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UNDERGRADUATE
AMANDA BURDEN
Home Institution: University of Michigan
Major: Psychology
Email: aburden@umich.edu
Mentor(s): Patricia Arean, Ph.D.
Training Institution: University of California, San Francisco
Project Title: Late Life Depression And Life Reflection:
Developing A Measure To Examine The Relationships Among Life
Reflection, Therapist Response, And Patient Outcomes
Authors: Amanda Burden, Patricia Areán, Ph.D., Amber Gum, Ph.D.
Abstract: INTRODUCTION: Acceptance of the past is related to
less symptoms of depression (Rylands & Rickwood, 2001). Therapy with
older adults often involves some Life Reflection (LR; recall +
analysis of life events, Staudinger, 2001), but little is known about
the impact that active LR has on treatment response. To examine this
relationship, a new measure was needed to inventory both patient LR
emotions and therapist response. We hypothesized that (a) positive LR
emotions would be associated with less depression, (b) positive
therapist responses to LR content would predict greater improvement in
depression, and (c) LR emotions would shift from negative to more
positive emotions across sessions.
METHODS: To create the measure, we conducted literature review
and consulted with LR experts to identify categories for LR emotional
content and therapist reactions. Next, we rated 18 tapes (7 of Problem
Solving Therapy & 5 of Supportive Therapy) and collected depression
outcomes. We then ran frequencies, descriptive statistics, and
spearman rank correlations.
RESULTS: Total LR decreased across sessions, especially
negative LR emotions. Therapist reactions were overwhelmingly positive
across sessions. HDRS scores decreased across sessions, but did not
correlate with either LR emotions or therapist responses.
DISCUSSION: The results of this study suggest that our measure
of LR could be useful in future research on the impact of LR and
treatment response. Results indicate that the measure was sensitive to
patient LP and therapist reactions to LR over time. Although not
statistically significant, correlations between depression outcome and
LR were moderate in size, suggesting too little power to detect the
actual relationship.
LESLIE JORDAN
Home Institution: Sonoma State University
Major: Psychology
Email:
lesliejordan70@hotmail.com
Mentor(s): Laurie Lindamer, Ph.D.
Training Institution: University of California, San Diego
Project Title: Prevalence and Characteristics of Overweight and
Obesity in Older Adults with Mental Illness
Authors: Leslie Jordan, Hua Jin, M.D., Dilip V. Jeste, M.D.,
Laurie Lindamer, Ph.D.
Abstract: Obesity is a growing epidemic in the United States.
59% of the general population > age 40 are characterized as overweight
or obese (NHIS, 1998). There is growing recognition that persons with
mental illness are at a greater risk of being overweight or obese than
the general population, with the most evidence being among persons
with schizophrenia. To examine the prevalence of and the demographic
and clinical characteristics associated with overweight and obesity in
mentally ill older adults, data was obtained for 188 adults over age
40 participating in ongoing studies at UCSD. Body mass index (BMI) and
demographic variables were compared to the National Health Interview
Survey (NHIS) data from 1998. The results of data analyses indicate
that the prevalence of overweight and obesity is 71% in the sample
population and 84% in the sample of older adults with schizophrenia,
significantly higher than the general population data. The demographic
and clinical characteristics were not significant in determining BMI.
JENAY KARLSON
Home Institution: University of Michigan
Major: Psychology
Email: karlsonj@umich.edu
Mentor(s): Bruno Giordani, Ph.D.
Training Institution: University of Michigan Medical Center
Project Title: Cognition and Mobility Performance in Healthy
Old and Cognitively Impaired Individuals
Authors: Persad CC., Giordani B., Alexander N., Ashton-Miller
J., Guire K., Kemp J., Karlson J.
Abstract: To look at the effects of increasing cognitive
demands on mobility performance in both healthy and cognitively
impaired older adults, a walking version of the Trail Making test was
developed. In this task, participants were asked to walk along
pathways of instrumented markers that showed either numbers (as in
Trails A) or numbers and letters (as in Trails B) amongst other
distracters. Subjects were required to walk along the pathways by
stepping on a sequence of numbers or an alternating sequence of
numbers and letters, just as done in the standard Trails task. Time to
complete the task was recorded. In addition, all participants were
administered a short battery of neuropsychological tests. Currently, 8
healthy older adults (NC), 8 Mild Cognitive Impairment (MCI) and 8
patients with Alzheimer’s disease (AD) have been tested. Results
demonstrated that the AD impaired individuals have more difficulty on
the Trails B version of the walking trails task in comparison to the
healthy group. In addition, several neuropsychological measures were
significantly correlated with performance, and particular measured of
executive functioning were important. Consistent with earlier
findings, these results demonstrate the importance of cognitive
functioning to successful mobility performance.
MICHAEL KRAUS
Home Institution: University of California, Berkeley
Major: Psychology
Email: mwkraus@ucsd.edu
Mentor(s): Guerry Peavy, Ph.D.
Training Institution: University of California, San Diego ADRC
Project Title: Cognitive, Motor, and Behavioral Contributions to
Functional Decline in
Alzheimer's Disease and Dementia with Lewy Bodies
Authors: Michael Kraus, Joanne M. Hamilton, David P. Salmon, Guerry M.
Peavy
Abstract: The independent contributions of cognitive, motor, and
behavioral dysfunction to decline in activities of daily living (ADL)
were examined for two similar progressive dementia syndromes:
Alzheimer’s Disease (AD) and Dementia with Lewy Bodies (DLB). Data
from 34 autopsy-confirmed DLB patients and 34 autopsy-confirmed AD
patients were retrospectively examined for cognitive, motor, and
behavioral dysfunction and for impairment in physical ADL (PADL) and
instrumental ADL (IADL). Regression models predicting IADL were
significant for both AD and DLB patients, with cognitive dysfunction
accounting for significant variance for both AD and DLB patients and
motor dysfunction accounting for significant variance in DLB patients
only. Models predicting PADL were significant for AD patients only,
with cognitive and behavioral dysfunction accounting for significant
variance in AD patients only. These results suggest that AD patients
and DLB patients differ in the relative contributions of dysfunction
in each domain to decline in ADL. The failure of the regression model
to predict PADL decline in DLB patients suggests that other factors
such as visuospatial abilities may be relevant to decline in ADL.
NICHOLE KRYLA
Home Institution: University of California, Berkeley
Major: Psychology
Email:
nickry@uclink.berkeley.edu
Mentor(s): Ruth O'Hara, Ph.D.
Training Institution: Stanford University School of Medicine
Project Title: The Relationship of Apolipoprotein E Genotype to
Cortisol and DHEA in Alzheimer’s Patients
Authors: R O’Hara, Ph.D., N Kryla, T Miller, MD, S Hall, BA, J
Taylor, Ph.D., H Kraemer, Ph.D., JA Yesavage, M.D., A Schatzberg, MD,
J Tinklenberg, MD, G Murphy, MD, Ph.D.
Abstract: Objective: This study compared cortisol and
dehydroepiandrosterone (DHEA) levels in Alzheimer’s disease (AD)
patients with and without the Apolipoprotein (APOE) epsilon4 allele to
see if the e4 allele was associated with differential levels of the
two hormones.
Methods: Cross-sectional plasma measures of basal cortisol and
DHEA levels were compared in 75 AD patients with different frequencies
of the e4 allele.
Results: No significant difference in plasma cortisol levels were
observed among the non- e4, one e4, and two e4 groups. There was a
significant difference in the levels of plasma DHEA among the three
groups, with higher levels associated with the presence of the e4
allele in a dose-related fashion. When controlling for age, however,
this association was no longer observed.
Conclusion: We observed no significant moderating effect of
APOE genotype on the relationship between HPA axis measures of plasma
cortisol and DHEA and AD. Differences in levels of DHEA among groups
were likely due to age differences.
EMILY LAMPE
Home Institution: University of Michigan
Major: Neuroscience
Email: lampee@umich.edu
Mentor(s): Ruth O'Hara, Ph.D.
Training Institution: Stanford University School of Medicine
Project Title: The effects of Apolipoprotein e in depression
and rate of cognitive
decline
Authors: Emily Lampe, Ruth O'Hara, PhD and Jerome Yesavage, MD
PhD.
Abstract: I studied the relationship of elevated coritsol
levels and depression and how it impacted memory decline of elderly
patients. Past research has shown that depression has an effect on the
HPA axis which is believed to be associated with memory. The effects
of depression and high cortisol levels on this brain area combined
theoretically may increase the rate of cognitive decline. However,
when the cognition of depressed patients with high cortisol levels was
compared to the cognition of depressed patients with normal cortisol
levels there was no statistical difference.
ERIN WOODHEAD
Home Institution: Pennsylvania State University
Major: Human Development w Older Adult Focus
Email: elw151@psu.edu
Mentor(s): Silvia Sörensen, Ph.D. and Paul Duberstein, Ph.D.
Training Institution: University of Rochester
Project Title: Health and Social Network as Predictors of
Preparation for Future Care
Authors: Erin Woodhead and Silvia Sorensen, Ph.D.
Abstract: While at University of Rochester, I worked with Dr.
Silvia Sörensen on her research project regarding the types of plans
older adults (65+) make for their future care needs. Data collection
is ongoing, so I was trained to administer interviews to our
participants in their homes. In addition to looking at the types of
plans being made, Dr. Sörensen also investigates whether cognitive
skills, health, and family relationships are related to the types of
plans older adults make for their future care. My research project
focused on subjective health and social network closeness and
frequency of contact as predictors of both gathering information for
future care needs, and making concrete plans in regards to these care
needs. We used hierarchical multiple regression, and found that
subjective health significantly predicts gathering information, but
not making concrete plans. Closeness of social relationships was
significantly related to both gathering information and making
concrete plans, but frequency of contact was not related to either.
RADIN AUR
Home Institution: University of California, San Diego
Major: Biochemistry and Cell Biology
Email: raur@ucsd.edu
Mentor(s): Sonia Ancoli-Israel, Ph.D.
Training Institution: University of California, San Diego
Project Title: Daytime Sleepiness in Alzheimer’s Patients
Suffering SDB
Authors: Aur R, Greenfield, D., Ancoli-Israel S
Abstract: Introduction: Daytime sleepiness is prevalent in
patients with sleep disordered breathing (SDB)1,2. Previous studies
have shown that using Continuous Positive Airway Pressure (CPAP)
treatment successfully decreases daytime sleepiness in patients
suffering from SDB3. Also clear is that elderly patients with
Alzheimer’s Disease (AD) experience both daytime sleepiness and SDB4.
Since CPAP improves daytime sleepiness in patients with SDB, this
study examined the effect of CPAP on daytime sleepiness in elderly
patients with mild-moderate AD and SDB.
Methods: As part of a larger study, daytime sleepiness was
measured in thirteen elderly patients diagnosed with mild-moderate AD
and screened for SDB. Patients were randomized into either six-weeks
of real CPAP or three-weeks of sham CPAP followed by three-weeks of
real CPAP. The Epworth Sleepiness Scale (ESS) was used to determine
the patients’ level of daytime sleepiness. Subjects rated their
likelihood of falling asleep in different situations from 0-3 for a
total of 24 points. The excess daytime sleepiness (EDS) cut off was
set at 10. The ESS was administered at baseline, at three weeks and at
six weeks.
Results: Due to the small sample size a statistical analysis
could not be done. However, the total score on the ESS was reduced
from pre to post-CPAP treatment in the group receiving six-weeks of
CPAP. In addition, total score on ESS increased after three-weeks on
sham CPAP and decreased after three-weeks on real CPAP.
Conclusion: Although this is preliminary data and no
conclusions can be made at this point, the data suggest that treating
SDB in mild-moderate AD elderly patients may improve their daytime
sleepiness. These results indicate that with continual CPAP therapy,
daytime sleepiness and quality of life in this population might be
enhanced. Collection of further data will continue for statistical
examination and to help clarify the nature of the relationship between
daytime sleepiness and CPAP treatment in Alzheimer’s patients
suffering from SDB.
EMILY BELZ
Home Institution: John Carroll University
Major: Biology
Email: ebelz@jcu.edu,
ebelz15@yahoo.com
Mentor(s): Robert T. Rubin, M.D., Ph.D.
Training Institution: Allegheny Singer Research Institute,
Drexel University School of Medicine
Project Title: HPA Axis Responses to Cholinergic Stimulation±
Muscarinic Antagonist Pretreatment in Young and Aged Male and Female
Rats
Authors: Emily E. Belz, Brittany A. Fulton, Melissa
A. Moidel, Robert T. Rubin, R. Kenneth Czambel, Andrew
N. Miedel, Michael E. Rhodes
Abstract: Hypothalamic-pituitary-adrenal (HPA) axis
responsiveness to a variety of stimuli increases with age. The present
study determined HPA responses to the cholinesterase inhibitor
physostigmine (PHYSO), alone or following pretreatment with the
muscarinic antagonist scopolamine (SCOP). HPA measures were
adrenocorticotropic hormone (ACTH) and corticosterone (CORT).
Following PHYSO, aged rats had higher ACTH responses than did young
rats, and ACTH responses were higher in young males vs. females, but
lower in aged males vs. females. SCOP enhanced ACTH responses to PHYSO.
Following PHYSO, CORT responses were higher in young males vs. females
but not significantly different between aged males and females. SCOP
had no significant effect on CORT in any of the four groups, despite
its differential enhancement of ACTH responses.
These findings suggest an alteration in cholinergic regulation of the
HPA axis with aging that affects males and females differently. These
experiments provide a basis for designing muscarinic antagonist
pretreatment studies in elderly vs. young men and women.
CHRISTINE FRAUENHOFFER
Home Institution: University of Pennsylvania
Major: Health and Societies
Email:
csfrauen@sas.upenn.edu
Mentor(s): Joseph J. Gallo, M.D. MPH and Hillary Bogner, M.D.
Training Institution: University of Pennsylvania
Project Title: Using Mixed Methods to Understand the Sociocultural
Context of Adherence to Depression and Medical Treatments among Older
Primary Care Patients
Authors: Christine Frauenhoffer, Hillary Bogner, M.D., M.S.C.E, and
Joseph Gallo, M.D., M.P.H.
Abstract: BACKGROUND: Measuring, assessing, and predicting
patients' adherence to treatment remains a challenge for physicians.
We will examine the relationships between discrete patient
characteristics and self-reported adherence status in the primary care
setting.
METHODS: An age-stratified sample of 2,560 adults aged 65 years
and older was screened for depression at primary care practices in the
Baltimore, Maryland area. Three hundred fifty-five of the patients
participated in in-home interviews, which included additional
information about sociodemographic factors, physical functioning,
chronic medical conditions, use of medications and health services,
and attitudes about depression and its treatment. The survey
interviews will be balanced with a semi-structured interview for 160
racially diverse patients. The data from the standardized
questionnaire will guide the analysis of the in-home interviews. Using
this mixed methods approach, themes from both phases of the study will
be linked to each other and to information obtained about patients and
family members. Particular attention will be paid to the relationships
between sociodemographic factors, health behaviors, and feelings about
adherence to treatment for depression and chronic medical illness.
RESULTS: Upon completion of the 160 interviews, factors such as
age, gender, ethnicity, medical history, and health status will be
evaluated in relation to depression and medical treatment adherence.
DISCUSSION: The mixed methods design employs a comprehensive
approach to understanding how older adults' depression and medical
co-morbidities relate to each other and to treatment adherence. This
new perspective uses patient perceptions and feelings about depression
and medical illness to assist in designing more effective primary care
interventions.
CASEY PIERRE
Home Institution: University of Wisconsin-Madison
Major: Social Work
Mentor(s): Betty J. Kramer, PhD, MSSW
Training Institution: University of Wisconsin-Madison
Project Title: Challenges, Barriers, and Care Dilemmas at the
End-of-Life among Low-Income Elders with Advanced Chronic Disease:
Experiences of a Model Program
Authors: Betty J. Kramer, PhD, and Casey C. Pierre, BSW
Abstract: Inadequate care of the dying is emerging as a major
concern in the United States. Significant gaps exist in scientific
knowledge about end-of-life (EOL) care. Most research has focused on
persons receiving hospice care, persons in hospital settings, or
persons with cancer. This exploratory, descriptive study examined the
challenges to providing quality EOL care to low-income elders with
advanced chronic disease in an innovative, fully “integrated” managed
care program. Social workers from 11 interdisciplinary teams completed
120 surveys about deceased program participants regarding the
challenges to providing their care at the EOL. Four focus groups and
two in-depth interviews on care challenges were also conducted and
audiotaped. Open-ended survey responses and audiotapes were
transcribed verbatim and line by line analysis using constant
comparative methods were employed. Challenges, barriers, and care
dilemmas were reported in 89% of the surveys, and eight major themes
emerged to categorize them. The pervasive nature of complex challenges
even in a relatively rich resource environment suggests myriad
solutions and interventions with implications for practice,
professional education, research and policy. The need to infuse
palliative care throughout health care settings, and to train and
prepare providers to meet complex needs is fundamental to improving
care of low-income elders dying from advanced chronic disease and
their family members.
JONATHAN WEISS
Home Institution: Harvard University
Major: Psychology
Email:
weiss2@fas.harvard.edu
Mentor(s): Daniel L. Schacter, Ph.D.
Training Institution: Harvard University
Project Title: Reducing False Memories in Younger and Older
Adults: Distinctiveness
Heuristic or Criterion Shift?
Authors: Jonathan A. Weiss, David A. Gallo, Daniel L. Schacter
Abstract: Younger and older participants who study pictures exhibit
fewer false alarms on recognition memory tests than do participants
who study words (Schacter, Israel, & Racine, 1999). One explanation is
that participants who study pictures invoke the distinctiveness
heuristic (Dodson & Schacter, 2002), a retrieval mode in which
participants demand detailed recollections of test items before they
claim to recognize the items. An alternative explanation is that
participants who study pictures adopt more conservative decision
criteria than do participants who study words. In the present study,
we attempted to determine whether false recognition suppression
following pictorial encoding in younger and older adults is due to the
distinctiveness heuristic or to a criterion shift. We found that both
younger and older adults use the distinctiveness heuristic to suppress
false recognition and that both age groups use the heuristic equally
well. These results suggest that some memory monitoring processes may
not be impaired in old age.
REBECCA ZISSERSON
Home Institution: University of Pennsylvania
Major: Psychology and Biological Basis of Behavior
Email: rebeccaz@bu.edu
Mentor(s): David Oslin, MD
Training Institution: Department of Psychiatry, University of
Pennsylvania
Project Title: Relapse and Daily Affect Among Older Depressed
Alcohol Dependent Patients During Treatment
Authors: R.N. Zisserson, D.W. Oslin, T. Ten Have
Abstract: Objectives: Among the elderly, depression co-occurs
in patients with alcohol dependence at high rates. The interaction
between alcohol use and concurrent mental illness is complex. The aim
of this study was to explore the relationship between daily affect and
relapse to drinking among older adults in treatment for depression and
alcohol dependence. Methods: The sample consisted of 74 subjects age
55 or greater who met criteria for either independent major depression
or a substance induced major depression in combination with alcohol
dependence. All subjects were randomly assigned to 12 weeks of
naltrexone 50mg/day or placebo. In addiction, all subjects received
sertraline 100 mg/day and individual weekly psychosocial support.
Subjects were instructed to rate their daily affect every evening
using the Philadelphia Geriatric Center Positive and Negative Affect
Rating Scales. Outcomes for depression and alcohol consumption were
measured over 12 weeks. Results: There was no difference in the
average change in daily affect before compared with after relapse to
drinking. There was also no relationship between average change in
daily affect and the occurrence of a relapse. However, in some
individual cases there was evidence for a self medication effect (no
improvement in affect prior to relapse) and a harmful effect of
drinking (worsening of affect after a relapse). Discussion: Daily
prospective studies are important in exploring the relationship
between relapse to drinking and affect in order to improve treatments
and identify risk factors for depressed alcoholics in treatment. This
studied did not find relationship between change in slope of affect
and relapse. Further analyses of this data will examine changes in
affect in the 2-3 days immediately surrounding relapse events.
MEDICAL
KARIE DAHLGREN
Home Institution: University of Wisconsin Medical School
Major: Medicine
Email: kndahlgren@wisc.edu
Mentor(s): Lesley Blake, M.D.
Training Institution: Northwestern University
Project Title: Differences in Basal Cortisol Levels in a
Geriatric Psychiatry Inpatient Population
Authors: Karie Dahlgren and Lesley Blake, M.D.
Abstract: Dysregulation of the hypothalamic-pituitary-adrenal (HPA)
axis is a common finding among patients with psychiatric and
neurological disorders. The goal of this pilot study is to examine the
relationship between admission AM plasma cortisol levels and length of
stay in the hospital, amongst various DSM IV diagnoses in geriatric
patients. We conducted a retrospective chart review on 125 patients
that were at least 55 years old, and had been admitted to the
Northwestern Memorial Hospital geriatric psychiatric unit. The mean
cortisol level in patients with depression and psychosis was
significantly higher than patients with depression and dementia.
Length of stay did not depend on cortisol levels within or amongst the
various diagnostic groups. However, across the entire patient
population, negating diagnoses, there was a positive correlation
between length of stay and cortisol levels.
As expected, patients with depression with psychotic features had
significantly higher AM plasma cortisol levels than those with
depression with dementia. Recorded cortisol levels amongst other
discharge diagnoses had no significant relationship This is in
agreement with the literature, as there are conflicting results
comparing elevated cortisol levels between HPA axis disorders.
Continued recording and analysis is necessary to increase the sample
size, in order to further study potential effects of HPA axis
alterations of this patient population.
KRISTINA KURBANYAN
Home Institution: UCLA Medical School
Major: Medicine
Email: kkurbany@ucla.edu
Mentor(s): Helen Lavretsky, M.D.
Training Institution: University of California, Los Angeles
Project Title: Hormone Replacement Therapy And Sex Differences
In Brain Structure In Patients With Geriatric Depression
Authors: K Kurbanyan, H Lavretsky, D Pham, L Estanol, S Hwang,
R Blanton, A Toga, and A Kumar
Abstract: Geriatric depression is associated with structural
brain changes. Hormone Replacement Therapy (HRT) may lead to
improvement of depressive symptoms and cognition in postmenopausal
women. The reported effects of HRT on brain structure have been
inconsistent. We hypothesized that HRT would have beneficial effects
on mood, apathy, and brain volumes. Depressed elderly patients and
normal controls over age 60 were compared to examine the role of HRT
in sex-differences observed in medical comorbidity and structural
brain changes on magnetic resonance imaging (MRI). Neuropsychiatric,
laboratory, and physical examinations were performed, and measures of
medical burden (CIRS) and cerebrovascular risk factors (CVRF) were
obtained. Measures of total frontal lobe and frontal gray and white
matter volumes were obtained using MRI. In univariate analyses,
depressed patients were found to have smaller right and left frontal
and left frontal gray matter volumes than normal controls. In both
groups, men had more atrophy in frontal subregions compared to women.
In multivariate analyses, HRT was associated with less apathy in
depressed and control women compared to non-HRT women or men (p<0.03).
Evaluation of brain volumes revealed that non-HRT women in both
depressed and control groups had larger right frontal gray matter
volumes than HRT women or men (p<0.02). In conclusion, sex differences
may play an important role in clinical features and brain structure in
late-life depression, with men having greater susceptibility to
frontal and gray matter volume atrophy. HRT may improve mood and
apathy, and may lead to the reduction of frontal gray matter in
elderly women.
KATHERINE ELIZABETH GRECO
Home Institution: Emory University School of Medicine
Major: Medicine
Email:
kgreco@learnlink.emory.edu
Mentor(s): Larry E. Tune, M.D.
Training Institution: Wesley Woods Center of Emory University
Project Title: A retrospective study of the safety of
intramuscular ziprasidone in agitated elderly patients
Authors: K. Elizabeth Greco, BS; Larry E. Tune, MD; Frank W.
Brown, MD; William A. Van Horn, MD.
Abstract: Introduction: We examined the safety of IM
ziprasidone for agitation in elderly patients.
Methods: Medical records were examined for QTc intervals before
and after ziprasidone (n=23). Other medications were considered for
possible confounding. Cardiac events (torsades de pointes, arrest,
death) were recorded.
Results: There was no significant difference between QTc
intervals before and after ziprasidone. Some patients had QTc
prolongation and one required discontinuation of the medication (QTc=514ms).
One patient died but last received ziprasidone 4 days prior to death.
Conclusions: Preliminary results indicate that ziprasidone is
safe for use in elderly patients. Larger studies are needed in this
population, at risk for torsades de pointes because of age, comorbid
conditions and concomitant use of multiple medications.
KAREN MOORE GOLDSTEIN
Home Institution: Duke University School of Medicine
Major: Medicine
Email:
moore131@mc.duke.edu
Mentor(s): David Steffens, M.D. and Lori A. Bastian, M.D.
Training Institution: Duke University Medical Center
Project Title: Hormone Replacement Therapy and Depression
Severity in Older Women: Analysis of Baseline Data from the Improving
Mood-Promoting Access to Collaborative Treatment (IMPACT) Study
Authors: Goldstein KM, Harpole LH, Bastian LA, Stechuchak K,
Coffman C, Bosworth HB, Steffens DC.
Abstract: Depression in older adults is an important issue in
public health (Lebowitz et al., 1997). While estrogens are suspected
of having a beneficial effect on mood (Stoppe & Dören, 2002),
estrogen’s role in the etiology of and treatment for depression in
older women is unclear (Birkhauser, 2002; Meyers & Moline, 1997). This
paper reports the findings from analysis of baseline data from the
IMPACT study. Data from 1,168 women aged 60 years and older were used
to examine the relationship between Hormone Therapy (HT) use and
depression symptom severity. HT Users were significantly more likely
to be younger, Caucasian, married, have a higher income, and
have a higher degree of education. Women using HT reported
significantly more severe depression symptoms than did women not using
HT. Results from longitudinal analysis of IMPACT data should add more
information about effect of HT use on depression symptom severity in
older women.
GRADUATE
ELIZABETH CASTANEDA
Home Institution: University of Southern California
Major: Social Work
Email: ecastane@usc.edu
Mentor(s): Dilip V. Jeste, M.D. and Maureen Halpain, M.S.
Training Institution: University of California, San Diego
Project Title: Treated Prevalence of Serious Mental Illnesses
in San Diego County Public Mental Health System
Authors: Elizabeth Castañeda, Maureen Halpain, M.S., Laurie A.
Lindamer, Ph.D., Rebecca Daly, Shahrokh Golshan, Ph.D., Piadad Garcia,
Ed.D., John Shale, M.D., and Dilip V. Jeste, M.D.
Abstract: Mental Illness is a combination of multifaceted
factors that disables the lives of many Americans. Approximately, 44
million U.S. adults, based on a one-year period, have a diagnosable
disorder in any given year (Surgeon General Report, 1999; Robins and
Regier, 1991). Mental illness does not only affect and hinder the
lives of those with the illness it also plays an important role in the
lives of the caregivers and society as a whole.
In the late 1970’s the President’s Commission on Mental Health
identified several missing key factors in the area of American mental
health research and services. Such as, with the expected increase in
older adults as the baby boomers reach 65 years. As a result, over a
decade ago the National Institute of Mental Health (NIMH) started a
comprehensive report, which analyzed the prevalence rates of mental
disorders in the United States called the Epidemiological Catchments
Area Study (Robins and Regier, 1991). The objective of epidemiological
studies is to estimate the rate of illness in a defined population to
serve as a basis for understanding present disorders and untreated
cases that exist in a population (Robins and Regier, 1991). In
addition, the incidence rate of a disorder is instrumental for health
care professionals when conducting assessments and when new cases are
presented.
This is a descriptive study which examines the proportion of those 65
years and older, in the San Diego County Mental Health System, a
public-funded system, for schizophrenia, bipolar disorder, and major
depression. The purpose of this project was to describe the
characteristic of users of the San Diego County Mental Health System
by ethnicity and gender for schizophrenia, bipolar, and major
depression. Individuals diagnosed with either schizophrenia (n=7,220),
bipolar disorder (n=3,537), or major depression (n=8,838) during
1999-2000 fiscal year were analyzed. The three ethnic groups analyzed
were Whites, African-Americans, and Hispanics ages 18 and older. The
SANDAG 2000 Census for San Diego reported that adult Whites constitute
68% of the population compared to 75.1% of the US population.
African-Americans constitute 6% and Hispanics 26% of the San Diego
Census, compared to 12.3% and 12.5% of the US population,
respectively.
One-year prevalence rate in the SDCMHS for schizophrenia was 0.34%,
bipolar 0.20%, and major depression 0.45%. One-year prevalence rate in
the ECA study for Schizophrenia was 1.00%, bipolar disorder 1.00%, and
major depression 2.7%. When comparing the one year prevalence rates
for the SDCMHS database for diagnosis divided by the SANDAG 2000
Census for schizophrenia the results show 0.26% White, 0.06%
African-American, and 0.02% Hispanics. For bipolar the results
indicated that 0.17% were White, 0.02% were African-American, and
0.01% were Hispanics. However, the SANDAG 2000 Census reports that of
the total San Diego population 68% are White, 6% are African American,
and 26% are Hispanic.
Factors related to ethnicity and gender appear to influence mental
health diagnosis in a public system. Study limitations was the use of
the SDCMHS which is an administrative database. The SDCMHS does not
provide information in the case of multiple diagnosis as to which came
first. Therefore, a hierarchy diagnostic algorithm based on previous
literature was established; Schizophrenia = 1, Bipolar = 2, and Major
Depression =3
TONY DIPASQUALE
Home Institution: University of New Mexico
Major: Clinical Psychology
Email: tonyd@unm.edu
Mentor(s): Laura Roberts, M.D. and John Gluck, Ph.D.
Training Institution: Medical College of Wisconsin and
University of New Mexico School of Medicine
Project Title: Influence of Individual Values, Five-Factor
Personality Traits, and Coping Style on Choice of Treatment Among Men
with Newly Diagnosed Prostate Cancer: A Study Proposal
Authors: Tony DiPasquale, MS, John P. Gluck, Ph.D., & Laura
Roberts, M.D.
Abstract: Treatment of prostate cancer represents a major
emerging health problem for aging men. While it will strike a whopping
one of every six American men, 82% of those diagnosed will eventually
die from something other than prostate cancer. Patients are faced with
a dizzying array of choices during this time, such as whether to get
treated at all, and if they do get treated then with which of a number
of possibilities. None of the popular treatments have been proven
superior, and each has serious side effects. Relatively little is
known about how men under these circumstances choose their treatment.
The specific objectives of this exploratory study will be to determine
how treatment choice among New Mexican men recently diagnosed is
influenced by particular values, personality characteristics, and
decision-making style. This information can be used to improve
doctor-patient communication, by providing sound information and
responding to patients’ desired level of collaboration in decision
making, likely leading to improved patient satisfaction, psychological
functioning, treatment adherence, and recovery time.
GALI GOLDWASER
Home Institution: Colorado State University
Major: Counseling Psychology
Email:
ggold@lamar.colostate.edu
Mentor(s): Tom Patterson, Ph.D.
Training Institution: University of California, San Diego
Project Title: Functional Performance in Middle-aged and Older
Adult Hispanic and
Caucasian Schizophrenia Patients
Authors: Gali Goldwaser, B.A., Christine L. McKibbin, Ph.D.,
Sherrill R.
Goldman, M.A., & Thomas L. Patterson, Ph.D.
Abstract: Measures of functional skill in a middle-aged and
older adult population with psychosis are limited. More limited are
the functional measures designed to evaluate a Spanish-speaking
middle-aged and older adult population with schizophrenia or
schizoaffective disorder. The purpose of this study was to investigate
the psychometric validity of the UCSD Performance-based Skills
Assessment (UPSA), the Social Skills Performance Assessment (SSPA),
and the Medication Management Ability Assessment (MMAA) in a Hispanic
population. Fifty Hispanic and 44 Caucasians middle-aged and older
adult patients with schizophrenia or schizoaffective disorder were
administered the UPSA, SSPA, and MMAA. Measures of psychotic symptoms
were also administered. After controlling for age and severity of
symptoms, no differences were found between the Hispanic and Caucasian
performance. Differences were found in the financial and communication
domains of the UPSA. Results suggest that the UPSA has potential to be
a valid instrument and that the SSPA and the MMAA may be viable
instruments.
HELINE MIRZAKHANIAN
Home Institution: California State University, Los Angeles
Major: Psychology
Email: Heline23@aol.com
Mentor(s): Lisa Eyler Zorrilla, Ph.D.
Training Institution: University of California, San Diego
Project Title: A Study on Decisional Capacity: A Comparison
between Schizophrenia Patients and Healthy Controls
Authors: Heline Mirzakhanian, Lisa T. Eyler Zorrilla, Gregory
G. Brown & Dilip V. Jeste
Abstract: There has been much recent debate about capacity of
patients with mental illness to consent to treatment and research (NBAC
report, 1999; Oldham et al, 1999). However, not all studies used a
standardized method of assessing decisional capacity. Also, the
relationship of demographic variables such as age, gender, and
education to decisional capacity in healthy individuals and patients
has not been examined. The purpose of present study is to compare the
performance of schizophrenia patients and healthy controls on measures
of their ability to consent to a complex research study involving
magnetic resonance imaging and to examine demographic correlates of
decisional capacity with a particular focus on education, gender and
age. It is hypothesized that schizophrenia patients will have poorer
understanding of, appreciation for, and reasoning about a consent form
for a research study compared to healthy controls. Also, older age and
lower education will be associated with reduced decisional capacity,
but gender will not be related. Consent for a functional magnetic
resonance imaging (fMRI) study was presented using computerized slide
presentation with summaries and bulleted points. Decisional capacity
was assessed with MacArthur Competency Assessment Tool – Clinical
Research. Overall, healthy controls scored significantly higher on
each factor of the MacCAT-CR compared to schizophrenia patients.
Education level was significantly related to total understanding
scores in both patients and controls. Gender was also related to
understanding. Age was not related to any of the measures of
decisional capacity in either group.
ADRIANA COATES
Home Institution: University of Alabama
Major: Clinical Psychology
Email:
adriana.n.coates@ua.edu
Mentor(s): Forrest Scogin, Ph.D.
Training Institution: University of Alabama
Project Title: Behavioral Activation as a Treatment for
Geriatric Depression: The Development of a Treatment Manual and
Beginnings of a Case Study
Authors: Adriana Coates, B.S. & Forrest Scogin, Ph.D.
Abstract: Cognitive-behavior therapy (CBT) is an evidence-based
treatment for geriatric depression. The behavioral activation (BA)
component of CBT has been isolated as a treatment for depression.
Through BA, avoidance behaviors are challenged through activation of
goal-directed behavior. It is hypothesized that due to age-related
cognitive changes that occur in older populations, BA may be a
beneficial and simple way to treat geriatric depression. The goals of
the study were to evaluate the efficacy of BA in treating depression
in older adults and evaluate the ease of learning and administering BA
to participants. An AB design in combination with administration of
pre-treatment/post-treatment batteries were used. After 3 weeks of
treatment, the subject’s (N=1) Dysfunctional Attitudes Scale scores
steadily declined. His Geriatric Depression Scale scores have remained
stable. The changes in dysfunctional attitudes, though not targeted,
may precede changes in depression scores.
TAMARRA DUPART
Home Institution: Pacific Graduate School of Psychology
Major: Clinical Psychology
Email:
Tamarramary@yahoo.com
Mentor(s): Dolores Gallagher-Thompson, Ph. D.
Training Institution: Stanford University School of Medicine
Project Title: Attachment and the Caregiver of Older Adults
with Dementia of the Alzheimer’s Type
Authors: Tamarra Dupart, BA and Dolores Gallagher-Thompson, Ph.
D, ABPP
Abstract: I will be re-contacting female English speaking
caregivers of loved ones with dementia related to Alzheimer’s Disease,
who previously participated in the REACH (Resources for Enhancing
Alzheimer’s Caregiver Health) Study at the Palo Alto site. I will be
administering the 40-item Attachment Style Questionnaire (ASQ) to them
by mail and phone. The reported attachment style (secure versus
insecure) will be compared to the variables of reported depression,
reported burden, and reported stress. It is hypothesized that those
caregivers who tend towards secure attachment will report less
depression, stress, and burden in caring for their loved ones. Those
caregivers who tend towards insecure attachment will have reported
more depression, stress, and burden in caring for their loved ones. I
will also be comparing the attachment styles to six and eighteen month
reassessments, during and after intervention to see if there is a
difference between the two groups with regards to reported increase or
decrease in symptoms of depression, stress, and burden.
CHANDRAKALA GANESH
Home Institution: Pennsylvania State University
Major: Health Policy and Administration
Email: cxg913@psu.edu
Mentor(s): Dennis G. Shea, Ph.D.
Training Institution: The Pennsylvania State University
Project Title: A profile of Medicare Beneficiaries with
Alzheimer’s Disease (AD)
Authors: Chandrakala Ganesh, Dennis G. Shea
Abstract: Study objectives: Describe patterns of psychotropic
drug use, physical and mental co-morbidities, mental health visits and
prescription drug coverage among Medicare beneficiaries with AD.
Determine the factors responsible for differences in psychotropic drug
use and visits to mental health providers among Medicare beneficiaries
with AD
Hypothesis: (1) Medicare beneficiaries with AD are more likely
to be prescribed donepezil (2) Medicare beneficiaries with AD are more
likely to visit a primary care physician than a specialist.
Data & Methods: The Medicare Current Beneficiary Survey (MCBS),
1999 was used. The study sample includes community based Medicare
beneficiaries who reported AD in the survey records and had a claims
diagnosis of AD in the Part B Physician Supplier file or had a claims
diagnosis of AD in the inpatient hospital event file
Analysis procedure: Odds Ratios were calculated using logistic
regression. The dependent variables were (1) Prescription of donepezil
(2) Mental health visit by Medicare beneficiaries with AD. The
independent variables were self report/claims diagnosis of mental
health, co-morbid mental health conditions, mental health procedure
code, age, census, race, gender. Statistical Analysis Software (SAS®),
Version 8, was used for all analysis procedures.
Results: Less than 20% of beneficiaries visited a mental health
specialist. The chief predictors of visiting a specialist were: a
mental health procedure code, belonging to Northern or Western census,
being White and age over 75 years. Only 16% of beneficiaries with AD
were prescribed donepezil. The key predictors of a prescription were:
diagnosis of mental health, from census region South, being Black and
age over 75 years.
HILLARY LEROUX
Home Institution: University of Nevada, Reno
Major: Clinical Psychology
Email:
lerouxh@unr.nevada.edu
Mentor(s): Jane Fisher, Ph.D.
Training Institution: University of Nevada, Reno
Project Title: Detection of Late-Life Depression in Primary
Care Settings
Authors: Hillary LeRoux and Jane Fisher, PhD.
Abstract: The purpose of this study is to explore how Primary
Care Physician’s (PCP’s) and older adult patient’s use of verbal and
nonverbal behavioral cues affects the PCP’s ability to accurately
diagnose depression. This study will employ four videotaped vignettes
of an older adult actress exhibiting various symptoms of depression.
PCPs will view the vignettes giving interview questions throughout
each vignette and determine if depression is present. The PCPs’
interview questions will be explored to determine which type of
questions lead to a diagnosis of depression. The following hypotheses
will be tested: 1) Patient’s disclosure of somatic complaints will
decrease the PCP’s ability to recognize depression more than the
disclosure of cognitive complaints. 2) The patient with more severe
symptoms of depression will be more easily recognized by the PCP, than
the patient with mild symptoms. 3) The patient’s attempt to mask
depression by smiling rather than expressing symptoms, e.g. crying and
little eye contact, will decrease the PCP’s recognition rates.
MARGARET-ANNE MACKINTOSH
Home Institution: University of Southern California
Major: Clinical Psychology
Email: mackinto@usc.edu
Mentor(s): Margaret Gatz, Ph.D.
Training Institution: University of Southern California
Project Title: Generalized Anxiety Disorder and Worrying
Behaviors in Middle-Aged
and Older Adults
Authors: Margaret-Anne Mackintosh, Margaret Gatz, Ph.D, and Amy
Fiske,
Ph.D.
Abstract: This study investigated the impact of both genetic
and environmental influences on the occurrence of Generalized Anxiety
Disorder (GAD) and worrying behaviors in a sample of middle-aged and
older adults. A population-based sample of twins from the Swedish Twin
Registry was screened for GAD as part of the Screening across the
Lifetime Twin (SALT) Study conducted in 1998-2000. This project
studied differences in the rates and genetic and environmental
influences of GAD among groups of older adults (aged 65 and older) and
in middle-aged adults (55-64 years old). While shared environmental
factors played little to no role in the occurrence of worrying
behaviors, heritability was estimated to be .21 for males and .28 for
females. Also, behavioral genetic models are being developed to test
whether the same genetic and environmental factors influence worrying
behaviors for men and women as well as whether the proportion of
genetic and environmental contributions are different between genders.
JOHN W. RIDINGS
Home Institution: University of Illinois at Chicago
Major: Social Work
Email:
jw_ridings@hotmail.com
Mentor(s): Kendon J. Conrad, Ph.D.
Training Institution: University of Illinois at Chicago Health
Policy and Administration (M/C 923)
Project Title: Using a money management measure (M3) to assess
financial disability and financial abuse among the elderly: A program
of research
Authors: Dr. Kendon Conrad, Rachel Seymore (MS), Dr. Madeyln Iris, &
John Ridings (AM, LCSW)
Abstract: The Money Management Measure (M3) represents a 3
month project aimed at improving the identification of financial
disability and financial abuse among elders. In particular, the
original design of the M3 was to be sensitive enough to work with
varying subpopulations of the elderly population (i.e. mentally).
Other goals of this study were to identify and conceptualize each
component of the M3, describing it in detail and suggesting when, with
whom, and how it could be used. Recommendations of this study are to
prepare a grant proposal for submission to NIH, which will hopefully
fund a pilot project that will compare M3 scores between a
community-dwelling elderly population and a mentally ill elderly
population from a Chicago-based Community Mental Health Center.
CHERIE SOPRANO
Home Institution: Pennsylvania State University
Major: Nursing
Email: sopranoc@aol.com,
cas408@psu.edu
Mentor(s): Ann M. Kolanowski, Ph.D., RN
Training Institution: The Pennsylvania State University
Project Title: Psychometric Properties of the Passivity in
Dementia Scale – Nursing Home Version (PDS-NHV): A Pilot Study
Authors: Cherie Ann Soprano MS, CRNP, PhD (c)
and Dr. Ann Kolanowski RN, PhD.
Abstract: The purpose of my research project was to obtain
psychometric data, specifically inter-rater reliability, test-retest
reliability, and internal consistency for the Passivity in Dementia
Scale – Nursing Home Version (PSD-NHV) instrument. The PDS-NHV is a
55-item instrument that measures passivity from the viewpoint of
Certified Nursing Assistants (CNAs) who care for nursing home
residents that exhibit passivity. Passivity is a dementia behavior
that has received little attention in the literature. Approximately
61% to 88% of nursing home residents with dementia exhibit passivity
on a daily basis. These
individuals are characterized as the “silent majority” who manifest a
reduction of energy, drive, motivation, emotional reactivity, and
initiative. Nursing home residents who exhibit passivity are at risk
of isolation, immobility, excess disability, and further cognitive
decline. Obtaining the data for the PDS-NHV was part of a larger study
which used a crossover experimental design with repeated measures. The
data from this pilot study suggest that the PDS-NHV is a reliable
instrument with high Cronbach’s alphas (Range .81 - .91), and shows
promising results for measuring passivity in nursing home residents
with dementia. Further research recommended includes using a larger
sample size and work on establishing this instrument’s validity.
BREA STRATTON
Home Institution: University of North Carolina at Chapel Hill
Major: Clinical Psychology
Email: brea@email.unc.edu
Mentor(s): Marilyn Hartman, Ph.D.
Training Institution: Univ. of North Carolina at Chapel Hill
Project Title: Age Differences in Concept Formation
Authors: Brea Stratton, B.A., & Marilyn Hartman, Ph.D.
Abstract: Age Differences in Concept Formation
Healthy older adults exhibit decline in a number of cognitive
abilities, yet little is known about the exact nature of these
deficits. One such ability that shows age-related changes is concept
formation, tested by standardized neuropsychological tests that
examine the ability to identity abstract relationships. Tests of
concept formation involve a number of cognitive components, including
selective attention, working memory, and concept identification. Older
adults’ deficits in any or some combination of these components could
be responsible for reduced performance.
Using the Concept Matching task, we will evaluate whether older adults
exhibit a deficit in concept identification, the ability to generate
abstract concepts from features of different stimuli. In addition to
cognitively demanding conditions, this new task includes a condition
with minimal demands on working memory and selective attention. We
will also determine whether selective attention plays a role in older
adults’ performance by manipulating stimulus complexity. Finally, we
will examine the relative contributions of selective attention and
concept identification to performance on a standardized test of
concept formation, the Sorting Test of the Delis Kaplan Executive
Function Scale (D-KEFS, Delis, Kaplan, & Kramer, 2001), and determine
the extent to which these abilities account for age differences in the
Sorting Test.
LAUREN WARREN
Home Institution: University of North Carolina at Chapel Hill
Major: Clinical Psychology
Mentor(s): Kathleen Welsh-Bohmer, Ph.D.
Training Institution: Duke University
Project Title: Defining subclinical Alzheimer's Disease: A
preliminary exploration using the Cache County Memory Study
Authors: L. H. Warren, J. Tschanz, K. D. Garrett, M. Norton, L.
Sanders, T. Ostbye, C. Pieper, and K. A. Welsh-Bohmer
Abstract: Multiple descriptors are used in the current
literature to describe transitional cognitive states along the
continuum of normal aging and dementia. Terms, such as mild cognitive
impairment (MCI) or cognitive impairment no dementia (CIND), are
frequently used interchangeably and the criteria for each are often
inconsistently applied. We conducted an analysis of the comparability
of the various recognized categorizations in a sample of nondemented
individuals enrolled in the Cache County Memory Study (CCMS), an
epidemiological study of dementia. We selected six descriptors of
transitional states: CIND, age-associated memory impairment [AAMI],
age-associated cognitive decline [AACD], mild ambiguous [MA], and two
different definitions of MCI. We applied the operationalized criteria
for these conditions retrospectively to the sample. The results showed
that the frequency of each nosology was not uniform. More individuals
could be categorized as CIND (514/654) than MCI (50/654). Criteria
emphasizing both functional change and neuropsychological decline
yielded an intermediate number of cases. Results suggest that the
different categorization approaches for the transitional states are
not interchangeable. Depending on which criteria are employed,
different results are likely when examining the utility of these terms
in predicting later outcomes of cognitive decline or dementia. |
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