Epidemiological studies of Alzheimer's disease and dementia are often two-phase studies including a screening phase and a clinical assessment phase. It is common to interview a relative of the subject at each of these phases to obtain information about the subject's exposure to risk factors. This can result in a misclassification error when assessing risk factors, as the two responses of the relative often differ. This is especially a problem for risk factors involving life-style and family history which cannot be confirmed using the subject's medical records. A naive analysis using data from each phase separately would give two different estimates of the odds ratio; both estimates could be biased. In this paper, we extend the estimation methods adjusting for misclassification developed by Liu and Liang to data collected through two-phase sampling. We first use a latent class analysis and the EM algorithm to estimate the misclassification parameters. We then derive the maximum pseudo-likelihood estimators, conditional on the misclassification parameters, to estimate the odds ratios accounting for the complex sampling study design. We propose to use the jack-knife estimator for estimation of the variances. We apply the above method to data collected in the Indianapolis-Ibadan Dementia Study to estimate the odds ratio for smoking adjusting for misclassification error.

Black or African American↗

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Data management in a longitudinal cross-cultural study.

The Indianapolis-Ibadan Dementia Project compares the rates of dementia at two sites, one in the U.S.A. and one in Nigeria. This paper concentrates on the data management issues in this longitudinal cross-cultural study. Approximately 2500 elderly people were recruited at each site, and continue to be re-assessed every two years. All the data are collected on paper and then entered into a FoxPro relational database. Most of the data management, including data cleaning, is done in Indianapolis. The design of the data collection forms is particularly important in a cross-cultural study, with the questions and the coding of responses clear and simple. Since Nigeria and the U.S.A. have different levels of technological development, the computer hardware and software were chosen to be suitable for use at either site. Exchange visits have been needed to address data management issues and resolve unexpected problems. The data management on cross-cultural studies can be handled successfully, given careful planning.

Black or African American↗

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Depression of elderly outpatients: primary care physicians' attitudes and practice patterns.

OBJECTIVE: To determine primary care physicians' attitudes and practice patterns concerning the diagnosis and treatment of depression in elderly outpatients. DESIGN: Survey of primary care physicians' attitudes using a 22-item questionnaire. Current practice patterns were identified from a computerized medical record system. SETTING: Academic primary care group practice at an urban ambulatory care clinic. PATIENTS/PARTICIPANTS: Thirty-five faculty general internists and 118 resident internal medicine physicians who had cared for 2,759 patients 65 years of age and older in the previous year. MEASUREMENTS AND MAIN RESULTS: Attitudes: Eighty percent of all physicians considered the diagnosis and treatment of depressed elderly patients to be their responsibility. Fifty-five percent of the internists felt confident in accurately diagnosing depression, and 35% felt confident in prescribing antidepressants for this population. Residents reported more difficulties in dealing with depressed elderly patients than did faculty. Practice patterns: Of patients greater than or equal to 65 years old, 8% were prescribed antidepressants, 5.4% had current diagnoses of depression, and 2% were seen for evaluation by psychiatry professionals. Age was negatively correlated with depression diagnosis, antidepressant drug use, and psychiatry evaluation. CONCLUSIONS: Internists in this primary care group practice accept responsibility for the treatment of depressed elderly patients but perceive their clinical skills as inadequate and are frustrated with their practice environment. Interventions aimed at improving the diagnosis and treatment of depressed elderly patients may be more effective if they are able to improve knowledge, attitudes, and the practice environment.

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Evaluation of multiple doses of milacemide in the treatment of senile dementia of the Alzheimer's type.

A multicenter, double-blind, placebo-controlled, parallel group study was conducted to assess the safety and efficacy of three doses of milacemide in the treatment of patients with senile dementia of the Alzheimer type of mild to moderate severity. Patients were randomly assigned to receive one of three dosages of milacemide (400, 800, or 1200 mg/day) or placebo for 4 weeks followed by a single-blind 4-week placebo period. One hundred forty-eight men and women older than 50 years of age were enrolled, and 129 patients completed the study. The differences among treatment groups were not statistically different with respect to total scores on the Alzheimer's Disease Assessment Scale or any items and subscales that were examined, nor were significant differences on the Clinical Global Impression Scale found. Clinically significant increases in liver function tests, specifically aspartate aminotransferase and alanine aminotransferase (AST and ALT), were reported for five of the patients receiving milacemide, requiring their withdrawal from the study.

Acetamides↗

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Caring for individuals with dementia: the Nigerian experience.

Recent epidemiological data, mainly from cross-cultural studies, have revealed that the burden of dementia and Alzheimer's disease (AD) the most common type, is significantly lower in developing than in the industrialized countries. Caring for individuals with dementia is a major consideration because most developing countries do not have the resources to provide comprehensive care in institutions. Home care that is practiced is ideal given the cultural scenario especially with the extended family support. Public policies on the care of the elderly however need to be well articulated and implemented. Hypertension was the most frequent medical co-morbidity of the demented subjects and about a third of subjects with AD were hypertensive, which may support vascular hypothesis in AD pathogenesis. The important behavioural disturbances experienced by caregivers and the associated stress levels were highlighted. The model used on the Indianapolis-Ibadan Dementia Study which involves periodic home visits, and empowerment of caregivers through regular meetings is envisaged to make caring for these individuals easier and adaptable in other African communities.

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Morbidity pattern in a sample of elderly Nigerians resident in Idikan community, Ibadan.

We documented the pattern of medical illnesses in 613 elderly Nigerians (398 females and 215 males) resident in Idikan community in Ibadan city. Their ages ranged from 65 to 110 years with a mean of 76.2 years. Medical disorders diagnosed either singly or in combinations were diagnosed in 364 (59.4%) subjects and there was no gender association. Cardiovascular problems were the commonest and high blood pressure (27.8%) was the most frequent diagnosis. Only 5 of the hypertensive subjects were aware of that diagnosis and were on regular medications. The complications presented with included heart failure and stroke. Visual impairment (12.1%) mainly due to cataracts and osteoarthritis (6.7%) in that order were next in frequency. The most frequent neurological disorders were hearing impairment and movement disorders. The other conditions encountered were similar to the findings in previous studies in this environment, and the usual findings in studies focusing on this age-group in other countries. The presence of morbidity was significantly associated with increasing age and poor performance on screening. The latter increased the probability of being selected for clinical examination with detection of medical problems or could suggest associated cognitive impairment. The prevalence of systemic hypertension was not different from findings in other communities in people of similar age groups. This study emphasises the role of hypertension as a major cause of morbidity in this community and stresses the need for increased health awareness especially with regards to regular checking of blood pressure so as to avoid complications.

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Foci of increased T2 signal intensity on brain MR scans of healthy elderly subjects.

Foci of increased T2 signal intensity were found on brain MR scans in 16 (59%) of 27 healthy elderly volunteer subjects, ages 63 to 86 years old. These foci were not related to cognitive function or cerebrovascular risk factors; instead, they were highly correlated to age, being present in 11 of 11 subjects aged 75 years and over.

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The CERAD Neuropsychological Test Battery: norms from a Yoruba-speaking Nigerian sample.

One-hundred normal, healthy, Yoruba-speaking Nigerian men and women aged 65 and above completed the Consortium to establish a Registry for Alzheimer's Disease-Neuropsychological Battery (CERAD-NB), a cognitive screening battery used in the evaluation of elderly patients with suspected dementia. Correlational analyses indicated pervasive education-influences on test performance. Gender-effects on the CERAD-NB were accounted for by education and there were essentially no age-effects. Education-stratified normative data are presented for all tests. Factor analysis revealed a one factor solution which accounted for 54.7% of the variance.

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The diagnosis of dementia associated with alcoholism: a preliminary report of a new approach.

The historical, clinical, neurological and neuropsychological features of 13 subjects with independently diagnosed dementia associated with alcoholism (AlcD) were compared to 13 subjects with probable Alzheimer's disease (AD), matched for age and severity of dementia. Neurological abnormalities were present in all the subjects with AlcD even though the diagnosis of Wernicke-Korsakoff was recorded in only one of these subjects. Only one subject with probable AD demonstrated any neurological abnormality. There was no difference between the AD and AlcD subjects in either the total scores of the Mini-Mental State Examination (MMSE) or in any of the subscores. The presence of neurological signs does appear to be a useful method to assist in the diagnosis of AlcD.

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