Verbal cued recall as a predictor of conversion to Alzheimer's disease in Mild Cognitive Impairment.

OBJECTIVE: This study was set up to investigate whether neuropsychological tests are able to predict conversion to AD among Mild Cognitive Impairment (MCI) patients. METHODS: At baseline the cognitive part of the Cambridge Examination for Mental Disorders of the Elderly (CAMCOG), the Mini Mental Status Examination (MMSE), the Geriatric Depression Scale (GDS), a Dutch variation of Rey's Auditory Verbal Learning Test, the Memory Impairment Screen plus (MISplus) and the Visual Association Test (VAT) were administered to 40 patients diagnosed with MCI. After 18 months, MCI-patients were reassessed and a follow-up diagnosis was established. Of those who were seen for follow-up (n = 31), seven fulfilled (NINCDS-ADRDA) criteria of probable AD, while 24 did not convert. RESULTS: A binary logistic regression analysis showed that the MISplus contributed most to the prediction of conversion (OR = 0.28, 95% CI 0.099-0.790). With a cut-off of 2 out of 6, a positive predictive value of 71.5%, a negative predictive value of 91.5% and an overall diagnostic accuracy of 87.0% were achieved. CONCLUSIONS: This prospective, longitudinal study shows that a score of 0 or 1 out of 6 on the MISplus may be a good indicator of future (within 18 months) progression to AD among MCI-patients.

Follow-up of cognitive and motor development of 10-year-old singleton children born after ICSI compared with spontaneously conceived children.

BACKGROUND: This is the first follow-up study of the cognitive, psychosocial, family-relational and medical development of ICSI children at ages 8 and 10. Second-wave study results on the cognitive and motor development of 10-year-old ICSI children are discussed and compared with the outcome at 8 years. METHODS: Developmental outcomes of 109 10-year-old singletons born through ICSI after at least 32 weeks of gestation were compared with those of 90 singletons of the same age born after spontaneous conception (SC). The outcomes were also compared with the outcomes of the children at age 8. RESULTS: 10-year-old ICSI children obtained total, verbal and performance intelligence scores comparable to those of SC children. No significant differences were found between ICSI and SC children regarding overall motor, manual and ball skills. ICSI children and girls appear to have better balance skills than SC children and boys, respectively. With regard to long-term follow-up, the IQ results of ICSI and SC children at age 10 appear to have converged (from slightly higher scores in the ICSI children at age 8), probably indicating a decreased effect of maternal educational level or stimulating home environment in the ICSI group over time. CONCLUSIONS: In this follow-up study, ICSI and SC children show a comparable cognitive and motor development until the age of 10. These findings are in line with those obtained at age 8.

Immunocytochemistry of renal membrane proteins on epoxy sections.

Immunocytochemistry performed on paraffin or cryosections is often hampered by poor morphology. Epoxy sections, in contrast, generally retain well-preserved tissue architecture. Immunocytochemistry, however, on epoxy-embedded sections is difficult due in part to the plastic itself and to the fixation conditions. Here, we present a technique for visualization of membrane proteins by immunocytochemistry on epoxy sections of kidneys fixed with glutaraldehyde without or with osmium post-fixation. Semithin sections were obtained from Epon 812-embedded mouse and rat kidney blocks. Before immunoperoxidase or immunofluorescence labeling, the sections were etched with the epoxy solvent, methanolic potassium hydroxide, followed by antigen retrieval using microwave heating. The sections were then treated with the primary antibody followed by secondary antibodies as usual. The distribution and expression patterns of a variety of membrane proteins, such as aquaporin (AQP)-1, AQP-2, and megalin, were identical to those observed by traditional immunocytochemical procedures on paraffin or cryosections. The advantages of our novel method include not only enhanced morphological quality but also the feasibility for investigators to visualize antigens of interest using archival specimens in Epon blocks.

Mild cognitive impairment: what's in a name?

BACKGROUND: Nowadays the term mild cognitive impairment (MCI) is used to fill the gap between cognitive changes associated with normal ageing and those associated with dementia. Despite some agreement in general definitions, MCI is still a heterogeneous clinical syndrome for which no DSM-IV criteria have yet been established. Criteria by Petersen et al. are presently the most applied in clinical practice. Moreover, little attention has been paid to the specific relation between MCI and depression. OBJECTIVE: This review highlights some concerns about the concept of MCI and provides guidelines within the field of neuropsychology to solve them. In a second part, the paper focuses on the specific relationship between depression in the elderly and MCI. RESULTS: We hypothesize that certain test instruments can be used to operationalize the criteria proposed by Petersen et al. Moreover, we suggest that cued recall might be of help to differentiate between progressive and non-progressive MCI. Concerning the specific relation between depression and MCI, we assume that elderly depression with concomitant cognitive problems can be seen as an MCI. CONCLUSION: The proposed adjustments and additions (neuropsychological instruments and the incorporation of depressive symptoms) in the diagnostic flowchart of Petersen may serve as useful tools for clinicians when making a diagnosis of MCI.

Differentiation between mild cognitive impairment, Alzheimer's disease and depression by means of cued recall.

BACKGROUND: Discriminating Alzheimer's disease (AD) and mild cognitive impairment (MCI) from depression is a challenge in psychogeriatric medicine. A study was set up to ascertain whether cued recall could be useful in differentiating early AD and MCI from depression among elderly individuals. METHOD: The Visual Association Test (VAT) and the Memory Impairment Screen-plus (MIS-plus) were administered together with the Mini-Mental State Examination (MMSE) and the Geriatric Depression Scale (GDS) to 40 MCI patients, 35 mild AD patients, 46 depressed patients and 52 healthy control subjects. RESULTS: A one-way analysis of variance (ANOVA) followed by post-hoc Scheffé tests showed that AD patients had significantly lower cued recall scores (i.e. combined VAT and MIS-plus scores) than MCI patients, who in turn had lower scores than depressed patients. The scores of depressed patients and controls were not significantly different. Discriminant analysis revealed that 94% of the AD patients and 96% of the depressed patients could be classified correctly by means of the GDS and the cued recall sores. Receiver operating characteristic (ROC) curves identified an optimal cut-off score of 8 (maximum score 12) for differentiating AD and MCI patients from depressed elderly patients and controls. Applying this cut-off, a sensitivity of 83% (58%) and a specificity of 85% (85%) was obtained when differentiating AD (MCI) from depression. CONCLUSIONS: Cued recall, operationalized by the combined scores of VAT and MIS-plus, is a useful method for differentiating AD patients from depressed individuals and healthy controls. Probably because of the great heterogeneity among MCI patients, the diagnostic power of cued recall decreases when applied to differentiate MCI from depression.

Cognitive and motor development of 8-year-old children born after ICSI compared to spontaneously conceived children.

BACKGROUND: As a continuation of two large-scale, multicentre studies on the development of 5-year-old ICSI children, we present results of the follow-up study undertaken on the cognitive and motor development of 8-year-old ICSI children. METHODS: Developmental outcomes of 151 8-year-old singletons born through ICSI after 32 weeks of gestation were compared with those of 153 singletons of the same age born after spontaneous conception (SC). Part of this population was seen in a cohort at the age 5 years. Outcome measures include Wechsler Intelligence Scale for Children-Revised (WISC-R) and Movement Assessment Battery for Children (ABC). RESULTS: Regarding intellectual functioning, ICSI children tend to obtain significantly higher total (P < 0.01), verbal (P < 0.01) and performance (P < 0.05) intelligence scores than SC children, nevertheless remaining in similar ranges. These effects are small (Cohen's d < 0.50). High maternal educational level stayed in the regression as a factor accounting for some of the variance in total IQ between the groups. In terms of motor development, no significant differences were found between ICSI and SC children regarding overall motor skills, manual, balance and ball skills. CONCLUSION: In this follow-up study, ICSI and SC children show a comparable cognitive and motor development until the age of 8 years.

Self-serving appraisal as a cognitive coping strategy to deal with age-related limitations: an empirical study with elderly adults in a real-life stressful situation.

Elderly people are often confronted with stressful events that threaten psychological homeostasis. Nevertheless, the lack of a general age-related drop in life satisfaction remains intriguing. The objective of this study was to analyze the basic mechanisms of perceived control and self-protective processes. Eighty-four elderly adults who underwent a fitness-to-drive evaluation were asked how they appraised their performance in a driving simulation task and were classified as over-estimators versus people who estimated their performance correctly and people who didn't overestimate their performance. Decreased physical resources were related to self-serving appraisal and less depressive feelings. The results are in line with theories on self-immunizing processes and provide support for the use of cognitive therapies in dealing with age-related limitations.

International collaborative study of intracytoplasmic sperm injection-conceived, in vitro fertilization-conceived, and naturally conceived 5-year-old child outcomes: cognitive and motor assessments.

OBJECTIVE: To date, very few studies have been conducted on the neurodevelopmental well-being of children conceived through intracytoplasmic sperm injection (ICSI). The limitations of these studies often include a lack of comparison with a demographically matched, naturally conceived (NC) group and the investigation of only very young children, with relatively small samples sizes. One study showed that there were no differences in IQ scores among ICSI-conceived, in vitro fertilization (IVF)-conceived, and NC children at 5 years of age. Unfortunately, psychomotor development was not assessed in that study. Because findings regarding these children's cognitive and motor development are inconclusive, the aim of this study was to shed more light on the cognitive and motor development of 5-year-old ICSI-conceived children. METHODS: A total of 511 ICSI-conceived children were compared with 424 IVF-conceived children and 488 NC controls. Children were recruited in 5 European countries, ie, Belgium, Denmark, Greece, Sweden, and the United Kingdom. Participation rates ranged from 45% to 96% in the ICSI and IVF groups and from 34% to 78% in the NC group. Cognitive and motor development was assessed with the Wechsler Preschool and Primary Scale of Intelligence-Revised (WPPSI-R) and McCarthy Scales of Children's Abilities (MSCA) Motor Scale, respectively. The WPPSI-R consists of 2 major scales, ie, Verbal and Performance, each including 6 subtests. The 6 Performance Scale subtests are object assembly, geometric design, block design, mazes, picture completion, and animal pegs. The 6 Verbal Scale subtests are information, comprehension, arithmetic, vocabulary, similarities, and sentences. Scores on the Performance and Verbal Scale subtests are summed to yield the performance IQ (PIQ) and verbal IQ (VIQ), respectively. Scores on both the Performance Scale and the Verbal Scale yield the full-scale IQ (FSIQ). IQ scales have a mean score of 100 and a SD of 15. Each subtest has a mean score of 10 and a SD of 3. The MSCA consists of 6 scales, ie, Verbal, Perceptual-Performance, Quantitative, General Cognitive, Memory, and Motor Scale. In this study, only the Motor Scale was administered. This scale assesses the child's coordination during performance of a variety of gross- and fine-motor tasks. Leg coordination, arm coordination, and imitative action tests provide measures of gross-motor ability. Draw-a-design and draw-a-child assess fine-motor coordination, as revealed by the levels of hand coordination and finger dexterity. The mean score for this test is 50, with a SD of . RESULTS: No differences were identified among ICSI, IVF, and NC children with respect to VIQ, PIQ, or FSIQ scores of the WPPSI-R. Furthermore, there were no differences between groups regarding the discrepancy between VIQ and PIQ scores. These results were not influenced by gender, country, or maternal educational level. However, in the subgroup of firstborn children with mothers who gave birth at an older age (33-45 years), NC children obtained significantly better VIQ and FSIQ scores than did children conceived through assisted reproductive technologies. These differences in VIQ and FSIQ scores between ICSI/IVF and NC children were relative, because NC children scored <1 IQ point higher than ICSI/IVF children. Therefore, these scores show no clinical relevance. For Verbal Scale subtests, variables such as age of the mother at the time of the birth, educational level of the mother, and gender and nationality of the child interacted with mode of conception, resulting in clinically irrelevant differences between scores for the ICSI/IVF and NC groups on the arithmetic, vocabulary, and comprehension subtests. For Performance Scale subtests, these same demographic factors interacted with mode of conception for the block design, object assembly, and animal pegs subtests, again resulting in clinically irrelevant differences among groups. In the 3 groups (ICSI, IVF, and NC), we observed equal numbers of children scoring below 1 SD from the mean on the WPPSI-R and the MSCA. CONCLUSIONS: This study includes a substantial number of children from several European countries. Apart from a few interaction effects between mode of conception and demographic variables, no differences were found when ICSI, IVF, and NC scores on the WPPSI-R and MSCA Motor Scale were compared. Nevertheless, the aforementioned interaction effects could indicate that demographic variables such as maternal age at the time of the birth and maternal educational level play different roles in the cognitive development of IVF and ICSI children, compared with NC children. Additional research is needed to explore and verify this finding. Previous studies revealed that ICSI children, in comparison with NC children, more frequently obtained scores below 1 SD from the mean on 3 subtests of the Performance Scale (object assembly, block design, and mazes) or showed a trend of 5.2% of ICSI children, compared with 2.5% of IVF children and 0.9% of NC children, obtaining a score below 1 SD from the mean, but those findings were not confirmed in this study. Here no differences were found among the 3 groups in the numbers of children scoring below 1 SD from the mean on the VIQ, PIQ, and FSIQ tests and the Verbal and Performance Scale subtests. Motor development results were somewhat more conclusive. There were no differences between the scores of ICSI, IVF, and NC children on the MCSA Motor Scale. No interaction effects were found between mode of conception and demographic variables, indicating that these results are not influenced by gender, nationality, maternal educational level, or maternal age at the time of the birth. Furthermore, equal proportions of children in all 3 groups scored below 1 SD from the mean. The results of this study are reassuring for parents who conceived through ICSI (or IVF). The findings indicate that the motor and cognitive development of their offspring is very similar to that of NC children. However, demographic factors such as maternal educational level and maternal age at the time of the birth might play different roles in the cognitive development of ICSI and IVF children, compared with NC children.

Psychological follow-up study of 5-year-old ICSI children.

BACKGROUND: The developmental outcomes of children born after ICSI are still a matter of concern. The purpose of the present study was to investigate psychological outcomes for 5-year-old children born after ICSI and compare these with outcomes for children born after spontaneous conception (SC). METHODS: Three hundred singleton children born after ICSI in Belgium, Sweden and the USA were matched by maternal age, child age and gender. Outcome measures included the Wechsler Preschool and Primary scales of intelligence (WPPSI-R), Peabody Developmental Motor Scales, Parenting Stress Index and Child Behaviour Checklist. RESULTS: Regarding cognitive development, no significant differences were found on WPPSI-R verbal and performance scales between ICSI and SC children. However, some differences were noted on subtests of the Performance Scale. ICSI children more often obtained a score below 1 SD of the mean on the subtests: Object Assembly, Block Design and Mazes (all P<0.05). Significant differences by site (i.e. Belgium, Sweden and New York) were found on subtests related to parenting stress, child behaviour problems and motor development (all P<0.05). These findings can probably be explained by variables other than conception mode, such as cultural differences and selection bias. CONCLUSIONS: Although the finding that a higher proportion of ICSI children obtained scores below the cut-off on some of the visual-spatial subscales of the WPPSI-R warrants further investigation, ICSI does not appear to affect the psychological well-being or cognitive development at age 5.

The influence of assisted reproduction on family functioning and children's socio-emotional development: results from a European study.

BACKGROUND: ICSI is used with increasing frequency, but there is less information about the children born following this method of assisted reproduction than other forms of IVF. Some authors have suggested that it may contribute to more family stress than IVF. METHODS: ICSI conceived children were compared with IVF conceived children and naturally conceived (NC) controls. They were selected in five European countries: Belgium, Denmark, Greece, Sweden and the UK, and seen for psychological testing and a paediatric examination when they were 5 years old. In all countries, except Greece, mothers and fathers were asked to complete questionnaires about parental well-being, family relationships, parenting and child behaviour. RESULTS: Very few differences were found between the ICSI and NC group or the ICSI and IVF group. The only significant differences were that mothers in the ICSI conceived group reported fewer hostile or aggressive feelings towards the child and higher levels of commitment to parenting than the mothers of NC children. CONCLUSIONS: The study confirms the results of previous work with IVF families. This should be encouraging for families using these techniques in the future.

Why do children want to know more about the donor? The experience of youngsters raised in lesbian families.

In this study, we focus on the donor origin of youngster who are raised in lesbian donor insemination (DI) families. The aim was to explore why some of these DI children like to know more about the donor while others do not, these data were gathered by means of a semi-structured interview. Secondly, we investigated, by means of several questionnaires, whether psychological variables such as global self-esteem, emotional and behavioral adjustment and children's perception of the quality of the parent-child relationship were in some way linked to whether or not they wanted to know more about the donor. In our study the majority of the children who preferred to have no information about the donor expressed their loyalty towards the social mother. For the majority of the children who opted for donor information, curiosity was the most salient motive. No differences were found with regard to the psychological variables between the two groups considered. In conclusion, the wish to know more about the donor or the absence of such a need is not reflected in the child's well-being and is not linked to the quality of the parent-child interaction.

Risk assessment for developing type 1 diabetes: intentions of behavioural changes prior to risk notification.

BACKGROUND: Recent progress in predictive techniques allows people at risk of developing type 1 diabetes to be identified in a pre-symptomatic stage and prevention trials to be implemented. The present study examined prospectively whether participants in a screening programme anticipated behavioural changes in the event of having a high risk. METHODS: Four hundred and three first-degree relatives of people with type 1 diabetes completed a self-administered questionnaire about their views on screening and diabetes, and questionnaires on well-being and locus of control. RESULTS: Prior to risk notification, 73% reported that they intended to introduce lifestyle changes if at high risk. The vast majority of the respondents (87%) reported that eating habits would be the main changes made. Those anticipating changes believed they could take actions to reduce their risk of type 1 diabetes (p<0.001) and to have personal control over diabetes onset (p<0.001). They were also more worried about developing diabetes (p<0.01) and preoccupied with diabetes-related symptoms (p<0.01). CONCLUSIONS: Prior to risk notification, the process of being screened raised concerns and expectations about future changes. Despite the lack of any evidence, people believed lifestyle changes would be effective in reducing their risk. Since the impact of lifestyle in the development of type 1 diabetes is not yet established, accurate information about the role of health behaviour in the progression to overt diabetes is needed to avoid unrealistic expectations on the benefit of these changes and unnecessary impairment to quality of life. Personally initiated changes should be monitored since they could importantly influence the progress and outcome of prevention trials.

What does it mean for youngsters to grow up in a lesbian family created by means of donor insemination?

In many countries fertility services still refuse to inseminate lesbian couples because they believe the child's welfare would be at stake. One of their concerns is that these children will be stigmatized because of their non-traditional family structure. In this follow-up study, we interviewed children from lesbian donor insemination (DI) families about how they present their 'non-traditional' family to people in their immediate social environment. We also explored whether or not children were teased or harassed about their lesbian family and whether or not coping with a non-traditional family constellation was reflected in their psychological well-being. According to this study, almost all children from lesbian DI families share the fact that they live in a two-mother unit spontaneously with close friends who react positively. Others are only informed about the non-traditional family structure when they ask questions about it. From the children's answers, we can conclude that for some peers it is hard to understand that someone can have two mothers without having a father somewhere. Compared with children from heterosexual families, these DI children are not more likely to be teased but they are more prone to family-related teasing incidents. However, introducing their non-traditional family into their peer group does not seem to interfere with their psychological well-being. Nonetheless, teachers indicate that children from lesbian families experience more attention problems compared with children from heterosexual households.

Predicting at-fault car accidents of older drivers.

Considerable research shows car accidents are difficult to predict using screening tests. The objective of this exploratory study is to determine whether detailed accident analysis taking into account the specific accident type might enhance the predictive power of a standardised road test and a set of selected neuropsychological tests. Moreover, this study addresses the validity and reliability of performance-based driving evaluation. The sample consisted of 84 older drivers between 65 and 96 years of age who were referred for a fitness-to-drive evaluation. Using discriminant analyses, the subjects were classified as drivers with and without at-fault accidents. We compared the accuracy of neuropsychological tests and a road test for postdicting all accidents, accidents classified into two categories and accidents classified into four different categories. The percentages of correctly classified subject were highest at the level of the most detailed classification. These results suggest that, although accident prediction is difficult, the predictability of car accidents by neurocognitive measurements and a road test increases when the kind of accident is specified.

An attempt to reconstruct children's donor concept: a comparison between children's and lesbian parents' attitudes towards donor anonymity.

BACKGROUND: This study investigated the donor concept of children who were born by means of donor insemination (DI), and their lesbian parents. METHODS: A total of 41 children aged between 7 and 17 years, and 45 parents, took part in the follow-up study. In-depth topic interviews were used to reconstruct how DI children and their mothers perceived the donor. Data were collected about the birth story, about children's conversations with their mothers concerning donor characteristics and about children's and parents' attitudes towards the status of the donor. RESULTS: 54% of these children preferred donor anonymity at this point in their life, whereas 46% wanted to know more about the donor. The majority of the latter group would have liked to know the donor's identity, with boys outnumbering girls. The remaining children of this group were content with non-identifying information. Children wanted to know more about the donors whereas the majority of the mothers preferred the donor to remain anonymous. CONCLUSIONS: Our results suggest that among DI children in general and among members of the same family, unit opinions differ on the status of the donor. A flexible system offering different types of donors seems to be necessary in order to meet the needs of each family.

Short cognitive/neuropsychological test battery for first-tier fitness-to-drive assessment of older adults.

Since fitness-to-drive evaluation of elderly drivers has become an important issue, we developed a short first-tier screening battery to evaluate the necessity for further referral to specialised centres. Our sample consisted of 84 subjects between 65 and 96 years who came to the Belgian Road Safety institute for a fitness-to-drive evaluation. Using cross-validated discriminant analyses, the predictive power of a battery consisting of the Trail Making Test, Part A, a visual acuity test, a clock drawing test, the Mini-Mental State Examination (MMSE) and age was analysed. The judgement by an independent driver instructor (fit-to-drive vs. not unconditional fit-to-drive), based on a real world road test was used as the dependent variable. Classification functions based on the significant discriminant function yielded a specificity score of 85% (subjects fit-to-drive correctly classified) and a sensitivity score of 80% (subjects as not unconditional fit-to-drive correctly classified). These results highlight the potential value of a short screening instrument that can be used in primary health care settings. This instrument may be useful as a first step in a multi-tier assessment procedure.

The relationship between cognitive/neuropsychological factors and car driving performance in older adults.

OBJECTIVES: Because demographic changes produce a society with a growing number of older people, seniors constitute the fastest growing segment of car drivers. The objective of this research project was to identify cognitive factors related to driving problems in older adults. A top-down approach has been used, testing theory-driven hypotheses. DESIGN: Correlational study. SETTING: Fitness-to-Drive Assessment Centre of the Belgian Road Safety Institute. PARTICIPANTS: The research sample consisted of 84 car drivers aged over 65 years, who were referred for a general fitness-to-drive evaluation. MEASUREMENTS: The relations between seven specific neuropsychological tests and self-reported accidents were investigated. Furthermore, the relations between these same tests and a road test, independently assessed using a detailed evaluation grid, were analyzed in depth. These analyses were followed by stepwise multiple regression analyses. RESULTS: In a stepwise regression model, four neuropsychological tests could account for 64% of the variance of the score on the road test. Moreover, it could be demonstrated that specific cognitive subskills share common variance with specific real-world situations. However, neuropsychological tests could explain only 19% of the variance of self-reported at fault car accidents. CONCLUSIONS: The initial results of this study indicate the relevance of a cognitive/neuropsychological approach to the driving ability of older people. However, the link with accident risk seems more complex. Consequently, neuropsychological screening procedures are in need of a broader perspective to prevent an overemphasis on unidimensional screening procedures focusing mainly on deficit and less on capacities for safe behavior.

Risk of malnutrition in retirement homes elderly persons measured by the "mini-nutritional assessment".

BACKGROUND: The combined influence of age-associated factors such as general health, degree of dependency, diminished odor perception, and poor oral health on the risk for malnutrition was explored. METHODS: A total of 81 persons living in retirement homes took part in the study (mean age 83.4 years, SD = 6.6, range 61-98). The Mini-Nutritional Assessment (MNA) was used to evaluate the risk of malnutrition. Odor perception was measured by the detection threshold for isoamylacetate. The number of drugs taken by each person was counted. General health status was determined by the Medical Outcome Study (MOS) scores. Oral examinations were carried out to count the number of natural teeth and type of dentures. RESULTS: On average, women had slightly, but significantly, lower MNA scores than men (respectively, 23.4, SD = 2.8; and 24.6, SD = 2.6; p = .048). The correlations between age and MNA score and between odor perception and MNA score were not significant. Significant correlations were found between age and number of natural teeth (r = -.26, p = .001) and between MNA score and number of natural teeth (r = .27, p = .001). The mean MNA score of complete denture wearers (22.8, SD = 2.9) was significantly lower than that of partial denture wearers (25.8, SD = 2.9; p = .0005). The total MOS and MNA scores were not correlated, but a significant correlation was found with the subscales mental functioning (r = .29, p = .003), social functioning (r = . 19, p = .045), and perceived health (r = .19, p = .047). No relation was found between the activities of daily living (ADL) and MNA scores. A significant negative correlation was observed between number of drugs taken and the MNA score (r = -.34, p = .001). When participants without risk of malnutrition (MNA > or = 24) were compared with those at risk (MNA = 17-23.5), again, the number of drugs taken was significantly different (on average, respectively, 4.5, SD = 2.9; and 7.0, SD = 2.6; p < .0005). Using multiple regression to test the separate effects of the different independent variables, the number of drugs taken showed a significant negative regression coefficient (beta = -.31, p = .008), as did the mental health score (beta = .27, p =.02), giving a total R2 = .32. The other parameters did not contribute significantly. CONCLUSION: Among the elderly in retirement homes, the health state (as measured by the MOS subscale mental health and by the medication use) appears to be the most clinically relevant parameter to explain the risk for malnutrition. Loss of natural teeth and perceived health are less independently contributing, whereas no contribution derives from decline of odor perception, degree of dependency, and age itself.

Counselling couples and donors for oocyte donation: the decision to use either known or anonymous oocytes.

In order to avoid a long waiting period, the Centre for Reproductive Medicine of the Free University of Brussels suggests that couples in need of donor oocytes search for a donor among family and friends. Recipient couples can choose between two types of donation: known donation, i.e. treatment with the oocytes of the donor recruited by the couple, or anonymous donation, i.e. an exchange of the donor recruited by the couple with a donor recruited by another couple in order to ensure anonymity between donor and recipients. In total, 144 couples were counselled by a psychologist in the decision-making process with regard to the kind of donation to be used. Some 68.8% of the recipient couples preferred known donation. This choice was mainly motivated by reasons related to fears associated with anonymity, such as fear of the unknown origin of genetic material and the trust that couples had in 'their' donor. Almost one-third of the couples opted to use anonymous oocytes. The desire to establish explicit boundaries between the two families involved was the major motivation for this choice. Approximately 44% of the couples were willing to tell the child about the oocyte donation.

Can strategic and tactical compensation reduce crash risk in older drivers?

OBJECTIVE: to determine whether the use of strategic and tactical compensation can successfully improve safety in older drivers. METHODS: 84 healthy subjects aged between 65 and 96 were referred for a fitness-to-drive evaluation. Using ANOVA and contrast analysis, we tested the hypothesis that bad drivers who have had no car accidents use more active compensation strategies than bad drivers who have caused accidents in the previous 12 months. We classified drivers as bad, average or good, based on a structured road test. RESULTS: drivers who select driving tasks below their capacities and compensate by adapting their driving style cause fewer accidents than those who do not apply these strategies. CONCLUSIONS: fitness-to-drive screening procedures need a broader perspective to prevent an over-emphasis on procedures which focus more on deficit than on capacities.