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Mielke MM, Fowler NR. Alzheimer disease blood biomarkers: considerations for population-level use. Nat Rev Neurol 2024; 20:495-504. [PMID: 38862788 PMCID: PMC11347965 DOI: 10.1038/s41582-024-00989-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2024] [Indexed: 06/13/2024]
Abstract
In the past 5 years, we have witnessed the first approved Alzheimer disease (AD) disease-modifying therapy and the development of blood-based biomarkers (BBMs) to aid the diagnosis of AD. For many reasons, including accessibility, invasiveness and cost, BBMs are more acceptable and feasible for patients than a lumbar puncture (for cerebrospinal fluid collection) or neuroimaging. However, many questions remain regarding how best to utilize BBMs at the population level. In this Review, we outline the factors that warrant consideration for the widespread implementation and interpretation of AD BBMs. To set the scene, we review the current use of biomarkers, including BBMs, in AD. We go on to describe the characteristics of typical patients with cognitive impairment in primary care, who often differ from the patient populations used in AD BBM research studies. We also consider factors that might affect the interpretation of BBM tests, such as comorbidities, sex and race or ethnicity. We conclude by discussing broader issues such as ethics, patient and provider preference, incidental findings and dealing with indeterminate results and imperfect accuracy in implementing BBMs at the population level.
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Affiliation(s)
- Michelle M Mielke
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
| | - Nicole R Fowler
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
- Indiana University Center for Aging Research, Indianapolis, IN, USA
- Regenstrief Institute, Inc., Indianapolis, IN, USA
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2
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Sideman AB, Hernandez de Jesus A, Alagappan C, Ma M, Koenig CJ, Alving LI, Segal-Gidan F, Goldberger R, Sohmer D, Rosen H. Strengthening Primary Care Workforce Capacity in Dementia Diagnosis and Care: A Qualitative Study of Project Alzheimer's Disease-ECHO. Med Care Res Rev 2024:10775587241251868. [PMID: 38819958 DOI: 10.1177/10775587241251868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2024]
Abstract
Primary care practitioners (PCPs) are the first point of contact for most patients with suspected dementia and have identified a need for more training and support around dementia diagnosis and care. This qualitative study examined the Alzheimer's Disease-Extension for Community Healthcare Outcomes (AD-ECHO) program. AD-ECHO was designed to strengthen PCP capacity in dementia through bimonthly virtual meetings with a team of dementia experts. We conducted 24 hr of direct observations at AD-ECHO sessions and interviewed 14 participants about their experiences participating. Using thematic analysis, we found that participants valued the supportive learning environment and resources; knowledge gained empowered them to take more action around dementia; they identified ways of disseminating knowledge gained into their practice settings, and many desired ongoing AD-ECHO engagement. However, most identified time as a barrier to participation. AD-ECHO has the potential to strengthen the primary care workforce's knowledge and confidence around dementia care.
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Affiliation(s)
| | | | | | - Melissa Ma
- University of California, San Francisco, USA
| | | | | | | | | | | | - Howie Rosen
- University of California, San Francisco, USA
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Hinton L, Tran D, Peak K, Meyer OL, Quiñones AR. Mapping racial and ethnic healthcare disparities for persons living with dementia: A scoping review. Alzheimers Dement 2024; 20:3000-3020. [PMID: 38265164 PMCID: PMC11032576 DOI: 10.1002/alz.13612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 08/25/2023] [Accepted: 11/25/2023] [Indexed: 01/25/2024]
Abstract
INTRODUCTION We set out to map evidence of disparities in Alzheimer's disease and Alzheimer's disease related dementias healthcare, including issues of access, quality, and outcomes for racial/ethnic minoritized persons living with dementia (PLWD) and family caregivers. METHODS We conducted a scoping review of the literature published from 2000 to 2022 in PubMed, PsycINFO, and CINAHL. The inclusion criteria were: (1) focused on PLWD and/or family caregivers, (2) examined disparities or differences in healthcare, (3) were conducted in the United States, (4) compared two or more racial/ethnic groups, and (5) reported quantitative or qualitative findings. RESULTS Key findings include accumulating evidence that minoritized populations are less likely to receive an accurate and timely diagnosis, be prescribed anti-dementia medications, and use hospice care, and more likely to have a higher risk of hospitalization and receive more aggressive life-sustaining treatment at the end-of-life. DISCUSSION Future studies need to examine underlying processes and develop interventions to reduce disparities while also being more broadly inclusive of diverse populations.
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Affiliation(s)
- Ladson Hinton
- School of MedicineUniversity of CaliforniaDavisSacramentoCaliforniaUSA
| | - Duyen Tran
- School of MedicineUniversity of CaliforniaDavisSacramentoCaliforniaUSA
| | - Kate Peak
- Department of Family MedicineOregon Health & Science University (OHSU)PortlandOregonUSA
| | - Oanh L. Meyer
- School of MedicineUniversity of CaliforniaDavisSacramentoCaliforniaUSA
| | - Ana R. Quiñones
- Department of Family MedicineOregon Health & Science University (OHSU)PortlandOregonUSA
- OHSU‐PSU School of Public HealthOregon Health & Science UniversityPortlandOregonUSA
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Angelidou IA, Stocker H, Beyreuther K, Teichmann B. Validation of the "Perceptions Regarding pRE-Symptomatic Alzheimer's Disease Screening" (PRE-ADS) Questionnaire in the German Population: Attitudes, Motivations, and Barriers to Pre-Symptomatic Dementia Screening. J Alzheimers Dis 2024; 97:309-325. [PMID: 38189757 PMCID: PMC10789340 DOI: 10.3233/jad-230961] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND Attitudes, motivations, and barriers to pre-symptomatic screening for Alzheimer's disease (AD) in the general population are unclear, and validated measurement tools are lacking. OBJECTIVE Translation and validation of the German version of the "Perceptions regarding pRE-symptomatic Alzheimer's Disease Screening" (PRE-ADS) questionnaire. METHODS A convenience sample (N = 256) was recruited via an online platform. Validation of the PRE-ADS-D consisted of assessments of reliability, structural validity using Principal Component Analysis (PCA) and Exploratory Factor Analysis (EFA) and construct validity using known-group tests. A subscale "Acceptability of Screening", with 5 PRE-ADS-D items, was extracted to measure acceptance of screening in clinical practice. The STROBE checklist was used for reporting. RESULTS EFA revealed a three-factor model for the PRE-ADS-D. Acceptable to good internal consistency was found for the 25-item scale (α= 0.78), as well as for the three factors "Concerns about Screening" (α= 0.85), "Intention to be Screened" (α= 0.87), and "Preventive Health Behaviors" (α= 0.81). Construct validity was confirmed for both the 25-item PRE-ADS-D and the "Acceptability of Screening" scale (α= 0.91). Overall, 51.2% of the participants showed a preference for screening. Non-parametric tests were conducted to further explore group differences of the sample. CONCLUSIONS The PRE-ADS-D is a reliable and valid tool to measure attitudes, motives, and barriers regarding pre-symptomatic dementia screening in the German-speaking general population. Additionally, the subscale "Acceptability of Screening" demonstrated good construct validity and reliability, suggesting its promising potential as a practical tool in clinical practice.
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Affiliation(s)
| | - Hannah Stocker
- Network Aging Research, Heidelberg University, Heidelberg, Germany
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | | | - Birgit Teichmann
- Network Aging Research, Heidelberg University, Heidelberg, Germany
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An adapted Arabic version of the Test of Nine Images for the illiterate Lebanese population: Validation and preliminary normative data. J Int Neuropsychol Soc 2023; 29:316-323. [PMID: 35504862 DOI: 10.1017/s1355617722000236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES In the absence of a simple validated instrument to screen for cognitive impairment among illiterate Lebanese older adults, the aims of this study were to validate an Arabic version of the Test of Nine Images (A-TNI93) adapted by the Working Group on Dementia at Saint Joseph University: Groupe de Travail sur les Démences de l'Univesité Saint Joseph (GTD-USJ) for illiterate older Lebanese and to establish normative data. METHOD A national population-based sample of 332 community-dwelling illiterate Lebanese aged 55 years and older was administered the A-TNI93 (GTD-USJ) scoring free and overall recall. The sample is part of a larger national sample (1342 participants) used to validate an Arabic version of the Mini-Mental State Examination already reported. Reproducibility, sensitivity, specificity, and area under the curve of the A-TNI93 (GTD-USJ) scoring to detect cognitive impairment according to Clinical Dementia Rating (CDR) as the gold standard were measured. Normative data were established among 188 cognitively normal participants. RESULTS A threshold score of six on free recall (FR) provided a sensitivity of 66.7% and a specificity of 90.5%. The area under the curve was 0.93. By taking either scores, that is, a FR ≤ 6 or a total recall ≤ 8, the A-TNI93 (GTD-USJ) slightly improved dementia case detection with a sensitivity of 70.8% and a specificity of 88%. Normative data illustrate the distribution of cognitive performance among illiterate older adults. CONCLUSIONS Compared to the CDR requiring physician's competence, the A-TNI93 (GTD-USJ) is a valid Arabic adaptation to screen for cognitive impairment among illiterate Lebanese older adults.
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Sideman AB, Gilissen J, Harrison KL, Garrett SB, Terranova MJ, Ritchie CS, Geschwind MD. Caregiver Experiences Navigating the Diagnostic Journey in a Rapidly Progressing Dementia. J Geriatr Psychiatry Neurol 2022:8919887221135552. [PMID: 36412170 DOI: 10.1177/08919887221135552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
INTRODUCTION People with suspected Alzheimer's disease and related dementias (ADRD) and their families experience a burdensome process while seeking a diagnosis. These challenges are problematic in the most common dementia syndromes, but they can be even more distressing in rarer, atypical syndromes such as rapidly progressive dementias (RPDs), which can be fatal within months from onset. This study is an examination of the diagnostic journey experience from the perspective of caregivers of people who died from the prototypic RPD, sporadic Creutzfeldt-Jakob Disease (sCJD). METHODS eIn this mixed-methods study, qualitative data were drawn from interviews with former caregivers of 12 people who died from sCJD. Chart review data were drawn from research and clinical chart data about the person with sCJD. Data were analyzed by a multidisciplinary research team using qualitative and descriptive statistical analysis. RESULTS We identified 4 overarching themes that characterized the experience of the diagnostic journey in sCJD: clinician knowledge, clinician communication, experiences of uncertainty, and the caregiver as advocate. We also identified 4 phases along the diagnostic journey: recognition, the diagnostic workup, diagnosis, and post-diagnosis. Sub-themes within each phase include struggles to recognize what is wrong, complex processes of testing and referrals, delay and disclosure of diagnosis, and access to resources post-diagnosis. CONCLUSIONS Findings suggest that more work is needed to improve clinician diagnostic knowledge and communication practices. Furthermore, caregivers need better support during the diagnostic journey. What we learn from studying sCJD and other RPDs is likely applicable to other more common dementias.
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Affiliation(s)
- Alissa Bernstein Sideman
- Institute for Health Policy Studies, University of California, San Francisco, CA, USA.,Global Brain Health Institute, University of California, San Francisco, CA, USA.,Department of Humanities and Social Sciences, 8785University of California San Francisco, San Francisco, CA, USA.,Department of Neurology, 8785University of California San Francisco, San Francisco, CA, USA
| | - Joni Gilissen
- Global Brain Health Institute, University of California, San Francisco, CA, USA.,Department Family Medicine & Chronic Care, 70493Vrije Universiteit Brussel(VUB), Belgium
| | - Krista L Harrison
- Institute for Health Policy Studies, University of California, San Francisco, CA, USA.,Global Brain Health Institute, University of California, San Francisco, CA, USA.,Division of Geriatrics, University of California, San Francisco, CA, USA
| | - Sarah B Garrett
- Institute for Health Policy Studies, University of California, San Francisco, CA, USA
| | - Michael J Terranova
- Department of Neurology, 8785University of California San Francisco, San Francisco, CA, USA
| | - Christine S Ritchie
- Global Brain Health Institute, University of California, San Francisco, CA, USA.,The Mongan Institute and the Division of Palliative Care and Geriatric Medicine, 2348Massachusetts General Hospital, Boston, MA, USA
| | - Michael D Geschwind
- Department of Neurology, 8785University of California San Francisco, San Francisco, CA, USA
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Noori A, Magdamo C, Liu X, Tyagi T, Li Z, Kondepudi A, Alabsi H, Rudmann E, Wilcox D, Brenner L, Robbins GK, Moura L, Zafar S, Benson NM, Hsu J, R Dickson J, Serrano-Pozo A, Hyman BT, Blacker D, Westover MB, Mukerji SS, Das S. Development and Evaluation of a Natural Language Processing Annotation Tool to Facilitate Phenotyping of Cognitive Status in Electronic Health Records: Diagnostic Study. J Med Internet Res 2022; 24:e40384. [PMID: 36040790 PMCID: PMC9472045 DOI: 10.2196/40384] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/29/2022] [Accepted: 07/31/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Electronic health records (EHRs) with large sample sizes and rich information offer great potential for dementia research, but current methods of phenotyping cognitive status are not scalable. OBJECTIVE The aim of this study was to evaluate whether natural language processing (NLP)-powered semiautomated annotation can improve the speed and interrater reliability of chart reviews for phenotyping cognitive status. METHODS In this diagnostic study, we developed and evaluated a semiautomated NLP-powered annotation tool (NAT) to facilitate phenotyping of cognitive status. Clinical experts adjudicated the cognitive status of 627 patients at Mass General Brigham (MGB) health care, using NAT or traditional chart reviews. Patient charts contained EHR data from two data sets: (1) records from January 1, 2017, to December 31, 2018, for 100 Medicare beneficiaries from the MGB Accountable Care Organization and (2) records from 2 years prior to COVID-19 diagnosis to the date of COVID-19 diagnosis for 527 MGB patients. All EHR data from the relevant period were extracted; diagnosis codes, medications, and laboratory test values were processed and summarized; clinical notes were processed through an NLP pipeline; and a web tool was developed to present an integrated view of all data. Cognitive status was rated as cognitively normal, cognitively impaired, or undetermined. Assessment time and interrater agreement of NAT compared to manual chart reviews for cognitive status phenotyping was evaluated. RESULTS NAT adjudication provided higher interrater agreement (Cohen κ=0.89 vs κ=0.80) and significant speed up (time difference mean 1.4, SD 1.3 minutes; P<.001; ratio median 2.2, min-max 0.4-20) over manual chart reviews. There was moderate agreement with manual chart reviews (Cohen κ=0.67). In the cases that exhibited disagreement with manual chart reviews, NAT adjudication was able to produce assessments that had broader clinical consensus due to its integrated view of highlighted relevant information and semiautomated NLP features. CONCLUSIONS NAT adjudication improves the speed and interrater reliability for phenotyping cognitive status compared to manual chart reviews. This study underscores the potential of an NLP-based clinically adjudicated method to build large-scale dementia research cohorts from EHRs.
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Affiliation(s)
- Ayush Noori
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
| | - Colin Magdamo
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
| | - Xiao Liu
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
| | - Tanish Tyagi
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
| | - Zhaozhi Li
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
| | - Akhil Kondepudi
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
| | - Haitham Alabsi
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Emily Rudmann
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
- Vaccine and Immunotherapy Center, Division of Infectious Disease, Boston, MA, United States
| | - Douglas Wilcox
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Laura Brenner
- Harvard Medical School, Boston, MA, United States
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Gregory K Robbins
- Harvard Medical School, Boston, MA, United States
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States
| | - Lidia Moura
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Sahar Zafar
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Nicole M Benson
- Harvard Medical School, Boston, MA, United States
- Mongan Institute, Massachusetts General Hospital, Boston, MA, United States
- McLean Hospital, Belmont, MA, United States
| | - John Hsu
- Harvard Medical School, Boston, MA, United States
- Mongan Institute, Massachusetts General Hospital, Boston, MA, United States
| | - John R Dickson
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Alberto Serrano-Pozo
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Bradley T Hyman
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Deborah Blacker
- Harvard Medical School, Boston, MA, United States
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - M Brandon Westover
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Shibani S Mukerji
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States
| | - Sudeshna Das
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
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Splonskowski M, Jacova C. Older Adults' Likelihood of Participating in Home-Based Cognitive Assessment. Dement Geriatr Cogn Disord 2022; 51:32-41. [PMID: 35193138 DOI: 10.1159/000521903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 01/05/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Timely detection of cognitive impairment among older adults has shown to lead to better health and financial outcomes but is hampered by psychological, financial, and physical barriers to participation in cognitive assessment. Home-based cognitive assessment (HBCA) could help overcome some of these barriers. This study aimed to examine older adults' likelihood of participation in HBCA and identify factors predicting this likelihood. MATERIALS AND METHODS A cross-sectional online survey distributed through Amazon Mechanical Turk, was used to collect data from adults aged 50 years or older residing in the USA The survey was designed to gauge attitudes toward technology and cognitive assessment and to measure psychological variables including subjective cognitive decline (SCD), depression, and anxiety. Information on income and geographic location (rural vs. suburban and urban) was also collected. Univariate and hierarchical regression analyses were conducted to examine the contributions of these variables to a composite measure of likelihood of participation in HBCA. RESULTS Complete data were obtained on n = 483 (age 50-79). Approximately, two-thirds of respondents described themselves as likely or very likely to participate in HBCA. In univariate analyses, younger age, higher income, higher technology assessment acceptance scores, and higher SCD burden were associated with higher likelihood of participation. Hierarchical regression revealed significant stepwise increments in explained variance: demographic variables 4.1%, technology acceptance 25.2%, assessment acceptance 15.4%, and SCD burden 1.6%. The contribution of SCD was moderated by sex and found for women but not for men. DISCUSSION/CONCLUSION A large proportion of adults aged 50 and above described themselves likely to participate in HBCA. Middle-aged, technology-savvy, higher income adults expressed the most positive attitudes toward this type of service. Of interest is that HBCA may be particularly acceptable among older women with SCD, a group known to be at risk of cognitive decline. Our findings support the expansion of cognitive assessment services to the home setting.
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Affiliation(s)
| | - Claudia Jacova
- School of Graduate Psychology, Pacific University, Hillsboro, Oregon, USA
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Jacobson M, Joe E, Zissimopoulos J. Barriers to seeking care for memory problems: A vignette study. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2022; 8:e12238. [PMID: 35310532 PMCID: PMC8919244 DOI: 10.1002/trc2.12238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 12/01/2021] [Accepted: 12/15/2021] [Indexed: 11/06/2022]
Abstract
INTRODUCTION This study compares how older adults judge the need for follow-up care for memory-related problems when they are responding about themselves versus someone of the same age. METHODS Adults ages 65 and over in the Understanding America Study, a nationally representative internet panel, were invited to participate in a short survey with three vignettes describing memory-related problems associated with normal aging, mild cognitive impairment, and mild dementia. Respondents were randomly assigned to vignettes about themselves or about an individual of the same age and asked whether the problems warranted follow-up discussion with a health-care provider. Unadjusted and covariate-adjusted differences in the percent of affirmative responses to follow-up discussion and an index, ranging from 0 to 3, that summed affirmative responses, were compared across respondents randomly assigned to self- versus other-framed vignettes. RESULTS One thousand six hundred twenty-eight panel members (81.6%) completed the survey (mean age, 72.3 [range, 65-102], 801 female [49.2%] and 827 male [50.8%]) with 796 (48.9%) randomly assigned to vignettes about themselves and 832 (51.1%) to vignettes about individuals of the same age. Percent affirming need for follow-up ranged from 66.9% to 90.5% and was systematically lower for those randomized to vignettes about themselves. The differences ranged from -10.8 percentage points (95% confidence interval [CI], -13.6 to -7.9 percentage points) for the most severe to -13.9 percentage points (95% CI, -18.1 to -9.7 percentage points) for the mildest memory-related problem vignettes. The summary index was -0.444 points (95% CI, 0.563 to -0.326) or 0.491 of a standard deviation (95% CI, 0.622σ to -0.362σ) lower for scenarios about participants themselves relative to others. DISCUSSION Seniors were more likely to recognize and recommend follow-up for memory-related problems affecting someone else than the same problems affecting themselves, suggesting symptom education alone may not improve rates of cognitive assessment for detection of impairment and dementia.
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Affiliation(s)
- Mireille Jacobson
- University of Southern CaliforniaDavis School of GerontologyLos AngelesCaliforniaUSA
- University of Southern CaliforniaSchaeffer Center for Health Policy & EconomicsLos AngelesCaliforniaUSA
- National Bureau of Economic ResearchCambridgeMassachusettsUSA
| | - Elizabeth Joe
- Department of Neurology, University of Southern CaliforniaKeck School of MedicineLos AngelesCaliforniaUSA
| | - Julie Zissimopoulos
- University of Southern CaliforniaDavis School of GerontologyLos AngelesCaliforniaUSA
- University of Southern CaliforniaSchaeffer Center for Health Policy & EconomicsLos AngelesCaliforniaUSA
- Department of Health Care Management and Policy, University of Southern CaliforniaPrice School of Public PolicyLos AngelesCaliforniaUSA
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10
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Sideman AB, Chalmer R, Ayers E, Gershon R, Verghese J, Wolf M, Ansari A, Arvanitis M, Bui N, Chen P, Chodos A, Corriveau R, Curtis L, Ehrlich AR, Farias SET, Goode C, Hill-Sakurai L, Nowinski CJ, Premkumar M, Rankin KP, Ritchie CS, Tsoy E, Weiss E, Possin KL. Lessons from Detecting Cognitive Impairment Including Dementia (DetectCID) in Primary Care. J Alzheimers Dis 2022; 86:655-665. [PMID: 35124639 PMCID: PMC9048609 DOI: 10.3233/jad-215106] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background: Cognitive impairment, including dementia, is frequently under-detected in primary care. The Consortium for Detecting Cognitive Impairment, including Dementia (DetectCID) convenes three multidisciplinary teams that are testing novel paradigms to improve the frequency and quality of patient evaluations for detecting cognitive impairment in primary care and appropriate follow-up. Objective: Our objective was to characterize the three paradigms, including similarities and differences, and to identify common key lessons from implementation. Methods: A qualitative evaluation study with dementia specialists who were implementing the detection paradigms. Data was analyzed using content analysis. Results: We identified core components of each paradigm. Key lessons emphasized the importance of engaging primary care teams, enabling primary care providers to diagnose cognitive disorders and provide ongoing care support, integrating with the electronic health record, and ensuring that paradigms address the needs of diverse populations. Conclusion: Approaches are needed that address the arc of care from identifying a concern to post-diagnostic management, are efficient and adaptable to primary care workflows, and address a diverse aging population. Our work highlights approaches to partnering with primary care that could be useful across specialties and paves the way for developing future paradigms that improve differential diagnosis of symptomatic cognitive impairment, identifying not only its presence but also its specific syndrome or etiology.
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Affiliation(s)
- Alissa Bernstein Sideman
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, USA
- Department of Humanities & Social Sciences, University of California, San Francisco, San Francisco, CA, USA
- Global Brain Health Institute, University of California, San Francisco, San Francisco, CA and Trinity College Dublin, the University of Dublin, Dublin, Ireland
| | - Rachel Chalmer
- Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
| | - Emmeline Ayers
- The Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Richard Gershon
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Joe Verghese
- Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
- The Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Michael Wolf
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Center for Applied Health Research on Aging (CAHRA), Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Asif Ansari
- Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
| | - Marina Arvanitis
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Center for Applied Health Research on Aging (CAHRA), Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Nhat Bui
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Pei Chen
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Anna Chodos
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Roderick Corriveau
- National Institute of Neurological Disorders & Stroke, National Institute of Health, Bethesda, MA, USA
| | - Laura Curtis
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Amy R. Ehrlich
- Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Collette Goode
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Laura Hill-Sakurai
- Department of Family and Community Medicine, School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Cindy J. Nowinski
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Mukund Premkumar
- Department of Family and Community Medicine, School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Katherine P. Rankin
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Christine S. Ritchie
- Division of Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Mongan Institute Center for Aging and Serious Illness, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Elena Tsoy
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Erica Weiss
- The Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Katherine L. Possin
- Global Brain Health Institute, University of California, San Francisco, San Francisco, CA and Trinity College Dublin, the University of Dublin, Dublin, Ireland
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
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11
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Tyrrell M, Hedman R, Fossum B, Skovdahl K, Religa D, Hillerås P. Feeling valued versus abandoned: Voices of persons who have completed a cognitive assessment. Int J Older People Nurs 2021; 16:e12403. [PMID: 34231964 DOI: 10.1111/opn.12403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 05/28/2021] [Accepted: 06/11/2021] [Indexed: 01/10/2023]
Abstract
AIM To describe older persons' experiences of a cognitive assessment and possible neuropsychiatric symptoms [NPS] related to a neurocognitive diagnosis. BACKGROUND A cognitive assessment in primary care is offered to persons with suspected dementia with subsequent referral to a specialist clinic if required. The assessment process, with the likelihood of receiving a dementia diagnosis, is surrounded by uncertainty with long waiting times. Although NPS are common among persons with cognitive impairment persons are not routinely asked about these symptoms during a cognitive assessment. METHOD Interviews were held with 18 participants who had completed a cognitive assessment. The Neuropsychiatric Inventory [NPI] was incorporated into one of the interview questions enabling participants to self-report NPS, if present. Interview data were analysed using Interpretive Description. RESULTS Two main themes were identified: a matter of trust and making sense of a cognitive diagnosis. Experiences of the assessment process ranged from feeling valued to abandoned with variations of trust in the process. A diagnosis of mild cognitive impairment was experienced as an abstract diagnosis devoid of follow-up support. A lack of preparedness for the assessment existed among participants. Some experienced the process as standardised. One half of participants self-reported the presence of one to four NPS, regardless of neurocognitive diagnosis. Irritability and depression were most common NPS identified. CONCLUSIONS Experiences of a cognitive assessment varied from feeling valued by society to abandoned in the absence of follow-up support. The assessment was viewed as a standardised procedure failing to see the person behind the testing. Diagnosis disclosure conversations were experienced as diffuse with participants unprepared for a dementia diagnosis. The NPI enabled participants to identify and report the presence of NPS which otherwise could go undetected during the cognitive assessment, impacting on the person's well-being and daily life.
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Affiliation(s)
- Marie Tyrrell
- Sophiahemmet University, Stockholm, Sweden.,Karolinska Institutet, NVS, Stockholm, Sweden
| | | | - Bjöörn Fossum
- Sophiahemmet University, Stockholm, Sweden.,Karolinska Institutet, SöS, Stockholm, Sweden
| | | | | | - Pernilla Hillerås
- Sophiahemmet University, Stockholm, Sweden.,Karolinska Institutet, NVS, Stockholm, Sweden.,Red Cross University College, Stockholm, Sweden
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12
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Binng D, Splonskowski M, Jacova C. Distance Assessment for Detecting Cognitive Impairment in Older Adults: A Systematic Review of Psychometric Evidence. Dement Geriatr Cogn Disord 2021; 49:456-470. [PMID: 33291097 DOI: 10.1159/000511945] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 09/30/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Distance or remote cognitive assessments, administered via phone or computer platforms, have emerged as possible alternatives to traditional assessments performed during office visits. Distance refers to any nontraditional assessment feature, not only or necessarily location. We conducted a systematic review to examine the psychometric soundness of these approaches. METHOD We searched PubMed, PsycINFO, AgeLine, and Academic Search Premier for articles published between January 2008 and June 2020. Studies were included if participants were over the age of 50, a structured assessment of cognitive function in older adults was evaluated, the assessment method was deemed distant, and validity and/or reliability data were reported. Assessment distance was defined as having any of the following features: use of an electronic test interface, nonroutine test location (e.g., home), test self-administered, and test unsupervised. Distance was categorized as low, intermediate, or high. RESULTS/DISCUSSION Twenty-six studies met inclusion criteria. Sample sizes ranged from n = 8 to 8,627, and the mean age ranged from 57 to 83. Assessments included screens, brief or full batteries, and were performed via videoconferencing, phone, smartphone, or tablet/computer. Ten studies reported on low distance, 11 on intermediate distance, and 5 studies for high distance assessments. Invalid performance data were observed with older age and cognitive impairment. Convergent validity data were reported consistently and suggested a decline with increasing distance: r = 0.52-0.80 for low, 0.49-0.75 for intermediate, and 0.41-0.53 for high distance. Diagnostic validity estimates presented a similar pattern. Reliability data were reported too inconsistently to allow evaluation. CONCLUSION The validity of cognitive assessments with older adults appears supported at lower but not higher distance. Less is known about the reliability of such assessments. Future research should delineate the person and procedure boundaries for valid and reliable test results.
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Affiliation(s)
- Davina Binng
- School of Graduate Psychology, Pacific University, Hillsboro, Oregon, USA
| | | | - Claudia Jacova
- School of Graduate Psychology, Pacific University, Hillsboro, Oregon, USA,
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13
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Responsiveness and interpretability of commonly used outcome assessments of mobility capacity in older hospital patients with cognitive spectrum disorders. Health Qual Life Outcomes 2021; 19:68. [PMID: 33648508 PMCID: PMC7923341 DOI: 10.1186/s12955-021-01690-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 01/25/2021] [Indexed: 02/06/2023] Open
Abstract
Background In older hospital patients with cognitive spectrum disorders (CSD), mobility should be monitored frequently with standardised and psychometrically sound measurement instruments. This study aimed to examine the responsiveness, minimal important change (MIC), floor effects and ceiling effects of commonly used outcome assessments of mobility capacity in older patients with dementia, delirium or other cognitive impairment. Methods In a cross-sectional study that included acute older hospital patients with CSD (study period: 02/2015–12/2015), the following mobility assessments were applied: de Morton Mobility Index (DEMMI), Hierarchical Assessment of Balance and Mobility (HABAM), Performance Oriented Mobility Assessment, Short Physical Performance Battery, 4-m gait speed test, 5-times chair rise test, 2-min walk test, Timed Up and Go test, Barthel Index mobility subscale, and Functional Ambulation Categories. These assessments were administered shorty after hospital admission (baseline) and repeated prior to discharge (follow-up). Global rating of mobility change scales and a clinical anchor of functional ambulation were used as external criteria to determine the area under the curve (AUC). Construct- and anchor-based approaches determined responsiveness. MIC values for each instrument were established from different anchor- and distribution-based approaches. Results Of the 63 participants (age range: 69–94 years) completing follow-up assessments with mild (Mini Mental State Examination: 19–24 points; 67%) and moderate (10–18 points; 33%) cognitive impairment, 25% were diagnosed with dementia alone, 13% with delirium alone, 11% with delirium superimposed on dementia and 51% with another cognitive impairment. The follow-up assessment was performed 10.8 ± 2.5 (range: 7–17) days on average after the baseline assessment. The DEMMI was the most responsive mobility assessment (all AUC > 0.7). For the other instruments, the data provided conflicting evidence of responsiveness, or evidence of no responsiveness. MIC values for each instrument varied depending on the method used for calculation. The DEMMI and HABAM were the only instruments without floor or ceiling effects. Conclusions Most outcome assessments of mobility capacity seem insufficiently responsive to change in older hospital patients with CSD. The significant floor effects of most instruments further limit the monitoring of mobility alterations over time in this population. The DEMMI was the only instrument that was able to distinguish clinically important changes from measurement error. Trial registration German Clinical Trials Register (DRKS00005591). Registered February 2, 2015.
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14
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Lind KE, Hildreth K, Lindrooth R, Morrato E, Crane LA, Perraillon MC. The effect of direct cognitive assessment in the Medicare annual wellness visit on dementia diagnosis rates. Health Serv Res 2021; 56:193-203. [PMID: 33481263 DOI: 10.1111/1475-6773.13627] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To evaluate the relationship between direct cognitive assessment introduced with the Medicare Annual Wellness Visit (AWV) and new diagnoses of dementia, and to determine if effects vary by race. DATA SOURCES Medicare Limited Data Set 5% sample claims 2003-2014 and the HRSA Area Health Resources Files. STUDY DESIGN Instrumental Variable approach estimating the relationship between AWV utilization and new diagnoses of dementia using county-level Welcome to Medicare Visit rates as an instrument. DATA COLLECTION/EXTRACTION METHODS Three hundred twenty-four thousand three hundred and eighty-five fee-for-service Medicare beneficiaries without dementia when the AWV was introduced in 2011. PRINCIPAL FINDINGS Annual Wellness Visit utilization was associated with an increased probability of new dementia diagnosis with effects varying by racial group (categorized as white, black, Hispanic/Latino, or Asian based on Social Security Administration data). Hazard ratios (95% confidence intervals) for new dementia diagnosis within 6 months of AWV utilization were as follows: 2.34 (2.13, 2.58) white, 2.22 (1.71, 2.89) black, 4.82 (2.94, 7.89) Asian, and 6.14 (3.70, 10.19) Hispanic (P < .001 for each). Our findings show that estimates that do not control for selection underestimate the effect of AWV on new diagnoses. CONCLUSIONS Dementia diagnosis rates increased with AWV implementation with heterogenous effects by race and ethnicity. Current recommendations by the United States Preventive Services Task Force state that the evidence is insufficient to recommend for or against screening for cognitive impairment in older adults.
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Affiliation(s)
- Kimberly E Lind
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Kerry Hildreth
- School of Medicine, University of Colorado, Aurora, Colorado, USA
| | - Richard Lindrooth
- Colorado School of Public Health, University of Colorado, Aurora, Colorado, USA
| | - Elaine Morrato
- Colorado School of Public Health, University of Colorado, Aurora, Colorado, USA
| | - Lori A Crane
- Colorado School of Public Health, University of Colorado, Aurora, Colorado, USA
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15
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Aihara Y, Maeda K. Dementia Literacy and Willingness to Dementia Screening. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17218134. [PMID: 33158014 PMCID: PMC7662832 DOI: 10.3390/ijerph17218134] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/27/2020] [Accepted: 10/30/2020] [Indexed: 05/31/2023]
Abstract
The increasing prevalence of delayed and missed diagnoses for dementia constitutes major public concern. In this regard, inadequate knowledge and poor understanding of the condition may create a barrier to timely dementia screening. This cross-sectional study assessed dementia literacy, then identified the association between dementia literacy and willingness to undergo routine dementia screening among community-dwelling older adults in two urban areas of Japan. More specifically, structured questionnaires were distributed to a total of 854 individuals aged ≥ 65 years. A multivariate logistic regression was then used to explore the factors associated with dementia literacy and willingness to undergo routine dementia screening. Results showed that younger respondents and respondents who received dementia information from television/radio and/or paper-based sources were more likely to have high dementia literacy. While less than half of participants were willing to undergo routine dementia screening, those with higher dementia literacy were more willing to do so (albeit, not a statistically significant difference). Although there are pros and cons to routine dementia screening, it is necessary to implement such a system to detect dementia and cognitive impairment. Further, assessments should also attempt to gain information about individual beliefs and understandings related to dementia information.
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16
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Aihara Y, Maeda K. Intention to undergo dementia screening in primary care settings among community-dwelling older people. Int J Geriatr Psychiatry 2020; 35:1036-1042. [PMID: 32383788 DOI: 10.1002/gps.5326] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 04/24/2020] [Accepted: 04/25/2020] [Indexed: 01/13/2023]
Abstract
To improve the quality of care for people with dementia, several local governments in Japan have implemented a subsidized system for screening of dementia. This cross-sectional study aimed to identify factors that promote public intention to undergo dementia screening. A postal survey was conducted in a residential area that lies across the two cities which started a subsidized system for dementia screening. Semi-structured questionnaires were distributed to community-dwelling people aged ≥65 years; a total of 2269 persons were included in the analysis. χ2 test and multiple logistic regression analysis were used to identify factors associated with the willingness to undergo dementia screening. Among the people with dementia, only 28% had undergone a screening test for dementia. The participants who were certified of public long-term care need tended to undergo dementia screening. Approximately 67% of the participants were willing to undergo a dementia diagnosis test. Younger age, female sex, perceived poor health status, having a primary care physician, and independent daily activity level were associated with a greater willingness to undergo dementia screening using a subsidized system. Our study showed that majority of people with possible dementia do not undergo dementia screening. However, majority of people were willing to use a subsidized system for dementia screening. Further studies are required to support the benefits of a subsidized dementia screening in primary care settings. J Am Geriatr Soc 68:-, 2020.
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Affiliation(s)
- Yoko Aihara
- Faculty of Rehabilitation, Kobe Gakuin University, Kobe, Japan
| | - Kiyoshi Maeda
- Faculty of Rehabilitation, Kobe Gakuin University, Kobe, Japan
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17
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El-Hayeck R, Baddoura R, Wehbé A, Bassil N, Koussa S, Abou Khaled K, Richa S, Khoury R, Alameddine A, Sellal F. An Arabic Version of the Mini-Mental State Examination for the Lebanese Population: Reliability, Validity, and Normative Data. J Alzheimers Dis 2020; 71:525-540. [PMID: 31424409 DOI: 10.3233/jad-181232] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The Mini-Mental State Examination (MMSE) has not been validated in the Lebanese population and no normative data exist at the national level. OBJECTIVE To evaluate the reliability and validity of an Arabic version of MMSE developed by the "Groupe de Travail sur les Démences de l'Université Saint Joseph" (A-MMSE(GTD-USJ)) and to provide normative data by gender, age, and education in adults over 55. METHODS Study design: national cross-sectional survey. STUDY POPULATION 1,010 literate community-dwelling Lebanese residents aged 55 and above. OUTCOMES reproducibility, internal consistency, sensitivity, specificity, predictive values, and area under the curve of the A-MMSE(GTD-USJ) for the detection of cognitive impairment using the Clinical Dementia Rating (CDR) as the gold standard. Normative data were established from 720 healthy adults. A-MMSE(GTD-USJ) scores corresponding to the 5th, 10th, 15th, and 50th percentiles were identified according to gender, age, and education. RESULTS Intra-rater and inter-rater test-retest score correlations were 0.89 and 0.72, respectively. Cronbach alpha coefficient for internal consistency of the A-MMSE(GTD-USJ) was 0.71. A threshold value of 23 provided a sensitivity of 80% and a specificity of 89.4%. The area under the curve was 0.92. A-MMSE(GTD-USJ) scores increased with education and decreased with age. Women had significantly lower scores than men. Normative data for A-MMSE(GTD-USJ) stratified by gender, age, and education were generated. CONCLUSION In reference to the CDR, the A-MMSE(GTD-USJ) is a valid tool to assess cognitive status among Lebanese subjects aged 55 and above. Normative data will help clinicians in detecting cognitive impairment in this population.
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Affiliation(s)
- Rita El-Hayeck
- Department of Geriatrics, Saint Joseph University School of Medicine, Beirut, Lebanon.,Working Group on Dementia at Saint Joseph University: Groupe de Travail sur les Démences de l'USJ (GTD-USJ)
| | - Rafic Baddoura
- Department of Epidemiology and Public Health, Saint Joseph University School of Medicine, Beirut, Lebanon.,Working Group on Dementia at Saint Joseph University: Groupe de Travail sur les Démences de l'USJ (GTD-USJ)
| | - Amine Wehbé
- Department of Geriatrics, Saint Joseph University School of Medicine, Beirut, Lebanon.,Working Group on Dementia at Saint Joseph University: Groupe de Travail sur les Démences de l'USJ (GTD-USJ)
| | - Nazem Bassil
- Department of Geriatrics, University of Balamand, Saint George Hospital Medical Centre, Lebanon
| | - Salam Koussa
- Department of Neurology, Lebanese University, Lebanese Hospital Geitaoui-UMC, Beirut, Lebanon.,Working Group on Dementia at Saint Joseph University: Groupe de Travail sur les Démences de l'USJ (GTD-USJ)
| | - Karine Abou Khaled
- Department of Neurology, Saint Joseph University School of Medicine, Beirut, Lebanon.,Working Group on Dementia at Saint Joseph University: Groupe de Travail sur les Démences de l'USJ (GTD-USJ)
| | - Sami Richa
- Department of Psychiatry, Saint Joseph University School of Medicine, Beirut, Lebanon.,Working Group on Dementia at Saint Joseph University: Groupe de Travail sur les Démences de l'USJ (GTD-USJ)
| | - Rita Khoury
- Department of Geriatric Psychiatry, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Abbas Alameddine
- Department of Psychiatry, Hôtel-Dieu de France Hospital, Beirut and Department of Psychology, University of Balamand, Lebanon
| | - François Sellal
- Department of Neurology, Hôpitaux Civils de Colmar and INSERM U-1118, School of Medicine, Strasbourg University, France
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18
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Barnes DE, Zhou J, Walker RL, Larson EB, Lee SJ, Boscardin WJ, Marcum ZA, Dublin S. Development and Validation of eRADAR: A Tool Using EHR Data to Detect Unrecognized Dementia. J Am Geriatr Soc 2020; 68:103-111. [PMID: 31612463 PMCID: PMC7094818 DOI: 10.1111/jgs.16182] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 08/01/2019] [Accepted: 08/10/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Early recognition of dementia would allow patients and their families to receive care earlier in the disease process, potentially improving care management and patient outcomes, yet nearly half of patients with dementia are undiagnosed. Our aim was to develop and validate an electronic health record (EHR)-based tool to help detect patients with unrecognized dementia (EHR Risk of Alzheimer's and Dementia Assessment Rule [eRADAR]). DESIGN Retrospective cohort study. SETTING Kaiser Permanente Washington (KPWA), an integrated healthcare delivery system. PARTICIPANTS A total of 16 665 visits among 4330 participants in the Adult Changes in Thought (ACT) study, who undergo a comprehensive process to detect and diagnose dementia every 2 years and have linked KPWA EHR data, divided into development (70%) and validation (30%) samples. MEASUREMENTS EHR predictors included demographics, medical diagnoses, vital signs, healthcare utilization, and medications within the previous 2 years. Unrecognized dementia was defined as detection in ACT before documentation in the KPWA EHR (ie, lack of dementia or memory loss diagnosis codes or dementia medication fills). RESULTS Overall, 1015 ACT visits resulted in a diagnosis of incident dementia, of which 498 (49%) were unrecognized in the KPWA EHR. The final 31-predictor model included markers of dementia-related symptoms (eg, psychosis diagnoses, antidepressant fills), healthcare utilization pattern (eg, emergency department visits), and dementia risk factors (eg, cerebrovascular disease, diabetes). Discrimination was good in the development (C statistic = .78; 95% confidence interval [CI] = .76-.81) and validation (C statistic = .81; 95% CI = .78-.84) samples, and calibration was good based on plots of predicted vs observed risk. If patients with scores in the top 5% were flagged for additional evaluation, we estimate that 1 in 6 would have dementia. CONCLUSION The eRADAR tool uses existing EHR data to detect patients with good accuracy who may have unrecognized dementia. J Am Geriatr Soc 68:103-111, 2019.
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Affiliation(s)
- Deborah E. Barnes
- Department of Psychiatry, University of California, San Francisco
- Department of Epidemiology & Biostatistics, University of California, San Francisco
- San Francisco Veterans Affairs Health Care System
| | - Jing Zhou
- Biostatistics Unit, Kaiser Permanente Washington Health Research Institute
| | - Rod L. Walker
- Biostatistics Unit, Kaiser Permanente Washington Health Research Institute
| | | | - Sei J. Lee
- San Francisco Veterans Affairs Health Care System
- Department of Medicine, Division of Geriatrics, University of California, San Francisco
| | - W. John Boscardin
- Department of Epidemiology & Biostatistics, University of California, San Francisco
- San Francisco Veterans Affairs Health Care System
- Department of Medicine, Division of Geriatrics, University of California, San Francisco
| | | | - Sascha Dublin
- Kaiser Permanente Washington Health Research Institute
- Department of Epidemiology, University of Washington
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19
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Fowler NR, Perkins AJ, Gao S, Sachs GA, Boustani MA. Risks and Benefits of Screening for Dementia in Primary Care: The Indiana University Cognitive Health Outcomes Investigation of the Comparative Effectiveness of Dementia Screening (IU CHOICE)Trial. J Am Geriatr Soc 2019; 68:535-543. [PMID: 31792940 DOI: 10.1111/jgs.16247] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 08/30/2019] [Accepted: 10/01/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND/OBJECTIVE The benefits and harms of screening of Alzheimer disease and related dementias (ADRDs) are unknown. This study addressed the question of whether the benefits outweigh the harms of screening for ADRDs among older adults in primary care. DESIGN, SETTING, AND PARTICIPANTS Single-blinded, two-arm, randomized controlled trial (October 2012-September 2016) in urban, suburban, and rural primary care settings in Indiana. A total of 4005 primary care patients (aged ≥65 years) were randomized to ADRD screening (n = 2008) or control (n = 1997). INTERVENTION Patients were screened using the Memory Impairment Screen or the Mini-Cog and referred for a voluntary follow-up diagnostic assessment if they screened positive on either or both screening tests. MEASUREMENTS Primary measures were health-related quality of life (HRQOL; Health Utilities Index) at 12 months, depressive symptoms (Patient Health Questionnaire-9), and anxiety symptoms (Generalized Anxiety Disorder seven-item scale) at 1 month. RESULTS The mean age was 74.2 years (SD = 6.9 years); 2257 (66%) were female and 2301 (67%) were white. At 12 months, we were unable to detect differences in HRQOL between the groups (effect size = 0.009 [95% confidence interval {CI} = -0.063 to 0.080]; P = .81). At 1 month, differences in mean depressive symptoms (mean difference = -0.23 [90% CI = -0.42 to -0.039]) and anxiety symptoms (mean difference = -0.087 [90% CI = -0.246 to 0.072]) were within prespecified equivalency range. Scores for depressive and anxiety symptoms were similar between the groups at all time points. No differences in healthcare utilization, advance care planning, and ADRD recognition by physicians were detected at 12 months. CONCLUSION We were unable to detect a difference in HRQOL for screening for ADRD among older adults. We found no harm from screening measured by symptoms of depression or anxiety. Missing data, low rates of dementia detection, and high rate of refusal for follow-up diagnostic assessments after a positive screen may explain these findings. J Am Geriatr Soc 68:535-543, 2020.
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Affiliation(s)
- Nicole R Fowler
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana.,Indiana University Center for Aging Research, Indianapolis, Indiana.,Regenstrief Institute, Inc, Indianapolis, Indiana.,Center for Health Innovation and Implementation Science, Indiana Clinical and Translational Science Institute, Indianapolis, Indiana
| | - Anthony J Perkins
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Sujuan Gao
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Greg A Sachs
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana.,Indiana University Center for Aging Research, Indianapolis, Indiana.,Regenstrief Institute, Inc, Indianapolis, Indiana
| | - Malaz A Boustani
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana.,Indiana University Center for Aging Research, Indianapolis, Indiana.,Regenstrief Institute, Inc, Indianapolis, Indiana.,Center for Health Innovation and Implementation Science, Indiana Clinical and Translational Science Institute, Indianapolis, Indiana
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20
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Bernstein A, Rogers KM, Possin KL, Steele NZR, Ritchie CS, Kramer JH, Geschwind M, Higgins JJ, Wohlgemuth J, Pesano R, Miller BL, Rankin KP. Dementia assessment and management in primary care settings: a survey of current provider practices in the United States. BMC Health Serv Res 2019; 19:919. [PMID: 31783848 PMCID: PMC6884754 DOI: 10.1186/s12913-019-4603-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 10/03/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Primary care providers (PCPs) are typically the first to screen and evaluate patients for neurocognitive disorders (NCDs), including mild cognitive impairment and dementia. However, data on PCP attitudes and evaluation and management practices are sparse. Our objective was to quantify perspectives and behaviors of PCPs and neurologists with respect to NCD evaluation and management. METHODS A cross-sectional survey with 150 PCPs and 50 neurologists in the United States who evaluated more than 10 patients over age 55 per month. The 51-item survey assessed clinical practice characteristics, and confidence, perceived barriers, and typical practices when diagnosing and managing patients with NCDs. RESULTS PCPs and neurologists reported similar confidence and approaches to general medical care and laboratory testing. Though over half of PCPs performed cognitive screening or referred patients for cognitive testing in over 50% of their patients, only 20% reported high confidence in interpreting results of cognitive tests. PCPs were more likely to order CT scans than MRIs, and only 14% of PCPs reported high confidence interpreting brain imaging findings, compared to 70% of specialists. Only 21% of PCPs were highly confident that they correctly recognized when a patient had an NCD, and only 13% were highly confident in making a specific NCD diagnosis (compared to 72 and 44% for neurologists, both p < 0.001). A quarter of all providers identified lack of familiarity with diagnostic criteria for NCD syndromes as a barrier to clinical practice. CONCLUSIONS This study demonstrates how PCPs approach diagnosis and management of patients with NCDs, and identified areas for improvement in regards to cognitive testing and neuroimaging. This study also identified all providers' lack of familiarity with published diagnostic criteria for NCD syndromes. These findings may inform the development of new policies and interventions to help providers improve the efficacy of their decision processes and deliver better quality care to patients with NCDs.
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Affiliation(s)
- Alissa Bernstein
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, USA. .,Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, USA.
| | - Kirsten M Rogers
- Department of Neurology, University of California San Francisco, San Francisco, USA
| | - Katherine L Possin
- Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, USA.,Department of Neurology, University of California San Francisco, San Francisco, USA
| | | | - Christine S Ritchie
- Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, USA.,Division of Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Joel H Kramer
- Department of Neurology, University of California San Francisco, San Francisco, USA
| | - Michael Geschwind
- Department of Neurology, University of California San Francisco, San Francisco, USA
| | | | | | | | - Bruce L Miller
- Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, USA.,Department of Neurology, University of California San Francisco, San Francisco, USA
| | - Katherine P Rankin
- Department of Neurology, University of California San Francisco, San Francisco, USA
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21
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Bernstein A, Rogers KM, Possin KL, Steele NZR, Ritchie CS, Miller BL, Rankin KP. Primary Care Provider Attitudes and Practices Evaluating and Managing Patients with Neurocognitive Disorders. J Gen Intern Med 2019; 34:1691-1692. [PMID: 31044411 PMCID: PMC6712190 DOI: 10.1007/s11606-019-05013-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Alissa Bernstein
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, USA. .,Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, USA.
| | - Kirsten M Rogers
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Katherine L Possin
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Natasha Z R Steele
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA.,University of Washington School of Medicine, Seattle, WA, USA
| | - Christine S Ritchie
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Bruce L Miller
- Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, USA.,Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Katherine P Rankin
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
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Shao Y, Zeng QT, Chen KK, Shutes-David A, Thielke SM, Tsuang DW. Detection of probable dementia cases in undiagnosed patients using structured and unstructured electronic health records. BMC Med Inform Decis Mak 2019. [PMID: 31288818 DOI: 10.1186/s12911‐019‐0846‐4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Dementia is underdiagnosed in both the general population and among Veterans. This underdiagnosis decreases quality of life, reduces opportunities for interventions, and increases health-care costs. New approaches are therefore necessary to facilitate the timely detection of dementia. This study seeks to identify cases of undiagnosed dementia by developing and validating a weakly supervised machine-learning approach that incorporates the analysis of both structured and unstructured electronic health record (EHR) data. METHODS A topic modeling approach that included latent Dirichlet allocation, stable topic extraction, and random sampling was applied to VHA EHRs. Topic features from unstructured data and features from structured data were compared between Veterans with (n = 1861) and without (n = 9305) ICD-9 dementia codes. A logistic regression model was used to develop dementia prediction scores, and manual reviews were conducted to validate the machine-learning results. RESULTS A total of 853 features were identified (290 topics, 174 non-dementia ICD codes, 159 CPT codes, 59 medications, and 171 note types) for the development of logistic regression prediction scores. These scores were validated in a subset of Veterans without ICD-9 dementia codes (n = 120) by experts in dementia who performed manual record reviews and achieved a high level of inter-rater agreement. The manual reviews were used to develop a receiver of characteristic (ROC) curve with different thresholds for case detection, including a threshold of 0.061, which produced an optimal sensitivity (0.825) and specificity (0.832). CONCLUSIONS Dementia is underdiagnosed, and thus, ICD codes alone cannot serve as a gold standard for diagnosis. However, this study suggests that imperfect data (e.g., ICD codes in combination with other EHR features) can serve as a silver standard to develop a risk model, apply that model to patients without dementia codes, and then select a case-detection threshold. The study is one of the first to utilize both structured and unstructured EHRs to develop risk scores for the diagnosis of dementia.
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Affiliation(s)
- Yijun Shao
- George Washington University, 800 22nd St. NW, Science and Engineering Hall, Ste. #8390, Washington, DC, 20052, USA.,Washington DC VA Medical Center, 50 Irving St. NW, Washington, 20422, DC, USA
| | - Qing T Zeng
- George Washington University, 800 22nd St. NW, Science and Engineering Hall, Ste. #8390, Washington, DC, 20052, USA.,Washington DC VA Medical Center, 50 Irving St. NW, Washington, 20422, DC, USA
| | - Kathryn K Chen
- Geriatric Research, Education, and Clinical Center, S182 GRECC, VA Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA, 98108, USA.,Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 NE Pacific St., Box 356560, Seattle, WA, 98195, USA
| | - Andrew Shutes-David
- Geriatric Research, Education, and Clinical Center, S182 GRECC, VA Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA, 98108, USA.,Mental Illness Research, Education, and Clinical Center, S116 MIRECC, VA Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA, 98108, USA
| | - Stephen M Thielke
- Geriatric Research, Education, and Clinical Center, S182 GRECC, VA Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA, 98108, USA.,Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 NE Pacific St., Box 356560, Seattle, WA, 98195, USA
| | - Debby W Tsuang
- Geriatric Research, Education, and Clinical Center, S182 GRECC, VA Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA, 98108, USA. .,Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 NE Pacific St., Box 356560, Seattle, WA, 98195, USA.
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23
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Shao Y, Zeng QT, Chen KK, Shutes-David A, Thielke SM, Tsuang DW. Detection of probable dementia cases in undiagnosed patients using structured and unstructured electronic health records. BMC Med Inform Decis Mak 2019; 19:128. [PMID: 31288818 PMCID: PMC6617952 DOI: 10.1186/s12911-019-0846-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 06/20/2019] [Indexed: 02/07/2023] Open
Abstract
Background Dementia is underdiagnosed in both the general population and among Veterans. This underdiagnosis decreases quality of life, reduces opportunities for interventions, and increases health-care costs. New approaches are therefore necessary to facilitate the timely detection of dementia. This study seeks to identify cases of undiagnosed dementia by developing and validating a weakly supervised machine-learning approach that incorporates the analysis of both structured and unstructured electronic health record (EHR) data. Methods A topic modeling approach that included latent Dirichlet allocation, stable topic extraction, and random sampling was applied to VHA EHRs. Topic features from unstructured data and features from structured data were compared between Veterans with (n = 1861) and without (n = 9305) ICD-9 dementia codes. A logistic regression model was used to develop dementia prediction scores, and manual reviews were conducted to validate the machine-learning results. Results A total of 853 features were identified (290 topics, 174 non-dementia ICD codes, 159 CPT codes, 59 medications, and 171 note types) for the development of logistic regression prediction scores. These scores were validated in a subset of Veterans without ICD-9 dementia codes (n = 120) by experts in dementia who performed manual record reviews and achieved a high level of inter-rater agreement. The manual reviews were used to develop a receiver of characteristic (ROC) curve with different thresholds for case detection, including a threshold of 0.061, which produced an optimal sensitivity (0.825) and specificity (0.832). Conclusions Dementia is underdiagnosed, and thus, ICD codes alone cannot serve as a gold standard for diagnosis. However, this study suggests that imperfect data (e.g., ICD codes in combination with other EHR features) can serve as a silver standard to develop a risk model, apply that model to patients without dementia codes, and then select a case-detection threshold. The study is one of the first to utilize both structured and unstructured EHRs to develop risk scores for the diagnosis of dementia.
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Affiliation(s)
- Yijun Shao
- George Washington University, 800 22nd St. NW, Science and Engineering Hall, Ste. #8390, Washington, DC, 20052, USA.,Washington DC VA Medical Center, 50 Irving St. NW, Washington, 20422, DC, USA
| | - Qing T Zeng
- George Washington University, 800 22nd St. NW, Science and Engineering Hall, Ste. #8390, Washington, DC, 20052, USA.,Washington DC VA Medical Center, 50 Irving St. NW, Washington, 20422, DC, USA
| | - Kathryn K Chen
- Geriatric Research, Education, and Clinical Center, S182 GRECC, VA Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA, 98108, USA.,Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 NE Pacific St., Box 356560, Seattle, WA, 98195, USA
| | - Andrew Shutes-David
- Geriatric Research, Education, and Clinical Center, S182 GRECC, VA Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA, 98108, USA.,Mental Illness Research, Education, and Clinical Center, S116 MIRECC, VA Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA, 98108, USA
| | - Stephen M Thielke
- Geriatric Research, Education, and Clinical Center, S182 GRECC, VA Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA, 98108, USA.,Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 NE Pacific St., Box 356560, Seattle, WA, 98195, USA
| | - Debby W Tsuang
- Geriatric Research, Education, and Clinical Center, S182 GRECC, VA Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA, 98108, USA. .,Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 NE Pacific St., Box 356560, Seattle, WA, 98195, USA.
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25
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Caregivers' Experience of Decision-Making regarding Diagnostic Assessment following Cognitive Screening of Older Adults. J Aging Res 2019; 2018:8352816. [PMID: 30631599 PMCID: PMC6304837 DOI: 10.1155/2018/8352816] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 09/21/2018] [Accepted: 11/04/2018] [Indexed: 11/21/2022] Open
Abstract
Targeted screening for dementia among older adults in primary healthcare has potential benefits such as better clinical outcomes and the opportunity to access services. Cognitive screening can be followed up by further diagnostic assessment to determine a diagnosis of dementia. Unfortunately, the rates of accepting further diagnostic assessment following cognitive screening are low. The objective of this study was to explore the caregivers' decision-making process regarding uptake of diagnostic assessment following positive screening results. A qualitative design was employed, and interpretative phenomenological analysis was used to analyze the data. Three major themes in caregiver decision-making were identified: gathering information, protecting the patient, and balancing obligation and convenience in caregiving. These findings suggest that the decision-making process involved effort to process information through observations of the patient and that caregivers emphasized quality of life.
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26
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Wong S, Jacova C. Older Adults' Attitudes towards Cognitive Testing: Moving towards Person-Centeredness. Dement Geriatr Cogn Dis Extra 2018; 8:348-359. [PMID: 30483302 PMCID: PMC6243915 DOI: 10.1159/000493464] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 09/02/2018] [Indexed: 12/17/2022] Open
Abstract
Background Research on person-centered cognitive testing is beginning to emerge. The current study is the first to focus on eliciting concrete preferences around the test experience. Methods Adults ≥50 years old completed the Attitudes Around Cognitive Testing (AACT) questionnaire on mturk.com. AACT elicits preferences for cognitive tests, the importance attributed to having choices, and willingness to engage in testing. Results Data are reported for 289 respondents. The proportion of participants expressing preferences varied by domain (modality [49.5%], location [47.2%], company [80.1%], result delivery [78.3-89.7%]). Importance ratings for all domains had a median of 4 and a range of 1-5 using a Likert scale of agreement. Most participants (85.5%) were willing to engage in testing. Conclusion Older adults have preferences for cognitive tests, especially with delivery of results.
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Affiliation(s)
- Sara Wong
- Pacific University, Hillsboro, Oregon, USA
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27
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Braun T, Grüneberg C, Thiel C, Schulz RJ. Measuring mobility in older hospital patients with cognitive impairment using the de Morton Mobility Index. BMC Geriatr 2018; 18:100. [PMID: 29685107 PMCID: PMC5913915 DOI: 10.1186/s12877-018-0780-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 04/03/2018] [Indexed: 11/10/2022] Open
Abstract
Background Mobility is a key outcome in older patients with cognitive impairment. The de Morton Mobility Index (DEMMI) is an established measure of older people’s mobility that is promising for use in older patients with cognitive impairment. The aim of this study was to examine the DEMMI’s psychometric properties in older patients with dementia, delirium or other cognitive impairment. Methods This cross-sectional study was performed in a geriatric hospital and includes older acute medical patients with cognitive impairment indicated by a Mini Mental State Examination (MMSE) score ≤ 24 points. A Rasch analysis was performed to check the DEMMI’s unidimensionality. Construct validity was assessed by testing 13 hypotheses about expected correlations between the DEMMI and outcome measures of similar or related constructs, and about expected differences of DEMMI scores between groups differing in mobility related characteristics. Administration times were recorded. Results A sample of 153 patients with mild (MMSE 19–24 points; 63%) and moderate (MMSE: 10–18 points; 37%) cognitive impairment was included (age range: 65–99 years; mean MMSE: 19 ± 4, range: 8–24 points; diagnosis of dementia and delirium: 40% and 18%, respectively). Rasch analysis indicated unidimensionality with an overall fit to the model (P = 0.107). Internal consistency reliability was excellent (Cronbach’s alpha = 0.92). Eleven out of 13 (85%) hypotheses on construct validity were confirmed. The DEMMI showed good feasibility, and no adverse events occurred. The mean administration time of 5 min (range: 1–10) was not influenced by the level of cognitive impairment. In contrast to some other comparator instruments, no floor or ceiling effects were evident for the DEMMI. Conclusions Results indicate sufficient psychometric properties of the DEMMI in older patients with cognitive impairment. Trial registration German Clinical Trials Register (DRKS00005591). Registered February 2, 2015. Electronic supplementary material The online version of this article (10.1186/s12877-018-0780-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tobias Braun
- Hochschule für Gesundheit (University of Applied Sciences), Department of Applied Health Sciences, Physiotherapy Program, Bochum, Germany. .,University of Cologne, Medical Faculty, Cologne, Germany. .,St. Marien-Hospital, Department of Geriatric Medicine, Cologne, Germany.
| | - Christian Grüneberg
- Hochschule für Gesundheit (University of Applied Sciences), Department of Applied Health Sciences, Physiotherapy Program, Bochum, Germany
| | - Christian Thiel
- Hochschule für Gesundheit (University of Applied Sciences), Department of Applied Health Sciences, Physiotherapy Program, Bochum, Germany
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28
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Harrawood A, Fowler NR, Perkins AJ, LaMantia MA, Boustani MA. Acceptability and Results of Dementia Screening Among Older Adults in the United States. Curr Alzheimer Res 2018; 15:51-55. [PMID: 28891444 PMCID: PMC5963533 DOI: 10.2174/1567205014666170908100905] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 07/07/2017] [Accepted: 08/29/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To measure older adults acceptability of dementia screening and assess screening test results of a racially diverse sample of older primary care patients in the United States. DESIGN Cross-sectional study of primary care patients aged 65 and older. SETTING Urban and suburban primary care clinics in Indianapolis, Indiana, in 2008 to 2009. PARTICIPANTS Nine hundred fifty-four primary care patients without a documented diagnosis of dementia. MEASUREMENTS Community Screening Instrument for Dementia, the Mini-Mental State Examination, and the Telephone Instrument for Cognitive Screening. RESULTS Of the 954 study participants who consented to participate, 748 agreed to be screened for dementia and 206 refused screening. The overall response rate was 78.4%. The positive screen rate of the sample who agreed to screening was 10.2%. After adjusting for demographic differences the following characteristics were still associated with increased likelihood of screening positive for dementia: age, male sex, and lower education. Patients who believed that they had more memory problems than other people of their age were also more likely to screen positive for dementia. CONCLUSION Age and perceived problems with memory are associated with screening positive for dementia in primary care.
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Affiliation(s)
- Amanda Harrawood
- Indiana University Center for Aging Research, Indianapolis, IN
- Regenstrief Institute, Inc., Indianapolis, IN
| | - Nicole R. Fowler
- Indiana University Center for Aging Research, Indianapolis, IN
- Regenstrief Institute, Inc., Indianapolis, IN
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Anthony J. Perkins
- Indiana University Center for Aging Research, Indianapolis, IN
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Michael A. LaMantia
- Indiana University Center for Aging Research, Indianapolis, IN
- Regenstrief Institute, Inc., Indianapolis, IN
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Malaz A. Boustani
- Indiana University Center for Aging Research, Indianapolis, IN
- Regenstrief Institute, Inc., Indianapolis, IN
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN
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29
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Service use, advance planning and lifestyle changes following cognitive screening in primary healthcare in Singapore. Int Psychogeriatr 2018; 30:139-145. [PMID: 28927472 DOI: 10.1017/s1041610217001971] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Despite recent interest in community-based screening programs to detect undiagnosed cognitive disorder, little is known about whether screening leads to further diagnostic evaluation, or the effects of such programs in terms of actual changes in patient or caregiver behavior. This study followed up informants of older adults (i.e. caregivers of patients who completed informant-based screening regarding the patient) following participation in a study screening for undiagnosed memory problems, to explore uptake of further diagnostic evaluation or treatment, advance planning or preparations, lifestyle changes, medication adherence, and use of support services. METHODS A total of 140 informants of older adult patients were surveyed four to fifteen months following participation in a cognitive screening study. The informants were interviewed with a study-specific survey about cognitive assessment, advance planning, lifestyle changes, and use of support services and general medication adherence. RESULTS A minority of patients and informants had engaged in advance planning or made relevant lifestyle changes following cognitive screening. Those assessed as being at higher risk of memory problems were more likely to have attended a full diagnostic evaluation, engaged in support services and experienced medication adherence difficulties. CONCLUSION Only a small proportion of patients participating in cognitive screening subsequently engaged in diagnostic evaluation, advance planning, or lifestyle changes. However, those with higher risk of cognitive impairment were generally more likely to take some action following cognitive screening. Those at higher risk were also more vulnerable due to greater difficulties with medication adherence.
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30
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Poor Performance on a Preoperative Cognitive Screening Test Predicts Postoperative Complications in Older Orthopedic Surgical Patients. Anesthesiology 2017; 127:765-774. [PMID: 28891828 DOI: 10.1097/aln.0000000000001859] [Citation(s) in RCA: 165] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND The American College of Surgeons and the American Geriatrics Society have suggested that preoperative cognitive screening should be performed in older surgical patients. We hypothesized that unrecognized cognitive impairment in patients without a history of dementia is a risk factor for development of postoperative complications. METHODS We enrolled 211 patients 65 yr of age or older without a diagnosis of dementia who were scheduled for an elective hip or knee replacement. Patients were cognitively screened preoperatively using the Mini-Cog and demographic, medical, functional, and emotional/social data were gathered using standard instruments or review of the medical record. Outcomes included discharge to place other than home (primary outcome), delirium, in-hospital medical complications, hospital length-of-stay, 30-day emergency room visits, and mortality. Data were analyzed using univariate and multivariate analyses. RESULTS Fifty of 211 (24%) patients screened positive for probable cognitive impairment (Mini-Cog less than or equal to 2). On age-adjusted multivariate analysis, patients with a Mini-Cog score less than or equal to 2 were more likely to be discharged to a place other than home (67% vs. 34%; odds ratio = 3.88, 95% CI = 1.58 to 9.55), develop postoperative delirium (21% vs. 7%; odds ratio = 4.52, 95% CI = 1.30 to 15.68), and have a longer hospital length of stay (hazard ratio = 0.63, 95% CI = 0.42 to 0.95) compared to those with a Mini-Cog score greater than 2. CONCLUSIONS Many older elective orthopedic surgical patients have probable cognitive impairment preoperatively. Such impairment is associated with development of delirium postoperatively, a longer hospital stay, and lower likelihood of going home upon hospital discharge.
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31
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Culley DJ, Flaherty D, Reddy S, Fahey MC, Rudolph J, Huang CC, Liu X, Xie Z, Bader AM, Hyman BT, Blacker D, Crosby G. Preoperative Cognitive Stratification of Older Elective Surgical Patients: A Cross-Sectional Study. Anesth Analg 2017; 123:186-92. [PMID: 27028776 DOI: 10.1213/ane.0000000000001277] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Preexisting cognitive impairment is emerging as a predictor of poor postoperative outcomes in seniors. We hypothesized that preoperative cognitive screening can be performed in a busy preadmission evaluation center and that cognitive impairment is prevalent in elective geriatric surgical patients. METHODS We approached 311 patients aged 65 years and older presenting for preoperative evaluation before elective surgery in a prospective, observational, single-center study. Forty-eight patients were ineligible, and 63 declined. The remaining 200 were randomly assigned to the Mini-Cog (N =100) or Clock-in-the-Box [CIB; N = 100)] test. Study staff administered the test in a quiet room, and 2 investigators scored the tests independently. Probable cognitive impairment was defined as a Mini-Cog ≤ 2 or a CIB ≤ 5. RESULTS The age of consenting patients was 73.7 ± 6.4 (mean ± SD) years. There were no significant differences between patients randomly assigned to the Mini-Cog and CIB test in age, weight, gender, education, ASA physical status, or Charlston Index. Overall, 23% of patients met criteria for probable cognitive impairment, and prevalence was virtually identical regardless of the test used; 22% screened with the Mini-Cog and 23% screened with the CIB scored as having probable cognitive impairment (P = 1.0 by χ analysis). Both tests had good interrater reliability (Krippendroff α = 0.86 [0.72-0.93] for Mini-Cog and 1 for CIB). CONCLUSIONS Preoperative cognitive screening is feasible in most geriatric elective surgical patients and reveals a substantial prevalence of probable cognitive impairment in this population.
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Affiliation(s)
- Deborah J Culley
- From the *Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; †University of Cincinnati College of Medicine, Cincinnati, Ohio; ‡ Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; §Department of Anesthesiology, Perioperative and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; ∥Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; ¶ Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School and Harvard School of Public Health, Boston, Massachusetts; and #Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts
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Karuturi M, Wong ML, Hsu T, Kimmick GG, Lichtman SM, Holmes HM, Inouye SK, Dale W, Loh KP, Whitehead MI, Magnuson A, Hurria A, Janelsins MC, Mohile S. Understanding cognition in older patients with cancer. J Geriatr Oncol 2016; 7:258-69. [PMID: 27282296 PMCID: PMC4969091 DOI: 10.1016/j.jgo.2016.04.004] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 02/01/2016] [Accepted: 04/18/2016] [Indexed: 02/04/2023]
Abstract
Cancer and neurocognitive disorders, such as dementia and delirium, are common and serious diseases in the elderly that are accompanied by high degree of morbidity and mortality. Furthermore, evidence supports the under-diagnosis of both dementia and delirium in older adults. Complex questions exist regarding the interaction of dementia and delirium with cancer, beginning with guidelines on how best measure disease severity, the optimal screening test for either disorder, the appropriate level of intervention in the setting of abnormal findings, and strategies aimed at preventing the development or progression of either process. Ethical concerns emerge in the research setting, pertaining to the detection of cognitive dysfunction in participants, validity of consent, disclosure of abnormal results if screening is pursued, and recommended level of intervention by investigators. Furthermore, understanding the ways in which comorbid cognitive dysfunction and cancer impact both cancer and non-cancer-related outcomes is essential in guiding treatment decisions. In the following article, we will discuss what is presently known of the interactions of pre-existing cognitive impairment and delirium with cancer. We will also discuss identified deficits in our knowledge base, and propose ways in which innovative research may address these gaps.
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Affiliation(s)
- Meghan Karuturi
- University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Melisa L Wong
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
| | - Tina Hsu
- The Ottawa Hospital Cancer Center, Ottawa, Canada
| | | | | | - Holly M Holmes
- University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Sharon K Inouye
- Harvard Medical School, Boston, MA, USA; Beth Israel Deaconess Medical Center, Boston, MA, USA; Aging Brain Center, Hebrew SeniorLife, Boston, MA, USA
| | | | - Kah P Loh
- University of Rochester Medical Center, Rochester, NY, USA
| | | | | | - Arti Hurria
- Comprehensive Cancer Center, City of Hope, Duarte, CA, USA
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Dixon BE, Whipple EC, Lajiness JM, Murray MD. Utilizing an integrated infrastructure for outcomes research: a systematic review. Health Info Libr J 2015; 33:7-32. [PMID: 26639793 DOI: 10.1111/hir.12127] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 10/16/2015] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To explore the ability of an integrated health information infrastructure to support outcomes research. METHODS A systematic review of articles published from 1983 to 2012 by Regenstrief Institute investigators using data from an integrated electronic health record infrastructure involving multiple provider organisations was performed. Articles were independently assessed and classified by study design, disease and other metadata including bibliometrics. RESULTS A total of 190 articles were identified. Diseases included cognitive, (16) cardiovascular, (16) infectious, (15) chronic illness (14) and cancer (12). Publications grew steadily (26 in the first decade vs. 100 in the last) as did the number of investigators (from 15 in 1983 to 62 in 2012). The proportion of articles involving non-Regenstrief authors also expanded from 54% in the first decade to 72% in the last decade. During this period, the infrastructure grew from a single health system into a health information exchange network covering more than 6 million patients. Analysis of journal and article metrics reveals high impact for clinical trials and comparative effectiveness research studies that utilised data available in the integrated infrastructure. DISCUSSION Integrated information infrastructures support growth in high quality observational studies and diverse collaboration consistent with the goals for the learning health system. More recent publications demonstrate growing external collaborations facilitated by greater access to the infrastructure and improved opportunities to study broader disease and health outcomes. CONCLUSIONS Integrated information infrastructures can stimulate learning from electronic data captured during routine clinical care but require time and collaboration to reach full potential.
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Affiliation(s)
- Brian E Dixon
- Richard M. Fairbanks School of Public Health at IUPUI, Indianapolis, IN, USA.,Regenstrief Institute, Inc., Indianapolis, IN, USA.,Center for Health Information and Communication, Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service CIN 13-416, Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA
| | - Elizabeth C Whipple
- Ruth Lilly Medical Library, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Michael D Murray
- Regenstrief Institute and Purdue University, Indianapolis, IN, USA
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Fowler NR, Frame A, Perkins AJ, Gao S, Watson DP, Monahan P, Boustani MA. Traits of patients who screen positive for dementia and refuse diagnostic assessment. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2015; 1:236-241. [PMID: 26258162 PMCID: PMC4527161 DOI: 10.1016/j.dadm.2015.01.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND As part of the debate about screening for dementia, it is critical to understand why patients agree or disagree to diagnostic assessment after a positive screening test. We used the Perceptions Regarding Investigational Screening for Memory in Primary Care (PRISM-PC) questionnaire to measure the characteristics of patients who screened positive for dementia but refused further diagnostic assessment. METHODS Survey of patients ≥65 years old without a diagnosis of dementia attending primary care clinics in Indianapolis, IN, in 2008 and 2009. RESULTS Five hundred and fifty-four individuals completed the PRISM-PC and 63 screened positive. Of those, 21 (33%) accepted and 42 (67%) refused diagnostic assessment. In adjusted models, having larger stigma domain scores and living alone were significantly associated with increased odds of refusing the diagnostic assessment. CONCLUSION Despite screening positive, many patients refused a diagnostic assessment. Living alone and the perceived stigmas of dementia are associated with the refusal of diagnostic assessment for dementia.
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Affiliation(s)
- Nicole R. Fowler
- Indiana University Center for Aging Research, Indianapolis, IN, USA
- Regenstrief Institute, Inc., Indianapolis, IN, USA
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Amie Frame
- Indiana University Center for Aging Research, Indianapolis, IN, USA
- Regenstrief Institute, Inc., Indianapolis, IN, USA
| | - Anthony J. Perkins
- Indiana University Center for Aging Research, Indianapolis, IN, USA
- Regenstrief Institute, Inc., Indianapolis, IN, USA
| | - Sujuan Gao
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Dennis P. Watson
- Department of Health Policy and Management, Indiana University Richard M. Fairbanks, School of Public Health, Indianapolis, IN, USA
| | - Patrick Monahan
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Malaz A. Boustani
- Indiana University Center for Aging Research, Indianapolis, IN, USA
- Regenstrief Institute, Inc., Indianapolis, IN, USA
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
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Davey DA. Alzheimer's disease and vascular dementia: one potentially preventable and modifiable disease. Part I: Pathology, diagnosis and screening. Neurodegener Dis Manag 2015; 4:253-9. [PMID: 25095819 DOI: 10.2217/nmt.14.13] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Alzheimer's disease (AD) and vascular dementia (VaD) frequently coexist and their separation may well be a false dichotomy. The neurodegenerative and cerebrovascular changes vary from the extremes of 'pure AD' to 'pure VaD' and a combination of changes is the most frequent. Both changes have a preclinical phase of decades. The clinical presentation is often out of proportion to the neuropathology to a lesser or greater degree. The diagnosis of dementia or mild cognitive impairment is based on clinical assessment and diagnostic criteria have been published. Neuropsychological testing and specialist evaluation may be required. The UK and US governments propose screening of all older adults. The value of routine screening has been questioned. Consent for testing and counseling are essential.
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Kotagal V, Langa KM, Plassman BL, Fisher GG, Giordani BJ, Wallace RB, Burke JR, Steffens DC, Kabeto M, Albin RL, Foster NL. Factors associated with cognitive evaluations in the United States. Neurology 2014; 84:64-71. [PMID: 25428689 DOI: 10.1212/wnl.0000000000001096] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE We aimed to explore factors associated with clinical evaluations for cognitive impairment among older residents of the United States. METHODS Two hundred ninety-seven of 845 subjects in the Aging, Demographics, and Memory Study (ADAMS), a nationally representative community-based cohort study, met criteria for dementia after a detailed in-person study examination. Informants for these subjects reported whether or not they had ever received a clinical cognitive evaluation outside of the context of ADAMS. Among subjects with dementia, we evaluated demographic, socioeconomic, and clinical factors associated with an informant-reported clinical cognitive evaluation using bivariate analyses and multivariable logistic regression. RESULTS Of the 297 participants with dementia in ADAMS, 55.2% (representing about 1.8 million elderly Americans in 2002) reported no history of a clinical cognitive evaluation by a physician. In a multivariable logistic regression model (n = 297) controlling for demographics, physical function measures, and dementia severity, marital status (odds ratio for currently married: 2.63 [95% confidence interval: 1.10-6.35]) was the only significant independent predictor of receiving a clinical cognitive evaluation among subjects with study-confirmed dementia. CONCLUSIONS Many elderly individuals with dementia do not receive clinical cognitive evaluations. The likelihood of receiving a clinical cognitive evaluation in elderly individuals with dementia associates with certain patient-specific factors, particularly severity of cognitive impairment and current marital status.
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Affiliation(s)
- Vikas Kotagal
- From the Departments of Neurology (V.K., B.J.G., R.L.A.), Internal Medicine (K.M.L., M.K.), Psychiatry (B.J.G.), and Psychology (B.J.G.), University of Michigan, Ann Arbor; Departments of Psychiatry (B.L.P.) and Neurology (J.R.B.), Duke University Medical Center, Durham, NC; Department of Psychology (G.G.F.), Colorado State University, Fort Collins; Department of Epidemiology (R.B.W.), University of Iowa, Iowa City; Department of Psychiatry (D.C.S.), University of Connecticut Health Center, Farmington; and Department of Neurology (N.L.F.), University of Utah, Salt Lake City.
| | - Kenneth M Langa
- From the Departments of Neurology (V.K., B.J.G., R.L.A.), Internal Medicine (K.M.L., M.K.), Psychiatry (B.J.G.), and Psychology (B.J.G.), University of Michigan, Ann Arbor; Departments of Psychiatry (B.L.P.) and Neurology (J.R.B.), Duke University Medical Center, Durham, NC; Department of Psychology (G.G.F.), Colorado State University, Fort Collins; Department of Epidemiology (R.B.W.), University of Iowa, Iowa City; Department of Psychiatry (D.C.S.), University of Connecticut Health Center, Farmington; and Department of Neurology (N.L.F.), University of Utah, Salt Lake City
| | - Brenda L Plassman
- From the Departments of Neurology (V.K., B.J.G., R.L.A.), Internal Medicine (K.M.L., M.K.), Psychiatry (B.J.G.), and Psychology (B.J.G.), University of Michigan, Ann Arbor; Departments of Psychiatry (B.L.P.) and Neurology (J.R.B.), Duke University Medical Center, Durham, NC; Department of Psychology (G.G.F.), Colorado State University, Fort Collins; Department of Epidemiology (R.B.W.), University of Iowa, Iowa City; Department of Psychiatry (D.C.S.), University of Connecticut Health Center, Farmington; and Department of Neurology (N.L.F.), University of Utah, Salt Lake City
| | - Gwenith G Fisher
- From the Departments of Neurology (V.K., B.J.G., R.L.A.), Internal Medicine (K.M.L., M.K.), Psychiatry (B.J.G.), and Psychology (B.J.G.), University of Michigan, Ann Arbor; Departments of Psychiatry (B.L.P.) and Neurology (J.R.B.), Duke University Medical Center, Durham, NC; Department of Psychology (G.G.F.), Colorado State University, Fort Collins; Department of Epidemiology (R.B.W.), University of Iowa, Iowa City; Department of Psychiatry (D.C.S.), University of Connecticut Health Center, Farmington; and Department of Neurology (N.L.F.), University of Utah, Salt Lake City
| | - Bruno J Giordani
- From the Departments of Neurology (V.K., B.J.G., R.L.A.), Internal Medicine (K.M.L., M.K.), Psychiatry (B.J.G.), and Psychology (B.J.G.), University of Michigan, Ann Arbor; Departments of Psychiatry (B.L.P.) and Neurology (J.R.B.), Duke University Medical Center, Durham, NC; Department of Psychology (G.G.F.), Colorado State University, Fort Collins; Department of Epidemiology (R.B.W.), University of Iowa, Iowa City; Department of Psychiatry (D.C.S.), University of Connecticut Health Center, Farmington; and Department of Neurology (N.L.F.), University of Utah, Salt Lake City
| | - Robert B Wallace
- From the Departments of Neurology (V.K., B.J.G., R.L.A.), Internal Medicine (K.M.L., M.K.), Psychiatry (B.J.G.), and Psychology (B.J.G.), University of Michigan, Ann Arbor; Departments of Psychiatry (B.L.P.) and Neurology (J.R.B.), Duke University Medical Center, Durham, NC; Department of Psychology (G.G.F.), Colorado State University, Fort Collins; Department of Epidemiology (R.B.W.), University of Iowa, Iowa City; Department of Psychiatry (D.C.S.), University of Connecticut Health Center, Farmington; and Department of Neurology (N.L.F.), University of Utah, Salt Lake City
| | - James R Burke
- From the Departments of Neurology (V.K., B.J.G., R.L.A.), Internal Medicine (K.M.L., M.K.), Psychiatry (B.J.G.), and Psychology (B.J.G.), University of Michigan, Ann Arbor; Departments of Psychiatry (B.L.P.) and Neurology (J.R.B.), Duke University Medical Center, Durham, NC; Department of Psychology (G.G.F.), Colorado State University, Fort Collins; Department of Epidemiology (R.B.W.), University of Iowa, Iowa City; Department of Psychiatry (D.C.S.), University of Connecticut Health Center, Farmington; and Department of Neurology (N.L.F.), University of Utah, Salt Lake City
| | - David C Steffens
- From the Departments of Neurology (V.K., B.J.G., R.L.A.), Internal Medicine (K.M.L., M.K.), Psychiatry (B.J.G.), and Psychology (B.J.G.), University of Michigan, Ann Arbor; Departments of Psychiatry (B.L.P.) and Neurology (J.R.B.), Duke University Medical Center, Durham, NC; Department of Psychology (G.G.F.), Colorado State University, Fort Collins; Department of Epidemiology (R.B.W.), University of Iowa, Iowa City; Department of Psychiatry (D.C.S.), University of Connecticut Health Center, Farmington; and Department of Neurology (N.L.F.), University of Utah, Salt Lake City
| | - Mohammed Kabeto
- From the Departments of Neurology (V.K., B.J.G., R.L.A.), Internal Medicine (K.M.L., M.K.), Psychiatry (B.J.G.), and Psychology (B.J.G.), University of Michigan, Ann Arbor; Departments of Psychiatry (B.L.P.) and Neurology (J.R.B.), Duke University Medical Center, Durham, NC; Department of Psychology (G.G.F.), Colorado State University, Fort Collins; Department of Epidemiology (R.B.W.), University of Iowa, Iowa City; Department of Psychiatry (D.C.S.), University of Connecticut Health Center, Farmington; and Department of Neurology (N.L.F.), University of Utah, Salt Lake City
| | - Roger L Albin
- From the Departments of Neurology (V.K., B.J.G., R.L.A.), Internal Medicine (K.M.L., M.K.), Psychiatry (B.J.G.), and Psychology (B.J.G.), University of Michigan, Ann Arbor; Departments of Psychiatry (B.L.P.) and Neurology (J.R.B.), Duke University Medical Center, Durham, NC; Department of Psychology (G.G.F.), Colorado State University, Fort Collins; Department of Epidemiology (R.B.W.), University of Iowa, Iowa City; Department of Psychiatry (D.C.S.), University of Connecticut Health Center, Farmington; and Department of Neurology (N.L.F.), University of Utah, Salt Lake City
| | - Norman L Foster
- From the Departments of Neurology (V.K., B.J.G., R.L.A.), Internal Medicine (K.M.L., M.K.), Psychiatry (B.J.G.), and Psychology (B.J.G.), University of Michigan, Ann Arbor; Departments of Psychiatry (B.L.P.) and Neurology (J.R.B.), Duke University Medical Center, Durham, NC; Department of Psychology (G.G.F.), Colorado State University, Fort Collins; Department of Epidemiology (R.B.W.), University of Iowa, Iowa City; Department of Psychiatry (D.C.S.), University of Connecticut Health Center, Farmington; and Department of Neurology (N.L.F.), University of Utah, Salt Lake City
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Abstract
This report discusses the public health impact of Alzheimer's disease (AD), including incidence and prevalence, mortality rates, costs of care, and overall effect on caregivers and society. It also examines the impact of AD on women compared with men. An estimated 5.2 million Americans have AD. Approximately 200,000 people younger than 65 years with AD comprise the younger onset AD population; 5 million are age 65 years or older. By mid-century, fueled in large part by the baby boom generation, the number of people living with AD in the United States is projected to grow by about 9 million. Today, someone in the country develops AD every 67 seconds. By 2050, one new case of AD is expected to develop every 33 seconds, or nearly a million new cases per year, and the total estimated prevalence is expected to be 13.8 million. In 2010, official death certificates recorded 83,494 deaths from AD, making AD the sixth leading cause of death in the United States and the fifth leading cause of death in Americans aged 65 years or older. Between 2000 and 2010, the proportion of deaths resulting from heart disease, stroke, and prostate cancer decreased 16%, 23%, and 8%, respectively, whereas the proportion resulting from AD increased 68%. The actual number of deaths to which AD contributes (or deaths with AD) is likely much larger than the number of deaths from AD recorded on death certificates. In 2014, an estimated 700,000 older Americans will die with AD, and many of them will die from complications caused by AD. In 2013, more than 15 million family members and other unpaid caregivers provided an estimated 17.7 billion hours of care to people with AD and other dementias, a contribution valued at more than $220 billion. Average per-person Medicare payments for services to beneficiaries aged 65 years and older with AD and other dementias are more than two and a half times as great as payments for all beneficiaries without these conditions, and Medicaid payments are 19 times as great. Total payments in 2014 for health care, long-term care, and hospice services for people aged 65 years and older with dementia are expected to be $214 billion. AD takes a stronger toll on women than men. More women than men develop the disease, and women are more likely than men to be informal caregivers for someone with AD or another dementia. As caregiving responsibilities become more time consuming and burdensome or extend for prolonged durations, women assume an even greater share of the caregiving burden. For every man who spends 21 to more than 60 hours per week as a caregiver, there are 2.1 women. For every man who lives with the care recipient and provides around-the-clock care, there are 2.5 women. In addition, for every man who has provided caregiving assistance for more than 5 years, there are 2.3 women.
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Preferences of older people for early diagnosis and disclosure of Alzheimer's disease (AD) before and after considering potential risks and benefits. Arch Gerontol Geriatr 2014; 59:607-12. [DOI: 10.1016/j.archger.2014.07.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 07/10/2014] [Accepted: 07/12/2014] [Indexed: 11/19/2022]
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Brooker D, La Fontaine J, Evans S, Bray J, Saad K. Public health guidance to facilitate timely diagnosis of dementia: ALzheimer's COoperative Valuation in Europe recommendations. Int J Geriatr Psychiatry 2014; 29:682-93. [PMID: 24458456 DOI: 10.1002/gps.4066] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2013] [Accepted: 11/26/2013] [Indexed: 11/08/2022]
Abstract
OBJECTIVE ALzheimer's COoperative Valuation in Europe (ALCOVE) was a Joint Action co-financed by the European Commission to produce a set of evidence-based recommendations for policymakers on dementia. This paper reports on timely diagnosis. METHODS Evidence was reviewed from scientific, policy and qualitative research. An online questionnaire was completed by experts from 24 European Union countries detailing current practice. An iterative process with people with dementia, family carers and professionals was utilised to develop recommendations. RESULTS Advances in the technical aspects of diagnosis have changed what is understood by early diagnosis. Although research into preclinical stages is crucial, diagnosing at these very earliest stages is not recommended as regular practice. On balance, it is suggested that citizens should have access to accurate diagnosis at a time in the disease process when it can be of most benefit to them. The term timely diagnosis is used to reflect this. The diagnosis can help citizens and their families make sense of what is happening and make lifestyle changes and plans for the future. The central principles identified to maximise benefit and to reduce harm associated with diagnosis at an earlier stage included reducing stigma about dementia; respecting the rights of the individual; recognising that how the diagnosis is given will impact on subsequent adjustment and that post diagnostic support are required for the person and their family. Detailed recommendations are provided for timely detection, the diagnostic process, complex diagnoses, response to early cognitive changes and workforce. CONCLUSIONS The recommendations can be utilised at a local, national and European level to benchmark progress.
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Affiliation(s)
- Dawn Brooker
- Association for Dementia Studies, University of Worcester, Worcester, UK
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Abstract
BACKGROUND Considering the discussion on implementing routine dementia screening in Germany, the objective of the current study was to validate the German version of the Perceptions Regarding Investigational Screening for Memory in Primary Care (PRISM-PC) questionnaire and to determine the acceptance of Alzheimer's disease screening in elderly German adults. METHODS The German version of the PRISM-PC was administered to a subsample of participants who attended the Berlin Aging Study II (n = 506). The questionnaire was validated by exploratory as well as confirmatory factor analysis. RESULTS Regarding acceptance of Alzheimer's disease screening (Section B) a single factor structure fitted best. In terms of attitudes regarding Alzheimer's disease (Section D), a hierarchical factor structure was modeled with the higher-order factor "Harms" covering the domains "Family Burden," "Dependence," "Emotional Suffering," "Stigma," and "Medical Care" on the one hand and the domain "Future Planning" on the other hand. Internal consistency of the different scales reached from α = 0.67 to α = 0.94. Overall, 71.2% of the participants indicated that they wanted to be screened for Alzheimer's disease on a regular basis. CONCLUSIONS This study suggests that acceptance can reliably be assessed with the section "Acceptance of Alzheimer's disease screenings" of the German PRISM-PC questionnaire. Furthermore, the majority of elderly German adults would like to be screened for Alzheimer's disease regularly, which might be an effective starting point in order to implement routine dementia screenings. As the sample is a convenience sample of (relatively) healthy older adults, generalizability of these results is limited.
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Ishioka M, Sugawara N, Kaneda A, Okubo N, Iwane K, Takahashi I, Yasui-Furukori N. The Yamaguchi fox/pigeon-imitation test, a brief cognitive performance rating tool, in a community-dwelling population: normative data for Japanese subjects - a preliminary study. Neuropsychiatr Dis Treat 2014; 10:1721-5. [PMID: 25246793 PMCID: PMC4166310 DOI: 10.2147/ndt.s66941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Screening tools for dementia should be valid and easy to complete and have a low psychological burden. Consistent with these principles, the Yamaguchi fox/pigeon-imitation test (YFPIT) has been developed. However, there is little information on the utility of the YFPIT for preclinical populations, although the detection of proven prodromal and preclinical states is important. MATERIALS AND METHODS We recruited 392 volunteers who were at least 60 years old (139 men and 253 women) and had participated in the Iwaki Health Promotion Project. The YFPIT was administered to all participants. RESULTS Most subjects succeeded in imitating the fox gesture regardless of their cognitive function impairment, while the success rates for the pigeon gesture were 75.3% in the normal group and 56.3% in the cognitive impairment group. The sensitivity, specificity, positive predictive value (PV(+)), and negative predictive value (PV(-)) were 43.8%, 75.3%, 7.0%, and 97.0%, respectively. The greatest significant difference between the imitation of the pigeon gesture and cognitive impairment was found in females with subjective memory impairments (P=0.001). In that group, the sensitivity, specificity, PV(+), and PV(-) were 100%, 81.9%, 18.8%, and 100%, respectively. CONCLUSION This study suggests that the utility of the YFPIT is limited in the general population, but that it is a useful tool in females with subjective memory impairments in a community-dwelling population.
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Affiliation(s)
| | - Norio Sugawara
- Department of Neuropsychiatry, Hirosaki University, Hirosaki, Japan
| | - Ayako Kaneda
- Department of Neuropsychiatry, Hirosaki University, Hirosaki, Japan
| | - Noriyuki Okubo
- Department of Social Medicine, Graduate School of Medicine, Hirosaki University, Hirosaki, Japan
| | - Kaori Iwane
- Department of Social Medicine, Graduate School of Medicine, Hirosaki University, Hirosaki, Japan
| | - Ippei Takahashi
- Department of Social Medicine, Graduate School of Medicine, Hirosaki University, Hirosaki, Japan
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Cai X, Campbell N, Khan B, Callahan C, Boustani M. Long-term anticholinergic use and the aging brain. Alzheimers Dement 2013; 9:377-85. [PMID: 23183138 PMCID: PMC3674201 DOI: 10.1016/j.jalz.2012.02.005] [Citation(s) in RCA: 123] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Revised: 02/01/2012] [Accepted: 02/01/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Older Americans are facing an epidemic of chronic diseases and are thus exposed to anticholinergics (ACs) that might negatively affect their risk of developing mild cognitive impairment (MCI) or dementia. OBJECTIVE To investigate the association between impairment in cognitive function and previous AC exposure. DESIGN A retrospective cohort study. SETTING Primary care clinics in Indianapolis, Indiana. PARTICIPANTS A total of 3690 older adults who have undergone cognitive assessment and had a 1-year medication-dispensing record. OUTCOME Cognitive function was measured in two sequential steps: a two-step screening process followed by a formal diagnostic process for participants with positive screening results. EXPOSURE Three patterns of AC exposure were defined by the duration of AC exposure, the number of AC medications dispensed at the same time, and the severity of AC effects as determined by the Anticholinergic Cognitive Burden list. RESULTS Compared with older adults with no AC exposure and after adjusting for age, race, gender, and underlying comorbidity, the odds ratio for having a diagnosis of MCI was 2.73 (95% confidence interval, 1.27-5.87) among older adults who were exposed to at least three possible ACs for at least 90 days; the odds ratio for having dementia was 0.43 (95% confidence interval, 0.10-1.81). CONCLUSION Exposure to medications with severe AC cognitive burden may be a risk factor for developing MCI.
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Affiliation(s)
- Xueya Cai
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Noll Campbell
- Regenstrief Institute, Inc., Indianapolis, Indiana
- Indiana University Center for Aging Research, Indianapolis, Indiana
- Department of Pharmacy Practice, Purdue University College of Pharmacy, West Lafayette, IN
- Wishard Health Services, Indianapolis, Indiana
| | - Babar Khan
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Chris Callahan
- Regenstrief Institute, Inc., Indianapolis, Indiana
- Indiana University Center for Aging Research, Indianapolis, Indiana
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Malaz Boustani
- Regenstrief Institute, Inc., Indianapolis, Indiana
- Indiana University Center for Aging Research, Indianapolis, Indiana
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
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Borson S, Frank L, Bayley PJ, Boustani M, Dean M, Lin PJ, McCarten JR, Morris JC, Salmon DP, Schmitt FA, Stefanacci RG, Mendiondo MS, Peschin S, Hall EJ, Fillit H, Ashford JW. Improving dementia care: the role of screening and detection of cognitive impairment. Alzheimers Dement 2013; 9:151-9. [PMID: 23375564 DOI: 10.1016/j.jalz.2012.08.008] [Citation(s) in RCA: 167] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Accepted: 08/21/2012] [Indexed: 12/20/2022]
Abstract
The value of screening for cognitive impairment, including dementia and Alzheimer's disease, has been debated for decades. Recent research on causes of and treatments for cognitive impairment has converged to challenge previous thinking about screening for cognitive impairment. Consequently, changes have occurred in health care policies and priorities, including the establishment of the annual wellness visit, which requires detection of any cognitive impairment for Medicare enrollees. In response to these changes, the Alzheimer's Foundation of America and the Alzheimer's Drug Discovery Foundation convened a workgroup to review evidence for screening implementation and to evaluate the implications of routine dementia detection for health care redesign. The primary domains reviewed were consideration of the benefits, harms, and impact of cognitive screening on health care quality. In conference, the workgroup developed 10 recommendations for realizing the national policy goals of early detection as the first step in improving clinical care and ensuring proactive, patient-centered management of dementia.
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Affiliation(s)
- Soo Borson
- Memory Disorders Clinic and Dementia Health Services, University of Washington School of Medicine, Seattle, WA, USA
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Dementia skills and competencies for primary care liaison: a model for improving identification and timely diagnosis. Prim Health Care Res Dev 2012; 14:240-9. [PMID: 23127509 DOI: 10.1017/s1463423612000266] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVES The need to improve the response of primary care in terms of identification of people with undiagnosed dementia has long been recognised. The role of Primary Care Liaison was identified as a possible solution. An in-depth consultation was undertaken to identify professional competencies required in executing such a role. METHODS Comprehensive literature and policy reviews were conducted to establish draft competencies or different options/combinations of competencies and competency levels. Consultations with a wide range of professional stakeholders (n = 23) and over 70 users and carers were conducted through focus groups, electronic document circulation and telephone interviews. An Equality Impact Assessment was conducted concurrent to the consultation. RESULTS The literature demonstrated a clear need both to improve the rate of diagnosis for people with dementia and to improve the way in which the diagnosis is made. The stakeholder consultation repeatedly affirmed that without a diagnosis the person with dementia and their caregivers did not get access to the appropriate services, and validated the need for a role that would be able to improve a system that would deliver an early and 'timely' diagnosis. Competencies, based on the literature and policy documents, were developed and debated through the consultation processes. CONCLUSIONS Three main areas of competency were identified: counselling; screening; and health education and promotion. The competencies identified require a skilled experienced professional approach. A useful team model would be that the role is placed within a 'GP cluster' as accessibility to GP records and collaborative working with GPs is essential within the role. Personal continuing professional development has a high profile in maintaining these competencies.
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Raab MF, Anstadt SP. Improving Office Detection of Asymptomatic Dementia. J Am Geriatr Soc 2011; 59:1975-6. [DOI: 10.1111/j.1532-5415.2011.03610_10.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Mitchell AJ, Meader N, Pentzek M. Clinical recognition of dementia and cognitive impairment in primary care: a meta-analysis of physician accuracy. Acta Psychiatr Scand 2011; 124:165-83. [PMID: 21668424 DOI: 10.1111/j.1600-0447.2011.01730.x] [Citation(s) in RCA: 97] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We aimed to examine the ability of the general practitioners (GPs) to recognize a spectrum of cognitive impairment from mild cognitive impairment (MCI) to severe dementia in routine practice using their own clinical judgment. METHOD Using PRISMA criteria, a meta-analysis of studies testing clinical judgment and clinical documentation was conducted against semi-structured interviews (for dementia) and cognitive tests (for cognitive impairment). We located 15 studies reporting on dementia, seven studies that examined recognition of broadly defined cognitive impairment, and eight regarding MCI. RESULTS By clinical judgment, clinicians were able to identify 73.4% of people with dementia and 75.5% of those without dementia but they made correct annotations in medical records in only 37.9% of cases (and 90.5% of non-cases). For cognitive impairment, detection sensitivity was 62.8% by clinician judgment but 33.1% according to medical records. Specificity was 92.6% for those without cognitive impairment by clinical judgment. Regarding MCI, GPs recognized 44.7% of people with MCI, although this was recorded in medical notes only 10.9% of the time. Their ability to identify healthy individuals without MCI was between 87.3% and 95.5% (detection specificity). CONCLUSION GPs have considerable difficulty identifying those with MCI and those with mild dementia and are generally poor at recording such diagnoses in medical records.
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Affiliation(s)
- Alex J Mitchell
- Leicester General Hospital, Leicestershire Partnership Trust, UK.
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Abstract
Alzheimer's disease (AD) is the sixth leading cause of all deaths in the United States and is the fifth leading cause of death in Americans aged ≥65 years. Although other major causes of death have been on the decrease, deaths because of AD have been rising dramatically. Between 2000 and 2008 (preliminary data), heart disease deaths decreased by 13%, stroke deaths by 20%, and prostate cancer-related deaths by 8%, whereas deaths because of AD increased by 66%. An estimated 5.4 million Americans have AD; approximately 200,000 people aged <65 years with AD comprise the younger-onset AD population. Every 69 seconds, someone in America develops AD; by 2050, the time is expected to accelerate to every 33 seconds. Over the coming decades, the baby boom population is projected to add 10 million people to these numbers. In 2050, the incidence of AD is expected to approach nearly a million people per year, with a total estimated prevalence of 11 to 16 million people. Dramatic increases in the numbers of "oldest-old" (those aged ≥85 years) across all racial and ethnic groups will also significantly affect the numbers of people living with AD. In 2010, nearly 15 million family and other unpaid caregivers provided an estimated 17 billion hours of care to people with AD and other dementias, a contribution valued at more than $202 billion. Medicare payments for services to beneficiaries aged ≥65 years with AD and other dementias are almost 3 times higher than for beneficiaries without these conditions. Total payments in 2011 for health care, long-term care, and hospice services for people aged ≥65years with AD and other dementias are expected to be $183 billion (not including the contributions of unpaid caregivers). This report provides information to increase understanding of the public health effect of AD, including incidence and prevalence, mortality, health expenditures and costs of care, and effect on caregivers and society in general. The report also examines the current state of AD detection and diagnosis, focusing on the benefits of early detection and the factors that present challenges to accurate diagnosis.
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Tappen RM, Gibson SE, Williams CL. Explanations of AD in ethnic minority participants undergoing cognitive screening. Am J Alzheimers Dis Other Demen 2011; 26:334-9. [PMID: 21697141 PMCID: PMC10845518 DOI: 10.1177/1533317511412047] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The purpose of this study was to describe and compare explanations of Alzheimer's disease (AD) of African American, Afro-Caribbean, and European American older adults undergoing cognitive screening. Participants were asked a series of open-ended questions regarding what they knew about AD and if they were experiencing memory problems. Responses were coded and quantized for analysis. Forty percent reported experiencing memory problems. Afro-Caribbeans made significantly more incorrect statements about AD and were less likely to identify memory loss as a symptom. Half the participants said they would seek their physician's advice if the screening was positive; none mentioned a memory disorder center. Misconceptions about AD included the effect of aluminum, brain collapse, relaxed brain, shaking, tremors, and physical illness. More Afro-Caribbeans, all of whom were first generation, had misconceptions about AD. Campaigns to educate the public about AD need to provide culturally sensitive and appropriate information to ethnic minority populations.
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Affiliation(s)
- Ruth M Tappen
- Florida Atlantic University, Christine E. Lynn College of Nursing, Boca Raton, FL, USA.
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Holsinger T, Boustani M, Abbot D, Williams JW. Acceptability of dementia screening in primary care patients. Int J Geriatr Psychiatry 2011; 26:373-9. [PMID: 20845398 DOI: 10.1002/gps.2536] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2010] [Accepted: 03/26/2010] [Indexed: 11/12/2022]
Abstract
OBJECTIVES To determine the acceptability of dementia screening in two populations of older adults in different primary care settings. METHODS Cross-sectional study of consecutive patients presenting for primary care appointments in the Duke University Health System (n = 152) or Durham VA Medical Center (n = 193) were evaluated face to face using the Dementia Screening and Perceived Harms (SAPH) questionnaire. RESULTS Overall, 81% of primary care patients indicated that they would want to be screened to determine if they are developing dementia. After exposure to possible risks and benefits of screening, 86% of patients indicated they would like to be screened. The SAPH was easy to use and contained five relevant and cohesive domains. The items most associated with a desire for dementia screening were male gender, acceptance of other types of screening, and a belief that a treatment for dementia exists. CONCLUSIONS Primary care patients in two different health care systems indicated they would like to be screened for dementia. The SAPH was easy to use and contains cohesive domains.
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Affiliation(s)
- Tracey Holsinger
- Durham VA Medical Center, Duke University Medical Center, Durham, NC, USA.
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Boustani MA, Justiss MD, Frame A, Austrom MG, Perkins AJ, Cai X, Sachs GA, Torke AM, Monahan P, Hendrie HC. Caregiver and noncaregiver attitudes toward dementia screening. J Am Geriatr Soc 2011; 59:681-6. [PMID: 21438862 DOI: 10.1111/j.1532-5415.2011.03327.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To compare attitudes toward dementia screening of older adults with and without an experience of dementia caregiving. DESIGN A cross-sectional study. SETTING Primary care clinics in Indianapolis, Indiana. PARTICIPANTS Eighty-one participants with dementia caregiving experience (CG) and a random sample of 125 participants without dementia caregiving experience (NCG). MEASUREMENTS Attitudes of dementia screening, including acceptance of dementia screening and its perceived harms and benefits, as determined according to the Perceptions Regarding Investigational Screening for Memory in Primary Care questionnaire. RESULTS After adjusting for age, race, sex, and education, CGs had a lower dementia screening acceptance mean score (53.9 vs 60.6; P=.03) and a higher perceived suffering score (61.6 vs 55.9, P=.04) than NCGs, but there were no differences in perceived benefits of dementia screening (72.8 vs 69.0; P=.50), perceived stigma (32.9 vs 37.5; P=.12), and perceived negative effect on independence (47.6 vs 54.0; P=.20). The top three barriers to screening identified by both groups were emotional suffering by the family (86% of CGs and 75% of NCGs), loss of driving privileges (75% of CGs and 78% of NCGs), and becoming depressed (64% of CGs and 43% of NCGs). CONCLUSION The experience of being a dementia caregiver may influence one's own attitude about accepting dementia screening for oneself.
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Affiliation(s)
- Malaz A Boustani
- Center for Aging Research, Department of Medicine, School of Medicine, School of Health and Rehabilitation Sciences, Indiana University, Indianapolis, Indiana, USA.
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