OBJECTIVE: To investigate the frequency and longitudinal course of symptoms of depression, agitation, and psychosis in a longitudinally studied sample of patients with Alzheimer's disease (AD).
...DESIGN: Longitudinal study of AD patients with follow‐up assessments at 6‐month intervals for an average of more than 3 years.
SETTING: Alzheimer's Disease Research Center of the Mount Sinai Medical Center and the Bronx VA Medical Center, New York.
PARTICIPANTS: A total of 153 AD patients.
MEASUREMENTS: Blessed Test of Information, Memory and Concentration (BIMC) and the Alzheimer's Disease Assessment Scale cognitive (ADAS‐Cog) and noncognitive (ADAS‐NC) subscales.
RESULTS: At entry into the study, more than 90% of patients had a behavioral disturbance that was rated as mild or worse on one of the 10 ADAS noncognitive items; and 40% had at least one rating that was moderate or severe. Correlational analyses indicated that, with the exception of the two mood‐related items, noncognitive symptoms on the ADAS were not highly correlated with one another. Only one of the noncognitive items, concentration, was strongly correlated with the severity of cognitive impairment. On average, patients showed progressively worse cognitive functioning over time as measured both by the ADAS‐Cog and the BIMC. The mean severity of noncognitive symptoms did not change during the course of a 5‐year follow up. The severity of behavioral disturbance at any one evaluation was negatively correlated with change in behavior during the next 6 months and was not correlated with cognitive decline.
CONCLUSION: Mild behavioral disturbances are common, whereas moderate to severe behavioral symptoms are less frequent in this population of AD patients. Disturbances in mood and manifestations of agitation and psychotic symptoms are not closely related to one another and show little progressive worsening over time. Rather, they tend to be episodic such that increasing severity at one time is usually followed by improvement later. Concentration problems are a manifestation of cognitive dysfunction rather than behavioral disturbance in AD. Implications of these results for treatment of noncognitive disturbances in AD are discussed. J Am Geriatr Soc 45:1331–1338, 1997.
Relational aggression is often perceived as a female issue. Less is known about relational aggression in adolescent boys. This study examines whether the issues associated with relational aggression ...in girls are similar for boys to determine whether an intervention designed for girls would be relevant for boys. Focus group discussions illustrate that boys engage in relational aggression and that it appears to be lined to maintaining power and status amongst their friendship groups. After the intervention the boys reported having a greater understanding of relational aggression, in particular the effects of exclusion. They reported that conflict resolution and managing anger were difficult for them to do. They admitted that some of the techniques might be useful, but were less sure about whether they would use them. They expressed a desire to explore anger management in more detail. It seemed the lessons were more suitable for the older boys as they had the developmental and intellectual capacity to engage with the topic. Implications and limitations of this study are discussed.
Two unilateral hypoxic-ischemia (HI) models (moderate and severe) in immature rat brain have been used to investigate the role of various transcription factors and related proteins in delayed ...neuronal death and survival. The moderate HI model results in an apoptotic-like neuronal death in selectively vulnerable regions of the brain while the more severe HI injury consistently produces widespread necrosis resulting in infarction, with some necrosis resistant cell populations showing evidence of an apoptotic type death. In susceptible regions undergoing an apoptotic-like death there was not only a prolonged induction of the immediate early genes, c-
jun, c-
fos and
nur77, but also of possible target genes amyloid precursor protein (APP
751) and CPP32. In contrast, increased levels of BDNF, phosphorylated CREB and PGHS-2 were found in cells resistant to the moderate HI insult suggesting that these proteins either alone or in combination may be of importance in the process of neuroprotection. An additional feature of both the moderate and severe brain insults was the rapid activation and/or proliferation of glial cells (microglia and astrocytes) in and around the site of damage. The glial response following HI was associated with an upregulation of both the CCAAT-enhancer binding protein α (microglia only) and NFκB transcription factors.
For many men with prostate cancer, androgen deprivation therapy (ADT) offers hope for controlling the disease and increasing life expectancy. The side effects of treatment, however, can leave you ...with unexpected physical and emotional changes. In this title, Richard Wassersug, who went through ADT himself and understands the difficulties, and a team of experts give you and your loved ones the tools you need to prepare for treatment and live well during and post-treatment.
In this article, the authors report on the evaluation of an anti-bullying programme, the cool school programme (CSP), conducted in a secondary school in Ireland. The study explored how participation ...in the anti-bullying programme affected students and teachers in one second-level school. The programme focused on students' faith in the teachers' ability to deal with bullying effectively, their willingness and confidence in telling a teacher about bullying and whether they felt safe in school. Teacher confidence and behaviour with regard to bullying were also explored. The study found that 91 per cent of students felt that teachers took bullying seriously. Eighty-nine per cent thought that teachers knew how to deal with bullying and 75 per cent felt able to tell a teacher if they were bullied. Eighty-seven per cent said there was a better atmosphere in their class. Ninety-three per cent of students felt safe in school. Seventy-two per cent of teachers reported greater confidence in their ability to manage bullying and 84% reported increased vigilance. Ninety-four per cent thought that students felt safer in the school. Sixty-nine per cent said there was a better atmosphere in the school. Most felt that the programme was now part of the school culture (94%) and would continue in the school (97%). The authors acknowledge that relying on reported levels of bullying may not give a complete picture of the impact of an anti-bullying intervention. They argue that researchers may need to take into consideration teacher approachability, challenging the culture of silence, responding appropriately and ensuring student safety in school when evaluating programmes.
