Until recently, little attention has been paid to anxiety symptoms in dementia. However, anxiety is common in this population, and associated with poor outcome and quality of life. The current review examines the existing literature around three major themes: the definition of anxiety in dementia, the properties of available instruments for assessment, and the clinical characteristics of anxiety in this population. Defining anxiety in individuals with dementia is complicated by the overlap between symptoms of anxiety, depression and dementia, and by the influence of the source of information. Several instruments are available to assess anxiety in this population, including general neuropsychiatric instruments and two scales designed specifically for this purpose. The reliability of these instruments is acceptable, but their validity has not been sufficiently examined, and they may discriminate poorly between anxiety and depression. Anxiety may be higher in vascular dementia than in Alzheimer's Disease, and it decreases in the severe stages of dementia. It is associated with poor quality of life and behavioral disturbances, even after controlling for depression. Little is known, however, about its social and environmental correlates. Limitations of the existing literature and key directions for future research are discussed.

Traumatic brain injury (TBI) is often associated with enduring impairments in high-level cognitive functioning, including working memory (WM). We examined WM function in predominantly chronic patients with mild, moderate and severe TBI and healthy comparison subjects behaviorally and, in a small subset of moderate-to-severe TBI patients, with event-related functional magnetic resonance imaging (f MRI), using a visual n-back task that parametrically varied WM load. TBI patients showed severity-dependent and load-related WM deficits in performance accuracy, but not reaction time. Performance of mild TBI patients did not differ from controls; patients with moderate and severe TBI were impaired, relative to controls and mild TBI patients, but only at higher WM-load levels. f MRI results show that TBI patients exhibit altered patterns of activation in a number of WM-related brain regions, including the dorsolateral prefrontal cortex and Broca's area. Examination of the pattern of behavioral responding and the temporal course of activations suggests that WM deficits in moderate-to-severe TBI are due to associative or strategic aspects of WM, and not impairments in active maintenance of stimulus representations. Overall, results demonstrate that individuals with moderate-to-severe TBI exhibit WM deficits that are associated with dysfunction within a distributed network of brain regions that support verbally mediated WM. (JINS, 2004, 10, 724-741.)

Masuda, Akihiko; Hayes, S. C.; Fletcher, Lindsay B.; Seignourel, P. J.; Bunting, K.; Herbst, S. A.; Twohig, M. P.; and Lillis, J., "The impact of Acceptance and Commitment Therapy versus education on stigma toward people with psychological disorders" (2007).

Tremors, such as those examined in this study, that are refractory to medications and have a poor response to VIM DBS monotherapy, may respond favorably to VIM plus VOA/VOP DBS. Two electrodes may be better than one for the treatment of certain disorders; however, more study will be required to confirm this hypothesis.

Lack of awareness of deficits is a common problem after traumatic brain injury (TBI), and is associated with worse functional outcome and poor compliance with rehabilitation. Little is known, however, about the course of awareness of deficits after TBI. Using a longitudinal design, we examined changes in self-awareness between the subacute stage (about 45 days after injury) and one-year follow-up in a sample of 123 individuals with moderate to severe TBI. Awareness of deficits was operationalised as the discrepancy between patient and family ratings on the Awareness Questionnaire (AQ) and Patient Competency Rating Scale (PCRS). Compared to baseline, awareness was improved at one year, as evidenced by smaller discrepancy scores and stronger correlations between participant and family ratings. Changes in awareness were most pronounced for the behavioural/affective domain and least pronounced for the motor/sensory domain, which showed best agreement at baseline. Even at one year, participants rated themselves as higher functioning than did their relatives. Awareness at baseline and, for the AQ, time to follow commands, significantly predicted awareness at one year. These results suggest that awareness of deficits improves between the subacute and post-acute stages after TBI, and highlight the need for effective interventions for persons with impaired awareness and for flexible timing of rehabilitation efforts.

Most theories of persuasion predict that limited ability and motivation to think about communications should increase the impact of source credibility on persuasion. Furthermore, this effect is assumed to occur, regardless of whether or not the recipients have prior attitudes. In this study, the effects of source credibility, ability, and motivation (knowledge, message repetition, relevance) on persuasion were examined meta-analytically across both attitude formation and change conditions. Findings revealed that the Source Credibility × Ability/Motivation interaction emerged only when participants lacked prior attitudes and were unable to form a new attitude based on the message content. In such settings, the effects of source credibility decayed rapidly. The implications of these findings for applied communication campaigns are discussed.

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Anxiety is common in dementia and is associated with decreased independence and increased risk of nursing home placement. However, little is known about the treatment of anxiety in dementia. This article reports results from two patients who were treated with a modified version of cognitive-behavioral therapy for anxiety in dementia (CBT-AD). Modifications were made in the content, structure, and learning strategies of CBT to adapt skills to the cognitive limitations of these patients and include collaterals (i.e., family members, friends, or other caregivers) in the treatment process. The patients received education and awareness training and were taught the skills of diaphragmatic breathing, coping self-statements, exposure, and behavioral activation. The Clinical Dementia Rating (CDR) Scale was used to characterize dementia severity and determine eligibility for treatment (a CDR score of 0.5 to 2.0 was required for participation). Other measures included the Rating Anxiety in Dementia scale, the Neuropsychiatric Inventory Anxiety subscale, and the Mini International Neuropsychiatric Interview. Outcome data showed improvement in anxiety as measured by standardized rating scales. We conclude that CBT-AD is potentially useful in treating anxiety in dementia patients and that this technique merits further study.