Safety of disclosing amyloid status in cognitively normal older adults.

INTRODUCTION: Disclosing amyloid status to cognitively normal individuals remains controversial given our lack of understanding the test's clinical significance and unknown psychological risk. METHODS: We assessed the effect of amyloid status disclosure on anxiety and depression before disclosure, at disclosure, and 6 weeks and 6 months postdisclosure and test-related distress after disclosure. RESULTS: Clinicians disclosed amyloid status to 97 cognitively normal older adults (27 had elevated cerebral amyloid). There was no difference in depressive symptoms across groups over time. There was a significant group by time interaction in anxiety, although post hoc analyses revealed no group differences at any time point, suggesting a minimal nonsustained increase in anxiety symptoms immediately postdisclosure in the elevated group. Slight but measureable increases in test-related distress were present after disclosure and were related to greater baseline levels of anxiety and depression. DISCUSSION: Disclosing amyloid imaging results to cognitively normal adults in the clinical research setting with pre- and postdisclosure counseling has a low risk of psychological harm.

Handwriting with a preferred retinal locus for AMD with scotomas.

PURPOSE: Individuals with macular scotomas from age-related macular degeneration frequently have difficulty writing legibly. The purpose of this study was to investigate the causes of this difficulty by documenting the location of the retinal image of the pen used for writing in relation to the scotoma and fixational preferred retinal locus (fPRL). METHODS: Subjects with macular scotomas from age-related macular degeneration and visually normal age-matched controls wrote words while observing their hand, pen, and text in a scanning laser ophthalmoscope. Scanning laser ophthalmoscope video images were analyzed to find the retinal positions of the subject's scotoma, fixation area, and pen tip. RESULTS: Control subjects placed their fovea and scotoma subjects placed their fPRL on or very close to the pen tip for both cursive writing and printing. Scotoma subjects' written text sloped downward at a greater angle than controls'. Text angle was negatively correlated with fPRL eccentricity, visual acuity, and the amount the scotoma obscured the writing guides. When printing, control subjects placed their fovea precisely in the center of printing box guides, whereas scotoma subjects exhibited highly dispersed placement of the fPRL. CONCLUSIONS: The principal finding is that, because the retinal locations of the pen tip and the fPRL or fovea are coincident or very close, the fPRL and fovea are "monitoring" the pen tip and its location on the page. It is the PRL determined by asking subjects to fixate (i.e., the fPRL) that is used when handwriting, not a separate "handwriting" PRL. The poor handwriting performance of those with macular scotomas seems to be primarily caused by difficulty in placing letters in the appropriate location probably because of reduced visual acuity of the fPRL and scotoma obscuration of the area on which to write.

Learning proficiency on the Wisconsin Card Sorting Test in people with serious mental illness: what are the cognitive characteristics of good learners?

Although it is widely accepted that schizophrenia and other serious mental illnesses (SMI) are associated with neurocognitive difficulties, there is great variability in neurocognitive functioning across individuals. In recent years, a growing number of schizophrenia studies have utilized the concept of learning potential to explore individual variation in cognition. Learning potential refers to the ability to benefit from instruction and is measured by assessing test performance before and after training. The present study was intended to explore the cognitive characteristics associated with learning potential in people with serious mental illness. Sixty individuals with schizophrenia, bipolar or major (unipolar) depression completed a learning potential assessment using the Wisconsin Card Sorting Test (WCST) and a battery of standard cognitive measures. Based on established criteria for WCST learner subgroups, participants were categorized as high achievers, learners or non-retainers. There were several significant cognitive differences among the three learner subgroups. Most notably, individuals who were categorized as learners on the WCST showed significantly better verbal and working memory compared to non-retainers. Secondary analyses revealed that the three SMI diagnostic groups (depression, bipolar, schizophrenia) were similar in learning potential and did not differ on any of the standard cognitive measures. This study provides support for learning potential classification in schizophrenia as well as other serious mental illnesses, and indicates that learning potential may specifically be related to verbal and working memory abilities.