Postinfectious glomerulonephritis (PIGN) is primarily a childhood disease that occurs after an upper respiratory tract infection or impetigo; its occurrence in older patients is not well characterized. Here, we report 109 cases of PIGN in patients Ն65 years old diagnosed by renal biopsy. The male to female ratio was 2.8:1. An immunocompromised background was present in 61%, most commonly diabetes or malignancy. The most common site of infection was skin, followed by pneumonia and urinary tract infection. The most common causative agent was staphylococcus (46%) followed by streptococcus (16%) and unusual gram-negative organisms. Hypocomplementemia was present in 72%. The mean peak serum creatinine was 5.1 mg/dl, and 46% of patients required acute dialysis. The most common light microscopic patterns were diffuse (53%), focal (28%), and mesangial (13%) proliferative glomerulonephritis. IgA-dominant PIGN occurred in 17%. Of the 72 patients with Ն3 months of follow-up (mean, 29 months), 22% achieved complete recovery, 44% had persistent renal dysfunction, and 33% progressed to ESRD. The presence of diabetes, higher creatinine at biopsy, dialysis at presentation, the presence of diabetic glomerulosclerosis, and greater tubular atrophy and interstitial fibrosis predicted ESRD. In summary, the epidemiology of PIGN is shifting as the population ages. Older men and patients with diabetes or malignancy are particularly at risk, and the sites of infection and causative organisms differ from the typical childhood disease. Prognosis for these older patients is poor, with fewer than 25% recovering full renal function.

Objectives To examine neuropsychiatric and neuropsychological predictors of progression from normal to early clinical stages of Alzheimer’s disease (AD). Design Longitudinal study Setting Massachusetts Alzheimer’s Disease Research Center longitudinal cohort Participants From a total sample of 559 older adults, 454 were included in the primary analysis: 283 with clinically normal cognition (CN), 115 with mild cognitive impairment (MCI) and 56 with subjective cognitive concerns (SCC) but no objective impairment, a proposed transitional group between CN and MCI. Measurements Two latent cognitive factors (Memory-Semantic, Attention-Executive) and two neuropsychiatric factors (Affective, Psychotic) were derived from the Alzheimer’s Disease Centers’ Uniform Data Set neuropsychological battery and Neuropsychiatric Inventory brief questionnaire. Factors were analyzed as predictors of time to progression to a worse diagnosis using a Cox proportional-hazards regression model with backward elimination. Covariates included baseline diagnosis, gender, age, education, prior depression, antidepressant medication, symptom duration, and interaction terms. Results Higher/better Memory-Semantic factor score predicted lower hazard of progression (HR=0.4 for one SD increase, p<0.0001), and higher/worse Affective factor score predicted higher hazard (HR=1.3 for one SD increase, p=0.01). No other predictors were significant in adjusted analyses. Using diagnosis as a sole predictor of transition to MCI, the SCC diagnosis carried a 4-fold risk of progression compared to CN (HR=4.1, p<0.0001). Conclusions These results identify affective and memory-semantic factors as significant predictors of more rapid progression from normal to early stages of cognitive decline and highlight the subgroup of cognitively normal elderly with SCC as those with elevated risk of progression to MCI.

Background/Study Context Older adults, especially those with reduced hearing acuity, can make good use of linguistic context in word recognition. Less is known about the effects of the weighted distribution of probable target and non-target words that fit the sentence context (response entropy). The present study examined the effects of age, hearing acuity, linguistic context, and response entropy on spoken word recognition. Methods Participants were 18 older adults with good hearing acuity (M age = 74.3 years), 18 older adults with mild-to-moderate hearing loss (M age = 76.1 years) and 18 young adults with age-normal hearing (M age = 19.6 years). Participants heard sentence-final words using a word-onset gating paradigm, in which words were heard with increasing amounts of onset information until they could be correctly identified. Degrees of context varied from a neutral context to a high context condition. Results Older adults with poor hearing acuity required a greater amount of word onset information for recognition of words when heard in a neutral context compared to older adults with good hearing acuity and young adults. This difference progressively decreased with an increase in words’ contextual probability. Unlike the young adults, both older adult groups’ word recognition thresholds were sensitive to response entropy. Response entropy was not affected by hearing acuity. Conclusions Increasing linguistic context mitigates the negative effect of age and hearing loss on word recognition. The effect of response entropy on older adults’ word recognition is discussed in terms of an age-related inhibition deficit.

Background Impairment in instrumental activities of daily living (IADL) emerges in the transition from mild cognitive impairment (MCI) to Alzheimer’s disease (AD) dementia. Some IADL scales are sensitive to early deficits in MCI, but none have been validated for detecting subtle functional changes in clinically normal (CN) elderly at risk for AD. Methods Data from 624 subjects participating in the Alzheimer’s Disease Neuroimaging Initiative and 524 subjects participating in the Massachusetts Alzheimer’s Disease Research Center, which are two large cohorts including CN elderly and MCI subjects, were used to determine which Functional Activities Questionnaire items best discriminate between and predict progression from CN to MCI. Results We found that “Remembering appointments” and “assembling tax records” best discriminated between CN and MCI subjects, while worse performance on “paying attention and understanding a TV program”, “paying bills/balancing checkbook”, and “heating water and turning off the stove” predicted greater hazard of progressing from a diagnosis of CN to MCI. Conclusions These results demonstrate that certain questions are especially sensitive in detecting the earliest functional changes in CN elderly at risk for AD. As the field moves toward earlier intervention in preclinical AD, it is important to determine which IADL changes can be detected at that stage and track decline over time.

Background Impairment in instrumental activities of daily living (IADL) starts as individuals with amnestic mild cognitive impairment (MCI) transition to Alzheimer’s disease (AD) dementia. However, most IADL scales have not shown IADL alterations in clinically normal (CN) elderly. The objective of this study was to determine which of the IADL-related Everyday Cognition (ECog) scale items are most sensitive for detection of early functional changes. Methods We assessed 290 CN and 495 MCI participants from the Alzheimer’s Disease Neuroimaging Initiative. We performed logistic regression analyses predicting the probability of CN vs. MCI diagnosis using only the 17 participant-based and 17 informant-based ECog items related to IADL. We then performed Cox regression analyses to predict progression from CN to MCI. All analyses were adjusted for demographic characteristics. Results We found that worse performance on “remembering a few shopping items” (participant and informant-based p<0.0001), “remembering appointments” (participant and informant-based p<0.0001), “developing a schedule in advance of anticipated events” (participant-based p=0.007), “balancing checkbook” (participant-based p=0.02), and “keeping mail and papers organized” (informant-based p=0.002) best discriminated MCI from CN. We found that worse performance on “keeping mail and papers organized” (participant-based Hazard Ratio (HR)=2.27, p=0.07) marginally predicted greater hazard of progressing from CN to MCI. Conclusions Our results indicate that a few simple questions targeting early functional changes, addressed either to the individual or informant, can effectively distinguish between CN elderly and individuals with MCI. Additionally, one of the above questions related to organization suggested which CN individuals are likely to progress to MCI.