Occupational differences in a Dutch sample of patients with primary progressive aphasia, behavioral variant frontotemporal dementia, and Alzheimer's dementia.

BACKGROUND: Cognitive reserve is a potential mechanism to cope with brain damage as a result of dementia, which can be defined by indirect proxies, including education level, leisure time activities, and occupational attainment. In this study we explored the association between dementia diagnosis and type of occupation in a retrospective Dutch outpatient memory clinic sample of patients with primary progressive aphasia (PPA), behavioral variant frontotemporal dementia (bvFTD), and Alzheimer's Dementia (AD). METHODS: We included data from 427 patients (bvFTD n = 87, PPA n = 148, AD n = 192) and compared the frequency of occupations (11 categories) between patients and data from the Dutch census using Pearson Χ2 tests and we calculated odds ratios (OR) by means of multinomial logistic regression analyses. We also investigated patient group differences in age, sex, education, disease duration, and global cognition. RESULTS: The frequency of teachers in patients with PPA was significantly higher than the frequency of teachers in patients with bvFTD [OR = 4.79, p = .007] and AD [OR = 2.04, p = .041]. The frequency of teachers in patients with PPA (16%) was also significantly higher than the frequency of teachers in the Dutch census [5.3%; OR = 3.27, p < .001]. The frequency of teachers in both bvFTD and AD groups were not significantly different from the frequency of teachers in the Dutch census (p = .078 and p = .513, respectively). CONCLUSIONS: A potential explanation for our results is the so called "wear and tear" hypothesis, suggesting that teachers have a communication-wise demanding occupation - and therefore are at higher risk to develop PPA. Alternatively, teaching requires continuous communication, hence teachers are more sensitive to subtle changes in their speech and language abilities. Our findings broaden our understanding of the relationship between occupational activity and cognitive reserve in the development of dementia.

Adrenal Incidentaloma and Adherence to International Guidelines for Workup Based on a Retrospective Review of the Type of Language Used in the Radiology Report.

INTRODUCTION: The purpose of this study is to explore what terms are used to describe adrenal incidentalomas and to determine what reporting factors are associated with clinicians adhering to international guidelines. METHODS: This retrospective study was approved by the institutional review board, with a waiver of informed consent. Adrenal incidentaloma cases were identified from CT reports between 2010 and 2012 and filtered based on terminology used to describe the adrenal mass at initial presentation. Cases were divided into two groups: masses described with specific terms (ie, nodule, presumably ≥1 cm in diameter) and nonspecific terms (ie, plump, likely to be smaller). P values were calculated using Student's t test and χ2 test. Rate of adherence of clinicians to workup guidelines was determined for both groups and was analyzed. RESULTS: Of 1,112 cases, 604 had a specific description of the adrenal mass. Patients of the specific group had a significantly larger mass (P < .01) and referral frequency was higher (P < .01). Of the nonspecific masses, 99.2% (504 of 508) were ≥1 cm in diameter, compared with 98.3% of the specific masses (594 of 604). Furthermore, diagnostic workup was more likely to occur when a specific term was used; when Houndsfield unit, size of the mass, and diagnostic recommendation were reported; and when adrenal incidentaloma findings were repeated in the conclusion of the report (all P < .01). CONCLUSION: Our study shows that inconsistent use of terms in radiology reports has to be avoided to increase adequate adrenal incidentaloma workup. A structured and thorough report with use of standardized terminology may increase adherence to international guidelines.