Patients' and Family Members' Subjective Experiences of a Diagnostic Evaluation of Mild Cognitive Impairment.

BACKGROUND: People with a diagnosis of mild cognitive impairment (MCI) often struggle with uncertainty and fear when learning of and coping with their diagnosis. However, little is known about their experiences and perspectives, and those of their care partners, when seeking out and undergoing a diagnostic evaluation for their cognitive symptoms. METHOD: This study is a secondary analysis of a focus group discussion that was initially conducted to learn the perspectives and experiences of participants and their care partners during a mock disclosure session of brain scan results. Participant's broader views on their experience of completing a cognitive evaluation resulting in an MCI diagnosis were evaluated in this study. Analysis used qualitative content methodology and line-by-line coding which generated categories and themes. RESULTS: The (1) "presence of a threat" and (2) attempts to "minimize the threat" emerged as overarching themes driving the process of seeking out a diagnostic evaluation for cognitive symptoms. Subthemes that highlight the complexity of the presence of a threat included the "fear of stigma," and the "emotional reactions" related to an MCI diagnosis. Three additional subthemes represented approaches that participants and their care partners used to minimize threat of MCI: "use of language" to minimize the threat; "information sharing and withholding"; and the "use of social support to legitimize personal experiences." CONCLUSION: These findings add to the literature by elucidating the uncertainty, fears, and coping strategies that accompany a diagnostic evaluation of MCI.

Subjective experiences of an art museum engagement activity for persons with early-stage Alzheimer's disease and their family caregivers.

OBJECTIVE: To describe the subjective experiences of older adults with early-stage Alzheimer's disease or related cognitive disorders (ADRDs) and their family caregivers who participated in an art museum engagement activity. METHODS: Four focus groups were conducted with 10 persons with ADRD and 10 family caregivers following the completion of a 1-time, 3-hour engagement activity. Participants also completed a brief satisfaction survey, and associations were examined using nonparametric statistics. RESULTS: Three key themes were identified: cognitive stimulation, social connections, and self-esteem. In addition, we identified programmatic issues such as activity-specific concerns and program logistics that could help improve future art program offerings. Past experience with art and perceived social cohesion were correlated with participants' overall satisfaction with the program. DISCUSSION: Efforts aimed at improving the quality of life of those with Alzheimer's disease and their family caregivers should consider the potential role of art museums.

Humor and laughter in persons with cognitive impairment and their caregivers.

PURPOSE: The purpose of this study was to describe humor and laughter in persons with cognitive impairment (PWCI) and caregivers who were recalling a shared experience in a focus group. DESIGN: Twenty participants attended an Art Engagement Activity at the Andy Warhol Art Museum, which included a guided tour and an art project. All PWCI had medically diagnosed cognitive disorders and all caregiver participants did not. Four focus groups were conducted and transcripts of audio-recorded sessions were transferred to a qualitative software program. METHOD: Words, phrases, and episodes of humor and laughter were used to construct codes, which were refined during group analysis using constant comparison. FINDINGS: Humor and laughter were present in all four focus groups. Emerging themes of humor included silliness, sarcasm, and commenting about hardships of dementia. Laughter was identified in segments with and without humor. Some PWCI were unable to follow social cues. CONCLUSIONS: Humor and laughter played a role in creating a safe social environment. PWCI were able to engage in humor during social interactions, yet some had difficulty recognizing social cues. Further study may reveal roles of humor and laughter in adaptation to cognitive decline and holistic interventions for improved quality of life.

Cooperative expression of monocyte chemoattractant protein 1 within the bovine corpus luteum: evidence of immune cell-endothelial cell interactions in a coculture system.

Endothelial cells (EC) of the bovine corpus luteum (CL) are a known source of proinflammatory mediators, including monocyte chemoattractant protein 1 (CCL2) and endothelin 1 (EDN1). Here, a coculture system was devised to determine if immune cells and PGF 2alpha together affect CCL2 and EDN1 secretion by EC. Luteal EC were cultured either alone or together with peripheral blood mononuclear cells (PBMC), and treated without or with PGF 2alpha for 48 h (n = 6 experiments). Coculture of EC with PBMC increased CCL2 secretion an average of 5-fold higher compared with either cell type alone (P < 0.05). Basal secretion of EDN1 by EC was substantial (approximately 2 ng/ml), but was not affected by coculture with PBMC (P > 0.05). EC cocultured with concanavalin A-activated PBMC (ActPBMC) increased CCL2 secretion an average of 12-fold higher compared with controls (P < 0.05), but again, EDN1 secretion was unchanged (P > 0.05). Interestingly, PGF 2alpha did not alter either CCL2 or EDN1 secretion, regardless of culture conditions (P > 0.05). In a second series of experiments (n = 3 experiments), mixed luteal cells (MLC) were cultured alone or with PBMC as described above. Secretion of CCL2 and EDN1 was not affected by coculture or by PGF 2alpha (P > 0.05), but MLC produced less progesterone in the presence of ActPBMC (P < 0.05). Collectively, these results suggest that immune cells and EC can interact cooperatively to increase CCL2 secretion in the CL, but this interaction does not affect EDN1 secretion nor is it influenced by PGF 2alpha. Additionally, activated immune cells appear to produce a factor that impairs progesterone production by luteal steroidogenic cells.

Chemokines in the corpus luteum: implications of leukocyte chemotaxis.

Chemokines are small molecular weight peptides responsible for adhesion, activation, and recruitment of leukocytes into tissues. Leukocytes are thought to influence follicular atresia, ovulation, and luteal function. Many studies in recent years have focused attention on the characterization of leukocyte populations within the ovary, the importance of leukocyte-ovarian cell interactions, and more recently, the mechanisms of ovarian leukocyte recruitment. Information about the role of chemokines and leukocyte trafficking (chemotaxis) during ovarian function is important to understanding paracrine-autocrine relationships shared between reproductive and immune systems. Recent advances regarding chemokine expression and leukocyte accumulation within the ovulatory follicle and the corpus luteum are the subject of this mini-review.