Performance of elderly and young normals on the Gollin Incomplete Pictures Test.

Our study compared 26 young and 28 elderly subjects on the Gollin Incomplete Pictures Test. Young and elderly subjects differed, the older group requiring less fragmentation and more time for identification; response accuracy and latency were not correlated with one another.

Behavior Rating Scale for Dementia: development of test scales and presentation of data for 555 individuals with Alzheimer's disease.

We studied 555 Alzheimer's disease patients on the Behavior Rating Scale for Dementia (BRSD), which uses informant interviews to measure behavioral pathology in demented patients. For the 45 items, ratings of present ranged from 5% to 66% of the subjects, with 39 rated present in at least 10%. Twenty-nine items were significantly correlated with dementia severity. The mean number of items present per subject was 13.5; only two subjects had none rated present. Factor analysis identified six factors common to mildly and moderately demented subjects. Six subscales were developed: Depressive Symptoms, Inertia, Vegetative Symptoms, Irritability/Aggression, Behavioral Dysregulation, and Psychotic Symptoms. Interitem consistency was high for three subscales (alpha's from .75 to .80) and moderate for three (alpha's from .48 to .56). Four subscale scores and total scores were significantly but weakly correlated with dementia severity. Detailed results and test instructions are presented in the BRSD manual, available from The Consortium to Establish a Registry for Alzheimer's Disease.

Characterization of depression in Alzheimer's disease by the CERAD Behavior Rating Scale for Dementia (BRSD).

The authors selected 69 participants from an Alzheimer's disease research registry and diagnosed them as depressed or nondepressed by use of a semi-structured clinical interview. Responses to selected BRSD items were compared between the depressed and nondepressed groups. Differences between responses of the two groups on BRSD items related to anxiety and depression were significant. The groups did not significantly differ in their responses to items related to other content areas. On the basis of their responses to the BRSD anxiety and depression items, 70% of participants were correctly classified as depressed or nondepressed.

A longitudinal study of behavioral pathology across five levels of dementia severity in Alzheimer's disease: the CERAD Behavior Rating Scale for Dementia. The Alzheimer's Disease Cooperative Study.

As part of the Alzheimer's Disease Cooperative Study (ADCS) Instrument Development Project, the CERAD Behavior Rating Scale for Dementia (BRSD) was examined for its sensitivity to degree of cognitive impairment, its test-retest reliability, and its sensitivity to longitudinal change. Sixty-four normal elderly participants and 261 patients with AD stratified into severity groups based on Mini-Mental State Exam (MMSE) scores were rated on the BRSD at baseline and 12-month follow-up visits. A subset of subjects was evaluated at a 1-month follow-up visit. Baseline BRSD Total Score discriminated the normal group from each AD group, and mean Total Score significantly increased with increasing dementia severity. Test-retest reliability between baseline and 1-month Total Scores was satisfactory for all AD groups. Longitudinal change was evaluated by 12-month change scores, which were significant in only the normal and in one AD group. From the results, we argue that the value of behavioral pathology assessment in clinical trials would be enhanced if additive scores were based on groups of correlated items rather than on a broad array of behaviors, some of which may increase and others may decrease in frequency as AD progresses.

The Behavior Rating Scale for Dementia of the Consortium to Establish a Registry for Alzheimer's Disease. The Behavioral Pathology Committee of the Consortium to Establish a Registry for Alzheimer's Disease.

OBJECTIVE: The purpose of the study was to develop a standardized instrument, the Behavior Rating Scale for Dementia, for rating psychopathology in patients with probable Alzheimer's disease and to conduct a multicenter pilot study of this instrument. METHOD: The rating scale was developed collaboratively on the basis of clinical experience and existing instruments. Items were scaled according to frequency of psychopathology and were administered to an informant who was familiar with the subject. The scale was administered in a standardized manner by trained examiners who had met predetermined certification standards. The study group consisted of 303 subjects with probable Alzheimer's disease who had undergone standardized clinical evaluations by the Consortium to Establish a Registry for Alzheimer's Disease. RESULTS: Subjects had an average of 15 problems rated as present in the preceding month. Wide variability in the nature of disturbances was found, with a number of items rated as present since the illness began but not in the past month. Interrater agreement was high. Factor analysis suggested eight preliminary factors that mapped onto clinically relevant domains: depressive features, psychotic features, defective self-regulation, irritability/agitation, vegetative features, apathy, aggression, and affective lability. CONCLUSIONS: The Behavior Rating Scale for Dementia provides a standardized, reliable measure that can be administered to caregivers of demented subjects. On the basis of the present study, the scale has been revised slightly. After additional studies in progress, the Behavior Rating Scale for Dementia will be available for general use in assessing a wide range of psychopathology in dementia.

The effect of urgency on patient satisfaction and future emergency department choice.

Satisfaction with various aspects of a hospital visit may affect a patient's decisions about future patronage. Relationships between aspects of satisfaction, future use, and referral intentions, moderated by urgency, are explored in this study of 493 privately insured individuals. Results confirm the strong association between satisfaction and future intentions already established for other medical services and support increased attention to interactive marketing in medical settings.

Factors associated with emergency room choice among Medicare patients.

Changing macroenvironmental factors have caused hospital administrators to reassess their positions across all service lines and market segments. This pilot study explores relationships among the service experience, satisfaction and future patronage decisions among 368 Medicare patients, an often overlooked segment, who were recent users of a hospital emergency room. Results show widespread dissatisfaction with aspects of care. Many of these patients report that they do not intend to return to the same emergency room and would discourage others from choosing it.

The evaluation of behavioral disturbances in Alzheimer's disease: the utility of three rating scales.

Behavioral disturbances, eg, wandering, irritability, depression, and delusions, are observed in Alzheimer's disease (AD). Determining the importance of such symptoms requires that they be evaluated objectively. The Behavioral Pathology in Alzheimer's Disease Rating Scale (Behave-AD), Cornell Scale for Depression in Dementia (Cornell), and Brief Psychiatric Rating Scale (BPRS) were administered to 61 AD and 20 elderly control subjects. Only one AD subject showed no behavioral symptoms. All scales were reliably rated for presence or absence of symptoms. However, assessment of reliability of severity ratings was limited, because symptom frequency and severity were low. Although the Cornell and Behave-AD appeared more appropriate for AD subjects than did the BPRS, neither scale provided a complete description of behavioral symptoms, and each showed problems that interfere with its use. We recommend the development of a comprehensive scale with a well-anchored system of scaling and detailed rater instructions.

Performance of subjects with probable Alzheimer disease and normal elderly controls on the Gollin Incomplete Pictures Test.

Our study was designed to evaluate perceptual ability measured by the Gollin Incomplete Pictures Test (in which subjects identify fragmented pictures of common objects) in Alzheimer Disease. We developed a standardized procedure for administering Gollin's test and compared the performance of 58 Alzheimer patients and 37 elderly controls on the Gollin, two design copying tests, the Mini-Mental State Examination, a verbal version of the Knox Cubes test, a recognition memory test, and a verbal fluency test. Alzheimer patients performed significantly more poorly than controls on all tests. Factor analysis demonstrated a visual perceptual factor, with loadings on the Gollin test and design copying, and three other factors representing primary memory, secondary memory, and language. Results indicate the Gollin test measures visual perceptual ability, but the precise nature of the task requires further study. Identification of fragmented pictures appears a practical and potentially useful measure for evaluating at least some aspects of visual perception in patients with generalized cognitive impairment.

Assessment of functional ability in Alzheimer disease: a review and a preliminary report on the Cleveland Scale for Activities of Daily Living.

Assessment of activities of daily living (ADL) in Alzheimer disease (AD) is critical in establishing the diagnosis, monitoring disease progression, evaluating the efficacy of treatment interventions, and determining the need for health and social services. The proper method to measure ADL depends on the purposes to which the scale is to be put. Existing ADL scales differ as to the type of behaviors assessed, the nature of the observations made, and the manner in which the observations are quantified. These scales were not specifically designed to evaluate changes in the nature and extent of the broad spectrum of functional difficulties seen in individuals with AD. We describe the Cleveland Scale for Activities of Daily Living (CSADL), an informant-based instrument designed to expand upon the capacity of existing physical and instrumental ADL scales by assessing both premorbid and current component acts (e.g., initiation versus implementation) of daily living functions.

Age effects on a nonverbal auditory sustained attention task.

A nonverbal auditory test of sustained attention was administered to 20 young and 20 elderly women, screened to ensure good health. Groups were matched for intelligence. Older subjects performed as accurately as younger subjects. Neither group showed increases in response latency as a function of time spent on test. Older subjects took longer to respond than younger subjects, but only for a particular combination of stimulus duration and order of presenting stimulus durations. When subjects were presented long tones first, there was no difference in response latency associated with age or stimulus duration. When short tones were presented first, older subjects were slower than younger subjects in both duration conditions and in response to long tones were slower than all other subjects.

Neuropsychological analysis of a case of reduplicative paramnesia.

Following a right cerebral hemispheric CVA, a patient showed extensive reduplication of place (his hospital) and occasional reduplication of person. His language was essentially intact, but he was deficient on tests of conceptualization and on nonverbal tasks, both visual and auditory. Short- and long-term memory for nonverbal but not verbal material were also impaired. However, he had sufficient "memory" for the reduplicated hospitals to comment that they were spatially identical. He simply seemed unable to treat these memories as representing the same phenomena. Neuropsychological analysis suggest that reduplicative paramnesia represents a combination of perceptual and memory deficits as well as impaired ability to integrate information.

Microbehavioural analysis of the choice reaction time response in senile dementia.

Microbehavioural analysis of the human button-press response in a choice reaction time task enabled us to observe the traditional components of reaction time performance and also several additional indicators of psychomotor organization. The principal finding reported here is that in normal subjects stimulus conditions of varying difficulty differentially affect segments of the button-press response not ordinarily associated with cognitive demands of the task. This observation suggested the presence of a certain interaction between cognitive demands of the task and the subsequent motor output control. In a comparison of normal elderly and demented subjects, we demonstrated that the slower reaction times of the demented represent a virtual psychomotor disintegration. The apparent disintegration is interpreted as an inability of demented subjects properly to prepare, organize, and execute the response. The degree of disintegration is most evident during the motor time, which represents a transition between resting state and actual response completion.

EEG activity in the 13-15 Hz band correlates with intelligence in healthy elderly women.

Thirty-five elderly women in excellent health received a neuropsychological battery and resting electroencephalograms (EEGs) from bilateral parietal scalp electrodes. Spectral density analysis of the EEGs was designed to evaluate two levels each of slow activity (delta, 0.2-3.8 Hz and theta, 4.0-7.8 Hz), alpha activity (slow alpha, 7.0-9.8 Hz and fast alpha, 10.0-12.8 Hz) and fast activity (sigma, 13.2-14.8 Hz and beta, 15.0-20.0 Hz). There was no relationship between alpha slowing and cognitive impairment. However, significant correlations emerged between sigma activity and Wechsler Adult Intelligence Scale Scores. This association was strongest between right parietal sigma activity and WAIS Performance Scale weighted scores.

The basis of visual constructional disability in patients with unilateral cerebral lesions.

Patients with left and right unilateral hemispheric lesions were compared on the Form Assembly Task, a visual construction task requiring perceptual but not executive, motor, or verbal skills. Right lesioned patients were inferior to lefts and normals in both degree and frequency of impairment. Performances on the assembly task and two visual discrimination tasks were correlated among right but not left lesioned patients. Left lesioned patients took significantly longer to achieve maximum level of performance than either rights or normals. Neither sex nor duration of lesion affected Form Assembly performance. Results were consistent with the hypothesis that visual perceptual deficits underlie constructional difficulties among right but not left lesioned patients.

Sign language aphasia in a non-deaf-mute.

A 19-year-old left-handed man, who was raised by deaf-mute parents and learned sign language concurrently with normal speech, sustained a traumatic cerebral contusion. He subsequently had no evidence of apraxic, visual-spatial, or sensorimotor deficits of the left limbs with which he was accustomed to use signs. Globally aphasic with a dense right hemiparesis, he initially recovered sign language to a greater degree than spoken language with a reversal on follow-up observations. Receptive skills improved to a greater degree than expressive skills with no marked difference between verbal and sign language, but with natural signs better preserved than finger spelling.

Delayed auditory feedback and aphasia.

The effect of Delayed Auditory Feedback (DAF) was evaluated in three groups of subjects: 10 normal controls, 10 non-fluent aphasics, and 10 fluent aphasics. Speec production tasks consisted of (1) repeating sound and words; (2) naming objects; (3) producing sentences from given stimulus words; (4) answering questions; (5) reciting nursery rhymes; and (6) reading. Two delays were used, 180 and 360 msec. Two independent judges rated patients' responses for changes in intensity, duration, and quality of speech. Inter-judge reliability was considered satisfactory. Contrary to some previous reports, all subjects, including all the fluent aphasics, showed some DAF effect. Fluent aphasics, however, showed a significantly smaller DAF effect than non-fluent aphasics. Patient with conduction aphasia appeared to be the least impaired. Overall DAF effect was greater with 180 msec. than with 360 msec. The largest DAF effect occurred during answering question, followed by repeating, reading, nursery rhymes, sentence production, and naming, in that order. Repetition of a complex word produced a greater DAF effect than repetition of a simple sound. Finally, we found a differential effect of DAF on the three measures used in the study. We hypothesize that DAF effects result from changes in two separate monitoring systems. One systems is related to changes in the intensity of speech and does not appear to be affected by aphasia. The other is responsible for duration and qualitative changes in speech and is differentially affected in relation to pathology producing aphasia.