OBJECTIVE:To examine the effect of 2 instructions on the same walking while talking (WWT) task on task prioritization by nondisabled subjects.DESIGN:Cross-sectional survey with within subject comparisons.SETTING:Community-based sample.PARTICIPANTS:Older adults (N=189; mean age, 80.2+/-4.9y), who did not meet criteria from the Diagnostic and Statistical Manual, Fourth Edition, for dementia and were able to independently perform activities of daily living.INTERVENTIONS:Not applicable.MAIN OUTCOME MEASURES:Verbal and gait measures on the same WWT task with 2 different instructions: paying attention to both talking and walking (WWT-C) and paying attention only to talking (WWT-T).RESULTS:Task prioritization effects were seen on walking but not on talking. Compared with their baseline normal walking velocity (without talking), subjects slowed down more on WWT-T (median change, 28.3%) than WWT-C (median change, 26.4%). Comparing the 2 WWT conditions, velocity and cadence was slower during WWT-T compared with WWT-C, with longer stride length. Verbal output was not significantly different on the 2 conditions.CONCLUSIONS:Changing instructions while maintaining the same cognitive and motor tasks on WWT in older adults result in task prioritization effects.

Impaired recall for early items (primacy) and late items (recency) on word list recall tests are seen in Alzheimer's disease (AD). We compared conventional scoring on the Telephone Instrument for Cognitive Status (TICS) recall list with scorings based on retention-weighted recall (RWR: each item weighted by its serial position) in older adults participating in a community-based aging study. Subjects with mild AD (N=18) did not differ from those without dementia (N=231) with respect to recency (46% vs. 59%, p = 0.2), but had impaired primacy (2% vs. 39%, p < .001) on word recall on the TICS. RWR scoring improved the effect size (1.52 SD) compared to conventional scoring (1.08 SD). With a fixed sensitivity of 85%, specificity was lower using conventional scoring (56%) than RWR (76%) scoring. Our findings suggest that optimized RWR scoring of word list free recall can improve detection of mild AD compared to conventional scoring.

High educational acheivment has been shown to be protective against Alzheimer's Disease (AD). The cognitive reserve hypothesis suggests that this is because it is associated with greater cognitive reserve and thus higher cognitive performance for a given level of disease burden. It thus predicts that greater education and or occupational acheivement is associated with more rapid rates of decline proximal to the time of diagnosis due to increased disease burden. To test the cognitive reserve hypothesis by examining the effect of education and lifetime occupational achievement on memory decline during the preclinical course of dementia. We estimated rates of memory decline on the free recall score of the Buschke and Grober Free and Cued Selective Reminding Test with Immediate Recall (FCSRT–IR) as a function of education (measured in years) and occupational achievement (9 point scale) in 94 participants in the Einstein Aging Study age 70–97 who had detailed cognitive assessments at entry and at annual follow–up visits, and were diagnosed with incident dementia (70% AD or mixed). Linear mixed models were used to estimate the rate of cognitive decline as a function of time to diagnosis, and education or occupational achievement. Participants scored a mean of 23.5 on the FCSRT–IR (sd 8.2) at baseline and reported a mean of 12.6 years of formal education, with mean occupational achievement of 5.6. Occupational achievement and education were highly correlated (Spearman 0.67). The median follow up time before dementia diagnosis was 1.8 years (max 11.3 years). Participants reporting occupational achievement 4 or less declined 1.44 points per year (95% CI 0.68–2.20) on the FCSRT compared to 2.34 points per year (95% CI 1.91–2.78) for persons reporting occupational achievement 5 or higher. The difference was statistically significant (p=.045). Participants reporting 12 or fewer years of formal education declined 1.72 points per year (1.24, 2.19) and participants reporting more than 12 years declined 2.61 (1.94, 3.29) points per year, a statistically significant difference (p=.035). Thus as predicted by the cognitive reserve hypothesis, greater occupational and educational achievement are associated with more rapid cognitive decline in the years prior to dementia diagnosis.

Borson S, Scanlan JM, Chen P, Ganguli M. The Mini-Cog as a screen for dementia: validation in a population-based sample. J Am Geriatr Soc 2003;51:1451–4.[OpenUrl][1][CrossRef][2][PubMed][3][Web of Science][4] Q Does the Mini-Cog, a rapid cognitive screening test, accurately detect dementia in older people? ### ![Graphic][5]Design: Prospective cohort study. ### ![Graphic][6]Setting: 23 rural communities, Pennsylvania, USA; recruitment initiated early 1990s. ### ![Graphic][7]Patients: A subset of 1119 elderly people (mean age 73 years) randomly drawn from an age stratified random sample of 17 000 people from the Monongahela Valley Independent Elders Survey (MoVIES). Participants were aged >65 years, had a minimum of 6 years of formal education, and were living in the community. ### ![Graphic][8]Test: The Mini-Cog is a rapid screening test comprising two cognitive tasks: a … [1]: {openurl}?query=rft.jtitle%253DJournal%2Bof%2Bthe%2BAmerican%2BGeriatrics%2BSociety%26rft.stitle%253DJ%2BAm%2BGeriatr%2BSoc%26rft.aulast%253DBorson%26rft.auinit1%253DS.%26rft.volume%253D51%26rft.issue%253D10%26rft.spage%253D1451%26rft.epage%253D1454%26rft.atitle%253DThe%2BMini-Cog%2Bas%2Ba%2Bscreen%2Bfor%2Bdementia%253A%2Bvalidation%2Bin%2Ba%2Bpopulation-based%2Bsample.%26rft_id%253Dinfo%253Adoi%252F10.1046%252Fj.1532-5415.2003.51465.x%26rft_id%253Dinfo%253Apmid%252F14511167%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/external-ref?access_num=10.1046/j.1532-5415.2003.51465.x&link_type=DOI [3]: /lookup/external-ref?access_num=14511167&link_type=MED&atom=%2Febmental%2F7%2F2%2F38.atom [4]: /lookup/external-ref?access_num=000185535900016&link_type=ISI [5]: /embed/inline-graphic-1.gif [6]: /embed/inline-graphic-2.gif [7]: /embed/inline-graphic-3.gif [8]: /embed/inline-graphic-4.gif

total number of drugs received were independent predictors of blood pressure variability in multivariate analysis. The study found that, with a follow-up interval of 6 to 12 weeks, standardizing the blood pressure measurement procedures did not reduce the observed variation of blood pressure in geriatric patients. Instead of focusing on clinic policy, geriatricians should consider other alternatives for blood pressure monitoring, such as home self-monitoring if patients with high blood pressure variation were encountered. Further evaluations on the effect of alternative blood pressure measurement strategies in clinic practices are required. The full story on blood pressure monitoring will also require cost-effectiveness measures for different blood pressure measurement strategies.

Objective To compare the Double Memory Test (DMT) with standard memory tests in the diagnosis of early dementia. Background Diagnosis of dementia requires memory impairment, but few memory tests coordinate acquisition and retrieval to optimize encoding specificity for high sensitivity and specificity. The DMT was developed to improve early diagnosis. Design We compared the discriminative validity of the DMT, Paired Associates (PA), and Logical Memory (LM) memory tests in a nested case-control study of 30 cases of early dementia and 90 controls matched for age, education, and sex. Methods The DMT includes memory tests with (CCR) and without (ICR) encoding specificity. Both tests use category cues to elicit retrieval, but CCR optimizes encoding specificity because the same cues are used for acquisition and retrieval. ICR does not because category cues are used only for retrieval. We used conditional logistic regression to estimate diagnostic sensitivity and specificity. Results The median BIMC of dementia cases was 10, indicating mild dementia. CCR had much higher sensitivity (93%) and specificity (99%) than ICR (53%, 94%), PA (68%, 91%), and LM (48%, 92%). CCR had the greatest advantage in the mildest cases. Conclusions CCR has substantially higher sensitivity and specificity for diagnosis of early dementia than memory tests that do not coordinate acquisition and retrieval. Superior discrimination by CCR is due to an encoding specificity deficit in dementia that increases the difference in recall by cases and controls. CCR is an efficient test with excellent discriminative validity that should facilitate diagnosis of early dementia.

Right- and left-handed subjects performed a visual line bisection task with each hand. When bisecting horizontal lines, both groups bisected left of true center regardless of hand used. Regardless of hand preference, bisections were significantly left of center only when subjects performed with their left hand. Left-handed subjects using their left hand deviated significantly further left than right-handed subjects using their left hand. Regardless of hand used, right-handers bisected vertical lines significantly above veridical center. Left-handed subjects were not significantly above center with either hand. The results require both hemispheric advantage and lateralized activation affects for a complete explanation.

Right- and left-handed subjects performed a visual line bisection task with each hand. When bisecting horizontal lines, both groups bisected left of true center regardless of hand used. Regardless of hand preference, bisections were significantly left of center only when subjects performed with their left hand. Left-handed subjects using their left hand deviated significantly further left than right-handed subjects using their left hand. Regardless of hand used, right-handers bisected vertical lines significantly above veridical center. Left-handed subjects were not significantly above center with either hand. The results require both hemispheric advantage and lateralized activation effects for a complete explanation.