Qualitative data from patients and input from experts formed the basis of the EXACT's structure and item pool, ready for empirically based item reduction and reliability and validity testing.

The recognition that cognitive impairment of vascular origin is not limited to multi-infarct dementia has led to the development of several sets of new criteria for vascular dementia (VaD). We set out to define the spectrum of disease in patients presenting with vascular cognitive impairment (VCI). Of 412 patients consecutively seen at a memory clinic, 80 had VCI. These patients had vascular cognitive impairment not dementia (n = 19), VaD (n = 48), and mixed Alzheimer’s disease-VaD (n = 13). Radiographic patterns were: white matter changes only (40%); multiple infarcts (30%); single strategic stroke (14%), and no identified lesion (16%). Of note, 19 (24%) of these patients meet none of the currently published criteria for VaD. To better understand and treat ischaemic causes of cognitive impairment, the concept of VaD should be expanded to include patients who do not meet traditional dementia criteria.

Patient-reported outcome (PRO) measures are used to evaluate disease and treatments in many therapeutic areas, capturing relevant aspects of the disorder not obtainable through clinician or informant report, including those for which patients may have a greater level of awareness than those around them. Using PRO measures in mild cognitive impairment (MCI) and prodromal Alzheimer's disease (AD) presents challenges given the presence of cognitive impairment and loss of insight. This overview presents issues relevant to the value of patient report with emphasis on the role of insight. Complex activities of daily living functioning and executive functioning emerge as areas of particular promise for obtaining patient self-report. The full promise of patient self-report has yet to be realized in MCI and prodromal AD, however, in part because of lack of PRO measures developed specifically for mild disease, limited use of best practices in new measure development, and limited attention to psychometric evaluation. Resolving different diagnostic definitions and improving clinical understanding of MCI and prodromal AD will also be critical to the development and use of PRO measures.

We report data on the validity and responsiveness (i.e. sensitivity to change) of assessment instruments including Goal Attainment Scaling (GAS), at a single site in a multicentre trial of the experimental therapeutic agent linopirdine. Fifteen people (11 women) were evaluated. GAS yielded a mean 3.7 goals per patient (range 2–6). The mean gain in the GAS scores, 2.7 ± 16.4, was compared to changes in the Alzheimer''s Disease Assessment Scale-Cognitive Section, the Global Deterioration Scale, Clinical Global Impression and the Mini-Mental State Exam. GAS had the largest relative efficiency (0.47) when compared to the standard. GAS also had the largest effect size (0.61). The data suggest that an individualized approach may have merit as an outcome measure and as a means to better understanding treatment effects. Qualitative analysis revealed consistent goal setting in self-care, behaviour, cognition and leisure, suggesting that these areas should routinely be evaluated.

Objectives. To compare outcomes of distance education using interactive videoconferencing vs on-site education in pharmacotherapy courses. Methods. Four third-year required pharmacotherapy courses (Integumentary, Bone and Joint Disorders, Neurology, and Psychiatry) were offered locally (Amarillo, Tex) and at a distance (Lubbock, Tex, and Dallas, Tex) by interactive videoconferencing. To assess if students at distant sites are at a disadvantage, grade point averages (GPAs) before course enrollment and final grades attained were compared among all sites using one-way ANOVA. Results. Seventy-eight students were enrolled; 32 local (Amarillo) and 46 distant (Lubbock, n = 19; Dallas, n = 27). There were no significant differences in mean GPA before fall semester (precourse) enrollment (Amarillo = 83.5, Lubbock = 83.0, Dallas = 83.0; p = 0.91). There were no significant differences in student performance in the pharmacotherapy courses between local and distant sites (p>0.05 for all comparisons). Student performance in each course correlated with GPA. Conclusions. There was no difference in learning outcomes in pharmacotherapy courses between local and distant students using videoconferencing.