agreeableness. GLMs revealed significant differences where patients rated themselves higher than their partners rated them in Extraversion and Openness. CONCLUSION: These discrepancies in the way patients and partners view patient personality are probably multidimensional and may have neurological and/or psychological causes. The direction of the discrepancies are consistent with some prior research suggesting MS, which is a disease affecting both the cerebral white and gray matter, may give rise to lowering in self awareness. Conversely, patients may be finding emotional or personal benefits in their response to the disease unbeknownst to partners.

Cortical atrophy and personality in multiple sclerosis.

Although the cognitive disorder of multiple sclerosis (MS) is well characterized, little is known about personality changes that may occur in this disease. There are reliable personality tests available for research in neurological disease, based on the well-known Five Factor Model. Preliminary research suggests that cognitively impaired MS patients exhibit elevation in Neuroticism, and diminution in Extraversion, Agreeableness, and Conscientiousness, as do patients with Alzheimer's disease. We predicted that these characteristics would be associated with lower neocortical volume. We studied 44 patients using brain MRI and the NEO Five-Factor Inventory. Regression models controlling for T2 lesion volume, depression, and cognitive dysfunction revealed significant correlation between cortical atrophy and reduction in Extraversion and Conscientiousness. Discrepancies between patient- and informant-reports were found, and overreporting of high Openness and Conscientiousness among patients was associated with lower neocortical volume. A final regression model accounting for depression, cognitive function, and personality accounted for 38% of the variance in neocortical volume. These findings suggest that cortical atrophy in MS is associated with adverse impact on personality, although longitudinal research is needed to test this hypothesis.

Approaches to tobacco control & lung cancer screening among physician assistants.

BACKGROUND: This study explores physicians' assistants' (PA) knowledge and practice regarding tobacco cessation counseling, approaches to lung cancer early detection and management of patients at high risk of developing lung cancer. METHODS: A cross-sectional survey design was used to examine approaches to tobacco use prevention and the early detection of lung cancer among PAs from Western New York State. RESULTS: PAs report promoting use of the nicotine patch, nicotine spray and bupropion when counseling smokers on cessation. Reported management strategies for a patient at high risk of developing lung cancer were not supported by current literature. CONCLUSION: These findings suggest the need for professional educational programs aimed not only at conveying the continued importance of tobacco cessation counseling, but also information on the appropriate management options for patients at increased risk of developing lung cancer.

American Indian cancer survivors: exploring social network topology and perceived social supports.

BACKGROUND: The literature on social networks and social supports attests to the powerful influence of social relationships on health; there is a dearth of such studies with American Indians/Alaska Natives. METHOD: This exploratory study assesses the social network topology and perceived social supports received among American Indian cancer survivors and matched controls. RESULTS: Although there did not appear to be marked differences overall among cases and controls, expressive social supports (eg, companionship, moral support, encouragement, advice, and friendship) were ranked highly across each component of the network. CONCLUSIONS: The family appears to be the principal source of social supports relative to either best/closest friend or church/community.

Approaches to breast cancer screening among nurse practitioners.

PURPOSE: To determine nurse practitioners' (NPs') knowledge and reported practices regarding breast cancer screening in a climate of conflicting guidelines. DATA SOURCE: A descriptive, cross-sectional survey design was used to examine approaches to cancer screening among NPs in western New York. CONCLUSIONS: Among the 175 NP respondents, agreement with the accepted answers for the individual breast cancer-screening items ranged from 51% to 80%; responses did not vary by age group or gender. Overall, 54% demonstrated agreement with three or more of four breast cancer-screening items. IMPLICATIONS FOR PRACTICE: These findings suggest the need to implement educational interventions as one means of decreasing variation in breast cancer screening among NPs. Also, the development and endorsement of a single set of evidence-based breast cancer-screening guidelines would promote adoption of a single screening recommendation.

Nurse practitioners' knowledge, practice and attitudes about tobacco cessation & lung cancer screening.

PURPOSE: To determine nurse practitioners' (NPs') knowledge, practice, and attitudes about tobacco cessation counseling and lung cancer early detection. DATA SOURCE: A descriptive, cross-sectional survey design was used to examine NPs' approaches to primary and secondary prevention of tobacco use among patients in western New York. CONCLUSIONS: Among the 175 respondents, NPs appropriately counseled tobacco users on tobacco cessation. However, there was limited understanding of first-line pharmacological agents used for tobacco cessation and of how to manage treatment for a patient at high risk for lung cancer. IMPLICATIONS FOR PRACTICE: These findings suggest the need to implement professional educational programs aimed at conveying not only the importance of tobacco cessation counseling but also information on the most effective first-line pharmacological agents and appropriate management options for patients at increased risk of developing lung cancer.

Breast cancer screening beliefs by practice location.

BACKGROUND: This study examines variations in breast cancer screening among primary care clinicians by geographic location of clinical practice. METHODS: A cross-sectional survey design was used to examine approaches to breast cancer screening among physicians, nurse practitioners, and physician assistants involved in primary care practice. A summary index of beliefs about breast cancer screening was created by summing the total number of responses in agreement with each of four survey items; values for this summary variable ranged between zero and four. Respondents were classified into urban, rural and suburban categories based upon practise location. RESULTS: Among the 428 respondents, agreement with "correct" responses ranged from 50% to 71% for the individual survey items; overall, half agreed with three or more of the four breast cancer screening items. While no significant differences were noted by practice location, variation in responses were evident. Reported use of written breast cancer guidelines was less in both suburban (OR = 0.51) and urban areas (OR = 0.56) when compared to clinicians in rural areas. CONCLUSION: Development of an evidence-based consensus statement regarding breast cancer screening would support a single set of unambiguous guidelines for implementation in all primary care settings, thus decreasing variations in how breast cancer screening is approached across varied clinical settings.

Variations in approaches to breast cancer screening among primary care physicians.

BACKGROUND: Guidelines for breast cancer screening often provide conflicting recommndations. METHODS: A cross-sectional survey design was used to examine approaches to cancer screening among primary care physicians. RESULTS: Among the 187 respondents, levels of agreement with the "correct" response ranged between 50% and 73% for each of the four items relating to breast cancer screening; only 42% of physicians demonstrated agreement with three or more of the four items. Physician gender, specialty group, and age category were significant predictors of responses. CONCLUSIONS: These findings suggest the need to implement educational interventions as one means of decreasing variation in breast cancer screening.