The REAL Diabetes intervention improved blood glucose control and diabetes-related QOL among a typically hard-to-reach population, thus providing evidence that a structured OT intervention may be beneficial in improving both clinical and psychosocial outcomes among individuals with diabetes.

Objective The impact of the atypical antipsychotics, olanzapine, quetiapine and risperidone on cognition in patients with Alzheimer’s disease is unclear. This report describes the effects of time and treatment on neuropsychological function during the Clinical Antipsychotic Trials of Intervention Effectiveness Alzheimer’s disease study (CATIE-AD). Method CATIE-AD included 421 Alzheimer’s disease outpatients with psychosis or agitated/aggressive behavior, randomized to masked, flexible-dose olanzapine, quetiapine, risperidone or placebo. Based on clinician’s judgment, patients could discontinue originally assigned medication and be randomized to another medication. They were followed for 36 weeks. Cognitive assessments were obtained at baseline, 12 weeks, 24 weeks and 36 weeks. Outcomes were compared among 357 patients with baseline and at least one follow-up cognitive measure obtained while on their prescribed medication or placebo for at least 2 weeks before cognitive testing. Results Overall, patients showed steady, significant declines over time in most cognitive areas, including Mini-mental State Examination (2.4 points over 36 weeks) and Alzheimer’s Disease Assessment Scale-cog (4.4 points). Patients on antipsychotics declined more than patients on placebo on multiple cognitive measures, including the MMSE (p=0.004), BPRS cognitive subscale (p=0.05), and a cognitive summary score summarizing change on 18 cognitive tests (p=0.004). Conclusions In CATIE-AD atypical antipsychotics were associated with worsening cognitive function at a magnitude consistent with one year’s deterioration compared with placebo. Further cognitive impairment is an additional risk of atypical antipsychotic treatment for Alzheimer’s disease patients that should be considered when considering treatment.

We explored the effect of education and occupational complexity on the rate of cognitive decline (as measured by the Mini-Mental State Examination) in 171 patients with a confirmed Alzheimer's disease (AD) diagnosis. Complexity was measured as substantive complexity of work and complexity of work with data, people, and things. Average lifetime occupational complexity was calculated based on years at each occupation. Participants were followed for an average of 2.5 years and 3.7 visits. In multivariate mixed-effects models, high education, high substantive complexity, and high complexity of work with data and people predicted faster rates of cognitive decline, controlling for age, gender, native language, dementia severity, and entry into the analyses at initial versus follow-up testing. These results provide support for the concept of cognitive reserve according to which greater reserve may postpone clinical onset of AD but also accelerate cognitive decline after the onset.

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A dyslipidemic pattern was associated with HIV infection itself, was more severe in users of PI-containing HAART, but was not present in women taking non-PI HAART.