Validation and extension of the quick dementia rating system (QDRS).

Informant report dementia severity staging measures, such as the Quick Dementia Rating System (QDRS) offer clinicians useful diagnostic and staging information. These measures also potentially avoid many of the pitfalls inherent in mental status examinations (e.g., cultural bias, educational bias, floor and ceiling effects). We derive cut points for the QDRS and comprehensively examine their classification accuracy in a large, diagnostically heterogeneous, rural, memory disorder clinic sample. Our findings suggest the QDRS may be helpful when used in the context of a comprehensive diagnostic and staging evaluation. When used in isolation, the QDRS is insufficiently accurate for diagnosis and staging of dementia.

Stress-related increases in risk taking and attentional failures predict earlier relapse to smoking in young adults: A pilot investigation.

Substantial evidence links greater impulsivity and stress exposure to poorer smoking cessation outcomes. Results from adolescents also indicate that stress-related change in risk taking can impede cessation attempts. We investigated the effects of stress-related change in impulsivity, risk taking, attention and nicotine withdrawal, and craving in young adult smokers on time to smoking relapse in a relapse analogue paradigm. Twenty-six young adult smokers (50% women; mean age: 20.9 ± 1.8) were exposed to a stress imagery session followed by a contingency management-based relapse analogue paradigm. Participants smoked at least 5 cigarettes daily, with a mean baseline carbon monoxide (CO) level of 13.7 (± 5.1) ppm. Repeated measures analysis of variance (ANOVA) and paired t tests examined stress induction validity and Cox regressions of proportional hazards examined the effects of stress-related changes in nicotine withdrawal, nicotine craving, attention, impulsivity, and risk taking on time to relapse. While stress-related change in impulsivity, nicotine craving and withdrawal did not predict time to relapse (all ps > .10), greater stress-related increases in reaction time (RT) variability (p = .02) were predictive of shorter time to relapse, with trend-level findings for inattention and risk taking. Furthermore, changes in stress-related risk taking affected outcome in women more than in men, with a significant relationship between stress-related change in risk taking only in women (p = .026). Smoking cessation attempts in young adults may be adversely impacted by stress-related increases in risk taking and attentional disruption. Clinicians working with young adults attempting cessation may need to target these stress-related impairments by fostering more adaptive coping and resilience.

Performance on selected visual and auditory subtests of the Wechsler Memory Scale-Fourth Edition during laboratory-induced pain.

Although chronic pain patients commonly report problems with concentration and memory, recent research indicates that induced pain alone causes little or no impairment on several Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV) subtests, suggesting that cognitive complaints in chronic pain may be attributable to factors other than pain. The current studies examined potential effects of induced pain on Wechsler Memory Scale-Fourth Edition (WMS-IV) visual working memory index (VWM) subtests (Experiment 1, n = 32) and on the immediate portions of WMS-IV auditory memory (IAM) subtests (Experiment 2, n = 55). In both studies, participants were administered one of two subtests (Symbol Span or Spatial Addition for Experiment 1; Logical Memory or Verbal Paired Associates for Experiment 2) normally and were then administered the alternate subtest while experiencing either cold pressor pain induction or a nonpainful control condition. Results indicate that induced pain in nonclinical volunteers did not impair performance on either VWM or IAM performance, suggesting that pain alone does not account for complaints or deficits in these domains in chronic pain patients. Nonpainful variables such as sleep deprivation or emotional disturbance may be responsible for reported cognitive complaints in chronic pain patients.

The Effects of Cold Pressor-Induced Pain on PASAT Performance.

Although clinicians have frequently observed that patients with chronic pain experience cognitive deficits related to memory and concentration, research on these deficits is equivocal, with some studies showing significant impairment and others suggesting minimal deficits. As such, the present study sought to examine the relationship between laboratory-induced pain and performance on the Paced Auditory Serial Addition Test (PASAT) using a mixed factorial design. Seventy-two nonclinical volunteers were randomly assigned to a pain group, who took the PASAT while experiencing cold pressor-induced pain, or a control group, who took the PASAT while experiencing painless room-temperature water immersion. To account for practice effects, all participants were administered 1 practice trial and 3 standard trials of the PASAT, with the final trial administered in cold pressor-induced pain or painless water immersion. The results revealed a significant interaction between condition and PASAT performance, F(1, 64) = 23.63, p < .001, partial η(2) = .27. The control group increased performance by 6 items while the pain group showed no such improvement. The results suggest that because the pain group did not demonstrate the same practice effects relative to the control group, their performance was impaired by cold pressor-induced pain. However, the impairment was relatively mild (about 0.5 standard deviation) and did not occur in all participants.

Nonmedical use of prescription medications in young adults.

Nonmedical use of prescription medications (NUPM) is an area of increasing public health concern, particularly in young adults. Young adults aged 18 to 25 have the highest annual and monthly rates of NUPM of any age group in the US, with notable consequences from using opioid, stimulant, tranquilizer and sedative medication. This article will review the literature on young adult NUPM, focusing first on the characteristics of those young adults engaged in NUPM. Then, we will examine the most common motives for NUPM, the sources young adults use to engage in nonmedical use and the related process of medication diversion. Finally, we will outline treatment and make specific recommendations of ways clinicians can help prevent the spread of NUPM in young adults, completing the work by covering future directions for research.