Diffusion tension imaging is a good tool for assessing patients with dementia and behavioral problems and discriminating them from other dementia patients.

BACKGROUND: Dementia is one of the leading public health concerns as the world's population ages. Although Alzheimer's disease (AD) is the most common dementia diagnosis among older patients, some patients have additional behavioral symptoms. It is therefore important to provide an exact diagnosis, both to provide the best possible treatment for patients and to facilitate better understanding. PURPOSE: To investigate whether magnetic resonance imaging (MRI) with fractional anisotropy (FA) can accurately find patients with behavioral symptoms within a group of AD patients. MATERIAL AND METHODS: Forty-five patients from the geriatric outpatient clinic were recruited consecutively to form a group of patients with AD and behavioral symptoms (AD + BS) and a control group of 50 patients with established AD. All patients had a full assessment for dementia to establish the diagnosis according to ICD-10. MRI included 3D anatomical recordings for morphometric measurements, DTI for fiber tracking, and quantitative assessment of regional white matter integrity. The DTI analyses included computing of the diffusion tensor and its derived FA index. RESULTS: We found a significant difference in FA values between the patient groups' frontal lobes. The FA was greater in the study group in both left (0.39 vs 0.09, p < 0.05) and right (0.40 vs 0.16, p < 0.05) frontal lobes. CONCLUSION: MRI with FA will find damage in frontal tracts and may be used as a diagnostic tool and be considered a robust tool for the recognizing different types of dementia in the future.

The Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) is associated with informant stress.

OBJECTIVE: To study the association between informant stress and appraisal of patients' cognitive functioning as reported by the Informant Questionnaire on Cognitive Decline in the Elderly--IQCODE. METHODS: Routinely collected data from a geriatric outpatient department (207 dyads) during the years 1995-1998 were analysed. Relative stress scale (RSS) has been categorised for possible low, intermediate and high risk of psychiatric morbidity and caregivers were combined to four groups (female and male spouses and female and male non-spouses, respectively). The relationship between IQCODE (dependent) and categorised RSS and informant groups and patient age was further studied by means of the general linear model (GLM-UNIANOVA). RESULTS: In general, spouses reported better cognitive functioning than non-spouses. There was a significant association between IQCODE and RSS (p < 0.001), and the composite variable informant group and informant gender (p < 0.001). The main effect of the interaction term RSS x informant group + informant gender was not significant. Post hoc test, however, revealed a significant effect of the interaction term RSS x female spouses (p < 0.001) on IQCODE. CONCLUSION: IQCODE is associated with informant stress. Categorisation of RSS score into groups of low, intermediate and high risk for psychiatric morbidity can be a valuable contribution to a more meaningful application of RSS in general practice.

Staff attitudes towards institutionalised dementia residents.

AIM: To explore the attitudes of staff caring for institutionalised dementia residents and the variables associated with these attitudes. METHODS: Fourteen nursing homes and one hospital-based geriatric ward in Bergen, Norway were surveyed, using the translation of an Approach to Dementia Questionnaire. The study population (n = 291) was a mixture of registered nurses, auxiliary nurses, nursing assistants and non-trained aides. DESIGN: Survey. RESULTS: Significant differences in hope and person-centred attitudes were identified in this study. Nursing assistants, compared with registered nurses (p = 0.02), had significantly lower hope attitudes. Staff over 50 years of age reported significantly lower hope attitudes (p = 0.01) than those under 40 years of age. Staff with 10 and fewer years of work experience reported significantly lower hope attitudes (p = 0.02) than those with more than 10 years of experience. Nurses with specialised training in geriatrics, psychiatry or dementia care had significantly higher hope attitudes, compared with nurses without any special training (p = 0.04). The person-centred attitude was lower among participants who were over 50 years old, compared with their counterparts under the age of 40 (p < or = 0.01). DISCUSSION: Education, age, work experience, care unit size and specialised training are associated with differences in attitudes. We recommend that employers be proactive in encouraging and facilitating staff development by offering further training that aims to impart more positive attitudes. RELEVANCE TO CLINICAL PRACTICE: Improvements in staff competency levels will be more important in the future, as a result of the forecasted increase in the percentage of the population who will suffer from dementia and reside in nursing homes.

Quality and general practitioner satisfaction with reply letters for dementia patients.

OBJECTIVE: The exchange of information between specialists and general practitioners (GPs) is an important aspect of the referral process at the stage of diagnosis. Comprehensive and satisfactory information from specialists guides GPs in choosing the best possible management. The objective of this study was to assess the quality of information in reply letters with regard to the GPs' problem as presented, and the level of GP satisfaction, and to determine if there is any relation between the quality of the referrals and the reply letters. DESIGN: A retrospective review of reply letters from the Department of Geriatric Medicine to primary health care. A data sheet was developed using the existing literature. Three GPs assessed the quality of the reply letters and GP satisfaction. SETTING: Patient records in the geriatric department were collected, registered and examined according to pre-defined criteria. SUBJECTS: A total of 135 first-time replies from January 2002 to December 2002 were evaluated. All patients and relatives were informed that participation was voluntary and anonymity was guaranteed. MAIN OUTCOMES: Assessment of the quality of replies and GP satisfaction. RESULTS: The mean age of all referred patients was 78.7 years (standard deviation (SD) 7.3, range: 42 to 90 years) and 61.5% were female. Multi-rater agreement analysis showed that 86% of the replies were classified as very good/good quality, 10% as fair, and 4% as poor quality. The mean agreement was 85% (kappa 0.37; 95% confidence interval (CI) 0.29-0.45; P < 0.0001); 89% of the replies were classified as very satisfactory/satisfactory, 9% as less satisfactory and 2% as unsatisfactory. The mean agreement was 86% (kappa 0.34; 95% CI 0.25-0.42; P < 0.0001). CONCLUSION: The reply letters were overall of good quality and GPs were generally satisfied with the reply letters. No association between the quality of referral and reply letters was found.

Prostate magnetic resonance imaging: multiexponential T2 decay in prostate tissue.

PURPOSE: To investigate the T2 decay in prostate tissue for multiexponentiality and to assess how the biexponential model relates to established T2W contrast. MATERIALS AND METHODS: A 32-echo spin-echo sequence was performed on 16 volunteers. Six single-voxel decay curves were sampled from each prostate. Prediction accuracies were assessed by jackknifing for the mono-, bi-, and triexponential models. The differences were evaluated by cross-validated analysis of variance (CVANOVA). Multiple linear regression was performed to assess the relation between parameters in the biexponential model and the contrast in T2W images. RESULTS: Mono-, bi-, and triexponential models were preferred in 8 (10%), 72 (86%), and 4 (5%) cases, respectively. The biexponential short T2 was 64 msec (range 43 to 92 msec) and the long T2 was 490 msec (range 161 to 1319 msec). The fitted signal fraction, f, of the long T2 component was 27% (range 3% to 80%). The adjusted R(2) was 75.1% for the full regression model and decreased by 0.9%, 1.3%, and 39.2% when short T2, long T2, and f were removed from the model, respectively. CONCLUSION: Prostatic T2 decay was, in general, biexponential. The differences between the T2 components were large enough for accurate quantification. The T2W image contrast was primarily predicted by the biexponential signal fractions.

Large scale evaluation of WHO's ultrasonographic staging system of schistosomal periportal fibrosis in Ethiopia.

OBJECTIVES: To evaluate the recent WHO's ultrasonographic diagnostic staging system of schistosomal periportal thickening/fibrosis and to assess intra/inter-observer variation associated with its use. METHODS: Local standard of portal branch wall thickness (PBWT) for height was established using 150 healthy subjects. Intra and inter-observer variation in image pattern identification and PBWT measurements were assessed in 94 and 35 subjects, respectively, with differing stages of periportal thickening fibrosis. WHO's diagnostic criteria were evaluated in 2,451 community members (1,277 males, 1,174 females; mean age 18.8 years) with an overall Schistosoma mansoni prevalence estimate of 65.9%. RESULTS: There were no significant inter/intra-observer variations in image pattern identification and PBWT measurements. Based on Ethiopian PBWT-for-height standard, 128/2,451 (5.2%) had insipient, 46/2,451 (1.9%) had possible/probable and 112/2451 (4.6%) had definite/advanced periportal thickening/fibrosis. Comparable figures were obtained using the Senegalese PBWT-for-height standard and there was good agreement between Ethiopian and Senegalese healthy control-based diagnostic criteria in classifying the 286 subjects into stages of periportal thickening/fibrosis (kappa = 0.87, P < 0.001). CONCLUSIONS: With further improvement, the WHO's ultrasonographic diagnostic criteria can be used in health institutions and community surveys. Image pattern based assessment is simple and more reproducible than PBWT based assessment of periportal thickening/fibrosis. The latter is, however, more useful in clarifying the status of an individual with doubtful image pattern, and in monitoring post-treatment outcome of periportal thickening/fibrosis. Considering the comparability of PBWT-for-height standards, setting one international standard of PBWT-for-height is more practical than developing local standards for each endemic area.

MR imaging of the small bowel with increasing concentrations of an oral osmotic agent.

The aim of this study was to assess the quality of MR imaging and level of adverse effects with increasing concentrations of gastrografin. This is a prospective study with 24 healthy volunteers which were randomised into four groups receiving 50%, 25%, 10% and 0% gastrografin. The endpoint was bowel image quality based on distension, signal homogeneity and wall delineation evaluated by three independent radiologists, and the maximum bowel diameter at three different levels. The subjects also scored any adverse events on a 1-5 scale. The interradiologist agreement was relatively good, with kappa values varying between 0.81 and 0.41. Improved bowel distension and image quality were achieved with increasing concentrations. But significant dose-response effects were found between increasing osmolalities and the bowel diameters and also versus the score of adverse events. The most frequent adverse reactions were diarrhea, nausea and lack of palatability. There is a gradient relationship between increasing osmolality of gastrografin and improved image quality and the score of adverse effects. The optimum concentration of gastrografin is dependent of the tolerance of the adverse events.