Leisure activities impact brain aging and may be prevention targets. We characterized how physica... more Leisure activities impact brain aging and may be prevention targets. We characterized how physical and cognitive activities relate to brain health for the first time in autosomal dominant frontotemporal lobar degeneration (FTLD).
ImportanceKnowledge is lacking on the prevalence and prognosis of individuals with a β-amyloid–ne... more ImportanceKnowledge is lacking on the prevalence and prognosis of individuals with a β-amyloid–negative, tau-positive (A−T+) cerebrospinal fluid (CSF) biomarker profile.ObjectiveTo estimate the prevalence of a CSF A−T+ biomarker profile and investigate its clinical implications.Design, Setting, and ParticipantsThis was a retrospective cohort study of the cross-sectional multicenter University of Gothenburg (UGOT) cohort (November 2019-January 2021), the longitudinal multicenter Alzheimer Disease Neuroimaging Initiative (ADNI) cohort (individuals with mild cognitive impairment [MCI] and no cognitive impairment; September 2005-May 2022), and 2 Wisconsin cohorts, Wisconsin Alzheimer Disease Research Center and Wisconsin Registry for Alzheimer Prevention (WISC; individuals without cognitive impairment; February 2007-November 2020). This was a multicenter study, with data collected from referral centers in clinical routine (UGOT) and research settings (ADNI and WISC). Eligible individual...
Brain iron elevation is implicated in Alzheimer’s disease (AD) pathogenesis, but the impact of ir... more Brain iron elevation is implicated in Alzheimer’s disease (AD) pathogenesis, but the impact of iron on disease outcomes has not been previously explored in a longitudinal study. Ferritin is the major iron storage protein of the body; by using cerebrospinal fluid (CSF) levels of ferritin as an index, we explored whether brain iron status impacts longitudinal outcomes in the Alzheimer’s Disease Neuroimaging Initiative (ADNI) cohort. We show that baseline CSF ferritin levels were negatively associated with cognitive performance over 7 years in 91 cognitively normal, 144 mild cognitive impairment (MCI) and 67 AD subjects, and predicted MCI conversion to AD. Ferritin was strongly associated with CSF apolipoprotein E levels and was elevated by the Alzheimer’s risk allele, APOE-ɛ4. These findings reveal that elevated brain iron adversely impacts on AD progression, and introduce brain iron elevation as a possible mechanism for APOE-ɛ4 being the major genetic risk factor for AD.
Considering reproducibility as the most important factor for longitudinal studies, given low fals... more Considering reproducibility as the most important factor for longitudinal studies, given low false-positive rates and a better preserved, more cohesive temporal structure, currently aggressive ICA-AROMA is likely the most suitable noise regression technique for rs-fMRI studies of older adults.
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring
Alzheimer's disease (AD) and other dementias are a global challenge. Early diagnosis is important... more Alzheimer's disease (AD) and other dementias are a global challenge. Early diagnosis is important to manage the disease. However, there are barriers to diagnosis that differ by region. Researchers from Brazil, China, Nigeria, Spain, and Sweden have identified key barriers to AD diagnosis in their countries. In Brazil, socioeconomic inequalities and poor recognition of dementia by physicians can prevent diagnosis. In China, a very large population and lack of physician training in dementia make diagnosis problematic. In Nigeria, socioeconomic inequalities and cultural stigma can stand in the way of diagnosis. In Spain, patient hesitancy and an overloaded health-care system are barriers to diagnosis. In Sweden, inconsistent use of biomarkers is a prominent barrier to diagnosis of AD. To support diagnosis, more focus is needed on education of patients and physicians, increased use of support services, and improved access to biomarkers to accurately diagnose AD.
Background Alzheimer’s disease, the most common cause of dementia, causes a progressive and irrev... more Background Alzheimer’s disease, the most common cause of dementia, causes a progressive and irreversible deterioration of cognition that can sometimes be difficult to diagnose, leading to suboptimal patient care. Methods We developed a predictive model that computes multi-regional statistical morpho-functional mesoscopic traits from T1-weighted MRI scans, with or without cognitive scores. For each patient, a biomarker called “Alzheimer’s Predictive Vector” (ApV) was derived using a two-stage least absolute shrinkage and selection operator (LASSO). Results The ApV reliably discriminates between people with (ADrp) and without (nADrp) Alzheimer’s related pathologies (98% and 81% accuracy between ADrp - including the early form, mild cognitive impairment - and nADrp in internal and external hold-out test sets, respectively), without any a priori assumptions or need for neuroradiology reads. The new test is superior to standard hippocampal atrophy (26% accuracy) and cerebrospinal fluid b...
Archives of physical medicine and rehabilitation, Jan 24, 2016
To evaluate the extent of variability in functional responses among participants in the LIFE stud... more To evaluate the extent of variability in functional responses among participants in the LIFE study, and to identify the relative contributions of intervention adherence, physical activity, and demographic and health characteristics to this variability. Secondary analysis of the Lifestyle Interventions and Independence for Elders (LIFE) study. Multicenter U.S. institutions participating in the LIFE study. A volunteer sample of 1635 sedentary men and women aged 70 to 89 years who were able to walk 400 m, but had physical limitations, defined as a score on the Short Physical Performance Battery (SPPB) of ≤9. Moderate-intensity physical activity (PA, n=818) consisting of aerobic, resistance and flexibility exercises performed both center-based (twice/wk) and in or around the home environment (3-4 times/wk) or health education (HE, n=817) consisting of weekly to monthly workshops covering relevant health information. Physical function: gait speed over 400-m and lower extremity function (...
Journal of the American Medical Directors Association, Jan 30, 2016
The purpose of this study was to examine the relationship between dynapenia and metabolic risk fa... more The purpose of this study was to examine the relationship between dynapenia and metabolic risk factors in obese and nonobese older adults. A total of 1453 men and women (age ≥70 years) from the Lifestyle Interventions and Independence for Elders (LIFE) Study were categorized as (1) nondynapenic/nonobese (NDYN-NO), (2) dynapenic/nonobese (DYN-NO), (3) nondynapenic/obese (NDYN-O), or (4) dynapenic/obese (DYN-O), based on muscle strength (Foundation for the National Institute of Health criteria) and body mass index. Dependent variables were blood lipids, fasting glucose, blood pressure, presence of at least 3 metabolic syndrome (MetS) criteria, and other chronic conditions. A significantly higher likelihood of having abdominal obesity criteria in NDYN-NO compared with DYN-NO groups (55.6 vs 45.1%, P ≤ .01) was observed. Waist circumference also was significantly higher in obese groups (DYN-O = 114.0 ± 12.9 and NDYN-O = 111.2 ± 13.1) than in nonobese (NDYN-NO = 93.1 ± 10.7 and DYN-NO = ...
Background The need for preventive therapies that interrupt the progression of Alzheimer’s diseas... more Background The need for preventive therapies that interrupt the progression of Alzheimer’s disease (AD) before the onset of symptoms or when symptoms are emerging is urgent and has spurred the ongoing development of disease-modifying therapies (DMTs) in preclinical and early AD (mild cognitive impairment [MCI] to mild dementia). Assessing the meaningfulness of what are likely small initial treatment effects in these earlier stages of the AD patho-clinical disease continuum is a major challenge and warrants further consideration. Body To accommodate a shift towards earlier intervention in AD, we propose meaningful benefits as a new umbrella concept that encapsulates the spectrum of potentially desirable outcomes that may be demonstrated in clinical trials and other studies across the AD continuum, with an emphasis on preclinical AD and early AD (i.e., MCI due to AD and mild AD dementia). The meaningful benefits framework applies to data collection, assessment, and communication acros...
The journal of prevention of Alzheimer's disease, 2017
We examined whether multiple domains of baseline cognitive performance were associated with prosp... more We examined whether multiple domains of baseline cognitive performance were associated with prospective physical activity (PA) adherence in the Lifestyle Interventions and Independence for Elders Pilot study (LIFE-P). The LIFE-P study was a single-blind, multicenter, randomized controlled trial of a PA intervention compared to a successful aging educational intervention in sedentary, mobility-limited older adults. A 12-month structured, moderate-intensity, multi-modal PA program that included walking, resistance training, and flexibility exercises. For the first 2 months (adoption), 3 center-based exercise sessions (40-60 min) / week were conducted. During the next 4 months (transition), center-based sessions were conducted 2 times / week. The subsequent maintenance phase consisted of optional once-to-twice-per-week center-based sessions and home-based PA. Tests of executive and global cognitive functioning, working memory and psychomotor speed were administered at baseline. Median ...
OBJECTIVE: To determine the prevalence of unrecognized lower extremity peripheral arterial diseas... more OBJECTIVE: To determine the prevalence of unrecognized lower extremity peripheral arterial disease (PAD) among men and women aged 55 years and older in a general internal medicine (GIM) practice and to identify characteristics and functional performance associated with unrecognized PAD.
Introduction: The Advancing Research and Treatment in Frontotemporal Lobar Degeneration and Longi... more Introduction: The Advancing Research and Treatment in Frontotemporal Lobar Degeneration and Longitudinal Evaluation of Familial Frontotemporal Dementia Subjects longitudinal studies were designed to describe the natural history of familial-frontotemporal lobar degeneration due to autosomal dominant mutations. Methods: We examined cognitive performance, behavioral ratings, and brain volumes from the first time point in 320 MAPT, GRN, and C9orf72 family members, including 102 non-mutation carriers, 103 asymptomatic carriers, 43 mildly/questionably symptomatic carriers, and 72 carriers with dementia. Results: Asymptomatic carriers showed similar scores on all clinical measures compared with noncarriers but reduced frontal and temporal volumes. Those with mild/questionable impairment showed decreased verbal recall, fluency, and Trail Making Test performance and impaired mood and self-monitoring. Dementia was associated with impairment in all measures. All MAPT carriers with dementia showed temporal atrophy, but otherwise, there was no single cognitive test or brain region that was abnormal in all subjects. Discussion: Imaging changes appear to precede clinical changes in familial-frontotemporal lobar degeneration, but specific early clinical and imaging changes vary across individuals.
All in-text references underlined in blue are linked to publications on ResearchGate, letting you... more All in-text references underlined in blue are linked to publications on ResearchGate, letting you access and read them immediately.
OBJECTIVES: To determine whether body mass index (BMI) is independently associated with cognitive... more OBJECTIVES: To determine whether body mass index (BMI) is independently associated with cognitive function in postmenopausal women and the relationship between body fat distribution as estimated by waist-hip ratio (WHR). DESIGN: Cross-sectional data analysis. SETTING: Baseline data from the Women’s Health Initiative (WHI) hormone trials. PARTICIPANTS: Eight thousand seven hundred forty-five postmenopausal women aged 65 to 79 free of clinical evidence of dementia who completed the baseline evaluation in the WHI hormone trials. MEASUREMENTS: Participants completed a Modified Mini-Mental State Examination (3MSE), health and lifestyle questionnaires, and standardized measurements of
Objective: To build a network of clinical research sites for frontotemporal lobar degeneration (F... more Objective: To build a network of clinical research sites for frontotemporal lobar degeneration (FTLD) spectrum disorders and prepare for clinical trials of new therapeutic agents. Background: The ARTFL consortium aims to A) characterize the North American population of sporadic FTLD patients in preparation for clinical trials (Project 1) and B) characterize longitudinal changes in both asymptomatic and symptomatic familial FTLD (fFTLD) over one year to better understand these disorders and to develop new clinical trial outcome measures (Project 2). ARTFL works closely with the new FTD Disorders Registry (www.ftdregistry.org) for participant recruitment and characterization. Design/Methods: Participants are evaluated with a standardized battery including neurological exams and neuropsychological testing. DNA, plasma, mRNA, and PBMCs are collected and stored at the National Cell Repository for Alzheimer’s Disease. All participants are genotyped for FTLD-associated mutations. Asymptoma...
VOL 58, NO 1 / JANUARY 2009 9 www.jfponline.com IN THIS ARTICLE tient thinks this is a natural co... more VOL 58, NO 1 / JANUARY 2009 9 www.jfponline.com IN THIS ARTICLE tient thinks this is a natural consequence of age. Fran B, a 72-year-old, presents with complaints of memory problems that began about 6 months ago. She’s worried about her son and has had increasing diffi culty concentrating, sleeping, and keeping track of her things. If these were your patients, whom would you screen for dementia? Would you decide whether to screen based on your “gut,” or a defi ned set of criteria? Would you have several screening tools on hand, and know enough about them to determine which one might be best suited for a particular patient? If you make decisions about screening based on your gut or aren’t sure which tools are best for which patients, you’re far from alone. Cognitive impairment, particularly in the early stages, can be diffi cult and time-consuming to detect, and community physicians fail to diagnose mild-to-moderate dementia more than 50% of the time.1-5 Family members and caregivers...
Leisure activities impact brain aging and may be prevention targets. We characterized how physica... more Leisure activities impact brain aging and may be prevention targets. We characterized how physical and cognitive activities relate to brain health for the first time in autosomal dominant frontotemporal lobar degeneration (FTLD).
ImportanceKnowledge is lacking on the prevalence and prognosis of individuals with a β-amyloid–ne... more ImportanceKnowledge is lacking on the prevalence and prognosis of individuals with a β-amyloid–negative, tau-positive (A−T+) cerebrospinal fluid (CSF) biomarker profile.ObjectiveTo estimate the prevalence of a CSF A−T+ biomarker profile and investigate its clinical implications.Design, Setting, and ParticipantsThis was a retrospective cohort study of the cross-sectional multicenter University of Gothenburg (UGOT) cohort (November 2019-January 2021), the longitudinal multicenter Alzheimer Disease Neuroimaging Initiative (ADNI) cohort (individuals with mild cognitive impairment [MCI] and no cognitive impairment; September 2005-May 2022), and 2 Wisconsin cohorts, Wisconsin Alzheimer Disease Research Center and Wisconsin Registry for Alzheimer Prevention (WISC; individuals without cognitive impairment; February 2007-November 2020). This was a multicenter study, with data collected from referral centers in clinical routine (UGOT) and research settings (ADNI and WISC). Eligible individual...
Brain iron elevation is implicated in Alzheimer’s disease (AD) pathogenesis, but the impact of ir... more Brain iron elevation is implicated in Alzheimer’s disease (AD) pathogenesis, but the impact of iron on disease outcomes has not been previously explored in a longitudinal study. Ferritin is the major iron storage protein of the body; by using cerebrospinal fluid (CSF) levels of ferritin as an index, we explored whether brain iron status impacts longitudinal outcomes in the Alzheimer’s Disease Neuroimaging Initiative (ADNI) cohort. We show that baseline CSF ferritin levels were negatively associated with cognitive performance over 7 years in 91 cognitively normal, 144 mild cognitive impairment (MCI) and 67 AD subjects, and predicted MCI conversion to AD. Ferritin was strongly associated with CSF apolipoprotein E levels and was elevated by the Alzheimer’s risk allele, APOE-ɛ4. These findings reveal that elevated brain iron adversely impacts on AD progression, and introduce brain iron elevation as a possible mechanism for APOE-ɛ4 being the major genetic risk factor for AD.
Considering reproducibility as the most important factor for longitudinal studies, given low fals... more Considering reproducibility as the most important factor for longitudinal studies, given low false-positive rates and a better preserved, more cohesive temporal structure, currently aggressive ICA-AROMA is likely the most suitable noise regression technique for rs-fMRI studies of older adults.
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring
Alzheimer's disease (AD) and other dementias are a global challenge. Early diagnosis is important... more Alzheimer's disease (AD) and other dementias are a global challenge. Early diagnosis is important to manage the disease. However, there are barriers to diagnosis that differ by region. Researchers from Brazil, China, Nigeria, Spain, and Sweden have identified key barriers to AD diagnosis in their countries. In Brazil, socioeconomic inequalities and poor recognition of dementia by physicians can prevent diagnosis. In China, a very large population and lack of physician training in dementia make diagnosis problematic. In Nigeria, socioeconomic inequalities and cultural stigma can stand in the way of diagnosis. In Spain, patient hesitancy and an overloaded health-care system are barriers to diagnosis. In Sweden, inconsistent use of biomarkers is a prominent barrier to diagnosis of AD. To support diagnosis, more focus is needed on education of patients and physicians, increased use of support services, and improved access to biomarkers to accurately diagnose AD.
Background Alzheimer’s disease, the most common cause of dementia, causes a progressive and irrev... more Background Alzheimer’s disease, the most common cause of dementia, causes a progressive and irreversible deterioration of cognition that can sometimes be difficult to diagnose, leading to suboptimal patient care. Methods We developed a predictive model that computes multi-regional statistical morpho-functional mesoscopic traits from T1-weighted MRI scans, with or without cognitive scores. For each patient, a biomarker called “Alzheimer’s Predictive Vector” (ApV) was derived using a two-stage least absolute shrinkage and selection operator (LASSO). Results The ApV reliably discriminates between people with (ADrp) and without (nADrp) Alzheimer’s related pathologies (98% and 81% accuracy between ADrp - including the early form, mild cognitive impairment - and nADrp in internal and external hold-out test sets, respectively), without any a priori assumptions or need for neuroradiology reads. The new test is superior to standard hippocampal atrophy (26% accuracy) and cerebrospinal fluid b...
Archives of physical medicine and rehabilitation, Jan 24, 2016
To evaluate the extent of variability in functional responses among participants in the LIFE stud... more To evaluate the extent of variability in functional responses among participants in the LIFE study, and to identify the relative contributions of intervention adherence, physical activity, and demographic and health characteristics to this variability. Secondary analysis of the Lifestyle Interventions and Independence for Elders (LIFE) study. Multicenter U.S. institutions participating in the LIFE study. A volunteer sample of 1635 sedentary men and women aged 70 to 89 years who were able to walk 400 m, but had physical limitations, defined as a score on the Short Physical Performance Battery (SPPB) of ≤9. Moderate-intensity physical activity (PA, n=818) consisting of aerobic, resistance and flexibility exercises performed both center-based (twice/wk) and in or around the home environment (3-4 times/wk) or health education (HE, n=817) consisting of weekly to monthly workshops covering relevant health information. Physical function: gait speed over 400-m and lower extremity function (...
Journal of the American Medical Directors Association, Jan 30, 2016
The purpose of this study was to examine the relationship between dynapenia and metabolic risk fa... more The purpose of this study was to examine the relationship between dynapenia and metabolic risk factors in obese and nonobese older adults. A total of 1453 men and women (age ≥70 years) from the Lifestyle Interventions and Independence for Elders (LIFE) Study were categorized as (1) nondynapenic/nonobese (NDYN-NO), (2) dynapenic/nonobese (DYN-NO), (3) nondynapenic/obese (NDYN-O), or (4) dynapenic/obese (DYN-O), based on muscle strength (Foundation for the National Institute of Health criteria) and body mass index. Dependent variables were blood lipids, fasting glucose, blood pressure, presence of at least 3 metabolic syndrome (MetS) criteria, and other chronic conditions. A significantly higher likelihood of having abdominal obesity criteria in NDYN-NO compared with DYN-NO groups (55.6 vs 45.1%, P ≤ .01) was observed. Waist circumference also was significantly higher in obese groups (DYN-O = 114.0 ± 12.9 and NDYN-O = 111.2 ± 13.1) than in nonobese (NDYN-NO = 93.1 ± 10.7 and DYN-NO = ...
Background The need for preventive therapies that interrupt the progression of Alzheimer’s diseas... more Background The need for preventive therapies that interrupt the progression of Alzheimer’s disease (AD) before the onset of symptoms or when symptoms are emerging is urgent and has spurred the ongoing development of disease-modifying therapies (DMTs) in preclinical and early AD (mild cognitive impairment [MCI] to mild dementia). Assessing the meaningfulness of what are likely small initial treatment effects in these earlier stages of the AD patho-clinical disease continuum is a major challenge and warrants further consideration. Body To accommodate a shift towards earlier intervention in AD, we propose meaningful benefits as a new umbrella concept that encapsulates the spectrum of potentially desirable outcomes that may be demonstrated in clinical trials and other studies across the AD continuum, with an emphasis on preclinical AD and early AD (i.e., MCI due to AD and mild AD dementia). The meaningful benefits framework applies to data collection, assessment, and communication acros...
The journal of prevention of Alzheimer's disease, 2017
We examined whether multiple domains of baseline cognitive performance were associated with prosp... more We examined whether multiple domains of baseline cognitive performance were associated with prospective physical activity (PA) adherence in the Lifestyle Interventions and Independence for Elders Pilot study (LIFE-P). The LIFE-P study was a single-blind, multicenter, randomized controlled trial of a PA intervention compared to a successful aging educational intervention in sedentary, mobility-limited older adults. A 12-month structured, moderate-intensity, multi-modal PA program that included walking, resistance training, and flexibility exercises. For the first 2 months (adoption), 3 center-based exercise sessions (40-60 min) / week were conducted. During the next 4 months (transition), center-based sessions were conducted 2 times / week. The subsequent maintenance phase consisted of optional once-to-twice-per-week center-based sessions and home-based PA. Tests of executive and global cognitive functioning, working memory and psychomotor speed were administered at baseline. Median ...
OBJECTIVE: To determine the prevalence of unrecognized lower extremity peripheral arterial diseas... more OBJECTIVE: To determine the prevalence of unrecognized lower extremity peripheral arterial disease (PAD) among men and women aged 55 years and older in a general internal medicine (GIM) practice and to identify characteristics and functional performance associated with unrecognized PAD.
Introduction: The Advancing Research and Treatment in Frontotemporal Lobar Degeneration and Longi... more Introduction: The Advancing Research and Treatment in Frontotemporal Lobar Degeneration and Longitudinal Evaluation of Familial Frontotemporal Dementia Subjects longitudinal studies were designed to describe the natural history of familial-frontotemporal lobar degeneration due to autosomal dominant mutations. Methods: We examined cognitive performance, behavioral ratings, and brain volumes from the first time point in 320 MAPT, GRN, and C9orf72 family members, including 102 non-mutation carriers, 103 asymptomatic carriers, 43 mildly/questionably symptomatic carriers, and 72 carriers with dementia. Results: Asymptomatic carriers showed similar scores on all clinical measures compared with noncarriers but reduced frontal and temporal volumes. Those with mild/questionable impairment showed decreased verbal recall, fluency, and Trail Making Test performance and impaired mood and self-monitoring. Dementia was associated with impairment in all measures. All MAPT carriers with dementia showed temporal atrophy, but otherwise, there was no single cognitive test or brain region that was abnormal in all subjects. Discussion: Imaging changes appear to precede clinical changes in familial-frontotemporal lobar degeneration, but specific early clinical and imaging changes vary across individuals.
All in-text references underlined in blue are linked to publications on ResearchGate, letting you... more All in-text references underlined in blue are linked to publications on ResearchGate, letting you access and read them immediately.
OBJECTIVES: To determine whether body mass index (BMI) is independently associated with cognitive... more OBJECTIVES: To determine whether body mass index (BMI) is independently associated with cognitive function in postmenopausal women and the relationship between body fat distribution as estimated by waist-hip ratio (WHR). DESIGN: Cross-sectional data analysis. SETTING: Baseline data from the Women’s Health Initiative (WHI) hormone trials. PARTICIPANTS: Eight thousand seven hundred forty-five postmenopausal women aged 65 to 79 free of clinical evidence of dementia who completed the baseline evaluation in the WHI hormone trials. MEASUREMENTS: Participants completed a Modified Mini-Mental State Examination (3MSE), health and lifestyle questionnaires, and standardized measurements of
Objective: To build a network of clinical research sites for frontotemporal lobar degeneration (F... more Objective: To build a network of clinical research sites for frontotemporal lobar degeneration (FTLD) spectrum disorders and prepare for clinical trials of new therapeutic agents. Background: The ARTFL consortium aims to A) characterize the North American population of sporadic FTLD patients in preparation for clinical trials (Project 1) and B) characterize longitudinal changes in both asymptomatic and symptomatic familial FTLD (fFTLD) over one year to better understand these disorders and to develop new clinical trial outcome measures (Project 2). ARTFL works closely with the new FTD Disorders Registry (www.ftdregistry.org) for participant recruitment and characterization. Design/Methods: Participants are evaluated with a standardized battery including neurological exams and neuropsychological testing. DNA, plasma, mRNA, and PBMCs are collected and stored at the National Cell Repository for Alzheimer’s Disease. All participants are genotyped for FTLD-associated mutations. Asymptoma...
VOL 58, NO 1 / JANUARY 2009 9 www.jfponline.com IN THIS ARTICLE tient thinks this is a natural co... more VOL 58, NO 1 / JANUARY 2009 9 www.jfponline.com IN THIS ARTICLE tient thinks this is a natural consequence of age. Fran B, a 72-year-old, presents with complaints of memory problems that began about 6 months ago. She’s worried about her son and has had increasing diffi culty concentrating, sleeping, and keeping track of her things. If these were your patients, whom would you screen for dementia? Would you decide whether to screen based on your “gut,” or a defi ned set of criteria? Would you have several screening tools on hand, and know enough about them to determine which one might be best suited for a particular patient? If you make decisions about screening based on your gut or aren’t sure which tools are best for which patients, you’re far from alone. Cognitive impairment, particularly in the early stages, can be diffi cult and time-consuming to detect, and community physicians fail to diagnose mild-to-moderate dementia more than 50% of the time.1-5 Family members and caregivers...
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Papers by Diana Kerwin