Clinical Rating Scale Research Articles

White matter free water mediates the associations between placental growth factor, white matter hyperintensities, and cognitive status.

Placental growth factor (PlGF) may regulate cerebrovascular permeability. We hypothesized that white matter interstitial fluid accumulation, estimated via magnetic resonance imaging (MRI) free water (FW), would explain the associations between elevated PlGF, white matter hyperintensities (WMH), and cognitive impairment. MarkVCID consortium participants ≥55 years old with plasma PlGF and brain MRI were included. We tested cross-sectionally whether FW mediated the associations between PlGF and WMH, or PlGF and cognition, measured using the Clinical Dementia Rating (CDR) scale and an executive function (EF) composite (Uniform Data Set version 3 [UDS3]-EF). For 370 participants (mean age 72), a higher PlGF was associated with higher FW, higher WMH, and higher CDR, but not UDS3-EF. Higher FW was associated with higher WMH, higher CDR, and lower UDS3-EF. FW explained 26% of the association between PlGF and CDR and 73% of the association between PlGF and WMH. Elevated PlGF may contribute to WMH and cognitive impairment through white matter FW accumulation. NCT06284213 HIGHLIGHTS: PlGF is a promising blood-based biomarker for vascular cognitive impairment. In MarkVCID, higher PlGF was associated with accumulated white matter FW on MRI. FW mediated the association between higher PlGF and MRI-visible white matter injury. FW mediated the association between PlGF and worse CDR scale. PlGF may contribute to cognitive dysfunction via accumulated interstitial fluid.

Validity and Reliability of the Turkish Version of General Practitioner Assessment of Cognition

ABSTRACT The General Practitioner Assessment of Cognition (GPCOG) was explicitly developed as a brief cognitive screening tool for general practitioners. It consists of a patient section testing cognition and an informant section asking historical questions. This study aimed to test the validity and reliability of the Turkish version of GPCOG-Tr on older Turkish adults. The study included two hundred thirty (n = 230) community-dwelling individuals aged at least 55. The GPCOG was translated, back-translated, and revised to determine the final GPCOG-Tr. The sample was divided into the patient group (with memory complaints) and the control group (without memory complaints). The GPCOG-Tr was compared against standard criteria for diagnosis of dementia (Diagnostic and Statistical Manual of Mental Disorders − 5th edition), the Clinical Dementia Rating scale, the Mini-mental State Examination, The Alzheimer’s Disease Assessment Scale-Cognitive (ADAS-Cog) subscale, and the Geriatric Depression Scale (GDS). The reliability test was done on 30 participants after two weeks. The two-stage method of administering the GPCOG-Tr had a sensitivity of 85%, a specificity of 92%, a misclassification rate of 11.3%, and a positive predictive value of 92%. The test-retest correlation coefficients ranged from 0.86 to 0.98. The GPCOG-Tr total was at least equivalent to the MMSE and ADAS-Cog in detecting dementia. The GPCOG-Tr displayed solid psychometric properties, offering the general practitioners an efficient cognitive instrument for older Turkish people.

Impact of the COVID-19 Pandemic on People with Dementia and their Caregivers: A Multiphase Observational Study from India.

The COVID-19 pandemic has had multifaceted and enduring impacts on people with dementia and their caregivers; however, our understanding of the long-term outcomes remains limited. We aimed to explore the long-term effects of the COVID-19 pandemic on cognitive symptoms and vaccination rates in people living with dementia. This study was conducted as a part of a longitudinal study design in two specialized hospitals in South India. In this study, patients with dementia and their caregivers assessed in earlier phases ('period of lockdown with phased relaxations - phase-I' and 'cluster of cases transmission phase - phase-II') were telephonically interviewed. We adopted a quantitative approach to understand disease progression during the three-year course of the pandemic. Changes in cognition and disease severity were measured using the Clinical Dementia Rating (CDR) scale. In brief, semistructured interviews were carried out with caregivers of people with dementia to gain insights into vaccination rates. Data obtained from the current study (phase III) were compared against phase I data, which served as the baseline. Among the 72 participants contacted in the current phase, 59 (81·9%) could be reevaluated for dementia severity and vaccination status, whereas 13 (18·0%) had died. Among the 59 participants, 33 (55·9%) had severe dementia (CDR 3). This is in contrast to phases I and II, when 17·6% and 19·2% of the participants, respectively, were classified as CDR 3. A significant difference in dementia severity between the two phases (phases I and III) was observed. In addition, we observed vaccination hesitancy among caregivers of patients with dementia. This study would provide valuable insights into the long-term impact of the COVID-19 pandemic on the cognitive outcomes and vaccination status of patients with dementia. This overall longitudinal study has compared dementia severity between different phases throughout the pandemic, with implications for future studies to tailor home-based support and healthcare interventions in order to meet these evolving needs.

Pain in Tourette Syndrome: A Comprehensive Review.

Objectives: Recent survey data suggest that a high proportion of patients with Tourette syndrome (TS) experience pain, yet pain features in TS have not been previously investigated in a systematic manner. This article reviews the current understanding and impact of pain in TS as well as identifies possible areas for emphasis for future research on pain in TS. Methods: Using a comprehensive search strategy in two relevant research databases (PubMed and Scopus), we searched for relevant peer-reviewed, primary research articles, and review articles. Search terms used were Tourette syndrome, tic disorder, pain, pain management, sensory, and sensory gating. Results: A total of 116 pertinent articles were identified. Pain is reported by 47%-60% of individuals with TS and may relate to different aspects of tic phenomenology or other causes. Pain is more prevalent among TS patients than in the general population and negatively impacts quality of life. To standardize future research efforts, we propose the following classification: tic-related immediate pain, tic-related delayed injury/pain, suppression-related pain, premonitory urge-related pain, and associated primary pain syndromes. Altered sensory gating and interoceptive processing abnormalities are possible mechanisms contributing to pain in TS but warrant further study. Despite pain prevalence, most TS clinical rating scales and outcome measures used in therapeutic studies do not incorporate sufficient information regarding pain. Therapies known to improve pain in non-TS conditions that are also reported to improve tics have not been investigated for their effects on pain among TS patients. Conclusion: TS can be associated with a chronic pain syndrome that negatively affects quality of life. Future research using a systematic framework is needed to better understand pain cause(s) and prevalence, develop appropriate assessment methods, establish outcome measures, and understand mechanisms of pain in TS. Such investigations are likely to lead to therapeutic options for this troublesome symptom.

Clinical Correlates of Antipsychotic Plasma Levels with Long-Acting Paliperidone: Corrélats cliniques des concentrations plasmiques de palipéridone à libération prolongée.

The majority of patients with schizophrenia experience dramatic improvement in psychotic symptoms when treated with antipsychotic medication. Maintenance treatment can prevent relapses but problems with medication adherence limit effectiveness. Long-acting injectable antipsychotics (LAIs) provide an opportunity to establish adherence but challenges remain in ensuring that the dose selected is therapeutic. Therapeutic drug monitoring has not been established as valuable for LAIs in the maintenance treatment of schizophrenia. This exploratory study was undertaken to describe plasma paliperidone levels in outpatients treated with the LAI paliperidone palmitate and to determine whether paliperidone levels are associated with subjective experience on medication and side effects. Twenty-one outpatients with schizophrenia receiving treatment with LAI paliperidone consented to participation in this study. Blood samples were obtained for measurement of paliperidone and prolactin levels at the first visit. A second paliperidone level was obtained at the time of the next injection for 18 of the participants. Clinical rating scales were administered at the first visit to assess illness severity, attitudes regarding medication, subjective well-being and side effects. Paliperidone levels were highly correlated at the two time points (ρ = .85; P < .001). Mean paliperidone level at the first visit was 34.9 ng/ml and ranged from 5.1 to 73.9 ng/ml. Higher paliperidone levels were correlated with higher prolactin levels (ρ = 0.59, P < .01) and lower sexual desire (ρ = -.58, P < .01). We demonstrated that paliperidone levels can be measured reliably in patients receiving LAI paliperidone. Higher plasma levels were associated with higher prolactin levels and reduced sexual desire but not with measures of subjective experience on medications or other side effects. Measurement of paliperidone levels in patients treated with paliperidone palmitate may have the potential to minimize the dose of medication prescribed and, in turn, the severity of sexual side effects.

"Quality over quantity:" smaller, targeted lesions optimize quality of life outcomes after MR-guided focused ultrasound thalamotomy for essential tremor.

MRI-guided focused ultrasound (MRgFUS) thalamotomy of the nucleus ventralis intermedius (VIM) has emerged as a powerful and safe treatment modality for refractory essential tremor. While the efficacy of this technique has been extensively described, much remains unclear about how to optimize MRgFUS for patient quality of life (QoL), which may depend as much on a patient's adverse effect profile as on the magnitude of tremor suppression. Diffusion tensor imaging (DTI) has been used to help guide targeting strategies but can pose certain challenges for scalability. In this study, we propose the use of a simplified patient-reported change in QoL assessment to create an unbiased representation of a patient's perception of overall benefit. Further, we propose a large-sample-size, high-resolution, 7 T DTI database from the Human Connectome Project to create a normative tractographic atlas (NTA) with representations of ventral intermediate nucleus subregions most likely to be structurally connected to the motor cortex. The NTA network-based hotspots are then nonlinearly fitted to each patient's T1-weighted MRI. We found that smaller lesion size and higher extent to which the lesion is within the NTA hotspot predicted patients' change in QoL at last follow-up. Though long-term change in clinical rating scale for tremor (CRST) impacted QoL, neither intraoperative tremor suppression nor the patient's long-term perception of tremor suppression correlated with QoL. We provide an intraoperative threshold for accumulated dose volume (<0.06 cc), which along with the network-based hotspot in the NTA, may facilitate an easily scalable approach to help limit treatment to small, safe yet effective lesions that optimize change in QoL after MRgFUS.

Patient-rated scales improve the classification accuracy for patients with depression and anxiety disorder: a linear discriminant analysis

BackgroundThe current study aimed to investigate the performances of clinical scales rated by clinicians and patients as well as cognitive function tests in distinguishing patients with affective and anxiety disorders from healthy controls (HCs).MethodsWe recruited a total of 122 subjects, comprising 24 patients with bipolar disorder (BD), 34 patients with major depressive disorder (MDD), 29 patients with anxiety disorder (AD), and 35 matched HCs. Three clinician-rated scales and five patient-rated scales were used to quantify clinical symptoms, while four cognitive tests were employed to measure cognitive functions in all subjects. Fisher’s discriminant analysis (FDA) was employed to distinguish patients from HCs, as well as to discriminate patient sub-groups from each other. In the FDA model, the prior probability of each group was set as 0.5 in the two-group classification and 0.25 in the four-group classification.ResultsThe results showed that patient-rated scales achieved higher classification accuracies than clinician-rated scales in identifying MDD and AD from HCs. In contrast, cognitive tests exhibited the lowest accuracy.ConclusionsThese findings suggest that patient-rated scales might improve the classification accuracy for patients with MDD and AD.

Efficacy of Cognitive Interventions in Mild Cognitive Impairment due to Alzheimer's Disease- An Open-Labelled Exploratory Analysis.

Efficacy data on nonpharmacotherapy-based interventions such as cognitive retraining and mindfulness meditation on improving neuropsychological functioning in early Alzheimer's disease (AD) are sparse in Indian literature. The objective of the study was to quantify the effect of cognitive retraining (CR) versus mindfulness training (MT) on neuropsychological test performance in patients with early AD. We administered CR and MT strategies in two prospectively enrolled groups of individuals (N = 34) who met the criteria for mild cognitive impairment (MCI) due to AD. Inclusion was based on patient choice and informed consent. One group of 20 patients was imparted supervised CR, and the other group included 14 patients who opted for MT as open-labeled interventions, with group allocation based on participant choice. Paired t test was performed with assessment of baseline and postintervention neuropsychological scores of CR and MT groups. The CR group revealed significant improvement on scores at 3 months (P < 0.05) for Addenbrooke's Cognitive Examination (ACE) subcomponents, particularly total score, memory, visuospatial, and language subscores as well as on Clinical Dementia Rating (CDR) scale. The MT group showed no significant differences on these tests post-intervention with a trend toward improvement on recall scores, and none of the other test scores demonstrated a declining trend. This proof-of-concept study demonstrated significant benefit of CR in improving neuropsychological test performance in patients with MCI due to AD and need to be studied in long-term, multicenter, randomized controlled trials in harmonized groups of patients with MCI and early AD.

A Simple Physical Examination Predicts Cognitive Decline in Very Mild Dementia.

Different exercises have different effects upon physical fitness and cognitive domains. In this context, physical fitness behaviors have been identified as a contributing factor to cognitive decline in patients with very mild dementia. The present study aimed to further determine baseline senior fitness behaviors in patients with very mild dementia and possible factors related to rapid cognitive decline. This prospective cohort study was performed in a medical center in Taiwan, involving 132 patients with very mild dementia who were followed-up over 1 year. Assessments included the Senior Fitness Test (physical function), Mini-Mental State Examination (MMSE), and Clinical Dementia Rating (CDR) Scale. Patients with a decline in MMSE of at least 2 points within 1 year were defined as having rapid cognitive decline. Age, sex, years of education, and baseline MMSE did not differ significantly between the groups (p > 0.05). At 1 year of follow-up, dietary habits and comorbidities did not differ between the rapid decline and not-rapid decline groups. At 1 year, performance on the right back scratch test was significantly better in the not-rapid decline group compared with the rapid decline group (-14 [-39-37.5] cm vs. -17 [-57-7] cm; p = 0.038). In a multiple regression analysis, the only factor that was significantly associated with rapid cognitive decline was the right back scratch test (p = 0.022). Despite the similarity in the status of dementia, the right hand back scratch test appears to serve an important function in detecting cognitive decline in patients with very mild dementia.

Preoperative Neurofilament Light Associated With Postoperative Delirium in Hip Fracture Repair Patients Without Dementia

Delirium commonly occurs in older adults following surgery; although its pathophysiology is not fully understood, underlying neurodegeneration is a risk factor. Examine the association of preoperative levels of markers of neuronal damage, neurofilament light (NfL) and phosphorylated tau (p-tau)181, with postoperative delirium. Preoperative CSF and plasma were obtained from 158 patients undergoing hip fracture repair and enrolled in the clinical trial "A STrategy to Reduce the Incidence of Postoperative Delirium in Elderly Patients" (STRIDE). Delirium diagnosis was adjudicated by a consensus panel. The association of plasma and CSF NfL and p-tau181 levels with delirium incidence and severity were examined for the overall cohort and for the subgroup (n=134) of patients without dementia. Patients who developed delirium were older, had lower Mini-Mental State Exam (MMSE) score, higher Clinical Dementia Rating (CDR) and Geriatric Depression Scale (GDS) scores at baseline; the overall incidence of delirium was 37.6% and 31.1% for the subgroup without dementia. Plasma and CSF p-tau181 levels were not associated with delirium incidence or severity. CSF NfL levels were significantly associated with delirium severity, but not with incidence in the overall cohort. In the subgroup of patients without dementia, CSF NfL levels were significantly associated with increased odds of delirium incidence (OR 4.74, 95% CI 1.21-18.59, p=0.03) adjusted for age, sex, and CDR. CSF NfL was significantly associated with delirium incidence and severity in patients without dementia undergoing hip fracture repair. Results confirm prior studies suggesting NfL as an important marker of delirium risk and supports an association between pre-existing axonal injury and delirium. These results highlight delirium vulnerability in older hip fracture patients, even when clinical dementia is not identified.

The Clinical Dementia Rating scale is useful but caution is needed.

The Clinical Dementia Rating scale is useful but caution is needed.

Changes in Clinical Competence of Novice Physical Therapists During Their First Year of Employment: A Single Center Retrospective Observational Study in Japan

Background and Objectives: This study aimed to examine the development of clinical competence of novice physical therapists (PTs) during their first year of employment, following the implementation of an original in-house educational program. The educational program was designed to offer diverse training opportunities at an early stage, during the first year of employment. Methods: Thirty-eight novice PTs (21 males and 17 females, mean age 23.4 ± 3.2 years) participated in this study. All participants underwent educational programs and a self-assessment using the Clinical Competence Evaluation Scale in Physical Therapy (CEPT) on the first day of employment (entry-level) and after 1, 3, 6, and 12 months of employment. The total score and CEPT component-wise scores—“knowledge,” “clinical reasoning,” “skill,” “communication,” “attitude,” “self-education,” and “self-management”—at the 4 assessment points (1, 3, 6, and 12 months) were compared with values on the first day. Results: The total scores at 3, 6, and 12 months of employment were significantly higher than those on the first day of employment (P &lt; .05). Among the total scores on the 7 components, those for “knowledge,” “clinical reasoning,” “skill,” and “communication” at 3, 6, and 12 months after employment were also significantly higher than those on the first day of employment (P &lt; .05). The scores for “attitude” and “self-education” 12 months after employment were significantly higher than those on the first day of employment. However, the “self-management” scores at 1, 3, 6, and 12 months after employment did not significantly change compared with those on the first day of employment. Conclusions: The total score was significantly higher after 3 months. The participant’s clinical competence may have improved because they participated in an educational program related to “knowledge,” “clinical reasoning,” “skills,” and “communication” at an earlier stage in the first year. However, their progress was comparatively slower in other areas, suggesting that the content might not have been sufficient. This study revealed the effectiveness of the educational program on novice PTs’ clinical competence at a single institution in Japan. Positive outcomes were obtained for several parameters. Furthermore, the results reveal the need for content modifications within the educational program to improve PTs’ performance across all evaluated items.

Tremor Severity and Operative Parameters Predict Imbalance in Patients Undergoing Focused Ultrasound Thalamotomy.

Imbalance is the most commonly reported side effect following focused ultrasound (FUS) thalamotomy for essential tremor (ET). It remains unknown which patients are more likely to develop imbalance following FUS treatment. To identify preoperative and treatment-related sonication parameters that are predictive of imbalance following FUS treatment. We retrospectively collected demographic data, preoperative Fahn-Tolosa-Marin Clinical Rating Scale for Tremor (FTM) scores and FUS treatment parameters in patients undergoing FUS thalamotomy for treatment of ET. The presence of imbalance was evaluated at several discrete time-points with up to 4 years of follow-up. Multiple machine learning classifiers were built and evaluated, aiming to maximize accuracy while minimizing feature set. Of the 297 patients identified, the presence of imbalance peaked at 1 week following operation at 79%. This declined rapidly with 29% reporting imbalance at 3 months, and only 15% at 4 years. At 1 week, total preoperative FTM scores and Maximum Energy delivered in FUS could predict the presence of imbalance at 92.8% accuracy. At 3 months, the total preoperative FTM scores and maximum power delivered could predict the presence of imbalance with 90.6% accuracy. Post-operative lesion size and extent into thalamic nuclei, internal capsule, and subthalamic regions were identified as likely key underlying drivers of these predictors. A machine learning model based on preoperative tremor scores and maximum energy/power delivered predicted the development of short-term imbalance and long-term imbalance following FUS thalamotomy.

Hypomanic symptoms in major depressive disorder: Prognostic impact and treatment issues

BackgroundMixed depression (MXD), defined as (hypo)manic symptoms occurring within major depressive episodes, is common in both bipolar and unipolar disorders, but its prognostic and treatment implications remain unclear. This study aimed to examine the relationship between hypomanic symptoms, treatment response and remission of suicidal thoughts. MethodsWe analyzed 1243 adults with major depressive disorder (MDD), recruited for a naturalistic study on treatment-resistant depression. Data were gathered cross-sectionally and retrospectively through structured interviews and clinical rating scales including the Young Mania Rating Scale (YMRS) and Montgomery-Asberg Depression Rating Scale (MADRS); statistical analyses were performed using univariate and multivariate methods. ResultsHypomanic symptoms were present in 651 patients (45 %), while 307 patients (25 %) responded to treatment. Both treatment responders (p < 0.0001) and those who achieved remission from suicide ideation (p = 0.0085) showed lower hypomanic (YMRS) scores. Multivariate analysis showed that hypomanic symptoms were negatively linked to treatment response (O.R. 0.71–0.87), while bipolar spectrum markers such as age at illness onset (O.R. 1.00–1.03) and MDD recurrence (O.R. 0.47–0.89) predicted remission from suicidal thoughts. Medications commonly used to treat bipolar disorder showed some benefits, with dopamine/serotonin antagonists improving suicide ideation (p < 0.0001) and mood stabilizers being associated with reduced hypomanic symptoms (p = 0.0003). LimitationsThe study lacked prospective clinical assessments and treatment randomization. ConclusionHypomanic symptoms are common in unipolar depression; their assessment is essential to identify challenging-to-treat cases and select the best pharmacological options.

Effects of Family Audio Recordings on Depression, Cognitive Function, and Sleep Quality of Individuals With Alzheimer's Disease: A Randomized Controlled Trial.

To explore the effects of family audio recordings on depression, cognitive function, and sleep quality among individuals with Alzheimer's disease in nursing homes. A randomized controlled study design was used, and 107 participants with Alzheimer's disease were stratified and randomly assigned to groups based on Clinical Dementia Rating Scale scores. The control group received usual care and health education, and the experimental group received usual care, health education, and a family audio recording intervention. The experimental group showed significantly lower depression scores compared to the control group post-intervention. A within-group comparison of sleep quality scores in the experimental group was significantly different. At post-intervention, cognitive function scores in the control group significantly decreased compared to before the intervention. Family audio recording interventions helped alleviate depression symptoms in individuals with Alzheimer's disease, improved their sleep quality, and delayed the progression of cognitive decline to some extent. [Journal of Gerontological Nursing, xx(x), xx-xx.].

Change in EEG-EMG synchronization reflecting abnormal functional corticomuscular coupling following stroke: A pilot study

Stroke is a common clinical cardiovascular and cerebrovascular disease, which can cause severe motor dysfunction. Therefore, it is an important topic to investigate the abnormality mechanism of the cerebral cortex and the corresponding muscles after stroke. In this study, we investigated the functional corticomuscular coupling (FCMC) at specific frequencies by analyzing differences between stroke patients and healthy controls in hand movements. The transfer spectral entropy (TSE) method was used to analyze simultaneous electroencephalography (EEG) and electromyography (EMG) in the right-hand steady state force task. The results illustrated that healthy subjects had the highest TSE values at the beta band in the EMG→EEG and EEG→EMG directions, and the TSE value in the EEG→EMG direction was higher than that in the EMG→EEG direction. In contrast, for stroke patients, beta band coupling was weakened, and there was a notably higher enhancement of alpha and gamma bands in the EMG→EEG direction relative to the EEG→EMG direction. Further analysis found significant correlations between TSE area values at beta2 and gamma2 bands and clinical rating scales. This study demonstrates the frequency specificity properties of FCMC estimated by TSE can assess the rehabilitation status of stroke patients and contribute to our comprehension of the potential mechanism of motor control systems.

Extended-Release Lithium Treatment for Adolescents with Bipolar Disorder with or Without Comorbid Autism Spectrum Disorder: Protocol of a Longitudinal Prospective Naturalistic Study for the Assessment of Efficacy and Tolerability.

Background: Lithium is the gold-standard treatment for Bipolar Disorder (BD) in both adults and adolescents, effectively managing mood episodes and reducing suicide risk. While its efficacy in neurotypical youth is well established, its use in adolescents with Autism Spectrum Disorder (ASD) and comorbid BD remains under-researched. Here, we present the protocol for a study aiming to evaluate the efficacy and tolerability of Extended-Release Lithium Salts in treating adolescents with BD and comorbid ASD compared to neurotypical BD patients. Methods: This longitudinal prospective naturalistic comparative study will enroll lithium-naïve adolescents aged 12-18 with BD, with or without comorbid ASD, from the Department of Child and Adolescent Psychiatry and Psychopharmacology. Participants will be followed for six months while receiving Extended-Release Lithium Salts treatment. Primary outcomes will include mood instability, suicidality, emotional dysregulation, and aggression, assessed through a range of clinical rating scales and diagnostic tools at baseline, three months, and six months. Secondary outcomes will focus on the safety and tolerability of Extended-Release Lithium Salts, with measures including side effect ratings, physical exams, and laboratory tests. Results: We hypothesize that Extended-Release Lithium Salts will demonstrate non-inferiority in treating BD symptoms in adolescents with comorbid ASD compared to those without ASD. Conclusions: This study is poised to fill a significant gap in the literature by providing critical data on the use of lithium for adolescents with BD and ASD. Findings will inform clinical practice and future research, potentially guiding more personalized treatment approaches for this complex and vulnerable population.

Measuring clinical outcomes in adult ADHD clinics: psychometrics of a new scale, the adult ADHD Clinical Outcome Scale.

Adult attention-deficit hyperactivity disorder (ADHD) clinics are in their infancy in Ireland and internationally. There is an urgent need for clinical evaluation of these services. Until now, clinical outcomes have relied mainly on functional scales and/or quality of life. However, adult ADHD is a longstanding disorder with many comorbidities. Although medication for ADHD symptoms can have immediate effects, co-occurring problems may take considerably longer to remediate. To present the psychometrics of a short outcome measure of key clinical areas including symptoms. The ADHD Clinical Outcome Scale (ACOS), developed by the authors, is a clinician-rated scale and was administered in consecutive adults attending an ADHD clinic. A modified version was completed by the participant. A second clinician independently administered the scale in a subsample. ACOS consists of 15 items rated on a Likert scale. Two self-report scales, the Adult ADHD Quality of Life Questionnaire (AAQoL) and Weiss Functional Impairment Rating Scale (WFIRS), were also administered. The mean age of 148 participants was 30.1 years (s.d. = 9.71), and 81 were female (54.7%). The correlation for interrater reliability was r = 0.868, and that between the participant and clinician versions was r = 0.663. The intraclass correlation coefficient for the internal consistency was 0.829, and the correlations for concurrent validity with total AAQoL and WFIRS scores were r = -0.573 and r = 0.477, respectively. Factor analysis revealed four factors: (a) attentional/organisational problems; (b) hyperactivity/impulsivity; (c) comorbidities; and (d) alcohol/drug use, self-harm and tension in relationships. The psychometrics of the ACOS are promising, and the inclusion of typically co-occurring clinical domains makes it suitable for use as a clinician-rated outcome measure in every contact with patients attending adult ADHD clinics.

Apathy, gait slowness, and executive dysfunction (AGED) triad: opportunities to predict and delay dementia onset.

This study investigates whether older adults diagnosed with the apathy, gait impairment, and executive dysfunction (AGED) triad, frequently associated with cerebrovascular disease and confounded with depression, have earlier dementia onset. We followed 322 community-dwelling older individuals (mean age 72.0 ± 6.4years; 58.3% women) free of dementia at baseline for up to 9years. The AGED triad was identified when gait slowness (< 1m/s), apathy (assessed by Geriatric Depression Scale-3A with ≥ 2 items), and executive dysfunction (assessed by the 75th percentile of Trail Making Test-part B by age range) were simultaneously present. Incident dementia was diagnosed using the clinical dementia rating scale. Over the 9-year follow-up (mean 45.1 ± 28.6months), 44 participants (13.6%) converted to dementia. Sixteen participants (5.0%) were diagnosed with AGED triad + and showed a significantly higher risk of earlier conversion to dementia compared with AGED triad- (hazard ratio = 5.08, 95%CI 2.16-11.97; p = 0.0001), as well as to those with only one AGED factor or fewer AGED factors. Hypertension and diabetes were 2 and 3 times more prevalent, respectively, in individuals with AGED triad + . These findings suggest that the AGED triad serves as a simplified and effective behavioral marker for accelerated progression to dementia.

Referral Sources Across Racial and Ethnic Groups at Alzheimer's Disease Research Centers.

Despite the need to increase engagement of underrepresented groups (URG) in Alzheimer's disease and related dementias (ADRD) studies, enrollment remains low. Compare referral sources across racial and ethnic groups among participants enrolled in ADRC studies. Data for this cross-sectional secondary analysis were extracted from the National Alzheimer's Coordinating Center Uniform Data Set. We performed mixed effects logistic regression models using generalized estimating equations for professional referral versus non-professional referral by racial and ethnic group, adjusted for age, gender, education, visit year, and Clinical Dementia Rating scale (CDR) with a random effect for study site. Included in the analysis were 48,330 participants across 46 ADRCs (mean [SD] age, 71.3 [10.5] years; 20,767 female [57%]; 4,138 Hispanic [8.6%]; 1,392 non-Hispanic Asian [2.9%]; 6,766 non-Hispanic Black [14%] individuals; and 676 individuals [1.4%] of other races. Non-Hispanic Black and Asian participants had lower odds of being referred by a professional contact compared to non-Hispanic White participants (Black: adjusted OR = 0.61, 95% CI = 0.44-0.86, p = 0.005; Asian: adjusted OR = 0.65, 95% CI, p = 0.004). In participants who had completed an MRI, there was no significant difference in referral source across ethnic and racial groups. Further studies are needed to better understand the systemic and structural factors that contribute to differences in referral sources and disparities in recruitment of URG into ADRD studies.