Heidi Splete

WASHINGTON – An exercise program designed to overcome neural deficits improved elders' walking more than physical therapy that focused on lower-body muscles did, results of a randomized, controlled trial of the two approaches show.

Standard physical therapy aimed at building strength, flexibility, balance, and endurance has been shown to improve gait in older adults, but only modestly, said Jessie Van Swearingen, Ph.D., a physical therapist and rehabilitation specialist at the University of Pittsburgh. So she and her colleagues looked for an option.

“There is evidence that the brain has a significant impact on gait,” she said while presenting the study at the annual meeting of the American Geriatrics Society. “We thought about motor learning because changes in gray-matter volume have been associated with slow speed and gait changes.”

“Motor-learning” exercises involve goal-oriented stepping and walking, such as practicing stepping across and behind. Dr. Dr. Van Swearingen and her colleagues randomized 25 community-dwelling adults (average age 77 years) with gait problems to each of the interventions, which then took place in small group settings under the supervision of a physical therapist. Each group participated in 40- to 60-minute activity sessions twice a week for 12 weeks. Each session included 20–30 minutes of walking. Three people dropped out of the study for reasons unrelated to either intervention.

The motor-learning group practiced walking patterns including ovals, spirals, and serpentine paths. As the participants improved, they advanced to more-challenging walking patterns.

Participants in both groups showed improvements in gait abnormalities and walking speed during the study, but the motor-learning group's average improvements were significantly better than those of the standard group. Neither group reported a difference in perceived exertion after the interventions. Dr. Van Swearingen stated that she had no relevant financial conflict to disclose.

WASHINGTON – An exercise program designed to overcome neural deficits improved elders' walking more than physical therapy that focused on lower-body muscles did, results of a randomized, controlled trial of the two approaches show.

Standard physical therapy aimed at building strength, flexibility, balance, and endurance has been shown to improve gait in older adults, but only modestly, said Jessie Van Swearingen, Ph.D., a physical therapist and rehabilitation specialist at the University of Pittsburgh. So she and her colleagues looked for an option.

“There is evidence that the brain has a significant impact on gait,” she said while presenting the study at the annual meeting of the American Geriatrics Society. “We thought about motor learning because changes in gray-matter volume have been associated with slow speed and gait changes.”

“Motor-learning” exercises involve goal-oriented stepping and walking, such as practicing stepping across and behind. Dr. Dr. Van Swearingen and her colleagues randomized 25 community-dwelling adults (average age 77 years) with gait problems to each of the interventions, which then took place in small group settings under the supervision of a physical therapist. Each group participated in 40- to 60-minute activity sessions twice a week for 12 weeks. Each session included 20–30 minutes of walking. Three people dropped out of the study for reasons unrelated to either intervention.

The motor-learning group practiced walking patterns including ovals, spirals, and serpentine paths. As the participants improved, they advanced to more-challenging walking patterns.

Participants in both groups showed improvements in gait abnormalities and walking speed during the study, but the motor-learning group's average improvements were significantly better than those of the standard group. Neither group reported a difference in perceived exertion after the interventions. Dr. Van Swearingen stated that she had no relevant financial conflict to disclose.

WASHINGTON – An exercise program designed to overcome neural deficits improved elders' walking more than physical therapy that focused on lower-body muscles did, results of a randomized, controlled trial of the two approaches show.

Standard physical therapy aimed at building strength, flexibility, balance, and endurance has been shown to improve gait in older adults, but only modestly, said Jessie Van Swearingen, Ph.D., a physical therapist and rehabilitation specialist at the University of Pittsburgh. So she and her colleagues looked for an option.

“There is evidence that the brain has a significant impact on gait,” she said while presenting the study at the annual meeting of the American Geriatrics Society. “We thought about motor learning because changes in gray-matter volume have been associated with slow speed and gait changes.”

“Motor-learning” exercises involve goal-oriented stepping and walking, such as practicing stepping across and behind. Dr. Dr. Van Swearingen and her colleagues randomized 25 community-dwelling adults (average age 77 years) with gait problems to each of the interventions, which then took place in small group settings under the supervision of a physical therapist. Each group participated in 40- to 60-minute activity sessions twice a week for 12 weeks. Each session included 20–30 minutes of walking. Three people dropped out of the study for reasons unrelated to either intervention.

The motor-learning group practiced walking patterns including ovals, spirals, and serpentine paths. As the participants improved, they advanced to more-challenging walking patterns.

Participants in both groups showed improvements in gait abnormalities and walking speed during the study, but the motor-learning group's average improvements were significantly better than those of the standard group. Neither group reported a difference in perceived exertion after the interventions. Dr. Van Swearingen stated that she had no relevant financial conflict to disclose.

Risk factors for mild cognitive impairment and progression from mild cognitive impairment to dementia are not the same for men and women, findings from a population-based study of 6,892 adults aged 65 years and older show.

Identifying the risk factors that cause mild cognitive impairment (MCI) to progress to dementia can help determine which patients might benefit from treatment, Sylvaine Artero of the Institut National de la Santé et de la Recherche Médicale (INSERM) U888, Montpellier, France, and colleagues reported

Previous studies have addressed the risk factors for progression from MCI to Alzheimer's disease and dementia, but most of those have not involved a general population and have not addressed gender-specific factors.

To determine the gender-specific factors that predict progression of MCI to dementia, the investigators recruited 6,892 community-dwelling adults aged 65 years and older and followed them for 4 years. The average age of the participants was 74 years, and approximately half were women. The study was based on a large multicenter prospective study on brain aging sponsored in part by Sanofi-Synthelabo.

A total of 2,882 participants (42%) met the criteria for MCI at baseline. Over the next 4 years, 189 were diagnosed with dementia, 1,626 maintained a diagnosis of MCI, and 1,067 returned to a normal level of function (J. Neurol. Neurosurg. Psychiatry 2008 May 1 [doi:10.1136/jnnp.2007.136903]).

Overall, 8% of men with MCI developed dementia, compared with 6% of the women, but women were significantly less likely than men to return to normal cognitive function (36% vs. 39%) and significantly more likely to maintain a diagnosed cognitive disorder over the 4-year follow-up period (58% vs. 53%).

In a multivariate analysis, older age significantly predicted progression to dementia in men and women.

In men, progression from mild cognitive impairment to dementia was more than three times as likely if they had the apoE4 allele, and more than twice as likely in those with a history of stroke, a low level of education, or difficulty with daily activities as measured by the Instrumental Activities of Daily Living scale (IADL).

In women, progression from mild cognitive impairment to dementia was more than three times as likely if they had IADL deficits and more than twice as likely if they had the apoE4 allele, a low level of education, or subclinical depression. And the odds of progressing to dementia were almost twice as high in women who took anticholinergic inhibitors (odds ratio 1.8).

Significant predictors of progression from MCI to dementia in both men and women in a less rigorous, univariate analysis included the apoE4 genotype, hypertension, diabetes, age, a low level of education, low intelligence, subclinical depression, stroke, social isolation, and difficulty with at least one activity of daily living. “MCI cases in the general population can be differentiated by a much larger number of sociodemographic and clinical factors than previously observed,” the investigators wrote.

The investigators said they had no financial conflicts to disclose.

Risk factors for mild cognitive impairment and progression from mild cognitive impairment to dementia are not the same for men and women, findings from a population-based study of 6,892 adults aged 65 years and older show.

Identifying the risk factors that cause mild cognitive impairment (MCI) to progress to dementia can help determine which patients might benefit from treatment, Sylvaine Artero of the Institut National de la Santé et de la Recherche Médicale (INSERM) U888, Montpellier, France, and colleagues reported

Previous studies have addressed the risk factors for progression from MCI to Alzheimer's disease and dementia, but most of those have not involved a general population and have not addressed gender-specific factors.

To determine the gender-specific factors that predict progression of MCI to dementia, the investigators recruited 6,892 community-dwelling adults aged 65 years and older and followed them for 4 years. The average age of the participants was 74 years, and approximately half were women. The study was based on a large multicenter prospective study on brain aging sponsored in part by Sanofi-Synthelabo.

A total of 2,882 participants (42%) met the criteria for MCI at baseline. Over the next 4 years, 189 were diagnosed with dementia, 1,626 maintained a diagnosis of MCI, and 1,067 returned to a normal level of function (J. Neurol. Neurosurg. Psychiatry 2008 May 1 [doi:10.1136/jnnp.2007.136903]).

Overall, 8% of men with MCI developed dementia, compared with 6% of the women, but women were significantly less likely than men to return to normal cognitive function (36% vs. 39%) and significantly more likely to maintain a diagnosed cognitive disorder over the 4-year follow-up period (58% vs. 53%).

In a multivariate analysis, older age significantly predicted progression to dementia in men and women.

In men, progression from mild cognitive impairment to dementia was more than three times as likely if they had the apoE4 allele, and more than twice as likely in those with a history of stroke, a low level of education, or difficulty with daily activities as measured by the Instrumental Activities of Daily Living scale (IADL).

In women, progression from mild cognitive impairment to dementia was more than three times as likely if they had IADL deficits and more than twice as likely if they had the apoE4 allele, a low level of education, or subclinical depression. And the odds of progressing to dementia were almost twice as high in women who took anticholinergic inhibitors (odds ratio 1.8).

Significant predictors of progression from MCI to dementia in both men and women in a less rigorous, univariate analysis included the apoE4 genotype, hypertension, diabetes, age, a low level of education, low intelligence, subclinical depression, stroke, social isolation, and difficulty with at least one activity of daily living. “MCI cases in the general population can be differentiated by a much larger number of sociodemographic and clinical factors than previously observed,” the investigators wrote.

The investigators said they had no financial conflicts to disclose.

Risk factors for mild cognitive impairment and progression from mild cognitive impairment to dementia are not the same for men and women, findings from a population-based study of 6,892 adults aged 65 years and older show.

Identifying the risk factors that cause mild cognitive impairment (MCI) to progress to dementia can help determine which patients might benefit from treatment, Sylvaine Artero of the Institut National de la Santé et de la Recherche Médicale (INSERM) U888, Montpellier, France, and colleagues reported

Previous studies have addressed the risk factors for progression from MCI to Alzheimer's disease and dementia, but most of those have not involved a general population and have not addressed gender-specific factors.

To determine the gender-specific factors that predict progression of MCI to dementia, the investigators recruited 6,892 community-dwelling adults aged 65 years and older and followed them for 4 years. The average age of the participants was 74 years, and approximately half were women. The study was based on a large multicenter prospective study on brain aging sponsored in part by Sanofi-Synthelabo.

A total of 2,882 participants (42%) met the criteria for MCI at baseline. Over the next 4 years, 189 were diagnosed with dementia, 1,626 maintained a diagnosis of MCI, and 1,067 returned to a normal level of function (J. Neurol. Neurosurg. Psychiatry 2008 May 1 [doi:10.1136/jnnp.2007.136903]).

Overall, 8% of men with MCI developed dementia, compared with 6% of the women, but women were significantly less likely than men to return to normal cognitive function (36% vs. 39%) and significantly more likely to maintain a diagnosed cognitive disorder over the 4-year follow-up period (58% vs. 53%).

In a multivariate analysis, older age significantly predicted progression to dementia in men and women.

In men, progression from mild cognitive impairment to dementia was more than three times as likely if they had the apoE4 allele, and more than twice as likely in those with a history of stroke, a low level of education, or difficulty with daily activities as measured by the Instrumental Activities of Daily Living scale (IADL).

In women, progression from mild cognitive impairment to dementia was more than three times as likely if they had IADL deficits and more than twice as likely if they had the apoE4 allele, a low level of education, or subclinical depression. And the odds of progressing to dementia were almost twice as high in women who took anticholinergic inhibitors (odds ratio 1.8).

Significant predictors of progression from MCI to dementia in both men and women in a less rigorous, univariate analysis included the apoE4 genotype, hypertension, diabetes, age, a low level of education, low intelligence, subclinical depression, stroke, social isolation, and difficulty with at least one activity of daily living. “MCI cases in the general population can be differentiated by a much larger number of sociodemographic and clinical factors than previously observed,” the investigators wrote.

The investigators said they had no financial conflicts to disclose.

BALTIMORE – Identifying shared endophenotypes might help clinicians characterize neurobehavioral syndromes and plan treatment, said a specialist in neurobehavioral development.

An endophenotype is a subset of features of a syndrome that are more highly correlated with a genetic mechanism than the whole syndrome, and grouping syndromes that share common features can help target and simplify treatment strategies, said Travis Thompson, Ph.D., also a professor in the department of pediatrics at the University of Minnesota, Minneapolis.

Some genetic evidence suggests that there might be shared inherited traits between autism and Prader-Willi syndrome (PW), and Dr. Thompson presented important behavioral similarities and differences between these two conditions at a meeting on developmental disabilities sponsored by Johns Hopkins University.

“Identifying clinically relevant endophenotypes can be more helpful than trying to figure out exactly which genes cause autism,” he said.

Phenotypic features that differ might be just as informative as those that are the same in understanding genetic and associated brain differences in clinical syndromes, Dr. Thompson said. “The fact that they are alike in some ways but different in a specific way tells you that there is probably a different genetic mechanism,” he said.

Candidates for a common genetic lesion include the γ-aminobutyric acid (GABA) receptor 3 (GABRB3), which might be absent or reduced in children with either autism or PW. And research has shown that both conditions might be associated with genes in the 15q11-q13 region of chromosome 15.

Features that are common to both autism and PW include compulsive behavior, social processing deficits (including facial processing deficits), and self-injury, Dr. Thompson said.

Compulsive behavior in children with either condition might be associated with overactive dopamine due in part to the missing or suppressed GABA-3 receptor. But some differences emerge within these categories. For example, compulsive behavior in children with PW often involves excessive overeating, which might be due to an overproduction of GABA. And skin picking is a common compulsive behavior in children with either condition, although in PW skin picking can start as early as 2 years of age, he said.

Studies have shown that face perception is limited in children with either autism or PW. This problem might be linked to a common genetic defect that might cause hypoactivation of the amygdala and fusiform face area–parts of the brain that recognize facial features.

More research is needed on common behavior phenotypes in neurobehavioral syndromes to determine which individuals show the maximum improvement to different treatments, and what characteristics of those individuals make them responsive to a specific intervention, he added. “That has to be the future of research in this area.”

BALTIMORE – Identifying shared endophenotypes might help clinicians characterize neurobehavioral syndromes and plan treatment, said a specialist in neurobehavioral development.

An endophenotype is a subset of features of a syndrome that are more highly correlated with a genetic mechanism than the whole syndrome, and grouping syndromes that share common features can help target and simplify treatment strategies, said Travis Thompson, Ph.D., also a professor in the department of pediatrics at the University of Minnesota, Minneapolis.

Some genetic evidence suggests that there might be shared inherited traits between autism and Prader-Willi syndrome (PW), and Dr. Thompson presented important behavioral similarities and differences between these two conditions at a meeting on developmental disabilities sponsored by Johns Hopkins University.

“Identifying clinically relevant endophenotypes can be more helpful than trying to figure out exactly which genes cause autism,” he said.

Phenotypic features that differ might be just as informative as those that are the same in understanding genetic and associated brain differences in clinical syndromes, Dr. Thompson said. “The fact that they are alike in some ways but different in a specific way tells you that there is probably a different genetic mechanism,” he said.

Candidates for a common genetic lesion include the γ-aminobutyric acid (GABA) receptor 3 (GABRB3), which might be absent or reduced in children with either autism or PW. And research has shown that both conditions might be associated with genes in the 15q11-q13 region of chromosome 15.

Features that are common to both autism and PW include compulsive behavior, social processing deficits (including facial processing deficits), and self-injury, Dr. Thompson said.

Compulsive behavior in children with either condition might be associated with overactive dopamine due in part to the missing or suppressed GABA-3 receptor. But some differences emerge within these categories. For example, compulsive behavior in children with PW often involves excessive overeating, which might be due to an overproduction of GABA. And skin picking is a common compulsive behavior in children with either condition, although in PW skin picking can start as early as 2 years of age, he said.

Studies have shown that face perception is limited in children with either autism or PW. This problem might be linked to a common genetic defect that might cause hypoactivation of the amygdala and fusiform face area–parts of the brain that recognize facial features.

More research is needed on common behavior phenotypes in neurobehavioral syndromes to determine which individuals show the maximum improvement to different treatments, and what characteristics of those individuals make them responsive to a specific intervention, he added. “That has to be the future of research in this area.”

BALTIMORE – Identifying shared endophenotypes might help clinicians characterize neurobehavioral syndromes and plan treatment, said a specialist in neurobehavioral development.

An endophenotype is a subset of features of a syndrome that are more highly correlated with a genetic mechanism than the whole syndrome, and grouping syndromes that share common features can help target and simplify treatment strategies, said Travis Thompson, Ph.D., also a professor in the department of pediatrics at the University of Minnesota, Minneapolis.

Some genetic evidence suggests that there might be shared inherited traits between autism and Prader-Willi syndrome (PW), and Dr. Thompson presented important behavioral similarities and differences between these two conditions at a meeting on developmental disabilities sponsored by Johns Hopkins University.

“Identifying clinically relevant endophenotypes can be more helpful than trying to figure out exactly which genes cause autism,” he said.

Phenotypic features that differ might be just as informative as those that are the same in understanding genetic and associated brain differences in clinical syndromes, Dr. Thompson said. “The fact that they are alike in some ways but different in a specific way tells you that there is probably a different genetic mechanism,” he said.

Candidates for a common genetic lesion include the γ-aminobutyric acid (GABA) receptor 3 (GABRB3), which might be absent or reduced in children with either autism or PW. And research has shown that both conditions might be associated with genes in the 15q11-q13 region of chromosome 15.

Features that are common to both autism and PW include compulsive behavior, social processing deficits (including facial processing deficits), and self-injury, Dr. Thompson said.

Compulsive behavior in children with either condition might be associated with overactive dopamine due in part to the missing or suppressed GABA-3 receptor. But some differences emerge within these categories. For example, compulsive behavior in children with PW often involves excessive overeating, which might be due to an overproduction of GABA. And skin picking is a common compulsive behavior in children with either condition, although in PW skin picking can start as early as 2 years of age, he said.

Studies have shown that face perception is limited in children with either autism or PW. This problem might be linked to a common genetic defect that might cause hypoactivation of the amygdala and fusiform face area–parts of the brain that recognize facial features.

More research is needed on common behavior phenotypes in neurobehavioral syndromes to determine which individuals show the maximum improvement to different treatments, and what characteristics of those individuals make them responsive to a specific intervention, he added. “That has to be the future of research in this area.”

More than half of adolescents with type 2 diabetes underestimate their weight, and so do their parents, according to results from interviews with 104 child-parent pairs.

“Clinicians should recognize that even extremely overweight children and their parents may not accurately perceive the presence of weight problems, let alone the negative consequences of failing to make difficult lifestyle changes that result in weight loss,” wrote Asheley Cockrell Skinner, Ph.D., of the University of North Carolina, Chapel Hill, and her colleagues.

Recognition of overweight is essential for adolescents with diabetes so they can make diet and exercise choices to lose weight and reduce their risk of complications associated with the disease and with overweight, the researchers said.

To determine the accuracy of weight perception among adolescents with type 2 diabetes and the impact of their perceived weight on healthy behaviors, the researchers interviewed 104 adolescents aged 12–20 years, and their parents, by telephone. The average weight of the study population was 221 pounds; 69% were girls. The average hemoglobin A1c level was 7.7%, and most of the adolescents were taking insulin, other medications, or both.

Overall, 87% of the adolescents met the Centers for Disease Control and Prevention's criteria for overweight, and the average body mass index of the group was 36 kg/m

Adolescents were significantly more likely to underestimate their own weight if their parents also underestimated their weight, compared with adolescents whose parents accurately estimated their weight (66% vs. 34%).

“While previous studies have shown that parents and adolescents often underestimate weight status, we were surprised that in this population, where the adolescents were generally very overweight and already had type 2 diabetes, underestimation of weight status was still very common,” Dr. Russell Rothman, study coauthor, said in an interview.

“Unfortunately, underestimation of weight was also associated with poorer dietary behaviors and more perceived barriers to following a healthy diet and exercising,” said Dr. Rothman, deputy director of the Diabetes Research and Training Center at Vanderbilt University, Nashville, Tenn.

The interview results showed that, overall, adolescents who underestimated their weight were significantly less likely than were those who estimated their weight correctly or overestimated to report healthy eating behaviors (31% vs. 52%) and exercise (27% vs. 44%). And parents who underestimated the adolescent's weight were significantly less likely to report that the adolescent exercised than were those who estimated the adolescent's weight correctly or overestimated it (26% vs. 46%).

No significant differences in weight perceptions according to race or insulin use were noted by parents or teens. Girls were significantly more likely than were boys to underestimate their weight, but the accuracy of the parents' estimates was not significantly different for boys versus girls. Weight estimates by parents and adolescents were least accurate for adolescents aged 13–16 years compared with those older than 16 and younger than 13, but these differences were not significant (Diabetes Care 2008;31:227–9).

Dr. Rothman said that although the findings seem obvious, they are worth noting so that doctors will raise the subject of weight with teen patients and ask about healthy eating and exercise.

“It is important to focus on very specific behaviors and goals that the adolescent can accomplish,” he said. He advised clinicians to practice shared goal-setting to help the adolescent set specific goals and then identify specific barriers. The next step is to guide the adolescent in problem solving, which will improve his or her self-management, he said.

The researchers were funded by awards from Vanderbilt University, the National Institutes of Health, the Agency for Healthcare Research and Quality, and the Department of Veterans Affairs.

More than half of adolescents with type 2 diabetes underestimate their weight, and so do their parents, according to results from interviews with 104 child-parent pairs.

“Clinicians should recognize that even extremely overweight children and their parents may not accurately perceive the presence of weight problems, let alone the negative consequences of failing to make difficult lifestyle changes that result in weight loss,” wrote Asheley Cockrell Skinner, Ph.D., of the University of North Carolina, Chapel Hill, and her colleagues.

Recognition of overweight is essential for adolescents with diabetes so they can make diet and exercise choices to lose weight and reduce their risk of complications associated with the disease and with overweight, the researchers said.

To determine the accuracy of weight perception among adolescents with type 2 diabetes and the impact of their perceived weight on healthy behaviors, the researchers interviewed 104 adolescents aged 12–20 years, and their parents, by telephone. The average weight of the study population was 221 pounds; 69% were girls. The average hemoglobin A1c level was 7.7%, and most of the adolescents were taking insulin, other medications, or both.

Overall, 87% of the adolescents met the Centers for Disease Control and Prevention's criteria for overweight, and the average body mass index of the group was 36 kg/m

Adolescents were significantly more likely to underestimate their own weight if their parents also underestimated their weight, compared with adolescents whose parents accurately estimated their weight (66% vs. 34%).

“While previous studies have shown that parents and adolescents often underestimate weight status, we were surprised that in this population, where the adolescents were generally very overweight and already had type 2 diabetes, underestimation of weight status was still very common,” Dr. Russell Rothman, study coauthor, said in an interview.

“Unfortunately, underestimation of weight was also associated with poorer dietary behaviors and more perceived barriers to following a healthy diet and exercising,” said Dr. Rothman, deputy director of the Diabetes Research and Training Center at Vanderbilt University, Nashville, Tenn.

The interview results showed that, overall, adolescents who underestimated their weight were significantly less likely than were those who estimated their weight correctly or overestimated to report healthy eating behaviors (31% vs. 52%) and exercise (27% vs. 44%). And parents who underestimated the adolescent's weight were significantly less likely to report that the adolescent exercised than were those who estimated the adolescent's weight correctly or overestimated it (26% vs. 46%).

No significant differences in weight perceptions according to race or insulin use were noted by parents or teens. Girls were significantly more likely than were boys to underestimate their weight, but the accuracy of the parents' estimates was not significantly different for boys versus girls. Weight estimates by parents and adolescents were least accurate for adolescents aged 13–16 years compared with those older than 16 and younger than 13, but these differences were not significant (Diabetes Care 2008;31:227–9).

Dr. Rothman said that although the findings seem obvious, they are worth noting so that doctors will raise the subject of weight with teen patients and ask about healthy eating and exercise.

“It is important to focus on very specific behaviors and goals that the adolescent can accomplish,” he said. He advised clinicians to practice shared goal-setting to help the adolescent set specific goals and then identify specific barriers. The next step is to guide the adolescent in problem solving, which will improve his or her self-management, he said.

The researchers were funded by awards from Vanderbilt University, the National Institutes of Health, the Agency for Healthcare Research and Quality, and the Department of Veterans Affairs.

More than half of adolescents with type 2 diabetes underestimate their weight, and so do their parents, according to results from interviews with 104 child-parent pairs.

“Clinicians should recognize that even extremely overweight children and their parents may not accurately perceive the presence of weight problems, let alone the negative consequences of failing to make difficult lifestyle changes that result in weight loss,” wrote Asheley Cockrell Skinner, Ph.D., of the University of North Carolina, Chapel Hill, and her colleagues.

Recognition of overweight is essential for adolescents with diabetes so they can make diet and exercise choices to lose weight and reduce their risk of complications associated with the disease and with overweight, the researchers said.

To determine the accuracy of weight perception among adolescents with type 2 diabetes and the impact of their perceived weight on healthy behaviors, the researchers interviewed 104 adolescents aged 12–20 years, and their parents, by telephone. The average weight of the study population was 221 pounds; 69% were girls. The average hemoglobin A1c level was 7.7%, and most of the adolescents were taking insulin, other medications, or both.

Overall, 87% of the adolescents met the Centers for Disease Control and Prevention's criteria for overweight, and the average body mass index of the group was 36 kg/m

Adolescents were significantly more likely to underestimate their own weight if their parents also underestimated their weight, compared with adolescents whose parents accurately estimated their weight (66% vs. 34%).

“While previous studies have shown that parents and adolescents often underestimate weight status, we were surprised that in this population, where the adolescents were generally very overweight and already had type 2 diabetes, underestimation of weight status was still very common,” Dr. Russell Rothman, study coauthor, said in an interview.

“Unfortunately, underestimation of weight was also associated with poorer dietary behaviors and more perceived barriers to following a healthy diet and exercising,” said Dr. Rothman, deputy director of the Diabetes Research and Training Center at Vanderbilt University, Nashville, Tenn.

The interview results showed that, overall, adolescents who underestimated their weight were significantly less likely than were those who estimated their weight correctly or overestimated to report healthy eating behaviors (31% vs. 52%) and exercise (27% vs. 44%). And parents who underestimated the adolescent's weight were significantly less likely to report that the adolescent exercised than were those who estimated the adolescent's weight correctly or overestimated it (26% vs. 46%).

No significant differences in weight perceptions according to race or insulin use were noted by parents or teens. Girls were significantly more likely than were boys to underestimate their weight, but the accuracy of the parents' estimates was not significantly different for boys versus girls. Weight estimates by parents and adolescents were least accurate for adolescents aged 13–16 years compared with those older than 16 and younger than 13, but these differences were not significant (Diabetes Care 2008;31:227–9).

Dr. Rothman said that although the findings seem obvious, they are worth noting so that doctors will raise the subject of weight with teen patients and ask about healthy eating and exercise.

“It is important to focus on very specific behaviors and goals that the adolescent can accomplish,” he said. He advised clinicians to practice shared goal-setting to help the adolescent set specific goals and then identify specific barriers. The next step is to guide the adolescent in problem solving, which will improve his or her self-management, he said.

The researchers were funded by awards from Vanderbilt University, the National Institutes of Health, the Agency for Healthcare Research and Quality, and the Department of Veterans Affairs.

Risk factors for mild cognitive impairment and progression from mild cognitive impairment to dementia are not the same for men and women.

Identifying the risk factors that cause mild cognitive impairment (MCI) to progress to dementia can help determine which patients might benefit from treatment, Sylvaine Artero of the Institut National de la Santé et de la Recherche Médicale (INSERM) U888, Montpellier (France), and colleagues reported. Previous studies have addressed the risk factors for progression from MCI to Alzheimer's disease and dementia, but most of those have not involved a general population and have not addressed gender-specific factors.

To determine the gender-specific factors that predict progression of MCI to dementia, the investigators recruited 6,892 community-dwelling adults aged 65 years and older and followed them for 4 years (average age 74 years; half were women). The study was based on a large multicenter prospective study on brain aging sponsored in part by Sanofi-Synthelabo.

A total of 2,882 participants (42%) met the criteria for MCI at baseline. Over the next 4 years, 189 were diagnosed with dementia, 1,626 maintained MCI, and 1,067 returned to a normal level of function (J. Neurol. Neurosurg. Psychiatry 2008 May 1 [doi:10.1136/jnnp.2007.136903]).

Overall, 8% of men with MCI developed dementia, vs. 6% of the women, but women were significantly less likely than men to return to normal cognitive function (36% vs. 39%) and significantly more likely to maintain a diagnosed cognitive disorder over the 4 years (58% vs. 53%).

In a multivariate analysis, older age significantly predicted progression to dementia in men and women.

In men, progression from MCI to dementia was more than three times as likely if they had the APOEϵ4 allele, and more than twice as likely in those with a history of stroke, a low level of education, or difficulty with daily activities as measured by the Instrumental Activities of Daily Living scale (IADL). In women, progression from MCI to dementia was more than three times as likely if they had IADL deficits and more than twice as likely if they had the APOEϵ4 allele, a low level of education, or subclinical depression. And the odds of progressing to dementia were almost twice as high in women who took anticholinergic inhibitors (odds ratio 1.8).

Predictors of progression from MCI to dementia in both men and women in a less rigorous, univariate analysis included the APOEϵ4 genotype, hypertension, diabetes, age, a low level of education, low intelligence, subclinical depression, stroke, social isolation, and difficulty with at least IADL.

“MCI cases in the general population can be differentiated by a much larger number of sociodemographic and clinical factors than previously observed,” the investigators wrote. “These findings support the notion that MCI is a common end point to multiple etiological pathways which are not the same for men and women.”

The study was limited by a lack of analysis of MCI subtypes and by a short follow-up, which may account for the relatively low dementia rate, the investigators said. However, clinicians may be able to use the diverse risk factor data to develop gender-specific clinical interventions, they noted.

The investigators said they had no financial conflicts to disclose.

Risk factors for mild cognitive impairment and progression from mild cognitive impairment to dementia are not the same for men and women.

Identifying the risk factors that cause mild cognitive impairment (MCI) to progress to dementia can help determine which patients might benefit from treatment, Sylvaine Artero of the Institut National de la Santé et de la Recherche Médicale (INSERM) U888, Montpellier (France), and colleagues reported. Previous studies have addressed the risk factors for progression from MCI to Alzheimer's disease and dementia, but most of those have not involved a general population and have not addressed gender-specific factors.

To determine the gender-specific factors that predict progression of MCI to dementia, the investigators recruited 6,892 community-dwelling adults aged 65 years and older and followed them for 4 years (average age 74 years; half were women). The study was based on a large multicenter prospective study on brain aging sponsored in part by Sanofi-Synthelabo.

A total of 2,882 participants (42%) met the criteria for MCI at baseline. Over the next 4 years, 189 were diagnosed with dementia, 1,626 maintained MCI, and 1,067 returned to a normal level of function (J. Neurol. Neurosurg. Psychiatry 2008 May 1 [doi:10.1136/jnnp.2007.136903]).

Overall, 8% of men with MCI developed dementia, vs. 6% of the women, but women were significantly less likely than men to return to normal cognitive function (36% vs. 39%) and significantly more likely to maintain a diagnosed cognitive disorder over the 4 years (58% vs. 53%).

In a multivariate analysis, older age significantly predicted progression to dementia in men and women.

In men, progression from MCI to dementia was more than three times as likely if they had the APOEϵ4 allele, and more than twice as likely in those with a history of stroke, a low level of education, or difficulty with daily activities as measured by the Instrumental Activities of Daily Living scale (IADL). In women, progression from MCI to dementia was more than three times as likely if they had IADL deficits and more than twice as likely if they had the APOEϵ4 allele, a low level of education, or subclinical depression. And the odds of progressing to dementia were almost twice as high in women who took anticholinergic inhibitors (odds ratio 1.8).

Predictors of progression from MCI to dementia in both men and women in a less rigorous, univariate analysis included the APOEϵ4 genotype, hypertension, diabetes, age, a low level of education, low intelligence, subclinical depression, stroke, social isolation, and difficulty with at least IADL.

“MCI cases in the general population can be differentiated by a much larger number of sociodemographic and clinical factors than previously observed,” the investigators wrote. “These findings support the notion that MCI is a common end point to multiple etiological pathways which are not the same for men and women.”

The study was limited by a lack of analysis of MCI subtypes and by a short follow-up, which may account for the relatively low dementia rate, the investigators said. However, clinicians may be able to use the diverse risk factor data to develop gender-specific clinical interventions, they noted.

The investigators said they had no financial conflicts to disclose.

Risk factors for mild cognitive impairment and progression from mild cognitive impairment to dementia are not the same for men and women.

Identifying the risk factors that cause mild cognitive impairment (MCI) to progress to dementia can help determine which patients might benefit from treatment, Sylvaine Artero of the Institut National de la Santé et de la Recherche Médicale (INSERM) U888, Montpellier (France), and colleagues reported. Previous studies have addressed the risk factors for progression from MCI to Alzheimer's disease and dementia, but most of those have not involved a general population and have not addressed gender-specific factors.

To determine the gender-specific factors that predict progression of MCI to dementia, the investigators recruited 6,892 community-dwelling adults aged 65 years and older and followed them for 4 years (average age 74 years; half were women). The study was based on a large multicenter prospective study on brain aging sponsored in part by Sanofi-Synthelabo.

A total of 2,882 participants (42%) met the criteria for MCI at baseline. Over the next 4 years, 189 were diagnosed with dementia, 1,626 maintained MCI, and 1,067 returned to a normal level of function (J. Neurol. Neurosurg. Psychiatry 2008 May 1 [doi:10.1136/jnnp.2007.136903]).

Overall, 8% of men with MCI developed dementia, vs. 6% of the women, but women were significantly less likely than men to return to normal cognitive function (36% vs. 39%) and significantly more likely to maintain a diagnosed cognitive disorder over the 4 years (58% vs. 53%).

In a multivariate analysis, older age significantly predicted progression to dementia in men and women.

In men, progression from MCI to dementia was more than three times as likely if they had the APOEϵ4 allele, and more than twice as likely in those with a history of stroke, a low level of education, or difficulty with daily activities as measured by the Instrumental Activities of Daily Living scale (IADL). In women, progression from MCI to dementia was more than three times as likely if they had IADL deficits and more than twice as likely if they had the APOEϵ4 allele, a low level of education, or subclinical depression. And the odds of progressing to dementia were almost twice as high in women who took anticholinergic inhibitors (odds ratio 1.8).

Predictors of progression from MCI to dementia in both men and women in a less rigorous, univariate analysis included the APOEϵ4 genotype, hypertension, diabetes, age, a low level of education, low intelligence, subclinical depression, stroke, social isolation, and difficulty with at least IADL.

“MCI cases in the general population can be differentiated by a much larger number of sociodemographic and clinical factors than previously observed,” the investigators wrote. “These findings support the notion that MCI is a common end point to multiple etiological pathways which are not the same for men and women.”

The study was limited by a lack of analysis of MCI subtypes and by a short follow-up, which may account for the relatively low dementia rate, the investigators said. However, clinicians may be able to use the diverse risk factor data to develop gender-specific clinical interventions, they noted.

The investigators said they had no financial conflicts to disclose.

WASHINGTON — A history of type 2 diabetes was associated with a 34% higher risk of new-onset Parkinson's disease in older men, but diabetes did not seem to cause Parkinson's.

Data from epidemiology studies have suggested a link between diabetes and Parkinson's disease (PD), but there have been few prospective studies of the association.

To evaluate the relationship between new-onset PD and diabetes, Ashley E. Smith, a medical student at Northeastern Ohio Universities, Rootstown, and colleagues reviewed data from 21,841 men aged 40–84 years who were enrolled in the Physicians' Health Study. Those with a history of PD at baseline, with type 1 diabetes or unknown diabetes status, and who developed dementia before PD were excluded. They reported the findings in a poster presentation at the annual meeting of the American Geriatrics Society.

They identified 423 diabetes cases at baseline, 1,987 incident cases of diabetes, and 556 cases of PD over a median follow-up of 23.1 years. Mean baseline age was 55 years for men with diabetes and 52 years for men without diabetes. Mean age for PD diagnosis was 73 years.

Diabetes was associated with an increased risk of PD, but the risk did not increase with the duration or severity of diabetes. Instead, after adjustment for multiple factors including age, smoking, alcohol use, body mass index, hypertension, physical activity, and high cholesterol, the risk of PD was greatest in those with a normal baseline body mass index, older age at onset of diabetes, and a shorter duration of diabetes.

In the proportional hazard model, a diagnosis of diabetes was clustered around the diagnosis of PD, which supports a biological link between the two conditions. “Dopaminergic neurons are involved in glucose regulation and extensive damage to these neurons might lead to impaired peripheral glucose metabolism,” the investigators wrote.

More studies are needed to determine whether the increased risk of PD in adults with diabetes is because of detection bias or an underlying biological mechanism.

The study was supported in part by grants from the National Cancer Institute and the National Heart, Lung, and Blood Institute, in Bethesda, Md.

WASHINGTON — A history of type 2 diabetes was associated with a 34% higher risk of new-onset Parkinson's disease in older men, but diabetes did not seem to cause Parkinson's.

Data from epidemiology studies have suggested a link between diabetes and Parkinson's disease (PD), but there have been few prospective studies of the association.

To evaluate the relationship between new-onset PD and diabetes, Ashley E. Smith, a medical student at Northeastern Ohio Universities, Rootstown, and colleagues reviewed data from 21,841 men aged 40–84 years who were enrolled in the Physicians' Health Study. Those with a history of PD at baseline, with type 1 diabetes or unknown diabetes status, and who developed dementia before PD were excluded. They reported the findings in a poster presentation at the annual meeting of the American Geriatrics Society.

They identified 423 diabetes cases at baseline, 1,987 incident cases of diabetes, and 556 cases of PD over a median follow-up of 23.1 years. Mean baseline age was 55 years for men with diabetes and 52 years for men without diabetes. Mean age for PD diagnosis was 73 years.

Diabetes was associated with an increased risk of PD, but the risk did not increase with the duration or severity of diabetes. Instead, after adjustment for multiple factors including age, smoking, alcohol use, body mass index, hypertension, physical activity, and high cholesterol, the risk of PD was greatest in those with a normal baseline body mass index, older age at onset of diabetes, and a shorter duration of diabetes.

In the proportional hazard model, a diagnosis of diabetes was clustered around the diagnosis of PD, which supports a biological link between the two conditions. “Dopaminergic neurons are involved in glucose regulation and extensive damage to these neurons might lead to impaired peripheral glucose metabolism,” the investigators wrote.

More studies are needed to determine whether the increased risk of PD in adults with diabetes is because of detection bias or an underlying biological mechanism.

The study was supported in part by grants from the National Cancer Institute and the National Heart, Lung, and Blood Institute, in Bethesda, Md.

WASHINGTON — A history of type 2 diabetes was associated with a 34% higher risk of new-onset Parkinson's disease in older men, but diabetes did not seem to cause Parkinson's.

Data from epidemiology studies have suggested a link between diabetes and Parkinson's disease (PD), but there have been few prospective studies of the association.

To evaluate the relationship between new-onset PD and diabetes, Ashley E. Smith, a medical student at Northeastern Ohio Universities, Rootstown, and colleagues reviewed data from 21,841 men aged 40–84 years who were enrolled in the Physicians' Health Study. Those with a history of PD at baseline, with type 1 diabetes or unknown diabetes status, and who developed dementia before PD were excluded. They reported the findings in a poster presentation at the annual meeting of the American Geriatrics Society.

They identified 423 diabetes cases at baseline, 1,987 incident cases of diabetes, and 556 cases of PD over a median follow-up of 23.1 years. Mean baseline age was 55 years for men with diabetes and 52 years for men without diabetes. Mean age for PD diagnosis was 73 years.

Diabetes was associated with an increased risk of PD, but the risk did not increase with the duration or severity of diabetes. Instead, after adjustment for multiple factors including age, smoking, alcohol use, body mass index, hypertension, physical activity, and high cholesterol, the risk of PD was greatest in those with a normal baseline body mass index, older age at onset of diabetes, and a shorter duration of diabetes.

In the proportional hazard model, a diagnosis of diabetes was clustered around the diagnosis of PD, which supports a biological link between the two conditions. “Dopaminergic neurons are involved in glucose regulation and extensive damage to these neurons might lead to impaired peripheral glucose metabolism,” the investigators wrote.

More studies are needed to determine whether the increased risk of PD in adults with diabetes is because of detection bias or an underlying biological mechanism.

The study was supported in part by grants from the National Cancer Institute and the National Heart, Lung, and Blood Institute, in Bethesda, Md.

WASHINGTON — A nine-item questionnaire of self-reported symptoms was more reliable and efficient than the widely used Geriatric Depression Scale and the Minimum Data Set 2.0 scale at assessing mood disorders in nursing home patients, according to a study in 71 facilities across eight states.

Accurate detection of mood disorders in the long-term care population remains a constant challenge, said Dr. Debra Saliba, a geriatrician at the University of California, Los Angeles, and director of the Borun Center for Gerontological Research there. She reported the results at the annual meeting of the American Geriatrics Society.

Identifying depression in nursing home patients is important, she emphasized, because the condition is associated with poor functional status; increased perception of pain; stress; suicide; and more need for medical services. “In fact, a disproportionate number of successful suicides occur in people over the age of 65,” said Dr. Saliba.

Treating depression can be effective in reducing poor outcomes in long-term care residents, but depression often goes unnoticed in this population. Several screening tools for mood disorders are in use, but they haven't been compared with one another or to any validated psychiatric-assessment tool, said Dr. Saliba.

The new study compared the effectiveness of the nine-item Patient Health Questionnaire (PHQ-9), the Geriatric Depression Scale (GDS), Minimum Data Set version 2.0 (MDS 2.0) assessment by staff, and one of two validated tools for identifying mood disorders in a long-term care population.

The GDS was designed for older adults and has become a geriatric standard; this study used the newer version of the test, which is made up of 15 yes/no questions. But studies have suggested that the test may be overly influenced by somatic symptoms when individuals answer questions such as, “Have you stopped many of your activities and interests?” without being able to elaborate.

By contrast, PHQ-9 questions prompt open-ended responses to topics including sleep problems, feeling bad about oneself, and having trouble concentrating. The tool may be administered either as a self-reported survey or as part of an interview. The MDS 2.0 observer-rated scale avoids an interview or self-report.

“Some people have said that the PHQ-9 is too symptom driven or too complicated,” Dr. Saliba said, leading to questions of the survey's validity for assessing mood disorders in frail old people.

The investigators selected 418 nursing home residents scheduled to receive mandatory MDS 2.0 assessments. Nearly half the study participants were older than 85 years.

In addition to the MDS 2.0 assessment for each resident, one nurse administered the PHQ-9 and GDS, and a second nurse administered either the modified Schedule for Affective Disorders and Schizophrenia (mSADS) or the Cornell Scale for Depression.

The Cornell tool was used for residents whose cognition was too low to allow assessment by mSADS, but both of these tests are validated, “gold standard” tools, said Dr. Saliba.

About 80% of study participants were assessed by at least one of the screening tools as well as one of the validated tools. Overall, the GDS screen found 41% of residents with probable depression, PHQ-9 found 42%, and MDS 2.0 found 17%.

When the investigators used a measure of agreement adjusted for chance (kappa scores), the PHQ-9 had significantly higher agreement with the validated standard than either the GDS or the MDS 2.0 did. In fact, the MDS 2.0 assessment was less accurate than if the results had happened by chance, Dr. Saliba said.

“Contrary to the expectations of many, the PHQ-9 did not lead to more classification with depression,” she said.

Not only was the PHQ-9 tool more accurate than the GDS screen, but it also took less time to complete: 4.9 minutes for the PHQ-9 vs. 11.4 minutes for the GDS.

Most of the residents, including the large number with cognitive impairment, could complete the PHQ-9, said Dr. Saliba. The findings suggest that standardized mood assessment of older adults could be performed more effectively with the PHQ-9 than with the GDS or MDS 2.0, although more research is needed to confirm the results.

“We hadn't expected it to be quite so favorable for PHQ-9,” she said. “But it is often difficult for older adults to reduce their life experiences to yes or no questions.”

WASHINGTON — A nine-item questionnaire of self-reported symptoms was more reliable and efficient than the widely used Geriatric Depression Scale and the Minimum Data Set 2.0 scale at assessing mood disorders in nursing home patients, according to a study in 71 facilities across eight states.

Accurate detection of mood disorders in the long-term care population remains a constant challenge, said Dr. Debra Saliba, a geriatrician at the University of California, Los Angeles, and director of the Borun Center for Gerontological Research there. She reported the results at the annual meeting of the American Geriatrics Society.

Identifying depression in nursing home patients is important, she emphasized, because the condition is associated with poor functional status; increased perception of pain; stress; suicide; and more need for medical services. “In fact, a disproportionate number of successful suicides occur in people over the age of 65,” said Dr. Saliba.

Treating depression can be effective in reducing poor outcomes in long-term care residents, but depression often goes unnoticed in this population. Several screening tools for mood disorders are in use, but they haven't been compared with one another or to any validated psychiatric-assessment tool, said Dr. Saliba.

The new study compared the effectiveness of the nine-item Patient Health Questionnaire (PHQ-9), the Geriatric Depression Scale (GDS), Minimum Data Set version 2.0 (MDS 2.0) assessment by staff, and one of two validated tools for identifying mood disorders in a long-term care population.

The GDS was designed for older adults and has become a geriatric standard; this study used the newer version of the test, which is made up of 15 yes/no questions. But studies have suggested that the test may be overly influenced by somatic symptoms when individuals answer questions such as, “Have you stopped many of your activities and interests?” without being able to elaborate.

By contrast, PHQ-9 questions prompt open-ended responses to topics including sleep problems, feeling bad about oneself, and having trouble concentrating. The tool may be administered either as a self-reported survey or as part of an interview. The MDS 2.0 observer-rated scale avoids an interview or self-report.

“Some people have said that the PHQ-9 is too symptom driven or too complicated,” Dr. Saliba said, leading to questions of the survey's validity for assessing mood disorders in frail old people.

The investigators selected 418 nursing home residents scheduled to receive mandatory MDS 2.0 assessments. Nearly half the study participants were older than 85 years.

In addition to the MDS 2.0 assessment for each resident, one nurse administered the PHQ-9 and GDS, and a second nurse administered either the modified Schedule for Affective Disorders and Schizophrenia (mSADS) or the Cornell Scale for Depression.

The Cornell tool was used for residents whose cognition was too low to allow assessment by mSADS, but both of these tests are validated, “gold standard” tools, said Dr. Saliba.

About 80% of study participants were assessed by at least one of the screening tools as well as one of the validated tools. Overall, the GDS screen found 41% of residents with probable depression, PHQ-9 found 42%, and MDS 2.0 found 17%.

When the investigators used a measure of agreement adjusted for chance (kappa scores), the PHQ-9 had significantly higher agreement with the validated standard than either the GDS or the MDS 2.0 did. In fact, the MDS 2.0 assessment was less accurate than if the results had happened by chance, Dr. Saliba said.

“Contrary to the expectations of many, the PHQ-9 did not lead to more classification with depression,” she said.

Not only was the PHQ-9 tool more accurate than the GDS screen, but it also took less time to complete: 4.9 minutes for the PHQ-9 vs. 11.4 minutes for the GDS.

Most of the residents, including the large number with cognitive impairment, could complete the PHQ-9, said Dr. Saliba. The findings suggest that standardized mood assessment of older adults could be performed more effectively with the PHQ-9 than with the GDS or MDS 2.0, although more research is needed to confirm the results.

“We hadn't expected it to be quite so favorable for PHQ-9,” she said. “But it is often difficult for older adults to reduce their life experiences to yes or no questions.”

WASHINGTON — A nine-item questionnaire of self-reported symptoms was more reliable and efficient than the widely used Geriatric Depression Scale and the Minimum Data Set 2.0 scale at assessing mood disorders in nursing home patients, according to a study in 71 facilities across eight states.

Accurate detection of mood disorders in the long-term care population remains a constant challenge, said Dr. Debra Saliba, a geriatrician at the University of California, Los Angeles, and director of the Borun Center for Gerontological Research there. She reported the results at the annual meeting of the American Geriatrics Society.

Identifying depression in nursing home patients is important, she emphasized, because the condition is associated with poor functional status; increased perception of pain; stress; suicide; and more need for medical services. “In fact, a disproportionate number of successful suicides occur in people over the age of 65,” said Dr. Saliba.

Treating depression can be effective in reducing poor outcomes in long-term care residents, but depression often goes unnoticed in this population. Several screening tools for mood disorders are in use, but they haven't been compared with one another or to any validated psychiatric-assessment tool, said Dr. Saliba.

The new study compared the effectiveness of the nine-item Patient Health Questionnaire (PHQ-9), the Geriatric Depression Scale (GDS), Minimum Data Set version 2.0 (MDS 2.0) assessment by staff, and one of two validated tools for identifying mood disorders in a long-term care population.

The GDS was designed for older adults and has become a geriatric standard; this study used the newer version of the test, which is made up of 15 yes/no questions. But studies have suggested that the test may be overly influenced by somatic symptoms when individuals answer questions such as, “Have you stopped many of your activities and interests?” without being able to elaborate.

By contrast, PHQ-9 questions prompt open-ended responses to topics including sleep problems, feeling bad about oneself, and having trouble concentrating. The tool may be administered either as a self-reported survey or as part of an interview. The MDS 2.0 observer-rated scale avoids an interview or self-report.

“Some people have said that the PHQ-9 is too symptom driven or too complicated,” Dr. Saliba said, leading to questions of the survey's validity for assessing mood disorders in frail old people.

The investigators selected 418 nursing home residents scheduled to receive mandatory MDS 2.0 assessments. Nearly half the study participants were older than 85 years.

In addition to the MDS 2.0 assessment for each resident, one nurse administered the PHQ-9 and GDS, and a second nurse administered either the modified Schedule for Affective Disorders and Schizophrenia (mSADS) or the Cornell Scale for Depression.

The Cornell tool was used for residents whose cognition was too low to allow assessment by mSADS, but both of these tests are validated, “gold standard” tools, said Dr. Saliba.

About 80% of study participants were assessed by at least one of the screening tools as well as one of the validated tools. Overall, the GDS screen found 41% of residents with probable depression, PHQ-9 found 42%, and MDS 2.0 found 17%.

When the investigators used a measure of agreement adjusted for chance (kappa scores), the PHQ-9 had significantly higher agreement with the validated standard than either the GDS or the MDS 2.0 did. In fact, the MDS 2.0 assessment was less accurate than if the results had happened by chance, Dr. Saliba said.

“Contrary to the expectations of many, the PHQ-9 did not lead to more classification with depression,” she said.

Not only was the PHQ-9 tool more accurate than the GDS screen, but it also took less time to complete: 4.9 minutes for the PHQ-9 vs. 11.4 minutes for the GDS.

Most of the residents, including the large number with cognitive impairment, could complete the PHQ-9, said Dr. Saliba. The findings suggest that standardized mood assessment of older adults could be performed more effectively with the PHQ-9 than with the GDS or MDS 2.0, although more research is needed to confirm the results.

“We hadn't expected it to be quite so favorable for PHQ-9,” she said. “But it is often difficult for older adults to reduce their life experiences to yes or no questions.”

WASHINGTON — Fluoroquinolone resistance rose significantly over an 8-year period in hospitalized adults aged 65 years and older with gram-negative bacterial infections.

The safety and bioavailability of fluoroquinolones (FQs) have made them a popular choice for treating infections—especially urinary tract and intra-abdominal infections—in older adults. But increased fluoroquinolone resistance in gram-negative bacteria may have a significant impact on the use of these agents in this population, wrote Jon P. Furuno, Ph.D., of the University of Maryland, Baltimore, and his colleagues in a poster presented at the annual meeting of the American Geriatrics Society.

They collected microbiology data from all cultures that tested positive for gram-negative bacteria in patients aged 65 years and older who were admitted to the University of Maryland Medical Center between January 1998 and December 2005.

During that period, they analyzed a total of 1,839 Escherichia coli, 554 Proteus mirabilis, 1,044 Pseudomonas aeruginosa, 1,068 Klebsiella, and 480 Enterobacter cloacae isolates.

FQ resistance increased significantly across all species, from 8% in 1998 to almost 27% in 2005. But resistance varied by species and within years. Species-specific significant increases in the percentage of resistant isolates were observed from 1998 to 2005 for E. coli (3% vs. 31%), P. mirabilis (7 % vs. 39%), and Klebsiella (1.7% vs. 9.3%). Resistance rates in P. aeruginosa and E. cloacae increased from 1998 to 2005, but the differences were not statistically significant.

The researchers defined FQ resistance as resistance to all FQ drugs against which the isolates were tested, including ciprofloxacin, levofloxacin, and gatifloxacin.

They urged that prescribers consider the evidence of rising FQ resistance when choosing antibiotics for hospitalized older adults, although they conceded that more data are needed to determine the impact on treatment failure and subsequent outcomes in this population.

The study was supported in part by funding from the National Institutes of Health, the Centers for Disease Control and Prevention, and the Infectious Diseases Society of America. Dr. Furuno did not disclose any financial conflicts.

WASHINGTON — Fluoroquinolone resistance rose significantly over an 8-year period in hospitalized adults aged 65 years and older with gram-negative bacterial infections.

The safety and bioavailability of fluoroquinolones (FQs) have made them a popular choice for treating infections—especially urinary tract and intra-abdominal infections—in older adults. But increased fluoroquinolone resistance in gram-negative bacteria may have a significant impact on the use of these agents in this population, wrote Jon P. Furuno, Ph.D., of the University of Maryland, Baltimore, and his colleagues in a poster presented at the annual meeting of the American Geriatrics Society.

They collected microbiology data from all cultures that tested positive for gram-negative bacteria in patients aged 65 years and older who were admitted to the University of Maryland Medical Center between January 1998 and December 2005.

During that period, they analyzed a total of 1,839 Escherichia coli, 554 Proteus mirabilis, 1,044 Pseudomonas aeruginosa, 1,068 Klebsiella, and 480 Enterobacter cloacae isolates.

FQ resistance increased significantly across all species, from 8% in 1998 to almost 27% in 2005. But resistance varied by species and within years. Species-specific significant increases in the percentage of resistant isolates were observed from 1998 to 2005 for E. coli (3% vs. 31%), P. mirabilis (7 % vs. 39%), and Klebsiella (1.7% vs. 9.3%). Resistance rates in P. aeruginosa and E. cloacae increased from 1998 to 2005, but the differences were not statistically significant.

The researchers defined FQ resistance as resistance to all FQ drugs against which the isolates were tested, including ciprofloxacin, levofloxacin, and gatifloxacin.

They urged that prescribers consider the evidence of rising FQ resistance when choosing antibiotics for hospitalized older adults, although they conceded that more data are needed to determine the impact on treatment failure and subsequent outcomes in this population.

The study was supported in part by funding from the National Institutes of Health, the Centers for Disease Control and Prevention, and the Infectious Diseases Society of America. Dr. Furuno did not disclose any financial conflicts.

WASHINGTON — Fluoroquinolone resistance rose significantly over an 8-year period in hospitalized adults aged 65 years and older with gram-negative bacterial infections.

The safety and bioavailability of fluoroquinolones (FQs) have made them a popular choice for treating infections—especially urinary tract and intra-abdominal infections—in older adults. But increased fluoroquinolone resistance in gram-negative bacteria may have a significant impact on the use of these agents in this population, wrote Jon P. Furuno, Ph.D., of the University of Maryland, Baltimore, and his colleagues in a poster presented at the annual meeting of the American Geriatrics Society.

They collected microbiology data from all cultures that tested positive for gram-negative bacteria in patients aged 65 years and older who were admitted to the University of Maryland Medical Center between January 1998 and December 2005.

During that period, they analyzed a total of 1,839 Escherichia coli, 554 Proteus mirabilis, 1,044 Pseudomonas aeruginosa, 1,068 Klebsiella, and 480 Enterobacter cloacae isolates.

FQ resistance increased significantly across all species, from 8% in 1998 to almost 27% in 2005. But resistance varied by species and within years. Species-specific significant increases in the percentage of resistant isolates were observed from 1998 to 2005 for E. coli (3% vs. 31%), P. mirabilis (7 % vs. 39%), and Klebsiella (1.7% vs. 9.3%). Resistance rates in P. aeruginosa and E. cloacae increased from 1998 to 2005, but the differences were not statistically significant.

The researchers defined FQ resistance as resistance to all FQ drugs against which the isolates were tested, including ciprofloxacin, levofloxacin, and gatifloxacin.

They urged that prescribers consider the evidence of rising FQ resistance when choosing antibiotics for hospitalized older adults, although they conceded that more data are needed to determine the impact on treatment failure and subsequent outcomes in this population.

The study was supported in part by funding from the National Institutes of Health, the Centers for Disease Control and Prevention, and the Infectious Diseases Society of America. Dr. Furuno did not disclose any financial conflicts.

WASHINGTON – A nine-item questionnaire of self-reported symptoms was more reliable and efficient than the widely used Geriatric Depression Scale and the Minimum Data Set 2.0 scale at assessing mood disorders in nursing home patients, according to a study in 71 facilities across eight states.

Accurate detection of mood disorders in the long-term care population remains a constant challenge, said Dr. Debra Saliba, who is a geriatrician at the University of California, Los Angeles, and the director of the Borun Center for Gerontological Research there. She reported the results at the annual meeting of the American Geriatrics Society.

Identifying depression in nursing home patients is important, she emphasized, because the condition is associated with poor functional status; increased perception of pain; stress; suicide; and increased need for medical services. “In fact, a disproportionate number of successful suicides occur in people over the age of 65,” said Dr. Saliba.

Treating depression can be effective in reducing poor outcomes in long-term care residents, but depression often goes unnoticed in this population. There are several screening tools for mood disorders in use, but they have not been compared with one another or to any validated psychiatric-assessment tool, Dr. Saliba explained.

The new study compared the effectiveness of the nine-item Patient Health Questionnaire (PHQ-9), the Geriatric Depression Scale (GDS), Minimum Data Set version 2.0 (MDS 2.0) assessment by staff, and one of two validated tools for identifying mood disorders in a long-term care population.

The GDS was designed for older adults and has become a geriatric standard–this study used the newer version of the test, which is made up of 15 yes/no questions–but other studies have suggested that the test may be overly influenced by somatic symptoms when individuals answer questions such as, “Have you stopped many of your activities and interests?” without being able to elaborate.

By contrast, PHQ-9 questions prompt open-ended responses to topics including sleep problems, feeling bad about oneself, and having trouble concentrating. The tool may be administered either as a self-reported survey or as part of an interview. The MDS 2.0 observer-rated scale avoids an interview or self-report.

“Some people have said that the PHQ-9 is too symptom driven or too complicated,” Dr. Saliba said, leading to questions of the survey's validity for assessing mood disorders in frail old people.

She and her associates selected 418 nursing home residents who were scheduled to receive mandatory MDS 2.0 assessments. Nearly half of the study participants were older than 85 years.

In addition to the MDS 2.0 assessment for each resident, one nurse administered the PHQ-9 and GDS, and a second nurse administered either the modified Schedule for Affective Disorders and Schizophrenia (mSADS) or the Cornell Scale for Depression.

The Cornell tool was used for residents whose cognition was too low to allow assessment by mSADS, but both of these tests are validated, standard tools, said Dr. Saliba.

About 80% of study participants were assessed by at least one of the screening tools as well as one of the validated tools. Overall, the GDS screen found 41% of residents with probable depression, PHQ-9 found 42%, and MDS 2.0 found 17%.

When the investigators used a measure of agreement adjusted for chance (kappa scores), the PHQ-9 had significantly higher agreement with the validated standard than either the GDS or the MDS 2.0 did. In fact, the MDS 2.0 assessment was less accurate than if the results had happened by chance, Dr. Saliba said.

“Contrary to the expectations of many, the PHQ-9 did not lead to more classification with depression,” Dr. Saliba said.

Not only was the PHQ-9 tool more accurate than the GDS screen, but it also took less time to complete: 4.9 minutes for the PHQ-9 vs. 11.4 minutes for the GDS.

Most of the residents, including the large number with cognitive impairment, could complete the PHQ-9, said Dr. Saliba.

The findings suggest that standardized mood assessment of older adults could be performed more effectively with the PHQ-9 than with the GDS or MDS 2.0, although more research is needed to confirm the results.

“We hadn't expected it to be quite so favorable for PHQ-9,” she said. “But it is often difficult for older adults to reduce their life experiences to yes or no questions.”

WASHINGTON – A nine-item questionnaire of self-reported symptoms was more reliable and efficient than the widely used Geriatric Depression Scale and the Minimum Data Set 2.0 scale at assessing mood disorders in nursing home patients, according to a study in 71 facilities across eight states.

Accurate detection of mood disorders in the long-term care population remains a constant challenge, said Dr. Debra Saliba, who is a geriatrician at the University of California, Los Angeles, and the director of the Borun Center for Gerontological Research there. She reported the results at the annual meeting of the American Geriatrics Society.

Identifying depression in nursing home patients is important, she emphasized, because the condition is associated with poor functional status; increased perception of pain; stress; suicide; and increased need for medical services. “In fact, a disproportionate number of successful suicides occur in people over the age of 65,” said Dr. Saliba.

Treating depression can be effective in reducing poor outcomes in long-term care residents, but depression often goes unnoticed in this population. There are several screening tools for mood disorders in use, but they have not been compared with one another or to any validated psychiatric-assessment tool, Dr. Saliba explained.

The new study compared the effectiveness of the nine-item Patient Health Questionnaire (PHQ-9), the Geriatric Depression Scale (GDS), Minimum Data Set version 2.0 (MDS 2.0) assessment by staff, and one of two validated tools for identifying mood disorders in a long-term care population.

The GDS was designed for older adults and has become a geriatric standard–this study used the newer version of the test, which is made up of 15 yes/no questions–but other studies have suggested that the test may be overly influenced by somatic symptoms when individuals answer questions such as, “Have you stopped many of your activities and interests?” without being able to elaborate.

By contrast, PHQ-9 questions prompt open-ended responses to topics including sleep problems, feeling bad about oneself, and having trouble concentrating. The tool may be administered either as a self-reported survey or as part of an interview. The MDS 2.0 observer-rated scale avoids an interview or self-report.

“Some people have said that the PHQ-9 is too symptom driven or too complicated,” Dr. Saliba said, leading to questions of the survey's validity for assessing mood disorders in frail old people.

She and her associates selected 418 nursing home residents who were scheduled to receive mandatory MDS 2.0 assessments. Nearly half of the study participants were older than 85 years.

In addition to the MDS 2.0 assessment for each resident, one nurse administered the PHQ-9 and GDS, and a second nurse administered either the modified Schedule for Affective Disorders and Schizophrenia (mSADS) or the Cornell Scale for Depression.

The Cornell tool was used for residents whose cognition was too low to allow assessment by mSADS, but both of these tests are validated, standard tools, said Dr. Saliba.

About 80% of study participants were assessed by at least one of the screening tools as well as one of the validated tools. Overall, the GDS screen found 41% of residents with probable depression, PHQ-9 found 42%, and MDS 2.0 found 17%.

When the investigators used a measure of agreement adjusted for chance (kappa scores), the PHQ-9 had significantly higher agreement with the validated standard than either the GDS or the MDS 2.0 did. In fact, the MDS 2.0 assessment was less accurate than if the results had happened by chance, Dr. Saliba said.

“Contrary to the expectations of many, the PHQ-9 did not lead to more classification with depression,” Dr. Saliba said.

Not only was the PHQ-9 tool more accurate than the GDS screen, but it also took less time to complete: 4.9 minutes for the PHQ-9 vs. 11.4 minutes for the GDS.

Most of the residents, including the large number with cognitive impairment, could complete the PHQ-9, said Dr. Saliba.

The findings suggest that standardized mood assessment of older adults could be performed more effectively with the PHQ-9 than with the GDS or MDS 2.0, although more research is needed to confirm the results.

“We hadn't expected it to be quite so favorable for PHQ-9,” she said. “But it is often difficult for older adults to reduce their life experiences to yes or no questions.”

WASHINGTON – A nine-item questionnaire of self-reported symptoms was more reliable and efficient than the widely used Geriatric Depression Scale and the Minimum Data Set 2.0 scale at assessing mood disorders in nursing home patients, according to a study in 71 facilities across eight states.

Accurate detection of mood disorders in the long-term care population remains a constant challenge, said Dr. Debra Saliba, who is a geriatrician at the University of California, Los Angeles, and the director of the Borun Center for Gerontological Research there. She reported the results at the annual meeting of the American Geriatrics Society.

Identifying depression in nursing home patients is important, she emphasized, because the condition is associated with poor functional status; increased perception of pain; stress; suicide; and increased need for medical services. “In fact, a disproportionate number of successful suicides occur in people over the age of 65,” said Dr. Saliba.

Treating depression can be effective in reducing poor outcomes in long-term care residents, but depression often goes unnoticed in this population. There are several screening tools for mood disorders in use, but they have not been compared with one another or to any validated psychiatric-assessment tool, Dr. Saliba explained.

The new study compared the effectiveness of the nine-item Patient Health Questionnaire (PHQ-9), the Geriatric Depression Scale (GDS), Minimum Data Set version 2.0 (MDS 2.0) assessment by staff, and one of two validated tools for identifying mood disorders in a long-term care population.

The GDS was designed for older adults and has become a geriatric standard–this study used the newer version of the test, which is made up of 15 yes/no questions–but other studies have suggested that the test may be overly influenced by somatic symptoms when individuals answer questions such as, “Have you stopped many of your activities and interests?” without being able to elaborate.

By contrast, PHQ-9 questions prompt open-ended responses to topics including sleep problems, feeling bad about oneself, and having trouble concentrating. The tool may be administered either as a self-reported survey or as part of an interview. The MDS 2.0 observer-rated scale avoids an interview or self-report.

“Some people have said that the PHQ-9 is too symptom driven or too complicated,” Dr. Saliba said, leading to questions of the survey's validity for assessing mood disorders in frail old people.

She and her associates selected 418 nursing home residents who were scheduled to receive mandatory MDS 2.0 assessments. Nearly half of the study participants were older than 85 years.

In addition to the MDS 2.0 assessment for each resident, one nurse administered the PHQ-9 and GDS, and a second nurse administered either the modified Schedule for Affective Disorders and Schizophrenia (mSADS) or the Cornell Scale for Depression.

The Cornell tool was used for residents whose cognition was too low to allow assessment by mSADS, but both of these tests are validated, standard tools, said Dr. Saliba.

About 80% of study participants were assessed by at least one of the screening tools as well as one of the validated tools. Overall, the GDS screen found 41% of residents with probable depression, PHQ-9 found 42%, and MDS 2.0 found 17%.

When the investigators used a measure of agreement adjusted for chance (kappa scores), the PHQ-9 had significantly higher agreement with the validated standard than either the GDS or the MDS 2.0 did. In fact, the MDS 2.0 assessment was less accurate than if the results had happened by chance, Dr. Saliba said.

“Contrary to the expectations of many, the PHQ-9 did not lead to more classification with depression,” Dr. Saliba said.

Not only was the PHQ-9 tool more accurate than the GDS screen, but it also took less time to complete: 4.9 minutes for the PHQ-9 vs. 11.4 minutes for the GDS.

Most of the residents, including the large number with cognitive impairment, could complete the PHQ-9, said Dr. Saliba.

The findings suggest that standardized mood assessment of older adults could be performed more effectively with the PHQ-9 than with the GDS or MDS 2.0, although more research is needed to confirm the results.

“We hadn't expected it to be quite so favorable for PHQ-9,” she said. “But it is often difficult for older adults to reduce their life experiences to yes or no questions.”

A complex mixture of biologic, psychological, and social evidence suggests that alcohol consumption in children and adolescents is a developmental issue, based on data from several studies published in a supplement in the journal Pediatrics.

The supplement, sponsored by the National Institute on Alcohol Abuse and Alcoholism, is intended as a clinicians' reference for current research on the developmental factors that may play a role in when and whether children and adolescents use and abuse alcohol. Contributors to the articles include experts in child and adolescent health and development, along with specialists in behavior, prevention research, neuroscience, brain imaging, and genetics.

Studying the developmental components of underage drinking at all developmental stages may help clinicians and public health officials intervene with children, families, and communities to prevent and treat alcohol problems in children and reduce the risk of long-term problems, wrote Ann S. Masten, Ph.D., of the University of Minnesota, Minneapolis, and her colleagues in an article that introduced the concept of a developmental framework for underage drinking (Pediatrics 2008;121:S235-51).

Data from animal studies show that adolescence is a time of particular sensitivity to alcohol, and chronic exposure to alcohol during adolescence promotes cell death and may have negative effects that last into adulthood. Similarly, limited studies in human adolescents suggest that severe alcohol use disorders may be associated with a reduced hippocampal volume, although the results are not definitive, the investigators noted.

Developmental changes throughout childhood and adolescence include changes in form, function, organization, and context, they wrote. Several studies presented in the supplement highlight the connections between these changes and alcohol use and abuse at different developmental stages. Developmental pathways that can steer children toward or away from alcohol appear when they are younger than 10 years old, based on data reported by Robert A. Zucker, Ph.D., of the University of Michigan, Ann Arbor, and his colleagues.

Many factors that have an impact on alcohol use and abuse by children and teens are not specific to alcohol, the investigators noted. Instead, the development of both internalizing and externalizing behaviors can become either risk factors or protective factors with regard to a child's early experiences with alcohol. The nonspecific risk factors are as important as the alcohol-specific factors in affecting how a child responds to alcohol, they explained.

Findings from studies of infants have shown that some infants respond more quickly than others to stimuli. Their abilities to focus on an object or shift focus in response to new stimuli reflect the beginnings of self-regulation and control systems that will ultimately affect how well the individual can plan, reflect, and decide whether to proceed with a particular action. In addition, data from longitudinal studies of young children suggest that externalizing behaviors including aggression, impulsivity, and lack of control, as well as internalizing behaviors including anxiety, sadness, and depression, not only appear in early childhood but predict an increased risk of substance abuse problems. These traits tend to persist throughout childhood and adolescence, Dr. Zucker and his associates noted.

“Despite the preponderance of evidence, it is still rare for clinicians to recognize that drinking problems of youths have their beginnings well before alcohol use is initiated,” they said.

More research is needed to understand the factors that influence initial alcohol use in children, and the data are not conclusive as to whether children who first experiment with drinking when they are younger than age 12 years are at greater risk than those who initiate alcohol use at age 13–14 years. Social contexts, including drinking habits in the child's home and the child's exposure to alcohol through mass media, contribute to children's attitudes toward alcohol and expectations of its effects.

Children in alcoholic families are at increased risk for developing alcohol-related problems. Based on data from the National Longitudinal Alcohol Epidemiologic Survey published in 2000, 15% of children aged 17 years and younger in the United States were living with at least one adult who met criteria for alcohol abuse or dependence within a year of the survey. Although alcohol use at a young age is a problem, some parents opt to introduce children to responsible drinking patterns within a family context, and any public or school-based alcohol abuse prevention programs must take family and cultural considerations into account in order to be effective, Dr. Zucker and his associates said.

Changes in family and peer relationships, as well as developmental and cognitive changes related to puberty, have an impact on the onset and escalation of alcohol use in youth between 10 and 15 years of age, according to a report by Michael Windle, Ph.D., of Emory University, Atlanta, and colleagues (Pediatrics 2008;121:S273-89). Early adolescents begin spending less time with parents and families and more time alone or with peers.

In addition, early adolescents become more aware of societal influences, and they become more like adults in their active consumption of cultural messages from the mass media and their peers. Studies have shown that third-graders tend to associate drinking alcohol with negative outcomes such as acting wild, rude, or silly, the investigators noted. By contrast, by age 10 most children have formed response-outcome expectancies about drinking alcohol that are more positive. Early adolescents are increasingly sensitive to peer behaviors, and the mass media could serve as a “superpeer” in forming their thinking, they said. Movies and television aimed at adolescents often show teenagers drinking and rarely show them suffering any negative consequences.

The biologic effects of puberty also have an impact on alcohol use in early adolescence, although the mechanism of these effects has not been well studied, Dr. Windle and associates noted. But data from multiple studies have shown that the changes that occur in the brain during early and middle adolescence include changes in neurocognitive functions (such as decision making and risk taking) that are linked to alcohol use.

“Family history of alcoholism, parents' drinking levels, perceptions of peer drinking, and prototypes of typical adolescent drinkers all seem to help shape expectancies,” the investigators wrote. But learning and personality factors play a role, too. It also must be understood that each human is an active agent in determining developmental pathways and that resilience (resistance to moving down problematic pathways) is as important to understand as are processes leading to maladaptation and disease,” they emphasized.

Alcohol-specific risk factors and protective factors have a significant impact at this age. Data from multiple prediction studies have shown that the number of alcohol-using friends can account for up to 50% of the variance in teen and preteen alcohol use. And parents and older siblings continue to influence adolescent alcohol use and contribute to alcohol expectancies that formed during early childhood. Protective factors that deter early adolescents from alcohol use include an affectionate temperament, high levels of religiosity, and nurturing, supportive parents, based on data from prospective studies.

By late adolescence, aged 16–20 years, alcohol use tends to escalate and youth are increasingly vulnerable to alcohol use problems and alcohol use disorders. The increased vulnerability stems from a combination of the ongoing early adolescent risk factors and the unique neurologic, social, and cognitive changes that occur in late adolescence, wrote Sandra A. Brown, Ph.D., of the University of California, San Diego, and her colleagues (Pediatrics 2008;121:S290-310).

“Adolescence is now realized as a period of continued neurologic development, and the adolescent brain may be especially vulnerable to the neurotoxic effects of alcohol, especially given the typical ways in which youths drink,” the investigators wrote.

Data from behavioral genetics research show that the genetic factors that can affect adolescent alcohol use appear to have greater impact during the transition from middle to late adolescence. In addition, genetic influences that have an impact on problem drinking appear to overlap with other disinhibited behaviors that are influenced by genetics. But that doesn't mean that genetics alone contribute to the tendency toward alcohol abuse in some adolescents and not others. In fact, more evidence suggests that genetic influences on such complex behaviors as problem drinking result from a mix of environmental and inherited factors, they noted.

Problems with alcohol in late adolescence have proven links not only to problem drinking but also to an increased risk for mental health problems and poor social function in adulthood. Findings from longitudinal studies of alcohol use enhance the developmental picture by showing how individuals and subgroups of adolescents differ in their patterns of alcohol use over time.

The trajectory groups most often used to characterize adolescent drinking patterns include abstainers/light stable moderate drinkers, fling drinkers, decreasers, chronic heavy drinkers, and late-onset heavy drinkers. The proportion of adolescents who fall within these groups varies among different studies, but in general the abstainers/light drinkers account for 20%–65% of the adolescent population, while stable moderate drinkers account for approximately 30%, fling drinkers and decreasers each account for approximately 10%, and chronic heavy drinkers and late-onset heavy drinkers each account for less than 10%.

Risk factors and protective factors associated with alcohol use and abuse in late adolescents have been well studied. Risk factors include a family history of alcoholism, history of mental health problems, and history of physical or sexual abuse. Protective factors include long-term educational or job goals and positive family and social relationships. The timing of other life transitions such as getting a job and getting married also can have an impact on alcohol use and abuse in late adolescence.

“It is increasingly clear that the emergence and progression of drinking behavior are influenced by development, that underage drinking has developmental consequences, that alcohol use disorders are developmental in nature, and that efforts to prevent or to reduce underage drinking behavior must be developmentally informed to be strategic, sensitive, and effective,” Dr. Masten and colleagues wrote in the introduction.

The authors of the studies in the supplement had no relevant financial relationships to disclose.

Chronic exposure to alcohol during adolescence may have negative effects that last into adulthood. ©Ivonne

A complex mixture of biologic, psychological, and social evidence suggests that alcohol consumption in children and adolescents is a developmental issue, based on data from several studies published in a supplement in the journal Pediatrics.

The supplement, sponsored by the National Institute on Alcohol Abuse and Alcoholism, is intended as a clinicians' reference for current research on the developmental factors that may play a role in when and whether children and adolescents use and abuse alcohol. Contributors to the articles include experts in child and adolescent health and development, along with specialists in behavior, prevention research, neuroscience, brain imaging, and genetics.

Studying the developmental components of underage drinking at all developmental stages may help clinicians and public health officials intervene with children, families, and communities to prevent and treat alcohol problems in children and reduce the risk of long-term problems, wrote Ann S. Masten, Ph.D., of the University of Minnesota, Minneapolis, and her colleagues in an article that introduced the concept of a developmental framework for underage drinking (Pediatrics 2008;121:S235-51).

Data from animal studies show that adolescence is a time of particular sensitivity to alcohol, and chronic exposure to alcohol during adolescence promotes cell death and may have negative effects that last into adulthood. Similarly, limited studies in human adolescents suggest that severe alcohol use disorders may be associated with a reduced hippocampal volume, although the results are not definitive, the investigators noted.

Developmental changes throughout childhood and adolescence include changes in form, function, organization, and context, they wrote. Several studies presented in the supplement highlight the connections between these changes and alcohol use and abuse at different developmental stages. Developmental pathways that can steer children toward or away from alcohol appear when they are younger than 10 years old, based on data reported by Robert A. Zucker, Ph.D., of the University of Michigan, Ann Arbor, and his colleagues.

Many factors that have an impact on alcohol use and abuse by children and teens are not specific to alcohol, the investigators noted. Instead, the development of both internalizing and externalizing behaviors can become either risk factors or protective factors with regard to a child's early experiences with alcohol. The nonspecific risk factors are as important as the alcohol-specific factors in affecting how a child responds to alcohol, they explained.

Findings from studies of infants have shown that some infants respond more quickly than others to stimuli. Their abilities to focus on an object or shift focus in response to new stimuli reflect the beginnings of self-regulation and control systems that will ultimately affect how well the individual can plan, reflect, and decide whether to proceed with a particular action. In addition, data from longitudinal studies of young children suggest that externalizing behaviors including aggression, impulsivity, and lack of control, as well as internalizing behaviors including anxiety, sadness, and depression, not only appear in early childhood but predict an increased risk of substance abuse problems. These traits tend to persist throughout childhood and adolescence, Dr. Zucker and his associates noted.

“Despite the preponderance of evidence, it is still rare for clinicians to recognize that drinking problems of youths have their beginnings well before alcohol use is initiated,” they said.

More research is needed to understand the factors that influence initial alcohol use in children, and the data are not conclusive as to whether children who first experiment with drinking when they are younger than age 12 years are at greater risk than those who initiate alcohol use at age 13–14 years. Social contexts, including drinking habits in the child's home and the child's exposure to alcohol through mass media, contribute to children's attitudes toward alcohol and expectations of its effects.

Children in alcoholic families are at increased risk for developing alcohol-related problems. Based on data from the National Longitudinal Alcohol Epidemiologic Survey published in 2000, 15% of children aged 17 years and younger in the United States were living with at least one adult who met criteria for alcohol abuse or dependence within a year of the survey. Although alcohol use at a young age is a problem, some parents opt to introduce children to responsible drinking patterns within a family context, and any public or school-based alcohol abuse prevention programs must take family and cultural considerations into account in order to be effective, Dr. Zucker and his associates said.

Changes in family and peer relationships, as well as developmental and cognitive changes related to puberty, have an impact on the onset and escalation of alcohol use in youth between 10 and 15 years of age, according to a report by Michael Windle, Ph.D., of Emory University, Atlanta, and colleagues (Pediatrics 2008;121:S273-89). Early adolescents begin spending less time with parents and families and more time alone or with peers.

In addition, early adolescents become more aware of societal influences, and they become more like adults in their active consumption of cultural messages from the mass media and their peers. Studies have shown that third-graders tend to associate drinking alcohol with negative outcomes such as acting wild, rude, or silly, the investigators noted. By contrast, by age 10 most children have formed response-outcome expectancies about drinking alcohol that are more positive. Early adolescents are increasingly sensitive to peer behaviors, and the mass media could serve as a “superpeer” in forming their thinking, they said. Movies and television aimed at adolescents often show teenagers drinking and rarely show them suffering any negative consequences.

The biologic effects of puberty also have an impact on alcohol use in early adolescence, although the mechanism of these effects has not been well studied, Dr. Windle and associates noted. But data from multiple studies have shown that the changes that occur in the brain during early and middle adolescence include changes in neurocognitive functions (such as decision making and risk taking) that are linked to alcohol use.

“Family history of alcoholism, parents' drinking levels, perceptions of peer drinking, and prototypes of typical adolescent drinkers all seem to help shape expectancies,” the investigators wrote. But learning and personality factors play a role, too. It also must be understood that each human is an active agent in determining developmental pathways and that resilience (resistance to moving down problematic pathways) is as important to understand as are processes leading to maladaptation and disease,” they emphasized.

Alcohol-specific risk factors and protective factors have a significant impact at this age. Data from multiple prediction studies have shown that the number of alcohol-using friends can account for up to 50% of the variance in teen and preteen alcohol use. And parents and older siblings continue to influence adolescent alcohol use and contribute to alcohol expectancies that formed during early childhood. Protective factors that deter early adolescents from alcohol use include an affectionate temperament, high levels of religiosity, and nurturing, supportive parents, based on data from prospective studies.

By late adolescence, aged 16–20 years, alcohol use tends to escalate and youth are increasingly vulnerable to alcohol use problems and alcohol use disorders. The increased vulnerability stems from a combination of the ongoing early adolescent risk factors and the unique neurologic, social, and cognitive changes that occur in late adolescence, wrote Sandra A. Brown, Ph.D., of the University of California, San Diego, and her colleagues (Pediatrics 2008;121:S290-310).

“Adolescence is now realized as a period of continued neurologic development, and the adolescent brain may be especially vulnerable to the neurotoxic effects of alcohol, especially given the typical ways in which youths drink,” the investigators wrote.

Data from behavioral genetics research show that the genetic factors that can affect adolescent alcohol use appear to have greater impact during the transition from middle to late adolescence. In addition, genetic influences that have an impact on problem drinking appear to overlap with other disinhibited behaviors that are influenced by genetics. But that doesn't mean that genetics alone contribute to the tendency toward alcohol abuse in some adolescents and not others. In fact, more evidence suggests that genetic influences on such complex behaviors as problem drinking result from a mix of environmental and inherited factors, they noted.

Problems with alcohol in late adolescence have proven links not only to problem drinking but also to an increased risk for mental health problems and poor social function in adulthood. Findings from longitudinal studies of alcohol use enhance the developmental picture by showing how individuals and subgroups of adolescents differ in their patterns of alcohol use over time.

The trajectory groups most often used to characterize adolescent drinking patterns include abstainers/light stable moderate drinkers, fling drinkers, decreasers, chronic heavy drinkers, and late-onset heavy drinkers. The proportion of adolescents who fall within these groups varies among different studies, but in general the abstainers/light drinkers account for 20%–65% of the adolescent population, while stable moderate drinkers account for approximately 30%, fling drinkers and decreasers each account for approximately 10%, and chronic heavy drinkers and late-onset heavy drinkers each account for less than 10%.

Risk factors and protective factors associated with alcohol use and abuse in late adolescents have been well studied. Risk factors include a family history of alcoholism, history of mental health problems, and history of physical or sexual abuse. Protective factors include long-term educational or job goals and positive family and social relationships. The timing of other life transitions such as getting a job and getting married also can have an impact on alcohol use and abuse in late adolescence.

“It is increasingly clear that the emergence and progression of drinking behavior are influenced by development, that underage drinking has developmental consequences, that alcohol use disorders are developmental in nature, and that efforts to prevent or to reduce underage drinking behavior must be developmentally informed to be strategic, sensitive, and effective,” Dr. Masten and colleagues wrote in the introduction.

The authors of the studies in the supplement had no relevant financial relationships to disclose.

Chronic exposure to alcohol during adolescence may have negative effects that last into adulthood. ©Ivonne

A complex mixture of biologic, psychological, and social evidence suggests that alcohol consumption in children and adolescents is a developmental issue, based on data from several studies published in a supplement in the journal Pediatrics.

The supplement, sponsored by the National Institute on Alcohol Abuse and Alcoholism, is intended as a clinicians' reference for current research on the developmental factors that may play a role in when and whether children and adolescents use and abuse alcohol. Contributors to the articles include experts in child and adolescent health and development, along with specialists in behavior, prevention research, neuroscience, brain imaging, and genetics.

Studying the developmental components of underage drinking at all developmental stages may help clinicians and public health officials intervene with children, families, and communities to prevent and treat alcohol problems in children and reduce the risk of long-term problems, wrote Ann S. Masten, Ph.D., of the University of Minnesota, Minneapolis, and her colleagues in an article that introduced the concept of a developmental framework for underage drinking (Pediatrics 2008;121:S235-51).

Data from animal studies show that adolescence is a time of particular sensitivity to alcohol, and chronic exposure to alcohol during adolescence promotes cell death and may have negative effects that last into adulthood. Similarly, limited studies in human adolescents suggest that severe alcohol use disorders may be associated with a reduced hippocampal volume, although the results are not definitive, the investigators noted.

Developmental changes throughout childhood and adolescence include changes in form, function, organization, and context, they wrote. Several studies presented in the supplement highlight the connections between these changes and alcohol use and abuse at different developmental stages. Developmental pathways that can steer children toward or away from alcohol appear when they are younger than 10 years old, based on data reported by Robert A. Zucker, Ph.D., of the University of Michigan, Ann Arbor, and his colleagues.

Many factors that have an impact on alcohol use and abuse by children and teens are not specific to alcohol, the investigators noted. Instead, the development of both internalizing and externalizing behaviors can become either risk factors or protective factors with regard to a child's early experiences with alcohol. The nonspecific risk factors are as important as the alcohol-specific factors in affecting how a child responds to alcohol, they explained.

Findings from studies of infants have shown that some infants respond more quickly than others to stimuli. Their abilities to focus on an object or shift focus in response to new stimuli reflect the beginnings of self-regulation and control systems that will ultimately affect how well the individual can plan, reflect, and decide whether to proceed with a particular action. In addition, data from longitudinal studies of young children suggest that externalizing behaviors including aggression, impulsivity, and lack of control, as well as internalizing behaviors including anxiety, sadness, and depression, not only appear in early childhood but predict an increased risk of substance abuse problems. These traits tend to persist throughout childhood and adolescence, Dr. Zucker and his associates noted.

“Despite the preponderance of evidence, it is still rare for clinicians to recognize that drinking problems of youths have their beginnings well before alcohol use is initiated,” they said.

More research is needed to understand the factors that influence initial alcohol use in children, and the data are not conclusive as to whether children who first experiment with drinking when they are younger than age 12 years are at greater risk than those who initiate alcohol use at age 13–14 years. Social contexts, including drinking habits in the child's home and the child's exposure to alcohol through mass media, contribute to children's attitudes toward alcohol and expectations of its effects.

Children in alcoholic families are at increased risk for developing alcohol-related problems. Based on data from the National Longitudinal Alcohol Epidemiologic Survey published in 2000, 15% of children aged 17 years and younger in the United States were living with at least one adult who met criteria for alcohol abuse or dependence within a year of the survey. Although alcohol use at a young age is a problem, some parents opt to introduce children to responsible drinking patterns within a family context, and any public or school-based alcohol abuse prevention programs must take family and cultural considerations into account in order to be effective, Dr. Zucker and his associates said.

Changes in family and peer relationships, as well as developmental and cognitive changes related to puberty, have an impact on the onset and escalation of alcohol use in youth between 10 and 15 years of age, according to a report by Michael Windle, Ph.D., of Emory University, Atlanta, and colleagues (Pediatrics 2008;121:S273-89). Early adolescents begin spending less time with parents and families and more time alone or with peers.

In addition, early adolescents become more aware of societal influences, and they become more like adults in their active consumption of cultural messages from the mass media and their peers. Studies have shown that third-graders tend to associate drinking alcohol with negative outcomes such as acting wild, rude, or silly, the investigators noted. By contrast, by age 10 most children have formed response-outcome expectancies about drinking alcohol that are more positive. Early adolescents are increasingly sensitive to peer behaviors, and the mass media could serve as a “superpeer” in forming their thinking, they said. Movies and television aimed at adolescents often show teenagers drinking and rarely show them suffering any negative consequences.

The biologic effects of puberty also have an impact on alcohol use in early adolescence, although the mechanism of these effects has not been well studied, Dr. Windle and associates noted. But data from multiple studies have shown that the changes that occur in the brain during early and middle adolescence include changes in neurocognitive functions (such as decision making and risk taking) that are linked to alcohol use.

“Family history of alcoholism, parents' drinking levels, perceptions of peer drinking, and prototypes of typical adolescent drinkers all seem to help shape expectancies,” the investigators wrote. But learning and personality factors play a role, too. It also must be understood that each human is an active agent in determining developmental pathways and that resilience (resistance to moving down problematic pathways) is as important to understand as are processes leading to maladaptation and disease,” they emphasized.

Alcohol-specific risk factors and protective factors have a significant impact at this age. Data from multiple prediction studies have shown that the number of alcohol-using friends can account for up to 50% of the variance in teen and preteen alcohol use. And parents and older siblings continue to influence adolescent alcohol use and contribute to alcohol expectancies that formed during early childhood. Protective factors that deter early adolescents from alcohol use include an affectionate temperament, high levels of religiosity, and nurturing, supportive parents, based on data from prospective studies.

By late adolescence, aged 16–20 years, alcohol use tends to escalate and youth are increasingly vulnerable to alcohol use problems and alcohol use disorders. The increased vulnerability stems from a combination of the ongoing early adolescent risk factors and the unique neurologic, social, and cognitive changes that occur in late adolescence, wrote Sandra A. Brown, Ph.D., of the University of California, San Diego, and her colleagues (Pediatrics 2008;121:S290-310).

“Adolescence is now realized as a period of continued neurologic development, and the adolescent brain may be especially vulnerable to the neurotoxic effects of alcohol, especially given the typical ways in which youths drink,” the investigators wrote.

Data from behavioral genetics research show that the genetic factors that can affect adolescent alcohol use appear to have greater impact during the transition from middle to late adolescence. In addition, genetic influences that have an impact on problem drinking appear to overlap with other disinhibited behaviors that are influenced by genetics. But that doesn't mean that genetics alone contribute to the tendency toward alcohol abuse in some adolescents and not others. In fact, more evidence suggests that genetic influences on such complex behaviors as problem drinking result from a mix of environmental and inherited factors, they noted.

Problems with alcohol in late adolescence have proven links not only to problem drinking but also to an increased risk for mental health problems and poor social function in adulthood. Findings from longitudinal studies of alcohol use enhance the developmental picture by showing how individuals and subgroups of adolescents differ in their patterns of alcohol use over time.

The trajectory groups most often used to characterize adolescent drinking patterns include abstainers/light stable moderate drinkers, fling drinkers, decreasers, chronic heavy drinkers, and late-onset heavy drinkers. The proportion of adolescents who fall within these groups varies among different studies, but in general the abstainers/light drinkers account for 20%–65% of the adolescent population, while stable moderate drinkers account for approximately 30%, fling drinkers and decreasers each account for approximately 10%, and chronic heavy drinkers and late-onset heavy drinkers each account for less than 10%.

Risk factors and protective factors associated with alcohol use and abuse in late adolescents have been well studied. Risk factors include a family history of alcoholism, history of mental health problems, and history of physical or sexual abuse. Protective factors include long-term educational or job goals and positive family and social relationships. The timing of other life transitions such as getting a job and getting married also can have an impact on alcohol use and abuse in late adolescence.

“It is increasingly clear that the emergence and progression of drinking behavior are influenced by development, that underage drinking has developmental consequences, that alcohol use disorders are developmental in nature, and that efforts to prevent or to reduce underage drinking behavior must be developmentally informed to be strategic, sensitive, and effective,” Dr. Masten and colleagues wrote in the introduction.

The authors of the studies in the supplement had no relevant financial relationships to disclose.

Chronic exposure to alcohol during adolescence may have negative effects that last into adulthood. ©Ivonne