A meta-analysis of peripheral tocopherol levels in age-related cognitive decline and Alzheimer's disease.

Objectives: Findings from observational studies and clinical trials on the associations between vitamin E and dementia remain controversial. Here we conducted a meta-analysis to determine the difference in blood tocopherols levels between patients with Alzheimer's disease (AD) or age-related poor cognitive function and healthy controls.Methods: Standardised mean difference (SMD) and 95% confidence intervals (CIs) were calculated and entered into a random effects model. Study quality, heterogeneity and publication bias were also investigated.Results: Thirty-one articles were included in the meta-analysis, which included analyses for α-, ß-, γ- and δ-tocopherols. These results indicated that individuals with AD or age-related cognitive deficits and mild cognitive impairment (MCI) had lower circulatory concentrations of α-tocophenol compared with healthy controls (AD: SMD = -0.97, 95% confidence interval [CI] = -1.27 to -0.68, Z = 6.45, P < 0.00001; age-related cognitive deficits and MCI: SMD = -0.72, 95% CI = -1.12 to -0.32, Z = -3., P < 0.0005). Levels of ß-, γ- and δ-tocophenols did not significantly differ between groups of AD and age-related cognitive deficits compared to controls.Discussion: These results suggest that lower α-tocopherol levels have a strong association with AD and MCI supporting evidence for the role of diet and vitamin E in AD risk and age-related cognitive decline.

Assessment of the Readability of Genetic Counseling Patient Letters.

Patient letters are a powerful tool that genetic counselors use to communicate with their patients. Patient letters are often sent to provide information on a new diagnosis, reiterate test results, and to serve as a permanent record of the visit. Patient letters, however, are only helpful if the patients can understand them. More than 50 % of the US population reads below a 9th grade reading level and over one-third of the population has low health literacy skills. In this study we evaluate the readability of genetic counseling patient letters by assessing reading level, image use, and terminology use. One hundred forty-nine genetic counselors participated in the survey and of these, 79 submitted a sample patient letter. Analyses of the letters revealed a mean reading level of 10.93. On average, 6 genetic terms were included in each letter, and only 25 % of these terms were defined. Analyses of survey responses revealed over 75 % of the genetic counselors did not include images in their patient letters. These results indicate there is room for improvement in order to make genetic counseling patient letters more accessible to the general population.

Genetic counselors' experiences with adolescent patients in prenatal genetic counseling.

Adolescents comprise a portion of women who present to genetic counselors prenatally. In this study, prenatal genetic counselors (N=128) were surveyed regarding their perceptions of genetic counseling sessions for adolescent (ages 13-19) and adult (ages 20-34) patients. Counselors perceived differences in methods used to communicate risk information for adolescent versus adult populations. Respondents reported that it is more difficult for adolescents to understand prognostic information than adults. They also noted differences between adult and adolescent populations with respect to the people who typically accompany the patient to the session. Respondents stated that adolescents were accompanied by a parent, friend, or sibling, which differed from adults who reportedly were accompanied by a significant other, father of the pregnancy, or by no one. These findings suggest it is important to recognize that adolescent patients are in a unique stage of their development which may influence a prenatal genetic counseling session.