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MEDICAL STUDENTS
Name: Deepa Bhupali
Home University: Wright State University School of Medicine
Major: Medicine
Email:
deepabhupali@yahoo.com
Mentor(s): Jane Pearson, Ph.D.
Host University: National Institute of Mental Health
Research project: Side Effect Measures for Antidepressant
Medications: A Review
Authors: Deepa Bhupali, B.A. and Jane Pearson, Ph.D.
Abstract: Since June 2003, the FDA has been investigating
claims that selective serotonin reuptake inhibitors (SSRIs) cause an
increased risk of suicidal thoughts and behavior when compared to
placebo. The major obstacle in comparing trials of the same
medications, and medications of the same class, is the lack of a
consistently used tool to assess side effects of SSRIs. A literature
review of currently used side effect measures identified challenges
involved in creating a standardized tool, and examined whether
measures used with geriatric samples differed from those used with
younger adult or youth samples. Currently there are no clinically
used measures specific to a geriatric population. The lack of
standardized language, along with issues of timing and patient and
clinician acceptability across measures are among the obstacles
identified. Recommendations as to what qualities are most important
in the creation of a standardized side effect inquiry and assessment
tool are presented.
Name: Stephanie Chow
Home University: SUNY at Buffalo School of Medicine and
Biomedical Sciences
Major: Medicine
Email:
swchow@alum.mit.edu
Mentor(s): Debby Tsuang, M.D., M.Sc.
Host University: University of Washington
Research project: Diagnostic Accuracy of Concomitant Lewy-Related
Pathology in a Kindred with Familial Alzheimer's Disease: a
Clinical-Neuropathological Study
Authors: Stephanie W. Chow, Martha Peterson, Darcy J. Vavrek,
Ellen Steinbart, Thomas D. Bird, James B. Leverenz, Debby W. Tsuang
Abstract: Dementia with Lewy bodies(DLB) is recognized as the
second commonest neurodegenerative dementia after Alzheimer’s
Disease(AD). There is substantial clinical and neuropathological
overlap between DLB and AD and between DLB and Parkinson disease
(PD). Due to differences in illness course and treatment response
between patients with and without Lewy Related Pathology(LRP), early
and accurate clinical identification of LRP patients with dementia
consistent with AD is important. We applied the 2005 consortium
clinical diagnosis for DLB to one family and examined whether the
clinical diagnosis of DLB was confirmed by neuropathological
findings. Five of six cases met consensus criteria for probable and
possible dementia with Lewy bodies and had neuropathologically
confirmed LRP. Only one subject with a clinical diagnosis of
possible DLB did not have LRP, despite having had visual
hallucinations. In a family with clinical and neuropathological AD,
application of consensus DLB criteria resulted in an accurate
diagnosis of concomitant LRP.
Name: Larissa Dobransky
Home University: Drexel University College of Medicine
Major: Medicine
Email:
lars15sky@yahoo.com
Mentor(s): Hillary Bogner, M.D.
Host University: University of Pennsylvania
Research project: Patient Ethnicity and Informant Perceptions
Regarding the Need for Depression Treatment
Authors: Larissa N Dobransky BS, Hillary R Bogner MD MSCE
Abstract: PURPOSE: Black Americans are less likely than white
Americans to seek professional treatment for depression. Whether
treatment recommendations are sought and implemented by patients
will be influenced by the role families play in diagnostic
acceptance and treatment decisions. We investigated the association
of ethnicity with the perceived need for treatment of depression by
informants of older primary care patients.
METHOD: Cross-sectional survey of 355 older adults with and without
significant depressive symptoms. At the baseline visit, informants’
ratings of apathy and need for depression treatment were obtained on
314 of the 355 patients who completed the in-home interviews.
RESULTS: Older black patients were less likely to be rated as
needing depression treatment by their informants across the entire
range of Center for Epidemiological Studies Depression Scale (CES-D).
Informants were significantly less likely to rate black patients
with a CES-D score of 24 and over as needing depression treatment
(19%) compared to white patients with a CES-D score of 24 and over
(47%; p=0.02). This difference was not explained by informant
ratings of patient apathy, cognition, and physical function. Older
black patients were less likely to be rated as needing depression
treatment by their informants (Odds Ratio (OR) = 0.34; 95%
Confidence Interval (CI) = [0.18, 0.64]) adjusting for severity of
depressive symptoms, cognition, functional status, and other
potentially influential characteristics.
CONCLUSIONS: Our study suggests that patient ethnicity may play a
role in the informant perceived need for depression treatment of
older adults who present in the primary care setting. Further study
of attitudes, expectations, and values of patients and family
members in primary care settings may help elucidate the interplay of
physician, patient, and family.
Name: Nicholas Frost
Home University: University of Maryland School of Medicine
Major: M.D/Ph.D.
Email:
nfros001@umaryland.edu
Mentor(s): Thomas Blanpied, Ph.D.
Host University: University of Maryland, Baltimore
Research project: Localization And Kinetics Of Actin Dynamics
In Dendritic Spines Controlled By Protein Interactions At The
Postsynaptic Density
Authors: Nicholas A. Frost, Steven Zhan, Thomas A. Blanpied
Abstract: In the brain, communication between neurons takes
place at points of connection called synapses. Synapses are
inherently plastic, and can undergo rapid changes in morphology and
molecular content. Such synaptic plasticity is required for
developmentally regulated changes in behavior and cognition, and
underlies learning and memory throughout the lifespan. We are
investigating the cellular mechanisms that dynamically control
synapse structure and function.
Most excitatory synapses take place on small, bulbous protrusions
from the neuronal dendrite called dendritic spines. A broad variety
of neuropsychiatric and neurological diseases are accompanied by
patterns of spine disruption. For instance, one of the earliest
changes in Alzheimer’s disease brain pathology is a loss of
dendritic spines, which precedes the more well-known neuronal death
that occurs in advanced stages. The onset of dementia in fact
correlates more strongly with spine loss than cell death. In
addition, the major hereditary mental retardation syndromes, Fragile
X and Down’s, are accompanied by changes in spine morphology, in
particular a decrease in mature spines and an increase in elongated
protrusions that resemble spine precursors called filopodia.
Schizophrenia, on the other hand, is accompanied by a reduced spine
density in neurons of the prefrontal cortex, and area known to be
affected in the disease. Thus, abnormal spine growth and structure
accompanies, and likely underlies, diverse psychiatric pathology.
The major determinant of spine morphology is the intracellular actin
cytoskeleton. Spines are rich in actin, and polymerization and
depolymerization of branching actin filaments in the spine has
recently been shown to be rapidly regulated. This actin turnover
provides the fundamental mechanism of spine morphological change.
Name: Kathleen (Katie) Hecksel
Home University: Mayo Clinic School of Medicine
Major: Medicine
Email:
hecksel.kathleen@mayo.edu
Mentor(s): J. Michael Bostwick, M.D.
Host University: Mayo Clinic College of Medicine
Research project: Atypical Compulsions in a Southeastern
Minnesota Population of Parkinson's Disease Patients on Dopamine
Agonist Drugs
Authors: Hecksel KA, Bostwick JM, Ahlskog JE
Abstract: In a Southeastern Minnesota community-based
population, 1.6% (8/503) of idiopathic Parkinson’s disease (PD)
patients developed atypical compulsions between 2004 and 2006. Among
these, 87.5 % (7/8) of patients were on the dopamine agonist drugs,
pramipexole or ropinirole (at doses used to treat PD). During the
year after a case series was published by Dodd et al. reporting a
link between dopamine agonist drugs and pathological gambling [1],
compulsions were discussed three times more often (6.3% [15/238] in
2005-2006 vs. 1.9% [5/265] in 2004-2005) by providers at the Mayo
Clinic and new diagnosis of compulsions among this PD population
nearly doubled to 2.1% (5/238 compared to 3/265 the previous year).
In 2004-2005, 4.5% (3/66) of patients on dopamine agonist drugs
developed compulsions. All three patients with compulsions in
2004-2005 were on dopamine agonist drugs. In 2005-2006, 8.8% (5/57)
of patients taking dopamine agonist drugs developed compulsions;
only 16.7% (1/6) patients were not on a dopamine agonist drug at the
onset of their compulsive behavior. While most compulsive behaviors
in this population involved gambling and hypersexuality, two
patients identified in 2004-2005 compulsively engaged in hobbies
(yard work and stained glass design, respectively). In addition, 57%
(4/7) of patients with compulsive behavior on dopamine agonist drugs
had more than one type of compulsion.
Name: Elisabeth Hurliman
Home University: University of Minnesota
Major: Medicine
Email: hurli001@umn.edu
Mentor(s): Jose V. Pardo, M.D., Ph.D.
Host University: University of Minnesota
Research project: Glucose Brain Metabolism and Cognitive
Performance in Healthy Aging
Authors: Elisabeth Hurliman, Joel T. Lee, Sohail A. Sheikh,
Christa Surerus-Johnson, Kristin R. Munch, John V. Carlis, Scott M.
Lewis, Michael A. Kuskowski, Laura L. Salvati, Maurice W. Dysken &
Jose V. Pardo
Abstract: Metabolic and cognitive changes associated with
healthy and pathological aging require further study. Establishing a
cognitive and biological profile of aging in healthy older adults
will aid in making the diagnostic differential of pathological
cognitive and brain-based decline in an aging population. This
project seeks to identify brain metabolic changes and cognitive
performance correlated with aging.
A normative database of healthy subjects was used for this study.
All subjects completed a physical exam, cognitive screening,
structural MRI, FDG PET, and DNA buccal swab collection.
Metabolism in several brain regions showed significantly negative
correlations with age. These regions include the dorsal medial
prefrontal cortex, anterior cingulate, basal forebrain, and
dorsomedial thalamus. Cognitive performance decline correlated with
changes in metabolism in medial brain regions. Ongoing study
activities include DNA analysis for APOE genotyping and high field
MR spectroscopy to further identify metabolites associated with
healthy aging in the identified regions of interest.
Name: Donovan Maust
Home University: Johns Hopkins University School of Medicine
(JHUSOM)
Major: Medicine
Email: donovan@jhmi.edu
Mentor(s): Peter Rabins, M.D.
Host University: John Hopkins Hospital
Research project: Treatment decisions for nursing home
residents with advanced dementia:
The Care of Nursing Home Residents with Advanced Dementia Study (CareAD)
Authors: Donovan T. Maust, BS, David M. Blass, MD, Betty S.
Black, PhD, Peter V. Rabins, MD, MPH
Abstract: Background: Dementia differs from other terminal
illness in progression and the fact that many do not perceive it as
a cause of death. Given the role of surrogate decision-makers, it is
important to describe and better understand decision-making in
advanced dementia. Objective: Identify characteristics associated
with surrogate decisions regarding aggressive treatment in advanced
dementia. Methods: 123 residents and their surrogates from three
nursing homes agreed to participate. Using logistic regression
models, variables reflecting demographics, illness, communication,
and surrogate background were explored for association with
treatment. Results: White race, male gender, and worse surrogate
perception of resident quality of life (QOL) were all predictors of
decisions to not provide treatment. Treatment decisions were not
associated with surrogate or resident age, relationship, or
surrogate religiosity. Conclusions: Surrogate decision-makers are
less likely to provide aggressive care for patients who are white,
male, or perceived to have worse QOL. The observed gender difference
and lack of association with religiosity suggest areas for further
study.
Name: Rachel Solomon
Home University: Yale University
Major: Medicine
Email:
rachel.solomon@yale.edu
Mentor(s): Paul Kirwin, M.D.
Host University: Yale University
Research project: Longitudinal Evaluation of Quality of Life
in Older Persons with Advanced Illness
Authors: Rachel Solomon, BA; Terri Fried, MD; Peter van Ness,
PhD, John O’Leary, MA, Paul Kirwin, MD
Abstract: Background: It is generally assumed that, in older
adults, quality of life decreases as illness progresses. Maintaining
good quality of life in the face of declining health may tell us
something about qualities that facilitate adaptive response to
adversity.
Methods: 226 community dwelling individuals 60 years of age and
older with limited life expectancy due to cancer, congestive heart
failure, or chronic obstructive pulmonary disease were surveyed at
least every four months for up to two years. During each interview
quality of life (QOL) was assessed by both the Missoula Vitas
Quality of Life Index (MVQOLI) and a global question: “How would you
rate your overall quality of life?”
Results: Quality of life in this population is highly variable over
time. Nearly 50% of participants report two or more changes in the
directions of their QOL trajectories. These results indicate that a
decline in QOL is not an inevitable part of advancing illness. We
also determined that the MVQOLI is not effectively capturing change
in QOL as reflected by the global item.
Our future work will examine the relationships between
sociodemographic, health status, and psychosocial variables with the
global single-item QOL question.
Name: Julia Switzer
Home University: Jefferson Medical College
Major: Medicine
Email:
julia.switzer@jefferson.edu
Mentor(s): Marsha Wittink, M.D.
Host University: University of Pennsylvania
Research project: Using Conjoint Analysis to Assess
Preferences for Depression Treatment in Primary Care
Authors: Julia Switzer, BA and Marsha Wittink, MD
Abstract: Objective: To determine the feasibility of using
conjoint analysis to assess the features of depression management in
primary care that older patients find most acceptable. Background
and Methods: Primary care is an important site for the
identification and treatment of depression in older adults.
Incorporating patient preferences into treatment protocols may
improve satisfaction and compliance. Conjoint analysis was developed
in market research to measure consumer preferences judgments by
forcing respondents to make tradeoffs by assigning relative
importance to particular attributes of a product. We used conjoint
analysis to understand what aspects of medication (side effects and
severity of side effects) and counseling (timing and location of
sessions) are most valued and therefore most likely to improve
treatment uptake. Results: At time of presentation, 23 patients had
completed the conjoint task. Patients preferred counseling to
medication and this distinction contributed to 38% of the overall
preference decision. Patients preferred counseling in the doctor’s
office rather than the office of a mental health professional or
place of worship and location contributed to 28% of the overall
decision. Type of side effect, severity of side effect and the
number of counseling sessions did not strongly influence decision
making. Conclusions: Conjoint analysis can be used in a primary care
setting to study preferences for depression treatment. People in
this sample strongly prefer counseling to medication but the
attributes we selected did not fully explain what it is that people
like better about counseling. This project is ongoing in order to
more precisely describe patient preferences for depression
treatments.
Name: Janice Ngee Foong Thai
Home University: Stony Brook University School of Medicine
Major: Medicine
Email:
ngeefoong.thai@hsc.stonybrook.edu
Mentor(s): Eric R. Kandel, M.D.
Host University: Columbia University
Research project: The Effect of Chaperone Proteins on the
Prion-Like Aggregation Properties of Mouse CPEB-3
Authors: Janice N.F. Thai, Kim D. Allen, Jennifer Lee, Martin
Theis, Eric R. Kandel
Abstract: A key question in neuroscience is what are the
molecular factors that govern the changes in synaptic strength that
underlie learning and memory– and how, in light of the turnover of
cellular substrates, such changes persist. In pursuit of this, Si et
al., (2003) identified a neuronal form of a translational regulator,
Aplysia CPEB, as essential for the long-term facilitation associated
with memory formation. Additionally, he found that Aplysia CPEB
exhibited significant features of prions of yeast and hypothesized
that these features allow CPEB activity to propagate over time (Si,
Lindquist and Kandel, 2003). Such prion-like properties include the
ability of CPEB to exist in two different conformational states, the
soluble and aggregate states. The aggregated state is transmissible
and self-propagating by converting the soluble form into the
aggregated form. Four CPEB gene families have been identified in the
mouse hippocampus (Theis, Si and Kandel, 2003). One of these,
CPEB-3, also bears a Q/N rich N-terminal domain similar to the prion-forming
domains of yeast and is the most likely functional homolog of
Aplysia CPEB. CPEB-3 is regulated by dopamine and is inducible by
neuronal stimulation. We have found that, like other prions,
CPEB-3-GFP fusion proteins readily form aggregates in yeast. Certain
chaperone proteins play key roles in aggregate formation in both fly
and yeast models of prion propagation, including studies with the
mammalian prion, PrP. The most famous of these chaperones, is Hsp104
(Chernoff et al., 1995). Here we show that as in the case of other
prions, everexpression of Hsp104 greatly reduces the frequency of
CPEB-3 aggregates detected by fluorescence microscopy by as much as
six fold and completely eliminates the aggregate (pellet) fraction
resolved by centrifugation fractionation analysis. Furthermore, we
have found that members of two highly conserved chaperone families;
Hsp70 and Hsp40 also exert significant differential effects on the
prion-like aggregation properties of mouse CPEB-3 in vivo. While
overexpression of Hsp70 antagonizes CPEB-3-GFP aggregation and
eliminates the pellet fraction resolved from yeast lysates, excess
Hsp40 has the opposite effect, doubling the number of cells bearing
visible CPEB-3-GFP aggregates and stabilizing the pellet fraction.
Unlike Hsp104, for which no animal ortholog has been identified,
both Hsp70 and Hsp40 are present in neurons. Hsp40 in particular has
been shown to play crucial roles in synaptic plasticity. These data
suggest the existence of a conserved system of regulation of
aggregate formation that could modulate CPEB-3 activity at the
synapse.
Name: Michael Ward
Home University: University of Wisconsin-Madison
Major: Medicine
Email: maward2@wisc.edu
Mentor(s): Sterling Johnson, Ph.D.
Host University: University of Wisconsin Madison
Research project: Effect of vascular risk, APOE genotype, and
family history of Alzheimer’s disease on brain white matter in
asymptomatic middle-aged adults
Authors: Michael A. Ward, Timothy M. Hess, Cynthia M.
Carlsson, Mehul A. Trivedi, Britta M. Jabbar, Howard A. Rowley,
Sanjay Asthana, Mark A. Sager, Sterling C. Johnson
Abstract: Background: Vascular risk factors are common in
American adults, contributing not only to cardiovascular disease
pathology, but also to changes in the structure and function of the
brain associated with Alzheimer’s disease (AD). In cognitively
impaired older adults, vascular risk factors are associated with
deleterious brain white matter (WM) changes and cognitive decline.
The purpose of this study was to determine whether the relationship
between vascular risk factors and WM and cognition is also observed
in cognitively healthy adults between the ages of 40 and 65, and
whether APOE genotype or family history of AD, or both alter this
effect. Methods: T1-weighted 3D volumetric magnetic resonance
imaging was used to examine regional brain WM for 201 individuals
(average = 54.6 years; standard deviation = 6.4 years; 71 male and
130 female) using voxel-based morphometry. A multiple linear
regression model was used to assess the effect of vascular risk,
APOE genotype, and family history of AD on regional brain WM and
various parameters of cognition. Variables used to assess vascular
risk included body mass index, systolic and diastolic blood pressure
(BP), and non-fasting total serum cholesterol. Results: Increased
vascular risk was associated with diffuse brain WM concentration
changes in the cerebrum, cerebellum, and brainstem bilaterally with
the largest change occurring within the centrum semiovale
bilaterally. Systolic BP was the main contributor of this affect on
WM change. The deleterious effects of systolic BP on brain WM were
exacerbated for individuals with a family history of AD and were
independent of APOE genotype. Vascular risk factors, APOE genotype,
and family history of AD had no affect on learning memory, working
memory, cognitive speed, or global mental status. Conclusions: These
findings suggest that late middle-aged adults with increased
vascular risk may already be experiencing deleterious brain WM
changes. Further, this effect appears to be exacerbated for
individuals with a family history of AD and therefore may
potentially put them at greater risk for future cognitive decline.
Name: Rachel Weisenfeld
Home University: Wayne State University - School of Medicine
Major: Medicine
Email:
rweisenf@med.wayne.edu
Mentor(s): Peter Lichtenberg, Ph.D.
Host University: Wayne State University
Research project: Comprehensive Geriatric Mental Health
Treatment Plan (CGMHTP)
Authors: Rachel Weisenfeld, B.S. and Peter Lichtenberg,
Ph.D., ABPP
Abstract: The Comprehensive Geriatric Mental Health Treatment
Plan (CGMHTP) was designed to ensure that elderly patients in
long-term care receive adequate psychiatric assessment and
treatment. This study analyzed patients at a long-term care facility
in Dearborn, MI. Behave-AD scores were collected initially and at 3
months for 68 individuals, and werevshown to have significantly
decreased for those patients who were seen by psychiatry as compared
to those who were not. These findings confirmed our hypothesis and
point towards the importance of future research in this area,
hopefully leading to a change in the standard of care in geriatric
psychiatry.
GRADUATE STUDENTS
Name: Ann Aspnes
Home University: Duke University
Major: Clinical Psychology
Email: aspnes@duke.edu
Mentor(s): David C. Steffens, M.D.
Host University: Duke University Medical Center
Research project: Perseveration and Suicidality in Older
Adults with Depression Authors: Ann K. Aspnes, MA, and David C.
Steffens, MD
Abstract: Older adults have the highest suicide rate of any
group of American adults. The discovery of more specific indicators
of risk could aid clinicians and researchers in developing more
targeted interventions. Cognitive rigidity, such as perseveration in
neuropsychological testing, may contribute to suicide risk, and may
therefore identify older adults at higher suicide risk. The current
study examines this hypothesis in 227 older adults with major
depression who have participated in NIMH Clinical Research Center
for the Study of Depression in Later Life at Duke University.
Chi-square analyses found no significant association between recent
suicidal ideation or past suicide attempt and perseverative errors
made on tests of verbal fluency and visual memory. While the
findings did not support the present hypothesis, a likely
explanation is that perseverative errors are a better marker of
lower-order cognitive dysfunction rather than cognitive rigidity in
higher-order functions, such as social problem solving, which have
been associated with suicidality in past research.
Name: Stacey Cherup
Home University: University of Nevada, Reno
Major: Clinical Psychology
Email:
cherups@unr.nevada.edu
Mentor(s): Jane E. Fisher, Ph.D.
Host University: University of Nevada, Reno
Research project: Restraint Free Approaches to the Care of
Persons With Dementia
Authors: Stacey Cherup, B.S. and Jane Fisher, Ph.D.
Abstract: This project is investigating a contextual,
restraint-free approach to preventing behavioral disturbances in
persons with dementia. Given the adaptive function of behavioral
disturbances the goal of intervention is to promote the maintenance
of behavior and prevent excess disability. Five residents with
dementia residing at a long-term care facility were included as they
were reported by staff to be exhibiting especially difficult
behaviors. Phase 1 involved completion of questionnaires by staff
aimed at determining what the problem behaviors were, their context,
and their frequency. Phase 2 was baseline, where the behaviors were
directly observed and the consistency between the raters and the
actual behaviors were assessed. Phase 3 will involve the development
and implementation of individualized interventions. Staff training
will accompany each intervention, as well as staff trainings after
the completion of all interventions to promote continuation of the
interventions and generalization to other resident behaviors in the
facility
Name: Heather Fuller Iglesias
Home University: University of Michigan
Major: Developmental Psychology
Email: hfuller@umich.edu
Mentor(s): Toni Antonucci, Ph.D.
Host University: University of Michigan
Research project: Family Relations and Depression during the
Transition to Old Age
Authors: Heather Fuller Iglesias & Toni C. Antonucci, Ph.D.
Abstract: Social relations have an important influence on
mental health across the lifespan, particularly in late life. In the
current study we focus on how family relations influence depression
as individuals make the transition from middle age to old age. Using
longitudinal data from the Survey of Social Relations we examined
how quality of relationships with spouse and child and proportion of
family in social network are related to depressive symptoms over a
period of 12 years. Using structural equation modeling (SEM) we
found that increases in positive relations with spouse at Wave 1
were related to decreases in depressive symptoms at Wave 2 while
increasing depressive symptoms at Wave 1 was related to increased
negative quality of relations with child at Wave 2. People with a
higher proportion of family in social network at Wave 1 were more
likely to report increased depressive symptoms at Wave 2. We employ
the Convoy Model to interpret results as well as discuss
implications for future research.
Name: Michelle Hilgeman
Home University: University of Alabama
Major: Psychology
Email:
hilge001@bama.ua.edu
Mentor(s): Rebecca Allen, Ph.D.
Host University: The University of Alabama
Research project: Coping with a Life-Limiting Illness: An
Exploration of Socioemotional Selectivity Theory in Caregiving Dyads
Authors: Michelle M. Hilgeman & Rebecca S. Allen, Ph.D.
Abstract: Socioemotional selectivity theory posits that as
individuals being to perceive time as limited, emotional goals
(e.g., interpersonal closeness) are prioritized over future-oriented
ones (e.g., knowledge attainment). We explored differences in future
time perspective (FTP) between caregivers (CG) and care recipients
(CR) as well as racial differences between White and African
American participants (22 caregiving dyads; N=43) coping with a
life-limiting illness. Significant predictors of FTP included age,
religious coping, and an interaction between CR/CG status and race,
while subjective health was nonsignificant. Older individuals and
those with less religious coping reported more limited FTP.
Furthermore, CGs reported similar perceptions of time regardless of
race; however, for CRs African Americans had the most expansive
perception of time, while Whites had the most limited FTP. A better
understanding of cultural differences in FTP within the caregiving
context may inform future interventions designed to impact quality
of life and health care decisions in this population.
Name: Evanne Juratovac
Home University: Case Western Reserve University (Case)
Major: PhD / nursing
Email:
evanne.juratovac@case.edu
Mentor(s): May Wykle, Ph.D.
Host University: Case Western Reserve University
Research project: Understanding Effort in Family Caregiving:
A Pilot Study
Authors: Evanne Juratovac, MSN, RN (APRN-BC), May Wykle, PhD,
RN, FAAN, FGSA, Diana Morris, PhD, RN, FAAN, FGSA
Abstract: Effort explains how workers balance demands or
stressors of work to prevent undesirable health outcomes. Caregiving
is work, mostly done by families, and is associated with a
disproportionate prevalence of adverse health outcomes, including
depression. This study addressed effort in family caregiving, as it
may relate to the workload demands and health consequences of
caregiving. A purposive sample of family caregivers participated in
focus groups to describe effort as it related to their caregiving
responsibilities, and completed a questionnaire about their
caregiving situation, depressive symptoms (CES-D-10), and effort
(pilot visual analog scale [VAS, 0-10]). These participants were all
Caucasian and resided with the care receiver; and most were female,
married, college-educated, and at least 60 years of age. They were a
mix of kin, and cared for older adults with a variety of chronic
conditions. The mean physical effort estimation on the VAS was 4.4;
and the mean mental and psychological effort was considerably
higher, at 6.6 and 7.6 respectively. Effort tended to co-vary with
depression: While half of the group reported no depressive symptoms
(CES-D-10) and lower effort, half had near ceiling depression scores
and considerably higher effort. Initial themes elicited from the
audiotaped focus group data are: Effort involves using energy,
making choices, control, learning, and balancing between one’s
expectations and the care receiver’s needs. Mental effort
predominated over physical effort in caregiving, yet inner effort
manifested physiologically, supporting a psychophysics
conceptualization of effort. Limitations of these findings include
the small number of initial informants. This work is ongoing: A
secondary recruitment strategy (mass-mailing) was added for two
additional focus groups. Data from these focus groups will be used
to design a scale to measure effort in caregiving, and interventions
for caregivers.
Name: Amanda Lehning
Home University: University of California at Berkeley
Major: Social Welfare
Email:
ajlehning@berkeley.edu
Mentor(s): Andrew Scharlach, Ph.D.
Host University: University of California, Berkeley
Research project: Mental Health Service Use in Nursing Homes
Authors: Amanda J. Lehning, MSS & Andrew Scharlach, PhD
Abstract: Background: Nursing homes have become the primary
providers of care for Americans diagnosed with a mental disorder.
Some researchers estimate the prevalence of mental illness among
nursing home residents ranged from 75 to 91 percent. Mental illness
can exert a significant negative impact on the functioning of both
the resident and the nursing home. Research evidence suggests,
however, that very few residents are receiving any mental health
treatment.
Methods: Using data from the Current Resident Survey of the 1999
National Nursing Home Survey, this study addressed the following
research questions:
1. What percentage of nursing home residents with a diagnosed mental
disorder receives mental health services?
2. What resident and facility characteristics predict mental health
service use?
Results: Nearly 40% of nursing home residents in this sample have at
least one mental disorder, only 26% of which receive mental health
services. Residents who receive mental health services are younger,
less likely to be married, and are more likely to be covered by
Medicaid, require assistance managing money, and live in a
for-profit facility that has 100 or more beds.
Conclusion: Findings indicate that nursing homes are not addressing
the mental health needs of a majority of nursing home residents with
a diagnosed mental disorder. Future research is needed to determine
why such a small proportion of residents receive mental health
treatment.
Name: Weiling Liu
Home University: Pacific Graduate School of Psychology
Major: Clinical Psychology
Email: wliu@pgsp.edu
Mentor(s): Larry Thompson, Ph.D. and Dolores
Gallagher-Thompson
Host University: Stanford University School of Medicine
Research project: Investigating the Influence of
Acculturation on Caregiving Burden and Strategies in
Chinese-American Dementia Caregivers
Authors: Weiling Liu, M.S., Larry Thompson, PhD, Heather L.
Gray, M.A.,
Dolores Gallagher-Thompson, PhD, and Peng-Chih Wang, PhD
Abstract: The process of dementia caregiving and its impact
on the Chinese-American family is not well known or documented. The
purpose of this study was to investigate acculturation’s effects on
burden experience and coping styles in Chinese-American dementia
caregivers. A total of 44 Chinese female caregivers (aged 34 to 80)
who provided at least eight hours a week of ongoing care to a
Chinese elderly relative with cognitive impairment were enrolled.
Participants were randomized to one of two intervention programs:
in-home intervention or minimal telephone support. Sessions were
conducted in English or a Chinese dialect. Results showed when
negative coping was low, the less Westernized experience greater
burden than the more Westernized. However, when negative coping was
high there was no difference between the two groups. While the
greater the use of positive coping the greater the level of burden,
whereas this relationship was not evident in the more Westernized
group.
Name: Roopa Mahadevan
Home University: Stanford University
Major: Psychology
Email:
roopam@stanford.edu
Mentor(s): Ruth O'Hara, Ph.D.
Host University: Stanford
University School of Medicine
Research project: Genetics and Neurocognitive Aging: 5-HTT
and APOE show interactive effect on
cortisol, hippocampal volume, and delayed recall performance in
community-dwelling, older adults
Authors: Ruth O'Hara, Ph.D. and Roopa Mahadevan
Abstract: The variability in the age of onset and scope of
neurodegenerative events among older adults has suggested that
genetics, particularly 5-HTT and APOE, might be an important
predictor of susceptibility to age-related disorders of cognition
and mood. Other studies have looked to stress to explain variability
in age-related neurocognitive outcomes, based on theories of
glucocorticoid-induced neurotoxicity in the hippocampus. Most
probably, both genetic and stress-based mechanisms are at work in
synergy to confer neural instability with age. Caspi (2003) found
that 5-HTT moderates the relationship between stressful life events
and depressive symptoms. Peskind (2001) found APOE status to be
associated with elevated glucocorticoid levels in AD patients.
However, the relational nature of the two genes in association with
stress, cognition, and the hippocampus has not been studied in
normally aging, older populations as yet. To this end, our study
looked at 5-HTT and APOE genotype and physiological stress (cortisol)
in relation to cognition (delayed recall performance) and
hippocampal volume (structural MRI). This was assessed in 154
healthy, male and female, older adults. The study revealed 5-HTT to
be a strong mediator of the effect of stress on cognitive outcomes,
a relationship that has important implications for the detection and
prevention of dementia and other age-related neurodegenerative
disorders of cognition and mood.
Name: Martin Morthland
Home University: University of Alabama
Major: Clinical Adult Psychology
Email:
morth001@bama.ua.edu
Mentor(s): Forrest Scogin, Ph.D.
Host University: University of Alabama
Research project: Technology Assisted Intervention for
Improving Mood: Developing a treatment program
Authors: Martin Morthland, M.Phil., & Forrest Scogin, Ph.D.
Abstract: This project examined the feasibility of using a
computer-assisted therapy program as an intervention to improve
older adults’ mood. The software was designed and the hardware was
chosen to accommodate older adults’ usage. The software was written
as an easy to use stand-alone program in C++ language. The hardware
was a tablet-PC that presents the program in a form that required a
stylus to navigate. The program contained five sessions of
Cognitive-Behavioral Therapy (CBT) that lasted approximately 45
minutes each. Content material was largely based on
Cognitive-Behavioral Therapy for Late Life Depression (Dick et al.,
1995). The goal of creating an easy-to-use, self-administered
computer intervention that may be used to improve the mood of older
adults was met. Knowledge of CBT techniques had increased and
ratings of satisfaction were high following the program. Further
development of this program appears feasible based on the program’s
performance and the participants’ opinions.
Name: Karon Phillips
Home University: University of South Florida
Major: Aging Studies (Ph.D. Program) & Public
Health-Department of Community and Family Health (MPH program)
Email:
kphillip@hsc.usf.edu
Mentor(s): David Chiribiga, Ph.D. and Yuri Jang, Ph.D.
Host University: University of South Florida
Research project: Predictors of Depression among Older
African American Men and Women
Authors: Karon L. Phillips, David Chiriboga, Ph.D., Yuri
Jang, Ph.D.
Abstract: Issue/Problem: Among adults age 65 and older,
African Americans are more likely to report that they have
depressive symptoms than White Americans (Turnbull & Mui, 1995).
African American women are more likely to suffer from depression
than African American men and White men (Brown & Keith, 2003). The
purpose of this study was to assess the predictors of depression
among older African American men and women.
Methods: The data used came from the Survey of Older Floridians.
Participants were asked questions pertaining to the following areas:
depression (a 10-item short form of the Center for Epidemiologic
Studies-Depression Scale (CES-D)), demographic variables (age, in
years, gender, marital status, annual income, and education, chronic
conditions, functional disability, self-rated health, and church
attendance. The participants were all age 65 and older. The final
sample size used in the present study was 360.
Analysis: Using bivariate correlations and multiple regression
analysis, correlates and predictors of depressions were examined. To
assess the predictors of depression
regression models were tested with the entry order of predictors
being (1) demographic variables (age, marital status, education, and
income), (2) health conditions (chronic conditions and functional
disability) and (3) additional predictors of health (self-reported
health and church attendance).
Conclusions: The results indicated that there are significant
differences in predictors of depression among older African American
men and women. Women displayed more predictors of depression than
men. Gender alone was not a predictor of these differences.
Name: Gauri Savla
Home University: San Diego State University/ University of
California, San Diego Joint Doctoral Program in Clinical Psychology
Major: Clinical Psychology
Email: gnayak@ucsd.edu
Mentor(s): Barton Palmer, Ph.D.
Host University: University of California, San Diego
Research project: Course of Neurocognitive Deficits in
Later-Life Bipolar Disorder
Name: Emily Schoenhofen
Home University: University of Southern California
Major: Clinical Psychology
Email: schoenho@usc.edu
Mentor(s): Margaret Gatz, Ph.D.
Host University: University of Southern California
Research project: Are Optimists at a Decreased Risk for
Cognitive Decline?
Authors: Emily Schoenhofen
Abstract: The purpose of this study was to examine the
relationship between positive personality traits and cognitive
decline. The sample for analysis was derived from the Swedish Twin/
Adoption Study of Aging (SATSA) study. SATSA obtained both
personality data (e.g. Agreeableness, Conscientiousness, Optimism,
and Openness to Experience) and longitudinal cognitive data.
Approximately 858 participants completed both personality data and
had at least one cognitive measurement. Latent growth curve models
were fit to assess performance scores at age 65 and decline in
cognitive performance over time. It was hypothesized that
individuals who endorsed higher levels of the positive personality
traits at baseline would have higher cognitive test scores at age 65
and lesser rates of cognitive decline. Results indicated that higher
levels of Openness to Experience were beneficial for both males and
females, even after controlling for education. Other personality
traits varied by sex and were sometimes contrary to the original
hypothesis.
Name: Mark Weinberger
Home University: University of Massachusetts Amherst
Major: Clinical Psychology
Email:
mark@psych.umass.edu
Mentor(s): Jo Anne Sirey, Ph.D. and Robert Abrams, M.D.
Host University: Weill Cornell Medical College
Research project: Predictors of Recovery from Major
Depression Among Adults Seeking Mental Health Care from Community
Clinics
Authors: Mark I. Weinberger, M.S., Jo Anne Sirey, Ph.D.,
Moonseong Heo, Ph.D., Eros Papademetriou, M.A., Martha L. Bruce,
Ph.D., & Barnett S. Meyers, M.D.
Abstract: Objective: To report on rate and predictors of
recovery among adults with major depression seeking mental health
outpatient care.
Method: Two-stage sampling technique was used to identify
individuals diagnosed as having Major Depressive Disorder (MDD).
Assessments of individual, clinical and functional characteristics
as well as treatment adequacy were conducted at admission, three,
and six months after seeking care. Logistic regression analyses were
conducted to evaluate the impact of hypothesized predictors of six
month recovery from depressive symptoms.
Results: Better physical functioning, fewer previous psychiatric
hospitalizations, three-month recovery status and adequacy of early
pharmacotherapy were predictors of six month recovery.
Conclusion: Our findings support the important impact of physical
disability, early treatment adequacy and the severity of prior
depressive episodes in charting the course of depression in
community settings. Identification of early non-response and
inadequate pharmacotherapy by three months could change the course
of the depression over time.
UNDERGRADUATE STUDENTS
Name: John Gilbert
Home University: Duke University
Major: Psychology (B.S.) – Neurosciences Concentration;
Biology (B.S.)
Email: jwg23@duke.edu
Mentor(s): Sarah H. Lisanby, M.D.
Host University: Columbia University
Research project: Current and Future Applications of
Repetitive Transcranial Magnetic Stimulation (rTMS) in Geriatric
Psychiatry
Authors: John W. Gilbert and Sarah H. Lisanby, MD
Abstract: An exploratory review of the literature on the use
of repetitive transcranial magnetic stimulation (rTMS) in geriatric
psychiatry was conducted to assess its potential therapeutic
applications in elderly populations. The review is divided into
three areas in which rTMS has been studied as a potential treatment:
depression, post-stroke rehabilitation, and age-related cognitive
decline. While rTMS has been validated as a safe and effective
treatment for depression in normal populations, results in the
elderly remain inconclusive. Little effort has been made to
distinguish among the various subtypes of depression and dosimetry
issues continue to confound research results. The use of rTMS in
post-stroke rehab and cognitive improvement is better supported, but
the impact of age-related anatomical and physiological changes on
treatment parameters remains poorly understood. Future directions
are suggested to assess why the elderly brain responds differently
to magnetic stimulation, with the goal of insight on the mechanism
by which rTMS acts on the brain more generally.
Name: Nonna Kozlenko
Home University: University of South Florida
Major: Gerontology/Bio-medical Sciences
Email:
nkozlenk@mail.usf.edu
Mentor(s): William E. Haley, Ph.D.
Host University: University of South Florida
Research project: Depressive Symptoms, Chronic Conditions, and
Active Life Expectancy in Older Adults
Authors: Sandra.L.Reynolds, Ph.D., William E. Haley, Ph.D.&
Nonna Kozlenko, A. A.
Abstract: This study addresses whether there is a link
between Depressive Symptoms (DS) and subsequent disability and
mortality that is independent of the presence of chronic disease in
men and women aged 70 years and older. We use 3 waves of AHEAD data
to examine transitions between 2 live states (active and disabled),
and death. These transitions are used to estimate Total, Active, and
Disabled Life Expectancy for older adults, with or without DS; then
with or without DS, in the presence or absence of cancer, diabetes,
heart disease, and stroke. Findings indicate that DS has independent
and negative effects on both mortality and disability; while the
exact effects depend on timeframe and methodology used, we rarely
find that the chronic conditions eliminate the effect of DS on
either mortality or disability. The implications are that Depressive
Symptoms represent a potentially harmful influence on both the
length and quality of remaining life for older adults, whether they
occur with or without co-morbidity.
Name: Jasmine Rodriguez
Home University: Hampton University
Major: Psychology
Email:
jasmine.rodriguez@pipeline.hamptonu.edu
Mentor(s): Jennifer J. Manley, Ph.D.
Host University: Columbia University
Research project: Examining acculturation, educational
attainment levels, literacy and
neuropsychological measures as predictors of depression in an
ethnically diverse geriatric population
Name: Jonathan Walgama
Home University: Austin College
Major: Biology
Email:
jwalgama@austincollege.edu
Mentor(s): Mark Kunik, M.D.
Host University: Baylor College of Medicine
Research project: Quality of Care: Aggression in a VA Sample
of Newly Diagnosed Dementia Patients
Authors: Mark E. Kunik, MD, MPH, Jonathan P. Walgama, A. Lynn
Snow, PhD, Jessica A. Davila, PhD, Paul E. Schulz, Avila B. Steele,
PhD, Robert O. Morgan, PhD
Abstract: Aggression is commonly associated with dementia,
yet it is highly under diagnosed and often inappropriately treated.
Practice guidelines support a search for underlying biopsychosocial
causes and initial use of non-pharmacologic interventions. Using
practice guidelines as a benchmark for standard care, we examined
the recognition, assessment and treatment of aggression in patients
newly diagnosed with dementia. Participants were ? 60 years age
diagnosed with dementia at the Michael E. DeBakey VA Medical Center
in Houston, TX, from 2001 to 2004. Of 385 eligible patients screened
by telephone using the Ryden Aggression Scale, 75 were found to be
aggressive. Charts of these 75 patients were reviewed 12 months
before and 3 months after telephone screening. Aggression had been
recognized in 31 (42%) of the 75 patients. Non-pharmacologic
interventions had been used in only 11(35%) of the 31 patients with
recognized aggression, while pharmacologic interventions were used
in 66 (88%) of the 75 patients and in all patients with recognized
aggression. Patients with recognized aggression had more psychiatric
comorbidities and received more psychotropic medications than
patients with unrecognized aggression. |
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