Use of latent class analyses for the estimation of prevalence of cognitive impairment, and signs of stroke and Parkinson's disease among African-American elderly of central Harlem: results of the Harlem Aging Project.

A probability sample (response rate of 79.4%) of 164 African-American elderly residing in central Harlem was assessed using several standard cognitive screening measures and scales measuring stroke and Parkinson's symptoms, respectively. Both traditional cutting scores and the methods of latent class analysis were used to estimate point prevalence.

Methodological issues in cognitive assessment and their impact on outcome measurement.

Assessment of cognitive impairment in chronic care populations is complicated by several factors that may interfere with the assessment process: physical frailty and disability; comorbid conditions such as depression; and decrements in vision, hearing, speech, and general communication. Moreover, cognitive impairment itself affects assessment of outcome domains such as depression, behavior, and function, thus contributing to several sources of measurement bias. Sources of bias are discussed in the context of findings from the literature relating individual and cognitive factors to outcome measurement.

A flexible system of detection for Alzheimer's disease and related dementias.

Brief methods for detecting Alzheimer's disease and related dementias (ADRD) are widely used in epidemiological and clinical research, and, increasingly, for clinical purposes in health care settings, such as primary medical care and geriatric evaluation and management (GEM) units. There are many instruments from which to choose for these purposes, but they have generally been developed in isolation. Little is known about the gains in precision (incremental validity) from using more than one instrument in an integrated manner in the process of detection, nor has there been a systematic evaluation of the usefulness of being able to choose from a repertoire of instruments to suit specific screening contexts.

Item bias in cognitive screening measures: comparisons of elderly white, Afro-American, Hispanic and high and low education subgroups.

A study of item bias in standard cognitive screening measures was conducted in a sample of Afro-American, Hispanic and non-Hispanic white elderly respondents who were part of a dementia case registry study. The methods of item-response theory were applied to identify biased items. Both cross-cultural and high and low education groups were examined to determine which items were biased.

Relative Rates of Dementia By Multiple Case Definitions, Over Two Prevalence Periods, In Three Sociocultural Groups.

The North Manhattan Aging Project registry, using both Reporting and Survey Components, identifies dementia cases among Latino, African-American, and non-Latino white sociocultural groups (9,349 persons 65 years of age or older) in contiguous census tracts. During a 2-year prevalence period of the reporting component, 1,592 persons were reported to the Registry and screened with five widely used brief cognitive measures; 844 were evaluated in a "clinical core," and 452 met research criteria for dementia, covering all subtypes, according to DSM-III-R criteria. Thirteen different case definitions for dementia were applied to the sociocultural groups at three levels of educational achievement, examining for associations with rates of dementia cases and controlling for age.

The impact of depression on quality of life of the elderly.

The individual who suffers the onset of a clinical level of depression is likely to experience a substantial transformation of the quality of his or her whole life. This can be demonstrated by examining the patterns of the course of depression from its onset to the end of life, in particular the impact of depression on morbidity (including symptom distress), functioning, and mortality.

Effects of treatment for isolated systolic hypertension on cognitive status and depression in the elderly.

The Systolic Hypertension in the Elderly Program (SHEP) was designed as a feasibility study and in part dealt with the effects of the treatment of isolated systolic hypertension on cognitive status and depression. Subjects were 60 years of age or older with a systolic blood pressure of 160 mmHg or greater and diastolic of less than 90 mmHg; free of several specified illnesses or chronic conditions. These volunteers were randomly assigned to treatment (n = 443) and placebo (n = 108) groups.