Advance care planning and proxy decision making for patients with advanced Parkinson disease.

Objectives: To examine advance care planning practices and proxy decision making by family healthcare proxies for patients with advanced Parkinson disease (PD).

Methods: Sixty-four spouses and adult children, self-designated as a/the healthcare proxy for advanced patients with PD, participated in a cross-sectional survey study.

Results: Sixty patients with PD (95%) had completed a living will, but only 38% had shared the document with a physician.

Prevalence and Cognitive Bases of Subjective Memory Complaints in Older Adults: Evidence from a Community Sample.

Objectives. To estimate the prevalence of subjective memory complaints (SMCs) in a sample of community-dwelling, older adults and to examine cognitive bases of these complaints. Participants.

Parkinson disease: research update and clinical management.

More than 1 million people in the United States have Parkinson disease (PD), more than are diagnosed as having multiple sclerosis, amyotrophic lateral sclerosis, muscular dystrophy, and myasthenia gravis combined. PD affects approximately 1 in 100 Americans older than 60 years. It burdens patients, their care partners, and the overall healthcare system.

Dermal application of nitric oxide releasing acidified nitrite-containing liniments significantly reduces blood pressure in humans.

Vascular ischemic diseases, hypertension, and other systemic hemodynamic and vascular disorders may be the result of impaired bioavailability of nitric oxide (NO). NO but also its active derivates like nitrite or nitroso compounds are important effector and signal molecules with vasodilating properties. Our previous findings point to a therapeutical potential of cutaneous administration of NO in the treatment of systemic hemodynamic disorders.

Assessing executive function in Parkinson disease: the alternating names test. Part I. Reliability, validity, and normative data.

Objectives: To evaluate psychometric properties (convergent and divergent validity; alternate forms reliability) and provide normative data for the Alternating Names Test (ANT), a new bedside test of set-switching, a component of executive function (EF). The test was specifically designed for use in persons with Parkinson disease (PD).

Design: Cross-sectional study.

A randomized pilot clinical trial of the safety of pioglitazone in treatment of patients with Alzheimer disease.

Objectives: To evaluate the safety of the peroxisome proliferator-activated receptor gamma agonist pioglitazone in nondiabetic patients with Alzheimer disease (AD) and to explore treatment effect sizes on clinical outcomes.

Design: Double-blind, placebo-controlled randomized controlled trial of 18-month duration.

Setting: Two academic medical center outpatient clinics.

How much striving is too much? John Henryism active coping predicts worse daily cortisol responses for African American but not white female dementia family caregivers.

Introduction: The John Henryism active coping (JHAC) hypothesis suggests that striving with life challenges predicts increased risk for cardiovascular disease for those with scarce coping resources. This study examined the moderating role of JHAC in the associations of 1) caregiver status and 2) care recipient functional status with diurnal salivary cortisol patterns among 30 African Americans (AAs) and 24 white female dementia caregivers and 63 noncaregivers (48 AAs).

Methods: Caregiver participants completed the JHAC-12 scale, Activities of Daily Living (ADL) scale, and Revised Memory and Behavior Problem checklist (RMBPC) and collected five saliva samples daily (at awakening, 9 A.

Impact of TimeSlips, a creative expression intervention program, on nursing home residents with dementia and their caregivers.

Purpose: Creative expression (CE) programs are emerging interventions to improve the quality of care and life of persons with dementia (PWDs) in long-term care settings. However, limited empirical evidence exists to support the effectiveness of these programs. Here, we report the findings from an assessment of the impact of TimeSlips (TS), a group storytelling program that encourages CE among PWDs and those who care for them.

Is exhaled carbon monoxide level associated with blood glucose level? A comparison of two breath analyzing methods.

The level of exhaled carbon monoxide (eCO) is considered a marker of oxidative stress in diabetes. Previous findings indicated that eCO levels correlated with blood glucose level. The aim of this work was to apply and compare two independent analyzing methods for eCO after oral glucose administration.

NO detection in biological samples: differentiation of 14 NO and 15 NO using infrared laser spectroscopy.

Accurate characterization of the biochemical pathways of nitric oxide (NO) is essential for investigations in the field of NO research. To analyze the different reaction pathways of enzymatic and non-enzymatic NO formation, determination of the source of NO is crucial. Measuring NO-related products in biological samples distinguishing between (14)NO and (15)NO offers the opportunity to specifically analyze NO signaling in blood and tissue.

Height and Alzheimer's disease: findings from a case-control study.

The purpose of this study is to examine the relationship of height, Apolipoprotein E genotype (APOE) and Alzheimer's disease (AD). Using a case-control design, subjects were recruited from the research registry of the University Memory and Aging Center of Case Western Reserve University and University Hospitals of Cleveland. On entry to the study, height was measured on 239 probable or possible AD patients and 341 healthy controls living in northeast Ohio.

Alzheimer's disease and smoking: bias in cohort studies.

The discrepancy between cohort and case-control studies regarding the association between smoking and Alzheimer's disease (AD) has been attributed to the competing risk of early mortality of smokers. A simulation study was conducted to show that the bias favoring smokers acts also on cohort studies. In the model, individuals {grow older} and have smoking habits according to published year-age-gender-specific patterns, with morbidity and mortality according to their demographic and smoking profiles.

Infrared laser spectroscopy for online recording of exhaled carbon monoxide-a progress report.

Despite the growing number of reports on breath CO measurements, the development of rapid and sensitive analysis techniques for measurements of this breath constituent still remains a challenge. We demonstrate the application of infrared laser spectroscopy for exhaled CO analysis. The breath samples are analyzed in real-time during single exhalations by means of cavity ring-down spectroscopy.

The role of adolescent IQ and gender in the use of cognitive support for remembering in aging.

The purpose of this study was to examine the role of adolescent IQ (AIQ) and gender in older adults' ability to use cognitive support to enhance memory. Subjects were 269 mid-1940s graduates of the same high school. Adolescent IQ scores were gathered from archives, and subjects' memory for words was tested with tasks that provided increasing cognitive support.

Cognitive functioning in healthy aging: the role of reserve and lifestyle factors early in life.

Purpose: According to the reserve perspective on cognitive aging, individuals are born with or can develop resources that help them resist normal and disease-related cognitive changes that occur in aging. The reserve perspective is becoming more sophisticated, but gaps in knowledge persist. In the present research, we considered three understudied questions about reserve: Is reserve primarily static (unchangeable) throughout the life course or dynamic (changeable, in terms of increases or decreases)? Can reserve be increased at any point in life, or are there optimal time periods--such as early life, midlife, or late life--to increase it? Does participation in different types of leisure and occupational activities in early life and midlife have different effects depending on specific domains of late-life cognitive functioning? Here we link early cognitive and activity data--gathered from archival sources--with cognitive data from older adults to examine these issues.

Mental health and diurnal salivary cortisol patterns among African American and European American female dementia family caregivers.

Using a sociocultural stress and coping model, this pilot study examines the influence of depressive symptoms and stress on diurnal salivary cortisol patterns among African American (N=30) and European American (N=24) female dementia caregivers and noncaregivers (African American, N=48; European American, N=15). Caregiving participants completed the Center for Epidemiological Studies Depression Scale (CES-D), Perceived Stress Scale (PSS), and Stress-Related Growth Scale (SRGS) as respective measures of depressive symptoms, stress, and stress resilience. Participants also collected five saliva samples daily for two consecutive days.

Use of live theater to increase minority participation in Alzheimer disease research.

Recruitment and retention of African Americans into Alzheimer disease (AD) research studies poses challenges owing to long-standing socio-economic and cultural differences, pragmatic difficulties in reaching the African American population, and a legacy of distrust of medical research. In this study, we report on our efforts to use live theater to educate African Americans about AD research and to increase minority participation in it. We describe our experiences at the University Memory and Aging Center (Cleveland, OH) in commissioning, writing, and producing several theater productions focused on themes related to African Americans and their experiences dealing with family members with AD.

Associations between dementia/mild cognitive impairment and cognitive performance and activity levels in youth.

Objectives: To study the associations between dementia/mild cognitive impairment (MCI) and cognitive performance and activity levels in youth.

Design: Retrospective cohort study.

Setting: Research volunteers living throughout the United States.

Participation in novelty-seeking leisure activities and Alzheimer's disease.

The objective was to study the associations between participation in different types of mentally stimulating leisure activities and status as Alzheimer's disease (AD) case or normal control. Research suggests that participation in leisure activities, especially mentally stimulating activities, is associated with a lower risk for AD. However, no study has yet evaluated associations between AD and different types of mental leisure activities, especially those involving "novelty seeking.

The relationships between television viewing in midlife and the development of Alzheimer's disease in a case-control study.

The relationship between leisure activities and development of cognitive impairment in aging has been the subject of recent research. We examined television viewing in association with risk of developing Alzheimer's disease (AD) in a case-control study. Given recent focus on the importance of intellectually stimulating activities as preventive measures against cognitive decline, it is important to examine the effects of less stimulating but common activities.

Factor structure of the CERAD neuropsychological battery.

The Consortium to Establish a Registry for Alzheimer's Disease (CERAD) neuropsychological battery was developed to evaluate cognitive impairments associated with Alzheimer's disease (AD). Previous studies have suggested that the battery is multi-dimensional, represented by either 3 or 5 dimensions. In this study a principal factor analysis was conducted using contemporary quantitative methods for determining the number of factors.

Pragmatic and internal validity issues in sampling in caregiver studies: a comparison of population-based, registry-based, and ancillary studies.

Objectives: Studies of caregivers illustrate a classic sampling dilemma: maximizing recruitment without compromising study validity. Because caregivers are defined in relation to a care recipient, sampling methods are often determined by pragmatic decisions such as access, efficiency, and costs. However, overlooking validity may result in selection bias, misclassification of caregiver status, and the confounding of results.

Effects of educational attainment and occupational status on cognitive and functional decline in persons with Alzheimer-type dementia.

Researchers have suggested that educational attainment and occupational status--indicators of cognitive and/or neurologic "reserve"--can help persons compensate for clinical manifestations of Alzheimer's disease (AD), such as the rates of cognitive and functional decline. The effects of educational attainment on rates of decline could be "direct" independent of occupational status), "indirect" (working through occupational status), or both. We used multilevel analysis for repeated measures to study the effects of educational attainment and occupational status on rates of decline in cognition (Mini-Mental State Examination, MMSE) and function (Cleveland Scale for Activities of Daily Living).

Development of a scale to predict decline in patients with mild Alzheimer's disease.

Objectives: To develop a scale that can assist in predicting likelihood of decline from mild dementia over 1 year in patients with Alzheimer's disease (AD).

Design: Retrospective cohort study.

Setting: University Memory and Aging Center.