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MEDICAL STUDENTS
Name: Karim Gokal
Home University: Emory University School of Medicine
Major: Medicine-psychiatry
Email: kgokal@emory.edu
Mentor(s): William McDonald, M.D.
Host University: Emory University
Research Project: A Pilot Study on Positive and Negative Affect
Schedule (PANAS) to Investigate Acute Mood Changes During Deep Brain
Stimulation (DBS) for Movement Disorders
Karim Gokal, M.D., Emory University Department. of Psychiatry
Paul Holtzheimer, M.D., Emory University Department. of Psychiatry
Abstract: Introduction: Mood changes with Deep Brain
Stimulation (DBS) for Parkinson’s Disease, especially during
programming, have not been adequately investigated. The purpose of
this pilot study is to conduct a detailed assessment of acute mood
changes during DBS for Movement Disorders using the PANAS. Methods: We
studied ten patients with movement disorders, mainly Parkinson’s
disease, as they were being treated with DBS by investigators from
Emory University Dept. of Neurology. After gathering demographic and
DBS specific data, a MMSE, HAMD-17, GDS, and IDS were administered,
along with the 20-item PANAS as baseline data. Any adjustments to the
location of the lead contacts, frequency and voltage were noted and a
PANAS was re-administered after the DBS adjustment. Results: There is
a strong correlation between PANAS scores and other validated tests
such as the HAMD-17, GDS, and IDS. There is no correlation between
PANAS score changes the Motor exam score changes after the first DBS
adjustment. Discussion: Our study validates the use of the PANAS,
which is brief and easier to use and measures acute changes in affect,
in Parkinson’s disease and other movement disorder patients by
correlating it to mean scores of the other three tests mentioned
above. In addition, our study shows that the changes in PANAS scores
after DBS adjustments are not necessarily effected by the changes in
motor exam scores. Thus, the physical act of DBS programming may be
having a direct effect on acute mood changes in the brain.
Name: Christine Palermo
Home University: University of Hawaii
Major: Medicine
Email: palermo@hawaii.edu
Mentor(s): Wayne McCormick, M.D., MPH
Host University: University of Washington
Research Project: The Kame Project: Exploring Causes of Death
in a Cohort Study of Dementia Christine O. Palermo, MSII, Wayne C.
McCormick, M.D., M.P.H.
Abstract: A cohort of 1142 older Japanese Americans was
identified within the Kame Project to study preferences and attitudes
regarding use of long-term care, LTC, (nursing home or home care).
Subjects were asked to consider hypothetical situations in which they
were temporarily disabled by hip fracture or permanently disabled by
dementing illness.
In this stage of the LTC study, we will determine whether subjects who
intended to use LTC services in the event of permanent disability did,
in fact, enter a nursing home or use paid home health. Futhermore, we
will look at the incidence of dementia in this cohort and its possible
correlation with the cause(s) of death in these individuals and their
use of LTC.
Name: Jennifer Prevost
Home University: University of California, San Diego
Major: Medicine
Email:
jprevost@stanford.edu
Mentor(s): Daniel Sewell, M.D.
Host University: University of California, San Diego Hillcrest
Medical Center
Research Project: Aromatherapy: A "Scentsical" Approach to
Treating Behavioral and Psychological Symptoms of Dementia
Abstract: It is common for patients with dementia to develop
behavioral and psychological symptoms of dementia (BPSD), which
include verbal or physical aggressive or nonaggressive agitation, at
some point during their illness. Current pharmacological or behavioral
treatment for BPSD may be costly, cause undesirable side effects, or
lack a therapeutic effect. For these reasons, there is an increasing
interest in evaluating the effectiveness of “alternative treatments.”
One such alternative treatment is aromatherapy, which refers to
essential oils extracted from plants that are massaged into the skin
and inhaled through the respiratory system. Although the precise
mechanism of action is unknown, it is suspected that the high
concentration of terpenes in essential oils may play a significant
role. We are conducting a randomized, placebo-controlled, double-blind
study to investigate the efficacy of Melissa essential oil in
decreasing agitated behavior in patients with dementia. We expect that
patients who receive lotion application containing Melissa oil will
exhibit a greater decrease in agitated behavior over two weeks than
patients in the control group who will receive unscented lotion
applications over the same time period. We will measure the changes in
agitated behavior by administering the Cohen-Mansfield Agitation
Inventory (CMAI) and the Behavior Pathology of Alzheimer’s Disease
(BEHAVE-AD) at three time points over the 14-day study period. We hope
to use scientific methodology to clarify whether aromatherapy with
Melissa oil is a safe and effective adjunctive treatment for BPSD.
Name: Rheinila Fernandes
Home University: University of California, San Francisco
Major: Medicine
Mentor(s): Owen Wolkowitz, M.D. and Sudha Prathikanti, M.D.
Host University: UCSF School of Medicine
Research Project: Treating Depression with Yoga Breathing: A
Feasibility Trial
Rheinila Fernandes, MSIV, Sudha Prathikanti, M.D., and Owen Wolkowitz,
M.D.
Abstract: Psychiatric researchers in India have accumulated a
preliminary body of clinical data suggesting that pranayama, a series
of breathing exercises within the yoga tradition of India, may have
significant anti-depressant and anti-stress effects. Since this is an
intervention that has not been studied on a large scale in the United
States or examined in the elderly, we conducted a Phase I feasibility
trial using pranayama in preparation for a 12-week randomized,
controlled double-blind pilot trial. We had seven participants age 55
and older, who had a diagnosis of major depression participate in one
month of daily pranayama exercises. We compared scores on Hamilton
Rating Scale of Depression and Beck Depression Inventory before and
after the intervention using a paired t-test. We found a statistically
significant reduction in symptoms over the course of the study. Our
design did not include a control group and many participants were also
receiving therapy and antidepressant medication, so we cannot
attribute change in symptoms to pranayama alone. We had a twenty eight
percent attrition rate. Seventy two percent of participants had some
prior exposure to yoga or meditation. All participants indicated that
they experienced some form of discomfort while doing the exercises and
so we experimented with modifications and received feedback about
accommodations to increase ease of exercises. All participants agreed
that the exercises were sometimes difficult to do when feeling
particularly depressed and desired frequent group practice sessions
because it was easier to do exercises in the company of others. The
results of our study suggest that older U.S. subjects with depression
may easily learn and regularly practice introductory pranayama
exercises in a group setting; moreover, although our study sample was
small, the pranayama exercises may have contributed to an improvement
in the subjects' depressive symptoms.
Name: Lena Maltzman
Home University: Lund University, Sweden
Major: Medicine
Email:
lenamaltzman@yahoo.com
Mentor(s): Thomas Patterson, Ph.D. and Sherrill Goldman, M.A.
Host University: University of California, San Diego
Research Project: Everyday Functioning in Middle-Aged and Older
Schizophrenia Patients with Neuroleptic-Induced Parkinsonism
Lena Maltzman, B.S. 1, Sherrill Goldman, M.A. 2, Brent Mausbach, Ph.D.
2, and
Thomas L. Patterson, Ph.D. 2
1Lund University, Home University of California, San Diego and VA San
Diego Healthcare System
Abstract: Purpose:. Neuroleptic-Induced Parkinsonism (NIP) is
an extrapyramidal side adverse event resulting from treatment with
neuroleptics, or dopamine receptor blocking agents (DRBA). The major
symptoms associated with NIP are abnormal slowness of movement (bradykinesia),
rigidity in joints of the limbs and neck, and a parkinsonian tremor
primarily seen in the hands. These symptoms generally recede after
discontinuation of treatment. NIP is diagnosed by clinical observation
or by a rating scale, such as the Simpson-Angus Scale (SAS). While
many studies have looked at clinical features and pathogenesis of NIP,
none have looked at its direct impacts on everyday functioning. This
study examined quality of life factors including everyday functional
and social skills and general well being in patients diagnosed with
NIP based on the SAS. We hypothesized that patients with NIP would
have lower quality of life compared to those without NIP.
Methods: Subjects included 145 patients all enrolled in the UCSD
Advanced Center for Interventions and Services Research (ACISR).
Patients were assessed for NIP (Simpson-Angus), general
psychopathology (PANSS and HAM-D), everyday functioning (UPSA),
medication adherence (MMAA), social skills (SSPA), health related
quality of well-being (QWB), and health symptoms (IMED).
Results: 122 patients met criteria for NIP using a cutoff of 0.3 on
the Simpson-Angus scale. Patients with NIP were more greatly impaired
in some of the functional outcome measures (UPSA) yet not all of them.
They also showed decreased quality of well-being (QWB). Although this
group was slightly older with lower mean education, this difference
was not very significant
Conclusion: NIP does impact everyday functioning and action should be
taken to minimize these side effects in order to to increase quality
of life in patients treated with neuroleptics.
Name: Lang Nguyen
Home University: University of Virginia
Major: Medicine
Email: lhn6f@virginia.edu
Mentor(s): Helen Lavretsky, M.D.
Host University: Universtiy of California, Los Angeles
Research Project: The relationship of plasma lipids and brain
regional volumes
Abstract: Cholesterol and lipid levels have been implicated in
the pathophysiology of geriatric depression and suicidal ideations. We
explored the relationships of plasma lipid levels to brain regional
volumes in older depressed patients and age and sex- matched controls.
We recruited 84 subjects over the age of 60, none are demented. Blood
test and MRI were taken by each subject. Data collected and partial
correlation analysis were performed. Cholesterol and triglyceride
levels negatively correlated with brain white and gray matter volumes,
while Non HDL cholesterol positively correlated with IFC white matter
volume. Cholesterol and lipid blood levels are likely to exhibit their
effect on geriatric depression via their effects on brain structure.
The use of lipid lowering drugs may protect against geriatric
depression.
Name: Emily (EB) Smith
Home University: University of California, San Francisco
Major: Medicine
Email:
esmith@itsa.ucsf.edu
Mentor(s): Bruce Miller, M.D.
Host University: University of California, San Francisco
Research Project: Anatomic substrates of emotional memory: A
neurodegeneration-lesion analysis
Name: Laura Wheeler
Home University: Brown University
Major: Anthropology and African Studies
Major: Medicine
Email:
Laura_Wheeler@brown.edu
Mentor(s): Steve Bartels, M.D.
Host University: Dartmouth University
Research Project: Correlates of Metabolic Risk Factors in Aging
Persons with Serious Mental Illness (SMI)
GRADUATE STUDENTS
Name: Jorge Armesto
Home University: University of Massachusetts Boston
Major: Clinical Psychology
Email:
armesto@post.harvard.edu
Mentor(s): Jennifer Moye, Ph.D.
Host University: Harvard Medical School
Research Project: Assessment of Capacity to Consent to
Treatment in Older Adults With Dementia and Schizophrenia
Jorge C. Armesto, Ph.D., Jennifer Moye, Ph.D., Michele Karel, Ph.D.,
Ronald Gurrera, M.D., Andrew R. Davis, B.A. & David DiCenso, B.A.
VA Boston Healthcare System (Brockton Campus)/Harvard Medical School
Abstract: Diminished capacity to consent to medical treatment
is a common concern in older adults with dementia or schizophrenia.
Capacity evaluations in older adults, however, can be challenging and
unreliable. In this pilot study, 20 older adults with dementia were
compared to 20 older adults with schizophrenia on four indices of
legal capacity (understanding, reasoning, appreciation, and expressing
a choice) as measured by the Assessment of Capacity to Consent to
Treatment—Tool (ACCT-T). Subjects also completed the Extended
Mini-Mental State (3MS) and Brief Symptom Inventory (BSI). Results
indicate that most individuals in both groups expressed a treatment
choice and had similar levels of impairment in their understanding of
the disorder and treatment information. However, Appreciation as
Distrust was a significantly more common problem in patients with
schizophrenia. Findings also indicate that cognitive and psychiatric
symptomatology may impact different decisional abilities. Finally, the
assessment of values and the consistency of choices with values is a
critical component in capacity evaluation and an area in need of
further study. Funding sources: Thanks to the support provided by PHS
(NIH) grant number P60 AG08814 OAIC Pilot Project and the START-MH
Summer Fellowship.
Name: Thea Brennan-Krohn
Home University: Harvard Extension School
Major: Health Careers Program (Pre-medical)
Email: theabk@yahoo.com
Mentor(s): Stephen Salloway, M.D.
Host University: Brown Medical School
Research Project: Molecular Biology of CADASIL
Abstract: I examined gene expression in parenchyma and vessels
of post-mortem brain tissue from patients with CADASIL (cerebral
autosomal dominant arteriopathy with subcortical infarcts and
leukoencephalopathy) and normal aged controls. CADASIL is a genetic
form of dementia associated with a mutation on the Notch3 gene of
chromosome 19, which causes strokes, dementia, and early death. After
extracting RNA from the tissue samples, I reverse transcribed it and
used quantitative real time RT-PCR to measure the levels of mRNA of
genes involved in the insulin/insulin-like growth factor 1 and 2
(IGF-1 and IGF-2) signaling pathway. These genes included
insulin-receptors, IGF-1 and IGF-2 receptors, Notch1 and Notch3, AAH,
and markers for endothelial cells and smooth muscle actin. I found
that there was impairment of the insulin/IGF-1 and -2 signaling
pathway in the parenchyma and white matter of patients with CADASIL.
 Name: Sarah Cook
Home University: University of Florida
Major: Clinical Psychology (with Neuropsychology specialty and
Gerontology certificate)
Email: scook@phhp.ufl.edu
Mentor(s): Frederick W. Unverzagt, Ph.D.
Host University: Indiana University School of Medicine
Research Project: Longitudinal Outcomes of Cognitive Impairment
in Elderly African Americans: Patterns and Predictors
Sarah E. Cook, Frederick W. Unverzagt, Kathleen A. Lane, Sujuan Gao,
Beverly Musick, Valerie Smith-Gamble, Jeanne Dickens, Rebecca M.
Evans, Jill R. Murrell, Olusegun Baiyewu, Oye Gureje, Adesola Ogunniyi,
Hugh C. Hendrie, Kathleen S. Hall
Abstract: Longitudinal studies of Cognitive Impairment No
Dementia (CIND) outcomes have reported substantial rates (13-45%) of
individuals originally classified as CIND but classified as normal on
follow-up examination. The determinants of longitudinal functional
outcome of (CIND) was examined in a community-based sample of African
Americans. Participants were part of a longitudinal, population-based
study of dementia and had at least 2 clinical assessments, one
assessment with diagnostic classification of CIND (Occasion 1) and the
subsequent assessment (Occasion 2) in which they were classified as
normal (Improvers, N=48), CIND (Stable, N=79), or dementia (Decliners,
N=51). The results indicated that compared to Stable, the Improvers
were more likely to have myocardial infarction and kidney disease in
their medical history and Decliners were more likely to have at least
one APOE e4 allele than the Stable group. Within-person change in
neuropsychological scores was clinically meaningful, while depression
did not contribute to longitudinal outcome. Findings suggest that
health factors and functional status contribute to the longitudinal
course of CIND in African Americans.
Name: Katherine Fiori
Home University: University of Michigan
Major: Developmental Psychology
Email: kfiori@umich.edu
Mentor(s): Toni Antonucci, Ph.D.
Host University: University of Michigan
Research Project: “Social Relations and Health Among the
Elderly: A Cross-Cultural and Person-Centered Approach”
Katherine L. Fiori and Toni C. Antonucci, University of Michigan
Abstract: The purpose of this study is to examine typologies of
social networks and their impact on physical and mental health in
three different cultures. Using data drawn from the United
States-Japan cross-national survey, Social Relations and Mental Health
over the Life Course (Antonucci & Akiyama, 1993), as well as data from
the Berlin Aging Study (Baltes et al., 1993), we conducted cluster
analyses using structural, functional, and evaluative aspects of
social networks for each country (the US, Japan, and Germany) in order
to distinguish among people with different network typologies.
Although there were many similarities, types and distributions of
networks also varied by country. We conducted MANOVAs to predict
mental health (e.g., depressive symptomatology) and physical health
(e.g., morbidity) based on the network types. Our findings confirm the
robustness of certain network types and their implications for
well-being (i.e., individuals in Large/Diverse or Friend-focused
network types have better physical and mental health than those in
more restricted network types), and extend previous research by
uncovering network types specific to the multidimensional perspective
(i.e., by including structural, functional, and evaluative aspects of
social networks in the cluster analysis).
Name: Chandrakala Ganesh
Home University: Pennsylvania State University
Major: Health Policy and Administration
Email: cxg913@psu.edu
Mentor(s): Dennis G. Shea, Ph.D.
Host University: Penn State
Research Project: Disparities in drug use for Alzheimer’s
disease (AD) among Medicare beneficiaries Chandrakala Ganesh, Dennis G
Shea
Abstract: Research objectives: There are three objectives of
this study: (1) To examine the trends in diffusion of AD drugs among
community-residing Medicare beneficiaries from 1996-2001, (2) To
determine if there are disparities in utilization of AD drugs among
Medicare beneficiaries, (3) To identify the health care costs
associated with the usage of AD drugs.
Study design: The study uses data from years 1996-2001 of the Medicare
Current Beneficiary Survey (MCBS). Repeated cross-sectional analyses
of MCBS data are conducted and logistic regression analysis are used
to determine beneficiary characteristics that are likely to determine
drug treatment for Alzheimer’s.
Population Studied: The study sample includes community based Medicare
beneficiaries who reported AD in the survey or claims records in MCBS.
Principal Findings: About 3.5 % of the community-dwelling Medicare
beneficiaries suffer from Alzheimer’s disease. Drug use increased from
1.4% to 31% over 5 years. About 25%-38% of beneficiaries who are
prescribed an AD drug do not have a formal diagnosis of AD.
Disparities in AD drug utilization were observed. Beneficiaries who
are white, in urban areas, with higher education, with drug coverage
had greater odds of usage of AD drugs than those who are black, in
rural areas, with lower education, no drug coverage. Mean annual total
drug and out-of-pocket expenditures of beneficiaries using AD drugs
were $2317 & $850 respectively, versus $1749 & $663 for beneficiaries
not using AD drugs.
Significance: Unfolds the impact of new drug technology on health care
utilization and health care costs in Alzheimer’s disease. Helps in
understanding how socioeconomic status and minority group membership
predict drug treatment sought by beneficiaries with Alzheimer’s
disease. Preliminary data shows some emerging disparities.
Name: Marissa Hansen
Home University: University of Southern California
Major: Doctor of Philosophy - Social Work
Mentor(s): Maria Aranda, Ph.D., MSW
Host University: University of Southern California
Research Project: Sociocultural adaptation of depression
treatment models for Latino older adults Marissa Hansen, MSW, Maria P.
Aranda, LCSW, Ph.D., Dr. Kathleen Ell, Ph.D.
Abstract: Objective: To conduct an exploratory review of the
literature and qualitative study on sociocultural adaptation models
for mental health services for minorities, particularly older adults.
A focus of the review is on the available knowledge regarding the
adaptation process of mental health treatment for the Hispanic
population. Additionally, the review presents experiences of mental
health clinicians in culturally adapting mental health services for
minority older adults to further highlight trends in the process
sociocultural adaptation. Method: Fifty-six journal articles related
to sociocultural adaptation were retrieved and reviewed
systematically. Three individual, face-to-face provider interviews and
two focus groups with mental health clinicians were conducted. Content
extraction and analysis were conducted to create theme summaries for
each data source. Findings from the literature and qualitative
interviews were synthesized. Results: There is limited empirical
research on the process of sociocultural adaptation of health or
mental health services. The majority of literature documents the
process of adapting measures/scales but fails to empirically assess
how to integrate cultural considerations in the treatment process.
Qualitative interviews yielded varying perspectives on the need and
means of culturally adapting treatment interventions. However,
linguistic equivalence, detailed assessments, and provider sensitivity
emerged as common themes. Both the interviews and the literature
highlight common cultural constructs that are integral in adapting
mental health services for Latino older adults. Conceptual and
practice-based models from the literature are highlighted to assist in
providing a framework for future empirical research on a
culturally-grounded approach to adaptation of depression treatment
models for Latino older adults.
Name: Katina Hebert
Home University: University of Alabama
Major: Psychology
Email:
heber002@bama.ua.edu
Mentor(s): Rebecca Allen, Ph.D.
Host University: University of Alabama
Research Project: Civil capacity assessment in
community-dwelling older adults seeking legal services. Hebert, K.,
Allen, R.S., Morthland, M., Castillo, J., & Marson, D.C. (2005).
Abstract: This study examined medical and financial
decision-making among community-dwelling, older adults (OAs) seeking
legal services. Thirty OAs presenting at a legal clinic completed a
modified telephone interview for cognitive status (TICS-m). Twelve
(40%) OAs scored below 27 on the TICS-m and were ineligible to
participate due to possible cognitive impairment. Ten OAs completed
the Capacity to Consent to Treatment Instrument (CCTI), the Financial
Capacity Instrument (FCI), and a brief neuropsychological battery. No
neurocognitive predictors of medical decision-making emerged.
Univariate (r = .702-.862, p=.025) and multivariate predictors (R2 =
.618-.710, p=.004) of specific financial abilities and overall
financial capacity included measures of verbal fluency, verbal
abstract reasoning, global cognitive functioning, information
processing speed, and semantic knowledge. The CCTI and FCI were not
significantly correlated (r= -.409, p =.241). Results suggest that
medical and financial decision-making are distinct capacities that may
be differentially affected by normal aging as well as Alzheimer’s
disease.
Name: David La Fazia
Home University: University of Washington
Major: Psychology and Sociology
Major: Social Welfare
Email:
dlafazia@u.washington.edu
Mentor(s): Linda Teri, Ph.D.
Host University: University of Washington
Research Project: Family Involvement and Dementia Resident
Outcomes in Assisted Living
David LaFazia, MSW, Linda Teri, PhD, Glenise McKenzie, MN, June
vanleynseele, MA, and Huda Piruz MN, ARNP
Abstract: Assisted-living (AL) residences are the fastest
growing residential care option for older adults in this country. More
than half of AL residents have dementia and many of them suffer from
affective or behavioral disorders. The purpose of this study is: 1) to
examine families’ perceptions of care and 2) to examine the
relationship between family involvement and dementia resident outcomes
in AL. Data were analyzed on 72 adult child-parent dyads. Families of
AL residents completed assessments via mail with telephone follow-up.
Assessments of residents to measure affective and behavioral stress
were conducted via interviews with direct care staff and residents.
Results indicate that families visited an average of more than once
per month and have high perceptions of care. There were negative
correlations between perceptions of care and all resident outcome
measures for families visiting greater than weekly. Findings suggest
that support of families to participate in the care of AL residents
may decrease resident problem behaviors.
Name: Heline Mirzakhanian
Home University: San Diego State University/University of
California, San Diego
Major: Clinical Psychology
Email:
hmirzakhanian@aol.com
Mentor(s): Lisa Eyler, Ph.D.
Host University: VA San Diego Healthcare System; University of
California San Diego
Research Project: Sick but still successfully aging: An
exploratory study comparing more and less successful older adults with
high illness burden
Heline Mirzakhanian, Lisa, T. Eyler, Ph.D. & Dilip, V. Jeste, M.D.
Abstract: The human life span has almost doubled and there is
an increased interest in understanding not only the factors that lead
to poor outcomes in aging, but also factors that are related to good
or above average outcomes. “Successful aging”, as it has sometimes
been called, has been defined by researchers as active engagement in
life, high physical and cognitive functioning and freedom from
disability. In a recent report however (Montross et al, in press), it
was found that only the first two elements were related to
individuals’ own ratings of how successfully they were aging.
Interestingly, level of self-reported illness was not related to
participants’ ratings of successful aging, even though there were many
individuals with fairly high illness burden. Thus, there appears to be
a range of levels of “success” among people who are ill, with some
reporting high success despite suffering from the increase in illness
burden typically associated with aging. The aim of this study was to
explore differences between older adults with high illness burden who
perceive themselves as successfully aging and those who see themselves
as aging less successfully shedding light on the factors that help
some older adults to maintain high quality of life in the face of
illness. Fifty adults over the age of 60 with high illness burden
participated in the study and were divided into two groups: more
successfully aging and less successfully aging. The groups were based
on self-rated successful aging scores and a variable combining
researcher defined items of successful aging. Analyses revealed
several statistically significant characterological differences
between the two groups. Overall, more successful individuals scored in
the direction of greater quality of life on many of the variables. The
more successful group was more optimistic than the less successful
group, had better cognitive functioning, a better geriatric morale,
was more resilient and has a better attitude towards life and self.
Name: Kathryn Moss
Home University: University of Alabama
Major: Clinical Psychology
Email: moss024@bama.ua.edu
Mentor(s): Forrest Scogin, Ph. D.
Host University: University of Alabama
Research Project: Title: Evaluating Change in DSM-Designated
Depressive Symptoms in Rural, Medically Frail Older Adults
Authors: Kathryn Moss, B. A., Forrest Scogin, Ph.D., & Martin
Morthland, MPhil.
Abstract: The SCL-90-R Depression subscale is often used as an
outcome measure in treatment studies for depression. Although it
measures depression along a continuous dimension, the subscale does
not directly correspond to the Diagnostic and Statistical Manual of
Mental Disorders-IV-TR (DSM-IV-TR) categorical diagnostic criteria for
depression. This study employed two methods to obtain a depression
diagnosis using the SCL-90-R that more closely reflected
DSM-designated symptoms using data from a study funded by the NIA
investigating the efficacy of home-delivered cognitive-behavioral
therapy (CBT) as a quality of life treatment in medically frail, rural
older adults. Depressive symptomology was assessed at pre- and
post-treatment and was evaluated in comparison to a minimal support
control (MSC) group. Depressive symptoms were further broken down into
psychological and somatic to determine whether a specific pattern of
improvement would be evidenced in a rural, medically frail sample of
older adults. The relations of ethnicity and sex to hostility and
depression were also examined. Results suggested that depressive
symptoms significantly improved for the treatment group utilizing both
diagnostic methods. Further, psychological symptoms of depression
improved more significantly than did somatic symptoms. Hostility also
significantly decreased as a result of the treatment. Ethnicity and
sex were not found to moderate the relation between the treatment and
change in depression or hostility.
Name: Robert Pietrzak
Home University: University of Connecticut
Major: Clinical Psychology / Neuropsychology
Email:
pietrzak@mph.uchc.edu
Mentor(s): Nancy Petry, Ph.D.
Host University: University of Connecticut Health Center
Research Project: Psychiatric and Medical Comorbidity in Older
Adult Disordered Gambling: Results from the National Epidemiologic
Survey on Alcohol and Related Conditions
Robert H. Pietrzak, M.P.H. and Nancy M. Petry, Ph.D.
Department of Psychiatry, University of Connecticut Health Center
Abstract: Objective: This study examined psychiatric and
medical correlates of recreational and disordered gambling in a
nationally representative sample of older adults. Method: Data were
analyzed from the National Epidemiologic Survey on Alcohol and Related
Conditions (NESARC). A total of 10,563 older adults (age 60 or older)
were surveyed, and they were the focus of this study. Results:
Recreational gamblers comprised 28.74% of the sample, and the lifetime
prevalence of disordered gambling was 0.85%. Compared to non-gamblers,
recreational gamblers had significantly elevated rates of lifetime
alcohol (30.1% vs. 12.8%), nicotine (16.9% vs. 8.0%), mood (12.6% vs.
11.0%), anxiety (15.0% vs. 11.6%), and personality disorders (11.3%
vs. 7.3%), and obesity (25.6% vs. 20.8%), but were less likely to have
past-year diagnoses of arteriosclerosis (4.7% vs. 6.0%) and cirrhosis
(0.2% vs. 0.4%). Disordered gamblers were significantly more likely
than non-gamblers to have lifetime alcohol (53.2% vs. 12.8%), nicotine
(43.2% vs. 8.0%), drug (4.6% vs. 0.7%), mood (39.5% vs. 11.0%),
anxiety (34.5% vs. 11.6%), and personality (43.0% vs. 7.3%) disorders,
to be obese (28.7% vs. 20.8%), and to have past-year diagnoses of
arthritis (60.2% vs. 44.3%) and angina (22.7% vs. 8.8%). These results
were significant even after controlling for sociodemographic,
psychiatric, and behavioral risk factors. Conclusions: Older adult
recreational gamblers may be at increased risk for psychiatric
comorbidities and obesity relative to non-gamblers, but they may be
less likely to have certain medical conditions. Disordered gambling is
highly comorbid with psychiatric disorders and some medical conditions
in older adults.
Name: Stacey Scott
Home University: University of Notre Dame
Major: Developmental Psychology
Email: sscott5@nd.edu
Mentor(s): Roxane Cohen Silver, Ph.D.
Host University: University of California, Irvine
Research Project: A lifespan perspective on terrorism: Age
differences in trajectories of response to the September 11 attacks
Stacey B. Scott, Michael J. Poulin, Roxane Cohen Silver
Abstract: Age-related differences in response to September 11
were examined in a nationally representative sample of adults, ages
18-101 (N=2812) using Hierarchical linear modeling analyses. Overall,
posttraumatic stress declined over the first year and became stable.
Older age was positively associated with levels of posttraumatic
stress at 2 months and with a steeper decline in the year after 9/11.
Fears of future attacks, while decreasing overall over the course of
the study, showed evidence of higher order trends. Age-differences in
fear trajectories were also apparent. The old-old differed from the
general pattern, declining less rapidly and showing less variability
over time. Age groups were most similar in their fear levels when
potentially fear-provoking events occurred (9/11, onset of the Iraq
war), but diverged as time passed. General distress did not change
over time, but a main effect for age appeared. Age is an important
factor for understanding responses to terrorism over time.
Name: James Williams
Home University: The Johns Hopkins University, Bloomberg School
of Public Health
Major: Psychiatric Epidemiology, PhD
Email: jrw3@jhu.edu
Mentor(s): Laura Marsh, M.D.
Host University: Johns Hopkins School of Medicine
Research Project: Selective Cognitive Impairments Associated
with Executive Dysfunction in Parkinson’s Disease
James R. Williams, M.H.S.1,4, Stephanie Yeager, B.S.2, Laura Marsh,
M.D.2,3,4, Susan S. Bassett, PhD2,4
Department of Mental Health1, Bloomberg School of Public Health,
Departments of Psychiatry2, Neurology3, and Morris K. Udall
Parkinson’s Disease Center4, School of Medicine
The Johns Hopkins University, Baltimore, Maryland
Abstract: Parkinson’s disease (PD) is a progressive
neurodegenerative disease characterized by its hallmark motor
symptoms. Early stages of PD often involve selective cognitive
impairments which can hinder one’s ability to successfully carry out
self-directed behaviors necessary to function independently, i.e.
executive function. Our primary aim was to identify individuals with
executive dysfunction and investigate the specific associated
cognitive impairments, in addition to the role of motor function and
psychiatric illnesses. Impairment in management of medications and/or
finances (measure of executive dysfunction) was self-reported by 18.6%
of this sample with mild to moderate PD. Executive dysfunction was not
associated with global cognitive impairment, but rather selective
deficits in attention, mental processing, and set-shifting as well as
disinhibited or apathetic behaviors. In order to maximize independent
function in this population, interventions need to be tailored to the
cognitive impairments underlying difficulties in carrying out daily
activities such as medication and finance management.
Name: John Worrall
Home University: University of Nevada, Reno
Major: Clinical Psychology
Email:
worrallj@unr.nevada.edu
Mentor(s): Jane Fisher, Ph.D.
Host University: University of Nevada, Reno
Research Project: Social Stimuli, Behavioral Variability and
Successful Aging, John M. Worrall, M.B.A & Jane E. Fisher, Ph.D.
Abstract: Adaptive responding and emotional maturity are often
hallmarks of successfully aged older adults. Video vignettes are being
used to study how healthy older adults respond to stressful social
situations vs. younger adults and older adults with chronic
depression. Participants are being asked to vary their assumptions
about the situations portrayed in the vignettes and to describe their
feelings and behaviors. The assumptions are used to help identify
stimuli that are particularly salient to behavioral variability. It is
hoped that subtle changes in the older person’s environment or the
shaping of different behaviors in response to the environment may be
used to improve outcomes. More data is needed but results from the
pilot study (five participants) appear consistent with the hypothesis
that healthy aging is associated with greater levels of behavioral
variability. Stimuli identified in the pilot involve previous
experience, perceived alternatives and the other person’s perceived
affect, intentions, demeanor, reasonableness and status.
UNDERGRADUATE STUDENTS
Name: Akanksha Thakur
Home University: Wellesley College
Major: Neuroscience
Email:
athakur@mclean.harvard.edu
Mentor(s): Jennifer Manly, Ph.D.
Host University: Columbia University College of Physicians and
Surgeons PH19
Research Project: Immigration, Cognition, and Aging among
Hispanic New York City Residents
Thakur, Akanksha S.; Cabo, Raquel; Sanchez, Danurys L.; Manly,
Jennifer J.
Abstract: There are reports that Hispanic elders are more
likely to develop age-related neurodegenerative diseases. One
potential problem with this line of research is that many
neuropsychological tests have low specificity among Hispanics. The
purpose of this study was to characterize how cultural and educational
experiences of elderly Hispanic immigrants impact their performance on
neuropsychological measures. Participants were 1,081 randomly selected
elderly Hispanic immigrants in Northern Manhattan. Neuropsychological
testing was administered in Spanish, and the battery was factor
analyzed to yield three factors: language, memory, and executive
function. Using multiple regression analysis, there was a significant
effect of time in the US on the language and executive function factor
scores, but there was no effect on the memory factor. The significant
effect of time in the US remained unchanged after years of education
and nationality were accounted for, and was reduced to
non-significance only after factoring in Spanish reading level
(executive function factor) and English fluency (language factor).
Quality of education, measured by Spanish reading level, and
acculturation, measured by English fluency, appear to be the key
background variables modulating cognitive test performance among
Hispanic elders.
Name: Heather Williams
Home University: Duke University
Major: Psychology (BS)
Email: htw@duke.edu
Mentor(s): David Steffens, M.D.
Host University: Duke University Medical Center
Research Project: The role of personality factors in executive
functioning among older depressives and controls
Heather T. Williams, Guy G. Potter, Douglas R. McQuoid, David C.
Steffens
Abstract: This study examined the role of personality factors
in executive function impairment among depressed elders and controls.
It was hypothesized that lower Openness to Experience and higher
Neuroticism in depressed patients would be associated with poorer
scores on executive function tests. Seventy-five depressed individuals
and one hundred three controls over the age of sixty were evaluated
with the NEO Personality Inventory and a neuropsychological battery.
T-tests showed lower Openness to Experience but not higher Neuroticism
to be associated with poorer executive function among depressed
patients but not controls. In regression analyses there was a
significant interaction between case status (depressed vs. control)
and Openness to Experience in predicting performance on three of five
neuropsychological variables. Older individuals who are
dispositionally inclined toward reduced cognitive flexibility and low
receptivity to changes in their environment appear to be more severely
impaired in executive function, raising the possibility of a common
underlying pathway.
Name: Wing Yeung
Home University: Stanford University
Major: Human Biology
Email:
wmyeung@stanford.edu
Mentor(s): Dolores Gallagher-Thompson, Ph.D. and Larry
Thompson, Ph.D.
Host University: Stanford Univ. School of Medicine
Research Project: Distress Levels and Formal Service Usage
Among Differentially Acculturated Chinese-American Caregivers
By Wing Man Yeung, Dolores Gallagher-Thompson, Ph.D., Peng-Chih Wang,
Ph.D., Heather Gray, M.A., and Larry Thompson, Ph.D.
Abstract: Evidence suggests that cultural expectations (Yu,
1984) and role perceptions (Jones 2000) can shape the way Chinese
caregivers perceive stress in their daily lives. Since little research
has focused on Chinese-American caregivers, it is of value to study
differentially acculturated caregivers and their perceptions of
distress and burdens. We assessed caregivers’ distress with
self-reported measures of general mental health and depression that
have been validated for use in this ethnic group. We also obtained a
self-report measure of formal service usage in our Chinese-American
sample. In our findings, the relationship between acculturation and
distress levels was as expected: symptoms of distress and depression
decreased with additional acculturation. We found no significant
relationship between acculturation and formal service usage. Upon
closer inspection, however, we discovered caregivers categorized some
formal services as other services, suggesting the need of a more
culturally-sensitive tool to gauge service usage in Chinese-American
caregivers.
Name: Oluseyi Adeniyi
Home University: University of Michigan Ann Arbor
Major: Biochemsitry
Email: oadeniyi@umich.edu
Mentor(s): Lary Walker, Ph.D.
Host University: Yerkes National Primate Research Center Emory
University
Research Project: Neurofibrillary tangles and intracellular Aß
in normal aging, Alzheimer’s disease and corticobasal degeneration
Oluseyi Adeniyi, Rebecca Rosen, Stephanie Pilato, Todd Preuss, Marla
Gearing, Lary Walker
Abstract: Alzheimer’s disease (AD) is a neurodegenerative
disease characterized by two hallmark lesions: extracellular plaques
with a core of aggregated ß-amyloid (Aß) peptide and intracellular
neurofibrillary tangles (NFTs), which are aggregates of
hyperphosphorylated tau protein. The Aß peptide also accumulates
abnormally within neurons; however, the role of this intracellular Aß
in AD-related neurodegeneration is not yet understood. It is thought
that intracellular interactions between Aß and tau may underlie the
neuronal dysfunction and degeneration seen in AD. In order to shed
light on the location and nature of this interaction, we used
immunohistochemistry with 2 antibodies (4G8 and AT8) to evaluate the
presence of Aß and abnormally phosphorylated tau in neurons in the
superior temporal gyrus of 4 subjects: an AD case, a corticobasal
degeneration case (CBD is a tauopathy with little or no plaque
pathology) and 2 age-matched control subjects. We found that the
neuronal distribution pattern of abnormally phosphorylated tau is
different in the AD and CBD cases while none was detected in the
normal cases. Surprisingly, we also found that the patterns of
intracellular Aß deposition and distribution are similar in all 4
cases. These preliminary data lead us to speculate that interactions
between Aß and tau may occur at a molecular level and thus the nature
and location of the interactions cannot be identified with light
microscopy. Additionally, our data indicate that intracellular
accumulation of the Aß peptide may not correlate with the cognitive
dysfunction seen in AD subjects.
Name: Natalia Escobar
Home University: University of California at Berkeley
Major: Psychology and Social Welfare (Double Major)
Email:
rescobar@berkeley.edu
Mentor(s): Thomas Patterson, Ph.D. and ,
Host University: University of California, San Diego
Research Project: Family Environment and Psychosocial Outcomes
in Older Mexican-Americans with Schizophrenia Natalia Escobar,
Sherrill Goldman, M.A., Brent Mausbach, Ph.D., and Thomas L.
Patterson, Ph.D.
Abstract: Purpose: Family environment is thought to influence
the expression of psychopathology. This study evaluates the
correlation between two elements of family environment, cohesion and
adaptability, and select psychosocial outcomes in older
Mexican-American patients with schizophrenia or schizoaffective
disorder.
Methods: Subjects included 17 Mexican-American patients (monolingual
Spanish-speaking), all participants in the PEDAL Pilot Project.
Patients were assessed in general psychopathology (PANSS and HAM-D),
everyday functioning (UPSA), social skills (SSPA), quality of life
(Lehman QOL), health related quality of well-being (QWB), and family
environment (FACES II).
Results: Higher family cohesion scores were associated with increased
scores in various quality of life elements, although there was a
negative correlation found with degree of satisfaction with social
contact with non-relatives. Higher adaptability scores were also
associated with higher quality of life scores, as well as quality of
well-being scores.
Conclusions: Results are likely affected by the Mexican culture’s
influence on family environment, as well as the living situations of
the study participants (most live with family, as opposed to living
alone or in board and care facilities). Future studies might include
other Hispanic subgroups and compare results to those of
Anglo-American patients.
Name: START-MH Participant
Home University: Harvard University
Major: Medical Anthropology
Mentor(s): Theodore Stern, M.D.
Host University: Harvard Medical School
Research Project: Clinical Challenges to the Delivery of
Geriatric End-of-Life Care
By START-MH Participant and Theodore A. Stern, M.D.
Abstract: Context: End-of-life care is a challenging yet
rewarding aspect of clinical practice. It has been a source of much
consternation to patients and caregivers. Unfortunately, practical
guidelines are often lacking to guide patients and caregivers through
this challenging and emotionally complex process.
Objective: We sought to learn more about end-of-life care and to
better understand the obstacles to effective and compassionate
end-of-life care, especially with regard to elder individuals. Based
upon this knowledge we hoped to make practical recommendations that
would be of assistance to patients, their family members, and the
clinicians who must face and manage care at the end of life.
Methods: We consulted well-respected medical, palliative care, and
psychiatric texts, as well as peer-reviewed articles in the
English-language found on Pub Med and Medline. Literature was gathered
from the years 1991 to 2005. In addition, interviews and discussions
were conducted with patients and clinicians.
Results: Central themes were identified associated with facing death,
loss, impending loss, and grief. Obstacles to well-informed
discussions faced by patients, clinicians and family members were
identified. These can include cognitive impairments, denial and
noncompliance, fear of pain, fear of loneliness, and concerns
regarding spirituality and religion for patients, as well as
inadequate compensation and lack of training for clinicians.
Discussion: Facing death is problematic for patients and health care
providers alike. Each is typically ill prepared because these
discussions generate apprehension, sadness, and other intense affects.
Strategies to enhance these discussions may offer a better
understanding of the context and meaning of illness, reduce distress,
and improve care.
Conclusion: End-of-life care can be improved. Issues and obstacles
surrounding end-of-life care can be faced, as each of us will need to
confront these issues at some point during our lives.
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