Gait and Balance in Alzheimer\u27s Disease: A Retrospective Analysis Across Varying Levels of Cognitive Impairment

Background: It was once thought that Alzheimer’s disease (AD) affected mostly cognition with minor motor impairment; however, it is becoming apparent that motor impairment may also be a prominent feature. Determining the extent of motor impairments throughout the continuum of cognitive impairment is critical in developing timely interventions for this population. Purpose/Hypothesis: The aim of this study was to gain a greater understanding of motor impairment in AD by exploring the relationships among gait, balance, and falls. Specifically, we explored the association of fall history to measures of cognition and performance-based balance measures in individuals with AD. We hypothesized that falls would increase as balance impairments became more severe. Additionally, we mapped the trajectory of gait and balance function along the continuum of cognitive impairment in individuals with AD. We hypothesized that balance and gait would be worse for those in the lower quartiles of cognitive function compared to those in the upper quartiles. Lastly, we sought to determine if fall history worsened as cognition declined. We hypothesized that falls history would be worse in lower quartiles of cognitive impairment compared to upper quartiles of cognitive impairment. Subjects: Retrospective data of 419 patients with brain health conditions and an initial evaluation for physical therapy at the Cleveland Clinic Lou Ruvo Center for Brain Health were extracted from electronic records. Of those 419, 155 were diagnosed by a neurologist with AD (age=77.4 ± 9.5; 69 males, 86 females) and were subsequently analyzed for this study. Materials/Methods: Patients were stratified into cognitive quartiles using scores from the Montreal Cognitive Assessment (MoCA): 0-9 (very severe cognitive impairment), 10-14 (severe cognitive impairment), 15-20 (Moderate to severe impairment), 21-30 (mild to moderate impairment). These cognitive function quartiles were then compared across the following measures: fall history (falls in last year, falls in the last 30 days, and fall injuries in the last year), 5 times Sit To Stand (5STS), Timed Up and Go (TUG), TUG cognitive (TUGcog), Preferred Gait Speed (PGS), Fast Gait Speed (FGS), 6 Minute Walk Test (6MWT), and Mini Balance Evaluation Systems Test (MBT). Results: For our first aim, there were no statistically significant differences between fallers and non-fallers for cognition, age, and measures of gait and balance (ps≥.068), except non-fallers walked farther on the 6MWT (p=.030). There were no statistically significant differences for recent (last 30 days) fallers and non-fallers across the same measures (ps≥.082). Fallers who had experienced an injury as a result of a fall in the last year performed more poorly on the 6MWT (p=.034) and MBT SOT (p=.008); all other comparisons were not statistically significant (ps≥.085). For our second aim, there were no statistically significant differences among the four cognitive quartiles for 5STS (p=.456), TUG (p=.060), FGS (p=.181), 6MWT (p=.468), MBT (p=.321); however, there were for TUGcog (p=.046) and PGS (p=.033). The mild to moderate impairment quartile was significantly faster than the severe quartile (p=.006) for the TUGcog. For PGS, the mild to moderate was significantly faster than the very severe quartile (p=.039) and the moderate to severe was significantly faster than the severe and the very severe quartiles (severe, p=.036; and, very severe, p=.016). For our third aim, there were no statistically significant differences in the proportions of fallers (p=.636), recent fallers (p=.868), and injured fallers (p=.565) across the four cognitive quartiles. Discussion: Despite impairments recognized in our study compared to normative data, patients in the study with a fall history were not significantly worse across most measures of gait and balance, except fallers had poorer walking endurance as measured in the 6MWT. Additionally, the proportion of fallers did not increase as severity of cognitive impairment increased, although walking impairment as measured with PGS and TUGcog, especially with cognitive demand, is more prominent in those with more severe cognitive impairment. Conclusions: Balance and gait dysfunction were prominent at all levels of cognitive impairment in our study of patients with AD and appears to become more prominent at the most severe cognitive impairment levels. These progressive deficits represent potentially mitigable motor impairment features of AD that warrant physical therapy

Eigenvalue Etch-A-Sketch

Paul Erdo ̋s’s Empty Hexagon Problem asks if there exists a number H(6) such that for all sets of n ≥ H points in general position on the plane six of the points form the vertices of an empty convex hexagon. This problem is open

Client perceptions of the most and least helpful aspects of couple therapy

Couple therapy research has traditionally utilized either quantitative or qualitative methods to examine the mechanisms of change and outcomes in couple therapy. Also, while studies have examined couples\u27 experiences in therapy, few have specifically examined the most and least helpful aspects of therapy according to the couple. The purpose of the present study was to utilize a mixed-methods design to examine couples\u27 written responses about their experiences in therapy. Two hundred ten individual responses were obtained from a sample of 134 couples who sought Traditional Behavioral Couple Therapy (TBCT) or Integrative Behavioral Couple Therapy (IBCT) for marital distress as part of a larger research project (Christensen et al., 2004). Content analysis of the written responses resulted in five reliably-coded domains; most and least helpful aspects of therapy included therapy, therapist, outcome, client, and logistical factors. Chi-square tests demonstrated treatment group differences on most helpful therapy, therapist, and client factors; and differences between those who recovered and those who deteriorated by 2-year follow up on least helpful therapist and outcome factors. McNemar\u27s tests (McNemar, 1947) also revealed just one significant difference between husbands and wives within IBCT on most helpful client factors. The results particularly suggest that couples in TBCT treatment report different most helpful factors than couples in IBCT treatment. Furthermore, the findings of the five domains found across treatments support the common factors research (e.g., Davis & Piercy, 2007a, 2007b; Sprenkle & Blow, 2004) and have several implications for the clinical treatment of couples

The “Mississippi of the West”: Religion, Conservatism, and Racial Politics in Utah, 1960–1978

Historians and Mormon scholars have largely ignored the African American experience in Utah during the latter half of the twentieth century. A close examination of Utah politics during the years 1960 to 1978 shows the profound influence of Mormonism and Latter-day Saint institutions in seemingly secular spaces, such as college campuses and state government. This work demonstrates how LDS theology and culture informed the sociopolitical landscape and contributed to white conservative resistance to racial equality readily found in Utah. Racial discrimination was not unique to Utah, but it did have its own particular flavor because of the predominance of Latter-day Saints in the state. This thesis explores the scholarship written about African Americans in Utah and elucidates the ways in which LDS theology and Church leadership extensively affected African American life in the Beehive State

Russian Organized Crime and the National Security of the United States

This thesis examines the impact of Russian organized crime on the national security of the United States. It begins by defining why Russian organized crime should be of concern to U.S. policymakers addressing the effects of Russian organized crime on the U.S. economy, national security, and domestic law enforcement. The thesis then analyzes the evolution of Russian organized crime from its emergence during the Soviet Union, through its growth during privatization, to its structural transformation in the modern era. This analysis establishes the fundamental principles of any potential U.S. policy on Russian organized crime and prompts several policy recommendations for the local, national, and international levels

Gender and Justice: The Experience of Female Lawyers in Indiananapolis

Gentleman M.B . is recorded in United States history as far back as 1638, and was a successful landowner, local leader, and attorney to the governor. What is not translated is that this gentleman was, in fact, a woman: Margaret Brent was the first known female attorney, and would be the only one allowed entrance to the Bar for more than 200 years. Even though centuries later, in 1869, Myra Bradwell (Illinois), Mary Magoon (Iowa) and Belle Mansfield (Iowa) gained access to the legal community, women remained an outcast minority until very recently. A mere two percent of the profession was female in 1970, rising to 12% by 1980. The American Bar Association\u27s 2008 statistics place women law students at 47%, while only 18.3% as partners of a firm, and report a grand total of 31.6% of all attorneys. The reluctant acceptance of women into the legal field still bears an effect of female status, progress and success. Prevailing stereotypes about a women\u27s place and responsibility for society have created difficult stigmas and challenges for females entering the legal field

Vocabulary Learning in Modality-Specific Context: Building Complete Representations

This study seeks to determine the extent to which phonology and orthography are generated when a word is learned in a single modality (visual or auditory) and how this affects the ability to later recognize that word in the opposite modality. Participants overall required fewer trials to learn words presented visually than auditorily, and performance in a recognition and recall task indicated that the word form representations were better specified with visual training. However, slower vocabulary learners showed a deficit in their ability to accurately recognize words learned visually and later heard. Results indicate that decoding takes place more readily than encoding (used to mean the opposite of decoding) and that slow learners have difficulty forming well-specified phonological representations when given words orthographically