Are there clinical differences between familial and nonfamilial Alzheimer's disease?

OBJECTIVE: The purpose of the study was to determine whether there are differences in clinical characteristics in two groups of patients with Alzheimer's disease, those reported to have a family history of dementia and those without a family history of dementia. METHOD: Using a data set from an Alzheimer's disease patient registry, funded as part of a National Institute on Aging cooperative agreement, the authors made comparisons of sociodemographic and clinical variables in a group of 462 patients with Alzheimer's disease, 172 reported to have at least one first-degree relative with dementia and 290 classified with no family history. RESULTS: Patients with a presumptive family history differed from those without a family history in two ways: the course of dementia was described as having a fast rather than a slow progression from onset of symptoms to diagnosis, and caregivers reported a higher prevalence of family history of psychiatric disorders. There were no significant differences in age at onset, duration, female gender, aphasia and apraxia, handedness, family history of Down's syndrome, or number of children, brothers, and sisters. CONCLUSIONS: The association of faster course and family history of psychiatric disorders in the patients with a family history of dementia is consistent with the hypothesis of heterogeneity, but the overall results could also be explained by a genetic-environmental model of Alzheimer's disease.

An empirical evaluation of the Global Deterioration Scale for staging Alzheimer's disease.

OBJECTIVE: Although the Global Deterioration Scale has been widely used since its publication in 1982, its stages are based on implicit assumptions about the linearity, temporality, and interdependence of cognitive, functional, and behavioral impairment in Alzheimer's disease. The authors evaluated the validity of these assumptions and tested the hypothesis that psychopathology and functional impairment would occur in earlier stages than the Global Deterioration Scale predicts. METHOD: The analyses were based on data on 324 patients with Alzheimer's disease who were selected from a registry of such patients. Data analyses included 1) descriptive statistics on the frequency of psychiatric symptoms and difficulties with activities of daily living and 2) logistic regression, with symptoms and functional impairment as independent variables, to test for significant changes in patients' status between stages of the Global Deterioration Scale. RESULTS: More than 50% of the patients at stage 2 displayed psychopathology, and 32% had two or more symptoms. The significant increase in psychiatric symptoms occurred between stages 3 and 4, not between stages 5 and 6 as predicted by the Global Deterioration Scale. Impairment in functional status was observed at all stages, and significant increases occurred between stages 3 and 4 as well as between stages 5 and 6. CONCLUSIONS: Psychiatric symptoms and functional impairment occur earlier than predicted by the Global Deterioration Scale, and the rate of change is also different from that specified in the scale. Separate scales to describe cognitive, clinical, and functional status may be the best way to describe the illness until better multidimensional instruments are developed.

Drug use patterns of persons with Alzheimer's disease and related disorders living in the community.

OBJECTIVE: To describe drug use patterns by persons with Alzheimer's disease, multi-infarct dementia, and mixed Alzheimer's disease and multi-infarct dementia. DESIGN: Multicenter, patient registry. SETTING: Community-living persons evaluated in primary care, geriatric, and Alzheimer ambulatory settings. PARTICIPANTS: Of the 930 persons in three diagnostic categories, there were 671 with probable or possible Alzheimer's disease by NINCDS/ADRDA criteria or Alzheimer's disease by DSM-III-R criteria, 162 multi-infarct cases by DSM-III-R criteria, and 97 mixed cases by DSM-III-R criteria. In each diagnostic category, 65% were women, and the majority were 70 years or older. MEASUREMENTS: The average number of all prescription and non-prescription drugs and selected therapeutic categories by age, sex, diagnosis, and mini-mental status score at the time of diagnosis or evaluation. RESULTS: Alzheimer patients average 2.3 drugs compared with multi-infarct (4.3; P < 0.0001) and mixed (3.7; P = 0.002) patients, and their pattern of drug use was different when stratified by therapeutic categories and drug classes. Drug use increased with age, and women used significantly more drugs than men in all three diagnostic categories. Women with Alzheimer's disease used significantly more cardiovascular drugs than men with Alzheimer's disease (P < 0.05). The lower the mini-mental status score in patients with any dementia, the greater the mean number of central nervous system agents used. The higher the mini-mental status score in a patient with multi-infarct or mixed dementia, the greater the use of cardiovascular drugs. CONCLUSION: Drug use by Alzheimer patients was lower than in multi-infarct and mixed patients, primarily due to a lower prevalence of cardiovascular drugs.

Hodgkin's disease and AIDS. Twenty-three new cases and a review of the literature.

Despite numerous reports suggesting an association of Hodgkin's disease (HD) with the acquired immunodeficiency syndrome (AIDS), HD in an individual seropositive for the human immunodeficiency virus (HIV) still is not considered a criterion for the diagnosis of AIDS. The authors report 23 new cases of HD in individuals at risk for AIDS and review the literature. As a group, individuals at risk for AIDS who develop HD have a more aggressive form of the illness (82% with stage III or IV), have or develop AIDS-related opportunistic infections (54%), second neoplasms (10%), and /or profound cytopenias (32%), and 85 to 90% are HIV positive when tested. More than two thirds die within 1 year of the diagnosis of HD. The authors conclude that HIV infection alters the clinical course of HD, that advanced or high-grade HD in HIV-infected individuals should be considered indicative of AIDS, and all patients with HD should be tested for HIV.

Toward a theory of sexual aggression: a quadripartite model.

Sexually aggressive behavior against adult females is an increasingly serious societal problem. The need for a unified theoretical model is addressed by integrating the elements of existing models into a quadripartite model in which the heterogeneity of sexual aggressors is accounted for by the prominence of potential etiological factors. The components of the model--physiological sexual arousal, cognitions that justify sexual aggression, affective dyscontrol, and personality problems--function as motivational precursors that increase the probability of sexually aggressive behavior. The relative prominence of these precursors within different sexually aggressive populations is used to define major subtypes.

The relationship between men's sexual aggression inside and outside the laboratory.

The purpose of this study was to develop a laboratory analogue of sexually aggressive behavior. Subjects viewed neutral, sexual-violent, and violent-sexual film vignettes and chose a vignette to show to a female confederate. Among highly sexually aggressive men (n = 25) according to the Coercive Sexuality Scale (CSS; Rapaport & Burkhart, 1984), 24% showed the sexual-violent vignette and 28% showed the violent-sexual vignette. Among men who did not report being sexually aggressive on the CSS (n = 13), none showed the sexual-violent vignette and only one showed the violent-sexual vignette. The between-group difference in vignette showing was statistically significant (p < .024). Subjects who showed the sexually aggressive vignettes reported that the female confederate was upset (p < .0001) and uncomfortable (p < .0001) in viewing these vignettes more than the subjects did who showed the neutral vignette. These results support the validity of this film-showing procedure as a laboratory analogue of sexually aggressive behavior.

The role of sexual arousal in sexually aggressive behavior: a meta-analysis.

Meta-analyses were performed on 9 studies of subjects' (N = 434) penile responsivity to rape stimuli. The mean effect size for raw score data suggested that most sexual aggressors against women exhibit slightly more rape arousal than control or comparison subjects, whereas the mean effect size for rape index (rape arousal:consenting sexual arousal) data suggested a moderate between-groups difference. Rape index effect sizes in individual studies, however, were heterogeneous. The rape index appears sensitive to differences between sexually aggressive men and those who are not but is not sensitive to differences between men who sexually aggress against women versus other types of sexual aggressors. Also discussed are the needs for standardization and methodological and statistical improvements.

Introduction to special section on theories of sexual aggression.

Sexual aggression is a serious societal problem, yet treatments for sexual aggressors have generally been ineffective in part because of the lack of unified theories to guide treatment. This brief article introduces the Special Section, which includes five theories of sexual aggression.

Hemisphere differences in perceiving positive and negative emotions.

Two experiments tested the hypothesis that positive emotions are processed primarily by the left hemisphere and negative emotions by the right hemisphere. In both experiments, facial expressions of positive and negative emotions were briefly presented to the left and right visual fields of normal dextral subjects. Experiment 1 investigated hemisphere differences in accuracy for naming the emotions, and Experiment 2 examined hemisphere differences in judging the intensity of the emotional expressions. Neither experiment found support for the hypothesized relationship. It was concluded that differential hemisphere involvement in processing positive and negative emotions, as suggested by previous studies, may occur, but only for the production, and not the perception of emotional expressions.

Cross-modal effects of anticipatory bogus heart rate feedback in a negative emotional context.

The goal of the present investigation was to examine the effect of altering the perceptions of one's own physiological arousal on the elicitation of emotional behavior as defined by galvanic skin response, the nonspecific galvanic skin response, and verbal report measures of discomfort and unpleasantness. After an initial three-minute rest period, 48 subjects were exposed to 10 successive slides of people who died violently and continuous auditory tones. Results showed that the groups simultaneously exposed to the noxious slides and tones labeled as bogus heart rate feedback responded to the slides with increased electrodermal activity as compared to subjects exposed to the identical auditory feedback labeled as extraneous noise. An increase in bogus heart rate tended to elicit the most pronounced electrodermal responses. As expected, bogus heart rate conditions resulted in greater self reports of discomfort and slide unpleasantness as compared to the noise conditions. These findings were explained as a function of a cyclic cognitive-visceral link.

Severe family violence and Alzheimer's disease: prevalence and risk factors.

This study describes the prevalence of violence and the putative risk factors for violence in 184 Alzheimer patients and their primary caregivers living in the community. Analysis of the severe violence subscale of the Conflict Tactics Scale indicated that 15.8% of patients had been violent in the year since diagnosis. A total of 5.4% of caregivers reported being violent toward the patient. The overall prevalence of violence was 17.4%. The variables most associated with violence were caregiver depression and living arrangement.

Global increase in response latencies by early middle age: complexity effects in individual performances.

Ten young women (age 20 to 22 years) and 10 middle-aged women (age 36 to 44 years) served as subjects in choice reaction time, letter classification, and abstract matching-to-sample tasks. In each of seven conditions, the older group responded more slowly than the younger group. Age differences showed a complexity effect. That is, differences between the latencies of young and old subjects increased as the latency of the young subjects increased. Both linear and power functions accurately described the relation between the latencies of the middle-aged and young adult groups. This was true not only for the relation between average latencies but also for the relation between corresponding quartiles of latency distributions. Similar results were observed at the individual level: All middle-aged subjects showed complexity effects, and, for each middle-aged subject, the relation between her latencies and those of the average young adult was well described by linear and power functions. These findings indicate that age-related slowing is apparent by age 40, and that complexity effects are observable in individual performances. This slowing is global and not specific to particular tasks, as indicated by the fact that the latencies of older adults can be predicted directly from those of younger adults without regard to the nature of the task.

Historical antecedents of dental anxiety.

Our data are based on retrospective self-reported answers of college students. To what extent do these answers accurately reflect the feelings of an actual clinical sample of dental patients? Although there is little direct evidence, a number of observations suggest that in the area of dental anxiety, college populations closely approximate the self-reported answers of the general population. The average level of dental anxiety in an actual clinical sample also appears to be remarkably similar to the average level of dental anxiety among a sample of college students. Kleinknecht and Bernstein found that, on a 1 to 5 scale, dental patients reported a mean level of dental anxiety of 2.31, and that when the identical question was used in a college population, the average level of dental anxiety was 2.47. In our sample, the mean level of dental anxiety was a similar 2.4 on a 0 to 6 scale. Obviously, self-reported answers are subject to distortions. However, it is important that these perceptions can still have a powerful bearing on the behaviors and feelings of patients. A number of observations and hypotheses about the historical origins of dental anxiety were confirmed. Some of these findings have direct clinical implications for the prevention of dental anxiety by dentists or treatment by psychologists. For example, high dentally anxious subjects are more concerned with and feel more ashamed about telling their dentist that they are dentally anxious. It may be helpful for dentists to provide an open forum about the patient's concern.(ABSTRACT TRUNCATED AT 250 WORDS)