<i>Introduction</i>. Vascular cognitive impairment is a common yet preventable cause for dementia. It needs high degree of suspicion and appropriate designing of investigatory tools to confirm diagnosis, identify comorbidities, and ascertain the areas of impairment. Commonly DSM-IV criterion is applied for diagnosis and detailed clinical and neuropsychological examination for identifying the specific phenotype is used. Early diagnosis using the mandatory criteria will help in early initiation of disease modifying treatment strategies which can result in partial reversal of vascular changes and arrest of progression. Patients with young onset disease might require genetic characterization for designing more aggressive treatment.<i> Discussion and Conclusion</i>. Dementias as such carry poor course and prognosis resulting in severe Disability Adjusted Life Years (DALYs) for patients and caregivers. Therefore, it is mandatory to identify treatable and preventable causes so that man power loss can be reduced.

Thomas Gregor Issac

Sadandavalli Retnaswami Chandra

Rita Christopher

Jamuna Rajeswaran

Mariamma Philip

Cerebral Small Vessel Disease Clinical, Neuropsychological, and Radiological Phenotypes, Histopathological Correlates, and Described Genotypes: A Review

<i>Objectives</i>. This study was aimed to explore the gender differences in the association between childhood socioeconomic status (SES) and cognitive function in later life.<i> Methods</i>. Using a nationally representative sample from the Health and Retirement Study, 5,544 females and 3,863 males were analyzed separately. Growth curve models were used to examine memory status and change in memory from 1998 to 2010.<i> Results</i>. The results showed that SES disadvantage in childhood was associated with lower memory at baseline controlling for adult SES and other covariates. In addition, cumulated disadvantage in SES was associated with poor memory in both genders. Statistically, the impact of cumulative SES on memory function at baseline was significantly different by gender.<i> Discussion</i>. These findings suggest that childhood SES has long-term effects on cognitive function among both men and women, and cumulative SES from childhood to adulthood may be more important for men than women with respect to their memory performance.

Jiyoung Lyu

Gender Differences in the Association between Childhood Socioeconomic Status and Cognitive Function in Later Life

<i>Background</i>. Patients with ischemic white matter lesions (WML) frequently report nonrestorative sleep or daytime sleepiness. However, subjective estimations of sleep and sleepiness can differ considerably from objective measures. The pupillographic sleepiness test (PST) could identify patients with sleep disorders requiring polysomnography (PSG) and further treatment.<i> Methods</i>. We performed a PST and a PSG of 35 nondemented patients with WML, who reported nonrestorative sleep or daytime sleepiness, and assessed the diagnostic value of the pupillary unrest index (PUI). Sleep parameters were compared to normative data.<i> Results</i>. The mean PUI of WML patients was normal (5.89&#x2009;mm/min) and comparable to PUIs of patients with other neurological disorders. All 9 of the 35 WML patients (25.7&#x25;) who had a PUI above normal also had clinically relevant sleep disorders (5: sleep apnea, 7: periodic leg movements, and 4: insomnia). Six patients with a normal PUI had mild to moderate primary insomnia.<i> Conclusion</i>. PST and PSG parameters were physiological in most patients with WML. Age-related changes and affective and neuropsychological disorders might account for their sleep-related complaints. An elevated PUI in patients with WML seems to indicate comorbid sleep disorders that require further diagnostic evaluation and treatment (sleep apnea, insomnia with periodic leg movements, but not primary insomnia).

Ralf Landwehr

Robert Liszka

Pupillographic Sleepiness Test and Polysomnography in Nondemented Patients with Ischemic White Matter Lesions

The purpose of this review is to present findings on the effects of stereotypes of aging on health outcomes related to older adults, such as physical and mental functioning (specifically) and overall well-being and perceived quality of life (more broadly). This review shows that both positive and negative stereotypes of aging can have enabling and constraining effects on the actions, performance, decisions, attitudes, and, consequently, holistic health of an older adult. This review further highlights a variety of limitations in stereotype research in aging contexts, including a lack of qualitative studies focusing on older adult perspectives and the fluctuating definition of what constitutes &#x201C;good health&#x201D; during older age.

Rylee A. Dionigi

Stereotypes of Aging: Their Effects on the Health of Older Adults

<i>Introduction</i>. We describe the design and implementation of a psychiatric collaborative care model in a university-based geriatric primary care practice. Initial results of screening for anxiety and depression are reported. <i>Methods and Materials</i>. Screens for anxiety and depression were administered to practice patients. A mental health team, consisting of a psychiatrist, mental health nurse practitioner, and social worker, identified patients who on review of screening and chart data warranted evaluation or treatment. Referrals for mental health interventions were directed to members of the mental health team, primary care physicians at the practice, or community providers. <i>Results</i>. Subjects (<svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-0.2129908pt" id="M1" height="9.21094pt" version="1.1" viewBox="-0.0498162 -8.99795 53.1719 9.21094" width="53.1719pt"><g transform="matrix(.0135,0,0,-0.0135,0,0)"><path id="g113-79" d="M822 650H589L583 622C660 617 677 607 674 561C672 534 664 481 647 390L600 137H596L273 650H126L120 622C176 620 194 615 207 594C221 571 225 557 214 504L161 257C141 166 129 112 121 85C108 42 83 30 29 28L23 0H260L266 28C193 33 173 42 176 89C178 122 186 172 202 255L256 527H259L583 -8H612L690 390C708 481 720 535 728 558C744 603 756 619 816 622L822 650Z"/></g><g transform="matrix(.0135,0,0,-0.0135,15.155,0)"><path id="g117-34" d="M535 323V373H52V323H535ZM535 138V188H52V138H535Z"/></g><g transform="matrix(.0135,0,0,-0.0135,26.893,0)"><path id="g113-50" d="M384 0V27C293 34 287 42 287 114V635C232 613 172 594 109 583V559L157 557C201 555 205 550 205 499V114C205 42 199 34 109 27V0H384Z"/></g><g transform="matrix(.0135,0,0,-0.0135,33.396,0)"><path id="g113-54" d="M153 550H386L412 615L406 623H120L82 318C104 327 142 338 184 338C294 338 347 275 347 187C347 112 305 39 221 39C160 39 119 71 97 89C88 97 80 96 71 90C59 80 50 67 49 57C48 45 52 36 66 23C80 9 123 -12 169 -12C221 -11 288 15 342 59C403 109 431 165 431 225C431 308 366 395 238 395C212 395 165 379 127 364L153 550Z"/></g><g transform="matrix(.0135,0,0,-0.0135,39.9,0)"><path id="g113-49" d="M241 635C89 635 35 457 35 312C35 153 89 -12 240 -12C390 -12 443 166 443 312C443 466 390 635 241 635ZM238 602C329 602 354 454 354 312C354 172 330 22 240 22C152 22 124 173 124 313S148 602 238 602Z"/></g><g transform="matrix(.0135,0,0,-0.0135,46.403,0)"><use xlink:href="#g113-54"/></g></svg>) comprised 38.2&#x25; of the 3940 unique patients seen at the practice during the 4-year study period. 37.1&#x25; (<svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-0.2129908pt" id="M2" height="9.21094pt" version="1.1" viewBox="-0.0498162 -8.99795 46.6443 9.21094" width="46.6443pt"><g transform="matrix(.0135,0,0,-0.0135,0,0)"><use xlink:href="#g113-79"/></g><g transform="matrix(.0135,0,0,-0.0135,15.155,0)"><use xlink:href="#g117-34"/></g><g transform="matrix(.0135,0,0,-0.0135,26.893,0)"><use xlink:href="#g113-54"/></g><g transform="matrix(.0135,0,0,-0.0135,33.396,0)"><use xlink:href="#g113-54"/></g><g transform="matrix(.0135,0,0,-0.0135,39.9,0)"><use xlink:href="#g113-54"/></g></svg>) screened positive for depression, 26.9&#x25; (<svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-0.2129908pt" id="M3" height="9.21094pt" version="1.1" viewBox="-0.0498162 -8.99795 46.6443 9.21094" width="46.6443pt"><g transform="matrix(.0135,0,0,-0.0135,0,0)"><use xlink:href="#g113-79"/></g><g transform="matrix(.0135,0,0,-0.0135,15.155,0)"><use xlink:href="#g117-34"/></g><g transform="matrix(.0135,0,0,-0.0135,26.893,0)"><path id="g113-53" d="M456 178V225H360V632H320C217 496 115 347 20 206V178H280V106C280 40 276 34 189 27V0H445V27C364 34 360 39 360 106V178H456ZM280 225H82C149 335 214 431 278 520H280V225Z"/></g><g transform="matrix(.0135,0,0,-0.0135,33.396,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.0135,0,0,-0.0135,39.9,0)"><use xlink:href="#g113-54"/></g></svg>) for anxiety, and 322 (21.4&#x25;) screened positive for both. Any positive score was associated with age (<svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-0.6617603pt" id="M4" height="9.65971pt" version="1.1" viewBox="-0.0498162 -8.99795 53.2534 9.65971" width="53.2534pt"><g transform="matrix(.0135,0,0,-0.0135,0,0)"><path id="g113-81" d="M600 480C600 590 528 650 384 650H143L137 622C222 614 225 607 210 531L130 127C113 41 106 36 23 28L17 0H294L300 28C204 36 195 42 212 127L243 284L314 263C327 263 339 263 352 264C465 271 600 337 600 480ZM508 481C508 351 402 304 329 304C289 304 265 311 250 317L295 559C302 594 310 606 323 611C335 616 350 619 367 619C455 619 508 573 508 481Z"/></g><g transform="matrix(.0135,0,0,-0.0135,12.15,0)"><path id="g117-91" d="M512 -3V55L134 254V256L512 456V514L75 281V230L512 -3Z"/></g><g transform="matrix(.0135,0,0,-0.0135,23.887,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.0135,0,0,-0.0135,30.39,0)"><path id="g113-47" d="M113 -12C146 -12 170 11 170 46C170 78 146 103 114 103S58 78 58 46C58 11 82 -12 113 -12Z"/></g><g transform="matrix(.0135,0,0,-0.0135,33.48,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.0135,0,0,-0.0135,39.983,0)"><path id="g113-52" d="M285 378C315 398 338 416 353 432C373 451 384 474 384 503C384 579 325 635 236 635H235C182 635 136 610 108 579L65 516L85 496C110 533 150 575 205 575C258 575 300 543 300 481C300 407 232 369 141 339L147 310C163 315 188 321 211 321C268 321 338 284 338 192C338 94 288 40 217 40C160 40 119 68 93 91C85 98 77 97 69 91C60 84 47 71 46 58C44 46 48 35 62 22C75 10 116 -12 162 -12C234 -12 424 62 424 224C424 297 373 359 285 376V378Z"/></g><g transform="matrix(.0135,0,0,-0.0135,46.486,0)"><use xlink:href="#g113-52"/></g></svg>), female gender (<svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-0.6617603pt" id="M5" height="9.65971pt" version="1.1" viewBox="-0.0498162 -8.99795 53.2534 9.65971" width="53.2534pt"><g transform="matrix(.0135,0,0,-0.0135,0,0)"><use xlink:href="#g113-81"/></g><g transform="matrix(.0135,0,0,-0.0135,12.15,0)"><use xlink:href="#g117-91"/></g><g transform="matrix(.0135,0,0,-0.0135,23.887,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.0135,0,0,-0.0135,30.39,0)"><use xlink:href="#g113-47"/></g><g transform="matrix(.0135,0,0,-0.0135,33.48,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.0135,0,0,-0.0135,39.983,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.0135,0,0,-0.0135,46.486,0)"><path id="g113-55" d="M137 343C167 482 260 545 321 574C357 591 397 603 429 609L423 641C382 634 335 622 295 608C189 570 37 457 37 238C37 84 125 -12 242 -12C362 -12 447 89 447 209C447 311 374 393 267 393C247 393 226 386 204 376L137 343ZM227 337C318 337 361 256 361 173C361 105 336 22 258 22C176 22 126 120 126 240C126 266 127 291 132 310C155 323 189 337 227 337Z"/></g></svg>), and a nonsignificant trend toward living alone (<svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-0.6617603pt" id="M6" height="9.65971pt" version="1.1" viewBox="-0.0498162 -8.99795 53.2534 9.65971" width="53.2534pt"><g transform="matrix(.0135,0,0,-0.0135,0,0)"><use xlink:href="#g113-81"/></g><g transform="matrix(.0135,0,0,-0.0135,12.15,0)"><use xlink:href="#g117-91"/></g><g transform="matrix(.0135,0,0,-0.0135,23.887,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.0135,0,0,-0.0135,30.39,0)"><use xlink:href="#g113-47"/></g><g transform="matrix(.0135,0,0,-0.0135,33.48,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.0135,0,0,-0.0135,39.983,0)"><path id="g113-58" d="M244 635C114 635 38 519 38 422C38 317 111 240 217 240C236 240 255 244 277 256L345 292C311 140 203 39 59 15L64 -15C89 -15 150 -5 204 17C339 72 440 202 440 386C440 521 368 635 244 635ZM228 602C326 602 352 479 352 390C352 370 351 347 348 324C327 308 293 296 258 296C174 296 124 369 124 458C124 517 152 602 228 602Z"/></g><g transform="matrix(.0135,0,0,-0.0135,46.487,0)"><use xlink:href="#g113-54"/></g></svg>). 8.87&#x25; had suicidal thoughts. <i>Conclusions</i>. Screening captured the most affectively symptomatic patients, including those with suicidal ideation, for intervention. The partnering of mental health professionals and primary care physicians offers a workable model for addressing the scarcity of expertise in geriatric psychiatry.

Robert C. Abrams

Blanca Bon&#xe9;

M. Cary Reid

Ronald D. Adelman

Risa Breckman

Ronald Goralewicz

Marlena Palombo

Amy Stern

Rouzi Shengelia

Jeanne Teresi

Psychiatric Assessment and Screening for the Elderly in Primary Care: Design, Implementation, and Preliminary Results

<i>Objectives</i>. To conduct cost-effectiveness analyses of urge incontinence treatments for older women. <i>Methods</i>. Decision-analytic models assessed three treatment pathways: (1) limited behavioral therapy (LBT); (2) full behavioral therapy (FBT) with biofeedback; and (3) drug (DRUG), with allowances for crossover options following initial treatments. Model inputs were gathered from published data. Cost data were based on third party payer reimbursement. Outcomes were measured as the number of incontinence episodes avoided and quality-adjusted life years gained (QALYs). <i>Results</i>. At baseline values costs per QALY gained ranged from US&#x24;3696 to &#x24;10609. LBT was the least costly with the lowest benefit. Switching from LBT to FBT, with the greatest gain, was &#x24;415 per additional QALY. DRUG was the most expensive option. Sensitivity analyses showed that only small changes in key inputs were required for DRUG to generate greater gains than FBT. Medication costs had to fall substantially for DRUG to be cost competitive. <i>Conclusion</i>. All treatment strategies provide QALYs gains at a bargain price, compared to the standard of US&#x24;50,000 per QALY gained. No single treatment strategy dominated under all conditions. Clinicians should offer multiple treatment options to older women with urge incontinence.

Victoria L. Phillips

Ali Bonakdar Tehrani

Holly Langmuir

Patricia S. Goode

Kathryn L. Burgio

Treating Urge Incontinence in Older Women: A Cost-Effective Investment in Quality-Adjusted Life-Years (QALY)

Although 20&#x25; of adults 60 years and older receive community-based supports and services (CBSS), clinicians may have little more than a vague awareness of what is available and which services may benefit their patients. As health care shifts toward more creative and holistic models of care, there are opportunities for CBSS staff and primary care clinicians to collaborate toward the goal of maintaining patients&#x2019; health and enabling them to remain safely in the community. This primer reviews the half-century history of these organizations in the United States, describes the most commonly used services, and explains how to access them.

Eugenia L. Siegler

Sonam D. Lama

Michael G. Knight

Evelyn Laureano

M. Carrington Reid

Community-Based Supports and Services for Older Adults: A Primer for Clinicians

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Journal of Geriatrics