Is ADHD a valid diagnosis in older adults?

ADHD is a neurodevelopmental syndrome that often persists into adulthood. It is possible that different criteria are necessary for older adults than younger adults: the manifestations of ADHD could change with age; other conditions with onset in later life share presenting symptoms with ADHD; different contextual challenges and patterns of compensatory support may exist. For these reasons, we reviewed evidence for the validity of DSM ADHD criteria in adulthood for individuals over the age of 50. Specifically, we evaluated evidence that the DSM criteria for ADHD identify a valid syndrome in older adults based on clinical presentation, laboratory or testing findings, absence of alternate diagnosis to explain symptoms, course of the syndrome, or familial presence of the condition. We found evidence that various ADHD criteria identify subjects with clinical presentations similar to that seen in younger adults, but only 92 well-described cases have been reported in the literature. ADHD traits also may be less common in the general population of older adults than in younger adults, suggesting that the threshold for an atypical burden of ADHD traits may be lower in older populations. Future research can establish a richer basis for validity of diagnostic criteria for ADHD in older adults.     

Is the bioavailability index applicable for trace elements in different types of soil?

Abstract

The bioavailability index (BI) is defined as the proportion of reduction in a plant’s accumulation of an element, caused by the removal of the extractable fraction of the element of interest from the soil. The BI and corresponding experimental methods were quantitatively applied to evaluate the bioavailability of trace elements in five Chinese soils. The soil was first extracted with various reagents (DTPA, HCl and NH₂OH.HCI) separately, to remove the extractable elements. The soil, after extraction, was washed with deionised water to eliminate the extractant used in the fractionation analysis. Then the pH of the soil was re-adjusted with CaO. The soil was then fertilised and incubated in a greenhouse for four weeks. Tests showed that after incubation the pH, cation exchange capacity (CEC) and organic matter (OM) of the treated soil were close to their original values. Wheat (Triticum aestivum L.) was planted in both the untreated and treated soil for eight weeks. After harvest the plant concentrations of the elements Cr, Mn, Co, Ni, Zn, Cu, Cd, and Pb were analysed by inductively coupled plasma mass spectrometry (ICPMS). Trace element accumulation by plants grown in the treated soil was reduced significantly compared with that of plants grown in the untreated soil. The results showed that BI values were in the order BI(DTPA)>BI(HCl)>BI(NH₂OH.HCl). This indicated that the DTPA-extractable fraction represented a highly available fraction of the total content. Variations of BI among different trace elements show that Cr, Mn, Zn and Co have a higher BI, in general for the elements tested, whereas, Cu, Cd and Pb have lower values. There are also slight differences in the BI among soils. However, no significant relationship could be found between the BI and the soil characteristics.     

Is tree diversity different in the Southern Hemisphere?

Questions: Is tree diversity higher in the southern hemisphere? Are latitudinal asymmetries in diversity sensitive to sampling effects? Location: 198 forested locales worldwide. Methods: I re‐analysed the Gentry database, which I augmented with an additional survey from New Zealand. Data were used to test whether latitudinal declines in tree diversity differ between the northern and southern hemispheres. Data were also used to test whether hemispheric asymmetries in diversity are sensitive to sampling effects, or geographic variation in tree densities. Results: Area‐based measurements of species diversity are higher in the southern hemisphere. However, southern forests house denser plant populations. After controlling for geographic variation in tree densities, diversity patterns reverse, indicating tree diversity is higher in the northern hemisphere. Conclusions: Latitudinal changes in tree diversity differ between hemispheres. However, the nature of hemispherical asymmetries in species diversity hinges on how diversity is defined, illustrating how different definitions of diversity can yield strikingly different solutions to common ecological problems.     

Weight-modification trials in older adults: what should the outcome measure be?

Background

Overweight older adults are often counseled to lose weight, even though there is little evidence of excess mortality in that age group. Overweight and underweight may be more associated with health status than with mortality, but few clinical trials of any kind have been based on maximizing years of healthy life (YHL), as opposed to years of life (YOL).

Objective

This paper examines the relationship of body mass index (BMI) to both YHL and YOL. Results were used to determine whether clinical trials of weight-modification based on improving YHL would be more powerful than studies based on survival.

Design

We used data from a cohort of 4,878 non-smoking men and women aged 65–100 at baseline (mean age 73) and followed 7 years. We estimated mean YHL and YOL in four categories of BMI: underweight, normal, overweight, and obese.

Results

Subjects averaged 6.3 YOL and 4.6 YHL of a possible 7 years. Both measures were higher for women and whites. For men, none of the BMI groups was significantly different from the normal group on either YOL or YHL. For women, the obese had significantly lower YHL (but not YOL) than the normals, and the underweight had significantly lower YOL and YHL. The overweight group was not significantly different from the normal group on either measure.

Conclusions

Clinical trials of weight loss interventions for obese older women would require fewer participants if YHL rather than YOL was the outcome measure. Interventions for obese men or for the merely overweight are not likely to achieve differences in either YOL or YHL. Evaluations of interventions for the underweight (which would presumably address the causes of their low weight) may be conducted efficiently using either outcome measure.

     

How far does prophylaxis against infection in total joint replacement offset its cost?

Selection of a cost effective method of prophylaxis against infection for patients undergoing total joint replacement was shown to depend on the number of arthroplasties performed each year at individual hospitals. When 100 arthroplasties were performed each year the prophylactic use of systemic antibiotics minimised the total costs of the department—that is, the combined costs of prophylaxis and reoperation for deep sepsis. Some departments also used local antibiotic prophylaxis in the form of polymethylmethacrylate cement impregnated with gentamicin or a combination of systemic and local prophylaxis at almost as low a total cost and with comparable effect.Selection of a method of prophylaxis should not be determined solely on the basis of reducing costs. When a value was assigned to the effects of loss of health an economic optimum was established that allowed selection of a more costly method of prophylaxis together with further reductions in the incidence of infection and the need for reoperation.     

Long-term Tai Chi practice in older adults is associated with “younger” functional abilities

Age-related alterations in physiology lead to declines in physical function that are associated with numerous adverse outcomes among older adults. Utilizing a hybrid design, we aimed to understand whether both long-term and short-term Tai Chi (TC) training are associated with age-related decline in physical function in healthy older adults. We first conducted cross-sectional comparisons among TC-naïve older adults (n = 60, 64.2 ± 7.7 years), TC-expert older adults (n = 27, 62.8 ± 7.6 years, 24.5 ± 12 years experience), and TC-naïve younger adults (n = 15, 28.7 ± 3.2 years) to inform long-term effects of TC training on physical function, including single leg stance time with eyes closed, grip strength, Timed Up and Go, maximum walking speed, functional reach, and vertical jump for lower-extremity power. There were significant differences among the three groups on all the six tests. For most functional tests, TC-experts performed better than age-matched TC-naïve controls and were statistically indistinguishable from young healthy adult controls. Long-term TC training was associated with higher levels of physical function in older adults, suggesting a potential preventative healthy aging effect. In the randomized longitudinal trial, TC-naïve subjects were randomized (n = 31 to Tai Chi group, n = 29 to usual care control group) to evaluate the short-term effects of TC over 6 months on all outcomes. TC's short-term impacts on physical function were small and not statistically significant. The impact of short-term training in healthy adults is less clear. Both potential longer-term preventive effects and shorter-term restorative effects warrant further research with rigorous, adequately powered controlled clinical trials.     

Step length determines minimum toe clearance in older adults and people with Parkinson’s disease

Reduced foot clearance when walking may increase the risk of trips and falls in people with Parkinson’s disease (PD). Changes in foot clearance in people with PD are likely to be associated with temporal-spatial characteristics of gait such as walking slowly which evokes alterations in the temporal-spatial control of stepping patterns. Enhancing our understanding of the temporal-spatial determinants of foot clearance may inform the design of falls prevention therapies.Thirty-six people with PD and 38 age-matched controls completed four intermittent walks under two conditions: self-selected and fast gait velocity. Temporal-spatial characteristics of gait and foot (heel and toe) clearance outcomes were obtained using an instrumented walkway and 3D motion capture, respectively. A general linear model was used to quantify the effect of PD and gait velocity on gait and foot clearance. Regression evaluated the temporal and spatial gait predictors of minimum toe clearance (MTC).PD walked slower regardless of condition (p = .016) and tended to increase their step length to achieve a faster gait velocity. Step length and the walk ratio consistently explained the greatest proportion of variance in MTC (>28% and >33%, respectively) regardless of group or walking condition (p < .001).Our results suggest step length is the primary determinant of MTC regardless of pathology. Interventions that focus on increasing step length may help to reduce the risk of trips and falls during gait, however, clinical trials are required for robust evaluation.     

Can self-report instruments of shoulder function capture functional differences in older adults with and without a rotator cuff tear?

Rotator cuff tears (RCT) are prevalent in older individuals and may compound age-associated functional declines. Our purpose was to determine whether self-report measures of perceived functional ability are valid for older patients with RCT. Twenty five subjects participated (12M/13F; age = 63.9 ± 3.0 years); 13 with RCT and 12 controls (CON). Participants completed self-report measures of shoulder function (SST, ASES, WORC) and health-related quality of life (SF-36). Isometric joint moment and range of motion (ROM) were measured at the shoulder. Relationships among functional self-reports, and between these measures and joint moment and ROM were assessed; group differences for total and subcategory scores were evaluated. There were significant correlations among self-reports (r_s = 0.62–0.71, p ⩽ 0.02). For RCT subjects, ASES was associated with all joint moments except adduction (p ⩽ 0.02); SST, ASES, and WORC were associated with abduction and external rotation ROM (p ⩽ 0.04). For RCT subjects, SST and WORC were associated with SF-36 physical function subcategory scores (p ⩽ 0.05). The RCT group scored worse than CON on all functional self-reports (p < 0.01) and WORC and ASES subcategories (p < 0.01). In conclusion, SST, ASES, and WORC demonstrate utility and discriminant validity for older individuals by distinguishing those with RCT, but this work suggests prioritizing ASES given its stronger association with functional group strength.     

The efficacy of cognitive–behavioral therapy for older adults with ADHD: a randomized controlled trial

Older adults with ADHD exhibit significant functional impairment, yet there is little research to guide clinicians in evidence-based care of these adults. This study examined response to treatment in older adults who participated in a previous study of the efficacy of cognitive–behavioral treatment (CBT) in adult ADHD. It was hypothesized that older adults would respond less well to CBT than younger adults, given the cognitive demands of the treatment. As described in the original publication, 88 adults who met DSM-IV criteria for ADHD were randomized to receive either a manualized 12-week CBT group intervention targeting executive dysfunction or a parallel Support group. In the current study, outcomes for 26 adults, aged 50 or older, were compared with those of 55 younger adults with respect to inattentive symptoms assessed on a structured interview by a blind clinician, as well as on ratings by self and/or collateral on measures of attention, executive dysfunction, and comorbidity. Contrary to the hypothesis, older and younger adults were equally responsive to CBT on measures of attention. The older adults also responded as well to Support as to CBT on several outcome measures. The results provide preliminary evidence that CBT is an effective intervention for older adults with ADHD. The unexpected response to support highlights a possible age-specificity of effective therapeutic intervention that requires further investigation.     

The walking dead: Is hydroethidine a suitable viability dye for intra-erythrocytic Plasmodium falciparum?

Hydroethidine has been used as a viability dye in various haemoparasites, including Plasmodium species. We compared flow cytometric quantification by hydroethidine and thiazole orange in P. falciparum. Dead parasites that did not develop or replicate exhibited high levels of DNA fragmentation and abnormal microscopic morphology, but were detected as viable ring-stage parasites by hydroethidine. Hydroethidine quantification was similar to thiazole orange, a DNA-binding dye that stains live and dead parasites. Data obtained cast concerns on hydroethidine as a suitable viability dye in P. falciparum and highlight the necessity of proper gating in flow cytometric studies quantifying parasitaemia.