RESEARCH Open Access
A longitudinal study of anxiety and
cognitive decline in dementia with
Lewy bodies and Alzheimer’s disease
Monica H. Breitve1,2,3*, Minna J. Hynninen4,5, Kolbjørn Brønnick6,12, Luiza J. Chwiszczuk1,3,7, Bjørn H. Auestad8,9,
Dag Aarsland10,11 and Arvid Rongve1,2,3
Abstract
Background: Anxiety in dementia is common but not well studied. We studied the associations of anxiety
longitudinally in Alzheimer’s disease (AD) and dementia with Lewy bodies (DLB).
Methods: In total, 194 patients with a first-time diagnosis of dementia were included (n = 122 patients with
AD, n = 72 patients with DLB). Caregivers rated the patients’ anxiety using the Neuropsychiatric Inventory, and
self-reported anxiety was assessed with the anxiety and tension items on the Montgomery–Åsberg Depression
Rating Scale. The Mini Mental State Examination was used to assess cognitive outcome, and the Clinical
Dementia Rating (CDR)-Global and CDR boxes were used for dementia severity. Linear mixed effects models
were used for longitudinal analysis.
Results: Neither in the total sample nor in AD or DLB was caregiver-rated anxiety significantly associated with
cognitive decline or dementia severity over a 4-year period. However, in patients with DLB, self-reported anxiety was
associated with a slower cognitive decline than in patients with AD. No support was found for patients with DLB with
clinical anxiety having a faster decline than patients with DLB without clinical anxiety. Over the course of 4 years, the
level of anxiety declined in DLB and increased in AD.
Conclusions: Anxiety does not seem to be an important factor for the rate of cognitive decline or dementia severity
over time in patients with a first-time diagnosis of dementia. Further research into anxiety in dementia is needed.
Keywords: Alzheimer’s disease, Dementia with Lewy bodies, Dementia, Anxiety, BPSD, Longitudinal
Background
Anxiety in dementia is common but not well studied. To
our knowledge, no longitudinal studies of the associa-
tions between anxiety and cognitive decline have been
done to date. The prevalence of anxiety in dementia is
estimated to range from 25 % to 71 %, and generalized
anxiety disorder seems to be the most common anxiety dis-
order [1]. People with co-morbid dementia and anxiety have
more impairment in activities of daily living, reduced quality
of life and more frequent nursing home admission than
people with dementia [2–4]. They also use more health care
services [5], and anxiety is associated with poorer relation-
ships with caregivers and increased caregiver burden [6].
In elderly individuals with no dementia, both depres-
sion and anxiety have been shown to be early predictors
of future cognitive decline [7, 8], and a more rapid
progression in cognitive decline over time has been
suggested, although the data are not conclusive [7, 9].
The risk of developing Alzheimer’s disease (AD) may
be up to 30 times higher among persons with mild cogni-
tive impair ...
DP due to CMD and suicidal behaviour_Rahman et al_2016Syed Rahman
This study examined the association between disability pension (DP) due to common mental disorders and subsequent suicidal behavior using data from Swedish nationwide registers. The study cohort included 46,515 individuals aged 19-64 who received a DP due to conditions like depression, anxiety or stress in 2005. The individuals were followed through 2010 to assess suicide attempts requiring hospitalization and completed suicides. The study found that having a main DP diagnosis of depression, or a secondary diagnosis of substance abuse or personality disorder, were risk factors for later suicidal behavior. Receiving a full-time versus part-time DP was also associated with increased suicide attempt risk in some groups. The results suggest certain DP diagnoses and characteristics may help identify those at higher risk of suicide who warrant
A Single Case Experiment For Cognitive-Behavioral Treatment Of Auditory Hallu...Richard Hogue
This document describes a single-case experiment that evaluated the impact of a new cognitive treatment for schizophrenia. The treatment integrated rational-emotive therapy and cognitive therapy for hallucinations and delusions. It was found to significantly reduce anxiety and depression, and increase quality of life and insight in a 37-year old female patient with schizophrenia. Gains were maintained at 3, 6, and 12 month follow-ups. The treatment shows promise for simultaneously targeting hallucinations and delusions.
This study examined psychiatric comorbidities and treatment outcomes in 100 mentally ill prisoners referred to a tertiary psychiatric hospital in India. The most common primary diagnoses were substance use disorder (45%) and adjustment disorder (36%). 46% of prisoners had more than one psychiatric diagnosis, most commonly intellectual disabilities, personality disorders, and substance use disorders. 59% were treated with medication alone, 27% required inpatient admission, and outcomes were generally positive with patients responding well to treatment. The high rates of comorbidities suggest the need for integrated treatment approaches within prison psychiatric services.
Greater levels of spirituality are associated with less severe depression. Patients reporting higher spirituality at baseline had lower scores on measures of hopelessness, dysfunctional attitudes, and depressive symptoms. Those who believed in God experienced greater decreases in depression, hopelessness, and dysfunctional thinking after 8 weeks of SSRI treatment compared to non-believers. Higher scores on a scale measuring spirituality correlated with greater improvements in depressive symptoms, hopelessness, and cognitive distortions following treatment. The findings suggest spirituality may enhance treatment outcomes for major depressive disorder.
This document provides an overview of psychosis in the elderly, including:
- Common causes are schizophrenia, affective disorders like depression, dementia, delirium, and Parkinson's disease.
- Biological factors underlie many psychotic symptoms. Antipsychotics are commonly used to treat psychosis but have risks.
- Psychosis is more prevalent in nursing home populations compared to community samples. As the population ages, cases of psychosis will rise significantly.
- Specific causes like Alzheimer's disease and depression are discussed in more detail, including their prevalence, clinical presentation, treatments and risks.
A CROSS-SECTIONAL STUDY ANALYSING THE LEVEL OF DEPRESSION AND ITS CAUSATIVE F...amsjournal
Depression is a pathological state of the mind characterised lack of self-confidence and self-esteem. The
cause of depression is multi factorial and various physical, psychological, environmental and genetic
factors have been implicated in the causation of depression. Despite being a serious condition in all age
groups, depression is more common and significant in the geriatric population as it is associated with
significant morbidity and mortality. Various scales have been developed to assess depression of which the
Geriatric Depression Scale is most suited for elderly population. It has a long form and short form, the
latter being more appropriate for elderly patients with dementia. In our study, we aim to analyse the
prevalence of depression among elderly patients visiting the outpatient departments of a tertiary care
hospital and determine the factors influencing depression in them. The study was an Observational cross sectional
study carried out on 51 elderly patients over the age of 60 years attending the various outpatient
departments of PSG Hospital. The Geriatric Depression Scale Short form was used to determine the
prevalence of depression. A self-designed questionnaire considering various factors causing depression
was administered to determine the factors influencing depression. It was found that among 51 elders in the
age group of 60 to 80 years, 58.8% were depressed of which 54% were males and 68% were females.
Financial fears regarding future and income insufficiency were the most important factors contributing to
depression. This shows that monetary fear is a major factor resulting in depression. The most effective
strategy to combat depression is to ensure appropriate self-report. The government and other organizations
must ensure that better support, both financial and other services like healthcare are provided to the
elderly in order to prevent depressive illnesses.
This document summarizes psychiatric disorders that are more prevalent in HIV-infected patients compared to the general population. It discusses how psychiatric illness can both increase the risk of HIV infection and negatively impact outcomes for HIV patients. Common psychiatric issues in HIV patients include depression, anxiety, substance abuse, and mania. Screening tools and treatment options are also reviewed.
DP due to CMD and suicidal behaviour_Rahman et al_2016Syed Rahman
This study examined the association between disability pension (DP) due to common mental disorders and subsequent suicidal behavior using data from Swedish nationwide registers. The study cohort included 46,515 individuals aged 19-64 who received a DP due to conditions like depression, anxiety or stress in 2005. The individuals were followed through 2010 to assess suicide attempts requiring hospitalization and completed suicides. The study found that having a main DP diagnosis of depression, or a secondary diagnosis of substance abuse or personality disorder, were risk factors for later suicidal behavior. Receiving a full-time versus part-time DP was also associated with increased suicide attempt risk in some groups. The results suggest certain DP diagnoses and characteristics may help identify those at higher risk of suicide who warrant
A Single Case Experiment For Cognitive-Behavioral Treatment Of Auditory Hallu...Richard Hogue
This document describes a single-case experiment that evaluated the impact of a new cognitive treatment for schizophrenia. The treatment integrated rational-emotive therapy and cognitive therapy for hallucinations and delusions. It was found to significantly reduce anxiety and depression, and increase quality of life and insight in a 37-year old female patient with schizophrenia. Gains were maintained at 3, 6, and 12 month follow-ups. The treatment shows promise for simultaneously targeting hallucinations and delusions.
This study examined psychiatric comorbidities and treatment outcomes in 100 mentally ill prisoners referred to a tertiary psychiatric hospital in India. The most common primary diagnoses were substance use disorder (45%) and adjustment disorder (36%). 46% of prisoners had more than one psychiatric diagnosis, most commonly intellectual disabilities, personality disorders, and substance use disorders. 59% were treated with medication alone, 27% required inpatient admission, and outcomes were generally positive with patients responding well to treatment. The high rates of comorbidities suggest the need for integrated treatment approaches within prison psychiatric services.
Greater levels of spirituality are associated with less severe depression. Patients reporting higher spirituality at baseline had lower scores on measures of hopelessness, dysfunctional attitudes, and depressive symptoms. Those who believed in God experienced greater decreases in depression, hopelessness, and dysfunctional thinking after 8 weeks of SSRI treatment compared to non-believers. Higher scores on a scale measuring spirituality correlated with greater improvements in depressive symptoms, hopelessness, and cognitive distortions following treatment. The findings suggest spirituality may enhance treatment outcomes for major depressive disorder.
This document provides an overview of psychosis in the elderly, including:
- Common causes are schizophrenia, affective disorders like depression, dementia, delirium, and Parkinson's disease.
- Biological factors underlie many psychotic symptoms. Antipsychotics are commonly used to treat psychosis but have risks.
- Psychosis is more prevalent in nursing home populations compared to community samples. As the population ages, cases of psychosis will rise significantly.
- Specific causes like Alzheimer's disease and depression are discussed in more detail, including their prevalence, clinical presentation, treatments and risks.
A CROSS-SECTIONAL STUDY ANALYSING THE LEVEL OF DEPRESSION AND ITS CAUSATIVE F...amsjournal
Depression is a pathological state of the mind characterised lack of self-confidence and self-esteem. The
cause of depression is multi factorial and various physical, psychological, environmental and genetic
factors have been implicated in the causation of depression. Despite being a serious condition in all age
groups, depression is more common and significant in the geriatric population as it is associated with
significant morbidity and mortality. Various scales have been developed to assess depression of which the
Geriatric Depression Scale is most suited for elderly population. It has a long form and short form, the
latter being more appropriate for elderly patients with dementia. In our study, we aim to analyse the
prevalence of depression among elderly patients visiting the outpatient departments of a tertiary care
hospital and determine the factors influencing depression in them. The study was an Observational cross sectional
study carried out on 51 elderly patients over the age of 60 years attending the various outpatient
departments of PSG Hospital. The Geriatric Depression Scale Short form was used to determine the
prevalence of depression. A self-designed questionnaire considering various factors causing depression
was administered to determine the factors influencing depression. It was found that among 51 elders in the
age group of 60 to 80 years, 58.8% were depressed of which 54% were males and 68% were females.
Financial fears regarding future and income insufficiency were the most important factors contributing to
depression. This shows that monetary fear is a major factor resulting in depression. The most effective
strategy to combat depression is to ensure appropriate self-report. The government and other organizations
must ensure that better support, both financial and other services like healthcare are provided to the
elderly in order to prevent depressive illnesses.
This document summarizes psychiatric disorders that are more prevalent in HIV-infected patients compared to the general population. It discusses how psychiatric illness can both increase the risk of HIV infection and negatively impact outcomes for HIV patients. Common psychiatric issues in HIV patients include depression, anxiety, substance abuse, and mania. Screening tools and treatment options are also reviewed.
This study aims to investigate whether cognitive remediation can improve cognitive and psychosocial function in patients at ultra-high risk (UHR) for psychosis. The FOCUS trial will enroll 126 UHR patients and randomly assign them to either cognitive remediation plus standard treatment, or standard treatment alone. The cognitive remediation involves 24 weekly group sessions and 12 individual sessions targeting neurocognition and social cognition. Outcomes will be assessed at 6 and 12 months and include cognition, functioning, symptoms, and rates of transition to psychosis. This is the first trial to evaluate the effects of comprehensive cognitive rehabilitation for UHR patients.
A Bayesian Framework for Diagnosing Depression Level of AdolescentsIIRindia
Depressive disorder is an illness that involves the body, mood and thoughts. It interferes with daily life, normal functioning and causes pain for both the person with the disorder and those who care about him/her. Severe depression may lead to serious illness or suicide. The most affected sector is the Adolescent Community. The biggest problem in diagnosing and treating depressive disorders is recognizing that someone is suffering from it. As various factors are involved, it is very difficult for the Psychologists to diagnose depressive disorders correctly at an early stage itself. Nowadays, computers are used in assisting Physicians to diagnose diseases and identify correct treatments according to the patient details. In the same way, computers can also be used in assisting psychologists to diagnose mental disorders and identify correct treatments according to the patient details. Various techniques are available to store the expert knowledge and computerize the diagnosis process. Bayesian Network is such a technique that combines statistics and expert knowledge to diagnose diseases effectively. This paper proposes a Framework for diagnosing depression level in adolescents using Bayesian Networks. Initially, Ontology should be constructed to provide a basis for Bayesian Networks. The ontology acts as the topology and shows the relationships between adolescent depression concepts. By applying probabilities to the relationships between concepts from the statistics, and by using Bayes Theorem, depression level of a patient can be diagnosed effectively. This framework may help novice psychologists to understand the domain concepts and also to diagnose the depression level and suggest correct treatments.
Literature Review- Major Depressive DisorderCooper Feild
This document provides a literature review on current research and perspectives regarding major depressive disorder (MDD). It summarizes research on the epidemiology, etiology, symptoms, and treatment of MDD. Regarding etiology, the document reviews research on anatomical, physiological, and genetic factors but notes the etiology is complex with no single cause identified. Treatment research indicates cognitive behavioral therapy can reduce relapse while incomplete recovery from initial episodes predicts a more severe long-term course. The review emphasizes the importance of fully understanding each patient's individual experience of MDD.
This study evaluated depression, anxiety, and stress in 111 patients with oral cancer using the DASS-21 questionnaire. Scores were highest for stress at diagnosis, depression one month after treatment and three months after discharge, but lowest for anxiety at all timepoints. Depression and stress scores significantly increased between diagnosis and three months after surgery, while anxiety scores were stable. The DASS-21 effectively evaluated stress. A positive correlation was found between DASS-21 and HADS questionnaire results. Psychological intervention is recommended to improve patient outcomes.
Obsessive compulsive disorder in adults assignment to turn in for gradeCASCHU3937
This document discusses obsessive compulsive disorder (OCD) in adults. It provides an overview of OCD, including its neurological and biological underpinnings such as involvement of cortico-striatal pathways and neurotransmitters like serotonin. Treatment options for OCD discussed include selective serotonin reuptake inhibitors (SSRIs), cognitive behavioral therapy (CBT), and emerging interventions like deep brain stimulation. The document concludes by discussing future directions for research on OCD including use of neuroimaging to predict treatment response and identify biological markers.
Fricchione psychosomatic medicine in mental healthjasonharlow
This document discusses the global burden of mental illness and the role that psychosomatic medicine can play in addressing it, particularly in Africa. It notes that mental disorders account for 13% of the global burden of disease and reviews strategies like integrating mental health treatment into primary care. Psychosomatic medicine is well-suited to contribute through its expertise in managing co-morbid medical and psychiatric conditions and working at the interface of different medical fields. The document argues that training consultation-liaison psychiatrists could help address Africa's lack of psychiatric resources and lack of treatment for co-occurring conditions.
Most people with dementia undergo behavioral changes during the course of the disease. They may become anxious or repeat the same question or activity over and over. The unpredictability of these changes can be stressful for caregivers. As the disease progresses, your loved one's behavior may seem inappropriate, childlike or impulsive. Anticipating behavioral changes and understanding the causes can help you deal with them more effectively.
Study of Depression and Role of Support Groups in Its Management among HIV/AI...paperpublications3
Abstract: The acquired immuno-deficiency syndrome (AIDS) is one of the most dreaded entities that modern medicine has ever had to tackle. Depression is the most frequently observed psychiatric disorder among HIV/AIDS patients. It interferes with all aspects of living and may have a severe negative impact on quality of life. An HIV positive diagnosis is a life changing event and may induce shock, a sense of helplessness, denial, and occasional self blame. Belonging to a support group may be of assistance in preventing depression. PLWHA should be advised to belong to a support group. To improve the role of support groups their sizes should be limited.
Methodology: Aim of the Study: To determine the prevalence of depression among HIV positives and to find out the role Support group in reduction of depression.
Study Setting & Design: A tertiary care hospital, and Positive networks, Cross sectional study.
Sample Size: Study constituted of 100 HIV positive patients, depression was assessed using BDI, The data was collected using a pretested semi structured preformed, after obtaining written informed consent.
Sampling Method: Random Sample
Statistical analysis: Data was be analyzed using SPSS version 11.5, statistical test ANOVA and CHI-SQUARE will be used and P less than 0.05 taken as significant.
Exclusion criteria: people below the age of 18 years and above 65 years patients, who are not given consent.
Study Duration: 6 Months
Data Collection: The data was collected using a BDI –Beck Depression Inventory Scale (annexure 1) The HIV positive subjects were invited to participate in the interview and those who presented for treatment, People were invited to participate in the interview and after obtaining a written informed consent the subjects were recruited in the study. The study details were explained to them that this procedure would not affect the scheduled times of their consultation. The interviews were conducted in medical consultation rooms by the investigator. Each interview lasted an average of 1 hour.
Results: The result showed was that statistically significant (p=0.002) depression among urban area.69.5% were depressed among primary education, 59.4% were depressed among 8-12, 100% were depressed those who are education above 12 standard. There is no statistically significant in education and depression.
62% were depressed daily waged, 61.1% were depressed among salaried, 83.3% were depressed among business, 84.6% were depressed among unemployed
There is no statistically significant depression based on their education.
Unmarried 100% were depressed, 67.3% married were depressed, 100% depressed among divorced, 100%were depressed among spouse, 64.1% were depressed among widowed. There is no statistically significant between depression and marital status.
This study examined risk factors for suicidal behavior in 46,745 individuals in Sweden who received disability pensions due to common mental disorders from 2005-2010. The researchers found that 1,046 (2.2%) individuals attempted suicide and 210 (0.4%) committed suicide during the follow-up period. Younger age, lower education, and living alone were associated with higher risks of suicide attempt and suicide. Having received inpatient mental health treatment or treatment for a prior suicide attempt from 2001-2005, as well as being prescribed both antidepressants and anxiolytics in 2005, were strongly linked to later suicide attempts and suicide. The researchers concluded that both socio-demographic characteristics and previous healthcare and medication history should be considered when
Depresi dan bunuh diri sebagai masalah kesehatan mental yang lazim untuk pasien hemodialisis. Tujuan: Para penulis meneliti faktor-faktor demografi dan psikologis yang terkait dengan depresi pada pasien hemodialisis dan dijelaskan hubungan antara depresi, kecemasan, kelelahan, kualitas kesehatan yang berhubungan hidup yang buruk, dan meningkatkan risiko bunuh diri.
This document discusses various screening instruments and scales used to assess migraines. It begins by providing an overview of migraines, noting they are underdiagnosed and undertreated. Several impact scales are described, including MIDAS for disability, HIT-6 for headache impact, and MSQ and EQ-5D for quality of life. Scales to evaluate comorbid psychiatric disorders like HADS, BDI, and PHQ-9 are also reviewed. The document stresses the importance of properly diagnosing and treating migraines and any comorbid conditions to improve outcomes and reduce the enormous indirect costs of migraines.
A PRACTICAL APPROACH TO PREDICTING DEPRESSION: VERBAL AND NON-VERBAL INSIGHTS...hiij
While global standards have been established for diagnosing depression, the reliance on expert judgement
and observation remains a challenge. This study delves into a potential approach of efficient data
collection to increase the practicability of machine learning models in accurately predicting depression
based on a comprehensive analysis of verbal and non-verbal cues exhibited by individuals.
This study examined the relationship between emotional intelligence (EI) and well-being in 73 surgical residents. The study found that EI scores positively correlated with psychological well-being and negatively correlated with burnout and depression. Regression analyses controlling for demographics found that EI strongly predicted well-being, emotional exhaustion, depersonalization, and depression among residents. The study concluded that EI is a strong predictor of resident well-being, and measuring EI could help identify residents most likely to thrive while interventions to increase EI may optimize resident wellness.
This document discusses a study on self-identification with major depressive disorder (MDD) among undergraduate college students. The study examined how exposure to diagnostic criteria and different patient accounts affected self-identification with MDD. Results showed those exposed to diagnostic criteria and an account of a clinically diagnosed patient were more likely to identify themselves as having MDD, compared to those exposed to other patient accounts or no additional information. The document provides background on rising internet use, depression prevalence among college students, and issues with primary care physicians prescribing antidepressants without oversight from mental health professionals. It argues proper diagnosis and long-term treatment are needed but often lacking.
Alero Okundia
Discussion Week 2
COLLAPSE
Beck Depression Inventory (BDI) is a psychological measure that is utilized to assess depression among clients over the age of 12. The tool is in the form of a questionnaire comprises of 21 questions. the BDI was developed in 1961. It has been revised several times, with the most recent version, BDI-II published in 1996, it is a self-reporting inventory (Smarr, 2019). Therefore, the answers to the 21 questions are provided by the client rather than being observed by the provider.
The development of BDI was established on the concept that an individual’s cognition leads to depression. According to this model, intrusive cognition can sustain a state of depression. For instance, a student who has negative thoughts about her appearance may end up depressed over issues such as weight, height, and appearance.
The BDI comprises 21, each representing various items (Smarr, 2019). These items are grouped into two major components. First is the somatic or physical component, which refers to physicals factors that depict the state of depression; examples include lack of appetite, tiredness and fatigue and changes in sleeping patterns (Smarr, 2019). Secondly the affective component. These refer to emotional aspects that describe the presence of a depression state. The affective components include pessimism, feelings of guilt, self-loathing and indecisiveness. These items are rated on a scale of 0 to 3 (Reis, et al., 2019). An item that represents a severe case of depression is given a score of 3 while cases that depict minimal evidence of depression are provided a score of 0.
Mental health providers and researchers mainly use BDI. The instrument is mainly useful in the clinical setting. Professional therapists utilize the BDI as a measurement for diagnosing depression (Smarr, 2019). BDI is also popular in the research field and widely used by scientists who study depression.
The device is also used in academia and workplaces to evaluate employees and students. In these settings, the BDI is administered by counselors and other paraprofessionals in the medical field to diagnose depression (Reis et al, 2019). The BDI measure is easily administered; however, a qualified provider is needed to interpret the outcome of the test, especially in items concerning self-harm and helplessness. Clients who are diagnosed with depression will be referred to a licensed mental health provider for treatment and therapy.
According to (Reis, et al. 2019), BDI has excellent psychometric properties as it has demonstrated high internal consistency, high validity, excellent construct, and test-retest reliability. However, the BDI system has limitations. The possibility of getting exaggerated results is one of the limitations that are associated with the BDI tool. Since the BDI measure is a self-inventory, there is a possibility of the client being evaluated, will give inaccurate information.
The second limitation the measures use ph.
This document discusses schizophrenia using a biopsychosocial model. It addresses evidence for brain localization in schizophrenia, genetic factors, and environmental factors. Schizophrenia is a disabling brain disorder affecting self and social functioning. Symptoms include hallucinations, delusions, and disorganized speech. Causes likely involve genetic and environmental factors. Treatment focuses on symptom management using medication and psychosocial support. Studies show common biological mechanisms between schizophrenia and depression. Research also provides preliminary evidence of brain localization and genetic risk factors for schizophrenia.
This systematic review and meta-analysis examines the evidence for the effectiveness of psychological interventions in reducing internalized stigma among adults with schizophrenia spectrum disorders. The review identified 27 studies that met eligibility criteria. Meta-analysis of 18 studies found a statistically significant overall effect in lowering internalized stigma. Subgroup analysis found Narrative Enhancement and Cognitive Therapy to have a statistically significant and highly homogenous effect. In conclusion, most psychological interventions are successful in reducing internalized stigma, especially NECT, and combining multiple therapies may be more beneficial.
Evolution of the diagnostic criteria for degenerative and cognitive disordersDario Yac
The diagnostic criteria for Alzheimer's disease have evolved over the past 25 years to incorporate biomarkers and define the disease from preclinical to dementia stages. Recent criteria proposed by the National Institute on Aging and Alzheimer's Association aim to provide a unified framework accounting for biomarkers to support clinical diagnosis. While biomarkers show Alzheimer's pathology may precede symptoms, the criteria caution about their validation and relationship to symptom onset is still unclear. The diagnostic process first determines if a patient meets criteria for dementia by showing impairments in memory and at least one other cognitive domain significantly impacting functioning.
The document outlines guidelines for the assessment, diagnosis, and treatment of dementia. It discusses evaluating patients through cognitive assessments, medical history and exams to diagnose dementia and rule out other conditions. It recommends non-pharmacological interventions as the primary treatment approach, including cognitive stimulation, physical activity, and psychosocial therapies. Medications are also discussed as options for symptom management, including acetylcholinesterase inhibitors and memantine, though none are considered curative.
Diagnosis and Management of Chronic pain associated with depression.pptxssuser40df77
Chronic pain and depression are often comorbid conditions that can mutually exacerbate one another through shared neural pathways and neuroplasticity changes in the brain. Approximately half of patients with depression report chronic pain, while 30-60% of individuals with chronic pain meet criteria for depression. Regions implicated in both chronic pain processing and mood regulation include the insular cortex, prefrontal cortex, anterior cingulate, thalamus, hippocampus and amygdala. Greater functional connectivity between the nucleus accumbens and prefrontal cortex in patients with sub-acute back pain has been found to predict transition to chronic pain. Effective treatment of depression may help alleviate chronic pain.
Mr. Bush, a 45-year-old middle school teacher arrives at the emergen.docxaudeleypearl
Mr. Bush, a 45-year-old middle school teacher arrives at the emergency department by EMS ground transport after he experienced severe mid-sternal chest pain at work. On arrival to the ED:
a. What priority interventions would you initiate?
b. What information would you require to definitively determine what was causing Mr. Bush’s chest pain?
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Movie Project Presentation Movie TroyInclude Architecture i.docxaudeleypearl
Movie Project Presentation: Movie: Troy
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This study evaluated depression, anxiety, and stress in 111 patients with oral cancer using the DASS-21 questionnaire. Scores were highest for stress at diagnosis, depression one month after treatment and three months after discharge, but lowest for anxiety at all timepoints. Depression and stress scores significantly increased between diagnosis and three months after surgery, while anxiety scores were stable. The DASS-21 effectively evaluated stress. A positive correlation was found between DASS-21 and HADS questionnaire results. Psychological intervention is recommended to improve patient outcomes.
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Fricchione psychosomatic medicine in mental healthjasonharlow
This document discusses the global burden of mental illness and the role that psychosomatic medicine can play in addressing it, particularly in Africa. It notes that mental disorders account for 13% of the global burden of disease and reviews strategies like integrating mental health treatment into primary care. Psychosomatic medicine is well-suited to contribute through its expertise in managing co-morbid medical and psychiatric conditions and working at the interface of different medical fields. The document argues that training consultation-liaison psychiatrists could help address Africa's lack of psychiatric resources and lack of treatment for co-occurring conditions.
Most people with dementia undergo behavioral changes during the course of the disease. They may become anxious or repeat the same question or activity over and over. The unpredictability of these changes can be stressful for caregivers. As the disease progresses, your loved one's behavior may seem inappropriate, childlike or impulsive. Anticipating behavioral changes and understanding the causes can help you deal with them more effectively.
Study of Depression and Role of Support Groups in Its Management among HIV/AI...paperpublications3
Abstract: The acquired immuno-deficiency syndrome (AIDS) is one of the most dreaded entities that modern medicine has ever had to tackle. Depression is the most frequently observed psychiatric disorder among HIV/AIDS patients. It interferes with all aspects of living and may have a severe negative impact on quality of life. An HIV positive diagnosis is a life changing event and may induce shock, a sense of helplessness, denial, and occasional self blame. Belonging to a support group may be of assistance in preventing depression. PLWHA should be advised to belong to a support group. To improve the role of support groups their sizes should be limited.
Methodology: Aim of the Study: To determine the prevalence of depression among HIV positives and to find out the role Support group in reduction of depression.
Study Setting & Design: A tertiary care hospital, and Positive networks, Cross sectional study.
Sample Size: Study constituted of 100 HIV positive patients, depression was assessed using BDI, The data was collected using a pretested semi structured preformed, after obtaining written informed consent.
Sampling Method: Random Sample
Statistical analysis: Data was be analyzed using SPSS version 11.5, statistical test ANOVA and CHI-SQUARE will be used and P less than 0.05 taken as significant.
Exclusion criteria: people below the age of 18 years and above 65 years patients, who are not given consent.
Study Duration: 6 Months
Data Collection: The data was collected using a BDI –Beck Depression Inventory Scale (annexure 1) The HIV positive subjects were invited to participate in the interview and those who presented for treatment, People were invited to participate in the interview and after obtaining a written informed consent the subjects were recruited in the study. The study details were explained to them that this procedure would not affect the scheduled times of their consultation. The interviews were conducted in medical consultation rooms by the investigator. Each interview lasted an average of 1 hour.
Results: The result showed was that statistically significant (p=0.002) depression among urban area.69.5% were depressed among primary education, 59.4% were depressed among 8-12, 100% were depressed those who are education above 12 standard. There is no statistically significant in education and depression.
62% were depressed daily waged, 61.1% were depressed among salaried, 83.3% were depressed among business, 84.6% were depressed among unemployed
There is no statistically significant depression based on their education.
Unmarried 100% were depressed, 67.3% married were depressed, 100% depressed among divorced, 100%were depressed among spouse, 64.1% were depressed among widowed. There is no statistically significant between depression and marital status.
This study examined risk factors for suicidal behavior in 46,745 individuals in Sweden who received disability pensions due to common mental disorders from 2005-2010. The researchers found that 1,046 (2.2%) individuals attempted suicide and 210 (0.4%) committed suicide during the follow-up period. Younger age, lower education, and living alone were associated with higher risks of suicide attempt and suicide. Having received inpatient mental health treatment or treatment for a prior suicide attempt from 2001-2005, as well as being prescribed both antidepressants and anxiolytics in 2005, were strongly linked to later suicide attempts and suicide. The researchers concluded that both socio-demographic characteristics and previous healthcare and medication history should be considered when
Depresi dan bunuh diri sebagai masalah kesehatan mental yang lazim untuk pasien hemodialisis. Tujuan: Para penulis meneliti faktor-faktor demografi dan psikologis yang terkait dengan depresi pada pasien hemodialisis dan dijelaskan hubungan antara depresi, kecemasan, kelelahan, kualitas kesehatan yang berhubungan hidup yang buruk, dan meningkatkan risiko bunuh diri.
This document discusses various screening instruments and scales used to assess migraines. It begins by providing an overview of migraines, noting they are underdiagnosed and undertreated. Several impact scales are described, including MIDAS for disability, HIT-6 for headache impact, and MSQ and EQ-5D for quality of life. Scales to evaluate comorbid psychiatric disorders like HADS, BDI, and PHQ-9 are also reviewed. The document stresses the importance of properly diagnosing and treating migraines and any comorbid conditions to improve outcomes and reduce the enormous indirect costs of migraines.
A PRACTICAL APPROACH TO PREDICTING DEPRESSION: VERBAL AND NON-VERBAL INSIGHTS...hiij
While global standards have been established for diagnosing depression, the reliance on expert judgement
and observation remains a challenge. This study delves into a potential approach of efficient data
collection to increase the practicability of machine learning models in accurately predicting depression
based on a comprehensive analysis of verbal and non-verbal cues exhibited by individuals.
This study examined the relationship between emotional intelligence (EI) and well-being in 73 surgical residents. The study found that EI scores positively correlated with psychological well-being and negatively correlated with burnout and depression. Regression analyses controlling for demographics found that EI strongly predicted well-being, emotional exhaustion, depersonalization, and depression among residents. The study concluded that EI is a strong predictor of resident well-being, and measuring EI could help identify residents most likely to thrive while interventions to increase EI may optimize resident wellness.
This document discusses a study on self-identification with major depressive disorder (MDD) among undergraduate college students. The study examined how exposure to diagnostic criteria and different patient accounts affected self-identification with MDD. Results showed those exposed to diagnostic criteria and an account of a clinically diagnosed patient were more likely to identify themselves as having MDD, compared to those exposed to other patient accounts or no additional information. The document provides background on rising internet use, depression prevalence among college students, and issues with primary care physicians prescribing antidepressants without oversight from mental health professionals. It argues proper diagnosis and long-term treatment are needed but often lacking.
Alero Okundia
Discussion Week 2
COLLAPSE
Beck Depression Inventory (BDI) is a psychological measure that is utilized to assess depression among clients over the age of 12. The tool is in the form of a questionnaire comprises of 21 questions. the BDI was developed in 1961. It has been revised several times, with the most recent version, BDI-II published in 1996, it is a self-reporting inventory (Smarr, 2019). Therefore, the answers to the 21 questions are provided by the client rather than being observed by the provider.
The development of BDI was established on the concept that an individual’s cognition leads to depression. According to this model, intrusive cognition can sustain a state of depression. For instance, a student who has negative thoughts about her appearance may end up depressed over issues such as weight, height, and appearance.
The BDI comprises 21, each representing various items (Smarr, 2019). These items are grouped into two major components. First is the somatic or physical component, which refers to physicals factors that depict the state of depression; examples include lack of appetite, tiredness and fatigue and changes in sleeping patterns (Smarr, 2019). Secondly the affective component. These refer to emotional aspects that describe the presence of a depression state. The affective components include pessimism, feelings of guilt, self-loathing and indecisiveness. These items are rated on a scale of 0 to 3 (Reis, et al., 2019). An item that represents a severe case of depression is given a score of 3 while cases that depict minimal evidence of depression are provided a score of 0.
Mental health providers and researchers mainly use BDI. The instrument is mainly useful in the clinical setting. Professional therapists utilize the BDI as a measurement for diagnosing depression (Smarr, 2019). BDI is also popular in the research field and widely used by scientists who study depression.
The device is also used in academia and workplaces to evaluate employees and students. In these settings, the BDI is administered by counselors and other paraprofessionals in the medical field to diagnose depression (Reis et al, 2019). The BDI measure is easily administered; however, a qualified provider is needed to interpret the outcome of the test, especially in items concerning self-harm and helplessness. Clients who are diagnosed with depression will be referred to a licensed mental health provider for treatment and therapy.
According to (Reis, et al. 2019), BDI has excellent psychometric properties as it has demonstrated high internal consistency, high validity, excellent construct, and test-retest reliability. However, the BDI system has limitations. The possibility of getting exaggerated results is one of the limitations that are associated with the BDI tool. Since the BDI measure is a self-inventory, there is a possibility of the client being evaluated, will give inaccurate information.
The second limitation the measures use ph.
This document discusses schizophrenia using a biopsychosocial model. It addresses evidence for brain localization in schizophrenia, genetic factors, and environmental factors. Schizophrenia is a disabling brain disorder affecting self and social functioning. Symptoms include hallucinations, delusions, and disorganized speech. Causes likely involve genetic and environmental factors. Treatment focuses on symptom management using medication and psychosocial support. Studies show common biological mechanisms between schizophrenia and depression. Research also provides preliminary evidence of brain localization and genetic risk factors for schizophrenia.
This systematic review and meta-analysis examines the evidence for the effectiveness of psychological interventions in reducing internalized stigma among adults with schizophrenia spectrum disorders. The review identified 27 studies that met eligibility criteria. Meta-analysis of 18 studies found a statistically significant overall effect in lowering internalized stigma. Subgroup analysis found Narrative Enhancement and Cognitive Therapy to have a statistically significant and highly homogenous effect. In conclusion, most psychological interventions are successful in reducing internalized stigma, especially NECT, and combining multiple therapies may be more beneficial.
Evolution of the diagnostic criteria for degenerative and cognitive disordersDario Yac
The diagnostic criteria for Alzheimer's disease have evolved over the past 25 years to incorporate biomarkers and define the disease from preclinical to dementia stages. Recent criteria proposed by the National Institute on Aging and Alzheimer's Association aim to provide a unified framework accounting for biomarkers to support clinical diagnosis. While biomarkers show Alzheimer's pathology may precede symptoms, the criteria caution about their validation and relationship to symptom onset is still unclear. The diagnostic process first determines if a patient meets criteria for dementia by showing impairments in memory and at least one other cognitive domain significantly impacting functioning.
The document outlines guidelines for the assessment, diagnosis, and treatment of dementia. It discusses evaluating patients through cognitive assessments, medical history and exams to diagnose dementia and rule out other conditions. It recommends non-pharmacological interventions as the primary treatment approach, including cognitive stimulation, physical activity, and psychosocial therapies. Medications are also discussed as options for symptom management, including acetylcholinesterase inhibitors and memantine, though none are considered curative.
Diagnosis and Management of Chronic pain associated with depression.pptxssuser40df77
Chronic pain and depression are often comorbid conditions that can mutually exacerbate one another through shared neural pathways and neuroplasticity changes in the brain. Approximately half of patients with depression report chronic pain, while 30-60% of individuals with chronic pain meet criteria for depression. Regions implicated in both chronic pain processing and mood regulation include the insular cortex, prefrontal cortex, anterior cingulate, thalamus, hippocampus and amygdala. Greater functional connectivity between the nucleus accumbens and prefrontal cortex in patients with sub-acute back pain has been found to predict transition to chronic pain. Effective treatment of depression may help alleviate chronic pain.
Similar to RESEARCH Open AccessA longitudinal study of anxiety andc.docx (20)
Mr. Bush, a 45-year-old middle school teacher arrives at the emergen.docxaudeleypearl
Mr. Bush, a 45-year-old middle school teacher arrives at the emergency department by EMS ground transport after he experienced severe mid-sternal chest pain at work. On arrival to the ED:
a. What priority interventions would you initiate?
b. What information would you require to definitively determine what was causing Mr. Bush’s chest pain?
.
Movie Project Presentation Movie TroyInclude Architecture i.docxaudeleypearl
Movie Project Presentation: Movie: Troy
Include: Architecture in the movie. Historical research to figure out if the movie did a good job of representing the art historical past of not. Anything in the movie that are related to art or art history. And provide its outline and bibliography (any website source is acceptable as well)
.
Motivation and Retention Discuss the specific strategies you pl.docxaudeleypearl
Motivation and Retention
Discuss the specific strategies you plan to use to motivate individuals from your priority
population to participate in your program and continue working on their behavior change.
You can refer to information you obtained from the Potential Participant Interviews. You
also can search the literature for strategies that have been successfully used in similar
situations; be sure to cite references in APA format.
.
Mother of the Year In recognition of superlative paren.docxaudeleypearl
The document discusses Facebook's decision in 2015 to change the "like" button on the platform. It describes how Chris Cox, Facebook's chief product officer, led discussions about overhauling the button. The like button had become a blunt tool, and Cox wanted to expand the range of emotions that users could express beyond just "liking" something. This would become the "Reactions" feature, allowing responses like love, haha, wow, sad, and angry. The change took over a year to develop and test before being publicly launched.
Mrs. G, a 55 year old Hispanic female, presents to the office for he.docxaudeleypearl
Mrs. G, a 55 year old Hispanic female, presents to the office for her annual exam. She reports that lately she has been very fatigued and just does not seem to have any energy. This has been occurring for 3 months. She is also gaining weight since menopause last year. She joined a gym and forces herself to go twice a week, where she walks on the treadmill at least 30 minutes but she has not lost any weight, in fact she has gained 3 pounds. She doesn’t understand what she is doing wrong. She states that exercise seems to make her even more hungry and thirsty, which is not helping her weight loss. She wants get a complete physical and to discuss why she is so tired and get some weight loss advice. She also states she thinks her bladder has fallen because she has to go to the bathroom more often, recently she is waking up twice a night to urinate and seems to be urinating more frequently during the day. This has been occurring for about 3 months too. This is irritating to her, but she is able to fall immediately back to sleep.
Current medications:
Tylenol 500 mg 2 tabs daily for knee pain. Daily multivitamin
PMH:
Has left knee arthritis. Had chick pox and mumps as a child. Vaccinations up to
date.
GYN hx:
G2 P1. 1 SAB, 1 living child, full term, wt 9lbs 2 oz. LMP 15months ago. No history of abnormal Pap smear.
FH:
parents alive, well, child alive, well. No siblings. Mother has HTN and father has high cholesterol.
SH:
works from home part time as a planning coordinator. Married. No tobacco history, 1-2 glasses wine on weekends. No illicit drug use
Allergies
: NKDA, allergic to cats and pollen. No latex allergy
Vital signs
: BP 129/80; pulse 76, regular; respiration 16, regular
Height 5’2.5”, weight 185 pounds
General:
obese female in no acute distress. Alert, oriented and cooperative.
Skin
: warm dry and intact. No lesions noted
HEENT:
head normocephalic. Hair thick and distribution throughout scalp. Eyes without exudate, sclera white. Wears contacts. Tympanic membranes gray and intact with light reflex noted. Pinna and tragus nontender. Nares patent without exudate. Oropharynx moist without erythema. Teeth in good repair, no cavities noted. Neck supple. Anterior cervical lymph nontender to palpation. No lymphadenopathy. Thyroid midline, small and firm without palpable masses.
CV
: S1 and S2 RRR without murmurs or rubs
Lungs
: Clear to auscultation bilaterally, respirations unlabored.
Abdomen
- soft, round, nontender with positive bowel sounds present; no organomegaly; no abdominal bruits. No CVAT.
Labwork:
CBC
:
WBC 6,000/mm3 Hgb 12.5 gm/dl Hct 41% RBC 4.6 million MCV 88 fl MCHC
34 g/dl RDW 13.8%
UA:
pH 5, SpGr 1.013, Leukocyte esterase negative, nitrites negative, 1+ glucose; small protein; negative for ketones
CMP:
Sodium 139
Potassium 4.3
Chloride 100
CO2 29
Glucose 95
BUN 12
Creatinine 0.7
GFR est non-AA 92 mL/min/1.73 GFR est AA 101 mL/min/1.73 Calcium 9.5
Total protein 7.6 Bilirubin, total 0.6 Alkaline.
Mr. Rivera is a 72-year-old patient with end stage COPD who is in th.docxaudeleypearl
Mr. Rivera is a 72-year-old patient with end stage COPD who is in the care of Hospice. He has a history of smoking, hypertension, obesity, and type 2 Diabetes. He is on Oxygen 2L per nasal cannula around the clock. His wife and 2 adult children help with his care. Develop a concept map for Mr. Rivera. Consider the patients Ethnic background (he and his family are from Mexico) and family dynamics. Please use the
concept map
form provided.
.
Mr. B, a 40-year-old avid long-distance runner previously in goo.docxaudeleypearl
Mr. B, a 40-year-old avid long-distance runner previously in good health, presented to his primary provider for a yearly physical examination, during which a suspicious-looking mole was noticed on the back of his left arm, just proximal to the elbow. He reported that he has had that mole for several years, but thinks that it may have gotten larger over the past two years. Mr. B reported that he has noticed itchiness in the area of this mole over the past few weeks. He had multiple other moles on his back, arms, and legs, none of which looked suspicious. Upon further questioning, Mr. B reported that his aunt died in her late forties of skin cancer, but he knew no other details about her illness. The patient is a computer programmer who spends most of the work week indoors. On weekends, however, he typically goes for a 5-mile run and spends much of his afternoons gardening. He has a light complexion, blonde hair, and reports that he sunburns easily but uses protective sunscreen only sporadically.
Physical exam revealed: Head, neck, thorax, and abdominal exams were normal, with the exception of a hard, enlarged, non-tender mass felt in the left axillary region. In addition, a 1.6 x 2.8 cm mole was noted on the dorsal upper left arm. The lesion had an appearance suggestive of a melanoma. It was surgically excised with 3 mm margins using a local anesthetic and sent to the pathology laboratory for histologic analysis. The biopsy came back Stage II melanoma.
1. How is Stage II melanoma treated and according to the research how effective is this treatment?
250 words.
.
Moving members of the organization through the change process ca.docxaudeleypearl
Moving members of the organization through the change process can be quite difficult. As leaders take on this challenge of shifting practice from the current state to the future, they face the obstacles of confidence and competence experienced by staff. Change leaders understand the importance of recognizing their moral purpose and helping others to do the same. Effective leaders foster moral purpose by building relationships, considering other’s perspectives, demonstrating respect, connecting others, and examining progress (Fullan & Quinn, 2016). For this Discussion, you will clarify your own moral perspective and how it will impact the elements of focusing direction.
To prepare:
· Review the Adams and Miskell article. Reflect on the measures taken in building capacity throughout the organization.
· Review Fullan and Quinn’s elements of Focusing Direction in Chapter 2. Reflect on aspects needed to build capacity as a leader.
· Analyze the two case examples used to illustrate focused direction in Chapter 2.
· Clarify your own moral purpose, combining your personal values, persistence, emotional intelligence, and resilience.
A brief summary clarifying your own moral imperative.
· Using the guiding questions in Chapter 2 on page 19, explain your moral imperative and how you can use your strengths to foster moral imperative in others.
· Based on Fullan’s information on change leadership, in which areas do you feel you have strong leadership skills? Which areas do you feel you need to continue to develop?
Learning Resources
Required Readings
Fullan, M., & Quinn, J. (2016).
Coherence: The right drivers in action for schools, districts, and systems
. Thousand Oaks, CA: Corwin.
Chapter 2, “Focusing Direction” (pp. 17–46)
Florian, L. (Ed.). (2014).
The SAGE handbook of special education
(2nd ed.). London, England: Sage Publications Ltd.
Chapter 23, “Researching Inclusive Classroom Practices: The Framework for Participation” (389–404)
Chapter 31, “Assessment for Learning and the Journey Towards Inclusion” (pp. 523–536)
Adams, C.M., & Miskell, R.C. (2016). Teacher trust in district administration: A promising line of inquiry. Journal of Leadership for Effective and Equitable Organizations, 1-32. DOI: 10.1177/0013161X1665220
Choi, J. H., Meisenheimer, J. M., McCart, A. B., & Sailor, W. (2016). Improving learning for all students through equity-based inclusive reform practices effectiveness of a fully integrated school-wide model on student reading and math achievement. Remedial and Special Education, doi:10.1177/0741932516644054
Sailor, W. S., & McCart, A. B. (2014). Stars in alignment. Research and Practice for Persons with Severe Disabilities, 39(1), 55-64. doi: 10.1177/1540796914534622
Required Media
Grand City Community
Laureate Education (Producer) (2016c).
Tracking data
[Video file]. Baltimore, MD: Author.
Go to the Grand City Community and click into
Grand City School District Administration Offices
. Revie.
Mr. Friend is acrime analystwith the SantaCruz, Califo.docxaudeleypearl
Mr. Friend is a
crime analyst
with the Santa
Cruz, California,
Police
Department.
Predictive Policing: Using Technology to Reduce Crime
By Zach Friend, M.P.P.
4/9/2013
Nationwide law enforcement agencies face the problem
of doing more with less. Departments slash budgets
and implement furloughs, while management struggles
to meet the public safety needs of the community. The
Santa Cruz, California, Police Department handles the
same issues with increasing property crimes and
service calls and diminishing staff. Unable to hire more
officers, the department searched for a nontraditional
solution.
In late 2010 researchers published a paper that the
department believed might hold the answer. They
proposed that it was possible to predict certain crimes,
much like scientists forecast earthquake aftershocks.
An “aftercrime” often follows an initial crime. The time and location of previous criminal activity helps to
determine future offenses. These researchers developed an algorithm (mathematical procedure) that
calculates future crime locations.1
Equalizing Resources
The Santa Cruz Police Department has 94 sworn officers and serves a population of 60,000. A
university, amusement park, and beach push the seasonal population to 150,000. Department personnel
contacted a Santa Clara University professor to apply the algorithm, hoping that leveraging technology
would improve their efforts. The police chief indicated that the department could not hire more officers.
He felt that the program could allocate dwindling resources more efficiently.
Santa Cruz police envisioned deploying officers by shift to the most targeted locations in the city. The
predictive policing model helped to alert officers to targeted locations in real time, a significant
improvement over traditional tactics.
Making it Work
The algorithm is a culmination of anthropological and criminological behavior research. It uses complex
mathematics to estimate crime and predict future hot spots. Researchers based these studies on
In Depth
Featured Articles
- IAFIS Identifies Suspect from 1978 Murder Case
- Predictive Policing: Using Technology to Reduce
Crime
- Legal Digest Part 1 - Part 2
Search Warrant Execution: When Does Detention Rise to
Custody?
- Perspective
Public Safety Consolidation: Does it Make Sense?
- Leadership Spotlight
Leadership Lessons from Home
Archive
- Web and Print
Departments
- Bulletin Notes - Bulletin Honors
- ViCAP Alerts - Unusual Weapons
- Bulletin Reports
Topics in the News
See previous LEB content on:
- Hostage Situations - Crisis Management
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About LEB
- History - Author Guidelines (pdf)
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Patch Call
Known locally as the
“Gateway to the Summit,”
which references the city’s
proximity to the Bechtel Family
National Scout Reserve. More
The patch of the Miamisburg,
Ohio, Police Department
prominently displays the city
seal surroun.
Mr. E is a pleasant, 70-year-old, black, maleSource Self, rel.docxaudeleypearl
Mr. E is a pleasant, 70-year-old, black, male
Source: Self, reliable source
Subjective:
Chief complaint:
“I urinate frequently.”
HPI:
Patient states that he has had an increase in urination for the past several years, which seems to be worsening over the past year. He estimates that he urinates clear/light yellow urine approximately every 1.5-2 hours while awake and is up 2-4 times at night to urinate. He states some urgency and hesitancy with urination and feeling of incomplete voiding. He denies any pain or blood. Denies any head trauma. Denies any increase in thirst or hunger. He denies any unintentional weight loss.
Allergies
: NKA
Current Mediations
:
Multivitamin, daily
Aspirin, 81 mg, daily
Olmesartan, 20 mg daily
Atorvastatin, 10 mg daily
Diphenhydramine, 50 mg, at night
Pertinent History:
Hypertension, hyperlipidemia, insomnia
Health Maintenance. Immunizations:
Immunizations up to date
Family History:
No cancer, cardiac, pulmonary or autoimmune disease in immediate family members
Social History:
Patient lives alone. He drinks one cup of caffeinated coffee each morning at the local diner. He denies any nicotine, alcohol or drug use.
ROS:
Incorporated into HPI
Objective:
VS
– BP: 118/68, HR: 86, RR: 16, Temp 97.6, oxygenation 100%, weight: 195 lbs, height: 70 inches.
Mr. E is alert, awake, oriented x 3. Patient is clean and dressed appropriate for age.
Cardiac: No cardiomegaly or thrills; regular rate and rhythm, no murmur or gallop
Respiratory: Clear to auscultation
Abdomen: Bowel sounds positive. Soft, nontender, nondistended, no hepatomegaly
Neuro: CN 2-12 intact
Renal/prostate: Prostate enlarged, non-tender. No asymmetry or nodules palpated
Labs:
Test Name
Result
Units
Reference Range
Color
Yellow
Yellow
Clarity
Clear
Clear
Bilirubin
Negative
Negative
Specific Gravity
1.011
1.003-1.030
Blood
Negative
Negative
pH
7.5
4.5-8.0
Nitrite
Negative
Negative
Leukocyte esterase
Negative
Negative
Glucose
Negative
mg/dL
Negative
Ketones
Negative
mg/dL
Negative
Protein
Negative
mg/dL
Negative
WBC
Negative
/hpf
Negative
RBC
Negative
/hpf
Negative
Lab
Pt’s Result
Range
Units
Sodium
137
136-145
mmol/L
Potassium
4.7
3.5-5.1
mmol/L
Chloride
102
98-107
mmol/L
CO2
30
21-32
mmol/L
Glucose
92
70-99
mg/dL
BUN
7
6-25
mg/dL
Creat
1.6
.8-1.3
mg/dL
GFR
50
>60
Calcium
9.6
8.2-10.2
mg/dL
Total Protein
8.0
6.4-8.2
g/dL
Albumin
4.5
3.2-4.7
g/dL
Bilirubin
1.1
<1.1
mg/dL
Alkaline Phosphatase
94
26-137
U/L
AST
25
0-37
U/L
ALT
55
15-65
U/L
Pt’s results
Normal Range
Units
WBC
9.9
3.4 - 10.8
x10E3/uL
RBC
4.0
3.77 - 5.28
x10E6/uL
Hemoglobin
11.5
11.1 - 15.9
g/dL
H.
Motor Milestones occur in a predictable developmental progression in.docxaudeleypearl
Motor Milestones occur in a predictable developmental progression in young children. They begin with reflexive movements that develop into voluntary movement patterns. For the motor milestone of independent walking, there are many precursor reflexes that must first integrate and beginning movement patterns that must be learned. Explain the motor progression of walking in a child, starting with the integration of primitive reflexes to the basic motor skills needed for a child to walk independently. Discuss at which time frame each milestone occurs from birth to walking (12-18 months of age). What are some reasons why a child could be delayed in walking? At what age is a child considered delayed in walking and in need of intervention? What interventions are available to children who are having difficulty walking? Please be sure to use APA citations for all sources used to formulate your answers.
.
Most women experience their closest friendships with those of th.docxaudeleypearl
Most women experience their closest friendships with those of the same sex. Men have suffered more of a stigma in terms of sharing deep bonds with other men. Open affection and connection is not actively encouraged among men. Recent changes in society might impact this, especially with the advent of the meterosexual male. “The meterosexual male is less interested in blood lines, traditions, family, class, gender, than in choosing who they want to be and who they want to be with” (Vernon, 2010, p. 204).
In this week’s reading material, the following philosophers discuss their views on this topic: Simone de Beauvoir, Thomas Aquinas, MacIntyre, Friedman, Hunt, and Foucault. Make sure to incorporate their views as you answer each discussion question. Think about how their views may be similar or different from your own. In at least 250 words total, please answer each of the following, drawing upon your reading materials and your personal insight:
To what extent do you think women still have a better opportunity to forge deeper friendships than men? What needs to change to level the friendship playing field for men, if anything?
How is the role of the meterosexual man helping to forge a new pathway for male friendships?
.
Most patients with mental health disorders are not aggressive. Howev.docxaudeleypearl
Most patients with mental health disorders are not aggressive. However, it is important for nurses to be able to know the signs and symptoms associated with the five phases of aggression, and to appropriately apply nursing interventions to assist in treating aggressive patients. Please read the case study below and answer the four questions related to it.
Aggression Case Study
Christopher, who is 14 years of age, was recently admitted to the hospital for schizophrenia. He has a history of aggressive behavior and states that the devil is telling him to kill all adults because they want to hurt him. Christopher has a history of recidivism and noncompliance with his medications. One day on the unit, the nurse observes Christopher displaying hypervigilant behaviors, pacing back and forth down the hallway, and speaking to himself under his breath. As the nurse runs over to Christopher to talk, he sees that his bedroom door is open and runs into his room and shuts the door. The nurse responds by attempting to open the door, but Christopher keeps pulling the door shut and tells the nurse that if the nurse comes in the room he will choke the nurse. The nurse responds by calling other staff to assist with the situation.
1. What phase of the aggression cycle is Christopher in at the beginning of this scenario? What phase is he in at the end the scenario? (State the evidence that supports your answers).
2. What interventions could have been implemented to prevent Christopher from escalating at the beginning of the scenario?
3. What interventions should the nurse take to deescalate the situation when Christopher is refusing to open his door?
4. If a restrictive intervention (restraint/seclusion) is used, what are some important steps for the nurse to remember?
SCHOLAR NURSING ARTICLE>>>APA FORMAT>>>
.
Most of our class readings and discussions to date have dealt wi.docxaudeleypearl
Most of our class readings and discussions to date have dealt with the issue of ethics and ethical behavior. Various philosophers have made contributions to jurisprudence including how to apply ethical principles (codes of conduct?) to ethical dilemma.
Your task is to watch the Netflix documentary ‘The Social Dilemma.’ If you cannot currently access Netflix it offers a free trial opportunity, which you can cancel after viewing the documentary. Should this not be an option for whatever reason, then please email me and we will create an alternative ethics question.
DUE DATE: Tuesday, Sept. 29, 2020 by noon
SEND YOUR NO MORE THAN 5 PAGE DOUBLE SPACED RESPONSE TO MY EMAIL ADDRESS. LATE PAPERS SUBJECT TO DOWNGRADING
As critics have written, the documentary showcases ways our minds are twisted and twirled by social media companies like Facebook, Twitter, and Google through their platforms and search engines, and the why of what they are doing, and what must be done to stop it.
After watching the movie, respond to the following questions in the order given. Use full sentences and paragraphs, and start off each section by stating the question you are answering. Be succinct.
What are the critical ethical issues identified?
What concerns are raised over the polarization of society and promulgation of fake news?
What is the “attention-extraction model” of software design and why worry?
What is “surveillance capitalism?”
Do you agree that social media warps your perceptions of reality?
Who has the power and control over these social media platforms – software designers, artificial intelligence (Ai), CEOs of media platforms, users, government?
Are social media platforms capable of self-regulation to address the political and ethical issues raised or not? If not, then should government regulate?
What other actions can be taken to address the basic concern of living in a world “…where no one believes what’s true.”
.
Most people agree we live in stressful times. Does stress and re.docxaudeleypearl
Stress may contribute to illness according to some research cited in textbooks. The question asks whether stress and reactions to stress can lead to health issues, and opinions should be supported by evidence from course materials. References in APA format are required.
Most of the ethical prescriptions of normative moral philosophy .docxaudeleypearl
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Moral psychologists and behavioral economists such as Jonathan Haidt and Dan Ariely take a different approach: focusing not on some normative ethical framework for moral judgment, but rather on the psychological foundations of moral intuition and on the limitations that our human frailty places on real-world honesty, decency, and ethical commitments.
In this context, write a short essay (minimum 400 words) on what you see as the most important differences between the traditional normative philosophical approaches and the more recent empirical approach of moral psychology when it comes to ethics. As part of your answer also make sure that you discuss the implications of these differences.
Deadline reminder:
this assignment is
due on June 14th
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Most healthcare organizations in the country are implementing qualit.docxaudeleypearl
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Thanks Uncle Sam!
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ISO/IEC 27001, ISO/IEC 42001, and GDPR: Best Practices for Implementation and...PECB
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RESEARCH Open AccessA longitudinal study of anxiety andc.docx
1. RESEARCH Open Access
A longitudinal study of anxiety and
cognitive decline in dementia with
Lewy bodies and Alzheimer’s disease
Monica H. Breitve1,2,3*, Minna J. Hynninen4,5, Kolbjørn
Brønnick6,12, Luiza J. Chwiszczuk1,3,7, Bjørn H. Auestad8,9,
Dag Aarsland10,11 and Arvid Rongve1,2,3
Abstract
Background: Anxiety in dementia is common but not well
studied. We studied the associations of anxiety
longitudinally in Alzheimer’s disease (AD) and dementia with
Lewy bodies (DLB).
Methods: In total, 194 patients with a first-time diagnosis of
dementia were included (n = 122 patients with
AD, n = 72 patients with DLB). Caregivers rated the patients’
anxiety using the Neuropsychiatric Inventory, and
self-reported anxiety was assessed with the anxiety and tension
items on the Montgomery–Åsberg Depression
Rating Scale. The Mini Mental State Examination was used to
assess cognitive outcome, and the Clinical
Dementia Rating (CDR)-Global and CDR boxes were used for
dementia severity. Linear mixed effects models
were used for longitudinal analysis.
Results: Neither in the total sample nor in AD or DLB was
caregiver-rated anxiety significantly associated with
cognitive decline or dementia severity over a 4-year period.
However, in patients with DLB, self-reported anxiety was
2. associated with a slower cognitive decline than in patients with
AD. No support was found for patients with DLB with
clinical anxiety having a faster decline than patients with DLB
without clinical anxiety. Over the course of 4 years, the
level of anxiety declined in DLB and increased in AD.
Conclusions: Anxiety does not seem to be an important factor
for the rate of cognitive decline or dementia severity
over time in patients with a first-time diagnosis of dementia.
Further research into anxiety in dementia is needed.
Keywords: Alzheimer’s disease, Dementia with Lewy bodies,
Dementia, Anxiety, BPSD, Longitudinal
Background
Anxiety in dementia is common but not well studied. To
our knowledge, no longitudinal studies of the associa-
tions between anxiety and cognitive decline have been
done to date. The prevalence of anxiety in dementia is
estimated to range from 25 % to 71 %, and generalized
anxiety disorder seems to be the most common anxiety dis-
order [1]. People with co-morbid dementia and anxiety have
more impairment in activities of daily living, reduced quality
of life and more frequent nursing home admission than
people with dementia [2–4]. They also use more health care
services [5], and anxiety is associated with poorer relation-
ships with caregivers and increased caregiver burden [6].
In elderly individuals with no dementia, both depres-
sion and anxiety have been shown to be early predictors
of future cognitive decline [7, 8], and a more rapid
progression in cognitive decline over time has been
suggested, although the data are not conclusive [7, 9].
The risk of developing Alzheimer’s disease (AD) may
be up to 30 times higher among persons with mild cogni-
4. http://creativecommons.org/licenses/by/4.0/
http://creativecommons.org/publicdomain/zero/1.0/
hypothesised in previous research [7, 12]. However,
others have reported that anxiety in elderly people is
not associated with increased risk of dementia or cognitive
decline [13, 14].
Few studies of anxiety in dementia with Lewy bodies
(DLB) have been done [15]. Ricci et al. [16] found that
anxiety was more common in patients with DLB than in
patients with AD, and this was later supported in a study
by our group [17]. Anxiety also is more common in
patients with DLB than in healthy control subjects and
is reported to be a risk factor for development of DLB
[18]. The severity of anxiety seems to be stable across
stages of dementia, except for a decrease at the terminal
stage [19, 20]. In a study of early-onset AD, the severity
of anxiety was increasing over 3 years, but the patients
were in different dementia severity stages at baseline [21].
Anxiety has overlapping symptoms with the dementia
disease itself, as well as with other behavioural and
psychological symptoms (BPSD) such as agitation and
depression. According to Seignourel et al. [19], there is
more support for that anxiety can be seen as a separate
clinical entity, and is distinctive from agitation. Depres-
sion and anxiety have a high co-morbidity rate in both
healthy elderly individuals and elderly persons with de-
mentia [17, 22]. Therefore, depression must be con-
trolled for to establish the independent contribution of
anxiety as a predictor of cognitive decline.
Identifying predictors of cognitive decline is important,
especially if an early intervention could reduce the speed
5. of cognitive decline, both in MCI and in dementia. We
investigated the association between anxiety and cognitive
decline during 4 years of follow-up in people with AD and
individuals with DLB.
Methods
Subjects
In total, 265 outpatients in clinics of old age psychiatry
and geriatric medicine in western Norway with a first-
time dementia diagnosis [Mini Mental State Examination
(MMSE) score >15] were recruited starting in 2005 and
followed annually. Patients with acute delirium or confu-
sion, terminal illness, or current or previous bipolar
disorder or psychotic disorder, or who were recently
diagnosed with a major somatic illness, were excluded
[23]. Follow-up examinations were conducted at the clinic
or in nursing homes. The study protocol was approved by
the Regional Committee for Medical and Health Research
Ethics in Western Norway. Written informed consent was
obtained from all participants in this study.
Measures
Dementia diagnosis
The diagnosis of dementia was based on criteria set
forth in the Diagnostic and Statistical Manual of Mental
Disorders, Fourth Edition. AD was diagnosed according
to the criteria of the National Institute of Neurological
and Communicative Disorders and Stroke/Alzheimer’s
Disease and Related Disorders Association [24]. DLB
was diagnosed according to the revised consensus cri-
teria [25]. For further information, see the publication by
Aarsland et al. [23]. Two independent raters made the
diagnoses, and so far the diagnosis has been neuropatho-
logically confirmed in 36 cases.
6. Assessment of anxiety and depression
Symptoms of anxiety were rated on the basis of informa-
tion obtained from a caregiver using Neuropsychiatric
Inventory (NPI) [26] subscale E (Anxiety). On the NPI,
symptoms are assessed for the previous 30 days, rating
frequency (score 1–4) and severity (score 1–3). Frequency
and severity are multiplied to obtain a sum score. A score
above 4 is generally seen as clinically significant [27] and
was used to identify DLB cases with clinical anxiety.
In the present study, both categorical (caseness, pres-
ence of clinically significant anxiety) and dimensional
scores were used.
Patients’ own perceptions of anxiety were measured
with the anxiety item on the Montgomery–Åsberg
Depression Rating Scale (MADRS) [28]. The MADRS
items are rated from 0 to 6. The anxiety item (item 3)
addresses “feelings of ill-defined discomfort, edginess,
inner turmoil, mental tension mounting to either panic,
dread or anguish” during the previous 3 days. Ratings of
the MADRS and the NPI were conducted independently.
Caregiver-rated depression was measured with NPI
subscale D (Depression), and self-reported depression
was measured using MADRS.
Cognitive screening and dementia severity rating
The outcome measure—progression of dementia—was
measured using two scales. The MMSE [29] is a brief
test used to screen for cognitive impairment. The Clinical
Dementia Rating (CDR) [30] is used to assess the severity
of dementia on a scale from 0 to 3 (CDR-Global). The
CDR scale also comprises six cognitive and practical do-
mains (CDR boxes): Memory, Orientation, Judgement and
Problem-Solving, Community Affairs, Home and Hobbies,
and Personal Care.
7. Statistical analyses
Statistical analyses were performed using IBM SPSS 22.0
software (IBM, Armonk, NY, USA) and the R statistical
software package [31]. Differences between AD and DLB
at baseline were analysed with Mann–Whitney U tests
because the variables were not normally distributed, and
by Pearson χ2 tests for categorical data. Longitudinal
analysis was done with linear mixed effects models using
MMSE and CDR as dependent variables. For some
Breitve et al. Alzheimer's Research & Therapy (2016) 8:3 Page
2 of 6
outcomes, models with both random intercept and slope
were used; for others, random intercept was sufficient
according to model fit criteria. For longitudinal analyses of
outcomes with very few categories, the different CDR
(box) scores, the assumption of a normally distributed
outcome poses a problem. To overcome this, we dichoto-
mized the CDR scores and employed mixed effects logistic
regression to analyse the probability of a CDR score of 2
or greater as a function of time, anxiety, depression and
possibly other covariates.
Results
Patients diagnosed with probable or possible AD (n = 122)
and DLB (n = 72) were included in the analysis (see
flowchart of study inclusion in Fig. 1). At baseline,
patients with AD and patients with DLB did not differ in
demographic and clinical variables, except that there were
more women in the AD group and higher NPI total score
in the DLB group (see Table 1).
We found no significant interaction between time
8. and anxiety—neither caregiver-rated nor self-reported
anxiety—on the MMSE, CDR-Global or CDR boxes.
There was no significant interaction between diagnostic
group, time and anxiety (caregiver-rated or self-reported)
on the MMSE, CDR-Global or CDR boxes, except for an
interaction between diagnostic group, time and MMSE for
self-reported anxiety (p = 0.039), even after controlling for
depression and/or total MADRS score, indicating that
anxiety in DLB was associated with a slower cognitive
decline than in AD.
There was no significant interaction in patients with
DLB between clinical significant anxiety at baseline and
time on the MMSE, CDR-Global or CDR boxes.
There was a significant interaction between diagnostic
group and time for caregiver-reported anxiety (p = 0.002).
Patients with DLB had a higher level of anxiety at baseline
than patients with AD, but the anxiety level was reduced
over time. This was contrary to patients with AD, among
whom the level of anxiety increased over time, adjusted
for CDR-Global and age (see Fig. 2). There was no signifi-
cant interaction between diagnostic group and time for
self-reported anxiety.
Discussion
In this longitudinal cohort study, we analysed the associ-
ation of anxiety and cognition over 4 years in people
with AD and individuals with DLB. We found no clear
indication that anxiety was associated with a faster
decline in cognition or dementia severity in either the
total sample or in DLB compared with AD, or between
patients with DLB with or without clinical anxiety. The
9. only observation was that anxiety in DLB was associated
with a slower cognitive decline than in AD.
The level of caregiver-reported anxiety was different
between patients with AD and patients with DLB over
time. During the observation period over 4 years, the
level of anxiety in patients with DLB was declining,
Fig. 1 Flowchart of patient inclusion in the study. AD
Alzheimer’s disease, DemVest Dementia Study of Western
Norway, DLB dementia with Lewy
bodies, FTD frontotemporal dementia, MCI mild cognitive
impairment, PDD Parkinson’s disease dementia, VaD vascular
dementia
Breitve et al. Alzheimer's Research & Therapy (2016) 8:3 Page
3 of 6
which was the opposite of an increasing anxiety level
in patients with AD. Self-reported anxiety was not
found to be different over time.
The observed decline of anxiety in DLB over time
could be due to treatment of anxiety-provoking halluci-
nations or to increased insight and learning how to
interpret the hallucinations as perceptual errors so that
they become pseudo-hallucinations.
Both psychological and biological mechanisms probably
cause the anxiety that occurs in patients with dementia.
Patients with dementia experience less coping in daily
living, lose overview and control, and might fear for the
future [19, 32]. In addition, atrophy and/or dysfunctions
in the limbic structures may make them less capable of
10. coping with fear and anxiety [18]. Higher levels of cortisol
due to stress can also cause hippocampal atrophy [11].
Furthermore, patients with MCI and anxiety have patho-
logical AD markers in the cerebrospinal fluid which are
not found in patients with depression and MCI, which
may also support a role of biological mechanisms [33].
Even though we did not find that anxiety was associated
with the rate of cognitive decline or dementia sever-
ity, it is important to focus on anxiety to avoid nega-
tive consequences for patients and their caregivers, as
mentioned above. In dementia care, anxiety should be
screened for and, when required, thoroughly mapped
before intervention.
Some limitations of our study should be noted. We
used NPI as the main anxiety measure, which is an
indirect way to measure anxiety via relatives or nurs-
ing home personnel. This is a commonly used and
validated measure in dementia research, but it may
not have satisfactory psychometric properties for
measuring anxiety [19]. In factor analysis of NPI, anx-
iety and depression often load on the same factor. A
majority of the studies have included only patients
with AD, and we found few published studies that
included patients with DLB or analysed them as a
subgroup [34, 35]. In our study, the correlations
between anxiety and other subtests from the NPI at
baseline were low, both in the total sample and in
AD and DLB, but in the longitudinal analysis we
controlled for depression to ensure that an observed
effect from anxiety was not due to a BPSD subsyndrome.
It has been recommended that, when studying anx-
iety in people with dementia, information should be
collected from multiple sources because the caregivers
11. can report verbalized or behavioural signs of anxiety
but not the internalized symptoms [19]. We therefore
used one item on MADRS to measure self-reported
anxiety, and it is based on the reliability of the patients’
answer. Bradford et al. [36] suggested that people with
mild to moderate dementia can give reliable self-reports
of anxiety symptoms, with validity comparable to reports
obtained from caregivers. In our sample, after 4 years,
34 % had a CDR score of 3, which indicates severe
Table 1 Participant characteristics at baseline
Characteristics Total (n = 194) AD (n = 122) DLB (n = 72) p
Value*
Age, yr (SD) 75.8 (7.6) 75.7 (7.8) 76.0 (7.3) 0.951
Women, n (%) 122 (62.9) 90 (73.6) 32 (44.4) <0.001
Education, yr (SD) 9.6 (2.9) 9.6 (3.0) 9.6 (2.9) 0.851
MMSE, mean (SD) 23.5 (2.7) 23.6 (2.3) 23.3 (3.1) 0.693
CDR-Global, median (IQR) 1.0 (0.5) 1.0 (0.5) 1.0 (0.5) 0.071
NPI anxiety, mean (SD) 1.8 (3.0) 1.5 (2.7) 2.2 (3.6) 0.197
NPI depression, mean (SD) 2.0 (2.6) 1.9 (2.5) 2.4 (2.7) 0.147
NPI total, mean (SD) 18.5 (17.3) 15.6 (16.0) 23.7 (18.2) 0.001
MADRS anxiety, median (IQR) 0 (2) 0 (2) 1 (2) 0.109
Clinically significant anxiety, % (median/IQR) 19.9 18.6 (6/4)
22.1 (8/8) 0.237
12. Non–clinically significant anxiety, % (median/IQR) 80.1 81.4
(0/0) 77.9 (0/1) 0.204
Abbreviations: AD Alzheimer’s disease, DLB Dementia with
Lewy bodies, MMSE Mini Mental State Examination, CDR
Clinical Dementia Rating, IQR interquartile
range, NPI Neuropsychiatric Inventory, MADRS Montgomery–
Åsberg Depression Rating Scale, SD standard deviation
*Differences between the AD and DLB groups were analysed
using the Mann-Whitney U test and Pearson’s χ2 test
Fig. 2 Anxiety as evaluated with the Neuropsychiatric Inventory
(NPI)
over the course of 4 years in patients with Alzheimer’s disease
(AD)
and patients with Lewy bodies (DLB)
Breitve et al. Alzheimer's Research & Therapy (2016) 8:3 Page
4 of 6
dementia and can challenge the reliability of the score. In
addition, assessing anxiety with only one item from a
depression scale is not optimal and limits the reliabil-
ity of the findings. Observations based only on this
score which are not in accordance with established
research should therefore be carefully weighed.
The MMSE and the CDR scale were used as out-
come measures. MMSE has been criticized for not
being able to adequately monitor cognitive decline in
pure DLB [37]. However, the MMSE was found to be
sensitive for cognitive changes in Parkinson’s disease,
which shares many features with DLB [38]. CDR is
designed for the phenotypes of AD, and less is
13. known about the psychometric properties when ad-
dressing DLB.
There were also missing data in our analysis, due both
to the inevitable facts that the dementia was progressing
and the patients were not able to participate in the
assessments, and also because of natural mortality
during follow-up. The most appropriate analysis, linear
mixed effects, was used to minimize this problem. There
is still a possibility that the null hypothesis was sup-
ported because of inadequate power. Unfortunately, the
dataset was not large enough to perform joint analysis.
The strengths of our study are that it include a
relatively large number of patients with DLB and that
they were followed annually until death. Patients were
included in the study according to the latest DLB
consortium criteria; they were thoroughly evaluated at
baseline; some also underwent ioflupane single-photon
emission computed tomography; and the diagnosis of
the patients was revised after 2 and 5 years by an
expert panel. Post-mortem autopsies of 36 patients to
date have confirmed the clinical diagnosis, with the
exception of two false-positive cases and one false-
negative case for DLB.
Conclusions
In this study, anxiety was not associated with the dementia
progression rate in AD or DLB. Anxiety gradually de-
creased over 4 years in DLB but gradually increased in
AD. More studies are needed.
Abbreviations
AD: Alzheimer’s disease; BPSD: behavioural and psychological
symptoms;
CDR: Clinical Dementia Rating; DemVest: Dementia Study of
14. Western
Norway; DLB: dementia with Lewy bodies; FTD:
frontotemporal dementia;
IQR: interquartile range; MADRS: Montgomery–Åsberg
Depression Rating
Scale; MCI: mild cognitive impairment; MMSE: Mini Mental
State Examination;
NPI: Neuropsychiatric Inventory; PDD: Parkinson’s disease
dementia;
SD: Standard deviation; VaD: vascular dementia.
Competing interests
DA has received research support and honoraria from H.
Lundbeck, Novartis
Pharmaceuticals and GE Healthcare Life Sciences. The other
authors declare
that they have no competing interests.
Authors’ contributions
MHB participated in the data acquisition, made the hypothesis,
analysed and
interpreted data and drafted the manuscript. MJH made the
hypothesis,
analysed and interpreted data, and drafted the manuscript. BHA
performed
longitudinal analysis, interpreted the results, wrote part of the
statistical
analysis and revised the manuscript. KB, LJC, DA and AR
contributed to the
hypothesis and interpretation of the analysis and revised the
manuscript.
All authors read and approved the final manuscript.
Acknowledgements
We thank the patients and their caregivers for participating in
the study.
15. Author details
1Department of Research and Innovation, Helse-Fonna HF
Haugesund
Hospital, Postbox 2170, 5504 Haugesund, Norway. 2Old Age
Department,
Clinic of Psychiatry, Helse-Fonna HF Haugesund Hospital,
Postbox 2170, 5504
Haugesund, Norway. 3Faculty of Medicine, University of
Bergen, Postbox
7804, 5020 Bergen, Norway. 4Department of Clinical
Psychology, University of
Bergen, Christies Gate 12, 5015 Bergen, Norway. 5NKS
Olaviken
Psychogeriatric Hospital, Ulriksdal 8, 5009 Bergen, Norway.
6TIPS – Centre for
Clinical Research in Psychosis, Stavanger University Hospital,
4011 Stavanger,
Norway. 7Neurological Department, Clinic of Medicine, Helse-
Fonna HF
Haugesund Hospital, Postbox 2170, 5504 Haugesund, Norway.
8Research
Department, Stavanger University Hospital, Stavanger, Norway.
9Department
of Mathematics and Natural Sciences, University of Stavanger,
4011
Stavanger, Norway. 10Centre for Age-Related Medicine,
Stavanger University
Hospital, Armauer Hansensvei 20, 4011 Stavanger, Norway.
11Division of
Neurogeriatrics, Department of Neurobiology, Care Sciences
and Society,
Centre for Alzheimer Research, Karolinska Institutet, 141 57
Huddinge,
Sweden. 12Network for Medical Sciences, University of
Stavanger, 4036
16. Stavanger, Norway.
Received: 7 September 2015 Accepted: 3 December 2015
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Instructions
Students will be assigned to small groups. Each group will be
assigned a group discussion board to complete the work for this
activity.
Each member of the group will select a journal article focused
on research related to your work or research interests.
(ATTACHED JOURNAL ARTICLE)
1. Outline the full article and summarize each section in 1-2
sentences.
24. 2. Considering what you know and have read about journal
articles, are there sections you might have included that have
been left out?
3. Why do you think these might have been left out?
4. What are one or two other things you might have changed
about or added to this article?
5. Write up a brief summary with the article reference as a
header and post it to your group discussion board under
Discussions in D2L.
6. Read your group members’ posts.
7. Each person will share their article critique, and then as a
group, discuss the feedback they would offer the author.
8. Point out the content you believed was missing, vague or
irrelevant as well as what you would have liked to learned from
the author.