Biomarkers sensitive to functional impairment, neuronal loss, tau, and amyloid pathology based on MR, PET, and CSF studies are increasingly used to diagnose Alzheimer's disease (AD), but clinical validation is incomplete, hampering reimbursement by payers, widespread clinical implementation, and impacting on health care quality. An expert group convened to develop a strategic research agenda to foster the clinical validation of AD biomarkers. These demonstrated sufficient evidence of analytical validity (phase I of a structured framework adapted from oncology). Research priorities were identified based on incomplete clinical validity (phases II and III), and clinical utility (phases IV and V). Priorities included: definition of the assays; reading procedures and thresholds for normality; performance in detecting early disease; accounting for the effect of covariates; diagnostic algorithms comprising combinations of biomarkers; and developing best practice guidelines for the use of biomarkers in qualified memory clinics in the context of phase IV studies. 5 GlossaryBiomarker. An objective measure of a biological or pathogenic process with the purpose of evaluating disease risk or prognosis, guiding clinical diagnosis or monitoring therapeutic interventions. While the term originally referred to traceable substances produced by or introduced into an organism, it later evolved to any measurable parameter, including those obtained via imaging procedures.Roadmap. Objective-oriented, structured, and efficient action plan. In science and technology also called "strategic research agenda".Alzheimer's disease (AD) dementia. Traditionally and according to the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association (NINCDS-ADRDA) criteria, Alzheimer's disease was defined as a syndrome with progressive cognitive impairment severe enough to impact on daily activities. A diagnosis of Alzheimer's disease could only be made after exclusion of other possible causes. 1 Sixty-five to 80% of cases of patients fulfilling these criteria have Alzheimer's pathology (plaques and tangles), the remainder having a range of other pathologies. In order to increase diagnostic certainty, contemporary criteria for AD dementia incorporate biomarker evidence for different aspects of Alzheimer's pathology, including imaging (magnetic resonance imaging -MRI -measures of atrophy; 18 F-fluorodeoxyglucose-positron emission tomography -FDG-PET -measures of cerebral hypometabolism; amyloid PET measures of fibrillar β-amyloid -A -deposition) and cerebrospinal fluid -CSF (decreased levels of A42, increased levels of tau and phospho-tau). 2,3 Alzheimer's disease process. Recognizing that AD pathology is present many years before symptoms emerge, new criteria classify the disease process on a continuum from asymptomatic to prodromal and finally to dementia stage. 4 Individuals at the asymptomatic stage can only be identified by biomarkers of Alzheimer's pathology. None...

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The aim of this work is to narratively review findings on emotional and social adjustment among visually impaired older adults. The definition of emotional adjustment employed here includes a decline in mental health, especially the occurrence of depression, as well as less severe manifestations of emotional disturbance, such as lower well-being. Empirical research on these topics strongly and consistently confirms difficulties in emotional functioning among visually impaired elders. In particular, a considerable body of research using different methodologies has shown the prevalence of depression in visually impaired groups to be at least twice as high as that found in normal populations. Social adjustment to vision loss is construed to involve difficulties in social functioning, changes in social support, and loneliness. Although research findings indicate loss of social activity and, to a lesser extent, loss of social support among the visually impaired, the relationship between vision loss and loneliness remains unclear. There are, however, firm indications that social support can provide an effective buffer against age-related vision loss.

Psychosocial group intervention is a promising approach to improve the quality of life in patients suffering from ARMD.

The purpose of this study was to gain insight from views of Tanzanian men and women on couple voluntary counselling and testing (CVCT) for HIV at antenatal clinics (ANC) in Tanzania. Data collection was through focus group discussions with women aged 25-48 years (n=8), women 18-24 years (n=10), HIV counsellors (n=11), men aged 20-34 (n=8) and men aged 35-75 years (n=8) and in-depth interviews (IDI) with five men and eight women. Participants were asked their views concerning men volunteering for CVCT for HIV, motivation of couples to receive results together and effective ways of counselling sero-discordant couples. Many participants agreed on the importance of incorporating CVCT at ANC, while others expressed reservations due to the cultural belief that ANC is for women. The importance of love, care and respect between sero-discordant couples was stressed; nonetheless, many anticipated that disclosure of HIV-positive status to an HIV-negative spouse could result in abandonment, divorce or violence against the woman whether she was sero-negative or -positive. Couple counselling and testing at ANC incorporating the suggestions made by study participants could become an important intervention for the prevention of HIV transmission and maintenance of good relations between sero-discordant partners.

This study examines the effect of primary and secondary control on 3 major outcomes experienced by visually impaired older adults, that is, functional ability, adaptation to vision loss, and positive affect. The authors' theoretical model is based on the J. Heckhausen and R. Schulz (1995) control framework, as well as a conceptual integration of these outcomes, and they hypothesized that control beliefs can substantially contribute to explaining interindividual differences in these outcomes. A path model applied to data from a sample (N = 90) of visually impaired older adults, suffering from age-related macular degeneration, the major cause of vision loss in old age, generally supports this expectation.

The popular recreational drug Ecstasy (3,4-methylenedioxymethamphetamine, or MDMA, and related congeners) is neurotoxic upon central serotonergic systems in animal studies. So far, the most convincing evidence for neurotoxicity-related functional deficits in humans derives from neurocognitive studies demonstrating dose-related memory problems in Ecstasy users. The aim of the current investigation was to study the relationship between the psychological profile of recreational Ecstasy users and the patterns of their drug use. Twenty-eight abstinent recreational Ecstasy users with concomitant use of cannabis only and two equally sized, matched groups of cannabis users and non-users were administered standardized self-rating scales for the assessment of psychological problems which are thought to be related to central serotonergic function. Ecstasy users had elevated scores on subscales measuring impulsiveness, anxiety, sensation seeking, somatic complaints, obsessive-compulsive behavior and psychoticism. Higher scores were associated with both heavier Ecstasy and heavier cannabis use. After controlling for cannabis use, most group differences in psychometric scores no longer achieved statistical significance. The present data are in line with other reports demonstrating a broad range of psychological problems in Ecstasy users. However, the concomitant use of other drugs, specifically cannabis, seems to be crucial in this respect. Therefore, compared with cognitive deficits, psychological problems appear to be less suitable functional indices of Ecstasy-related neurotoxic damage of central serotonergic systems in humans. Copyright 2001 John Wiley & Sons, Ltd.

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